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Green Cleaning, Sanitizing, and Disinfecting:

A Curriculum for Early Care and Education

This Green Cleaning, Sanitizing, and Disinfecting Toolkit for Early Care and Education was
developed by the University of California, San Francisco School of Nursing’s Institute for Health
& Aging, University of California, Berkeley’s Center for Environmental Research and Children's
Health, and Informed Green Solutions, with support from the California Department of
Pesticide Regulation.
Green Cleaning, Sanitizing, and Disinfecting: A Toolkit for Early Care and Education


We gratefully acknowledge the input of the many individuals who took the time to review the documents in this Toolkit.
The Collaborative to Improve Indoor Air Quality in Early Care and Education (ECE) Facilities provided expert, engaging,
and wide-ranging discussion of the issues presented here. We particularly thank the California Department of Pesticide
Regulation (DPR) for funding this second Toolkit.

Main Contributors
Vickie Leonard, RN, PhD, School of Nursing, Institute for Health & Aging, University of California, San Francisco (UCSF)

Carol Westinghouse, Informed Green Solutions, Vermont

Asa Bradman, PhD, Center for Environmental Research and Children's Health, School of Public Health, University of
California (UC), Berkeley

Additional Contributors
Jesse Erin Berns, UC Berkeley School of Public Health; Alex Blumstein; Lynn Rose, Environmental Consultant

Additional Reviewers
Jennifer Flattery, MPH, Occupational Health Branch, California Department of Public Health
Dennis Jordan, Certified Industrial Hygienist, Alameda County Healthy Homes Department
Judith Kunitz, Health Coordinator, Unity Council Children & Family Services, Oakland, CA
Jenifer Lipman, RN, NP, Head Start-State Preschool, Office of Education, Los Angeles County
Belinda Messenger, PhD, California Department of Pesticide Regulation (DPR)
Bobbie Rose, RN, Child Care Health Consultant, the California Childcare Health Program
Ann Schaffner, MS, California Department of Pesticide Regulation (DPR)
Justine Weinberg, MSEHS, Certified Industrial Hygienist, Occupational Health Branch,
California Department of Public Health

Phil Boise, Green Care for Children • Amber Brunskill, Lyn Garling and Michelle Niedermeier, Pennsylvania
Integrated Pest Management, Penn State University • Ellen Dektar, Alameda County LINCC Project • Peggy Jenkins
and Jeff Williams, California Air Resources Board • Jerome Paulson, Professor of Pediatrics and Environmental &
Occupational Health, George Washington University • Nita Davidson, DPR • Rebecca Sutton, Environmental Working
Group • Melanie Adams, Kathy Seikel, Bridget Williams, and Carlton Kempter, U.S. Environmental Protection Agency
(EPA) • Joan Simpson, Environmental & Occupational Health Assessment Program, Connecticut Department of Public
Health • Jason Marshall, Toxics Use Reduction Institute, UMass Lowell • Nancy Goodyear, UMass Lowell •
Debbie Shrem, Occupational Health Branch, California Department of Public Health •

Graphic Design: Robin Brandes Design,

Illustrations: Noa P. Kaplan,
Photography: Vickie Leonard,
Copy Editing: Joanna Green,
Suggested Citation: UCSF Institute for Health & Aging, UC Berkeley Center for Environmental Research and Children's
Health, Informed Green Solutions, and California Department of Pesticide Regulation. Green Cleaning, Sanitizing, and
Disinfecting: A Toolkit for Early Care and Education, University of California, San Francisco School of Nursing:
San Francisco, California, 2013.
Reproduction Information: These materials can be reproduced for non-commercial educational purposes. To request
permission to copy this Toolkit in bulk, contact Vickie Leonard at
Funding for this project has been provided in full or in part through a grant awarded by the California Department of
Pesticide Regulation (DPR). The contents of this document do not necessarily reflect the views and policies of DPR, nor
does mention of trade names or commercial products constitute endorsement or recommendation for use.
©2013 UCSF Institute for Health & Aging
This Toolkit is dedicated to the Early Care and and Education (ECE) program
providers, custodial staff and children who live and work in ECE facilities across the
United States. ECE staff work tirelessly to care for our nation’s children. We hope that
these materials will contribute to healthier ECE environments and to improved health
for those who spend time in them.
Green Cleaning, Sanitizing, and Disinfecting: A Toolkit for Early Care and Education

Table of Contents

Introduction 1 Some common chemicals and their

effects 14
Why should we change the way we
clean, sanitize, and disinfect? 1 What are endocrine disruptors? 14
What is the difference between cleaning, Improper use of cleaning, sanitizing,
sanitizing, and disinfecting? 2 and disinfecting chemicals can increase
exposure and health risks 15
Children are more sensitive to the health
effects of toxic chemicals 2 The endocrine system 15
What this Toolkit includes 3 Aerosols 16
Section 1: What is infectious disease? 4 Using cleaning, sanitizing, and
disinfecting products without good
There are different kinds of germs 4
ventilation 16
Germs: The good side 5
How do we prevent these health
How do germs get into our bodies? 6 hazards? 16
1. Direct contact 6 Section 4: Effects of cleaning, sanitizing, and
2. Droplets 6 disinfecting products on the environment 17
3. Airborne transmission 6 Triclosan in the environment 17
4. Fecal-oral transmission 7 Fragrances in the environment 18

5. Blood 7 Section 5: What is the difference between

cleaning, sanitizing, and disinfecting, and
6. Insect bites 8
how do these tasks help control infectious
Why do some people get sick and disease in ECE? 19
others do not? 8
Cleaning 19
Why are ECE programs the perfect
Sanitizing 19
environment for the spread of
infectious diseases? 8 Disinfecting 20

How are infectious diseases treated? 9 What are the recommendations and
requirements for sanitizing and
We can also reduce the spread of germs
disinfecting? 21
by our behaviors 9
Sanitizing and disinfecting requirements
One last thought on the role of
and recommendations comparison chart 22
infectious disease in health 9
Section 6: Personal practices for reducing
Section 2: Why is it important to clean
the spread of infectious disease in ECE 24
in ECE? 10
Behavioral strategies that can reduce
Children are more vulnerable 10
the spread of infectious disease 25
More reasons to clean in ECE 10
1. Cough and sneeze etiquette 25
Section 3: What are the health hazards of
2. Isolation/social distancing 25
cleaners, sanitizers, and disinfectants? 12
3. Vaccinations 25
Government regulations require only
limited labeling of cleaning products 12 4. Equipment 25

Acute and chronic health effects 12 5. Ventilation 26

What is asthma? 13 6. Air filtering and cleaning equipment 26

Table of Contents

Section 7: Choosing safer products for Disinfecting 40

cleaning, sanitizing, and disinfecting 28 Tools for disinfecting 41
Third-party certifiers: A way to identify Products and procedures for disinfecting 41
safer cleaning products 28
Hard surfaces (drinking fountains,
Ingredients to avoid 29 toilets, etc. 42
Choosing safer sanitizers 30 Bathroom floors 42
Choosing safer disinfectants 30 Section 10: What is a Hazard Communication
Group buying 31 Program? 43
Safety Data Sheets 31 Where does the Hazard Communication
Standard apply? 43
Section 8: Clean isn’t a smell! 32
What does the Hazard Communication
Health effects of fragrance chemicals in
Standard require? 43
air fresheners and “fragranced”
cleaners, sanitizers, and disinfectants 32 Safety Data Sheets (SDSs) for
hazardous products 44
Air fresheners 33
Label requirements for containers of
Are "natural" air fresheners any safer? 33
hazardous products 44
How to avoid fragrances and their
Information and training 44
health effects 33
The Hazardous Materials Identification
Section 9: What are the most effective and
System (HMIS®) 45
safest ways of cleaning, sanitizing, and
disinfecting in ECE? 34 Section 11: What is the most effective and
Routine cleaning 34
safest way to clean body fluids and blood
spills in ECE? 46
Tools for cleaning 34
Body fluid spills (BFSs) on porous and
Carpeting tips 35 nonporous surfaces 46
Cleaning products and procedures 35 What is a spill kit? 47
Surface cleaning 36 Glossary 48
Floor cleaning 36 Resources 51
What not to use and why 37 Appendices
Carpet cleaning 37 Appendix A: Model Green Cleaning,
Cleaning tips 37 Sanitizing, and Disinfection Policy for
Diluting concentrated products 38 ECE Programs 54

Sanitizing 38 Appendix B: Tips on Forming a Buying

Cooperative 56
Tools for sanitizing 38
Appendix C: How to Hire a Cleaning
Products and procedures for sanitizing 39
Service 57
Sanitizing food preparation areas
Appendix D: What, Where, and How
using a chemical sanitizer 39
Often to Clean, Sanitize, and Disinfect
Hand washed dishes 39 in ECE 58
Automatic dishwashers 39 Appendix E: Model Center Hazardous
Mouthed toys and pacifiers 40 Communication Program Policy 60

Electronics/keyboards 40
Green Cleaning, Sanitizing, and Disinfecting: A Toolkit for Early Care and Education


u Appropriate cleaning and targeted

disinfection of contaminated surfaces when
u Separation of food preparation, toileting,
and diaper changing activities
u Vaccination of children and staff

Why should we change the way we clean,

sanitize, and disinfect?
ECE programs prevent infectious disease by using
cleaning, sanitizing, and disinfecting products. In
the past, little thought was given to the risks
This Green Cleaning, Sanitizing, and Disinfecting
posed by these products. Many people mistakenly
Toolkit will help you make changes in your early
think that if a cleaning, sanitizing, or disinfecting
care and education (ECE) program so you can
product is sold to the public it has been reviewed
better maintain your facility while also reducing
and proven safe by government agencies. The U.S.
infectious disease. The Toolkit presents practical
Environmental Protection Agency (EPA) requires
information on how to
that products labeled as sanitizers or disinfectants
u keep ECE environments clean and safe do kill the germs that the product claims to kill,
using practices and products that are less but the registration review does not evaluate all
hazardous to health and the environment; possible health risks for users of the products.
u protect young children and staff from Cleaning products are also not routinely reviewed
infectious diseases. by the government to identify health risks to the
Group care of young children provides ideal user. Some manufacturers choose to have the EPA
conditions for the spread of infectious disease. evaluate their cleaning products for human health
Children in ECE get sick more often, and are and environmental safety through the Design for
hospitalized more often when they do get sick, the Environment (DfE) Safer Product Labeling
compared to children cared for at home. Parents Program, but this is voluntary and most products
must also take time off from work to care for sick are not reviewed.
children. We are constantly learning more about the
Research shows that there are several steps that potential health problems of cleaning, sanitizing,
can reduce the risk of infectious disease in ECE: and disinfecting products. Some of these
chemicals affect air quality and can cause or
u Development of written policies for
trigger health problems such as asthma. For
reducing the risk of infectious disease
example, 11% of people with work-related
u Education of child care center staff about asthma in California connected their asthma to
infection control practices that is repeated cleaning and disinfecting products. Over half of
on a regular basis, preferably these patients never had asthma before being
♢ every year exposed to the products – inhaling the products
caused their asthma. Four out of the 5 people
♢ when new products or policies are
diagnosed with work-related asthma in this study
were bystanders. They were not working directly
♢ when new employees are hired with cleaning or disinfecting chemicals. They
u Careful and frequent handwashing by both were simply nearby and exposed to them.
staff and children


Because these products have risks, it is important to review cleaning products in order to identify
to choose the safest products available. Many products that are effective and safer for human
companies are developing new, effective products health, wildlife, and the environment. This Toolkit
that contain less hazardous chemicals and are will help you make good choices about products
safer. and tools to use in your program.

Children are more sensitive to the health What is the difference between cleaning,
effects of toxic chemicals sanitizing, and disinfecting?
Fetuses and very young children are particularly Cleaning is done with water, a cleaning product,
sensitive to the effects of toxic chemicals. During and scrubbing. Cleaning does not kill bacteria,
early development, growth is rapid and organs, viruses, or fungi, which are generally referred to
especially the brain, are developing. In the US, as “germs.” Cleaning products are used to
researchers estimate that 5% of childhood cancer remove germs, dirt, and other organic material by
and 30% of childhood asthma are related to washing them down the drain.
chemical exposures. The President’s Cancer Panel
Sanitizing and disinfecting products are chemicals
noted in 2010, “the true burden of
that work by killing germs. These chemicals are
environmentally induced cancer has been grossly
also called antimicrobial pesticides. They are
regulated by the California Department of
Health effects from exposure to toxic chemicals Pesticide Regulation (or similar agencies in other
may not show up for years or even decades. states) and the U.S. Environmental Protection
Unlike adults, children have many years to Agency (EPA). Disinfectants kill more germs than
develop illnesses caused by early exposures to sanitizers. In most cases, a cleaning product is
toxic chemicals. It is important to practice the used first. Then the surface is either sanitized or
disinfected when it is necessary.
OF USING CHEMICALS TO CLEAN, Some of the questions we hear often from
ECE providers are:

u Which products should be used to clean?

u Which areas should be sanitized and

which should be disinfected and how
often? What is the difference?
Health risks of Health risks of
cleaning, sanitizing and infectious
disinfection chemicals diseases u What sanitizing and disinfecting products
RISK BENEFIT BALANCE are safe to use?

“precautionary principle” and protect children u How do we comply with child care
from potential health effects, even if some cause licensing regulations?
and effect relationships are not yet fully proven.
u Can disinfectants make us sicker than the
Many new products are marketed with terms such diseases they are meant to prevent?
as “green” to make the public think they are
u Can I use bleach safely?
safer. However, there is no legal definition of
these terms, and when they are used on a u If a product says that it is “green,” is it
product label, they do not assure that a product is safe to use?
safe. Fortunately, there are independent
organizations and government agencies working


This Toolkit will help you answer these questions. What this Toolkit includes
In this Toolkit you will find information on
u This Green Cleaning, Sanitizing, and
u what infectious disease is and how it is
Disinfecting for Early Care and Education
curriculum booklet
u the differences between cleaning,
u 4 posters
sanitizing, and disinfecting and when and
where each is needed; u Stand-alone fact sheets for ECE providers

u the health and environmental hazards u 2 fact sheets for families

associated with using and misusing
u A Choosing Green Cleaners, Sanitizers, and
cleaning, sanitizing, and disinfecting
Disinfectants wallet card
u A Green Cleaning, Sanitizing, and
u choosing safer cleaning, sanitizing, and
Disinfecting Checklist to help you develop
disinfecting products;
and maintain a safe and healthy cleaning,
u proper cleaning, sanitizing, and disinfecting sanitizing, and disinfection program

u non-chemical practices and tools that can

reduce the spread of infectious disease;

u the resources needed for ECE programs to

create their own policies and protocols for

♢ establishing a green cleaning program,

♢ purchasing safer, and possibly less
expensive, cleaning, sanitizing, and
disinfecting products,
♢ using cleaning, sanitizing, and
disinfecting products appropriately,
♢ negotiating a contract for cleaning
services with an outside vendor.

We hope you find the Toolkit useful. All of the

Toolkit materials, as well as references for each
section of this curriculum, are also available
online for download at no cost. You can find
them at:
Information on obtaining additional copies of the
Toolkit can be found on these websites as well.

Green Cleaning, Sanitizing, and Disinfecting: A Toolkit for Early Care and Education

Section 1: What is infectious disease?

dirt or food and water. Most are harmless or even

beneficial to us. They help us to digest food as
well as prevent infections caused by harmful
bacteria. Common bacterial infections include
some ear infections, some cases of diarrhea, strep
throat, and urinary tract infections. Bacteria can
also cause more serious infections such as
tuberculosis, whooping cough, staph infections,
bacterial pneumonia, and bacterial meningitis.
Some bacteria – for example, methicillin-resistant
Staphylococcus aureus (MRSA) – have developed
ways to resist antibiotics and can cause serious
Infectious diseases are caused by germs (also infectious diseases that are hard to treat. Bacteria
called microbes or microorganisms) that get into often attach to surfaces, especially moist ones,
our bodies and reproduce, causing symptoms that and form dense mats called biofilm. Bacteria in
make us feel sick. They can spread from one biofilms are much harder to kill. Keeping surfaces
person (or animal) to another when germs leave clean and dry prevents biofilms from developing.
one body and get into another. Sometimes
infectious diseases are also called communicable When we kill germs on a surface with a chemical
or contagious diseases. Microbes that cause disinfectant, it is important to think of this as
disease are called pathogens. temporary. The surface will be home to new
germs as soon as it is touched by hands, or
Infectious diseases are common in ECE. Studies
sneezed or coughed on. Bacteria can grow and
show that some young children in ECE have
divide very fast. They can double in number in 10
symptoms of infectious illness one-third to one-
minutes when they have food and water.
half of the days in a year!
Fungi, including yeasts and molds, are every-
There are different kinds of germs where. They can survive on surfaces for long
Viruses are the most common cause of illness. periods. Fungi can cause common skin infections
They are very small. Viruses can’t live on surfaces such as:
for very long. The common cold is a group of
u diaper rash
symptoms caused by 200 different viruses. This is
why young children get 8–10 colds a year. There u thrush in babies' mouths
are always more cold viruses that they haven’t u ringworm
had yet! Viruses also cause intestinal and u athlete's foot
respiratory flu. Antibiotics kill bacteria but cannot
u scalp infections, such as tinea capitis, and
kill viruses! They should not be used to treat
nail infections
illnesses caused by viruses. Luckily, we get better
from most viral illnesses without medical These infections are bothersome and can
treatment. sometimes take months to go away, but they
don’t cause serious illness in children with healthy
Bacteria are more complex than viruses. They can immune systems. They also don’t spread and
live and reproduce independently. Some can cause infection in the rest of the body in healthy
survive on surfaces for a long time, feeding off people.

Section 1: What is infectious disease?

