Caring for Our Childen, 3rd Edition (CFOC3)

Chapter 3: Health Promotion and Protection

3.2 Hygiene

3.2.1 Diapering and Changing Soiled Clothing

3.2.1.1: Type of Diapers Worn

Frequently Asked Questions/CFOC3 Clarifications

Reference: 3.2.1.1

Date: 10/13/2011

Topic & Location:
Chapter 3
Health Promotion
Standard 3.2.1.1: Type of Diapers Worn

Question:
Does this standard allow for use of the newer cloth diapers (with either a removable or connected absorbent inner liner and waterproof Velcro closure cover)? 

Answer:
Yes, (for children who require cloth diapers for a medical reason), but only if the cloth diaper and cover are removed simultaneously as one unit and not removed as two separate pieces (see page 105). Please review the Comments section of this Standard for more information.

Content in the STANDARD was modified on 8/9/2017.


Facilities should adhere to the procedures outlined in 3.2.1.2: Handling Cloth Diapers and 3.2.1.4: Diaper Changing Procedure to prevent and control infections caused by fecal contact:
 
Diapers worn by children should be able to contain urine and stool and minimize exposure to human waste in the child care setting. Children should use disposable diapers with absorbent material (e.g., polymers) or cloth diapers. Cloth diapers should have an absorbent inner layer that is completely covered with an outer waterproof layer that has a waist closure (i.e., not pull-on waterproof pants). The cloth diaper and waterproof later should be changed at the same time (1). Whichever diapering system is used in the facility, clothes should be worn over diapers while the child is in the facility.

No rinsing or dumping of the contents of cloth diapers should be performed at the child care facility. Soiled cloth diapers should be stored in a labeled container with a tight-fitting lid provided by an accredited commercial diaper service, or in a sealed plastic bag for removal from the facility by an individual child’s family, stored in a location inaccessible to children, and given directly to the parent/guardian daily upon discharge of the child. Children of all ages who are incontinent of urine or stool should wear a barrier method, such as a disposable diaper or a cloth diaper that is completely covered with an outer waterproof layer and a waist closure.

While single unit reusable diaper systems, with an inner cloth lining attached to an outer waterproof covering, and reusable cloth diapers, worn with a front closure waterproof cover, meet the physical criteria of this standard (if used as described), they have not been evaluated for their ability to reduce fecal contamination, or for their association with diaper dermatitis (rash). Moreover, it has not been demonstrated that the waterproof covering materials remain waterproof with repeated cleaning and disinfecting. Therefore, single-use disposable diapers should be encouraged for use in child care facilities.


RATIONALE

Procedures that reduce fecal contamination help control the spread of disease. Fecal contamination has been associated with increased diarrheal rates in child care facilities (1). Gastrointestinal tract disease, or diarrhea (caused by bacteria, viruses, and parasites) and hepatitis A virus infection are spread from infected persons through fecal contamination of hands and objects. Protective procedures includes minimal handling of soiled diapers and clothing, thorough hand hygiene, and containment of fecal matter.  Fecal contamination in child care settings may be reduced when single-use, disposable diapers are used compared to cloth diapers worn with pull-on waterproof pants (3). When clothes are worn over either disposable or cloth diapers with pull-on waterproof pants, there is a reduction in contamination of the environment (1, 3).

Diaper Rash
Diaper dermatitis (rash) occurs frequently in diapered children. Diapering practices that reduce the frequency and severity of diaper dermatitis will require less application of skin creams and ointments, thereby decreasing the likelihood for fecal contamination of caregivers/teachers’ hands. Most common diaper dermatitis is caused by prolonged contact of the skin with urine, feces, or both (1). The action of fecal digestive enzymes on urinary urea and the resulting production of ammonia make the diapered area more alkaline, which has been shown to damage skin (1). Damaged skin is more susceptible to other biological, chemical, and physical insults that can cause or aggravate diaper dermatitis (1). Frequency and severity of diaper dermatitis are lower when diapers are changed more often, regardless of the diaper used (1). The use of disposable diapers with absorbent material has been associated with less frequent and less severe diaper dermatitis in some children than with the use of cloth diapers and pull-on pants made of a waterproof material (2, 3).

COMMENTS
Reusable cloth diapers worn either without a covering or with pull-on waterproof pants do not meet the physical requirements of the standard.
TYPE OF FACILITY
Center, Large Family Child Care Home
RELATED STANDARDS
3.2.1.2 Handling Cloth Diapers
3.2.1.4 Diaper Changing Procedure
3.2.1.5 Procedure for Changing Children’s Soiled Underwear/Pull-Ups and Clothing
3.2.2.1 Situations that Require Hand Hygiene
3.2.2.2 Handwashing Procedure
3.2.2.3 Assisting Children with Hand Hygiene
3.2.2.4 Training and Monitoring for Hand Hygiene
3.2.2.5 Hand Sanitizers
5.2.7.4 Containment of Soiled Diapers
5.4.1.10 Handwashing Sinks
REFERENCES
  1. American Academy of Pediatrics. Infections Spread by the Fecal-Oral Route In: Kimberlin DW, Brady MT, Jackson MA, Long SS, eds. Red Book: 2018 Report of the Committee on Infectious Diseases. 31st Edition. Itasca, IL:  American Academy of Pediatrics; 2018: 143
  2. American Academy of Pediatrics. Healthychildren.org. 2015. Diaper rash. https://www.healthychildren.org/English/ages-stages/baby/diapers-clothing/Pages/Diaper-Rash.aspx
  3. Counts, J.L., Helmes, C.T., Kenneally, D., Otts, D.R. Modern disposable diaper constructions: Innovations in performance help maintain healthy diapered skin. 2014. Clinical Pediatrics. 53(9S):10S-13S. 
NOTES

Content in the STANDARD was modified on 8/9/2017.