Mold can be found anywhere there is constant Where do we find germs in our bodies?
moisture, like bathrooms and kitchens. You Bacteria and viruses are found in our body fluids:
cannot “catch” mold from another person. Mold
can cause irritations of the eye, skin, nose, throat, u blood u stool (feces)
and lungs, and can trigger asthma. It can produce u mucus u urine
an allergic reaction in some people. The best way
to control mold indoors is to get rid of moisture u saliva u discharges from
and leaks. the eyes and skin
u vomit
Parasites are larger than bacteria. They enter our
bodies through contaminated food or by
A good rule to remember: if it's wet and
penetrating our skin. They are common in
comes from someone else's body, it can be
developing nations around the world. A few
parasites infect children in the United States. The
three main parasites that are sometimes seen in
Some germs cause an infection in the upper
ECE are:
respiratory system (a URI). A cold is a URI. Other
u giardia, which is spread by germs infect the gastrointestinal system and
♢ drinking water that contains the giardia cause vomiting and diarrhea. Some, like the flu,
parasite; can cause both. These types of infectious diseases
are the most common in ECE.
♢ the fecal-oral route, (See "How do germs
get into our bodies?” on page 6);
u pinworms, which are also spread by the
fecal-oral route; Not all microbes cause disease. Bacteria, viruses, and fungi
are part of the ecosystems of our bodies. We’re made up of
u scabies, which are mainly spread by skin- 10 times as many microbial cells as human cells! All of the
to-skin contact and may be transmitted by microbes in our body together weigh 3 pounds – as much as
our brains! This collection of microbes is called our biome.
We need our biome to survive.
Insects, though not germs, can also spread Microbes help maintain the health of our bodies. For
infectious diseases. West Nile virus and Western example, they
equine encephalitis are uncommon diseases that • make vitamins;
do occur in the United States and are spread by • break down tough plants so we can digest them;
mosquito bites. Lyme disease and Babesiosis are • help to form our immune system and control
diseases spread by tick bites. inflammation.

Head lice, scabies, and bed bugs bite the human Exposure to germs in early childhood teaches our immune
system how to tell the difference between what is harmful
body and cause skin reactions. They can spread
and what is not. Allergies occur when the body sees
from person to person when they hitchhike from ordinary, harmless things like pollen as harmful.
one body to another or, in the case of bed bugs,
Some research even suggests that bacteria may help us
can be carried on luggage or bedding. maintain a healthy weight and protect us from asthma.
Fortunately, these infestations are only annoying. When we kill microbes with antibiotics, we kill the good
These insects do not carry serious diseases that with the bad, which is why we should only take antibiotics
can infect humans. when we really need them. And we shouldn’t think of all
microbes as bad germs that need to be wiped out. Some
illnesses are even treated using microbes. Probiotics or
microbe-containing yogurt are sometimes used to replace
some of our “good” microbes that are destroyed by

Section 1: What is infectious disease?

How do germs get into our bodies? u Germs that can spread by droplets are
more contagious than germs that require
Germs are spread in body fluids in the following
direct contact. When an infection can
spread between people that are only
➊ Direct contact: when body fluids are near each other, the infection is more
directly transferred from one person to contagious. Diseases caused by viruses
another. Examples of direct contact are and bacteria can be spread this way.
touching and kissing. An animal bite is
u Fungi and parasites are not transmitted
another example.
by droplets.

u Germs live longer on stainless steel,

plastic, and similar hard surfaces than
they do on fabric and other soft surfaces.
Germs also live longer when the surface
is wet and dirty. Food and water on a
surface provide germs with all they need
to survive and multiply! When droplets
land on a hard surface like a table or a
doorknob, the viruses in those droplets
can live several hours or more. Bacteria
➋ Droplets: when secretions fly out of kids'
can live for even longer.
(and adults’) noses and mouths (when they
sneeze, cough, spit, drool, slobber, or ➌ Airborne transmission: when germs float
vomit) into the air and then land on a hard suspended in the air attached to small
surface or are inhaled by another person. droplets or dust particles and travel more
than 3 feet.

u Droplets can fly only a short distance,

usually 3 feet or less, but if they land on
another child's eye, nose, or mouth they
can spread disease.

u Germs can also be spread when children

touch droplets that land on a surface like u Airborne germs can travel across a room,
a table and then touch their own eyes, down a hall, into a ventilation system, to
mouth, or nose before washing their another floor, or even from one building
hands. to another where another person can
breathe in the germ.
u Most of the germs that can be spread by
direct contact can also be spread by
Section 1: What is infectious disease?

u Germs that spread by airborne shared bowl, leaving germs on the

transmission are the most contagious of crackers. Other children who eat
all. We can inhale them deep into our crackers from the bowl can get sick.
lungs where they can cause more serious ♢ When dirty hands touch surfaces or
illness. Disinfecting doesn’t help with the objects, the germs are transferred
spread of these kinds of illness. there. When another person touches
u Luckily, not very many germs can travel those same surfaces, he gets the germs
this way. Those that do are difficult to on his hands. If he eats or puts his
control. For example, the viruses that hands in his eyes, nose, or mouth
cause chicken pox and measles are without washing them, the germs get
spread by airborne routes. Nine out of into his body and can make him sick.
ten unvaccinated people who breathe u Infections from animals can also be
the air of a person infected with chicken spread this way. For example, reptiles
pox or measles will get sick. Cleaning and and rodents have caused Salmonella
disinfecting will not prevent air-borne outbreaks in ECE programs. They also
illnesses. This is why vaccination is so carry germs on their skin which can cause
important. It is the only way to protect illness through direct contact.
yourself and children from these
u Some common viruses, including
extremely contagious diseases.
Hepatitis A, Norovirus, and Rotavirus, are
➍ Fecal-oral transmission: when germs in spread through fecal-oral routes. They
stool from one infected person make their may also be spread by droplets that are
way into the mouth of another person. produced when a person vomits – this
These germs usually cause vomiting and makes them very hard to prevent!
u Handwashing is our best defense against
u This happens most commonly when germs spread by the fecal-oral route!
infected people don’t wash their hands
➎ Blood: when an infected person's blood
after using the bathroom.
enters another person's body through a
♢ When dirty hands touch food, the break in the skin. Many of the germs that
can be found in blood can cause life-
threatening disease. However, most
blood-borne infections come from infected
needles, not from bleeding knees on the

germs from that person’s stool are

transferred to the food. When that
food is eaten by someone else, the
germs enter their body and they can
get sick. For example, a toddler touches
her dirty diaper, doesn’t wash her
hands, then takes crackers from a

Section 1: What is infectious disease?

u Luckily, infections from blood-borne Why are ECE programs the perfect
germs are easily prevented by: environment for the spread of infectious
♢ teaching children not to touch blood diseases?
and to tell an adult when there is an
u Children in ECE spend their days in groups,
injury that involves blood.
which means
♢ educating staff about how to handle
blood using standard precautions (See ♢ there is a large pool of germs to share;
Section 11 for information on cleaning
up a blood spill).
u If children and staff know their jobs
when it comes to blood, they can
prevent the transmission of infectious
diseases through blood in ECE.

➏ Insect bites: when an insect transmits

bacteria and viruses to humans
through their bites. West Nile virus
is a disease that is transmitted by ♢ the transfer of germs from one child to
mosquitoes, which are insects. many others is easier and faster because
they are in close contact with each other.
u Young children touch each other and hard
Why do some people get sick surfaces more than older children or adults,
while others do not? and then put their fingers in their mouths,
Whether or not a person is affected by germs eyes, or nose.
depends on several factors: u Young children don’t yet have good
u How many germs they are exposed to and personal hygiene skills.
how powerful (virulent) the germs are. If a
person is exposed to many powerful germs,
they are more likely to get sick.

u Their general health. If someone is

generally healthy and eating and sleeping
well, their immune system will function
better than the immune system of
someone who has other health problems,
eats poorly, and doesn’t get enough sleep.
♢ They cough, sneeze, drool and chew on
u Whether they are immune to the germ. If each other and their toys.
someone has an illness, they develop
♢ They are in diapers or the early stages of
antibodies to it. When they are exposed to
toilet learning and often have accidents.
the germ again, their body’s antibodies
recognize the microbe and destroy it and • Touching fecal matter and then the
they do not get sick. This is how vaccines mouth (the fecal-oral route) is a
work, too. Vaccines give your body a small common way to transfer germs that
dose of a germ so you can develop cause gastrointestinal disease.
antibodies. ♢ They don’t wash their hands unless an
adult tells them to or does it for them.

Section 1: What is infectious disease?

Read on! This Toolkit will help you better

Schools and child care centers have been understand all the ways that we can reduce the
found to be one of the main causes of the spread of infectious diseases in ECE.
spread of diseases like the flu to the rest of
One last thought on the role of infectious
the community.
disease in health
While it seems like preventing as much infectious
How are infectious diseases treated? disease as possible in ECE is a good thing, new
research shows that many of our chronic health
Viral infections like the common cold or stomach
conditions may be caused by growing up in overly
virus infections are not usually treated with
clean environments. Science is telling us that
medications. Treatment for these infections is
exposure to germs and the infectious diseases
supportive care (rest, fluids, and time). Common
they cause may contribute to a better functioning
viral infections cannot be completely prevented.
immune system. For example, children who grow
As a result, the average preschool age child gets
up on a farm are less likely to have asthma
8–10 colds a year. Infants and toddlers may get
because they are exposed to a wide range of
more. Some bacterial infections, like some ear
germs when they are young. There has been a
and skin infections, are treated with antibiotics.
sharp rise in allergies, asthma, and asthma-related
Some infections can be prevented with vaccines.
deaths in developed countries in the last 30 years.
We can also reduce the spread of germs by Many scientists argue that part of the cause is
our personal behaviors that the immune system of young children is not
stimulated enough by exposure to germs.
u Handwashing with plain (not antibacterial) Research also indicates that exposure to common
soap and water is one of the most infections early in life may be protective against
important ways that we can childhood leukemia. We still don’t know the
prevent the spread of germs. whole story of how exposure to germs affects our
Children are not the only immune system, but there is a connection.
ones who spread germs.
Remember, too, that when young children get
Teachers and parents also
sick from exposure to germs in ECE, they will not
spread germs on their hands.
get as sick when they enter elementary school.
This is because they have already developed
antibodies to many of the germs they come into
u Children and staff staying home when they
contact with in school.
are ill keeps germs at home, too.
It is important to keep this new science in mind
u Covering our coughs and sneezing into our when we weigh the risks of using hazardous
sleeves lowers the number of germs chemicals to keep ECE environments as germ-free
that we send out into the as possible. Exposure to these chemicals may
environment. Germs get cause illness, and not getting sick from common
caught in our clothing infections in childhood may also have risks.
instead, where they don’t
live very long!

Green Cleaning, Sanitizing, and Disinfecting: A Toolkit for Early Care and Education

Section 2: Why is it important to clean in ECE?

u Children eat more food per pound of body

weight than adults. They are also more
vulnerable to food borne illnesses.

u Children’s hand to mouth behavior means

they eat more dust than adults. Dust
contains many toxic chemicals from
cleaning products, pesticides, furnishings,
and other sources.

u Mouthing objects is more common in young


Why do we clean? This seems like a silly question,

but it is helpful to think about what we
accomplish when we clean.

Children are more vulnerable

Care of the physical environment is especially
important when caring for young children. They
are exposed to more germs and toxic chemicals
(for their size) than adults for the following

u Children breathe 4 to 6 times more air than

adults, and they breathe close to the
ground where pollutants in air tend to Young children are also still developing and have
concentrate. immature bodies. Their bodies are less able to get
u Children have more skin covering their rid of toxic substances than adults. Their
bodies relative to their weight than adults. developing organs, especially their brains, can be
affected by exposure to toxic substances. This can
u Children have more skin contact with the affect their growth and their ability to learn and
floor because of their size and behavior. function. So conditions which allow germs, pests,
This means they can absorb more pollutants chemicals, dirt, dust, and moisture to build up in
that concentrate on the floor through their the ECE environment can cause more health
skin. problems for young children than for the adults
who are caring for them.

More reasons to clean in ECE

u Children and staff feel better, both
physically and psychologically, when the
environment is cared for and clean.

u Research shows that when schools improve

their physical environments, children learn
better and feel better about themselves
and their school. They feel cared for.

Section 2: Why is it important to clean in ECE?

u Research shows that teachers are more Preschool is also a critical time for children to
satisfied with their jobs when the form important health and hygiene habits. When
environment is clean and well-maintained. you teach children the importance of personal
hygiene, and how to keep their environments
u Cleaning removes allergens and irritants
clean, you help them to establish healthy habits
that can cause or trigger asthma.
that last a lifetime.
u Getting rid of clutter makes it easier to
focus on tasks. It also gets rid of hiding
places for pests like rodents and
cockroaches. This reduces the need for
pesticides which may have their own
harmful health and environmental effects.
It also makes it easier to clean and control
dust. Dust contains pollutants that can
trigger allergies and asthma, and toxic
chemicals that can cause illness.

u The presence of moisture, standing water,

and mold can cause respiratory problems
and allergies. Keeping the indoor
environment clean and dry can reduce mold
and respiratory illnesses. It also reduces the
use of disinfectants, called fungicides, that
are used to get rid of mold after it

u Cleaning, sanitizing, and targeted

disinfection where required, can help
reduce the spread of infectious disease.
Cleaning helps reduce the number of
infectious diseases that are passed around
in an ECE program by:
♢ washing some germs down the drain;
♢ removing dirt and organic matter that
can reduce the effectiveness of sanitizers
and disinfectants.
u Respiratory illnesses such as colds, flu, and
asthma are the most common reason
children are absent from ECE. When
children are absent from ECE, their learning
suffers and their parents often miss work.
Young children are also affected when their
teachers or caregivers are absent due to

Green Cleaning, Sanitizing, and Disinfecting: A Toolkit for Early Care and Education

Section 3: What are the health hazards of cleaners, sanitizers,

and disinfectants?

Government regulations require only

limited labeling of cleaning products
Only the active ingredient chemicals in sanitizers,
disinfectants, and fungicides that kill bacteria,
viruses, or mold have to be listed on the product
label. Manufacturers are not required to list all of
the ingredients on cleaning product labels. Words
such as “natural,” “non-toxic,” and “green” that
appear on cleaning product labels are poorly
regulated by the government. While the Federal
Trade Commission has guidelines for
Cleaning, sanitizing, and disinfecting products manufacturers who use these terms, they are
play an important role in ECE. rarely enforced. Researchers have found that
cleaning products labeled with these terms often
However, some cleaning, sanitizing, and have as many hazardous chemicals as
disinfecting products also contain chemicals that conventional cleaning products. These gaps in
may cause health problems in children and staff. information on cleaning product labels make it
They may also cause problems in the environment difficult for the consumer to make wise choices
for our waterways and wildlife. Understanding when purchasing cleaning products.
the health risks of these products can help you

u choose them carefully; More than 85,000 commercial chemicals

have been developed in the last 60 years.
u use them more safely and only when and
When health testing is done, it is normally
where they are needed.
done on a single chemical. However, we are
Many people think that any cleaning, sanitizing, usually exposed to a mixture of chemicals.
or disinfecting product that is sold must be safe. Scientists do not understand the effects of
This is not true. being exposed to mixtures of chemicals.

u American Poison Control Centers report

that household cleaning products and Acute and chronic health effects
disinfectants are common causes of
poisoning in both children and adults. When we use cleaning, sanitizing, and disinfecting
chemicals, we can breathe them into our lungs and
u We don’t know much about the long-term absorb them through our skin. When these
health effects of many of these products. chemicals affect our health right away it is called
These health effects don’t show up for an acute effect, such as an asthma attack. But
months or years. Awareness of the long- some chemicals get stored in our bodies or we are
term effects is important for young children exposed to small amounts repeatedly over a long
because they have so many years in which time. This chronic exposure can cause cancer or
to develop health problems from early other diseases, such as asthma, years later. These
exposures. Therefore, it makes sense to are long-term or chronic health effects. Chemicals
limit children’s exposure to chemicals when also make their way into air and dust and continue
we don’t know for certain what effects they to expose children and staff over time. For
may have in the long term. example, a study of ECE facilities found residues in
dust of a dangerous pesticide that had been
banned for many years. Dust gets on children’s
hands and into their bodies.
Section 3: What are the health hazards of cleaners, sanitizers, and disinfectants?

When chemicals are used to clean, sanitize, and

disinfect, children and staff can be exposed to WHAT IS ASTHMA?
health risks because • Asthma is a chronic inflammatory disorder of the airways
in the lungs that results in the following symptoms:
u the chemicals in the product are hazardous; • wheezing • chest tightness
u the product is used in a way (such as not • coughing • trouble breathing
following the label directions) that • Over 350 substances are known to cause asthma in
increases exposures to the chemicals. people who have never had asthma before. Most of them
cause asthma through a process called sensitization. Small
Potentially harmful exposures from these exposures over time can cause asthma, even to adults.
products also depend on: • Asthma can also be caused by a single high exposure to
an irritating chemical. This type of asthma is called
u The product’s physical characteristics Reactive Airways Dysfunction Syndrome (RADS).
♢ Is it an aerosol (a fine spray that can be • Once a person has asthma, exposure to many “triggers,”
breathed deep into the lungs)? such as irritating chemicals, animal dander, cold air,
tobacco smoke, and exercise can cause an episode of
♢ Does it evaporate into the air easily asthma.
where we breathe it? • Many cleaning, sanitizing, and disinfecting products
u The characteristics of the building contain chemicals that can both cause and trigger asthma.
environment • Symptoms of asthma can usually be controlled with a
variety of drugs, but there is no known cure.
♢ Is the ventilation system the right size
• More people have asthma now than ever before. Almost
and in working order? 19 million Americans, including 7 million children, have
♢ What is the size of the room? asthma. That is nearly 1 in 10 children.

♢ Do the windows and doors open? • Children under 5 years old have the most hospitalizations
and emergency room visits for asthma.



Air trapped
in alveoli

smooth Tightened
muscles smooth

Wall inflamed
and thickened

Normal airway Asthma airway Airway during an Asthma attack

Section 3: What are the health hazards of cleaners, sanitizers, and disinfectants?

Some common chemicals and their effects

u Ammonia and bleach (sodium hypochlorite) DISRUPTORS?
cause asthma in workers who breathe too Hormones are substances that are produced by our
much of it in their jobs. They can trigger endocrine system.
asthma attacks in children or ECE providers • In very, very small amounts hormones control growth,
who already have asthma. They can also reproduction, metabolism, development, behavior, sleep
irritate the skin, eyes, and respiratory tract. functions, immune function, and stress. These are all
functions that are critical for life.
u Quaternary ammonium compounds (also
• These functions are controlled by hormonal messages sent
known as QUATs, QACs, or QATs) are not
by the endocrine system.
volatile compounds, but using them as
• Hormones also play a role in many diseases, including
sprays can cause nose and throat irritation.
diabetes and cancer.
Benzalkonium chloride is a severe eye
Endocrine disruptors are chemicals that interrupt or
irritant and causes and triggers asthma.
imitate those natural hormonal messages.
Exposures to QUATs may cause allergic skin
• Since hormones work at very small doses, endocrine
reactions. Use of QUATs has been associated
disrupting chemicals can also affect health in very small
with the growth of bacteria that are
resistant to disinfection. Sometimes this
• According to the National Institute of Environmental
resistance also transfers to antibiotics. In
Health Sciences, endocrine disruptors may cause reduced
laboratory studies, QUATs were found to fertility in women and men, early puberty in girls, and
damage genetic material (genes). increases in cancers of the breast, ovaries, and prostate.
u Triclosan is a suspected endocrine disruptor • A 2013 report from the World Health Organization reports
(see What are Endocrine Disrupters?) and that evidence linking hormone-mimicking chemicals to
human health problems has grown stronger over the past
may lead to the development of antibiotic-
decade, becoming a "global threat" that should be
resistant bacteria. addressed.
u Phthalates are used in fragrances that are
found in air fresheners and cleaning and
sanitizing products. They are endocrine
disruptors. Research indicates that
phthalates increase the risk of allergies and
asthma and can affect children's
neurodevelopment and thyroid function.
Studies show links between phthalates in
mothers to abnormal genital development
in boys. Phthalates have been found in
human urine, blood, semen, amniotic fluid,
and breast milk.

u Volatile organic compounds (VOCs) are

chemicals that vaporize at room
temperature. Many VOCs that are released
by cleaning supplies have been linked to
chronic respiratory problems such as
asthma, allergic reactions, and headaches. Phthalates are endocrine disruptors. They are used in
fragrances that are found in air fresheners and cleaning
and sanitizing products.

Section 3: What are the health hazards of cleaners, sanitizers, and disinfectants?

♢ Fragrances are mixtures of many THE ENDOCRINE SYSTEM

chemicals, including VOCs. They can
contain up to 3,000 separate ingredients.
There is no requirement that fragrance
ingredients be listed on the product label.
Many of these chemicals: pituitary gland

♢ can trigger asthma and allergies;

thyroid glands, parathyroid
♢ may be hazardous to humans. (See
Section 8 for more information on thymus
♢ Terpenes are chemicals found in pine, pancreas
lemon, and orange oils that are used in
many cleaning and disinfecting products adrenal glands
as well as in fragrances. Terpenes react
with ozone, especially on hot smoggy
days, forming
♢ very small particles like those found in
smog and haze that can irritate the testes
lungs and may cause other health (male)
problems ovaries
♢ formaldehyde which
• causes cancer, Hypothalamus Pancreas
• is a sensitizer that is linked to asthma Regulates hunger, thirst, Aids in the digestion of
sleep, and wakefulness, plus protein, fats, and carbohy-
and allergic reactions,
most of your involuntary drates. Produces insulin
• has damaged genes in lab tests, mechanisms including body which controls blood sugar
temperature. levels.
• is a central nervous system depressant
(slows down brain activity), Pituitary gland Adrenal glands
Controls all other Secrete hundreds of com-
• may cause joint pain, depression, endocrine glands, influences pounds including cortisone
headaches, chest pains, ear infections, growth, metabolism,* and adrenaline, which helps
chronic fatigue, dizziness, and loss of and regeneration. you react to emergencies.
Regulates your metabolic
sleep. Thyroid glands
processes in the cells, water
Regulate your energy and
Improper use of cleaning, sanitizing, and balance, blood pressure, etc.
your metabolism.
disinfecting chemicals can increase Ovaries, Testes
exposure and health risks Secretes the hormones
Influence how your blood
circulates and determines
necessary for calcium
Each year about 6 out of every 100 professional your mental vigor and your
custodians are injured by the chemicals they use sex drive.
to clean, sanitize, and disinfect. Burns to the eyes Thymus
Helps build resistance to
and skin are the most common injuries, followed
closely by breathing toxic mists or vapors.
* The conversion of nutients into energy and building materials
to meet your body’s needs.

Section 3: What are the health hazards of cleaners, sanitizers, and disinfectants?

Many of these injuries are due to improper use of

cleaning, sanitizing, and disinfecting products.
For example, many chemicals used for cleaning,
sanitizing, and disinfecting come in a
concentrated form. To be used, they have to be
correctly diluted with water:
u When diluting concentrated products
unsafely, the user increases her exposure to
the health hazards of the product. She is
exposed by breathing the fumes of the
concentrated product into her lungs or
absorbing the liquid through her skin.
u If the wrong chemicals are mixed together, the air. These suspended chemicals cause
they can react to form a toxic gas and the problems with breathing such as asthma. The
health effects can be much worse. For small particles created by aerosolization can get
example, when bleach is mixed with deeper into the lung. These products should
ammonia or quaternary ammonium never be used around children.
compounds (found in some disinfectants),
chloramine gas is created, which is highly Using cleaning, sanitizing, and disinfection
toxic. products without good ventilation
u If a chemical is too concentrated (the user When an ECE building does not have a good
doesn’t add the amount of water indicated ventilation system, or doors and windows are not
on the product label), then the health opened while cleaning, the concentration of
effects of using that product are increased. chemicals in indoor air increases; so do the health
They are increased for the person who is effects of those chemicals. It is important to make
using the product. They are also increased sure that your ventilation system is working
for the people who occupy the indoor space properly in order to reduce the concentration of
where it is used, especially children. chemicals in indoor air from cleaners, sanitizers,
u It is important to follow dilution and disinfectants and other sources. (For more
instructions carefully to avoid harm to the information, see Fact Sheet: What is Indoor Air
person doing the diluting, as well as to the Quality?)
children and staff in the building. Personal
How do we prevent these health hazards?
protective equipment such as gloves and
goggles, when indicated on the product Choosing less hazardous cleaning, sanitizing, and
label, should be worn while working with disinfecting products can reduce harmful health
concentrated chemicals. Better yet, avoid effects for children, ECE staff, and custodial
using products that require personal workers. It is also better for the environment.
protective equipment! There are also many non-chemical strategies for
cleaning, sanitizing, and disinfecting that are less
harmful to the user and to ECE staff and children.
Use of spray bottles, aerosol cans, and machines See Section 6 to learn about these alternative
such as carpet washers create a fine mist “best practices” and Section 7 for information on
(aerosolization) of the cleaning product, how to purchase safer products.
increasing the amount of chemical suspended in

Green Cleaning, Sanitizing, and Disinfecting: A Toolkit for Early Care and Education

Section 4: Effects of cleaning, sanitizing, and disinfecting products

on the environment
The transport of triclosan to wastewater
treatment plants occurs when people
u wash hands with antibacterial soap;

u hand-wash dishes with antibacterial dish


u use personal care products such as

toothpaste that contain triclosan;

u use products like cutting boards that

contain triclosan.

Cleaning, sanitizing, and disinfecting in ECE As a result, triclosan ends up in our drains,
reduces the risk of infectious disease and removes sewage systems, and eventually our waterways. It
allergens and irritants that cause or trigger also gets concentrated in the sludge created in
asthma and allergies. But many cleaners, wastewater treatment plants. Over 400,000
sanitizers, disinfectants, and fragrances, even pounds of triclosan and triclocarban are spread
those marketed as “green”, can pollute the air, on agricultural fields in the U.S. every year when
water, and soil. this waste treatment sludge is recycled as
“fertilizer.” Scientists are concerned that plants
These products are washed down the drains of
that grow in the soil contaminated with triclosan
our child care facilities, schools, homes, and
from sludge will absorb the triclosan. In
workplaces. They make their way in wastewater
experiments, researchers have found triclosan in
to the treatment plant where waste water is
carrots, pumpkins, and zucchini – foods that are
treated. During the treatment, sewage is
normally good for children. Triclosan is also found
separated into treated wastewater and sludge.
in lakes, rivers, ocean coastal waters, domestic
Treated water is then discharged into our ground
and drinking water, soils, indoor dust, fish and
water, rivers, lakes, and oceans. Many of these
other aquatic animals, and humans. Eating fish
waterways supply drinking water to our
and fruits and vegetables that contain triclosan is
communities. The problem is that wastewater
another way humans may be exposed. Research
treatment plants were not designed to remove
shows triclosan is present in human urine, blood,
these chemicals. It is important to think twice
and breast milk.
before washing or flushing anything down the
drain that can harm the environment. Choosing Sometimes the risks of using a chemical are
the products you use in your indoor environments balanced by the benefits. But the Food and Drug
carefully can help protect the environment as Administration (FDA) says that triclosan is no
well as your health. Below we describe two more effective at killing germs than washing well
examples of products that are harmful to the with soap and water. According to the Centers for
environment. Disease Control and Prevention (CDC), vigorous
handwashing in warm water with plain soap for
Triclosan in the environment at least 20 seconds is sufficient to fight germs in
Triclosan and its relative triclocarban are most cases. When soap and water are not
antimicrobial chemicals that slow or stop the available, use of an alcohol-based hand sanitizer
growth of bacteria, fungi, and mildew. They are product is a better option than soap that contains
found in antibacterial soaps, deodorants, triclosan.
sponges, and household cleaners and
disinfectants. Over 1 million pounds of triclosan
and triclocarban are disposed of in the
environment every year.
Section 4: Effects of cleaning, sanitizing, and disinfecting products on the environment

Many authorities, including the American Medical Fragrances in the environment

Association (AMA), now recommend that
Fragrances are chemicals that are in most
triclosan should not be used in consumer
cleaning, sanitizing, and disinfecting products.
products. The health and environmental risks of
triclosan are not worth the very limited benefits.
u react with sunlight to contribute to smog
formation in indoor and outdoor air;

u may affect water quality when they are

used in liquid products like cleaning and
personal care products.

Like triclosan, many fragrance chemicals are not

filtered out by water treatment. What goes down
the drain ends up in our drinking water and in
our lakes, streams, rivers, and bays. These

u break down slowly in the environment;

u are found in the water supply, leading to

high levels in nearly all fish, shellfish, and
other aquatic wildlife;

u are concentrated in larger animals when

larger fish and other wildlife eat
contaminated aquatic wildlife. From there,
these pollutants travel up the food chain to
human beings.

For more information on fragrances, see

Section 6.

Green Cleaning, Sanitizing, and Disinfecting: A Toolkit for Early Care and Education

Section 5: What is the difference between cleaning, sanitizing,

and disinfecting and how do these tasks help control infectious
disease in ECE?
u Has been shown to remove up to 98% of
bacteria and 93% of viruses from surfaces
using microfiber and water in tests
published by the EPA.

u Removes the food and water that allow

germs to survive and reproduce.

u Removes dust, molds, irritants, and

allergens that can trigger asthma

Before choosing a cleaning or antimicrobial Sanitizing is the use of a chemical product or
product, you will first need to decide whether the device (like a dishwasher or a steam mop) that
surface needs to be cleaned, sanitized, or reduces the number of germs on surfaces or
disinfected. In most cases, you will need to clean a objects to a level considered safe by public health
surface before you sanitize or disinfect. But it standards or requirements. Sanitizing kills most
doesn’t make sense to disinfect something that germs but not all of them.
only needs to be cleaned. The products used to
disinfect are more toxic and/or more expensive u For food service, a sanitizer should reduce
than products used just to clean. Overusing the number of germs on a surface by
antimicrobial products like sanitizers and 99.999% within 30 seconds.
disinfectants may also lead to the spread of u For hard surfaces not used for food service
"superbugs." Superbugs are germs that are not the level should be at least 99.9%.
easily killed by disinfectants and/or antibiotics.
u Sanitizing products should state on their
The CDC provides the following guidance on the label the surfaces they are intended to be
differences between cleaning, sanitizing, and used on.
u Sanitizing does not necessarily clean dirty
Cleaning surfaces or remove germs. Most sanitizers,
u Reduces germs, dirt, and impurities by as well as disinfectants, require a clean
removing them from surfaces or objects. surface in order to be effective at killing
Dirt and organic material make some germs.
disinfectants less effective, so cleaning is
Sanitizing in child care is required for specific
necessary before disinfecting in most cases.
areas, such as food preparation and contact
u Works by using soap or detergent and surfaces, and mouthed toys and pacifiers. For
water to physically remove germs from guidelines on when and where to clean, sanitize,
surfaces. This process does not necessarily and disinfect, see state child care regulations and
kill germs. Appendix 5: The Caring for Our Children:
National Health and Safety Performance
u Lowers the risk of spreading infection by
Standards, Routine Schedule for Cleaning,
washing germs down the drain.
Sanitizing, and Disinfecting.

Section 5: What is the difference between cleaning, sanitizing, and disinfecting and how do these tasks help
control infectious disease in ECE?

The U.S. EPA regulates sanitizers and
Disinfecting uses chemicals to kill 99.999% of disinfectants as pesticides. The U.S. Food and
germs on hard, non-porous surfaces or objects. Drug Administration (FDA) regulates
Disinfecting sanitizers used on food contact surfaces.
u does not necessarily clean dirty surfaces or Sanitizing and disinfecting require the use of
remove germs;
• EPA-registered chemical sanitizers and
u kills germs on contact (when the disinfectants;
disinfectant sits visibly wet, or “dwells,” on
the surface for a specified length of time) • disinfecting/sanitizing water-based devices
after the surface has been cleaned; (for example, those that use steam).

u only works on hard, nonporous surfaces. A pesticide is any substance or mixture of

Carpets and upholstery and other porous substances intended for preventing,
surfaces cannot be sanitized or disinfected destroying, repelling, or mitigating any pest.
with a chemical product; We think of pesticides when we think of
u is temporary! As soon as a surface has been getting rid of ants or cockroaches, but germs
touched or coughed, sneezed or breathed are also pests and the products used to kill
on, germs start growing on it again. them are pesticides.

Some germs are very hard to kill, while others are

easily killed by many disinfectants, and even plain
Incorrectly using a disinfectant may kill the
weaker germs, but the more resistant germs
Disinfectants are antimicrobial pesticides and survive. Incorrect use includes
must be registered with the U.S. EPA and the u disinfecting a dirty surface;
California Department of Pesticide Regulation
(DPR) or similar agencies in other states. u wiping or rinsing the disinfectant off the
surface before the recommended dwell
Some devices can be used to disinfect; for (contact) time is over;
example machines that apply steam to surfaces.
These devices are very effective, work quickly, and u not using the recommended dilution ratio
use no chemicals. Some are mops and others look (not concentrated enough);
like a canister vacuum with attachments for use
u using a combination disinfectant/cleaner
on different surfaces. They can also disinfect
without first removing visible dirt from the
surfaces that chemical disinfectants cannot, such
as upholstery and carpets. Dust mites that live in
these surfaces are also eliminated by these

Because disinfectants are pesticides designed to

kill or inactivate germs, you should make sure you
need them for the specific task. The overuse and
misuse of these products is a growing public
health and environmental concern. Studies have
found that the use of some disinfectant products
is creating microbes that can mutate into forms
that are resistant to particular disinfectants or
that become superbugs. These resistant germs are
also harder to kill with antibiotics.

Section 5: What is the difference between cleaning, sanitizing, and disinfecting and how do these tasks help
control infectious disease in ECE?

When deciding on what products to use on a What are the recommendations and
surface, there are several factors to consider: requirements for sanitizing and
➊ Whether the surface is porous or
nonporous. There are typically two levels of sanitizing and
disinfecting in an ECE facility:
u Manufacturers design their antimicrobial
products – and the U.S. Environmental ➊ Routine sanitizing and disinfecting: This
Protection Agency (EPA) registers them – level is used for those areas that need
on the basis of the surfaces they are sanitizing and disinfecting on a regular
meant to be used on and what the basis (after proper cleaning with a high-
surfaces are used for (for example, food quality microfiber cloth and an all-purpose
preparation). detergent).

u Different types of surfaces require Areas requiring routine sanitizing:

different types of products and methods
for removing or killing germs. ♢ Food contact surfaces (surfaces where
food is served, stored, or prepared)
➋ Whether it is likely that the surface is Areas needing routine disinfection:
touched by many people and will come in
contact with broken skin or mucous ♢ Surfaces and items that are regulated
membranes. These surfaces will require by state child care licensing require-
disinfection. If a surface is contaminated ments, such as changing tables and
with germs but no one is touching it, it bathroom sinks and toilets.
doesn’t need to be disinfected. It is best to ♢ High-touch areas that are at high risk
avoid unnecessary use of chemicals in that for collecting lots of germs, like door-
area. knobs, bathroom faucets, and drinking
➌ Whether the surface requires
The national quality
u sanitizing which removes most germs to standards for health
the level of 99.9% or more on non-food and safety in child
contact surfaces; care are contained in
the book Caring for
u disinfecting (to kill virtually everything).
Our Children (CFOC),
Remember, some infectious diseases are spread in by the American
the air. Disinfecting surfaces will not prevent the Academy of Pediatrics,
spread of these diseases! The only way to prevent the American Public Health Association, and the
the spread of airborne diseases is by our National Resource Center for Health and Safety in
behaviors. See Section 6 on non-chemical Child Care and Early Education. It is available
strategies for reducing the spread of infectious online at and includes a
disease. table of recommendations for which areas in ECE
facilities require cleaning, sanitizing, or
disinfection and how often. See Appendix D:
Model Center Policy on What, Where and how
often to Clean, Sanitize, and Disinfect in ECE on
page 58 for a copy of these recommendations.

Section 5: What is the difference between cleaning, sanitizing, and disinfecting and how do these tasks help
control infectious disease in ECE?

Routine sanitizing and disinfection are also

required by state child care regulations. For
example, in California, the most populous state,
the California Child Care Licensing regulations
mandate sanitizing and disinfecting in child care
facilities to reduce the risk of infectious diseases.
For information on regulations in other states,
see The chart
below provides the sanitizing and disinfecting
requirements for California child care centers’
infant and toddler classrooms, as well as
recommendations from Caring for Our Children
(CFOC). For the complete list of CFOC
recommendations, see Appendix D: Model Center
Policy on What, Where and how often to Clean,
Sanitize, and Disinfect in ECE on page 58.

Sanitizing and disinfecting requirements and recommendations comparison chart

Surface CA Child Care Licensing Required Frequency Caring for Our Children Recommendation Frequency


Diaper Disinfect After each use Disinfect After each use


Potty training Disinfect After each use Disinfect After each use

Disposable Sanitize Daily Sanitize Daily



General Disinfect Weekly, or Clean Weekly, monthly,

if soiled or wet or before use
by another

Infants Disinfect Daily, or Clean Weekly, monthly,

if soiled or wet or before use
by another


Dishes, utensils, Sanitize After each use Sanitize After each use

Section 5: What is the difference between cleaning, sanitizing, and disinfecting and how do these tasks help
control infectious disease in ECE?

➋ Disinfection for incidents and outbreaks. In For areas not mentioned in the Caring for Our
addition to routine sanitizing and Children recommendations or your state
disinfecting the following incidents and regulations, consider whether the area is a high-
outbreaks require increased sanitizing and touch area. Is it a surface touched by many
disinfecting: children and caregivers during the day? If so, it is
a surface that needs to be cleaned and may need
♢ Outbreaks of contagious disease, such as to be sanitized or disinfected, especially when
Methicillin-resistant Staphylococcus there is an outbreak of infectious disease in the
aureus (MRSA), influenza, and other facility.
infectious diseases. For outbreaks,
increased disinfection of high-touch
areas is appropriate. For guidance on
specific disease outbreaks, go to the CDC
website. Information on reducing the
spread of flu in ECE can be found at

♢ Incidents involving blood and body

fluids, such as fights, nosebleeds, and ac-
cidents on the playground. See
Identify high-touch surfaces in your facility. They will
Section 11 for information on cleaning up require more frequent cleaning and sometimes disinfecting
body fluids spills. during a disease outbreak.

♢ Incidents involving feces, vomit, and

saliva, such as in toileting areas in It is important to know the differences between
preschool. See Section 11 for cleaning, sanitizing, and disinfecting and what
information on cleaning up body fluids surfaces require what degree of cleanliness,
spills. because you only want to use the least hazardous
products and methods that are necessary for the

Green Cleaning, Sanitizing, and Disinfecting: A Toolkit for Early Care and Education

Section 6: Personal practices for reducing the spread of infectious

disease in ECE
almost any other surface. Caregivers change
diapers, assist children with toileting, wipe noses,
hold hands, handle mouthed toys, and more.
Frequent handwashing is the only way to stop the
circle of infection caused by caregivers’ hands.

ECE providers need to be involved in efforts to

improve handwashing in ECE. By making hand
washing a responsibility of staff as a whole,
hospitals have found improvements in hand
washing rates. When ECE staff members
implement handwashing, and other behavioral
Although microbes are everywhere, most are strategies described below for themselves as well
harmless and many are helpful. Only 1% of as for the children in their care, infectious disease
microbes cause disease. The goal of an infection- risk will be reduced. Handwashing also prevents
control program is to reduce the spread of the transfer of toxic chemicals from children’s
infectious disease by reducing contact with hands to their mouths. Studies show that children
pathogenic (disease-causing) germs or microbes. swallow more chemicals from the skin on their
This curriculum provides guidelines on choosing hands than from mouthing toxic products
safer chemical products to clean, sanitize, and directly. Hand sanitizers only kill bacteria. They do
disinfect, but it is very important to remember not remove toxic chemicals
that some of the most effective ways of reducing One of the most important lessons you can teach
the spread of infectious disease are found in our children in ECE is personal hygiene. This includes
personal behaviors. handwashing, blowing noses or sneezing into a
Disinfection should be called “temporary tissue, and/or coughing or sneezing into our
disinfection” because germs start to grow on elbow. Making these behaviors automatic for a
disinfected and sanitized surfaces as soon as you preschool child sets the stage for the child’s
touch them again. By washing your hands lifelong use of healthy habits. Preschool children
frequently, you reduce the number of germs that are eager to master routines and skills. An ECE
you pick up from and leave on the surfaces and program is an ideal place to begin shaping
people that you touch. You are also less likely to children’s health habits, routines, and practices.
transfer those germs to your nose, eyes, and For many children, it is the only place where they
mouth, where they can get into your body and will learn these skills. Incorporating these habits
cause infection and illness. into the curriculum and daily routine of the
program helps to prevent the spread of infectious
According to the CDC, handwashing is the single disease. (See Fact Sheet: Handwashing for tips on
most important thing you can do to reduce the handwashing.)
spread of infectious disease in ECE as well as at
home. If you focus on disinfecting but you don’t
wash your hands and practice good personal
hygiene, you will continue to spread disease. You
need to take personal responsibility for
protecting the young children in your care from
infectious disease. Research has shown that
caregiver hands in ECE harbor more germs than

Section 6: Personal practices for reducing the spread of infectious disease in ECE

Behavioral strategies that can reduce the ➌ Vaccinations

spread of infectious disease Next to hand washing, vaccinations are the
best way to protect against infectious
➊ Cough and sneeze etiquette
disease, according to the CDC.
u Cover your nose and mouth with a tissue
States require certain
when you cough or sneeze.
immunizations for
Throw the tissue away
infectious disease before
after use and wash your
children can attend ECE.
hands with soap and
Each center should know
water. If soap and water
what immunizations are
are not available, use an
required in their state.
alcohol-based hand
sanitizer. If a The publication Caring for Our Children:
tissue is not National Health and Safety Performance
available, cover your Standards recommends (and child care
mouth and nose licensing regulations in most states require)
with your sleeve, that child care facilities maintain
not your hand. documentation of the immunizations the
children in attendance have received.
u Avoid touching your
Immunizations are particularly important
eyes, nose, or mouth.
for children in ECE programs because they
The skin that lines your eyes,
are at higher risk of complications from
nose, and mouth is called your mucous
infectious disease due to their immature
membranes. Germs can make their way
immune systems. Vaccinations are also
into the body through mucous
recommended for caregivers, teachers, and
membranes, so keeping your hands away
other staff members. Check your state’s
from your face keeps germs from
child care guidelines for required and
entering your mucous membranes and
recommended vaccinations. For
helps to keep you from getting sick.
recommendations on adult vaccinations,
➋ Isolation/social distancing see the CDC website at
u Stay home if you are sick. Don’t risk
passing your germs on to others at your read/adult.html
program. Go to the CDC website
The CDC suggests that everyone 6 months
and older should get an annual flu vaccine.
for the latest information when there is
Remember, it takes about 2 weeks after
an infectious disease outbreak. They will
vaccination for your body to develop an
provide information on how to deal with
immune response.
special disease outbreaks like H1N1,
including how long you should stay ➍ Equipment
home before returning to work. Certain pieces of equipment can aid in
reducing the transmission of infectious
u Encourage children and staff who are
disease by reducing the number of high
coughing or sneezing to leave a 3-6 foot
touch areas where microbes may be spread
buffer between themselves and others.
or by increasing air flow from the
ventilation system in an ECE facility.

Section 6: Personal practices for reducing the spread of infectious disease in ECE

u No-touch bathroom facilities are u Passive ventilation is the air that comes
available as self-flushing toilets and in from opening and closing doors or
faucets that turn on and off windows. This source of air is also
automatically. Automatic flushers can be affected by the wind and conditions
added to most existing toilets. Hands- outside. You can increase the amount of
free faucets that use a sensor to turn the air brought in and removed from a room
water on and off are also available at by putting an exhaust fan in a window
most home improvement stores. on one side of a room or building, and
opening a window on the opposite side
u Disposal equipment such as diaper pails
to pull in air, move it across the space,
and garbage cans should have a tight-
and exhaust (remove) it to the outside.
fitting lid that can be opened with a foot
Make sure you are not bringing in air
pedal so that ECE staff are not touching
from an area where vehicles are idling.
places where microbes might live and
multiply. ➏ Air filtering and cleaning equipment
This equipment can filter or kill germs and
u Separate equipment for food
filter pollutants from cleaning and
preparation, diaper-changing, and
disinfectant products out of the air. Some
toddler handwashing. Keeping these
air cleaning devices are designed to be
activities physically separate helps reduce
installed in the ductwork of an HVAC
the risk of spreading germs from one
system to clean the air in the whole
activity to another.
building. You can also buy portable room
u Impermeable, seamless surfaces for use air cleaners to clean the air in a single
in food preparation, diaper-changing, room or specific areas. There are several
and handwashing. Surfaces that are processes available:
porous, cracked, or damaged increase
u Air filtering. To filter out germs such as
the likelihood that germs will escape
viruses, which are very tiny, requires a
disinfection and allow transmission,
filter that has a high-efficiency
especially when people touch these
particulate air (HEPA) rating. These
surfaces frequently.
should be properly sized for the room.
➎ Ventilation
u Air cleaning. Some equipment will kill
Ventilation is the exchange of fresh air
germs, but is not appropriate for use in a
within a building. Increasing the amount of
child care setting (such as ultraviolet
fresh air within a building and removing
light) or are not safe (such as devices that
indoor air containing germs that are
clean air but also create ozone, a
spread through the air can also reduce the
pollutant). Purchase an air cleaner on the
risk of infectious disease.
California Environmental Protection
u Mechanical ventilation is usually known Agency Air Resources Board list of
as a central heating, ventilating, and air- certified air cleaning devices available at
conditioning (HVAC) system. If you have
an HVAC system in your facility, make certified.htm or the EPA Guide to Air
sure it is inspected and serviced on a Cleaners in the Home available at:
yearly basis and that the air filters are
changed regularly.

Section 6: Personal practices for reducing the spread of infectious disease in ECE

Hand sanitizers
Many people use hand sanitizers instead of
soap and water when washing their hands.
Hands should always be washed with soap
and water when possible because sanitizers
don’t remove dirt, and germs can hide
under the dirt and remain on the hands.
When you can’t wash your hands, the CDC
recommends using an alcohol-based hand
sanitizer containing more than 60% alcohol.
Children are at greater risk of harm from
hand sanitizers because they can lick the
residue off their hands and ingest the
ingredients in the sanitizer.

Green Cleaning, Sanitizing, and Disinfecting: A Toolkit for Early Care and Education

Section 7: Choosing safer products for cleaning, sanitizing, and

Certified Cleaning Products is available at

Design for the Environment (DfE) is a U.S. EPA

program. DfE certifies both institutional and
retail/consumer products. A list of DfE-certified
cleaning and other products are available at

Look for these seals or logos

Using the least hazardous and most effective

products available will protect the health of the
children in your care, ECE staff, the custodial
personnel, and other building occupants. Using
these products is also better for the environment.
The logo or seal for third-party certified products
Third-party certifiers: A way to identify is on the product container.
safer cleaning products
Organizations that evaluate products using If a product does not carry a third-party
science-based criteria for health and certification logo, look for the following:
environmental impacts are called third-party u Ingredients listed on the label
certifiers. They help us identify less hazardous
cleaning products and publish lists of the u No signal word “Danger” on the label.
products they have evaluated and certified. They “Signal words” on the label are used to
have developed standards that they use to review indicate the product’s relative level of
products. These standards prohibit or limit severity of hazard and
chemicals that can cause the following: alert the reader
u cancer and reproductive harm
to a potential hazard.

u asthma u Non-aerosol
u corrosive damage to the skin and eyes u No overwhelming
u toxicity to fish and other aquatic animals chemical odor
u indoor air pollution and other
u Fragrance-free
environmental and health problems
u Dye-free

The 3 main certification agencies

EcoLogo is a program of Underwriters Laboratory
based in Canada. Some of these products are To make choosing products easier, go to the
available in the U.S. and some are not. A list of Transpare website where you can use their search
certified cleaning products is available at application to find and compare safer institutional cleaning products.

Green Seal is a program based in the U.S. and

used by many institutional purchasers. A list of
Section 7: Choosing safer products for cleaning, sanitizing, and disinfecting

Ingredients to avoid Institutional products

u These are purchased from a cleaning
If you can’t find third-party certified products,
products distributor.
avoid the ingredients on this list. They can be
u They are often not available in retail stores
harmful to our health or the environment.
in the community. For example, until
u 2-butoxyethanol (or ethylene glycol
recently, some of the newer and less
monobutyl ether) and other glycol ethers
hazardous accelerated hydrogen peroxide-
u Alkylphenol ethoxylates (some common based products have been available only
ones: nonylphenol and octylphenol through distributors.
ethoxylates, octoxynols)
u They are available as a concentrate that can
u Bisphenol A be diluted with water for different cleaning
u d-Limonene tasks. Distributors will provide the dilution
u Dyes (may be listed as FD&C or D&C) stations and labeled bottles that meet
Occupational Safety and Health
u Ethanolamines (common ones to look out
Administration (OSHA) requirements for
for: monoethanolamine [MEA],
hazard communication for the diluted
diethanolamine [DEA], triethanolamine
products. It’s important when using a
concentrate to dilute the product as
u Fragrances
recommended on the label.
u Parabens
u They come accompanied by Safety Data
u Phthalates Sheets (SDSs) that you must have on site to
u Pine or citrus oil satisfy OSHA rules.
u Quaternary ammonium compounds u Institutional products are generally less
Look out for these: expensive than similar products available in
♢ alkyl dimethyl benzyl ammonium chloride retail stores.
(ADBAC), benzalkonium chloride, Most distributors carry products certified as safer
dodecyl-dimethyl-benzyl ammonium by a third-party (Green Seal, EcoLogo, Design for
chloride the Environment). For more information on how
♢ lauryl dimethyl benzyl ammonium to set up group purchasing through a distributor,
chloride see Appendix B: Tips on Forming a Buying
Cooperative on page 56.
♢ benzyl-C10-16-alkyldimethyl, chlorides
♢ benzyl-C12-16-alkyldimethyl, chlorides Retail products
u These are purchased at a retail store like a
♢ benzyl-C12-18-alkyldimethyl, chlorides
grocery store.
♢ benzyl-C16-18-alkyldimethyl, chloride
u They come available in ready-to-use
♢ didecyl and didecyl dimethyl benzyl
containers or as concentrates such as
ammonium chloride
u Triclocarban
u Concentrated products do not come with
u Triclosan dilution equipment, increasing health
hazards for the user.
Choosing safer cleaning products
u Some are certified as safer by a third-party
An ECE facility can be cleaned using just a few (Green Seal, EcoLogo, Design for the
products. There are two types of products Environment).
available for cleaning a public space:
u Safety data sheets must be downloaded
from the internet or you may have to
contact the manufacturer for a copy.
Section 7: Choosing safer products for cleaning, sanitizing, and disinfecting

Choosing safer sanitizers ♢ A “hospital grade” disinfectant sounds

like it kills all sorts of germs, but it is only
Caring for Our Children: National Health and
required to kill two target organisms:
Safety Performance Standards recommends
Staphylococcus aureus and Pseudomonas
sanitizing for toys, thermometers, pacifiers,
aeruginosa. Many identify other germs
teething toys, eating utensils, tables and high
that they kill as well, but you have to
chair trays, food preparation areas, mixed use
check the label.
tables, and computer keyboards. (See Appendix
♢ Many infectious diseases found in ECE are
D: Model Center Policy on When and Where to
caused by viruses. Make sure you choose
Clean, Sanitize, and Disinfect in ECE.)
a product that is effective against viruses.
When choosing a sanitizer, look for the following:
u What is the dilution ratio of the product?
u A 0 rating on the Hazardous Materials (How do I mix it correctly?)
Identification System (HMIS) health rating u Is it a “one-step” disinfectant-cleaner or a
scale disinfectant that requires you to clean the
u The signal word "Caution” (rather than surface first? (Even when using one-step
"Danger" or "Warning") on the product products you have to pre-clean heavily
label soiled areas.)

u EPA registration number (verifies that the

product is registered by the EPA to kill the
germs claimed on the label)

u Approval for food contact surfaces

u Short dwell time (the time the sanitizer

must be left visibly wet on the surface and
in contact with the germs to kill them). For
example, 10 minutes would be considered a
very long dwell time and would most likely
require re-wetting for proper compliance
with the label.

Choosing safer disinfectants Bleach

There are many different types of disinfectants Sodium hypochlorite, or bleach, has long
available. When selecting and using disinfectants, been used in ECE to sanitize and disinfect.
always check for the following: Recently, bleach has been declared an
asthmagen by the Association of
u Does the product have an EPA Registration Occupational and Environmental Clinics. An
Number? All disinfectants are required to asthmagen is something that can cause
have an EPA Registration number. asthma. Recent changes in the concentration
u Is it approved for the task and surface you of EPA-registered bleach products also make
will use it on? correct dilution more confusing and difficult.
There are safer products available. For this
u Will it damage the surfaces cleaned with it?
reason, we are not recommending the use
u What germs does it kill? of bleach in ECE to sanitize and disinfect.
For more information, see Fact Sheet:
♢ Not all disinfectants kill all germs.
What’s the Problem with Bleach?

Section 7: Choosing safer products for cleaning, sanitizing, and disinfecting

The EPA’s Design for the Environment ♢ Carpet spotter/extraction cleaner

Antimicrobial Pesticide Pilot Project ♢ Glass and window cleaner
is the only program that can ♢ Neutral floor cleaner
legally certify disinfecting
u Heavy-duty cleaning product
products that are less hazardous
for human health and the u Hand soaps (with no antibacterial
environment in the U.S. If you see properties) and hand sanitizers
the DfE logo on an EPA-registered antimicrobial ♢ Foaming hand soap is a form of liquid
pesticide (disinfectant) label, you can be assured soap that has been whipped with air to
that the product create a foam of soap bubbles. This style
of soap requires special dispensers, but it
u is in the least-hazardous classes (i.e. III and
is easier to apply and lather, and results in
IV) of EPA’s acute toxicity category
less soap and water use. The dispensers
are also less likely to clog and drip.
u is unlikely to have carcinogenic or
u Environmentally preferable and safer
endocrine disruptor properties;
disinfectants and sanitizers. If possible
u is unlikely to cause developmental, choose a product that has been certified by
reproductive, mutagenic, or neurotoxic the Design for the Environment Disinfectant
effects; Pilot Program. For a list, visit
u has been shown to be effective against the
design-dfe pilot.html#means
microbes listed on the label (associated with
the Antimicrobial Testing Program or ♢ A 0-1 rating on the Hazardous Materials
otherwise). Identification System (HMIS) health scale
(See Section 10 for more information).
For more information on the Design for the
u Floor and carpet care products that are
Environment Pilot Project, go to:
effective, safer alternatives to the many
highly hazardous products on the market
♢ Wax stripper ♢ Floor sealer and finish
Group buying ♢ Carpet cleaner
Buying institutional cleaners or disinfectants and u Mineral build-up remover (used on toilets;
sanitizers from a cleaning products distributor in typically a highly hazardous product for
volume can help save money. If you belong to a which there are effective, less hazardous
group with other ECE programs, or to a group alternatives)
representing ECE programs, you can buy your
cleaning products together from an institutional Safety Data Sheets
distributor. (See Appendix B: Tips on Forming a Material Safety Data Sheets are now called
Buying Cooperative on page 56). Safety Data Sheets (SDSs) under new OSHA
You should request bids from several distributors requirements. See Section10: What is a
to compare prices for the following third-party Hazard Commununication Program for more
certified products: information on how to read a SDS.
u One concentrate that is diluted for the
following tasks:
♢ Bathroom/restroom cleaner
♢ All-purpose cleaner

Green Cleaning, Sanitizing, and Disinfecting: A Toolkit for Early Care and Education

Section 8: Clean isn’t a smell!

additional chemicals that may pose health risks

and are unnecessary. Even “unscented” or
“fragrance-free” products may contain chemicals
which are added to mask the smell of the
chemicals. Nevertheless, it is better to buy a
product marked fragrance-free than one that
contains fragrance when possible. Fragrances
enter the body in many ways. They are
u absorbed through the skin;

u inhaled into the lungs;

u swallowed, especially by children with

Scented products are everywhere in our daily
hand-to-mouth behaviors.
lives. Fragrance is added to personal care and
household products and many other items that Health effects of fragrance chemicals in air
we use each day. Most products used to clean, fresheners and “fragranced” cleaners,
sanitize, and disinfect contain fragrances. Air sanitizers, and disinfectants
fresheners are often used in ECE by staff members
u Fragrances can irritate the lungs and
who want to make indoor areas smell better,
trigger asthma, headaches, and allergic
especially when diapers are being changed
contact dermatitis (skin reactions).
frequently. But fragrances do not clean the air.
They disguise the smells by adding more u Higher levels of some fragrance chemicals
chemicals to the air. have been linked to reproductive problems
in women.
Manufacturers of cleaning products use
fragrances for many reasons besides making the u Some fragrance chemicals have been linked
product smell nice. Fragrances are used to to certain types of cancer.
u make you associate a particular smell with Phthalates are chemicals used as solvents and
use of their product; carriers for fragrances. Phthalates can accumulate
u hide or mask unpleasant odors that come in the human body. They are excreted in breast
from chemicals in the product; milk, exposing nursing infants who are especially
vulnerable to the health effects of chemicals
u signal to you that the product has worked because their bodies are developing rapidly.
and the area where it has been used is Phthalates are endocrine disruptors. They have
clean. been linked to

It is a common mistake to think that if a cleaning u an increase in prostate and breast cancer;
product doesn’t leave a scent after use, the
product didn’t work and the area is not clean. For u adverse reproductive system outcomes,
example, when you smell a citrus fragrance after including reduced semen quality and
cleaning it does not mean the product is safer, altered male genital development;
more “natural,” or does its job. Cleaning, u neurodevelopment problems, such as
sanitizing, and disinfecting products all contain attention disorders, in children who are
chemicals. Products that have a fragrance contain exposed prenatally.

Section 8: Clean isn’t a smell!

Air fresheners or hazardous, even those advertised as

"natural," "green," "organic," or that
Air fresheners are particularly concentrated
contained essential oils. Some of these
sources of fragrances that are full of toxic
chemicals have been found to be unsafe
even in very small amounts.
u The hazards of air fresheners are hidden.
u The toxic chemicals given off by "natural"
Like cleaning products, potentially
air fresheners were not significantly
hazardous chemicals contained in
different from other brands.
fragrances are not required to be listed on
the label. u The Federal Trade Commission (FTC)
recently released new guidelines, the Green
u Some chemicals in air fresheners are
Guides, designed to ensure that the
sensitizers that can lead to allergies. They
environmental claims made by marketers
can also trigger asthma, allergic reactions,
are truthful. These new guidelines
wheezing, headaches, and contact
discourage marketers from using general
environmental claims such as “natural,”
u Some chemicals in fragrances are endocrine “green” or “eco-friendly.” Unfortunately,
disruptors, mimicking or disrupting the the guidelines are not regulations. The FTC
body’s own hormones. can take action against companies that are
deceptive, but they have done so in only a
u Common air freshener chemicals, such as
handful of cases over the last 20 years.
limonene, can also react with other
Many companies continue to make claims
chemicals, particularly ozone. This results in
that their products are “green,” or
the creation of additional hazardous
“natural,” or “organic” when these terms
pollutants such as
have no legal definition.
♢ formaldehyde, which is linked with
How to avoid fragrances and their health
cancer and can cause asthma, and
acetaldehyde, which is also linked with
cancer; u Choose third-party certified products that
♢ ultrafine particles that can be inhaled are labeled unscented or "free and clear.”
deep into the lung. They are linked with u Look for products that do not have
heart and lung disease. "fragrance" listed as an ingredient (but
The use of a single air freshener can also violate remember that fragrances are not
the Americans with Disabilities Act, because necessarily listed on the label).
people who experience disabling health effects u Avoid products with a strong smell.
from air fresheners cannot access the public u Use ventilation instead of air fresheners.
facility. In two national studies, approximately
u Look for items marked “phthalate-free.”
20% of the U.S. population and 40% of persons
with asthma, reported headaches, breathing Note: Products called "fragrance-free" and
difficulties, or other health problems when "unscented" are not necessarily less hazardous.
exposed to air fresheners or deodorizers. Even if a product does not contain a fragrance, it
could still contain other chemicals that are
Are "natural" air fresheners any safer? classified as toxic or hazardous. For more
u Not necessarily. In tests, all air fresheners information on the chemicals in a product, read
tested gave off chemicals classified as toxic the Safety Data Sheet from the manufacturer, or
check on the manufacturer’s website.

Green Cleaning, Sanitizing, and Disinfecting: A Toolkit for Early Care and Education

Section 9: What are the most effective and safest ways of cleaning,
sanitizing, and disinfecting in ECE?
and mice, telephones, microwave and elevator
buttons, and light switches should be cleaned
with detergent, water, and a microfiber cloth
more frequently to control the spread of
infectious diseases. Some state child care licensing
regulations may require that some of these high-
touch surfaces be disinfected as well. This is
especially true if there is an outbreak of an
infectious disease in your program.

Tools for cleaning

u Walk-off mats placed at all of your
Each ECE program should have a written entryways help to capture the debris and
procedure for cleaning, sanitizing, and dirt tracked in on shoes. They also reduce
disinfecting. State child care regulations are good
sources for learning about requirements and
finding examples of cleaning schedules and
procedures. See Appendix D for the Caring for
Our Children recommendations and requirements
for cleaning, sanitizing, and disinfecting in ECE.

Routine cleaning
Cleaning physically removes visible dirt, dust, oils,
and germs (microbes – viruses, fungi, and wear and tear on floors and carpeting.
bacteria). The cleaning process uses an all- Look for good quality multi-level scraper
purpose detergent and water, and a scrubbing mats with rubber backings that hold water.
motion, just like washing our hands using soap, Where possible 15’ to 20’ is recommended
water, and rubbing. Always read product labels for maximum effect, but any length will
and follow directions. Cleaning should be done help keep the floors cleaner. Vacuum the
before sanitizing or disinfecting because germs walk-off mats daily.
can hide underneath dirt and debris where they u Microfiber (preferably ultra-fine high
escape being killed by a disinfectant. Most quality microfiber) cleaning cloths and
disinfectants require a thorough cleaning prior to mops work well for removing organic
application, whereas “one-step” disinfectants can matter (dirt, oils, grease) as well as germs
clean and disinfect but require that you pre-clean from surfaces. Microfibers used for cleaning
heavily soiled areas. Some disinfectants, such as are split many times to increase their
bleach and quaternary ammonium compounds, absorbing capacity. Split microfiber quality
lose their ability to disinfect well in the presence varies. Microfiber that catches slightly on
of dirt. the surface of your hand is better quality. A
High-touch surfaces laundering program is necessary if
(surfaces that are microfiber is used. This can include washing
touched many times a mops and cloths by hand, by machine, or
day by many different using a laundering service. Laundering will
hands) such as door help prevent the spread of germs from one
knobs, door push bars, surface to another (called cross-
sink handles, shared contamination).
computer keyboards
Section 9: What are the most effective and safest ways of cleaning, sanitizing, and disinfecting in ECE?

See Fact Sheet: What’s So Great About u Buffers and burnishers are machines used
Microfiber? If microfiber is not available, to clean, scrub or strip the finish from a
recycled content paper towels are vinyl floor. They also restore the glossy look
alternatives, but will not provide as much to a floor that has had a finish applied.
germ removal as microfiber. These machines can contribute to
particulate matter in indoor air which can
cause health problems. Buffers and
burnishers should be equipped with a high-
efficiency vacuum to capture the particles
that are created when performing these
tasks. They should not be used when
occupants are in the building. Installing
rubber floors makes burnishing
u Vacuums come in many different shapes
unnecessary. They only need to be scrubbed
and styles. There are websites that rate
with a microfiber mop and plain water and
vacuums and industrial versions are
buffed with a cleaning pad are safer than
available through cleaning product
distributors. (Ask your local school who they
purchase their vacuums from.) Look for a Carpeting tips
vacuum with a bag indicator light that tells
you when the bag should be changed. Carpeting can collect dust, dirt, and germs that are hard to
remove. They can also trigger allergies and asthma. Smaller
Some vacuums also have a green indicator
area rugs that can be laundered or removed for cleaning are
light that tells you when no more dirt is a safer choice than wall-to-wall carpeting.
being removed from the carpet. This helps
If your carpeting needs replacing, choose products approved
you to know how long to vacuum a rug. under the GreenGuard Gold certification or the Carpet and
Regular vacuuming also helps carpets to last Rug Institute’s Green Label or Green Label Plus program.
longer. Dirt is abrasive and can ruin carpet Carpets with low pile height and low pile density are easier
fibers if it is ground into the carpet. The to clean. Request carpeting and carpet padding that does
more often you vacuum, the more dirt you not contain formaldehyde.

remove before it can damage carpeting. Research tells us that vacuuming can help reduce asthma
Empty the bag when it is half filled or when episodes, allergies, and other health problems related to
dust in indoor air. Use a vacuum with a HEPA or high-
the indicator light comes on to ensure that
filtration filter so that the dust is retained inside the filter.
the vacuum sucks at full power. Floors and
Take your time and vacuum slowly. This picks up more dust
carpets need to be vacuumed daily.
and dirt. A dust finder indicator light that turns green when
HEPA or high-filtration vacuums filter out no more dust is being removed can be very helpful in
more dirt and germs than traditional determining if the carpet has been properly cleaned.
vacuums. Traditional vacuums can actually Vacuuming should be done when children and staff are
gone for the day.
blow small particles of dust back out of the
vacuum and into the air! HEPA vacuums
are the best choice for preventing dust Cleaning products and procedures
from floor and carpets from getting into
the indoor air. Vacuuming captures more A third-party certified all-purpose product is the
dust and dirt than sweeping. It can also best choice for routine cleaning. See Section 7:
reduce exposure to compounds such as Choosing Safer Products for Cleaning, Sanitizing,
fire-retardant chemicals, lead and other and Disinfecting. These are available as a
metals, and some phthalates that are concentrate (need to be diluted) or in ready-to-
largely found in dust. use (already diluted) form.

Section 9: What are the most effective and safest ways of cleaning, sanitizing, and disinfecting in ECE?

Surface cleaning
Manufacturers may claim that their products
➊ Put on non-latex chemical-resistant gloves are “green,” “natural,” or “earth-friendly,”
(nitrile or neoprene are best) when using but such claims are often meaningless or
cleaning products. All cleaning products misleading. To ensure that the products you
have some effect on the skin. buy are safer for health and the environ-
ment, look for the certification logo of
➋ Spray or squirt the solution on a microfiber
independent third-party organizations.
cloth or paper towel and apply to the
EcoLogo and Green Seal criteria cover many
surface to be cleaned.
characteristics, such as toxicity and
➌ Wipe or scrub the surface until it appears corrosivity limits, and also prohibit chemicals
clean. that:

➍ Rinse the cloth in clean water or, if the u cause allergic-type asthma;
cloth is very soiled, use a new damp cloth u are carcinogens, reproductive
(or a new paper towel) to rinse the surface. toxicants, and some that are endocrine
➎ Allow to air dry or wipe dry with a clean
cloth if the surface is to be used

➏ Dispose of towels and/or place washable

cloths in a closed receptacle container or
laundry basket for laundering.

Floor cleaning
➊ Fill a bucket with water and add the ➋ Place microfiber mop heads in the cleaning
cleaning solution (unless you have diluted solution.
the product using a dilution station, which
➌ Mop each room’s floor until it appears
is safer) according to label instructions. It is
clean and then change the microfiber mop
ideal to have a split bucket system with the
head. Bathroom floors should be mopped
cleaning solution on one side and the rinse
water on the other side. This will help to
keep the cleaning solution from getting ➍ Place used microfiber mop heads in a
dirty. container for laundering.

➎ Most floors can be cleaned and don’t need

to be disinfected, unless it is required by
licensing regulations. If body fluids are
present, disinfect floors after cleaning.

u Apply the disinfectant to the floors

following the label instructions and leave
visibly wet on the floor for the
recommended dwell time.

u Rinse if required by the label


Section 9: What are the most effective and safest ways of cleaning, sanitizing and disinfecting in ECE?

What not to use and why Cleaning tips

The use of cotton cloths, cotton mops, and Clean first before you disinfect. Germs can
sponges is not recommended. hide underneath dirt and other material on
Cotton cloths do not clean surfaces or surfaces where they are not affected by the
capture germs as well as microfiber. They can disinfectant. Dirt and organic material can
actually spread germs from one surface to also reduce the germ-killing ability of some
another. They do not last as long as micro- disinfectants.
fiber after frequent washing. The use of Use warm or hot water with any cleaning
cotton with a quaternary disinfectant can product unless the label states the product is
reduce the effectiveness of the disinfectant. formulated to be effective in cold water.
Cotton mops are much heavier, especially
Scrub vigorously with a microfiber cloth to
when fully wet, than microfiber mops and
remove dirt. Use a brush if the item is not
are more likely to cause injuries to the user.
smooth or has hard-to-reach corners where
They can move germs from one area to
dirt and germs can hide, such as toys and
another if not properly handled. It is more
difficult to replace and launder cotton mop
heads than microfiber mop heads. Clean completely on a regular schedule (see
Sponges should not be used for cleaning, Appendix D or your state child care
sanitizing, and disinfecting because they are regulations for a recommended schedule)
hard to clean and bacteria grow in them. and spot clean as needed.
Change water when it looks or feels dirty,
and after cleaning bathrooms, diaper
Carpet cleaning changing areas, and the kitchen.
Vacuum carpets at least daily or more frequently Clean the least dirty items and surfaces first
if needed, to pick up spills of food and other (for example, countertops before floors and
particles. Carpets should be thoroughly cleaned sinks before toilets).
(steam cleaning recommended) every 3 months or Store materials and toys in plastic tubs that
as needed. Steam or hot water extraction are easier to keep clean.
cleaning is typically done by a service using
Clean from top to bottom – high surfaces
equipment mounted on a truck or by a portable
first, then low surfaces.
system brought inside the building. Hot water is
sprayed under high pressure into the carpet and Apply cleaning products to a microfiber
immediately vacuumed out along with dirt. When cloth with a stream or coarse spray and then
done properly, steam cleaning can clean even wipe the surface to be cleaned (instead of
heavily soiled carpets. Sometimes detergent is spraying the product directly on the surface.)
also used, but low quality detergent, too much This protects the user from breathing the
detergent, or overly concentrated detergent may mist that bounces back from the hard
leave sticky residues that can attract dirt. In case surfaces and contaminates the air.
of blood or body fluid spills, wash thoroughly Remove microfiber mop pads from the
and rinse. handle and hand wash, rinse, and hang to
dry, or place in a bag for daily laundering.
Treat microfiber cloths the same way.
See Fact Sheet: What’s So Great About

Section 9: What are the most effective and safest ways of cleaning, sanitizing, and disinfecting in ECE?

Diluting concentrated products Sanitizing

A sanitizer is a product or device that reduces
The safest way to dilute concentrated germs on surfaces to levels considered safe by
products is to use a product dispensing public health codes or regulations. Sanitizers
system. The dispensing system automatically work by killing germs. For food service this level
dilutes the concentrate, and in doing so should be a 99.999% reduction in the number of
improves safety and conserves resources: microorganisms within 30 seconds. The level for
u It minimizes waste by correctly diluting hard surfaces not used for food service should be
the product. Using too concentrated a at least 99.9%. Sanitizing products should state
solution increases costs, but using the on their label the surfaces they are intended to
right amount improves how well the be used on.
product works. Sanitizing in child care is required for specific
u It prevents exposures to you and your areas such as food preparation and contact
staff and prevents spills of product surfaces, and mouthed toys and pacifiers. State
concentrates. child care regulations and Caring for Our
Children: National Health and Safety Performance
Standards, Routine Schedule for Cleaning,
Sanitizing, and Disinfecting, Appendix K specify
what needs to be sanitized on a regular basis.
(See Appendix D: What, Where and How Often to
Clean, Sanitize, and Disinfect in ECE for a copy of
the CFOC recommendations.)

Tools for sanitizing

Sanitizing can be done with a chemical product, a
sanitizing device, or in a dishwasher.
u Microfiber cloths work well for spreading
sanitizers on surfaces.
u Dishwashers are a great option for
sanitizing dishes, eating utensils, mouthed
plastic toys, and pacifiers and they
eliminate the need for chemical sanitizers.
u Devices
A dispensing system protects your staff, assures proper ♢ Steam cleaners can be used to sanitize,
dilution, and can save on product costs.
deodorize, and remove grease, dirt, and
product residues thoroughly and quickly
Ready-to-use (already diluted) products can also without chemicals. They can be used on
be purchased in bulk and transferred to smaller many surfaces, including bathroom
containers using a dispensing system to reduce fixtures, floors and countertops,
exposure to chemicals. Product vendors will often carpeting, and upholstery. Dry vapor
provide dispensing equipment at no cost if steam cleaners use super-heated low
enough product is purchased from them. When moisture steam – no chemicals – for
dispensing products from a larger container to a disinfecting, sanitizing, and cleaning
smaller one, labeling is required for the smaller surfaces. They are very effective and
“secondary” container. See Section 10: What is a approved for food contact as well as
Hazard Communication Program?

Section 9: What are the most effective and safest ways of cleaning, sanitizing, and disinfecting in ECE?

other surfaces including carpets and ➏ See federal and state regulations for
upholstery. They are one of the most specific requirements.
effective ways to remove bacteria that
have formed a biofilm (see page 41 for
more information on biofilm). Some cleaning products may claim that
rinsing isn’t necessary, but all products leave
♢ No-touch cleaning systems may be used
a residue that can contribute to particulate
with an EPA registered sanitizer. These
matter in the air over time. Rinsing non-food
systems spray cleaning solution/sanitizer
contact surfaces avoids this problem.
on soiled fixtures and floors, then wash
soils to the floor using pressurized water,
and finally vacuum the floor dry. The ➐ Place cloths in a receptacle for laundering.
equipment includes three main
components: an indoor pressure washer, a Hand-washed dishes
wet vacuum system, and a dilution ➊ If a 3-compartment sink is used, set up and
component. use the sink in the following manner:
Products and procedures for sanitizing
u Wash dishes in the first compartment
An EPA registered sanitizer or sanitizing device using a clean detergent solution and
that is rated for food contact surfaces should be water at or above 110°F, or at the
used when sanitizing surfaces as recommended temperature specified by the detergent
by state child care regulations or CFOC. (See manufacturer.
Appendix D: What, Where and How Often to u Rinse in the second compartment with
Clean, Sanitize, and Disinfect in ECE.) clean water.
Sanitizing food preparation areas using a u Sanitize in the third compartment with a
chemical sanitizer food grade sanitizing solution mixed at
the concentration specified on the
➊ Clean the surface first as described on page manufacturer’s label or by immersing in
hot water at or above 171°F for 30
➋ Read and follow the instructions on the seconds. Make sure you have the correct
product label for sanitizing food contact or sanitizer concentration by using an
other hard surfaces. appropriate test kit.

➌ Sanitize the surface using a sanitizing Automatic dishwashers

solution mixed at the concentration
Use a dishwasher with a sanitizing cycle that is
specified on the label or a ready-to-use
certified to meet NSF/ANSI 184 standard (See
➍ Apply the sanitizer using a stream or squirt for listings). This standard helps confirm that a
bottle. residential dishwasher can achieve a minimum
99.999% reduction of bacteria when operated on
➎ Allow to remain on the surface for the the sanitizing cycle. Follow manufacturer’s
dwell time listed on the product label. This instructions for use.
means visibly wet. Use a timer. If the
product dries before the end of the dwell
time, reapply. Products that have a shorter
dwell time (about 1 minute) are easier to
use because they don’t require

Section 9: What are the most effective and safest ways of cleaning, sanitizing, and disinfecting in ECE?

Mouthed toys (hard, non-porous surfaces Electronics/keyboards

only) and pacifiers
➊ A flexible silicone cover makes cleaning
➊ Place in the automatic dishwasher and and sanitizing keyboards much easier.
follow the instructions above for
➋ Wipe with a sanitizer and a clean
dishwasher use.
microfiber cloth or a paper towel. Don’t
spray sanitizer on a keyboard. Sanitizing
wipes can also be used on keyboards.

Dirt can make disinfectants less effective –

clean first, then disinfect.

Only toys with hard, non-porous surfaces

can be sanitized or disinfected.
Disinfecting works by using chemicals or devices
to kill almost all the germs on surfaces or objects.
This process does not necessarily clean dirty
surfaces or remove germs. By killing germs on a
surface after cleaning, the risk of spreading
infection is lower. Disinfecting kills germs on
contact, whereas cleaning works by washing
Toys with porous surfaces need to be away the germs that can be removed. Areas to be

➋ Boil pacifiers for one minute in drinkable


➌ Washing by hand
u Wash toys in a detergent and water
solution and rinse with water.
u Immerse the toys in the sanitizer solution
and wait for the recommended dwell
time. Rinse the toys if the label requires
this step (you may want to rinse anyway,
if children are mouthing the toys). Allow
to air dry or dry with a clean cloth or disinfected include door and cabinet handles
paper towel. touched by children, drinking fountains,
bathroom fixtures, and objects in toilet and
For toys that cannot be immersed:
diapering areas. (See Appendix D: What, Where
u Apply the sanitizer according to label and How Often to Clean, Sanitize, and Disinfect
instructions by spraying or squirting the in ECE.)
product on one side of the toy and
waiting for the recommended dwell
time, then the other side and wait again.
Rinse with clean water and air-dry or dry
using a clean microfiber cloth or a paper
Section 9: What are the most effective and safest ways of cleaning, sanitizing, and disinfecting in ECE?

Bacteria, a type of germ, are sometimes able

Tools for disinfecting
to form dense mats called biofilm that form a u Microfiber cloths or paper towels for
protective environment for germs. Biofilms applying disinfectants to surfaces
form on surfaces that are constantly wet.
When bacteria land on a hard, moist surface, u Microfiber mops for floors
they can easily be removed. But if they are not
u Devices
removed, they form stronger attachments to
♢ Dry vapor steam cleaners
surfaces and to each other, creating a
have been shown to be
community within a protective shell that
very effective for
increases their ability to survive and grow. This
disinfecting and is
biofilm develops within hours. It protects the
approved for food
bacteria from cleaners and disinfectants,
contact surfaces
which can kill only the bacteria on the outer
as well as other
layer. Once formed, the bacteria within
biofilms are up to 1000 times more resistant
to disinfectants than the same bacteria that
are not part of a biofilm. To reach the Products and
microbes within the biofilm, friction must be procedures
used to break down the shell. Microfiber for disinfecting
cloths or mops, brushes, or steam vapor can
be used to penetrate the biofilm. Key places An EPA-registered
in ECE buildings where biofilms develop are disinfectant is required to disinfect an area.
continuously damp or wet areas around sink See to check your
faucets, food preparation areas, and drains. state’s regulations for more specific information.
To prevent the development of biofilm, keep Many states require the use of a hospital-grade
surfaces clean and dry. Water and food are disinfectant in ECE.
what bacteria require in order to grow and
form biofilm.

Once formed, the bacteria within biofilms are up
to 1000 times more resistant to disinfectants than the
same bacteria that are not part of a biofilm.

At first, germs on surfaces But within hours, germs in Germs within the biofilm They form a more stable The thriving and well
are easily removed and the growing biofilm become grow, reproduce, and learn biofilm that is hard to protected colony of germs
killed by mild cleaners and firmly attached to the to communicate with each penetrate with provides a continuous
sanitizers. surface and to each other. other. disinfectants. supply of germs that easily
detach and contaminate
other surfaces.

Section 9: What are the most effective and safest ways of cleaning, sanitizing, and disinfecting in ECE?

Hard surfaces (drinking fountains, Bathroom floors

toilets, etc.)
➊ Follow the instructions on page 36 for
➊ Put on chemical-resistant gloves (nitrile, cleaning floors.
rubber are best) and other personal
➋ Read and follow the instructions on the
protective equipment as recommended on
label for the correct way to use the product
the label when using disinfectants.
selected for disinfecting floors. There may
➋ Follow the instructions for surface cleaning be separate instructions (on the product
on page 36. label or in state regulations) on how to
disinfect if body fluids are present.
➌ Follow the instructions on the disinfectant
product label to disinfect surfaces correctly. ➌ Place clean microfiber mop heads in the
disinfecting solution or squirt disinfecting
➍ Spray or squirt the disinfectant on the
solution directly on the area to be
microfiber cloth or paper towel and apply
disinfected. Use the mop to spread the
to the surface, or squirt the product
disinfectant until the surface is visibly wet.
directly on the surface so that the surface is
visibly wet. Avoid fine aerosol sprays. They ➍ Allow the disinfectant to remain wet on
can be inhaled and irritate the lungs. Some the floor for the recommended dwell time.
can cause or trigger asthma. Reapply if needed for the floor to remain
visibly wet for the entire dwell time.
➎ Allow to remain visibly wet on the surface
for the dwell time listed on the product ➎ Rinse if required by label instructions using
label. Reapply if needed for the surface to a clean microfiber mop head or cotton
stay wet for the entire dwell time. mop that has been washed and rinsed in
clean water and allow to air-dry.
➏ Rinse with a clean microfiber cloth or
paper towel if required by label ➏ Hang cotton mops to dry or launder
instructions. immediately (do not leave soaking in a
bleach solution) and place microfiber mop
➐ Allow to air-dry, or wipe dry with a clean
heads in a separate container for
cloth, if the surface is to be used

➑ Dispose of paper towels and place

washable cloths in a receptacle for

Green Cleaning, Sanitizing, and Disinfecting: A Toolkit for Early Care and Education

Section 10: What is a Hazard Communication Program?

Information about the products used in ECE and

their health hazards must be available and
understandable to your ECE staff. ECE employees
have both a need and a right to know what
chemicals they are exposed to when working and
the hazards of those chemicals.

Where does the Hazard Communication

Standard apply?
This OSHA requirement applies anywhere
employees may be exposed to hazardous
chemicals. In ECE, cleaners, sanitizers, and
disinfectants typically used by staff in their
routine work and in emergencies are potentially
hazardous to both staff using them and the
children in the facility. Therefore, OSHA's HCS
By law, every employer is responsible for applies to all ECE staff members who work with
providing their employees with a safe and these products.
healthy work place. Communicating to employees
about chemical hazards present in the workplace What does the Hazard Communication
is an important part of this responsibility. The Standard require?
OSHA Hazard Communication Standard (HCS)
This standard requires the facility to develop a
requires chemical manufacturers, importers,
written Hazard Communication Program that
distributors, and employers to provide hazard
includes the following:
information to employees and customers.
u Your plans for managing your Safety Data
As employers, ECE programs must have someone,
Sheets, which provide information on the
such as a child care health advocate, on staff who
chemical products in your facility, and a
is trained to recognize the potential hazards of
labeling system for product containers
diverse chemicals. A hazardous chemical is any
chemical that is u How you train your employees about
hazardous products and their safer use and
u a physical hazard (for example, it might management
explode or start a fire);
u A list of hazardous products used in your
u a health hazard (it may cause short- or facility
long-term health effects in employees who
u Methods to inform employees of the
are exposed).
hazards of non-routine tasks involving
Someone on your ECE staff must also know how hazardous products, such as emergency
to protect your facility’s employees from these response spill clean-up
hazards through u Methods to communicate hazards to
outside contractors who may be exposed to
u work policies and procedures;
hazardous products in your ECE facility
u the use of personal protective equipment

Section 10: What is a Hazard Communication Program?

Safety Data Sheets (SDSs) for hazardous ♢ The name of the hazardous chemical(s)
products ♢ Warnings for specific hazards:

SDSs (formerly Material Safety Data Sheets, or ♢ Health hazards with the parts of the
MSDSs) provide important information that you body that may be affected (such as
will need to safely manage the chemical products eyes, skin, and respiratory system)
used in your ECE facility. ECE programs and staff ♢ Physical hazards
should use the SDSs for the products they use (for example: flammable)

u as sources of information about hazards; ♢ The name and address of the chemical
u to obtain advice on what safety precautions
to take when using the product. u Labels must be:

The SDS provides general information about the ♢ Readable and understandable
product. It does not help you with the specific ♢ In English
precautions you should take when the product is
♢ Prominently displayed
used in an ECE environment. However, the SDS
information enables you to develop a program to u Removing or defacing labels on incoming
protect your staff and the children in your containers of hazardous products is
program. A product’s SDS also provides prohibited.
information for others who may need
information about the product, such as
Information and training
emergency responders and poison control u Information and training on hazardous
centers. products must be provided

u You must obtain an SDS from your supplier ♢ when employees are hired;
or from the internet for each hazardous ♢ when new physical hazards or health
product used in your facility. hazards are introduced into the work
u SDSs for the hazardous chemicals must be area;
kept on site and readily accessible to
♢ annually.
employees when requested.
u The information provided must include the
Label requirements for containers of
regulatory requirements described above,
hazardous products
as well as the following:
u Original labels must be attached to ♢ The work areas where hazardous
containers of hazardous products when products are present
they are purchased.
♢ The location and availability of the
u Secondary containers are the containers you written Hazard Communication Program,
use when you take product out of an the list of hazardous chemicals, and SDSs
original container and put it into another
♢ An explanation of an employee’s “Right
container, such as a spray bottle. All
to Know” about the chemicals being used
secondary containers of hazardous products
in the workplace and their health and
must be labeled with the following
safety risks
♢ A plan of whom to contact and what to
do in an emergency involving a haz-
ardous product

Section 10: What is a Hazard Communication Program?

u The training on hazardous products must The Hazardous Materials Identification

include information about the following: System (HMIS®)
♢ How to detect the presence or release of
This labeling system provides “at-a-glance”
a hazardous chemical (such as visual
communication of information to employees on
appearance or odor).
the hazards of a product. The label identifies
♢ The possible physical or health hazards of
the materials used in the ECE program u general health, flammability, and physical
hazards using color-coded fields;
♢ How ECE staff can protect themselves
from product hazards, including work u recommendations for personal protective
practices, emergency procedures, and equipment that should be used when
personal protective equipment such as working with the product.
gloves or mask Using the HMIS label on all containers in your
♢ The information in the Hazard facility will help you to meet OSHA’s Hazard
Communication Program, including how Communication Standard. It is recommended that
employees can obtain and use hazard they be used on all containers, even if the
information manufacturer's label is still in place. Blank and
product specific preprinted HMIS labels can be
♢ How to understand and use SDSs
purchased online or may be available from the
♢ How containers should be labeled distributor who sold the product.
♢ What to do in case of a product spill or
Blue indicates health hazard, red indicates
contact with a hazardous product
flammability, yellow indicates instability (for
♢ How to dispose of unused hazardous example, is it flammable or explosive), and the
products and packaging white section provides special information (such
as what personal protective equipment to wear).
The HMIS also uses a numerical system from 0-4
to indicate the severity of the hazard.

Using the HMIS label on all containers in your facility will help you to meet OSHA’s Hazard Communication Standard.

Green Cleaning, Sanitizing, and Disinfecting: A Toolkit for Early Care and Education

Section 11: What is the most effective and safest way to clean body
fluids and blood spills in ECE?

➊ Secure area and notify staff and other


➋ Prepare to clean up:

u Bring prepared spill kit to spill site if
there is a BFS.
u Select a disinfectant that is registered by
the U.S. EPA to disinfect blood spills.
Look for this information on the label.
Select a cleaner for carpets and a
disinfectant for hard surfaces.

Unlike most other spills, blood, feces, and vomit u Put on personal protective equipment
require more careful cleaning methods. These (PPE) (gloves, eye protection, and mask).
spills can endanger your health. The following
guidelines are meant to ensure that body fluid
spills (BFSs) are cleaned in a manner that prevents
any possibility of future illness related to the spill.
(This protocol does not apply to diaper changing
areas where fecal contamination has occurred;
this is addressed in diaper changing protocols.)
This procedure is also part of the Centers for
Disease Control and Prevention’s “Standard
Precautions” for the prevention of the spread of
infectious disease. This means that you must treat
all blood and other potentially infectious material
as if it is contaminated by pathogens (germs).

Responding to Body Fluid Spills (BFSs) on ➌ Remove contaminated objects, spill, and
porous and nonporous surfaces spill waste
u Cover all spills with absorbent powder
This OSHA requirement applies anywhere
and/or disposable paper or cloth towels,
employees may be exposed to hazardous
use the kit dustpan to remove these
chemicals. In ECE, cleaners, sanitizers, and
disinfectants typically used by staff in their
routine work and in emergencies are potentially u Soak up any liquid absorbed into porous
hazardous to both staff using them and the surfaces (like carpeting) with disposable
children in the facility. Therefore, OSHA's Hazard rags. Then wash surface thoroughly and
Communication Standard (HCS) applies to all ECE rinse.
staff members who work with these products. u Use nonporous equipment such as a
dustpan or tongs (not hands or vacuum)
to pick up contaminated sharp items
such as needles and broken glass.

Section 11: What is the most effective and safest way to clean body fluids and blood spills in ECE

➍ Disinfect hard, non-porous surfaces What is a spill kit?

Apply disinfectant and leave the disinfectant A spill kit is used to clean and decontaminate
visibly wet on the surface for the required areas where blood spills have occurred.
dwell time. Having a spill kit prepared makes it less
u For horizontal surfaces, pour disinfectant stressful to clean up a spill. They are safe for
directly on to spill area. use by staff and include personal protective
equipment for users as well as special
u For vertical surfaces, spray the
cleaning/decontamination agents. They can
disinfectant onto a cloth and wipe on
be purchased or made. You will need the
following items:
➎ Dispose of spill waste
u Personal protective clothing that is
u Place all materials used in the cleaning disposable, including gloves, goggles,
process, including PPE, sharp objects, and an N95 mask. A paper gown
etc., in the bucket with a double-lined should be included to protect your
plastic bag. Dispose of this waste in the clothing from cross-contamination
dumpster. when there is a large spill.
➏ Follow-up u Paper towels and an absorbent material.
u Remove your contaminated clothing, Commercially available absorbent
double-bag it in 2 mil. bags, label, wash material for spill kits can be purchased.
separately in a washing machine in hot Cat litter or vermiculite can also be
water, and dry on high setting. used. They are relatively inexpensive
u Wash your hands and other areas of your and work well, although they are messy.
body that come into contact with the u Tongs and a dustpan
disinfectant or body fluid spill u An EPA-registered disinfectant
immediately after spill clean-up for at
u Plastic bags (red will help identify the
least 20 seconds with liquid soap under
contaminated contents)
hot running water.
u If soap and water are unavailable, use
waterless hand sanitizer right away, and
then wash hands as soon as possible. The
hand sanitizer will not work effectively in
the presence of blood.
u If you have had an unprotected
exposure, immediately contact your
program director or a physician.
Allow reentry to area of spill when:
♢ all materials are removed;
♢ area is clean, properly disinfected,
and dry.

Green Cleaning, Sanitizing, and Disinfecting: A Toolkit for Early Care and Education


acute effects: nearly immediate signs and wastewater treatment plants, rivers and streams
symptoms of illness as a result of exposure to or landfills. Unfortunately, the term
harmful agents. biodegradable is unregulated. As a result, most
acute toxicity: harmful health effects from a cleaning supply manufacturers state that their
single dose or exposure to a toxic chemical or product is biodegradable. It is important to
other toxic substance. assume that a product with the label is no better
without the label.
aerosol: a term that in common use refers to a
spray can that emits solid or liquid particles into biofilms: thin armored fortresses that microbes
the air. build to live, breed, and hide in. Biofilms form
when a “community” of germs (bacterial, fungal,
air freshener: products used to mask unpleasant
algal) attaches to a moist surface by secreting a
smells. They contain formaldehyde, phthalates,
slimy, glue-like substance.
and other chemicals harmful to health. They are
highly flammable, strong irritants to eyes, skin, body fluid spill (BFS): spill of bodily fluids such as
and throat. Solid freshners can cause death if vomit, blood, or feces as a result of an illness or
eaten by people or pets. injury. Special precautions need to be taken by
the ECE provider when cleaning a BFS.
ammonia: a general-purpose cleaner used on
many household surfaces including glass, bleach alternatives (usually referred to as
porcelain, and other areas meant to be streak- chlorine-free bleach): products that contain a
free. Ammonia-based products are also used for bleach alternative such as oxygen bleach or
cleaning ovens and soaking items to loosen hydrogen peroxide. Oxygen bleach and hydrogen
baked-on grime. Exposure to high concentrations peroxide are less hazardous than chlorine bleach.
of ammonia in ambient air or in an unventilated If a bleach product must be used, avoid chlorine
area can cause skin irritation, eye irritation, and bleach and use chlorine-free alternatives.
burning of the nose, throat, and lower airway. chronic toxicity: adverse health effects from
Ammonia can cause asthma. repeated doses of a toxic chemical or other toxic
antibiotic resistance: when many bacteria are no substance over a relatively prolonged period of
longer killed by the antibiotics that are usually time, generally greater than one year.
used to kill them. The bacteria are now cleaning: helps reduce the number of infectious
"resistant" to these antibiotics and continue to diseases that are passed around in an ECE
multiply even if you are taking antibiotics. This is program by removing and washing some germs
a major problem leading to the development of down the drain. This is a safer way to eliminate
more severe diseases, and in some cases death, germs when less hazardous cleaning agents are
when in the past the problem might have been used. Cleaning also removes dirt and organic
easy to cure. matter that can reduce the effectiveness of
antimicrobial pesticides: see disinfecting agents. sanitizers and disinfectants.

asthma: chronic inflammatory disorder of the corrosive: a chemical that causes visible
airways in the lungs that results in one or several destruction of, or irreversible alterations in, living
of the following signs/symptoms: wheezing, tissue by chemical action at the site of contact.
coughing, chest tightness, and/or trouble Chemicals can also be corrosive to inanimate
breathing. surfaces. For example, bleach is corrosive to
stainless steel.
bioaccumulate: when more of a chemical is
absorbed and stored by the body than is broken detergents: agents that remove soil and organic
down by or eliminated from the body. material from surfaces. This allows for a
disinfectant to reach and destroy germs within or
biodegradable: the ability of a product to break
beneath the dirt.
down in the environment once it enters

direct contact: when body fluids are directly also result in watery eyes, coughing, wheezing,
transferred from one person to another and nausea, skin irritation, and burning sensations in
result in spread of infectious disease. Examples of the eyes, nose, and throat.
direct contact are touching, kissing, and sex. An fragrance: any substance, either natural or man-
animal bite is also an example of the spread of made, which conveys an odor or scent. More than
germs by direct contact. 3,000 chemicals are used in fragrances.
disinfecting: a process needed if the surface or indoor air pollution/indoor air quality: the level
item must be free and clear of all visible and of pollution in and around the buildings and
microscopic organisms. Disinfecting a surface will structures that we live, work, and play in. Poor
“kill” up to 99.999% of microscopic organisms indoor air quality can lead to illness.
within 10 minutes, or as claimed on the label of a
infectious disease: diseases that are spread from
particular product.
one person (or animal) to another. Sometimes
disinfecting agents: products registered by the called communicable or contagious diseases.
Environmental Protection Agency (EPA) as These may be caused by virus, bacteria, fungus,
“antimicrobial pesticides” that are used to protozoa, or other microbes.
control, prevent, or destroy harmful
microfiber: very effective cleaning material made
microorganisms (bacteria, viruses, or fungi) on
of tiny wedge-shaped fibers that pick up and hold
inanimate objects and surfaces. Antimicrobial
much more dirt, dust, bacteria, and other
products include sanitizers, disinfectants, and
microbes than a traditional cotton-based cleaning
sterilants (which completely eliminate or destroy
all forms of microbial life, including spores). They
must be certified by the EPA before they can be nonporous surface: a smooth, solid surface
labeled a disinfectant. without pores or holes that limit penetration of
liquid below the immediate surface.
dwell time: the amount of time that a sanitizer or
disinfectant must be in contact with the surface, neurotoxin: toxic substances from chemicals,
and remain wet, in order to achieve the product’s microorganisms, plants, or animals that interfere
advertised kill rate. with the development and functioning of the
nervous system.
early care and education (ECE): an umbrella term
used for the different types of programs that parabens: a class of chemicals used extensively by
provide the education and care of children 0 - 5. both the cosmetic and pharmaceutical industries
as a preservative. Parabens can disrupt the
endocrine disrupting chemicals (EDCs):
hormone (endocrine) system and have been
compounds that in very small amounts cause
linked to breast cancer.
illnesses by interfering with or mimicking the
natural hormonal functions of the body. Many porous surface: untreated woods, fabrics, and
chemicals used in fragrances and fragranced other surfaces that allow absorption of liquids
cleaning supplies, pesticides, plastics, and through the top surface.
personal care products are EDCs. Exposure to personal protective equipment (PPE): clothing
EDCs not only poses a health risk during worn to protect workers from hazards such as
exposure, but also increases risk of developing chemicals and germs.
diseases later in life. They can be especially
phthalates: chemicals used to make plastics softer
harmful to the developing fetus.
and/or more flexible and more durable. Some are
formaldehyde: a colorless, flammable, strong- endocrine disruptors. For example, they have
smelling chemical that is used in building been found to mimic female hormones, resulting
materials and to produce many household in feminization of boys. They are found in air
products. Exposure to formaldehyde can lead to fresheners, in fragrances in cleaning, sanitizing,
cancer and decreased brain activity. Exposure may and disinfecting products, as well as in toys,


shower curtains, vinyl flooring, lubricants, also provides information on how to recognize
adhesives, laundry detergents, nail polish, hair symptoms of overexposure and what to do if such
spray, and shampoo. In many instances phthalates incidents occur.
are not identified on product labels. Exposure can sanitary: the conditions that protect the health of
occur through direct contact with products the people in a building, especially cleanliness
containing phthalates, through leaching of and reduced exposure to disease-causing germs.
phthalates into other products, or through
sanitize: to reduce to a safe level, but not totally
general environmental contamination. Phthalates
eliminate, microorganisms on a treated surface.
do not remain in the body long, but most people
have measurable levels of phthalates in their sensitizer: material that can cause severe skin
urine because we are exposed to them constantly. responses such as dermatitis and/or respiratory
responses such as asthma in a sensitized person
reproductive toxic chemical (toxicant): a chemical
after exposure to a very small amount of the
that causes damage to or disease in male or
material. Sensitization develops over time. When
female reproductive systems or organs, or that
a person is first exposed to a sensitizer, there may
harms unborn fetuses.
be no obvious reaction. However, future
respiratory irritant: any substance which can exposures can lead to increasingly severe
cause inflammation or other harmful reactions in reactions in sensitized individuals. Not all exposed
the respiratory system (lungs, nose, mouth, larynx persons will react to sensitizing materials.
and trachea). Examples of respiratory irritants
surfactant: chemical used in certain cleaning
include tobacco smoke, ozone, bleach and some
products that help to loosen dirt and grease from
other inhaled household cleaners, sanitizers and
surfaces so that they can be washed away. Some
are safer than others. See the Design for the
respiratory sensitizer: a substance that causes an Environment website for information on which
allergic reaction in the respiratory system. Once a surfactants are healthier for both you and the
person is “sensitized” to this substance, further environment.
exposure to even tiny amounts will produce
terpenes: chemicals found in pine, lemon, and
symptoms. Sensitization generally happens after
orange oils that are used in many cleaning and
several months or even years of breathing in the
disinfecting products as well as in fragrances.
sensitizer. Can cause symptoms ranging from
Terpenes vary in toxicity and can react with ozone
those that are like a mild cold or flu to severe
to produce a number of compounds, including
asthma symptoms including wheezing, chest
formaldehyde, which causes asthma and cancer.
tightness, shortness of breath, difficulty breathing
and/or coughing. third-party certified products: cleaning products
that have been reviewed by one of the following
routine disinfection: the elimination of 99.999%
of germs from hard surfaces on a regular basis, as
EcoLogoTM Green Seal™ Design for the
required by regulation. Environment
Safety Data Sheet (SDS): formerly called Material triclosan: an antibacterial chemical used in
Safety Data Sheet or MSDS. Contains information various soaps and household cleaners.
on the potential health effects of exposure to
volatile organic compounds (VOCs): hazardous
chemicals or dangerous substances. The SDS
chemicals that easily evaporate and get into the
contains information on how to safely use and
air. VOCs are released from cleaning products
manage a hazardous product, appropriate
such as aerosol sprays, liquid cleaners, dry
personal protective equipment to use, and
cleaners, solvents, glues, and adhesives.
emergency procedures to follow. The SDS

Green Cleaning, Sanitizing, and Disinfecting: A Toolkit for Early Care and Education


Resources by section EPA, “Health Effects of Ozone in the General

Section 1: What is infectious disease? population.html
Aronson, S. and Shope, T. (2013) “Managing Green Facts, "Effects of biocides on antibiotic
Infectious Diseases in Child Care and Schools: A resistance"
Quick Reference Guide,” American Academy of antibiotic-resistance/index.htm
Pediatrics, Third Edition.
OSHA-NIOSH Info Sheet: Protecting Workers Who
Healthy Child Care, “Preventing and Managing Use Cleaning Chemicals
Infectious Diseases in Early Education and Child
San Francisco Asthma Task Force, “2013 Update:
National Education Association, “The Stomach Bug Bleach-free Disinfection and Sanitizing
Book: What School Employees Need to Know” for Child Care”
http://www.neahin.orglassets/pdfs/stomach-bug-book.pdf showdocument.aspx?documentid=3822
Rotbart, H., (2008) “Germ Proof Your Kids: the Section 4: Effects of cleaning, sanitizing, and
Complete Guide to Protecting (without disinfecting products on the environment
Overprotecting) Your Family from Infections”
Beyond Pesticides, “The Ubiquitous Triclosan:
Washington, DC: ASM Press.
A common antibacterial agent exposed”
Section 2: Why is it important to clean in ECE?
Committee to Review and Assess the Health and %20cited.pdf
Productivity Benefits of Green Schools, National Section 5: What is the difference between
Research Council, (2006) “Green Schools: Attributes cleaning, sanitizing, and disinfecting and how do
for Health and Learning”
these tasks help control infectious disease in ECE?
Section 3: What are the health hazards of CDC, “How to Clean and Disinfect Schools to Help
cleaners, sanitizers, and disinfectants? Slow the Spread of Flu”
American Lung Association, “Cleaning Supplies and
Household Chemicals” CDC, “Environmental Cleaning and Disinfecting for
home/resources/cleaning-supplies.html MRSA”
American Lung Association, “ASTHMA – FRIENDLY Fight BAC,a website designed to teach children and
CHILD CARE: A Checklist for Parents and Providers” parents about bacteria and how to minimize contact midland-states/ with it. The site gives information to parents about
program-information/asthma/caare/indoor-air-quality- minimizing the growth of bacteria around the home
checklist.pdf by adopting smart practices during food prep.
California EPA/Air Resources Board (CARB), (2012)
“Air pollution and contaminants at child-care and Section 6: Personal practices for reducing the
preschool facilities in California”
spread of infectious disease in ECE
CDC, “Influenza (Flu) Fact Sheet: Respiratory
CARB, “Cleaning Products and Indoor Air Quality”
Hygiene/Cough Etiquette in Healthcare Settings"
CDC, "CDC Recommendations for the Amount of
Environmental Working Group, “Cleaning Supplies
Time Persons with Influenza-Like Illness Should be
and Your Health“
Away from Others"
California Work-Related Asthma Prevention
CDC, "Technical Report for State and Local Public
Program, (2012) “Cleaning products and work-
Health Officials and School Administrators on CDC
related asthma: Information for workers” available
Guidance for School (K-12) Responses to Influenza
also in Chinese and Spanish, online at
during the 2009-2010 School Year."
EPA, "Guide to Air Cleaners in the Home"


Section 7: Choosing safer products for cleaning, Sarantis, H, Naidenko OV, Gray S, et al, (2010) “Not
sanitizing, and disinfecting so sexy: The health risks of secret chemicals in
Design for the Environment – list of products fragrance.” Breast Cancer Fund, Commonweal and
available at: Environmental Working Group
EcoLogo – list of products available at: 2010.pdf
21#21 Section 9: What are the most effective and safest
ways of cleaning, sanitizing, and disinfecting in
Environmental Working Group – information on
what’s in specific cleaning products. Available at: Alabama Department of Health Cleaning Procedures
GoodGuide’s Household Chemicals Guide American Academy of Pediatrics, American Public
_id=176856-household chemicals&sort_order=DESC Health Association, National Resource Center for
Health and Safety in Child Care and Early Education.
Grassroots Environmental Education –
2011. Caring for our children: National health and
The ChildSafe Cleaning Product List.
safety performance standards; Guidelines for early
care and education programs, 3rd edition. Elk Grove
GREENGUARD Product Guide Village, IL: American Academy of Pediatrics; Washington, DC: American Public Health
Green Seal - list of products available at: Association. Also available at • Appendix J. Selecting an Appropriate Sanitizer
Rose, L, Westinghouse, C, and the National Cleaning or Disinfectant -
for Healthy Schools and Infection Control
Workgroup, (2010) “Cleaning for healthy schools • Appendix K. Guide for Cleaning Sanitizing and
and infection control handbook” Disinfecting Color/CFOC3_K.pdf
• Appendix L. Cleaning Up Body Fluids –
San Francisco Approved List: Products that meet San
Francisco's Health and Environmental Requirements
CDC, “Seasonal Flu Information for Schools &
Childcare Providers”
Transpare, an easy to use web-based tool that allows
you to compare institutional cleaning products
Hennepin County Human Services and Public Health
based on their environmental, health, and safety
Department, “Cleaning, Sanitizing, and
characteristics. Transpare allows purchasers to see
what makes a product green and how green it is
and to find products that meet their facility
occupants’ specific needs. It complements the
existing third party certification process by providing The National Food Service Management Institute
a way to further compare green products based on (NFSMI), “Hazard Analysis Critical Control Point –
credible and verified data.. Based Standard Operating Procedures”
Women’s Voices for the Earth – Information on what
is in specific cleaning products and recipes for Section 10: What is a Hazard Communication
making less-toxic cleaners Program?
OSHA, “Fact Sheet: December 1st, 2013 Training
Requirements for the Revised Hazard
Section 8: Clean isn’t a smell! Communication Standard”
Potera, C. “Scented Products Emit a Bouquet of
VOCs,” Environmental Health Perspectives OSHA, “Brief: Hazard Communication Standard: Labels and Pictograms”


OSHA, “Quick Card: Hazard Communication Safety EPA, “What Are Antimicrobial Pesticides?”
Data Sheets” EcoLogo
EPA Design for the Environment
Section 11: What is the most effective and safest
way to clean body fluids and blood spills in ECE? Green Seal

OSHA, “Fact Sheet: OSHA's Bloodborne Pathogens Green Facts: Facts on Health and the Environment
Standard” GREENGUARD's certification program helps
factOl.pdf manufacturers create – and helps buyers identify –
State of California Health and Human Services interior products and materials that have low
Agency, Department of Social Services, Community chemical emissions, improving the quality of the air
Care Licensing, “INFORMATION RELEASE NO. 2009- in which the products are used. GREENGUARD Gold
03: STANDARD PRECAUTIONS” Certification (formerly known as GREENGUARD Children & Schools Certification) offers even stricter
certification criteria for low-emitting building
materials, furniture, finishes, cleaning products,
General resources electronics and consumer products used in
Ashkin, S., “The Science Behind Green Cleaning” environments where children and other sensitive populations spend extended periods of time.
Boise, P. “Go Green Rating Scale for Early Childhood CertificationPrograms_childrenSchools.aspx
Settings Handbook” and “Go Green Rating Scale for Healthy Schools Campaign
Early Childhood Settings,” St. Paul, MN: Redleaf
ISSA—The Worldwide Cleaning Industry Association:
Press. The Go Green Rating Scale Handbook explains
Green Cleaning
the science and research behind each item in the
This site offers a wealth of information on green
rating scale and provides support to help you make
the proper changes to create and maintain an
environmentally healthy and safe ECE setting. SF Asthma Task Force, “Bleach Free Child Care”

Canadian Partnership for Children’s Health and SF Asthma Task Force, “California Child Care
Environment, (2005) “Child Health and the Licensing Regulations for Sanitizing and
Environment – A Primer” Disinfecting” ent.aspx7documentid=2077 SF Asthma Task Force, “Child Care Center Toolkit,
CDC's app, Solve the Outbreak, is an engaging, fun English”
way to learn about diseases and outbreaks, see how aspx7documentlD=3823
disease detectives save lives around the world, and SF Asthma Task Force: Family Child Care Toolkit,
lets you try your hand at solving an outbreak. Trilingual ShowDocument.aspx7documentlD=3826
Children’s Environmental Health Network/Eco Tools for Schools Ventilation Checklist
Healthy Child Care
Council on Environmental Health, “Chemical- The Toxics Use Reduction Institute's Retail Cleaning
Management Policy: Prioritizing Children's Health” Product Testing & Evaluations http://www.greencleaning
127/5/ 983.full.html
Environmental Working Group, “Safe Cleaning Tips
for Your Home”

Green Cleaning, Sanitizing, and Disinfecting: A Toolkit for Early Care and Education

Appendix A

Model Green Cleaning, Sanitizing, and related to building contaminants and cleaning
Disinfection Policy for ECE programs products. The components of this policy includes
the following:

Program Name____________________________Date_____ u Provide parents, staff, and outside cleaning

contractors with:
Chemicals that are commonly used for cleaning,
1. a list of approved cleaning, sanitizing,
sanitizing, and disinfecting and maintaining
and disinfecting products and work
buildings can affect human health as well as the
practice procedures to be used in the
environment. Many such products contain
ingredients that may
2. procedures for safe and appropriate
u result in eye, skin or respiratory irritation
product dilution (if concentrates are
and chemical burns;
u cause or trigger asthma;
3. techniques to mitigate hazards (e.g.
u cause cancer, or harm a fetus in the womb; ventilation, dilution station, etc.).
u be endocrine disruptors; u Provide parents and staff with print and
u affect the developing brain and nervous online resources on green cleaning,
system. sanitizing, and disinfecting.
Children are more vulnerable than adults to the u Designate a Green Cleaning Coordinator for
health effects from exposure to hazardous our facility who will be trained in green
chemicals for several reasons. They take in more cleaning, sanitizing, and disinfecting policies
food, water, and air for their weight and size and practices and the prevention of
than adults. Their behaviors also put them at risk: infectious disease, and will act as a resource
mouthing objects and crawling on the floor may to our staff and families.
bring them into closer contact with toxic u Train employees to properly and safety use
chemicals. Their bodies are also less able to chemicals when they are hired and annually
process and get rid of toxics. thereafter, or sooner if new products are
Exposure to these chemicals also has serious introduced in the facility.
public health impacts for ECE staff and building u Review the facility periodically using the
occupants. Custodial workers experience one of Green Cleaning, Sanitizing, and Disinfecting
the highest rates of occupational asthma, twice Checklist.
the rate of other workers.
u Post warning signs in areas where cleaning
Policy products are locked and stored out of reach
of children.
Center name _____________________________________

will purchase less hazardous cleaning, sanitizing, u Ventilate the area as much as possible while
and disinfecting products and devices in order to cleaning to minimize exposure.
improve indoor air quality, enhance and protect u Provide personal protective equipment for
human and environmental health, foster a more our employees to use when it is necessary.
productive learning environment, and reduce u Keep records. Safety Data Sheets or a list of
liability. products and when and how they were used
Additionally, we will implement and practice must be kept for 30 years as required by the
green cleaning, sanitizing, and disinfecting Hazard Communication Program. Training
procedures to manage and clean our ECE facility records must also be kept. (See Section 10:
and to minimize exposure to toxic chemicals What is a Hazard Communication Program?)

Appendices: Appendix A: Model Green Cleaning, Sanitizing, and Disinfection Policy for ECE Programs

u Label cleaning products. Secondary 1. Follow the Caring for Our Children: National
containers of diluted cleaning products Health and Safety Performance Standards’
without the original label must be labeled Appendix K Schedule for Cleaning,
according to requirements of the OSHA Sanitizing, and Disinfecting listed in
Hazard Communication Standard. (See Appendix D of the Green Cleaning,
Section 10: What is a Hazard Sanitizing, and Disinfecting Toolkit for ECE.
Communication Program?)
2. Train providers in our facility in accordance
u Develop a procedure for the use of cleaning with the curriculum contained in the Green
cloths. Whenever possible, we will use Cleaning, Sanitizing, and Disinfecting
microfiber. When we use microfiber, we will Toolkit for ECE.
color code the cloths and mops to minimize
transferring germs from one part of the 3. Schedule periodic inspections of our facility
facility to another. using the Green Cleaning, Sanitizing, and
Disinfecting Checklist.
u Avoid known hazardous chemicals when
purchasing cleaning products. We will seek 4. Consult the U.S. Centers for Disease Control
to purchase products certified by a third- and Prevention website for instructions on
party, for example, those certified by Green implementing additional preventive actions
Seal, EcoLogo, and Design for the to reduce infectious disease if an outbreak
Environment. If these are not available, we of a serious infectious disease occurs.
will avoid products that
5. Purchase least-hazardous sanitizers,
♢ are aerosols;
disinfectants, and hand hygiene products as
♢ contain the chemicals listed on page 29. described in Section 7 of the Green
Cleaning, Sanitizing, and Disinfecting
Infectious diseases
Toolkit Curriculum.
There are many things to consider when working
to reduce the transmission of infectious disease in
child care settings. Children in ECE are at higher
risk for infectious diseases because they have
immature personal hygiene habits and they
commonly engage in hand-to-mouth activities.
Their immune systems are less developed, so they
are more susceptible to becoming sick when
exposed to disease. This policy strives to prevent
the transmission of disease through the use of the
least hazardous means possible.

To minimize exposure to infectious disease and

hazardous cleaning, sanitizing, and disinfecting
products, it is our policy that we will:

Green Cleaning, Sanitizing, and Disinfecting: A Toolkit for Early Care and Education

Appendix B

Tips on Forming a Buying Cooperative u other products, like food and cleaning
services, can be added to the cooperative
Many of the newer and less harmful cleaning, buying program, extending the cost
sanitizing, and disinfecting products on the savings.
market are only available through distributors.
Distributors buy in quantity from several Forming a buying cooperative
manufacturers and warehouse the goods for sale.
u Before making plans to organize your own
School districts and large institutions purchase
purchasing cooperative, find out if any
their products through distributors because they
other cooperatives are available to you.
can buy in volume and it costs less. Small ECE
Speak to the school district in your area.
programs can also purchase products and
Can you join with it to make purchases?
equipment from distributors by forming buying
cooperatives. u Find other ECE programs who are
interested in forming a cooperative.
Buying cooperatives are formed when groups join
together with others for joint purchasing. A u Contact the National Cooperative Business
cooperative, or co-op, buys and sells products or Association (NCBA). NCBA helps develop
services like any other business. The difference is cooperative businesses across the United
a co-op is owned and governed by its members, States through partnerships with
the people who use it. They get access to better CooperationWorks! – a network of rural
products and cheaper prices. Buying cooperatives co-op development centers – and the Urban
are especially helpful for ECE programs in rural Cooperative Development Initiative.
areas, where costs can be higher, than in urban Resources:
areas where there is more competition among USDA, A Guide for the Development of
retailers, and delivery costs are lower. Other Purchasing Cooperatives
benefits of forming a buying cooperative and
purchasing from a distributor are:
National Cooperative Business Association
u you often get access to a better selection of (NCBA)
better quality, safer products, including
newer products that may not be available
at local retail stores;
u dilution stations are often provided for free
when enough of a product is purchased;
u Safety Data Sheets and pre-printed labels
for secondary containers, required for your
Hazard Communication Program, are
u distributors often provide better service on
delivery and exchanges;
u buying cooperative members can share
experiences with products and provide
advice to each other;

Green Cleaning, Sanitizing, and Disinfecting: A Toolkit for Early Care and Education

Appendix C

How to Hire a Cleaning Service 5. Ensure that disinfectants used by the CS are
• registered with the EPA as a hard-surface
A cleaning service (CS) should clean, sanitize, and
hospital-grade disinfectant and preferably
disinfect your ECE environment in a safe, effective
approved by the EPA’s Design for the
manner, using third-party certified, least
Environment Antimicrobial Pesticide Pilot
hazardous cleaning, sanitizing, and disinfecting
Project. The EPA is the only agency that can
products. A CS must purchase the right products,
legally identify disinfecting products that
but they must also know how, where, and when
are safer for human health and the
to use them. A knowledgeable CS can also help
you create your own green cleaning program.
Here are some guidelines that will help you select 6. Confirm the CS uses a two-step process
a CS: (cleaning, then sanitizing or disinfecting)

1. Identify a CS with ECE facility experience. • Make sure the CS understands which areas
require sanitizing vs. disinfection, and
• Ask other ECE providers for the names of
when permission is required for use of
CSs that are familiar with cleaning,
more hazardous chemicals (i.e. application
sanitizing, and disinfecting products and
of cleaning materials that run a risk of
practices that protect human health and
inhalation hazard).
the environment
7. Does the service provide training to its
• Ask applicant CSs if they have experience
employees? If so, does it cover:
working in ECE; do they know the state
child care licensing regulations; and are • Hazard Communications;
they registered and insured? • proper use of products;
2. Ask the CSs if they are certified. • bloodborne pathogens?
• Are they a certified green CS; if so, by 8. Some ways to know your CS is not using a
whom, and what is the certification green cleaning program. The cleaning service
• uses products such as Pine-SolTM,
3. Ask what products they use. aerosolized cleaners, scented products, and
• Are they using cleaning products that are bleach;
certified by Green Seal, EcoLogo, or Design • does not use microfiber cloths and mops or
for the Environment to be free from a split-bucket system;
carcinogens, reproductive toxins,
• does not ventilate areas during and after
neurotoxins, fragrances, and other
ingredients which can cause health
problems? • uses the same cleaning equipment in
multiple areas without cleaning or
4. Find out what equipment they use.
switching out heads/cloths/etc.
• Are they using “greener” equipment such
• does not include recommendations for
as HEPA or high-filtration vacuums, buffers
safer, green-certified cleaning supplies.
and burnishers with a vacuum attachment,
and color-coded microfiber cloths and

Green Cleaning, Sanitizing, and Disinfecting: A Toolkit for Early Care and Education

Appendix D

What, Where and How Often to Clean, Sanitize, and Disinfect in ECE

Areas Before Each Use After Each Use Daily At the End of the Day Weekly Monthly Comments

Food Clean, Clean, Use a sanitizer safe for
preparation Sanitize Sanitize food contact

Eating Clean, If washing the dishes and

utensils & dishes Sanitize utensils by hand,
use a sanitizer safe for
food contact as the
final step in the process;
Use of an
automated dishwasher
will sanitize

Tables & Clean, Clean,

high chair trays Sanitize Sanitize
Countertops Clean Clean, Sanitize Use a sanitizer safe for
food contact
Food Clean Clean, Sanitize

Mixed-use tables Clean, Sanitize Before serving food

Refrigerator Clean
Plastic Clean Clean, Sanitize
mouthed toys
Pacifiers Clean Clean, Sanitize Reserve for use by only
1 child; use dishwasher
or boil for one minute

Hats Clean Clean after each

use if head lice are present

Door & Clean, Disinfect

cabinet handles

Floors Clean Sweep or vacuum, then

damp mop, (consider
microfiber damp mop to
pick up most particles)

Machine-washable Clean Launder

cloth toys

Dress-up clothes Clean Launder

Play activity Clean

Drinking Clean, Disinfect


Appendices: Appendix D: What, Where and How Often to Clean, Sanitize, and Disinfect in ECE

Areas Before Each Use After Each Use Daily At the End of the Day Weekly Monthly Comments


Computer Clean, Use sanitizing
keyboards Sanitize wipes, do not use

Phone Clean
Changing Clean, Disinfect Clean with
tables detergent, rinse,

Potty chairs Clean, Disinfect

Handwashing Clean, Disinfect

sinks & faucets

Countertops Clean, Disinfect

Toilets Clean, Disinfect

Diaper pails Clean, Disinfect

Floors Clean, Disinfect Damp mop with a

floor cleaner/
Bed sheets & Clean Clean before use
pillow cases by another child

Cribs, cots, Clean Clean before use

& mats by another child

Blankets Clean

Source: American Academy of Pediatrics, American Public Health Association, National Resource Center for Health and Safety in
Child Care and Early Education. 2011. Caring for our children: National health and safety performance standards; Guidelines for
early care and education programs, Appendix K. 3rd edition. Elk Grove Village, IL: American Academy of Pediatrics; Washington,
DC: American Public Health Association. Also available at

Green Cleaning, Sanitizing, and Disinfecting: A Toolkit for Early Care and Education

Appendix E

Model Center Hazardous Communication employees. If an SDS is incomplete, a new SDS will
Program Policy be requested from the manufacturer/supplier by
General Information Name

In order to comply with OSHA 1910.1200, Hazard SDSs shall be available to each employee during
Communication Standard, the following written his/her work shift. To obtain a copy of the SDS,
Hazard Communication Program has been request one from the Director.
established for ____________________________
Name of ECE Program 3. Employee Training and Information
The written program will be available at the ____________________________________________
Director’s office for review by any interested
employee. is responsible for the employee training program.
S/he will ensure that all elements specified below
1. Container Labeling
are carried out.
Name Prior to starting work, each new employee will
shall verify that all incoming containers received attend a health and safety orientation and will
for use are clearly labeled to indicate: receive information and training on the
• the identity of the contents (the identity
must match the corresponding Safety Data a. An overview of the requirements
Sheet); contained in the OSHA Hazard
Communication Standard, 1910.1200
• appropriate hazard warnings (including
routes of entry and target organs); b. Any operations in their work area where
hazardous chemicals are present
• the name and address of the manufacturer,
importer, or responsible party. c. Location and availability of our written
hazard program
The supervisor of each area will ensure that all
secondary containers (those containers other than d. Physical and health hazards of the
the original) will be labeled with: chemicals in their work area

1. the identity of the contents (the identity e. Methods and observation techniques used
must match the corresponding SDS); to determine the presence or release of
toxic and hazardous substances in the
2. appropriate hazard warnings (including
work area
routes of entry and target organs).
f. Measures employees can take to protect
2. Safety Data Sheets (SDSs) themselves from hazards in their
The Director will be responsible for obtaining and workplace, including specific procedures
maintaining Safety Data Sheets for the facility. It the employer has implemented to prevent
is the policy for this facility that when toxic or exposure to hazardous chemicals, such as
hazardous substances are received without an appropriate work practices, emergency
SDS, or the appropriate SDS is not on file, the procedures, and personal protective
chemical will not be accepted until such equipment
information is available. g. Explanation of the labeling system and
____________________________________________ what the label information means,
h. Explanation of SDSs and how employees
will review incoming SDSs for new and significant
can use this information to protect
health/safety information. They will see that any
new information is passed on to the affected
Appendices: Appendix E: Model Center Hazardous Communication Program Policy

Prior to a new chemical hazard being introduced Non-routine tasks performed by the employees of
into any section of this facility, each employee in this program are:
that section will be given information as outlined Task_____________________________________________
above. __________________________________________________
4. List of Hazardous Chemicals
The following is a list of all known toxic and
Toxic/Hazardous Substances________________________
hazardous substances used at the Center.
Further information on each listed substance
can be obtained by reviewing the appropriate
Safety Data Sheets.
Identity of Chemical_________________________________ If employees do not understand any aspect of the
____________________________________________________ above information, they should not perform the
____________________________________________________ task. The supervisor should be contacted for
____________________________________________________ additional training.
Toxic/Hazardous Substances__________________________ 6. Informing Contractors
It is the responsibility of the Director to provide
contractors with the following information:
• Notify contractors of the toxic and
Work Area and Process_______________________________
hazardous substances to which they may be
exposed while on the job site and how the
appropriate SDS can be obtained
• Precautionary measures that need to be
5. Hazardous Non-Routine Tasks taken to protect contracted employees
Periodically, employees are required to perform during the workplace's normal operating
hazardous non-routine tasks. Prior to starting conditions and in foreseeable emergencies
work on such projects, each affected employee • Explanation of labeling systems used
will be given information by their supervisor
The Director will also be responsible for
about hazardous chemicals to which they may be
contacting each contractor before work is started
exposed during such activity. This information will
in the facility to gather and disseminate any
information concerning chemical hazards that the
• specific hazards; contractor is bringing to our workplace.
• protective/safety measures the employee If anyone has questions or does not understand
can take; this plan, contact the Director. The Center’s
• measures the program has taken to lessen Hazard Communication Program will be
the hazards including ventilation, monitored by the Director to ensure that the
respirators, presence of another employee, policies are carried out and the plan is effective.
and emergency procedures.



Suggested Citation: UCSF Institute for Health & Aging, UC Berkeley Center for Environmental Research and Children's
Health, Informed Green Solutions, and California Department of Pesticide Regulation. Green Cleaning, Sanitizing, and
Disinfecting: A Toolkit for Early Care and Education, University of California, San Francisco School of Nursing:
San Francisco, California, 2013.
Reproduction Information: These materials can be reproduced for non-commercial educational purposes. To request
permission to copy this Toolkit in bulk, contact Vickie Leonard at
Funding for this project has been provided in full or in part through a grant awarded by the California Department of
Pesticide Regulation (DPR). The contents of this document do not necessarily reflect the views and policies of DPR, nor
does mention of trade names or commercial products constitute endorsement or recommendation for use.
©2013 UCSF Institute for Health & Aging
The creators of the Green Cleaning Toolkit include health care providers, childcare professionals, and public
health professionals.