[Code of Federal Regulations]
[Title 45, Volume 4]
[Revised as of October 1, 2004]
From the U.S. Government Printing Office via GPO Access
[CITE: 45CFR1304.22]

[Page 125-127]
 
                        TITLE 45--PUBLIC WELFARE
 
CHAPTER XIII--OFFICE OF HUMAN DEVELOPMENT SERVICES, DEPARTMENT OF HEALTH 
                           AND HUMAN SERVICES
 
PART 1304_PROGRAM PERFORMANCE STANDARDS FOR THE OPERATION OF HEAD START 
PROGRAMS BY GRANTEE AND DELEGATE AGENCIES--Table of Contents
 
        Subpart B_Early Childhood Development and Health Services
 
Sec. 1304.22  Child health and safety.

    (a) Health emergency procedures. Grantee and delegate agencies 
operating center-based programs must establish and implement policies 
and procedures to respond to medical and dental health emergencies with 
which all staff are familiar and trained. At a minimum, these policies 
and procedures must include:
    (1) Posted policies and plans of action for emergencies that require 
rapid response on the part of staff (e.g., a child choking) or immediate 
medical or dental attention;

[[Page 126]]

    (2) Posted locations and telephone numbers of emergency response 
systems. Up-to-date family contact information and authorization for 
emergency care for each child must be readily available;
    (3) Posted emergency evacuation routes and other safety procedures 
for emergencies (e.g., fire or weather-related) which are practiced 
regularly (see 45 CFR 1304.53 for additional information);
    (4) Methods of notifying parents in the event of an emergency 
involving their child; and
    (5) Established methods for handling cases of suspected or known 
child abuse and neglect that are in compliance with applicable Federal, 
State, or Tribal laws.
    (b) Conditions of short-term exclusion and admittance. (1) Grantee 
and delegate agencies must temporarily exclude a child with a short-term 
injury or an acute or short-term contagious illness, that cannot be 
readily accommodated, from program participation in center-based 
activities or group experiences, but only for that generally short-term 
period when keeping the child in care poses a significant risk to the 
health or safety of the child or anyone in contact with the child.
    (2) Grantee and delegate agencies must not deny program admission to 
any child, nor exclude any enrolled child from program participation for 
a long-term period, solely on the basis of his or her health care needs 
or medication requirements unless keeping the child in care poses a 
significant risk to the health or safety of the child or anyone in 
contact with the child and the risk cannot be eliminated or reduced to 
an acceptable level through reasonable modifications in the grantee or 
delegate agency's policies, practices or procedures or by providing 
appropriate auxiliary aids which would enable the child to participate 
without fundamentally altering the nature of the program.
    (3) Grantee and delegate agencies must request that parents inform 
them of any health or safety needs of the child that the program may be 
required to address. Programs must share information, as necessary, with 
appropriate staff regarding accommodations needed in accordance with the 
program's confidentiality policy.
    (c) Medication administration. Grantee and delegate agencies must 
establish and maintain written procedures regarding the administration, 
handling, and storage of medication for every child. Grantee and 
delegate agencies may modify these procedures as necessary to satisfy 
State or Tribal laws, but only where such laws are consistent with 
Federal laws. The procedures must include:
    (1) Labeling and storing, under lock and key, and refrigerating, if 
necessary, all medications, including those required for staff and 
volunteers;
    (2) Designating a trained staff member(s) or school nurse to 
administer, handle and store child medications;
    (3) Obtaining physicians' instructions and written parent or 
guardian authorizations for all medications administered by staff;
    (4) Maintaining an individual record of all medications dispensed, 
and reviewing the record regularly with the child's parents;
    (5) Recording changes in a child's behavior that have implications 
for drug dosage or type, and assisting parents in communicating with 
their physician regarding the effect of the medication on the child; and
    (6) Ensuring that appropriate staff members can demonstrate proper 
techniques for administering, handling, and storing medication, 
including the use of any necessary equipment to administer medication.
    (d) Injury prevention. Grantee and delegate agencies must:
    (1) Ensure that staff and volunteers can demonstrate safety 
practices; and
    (2) Foster safety awareness among children and parents by 
incorporating it into child and parent activities.
    (e) Hygiene. (1) Staff, volunteers, and children must wash their 
hands with soap and running water at least at the following times:
    (i) After diapering or toilet use;
    (ii) Before food preparation, handling, consumption, or any other 
food-related activity (e.g., setting the table);
    (iii) Whenever hands are contaminated with blood or other bodily 
fluids; and

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    (iv) After handling pets or other animals.
    (2) Staff and volunteers must also wash their hands with soap and 
running water:
    (i) Before and after giving medications;
    (ii) Before and after treating or bandaging a wound (nonporous 
gloves should be worn if there is contact with blood or blood-containing 
body fluids); and
    (iii) After assisting a child with toilet use.
    (3) Nonporous (e.g., latex) gloves must be worn by staff when they 
are in contact with spills of blood or other visibly bloody bodily 
fluids.
    (4) Spills of bodily fluids (e.g., urine, feces, blood, saliva, 
nasal discharge, eye discharge or any fluid discharge) must be cleaned 
and disinfected immediately in keeping with professionally established 
guidelines (e.g., standards of the Occupational Safety Health 
Administration, U.S. Department of Labor). Any tools and equipment used 
to clean spills of bodily fluids must be cleaned and disinfected 
immediately. Other blood-contaminated materials must be disposed of in a 
plastic bag with a secure tie.
    (5) Grantee and delegate agencies must adopt sanitation and hygiene 
procedures for diapering that adequately protect the health and safety 
of children served by the program and staff. Grantee and delegate 
agencies must ensure that staff properly conduct these procedures.
    (6) Potties that are utilized in a center-based program must be 
emptied into the toilet and cleaned and disinfected after each use in a 
utility sink used for this purpose.
    (7) Grantee and delegate agencies operating programs for infants and 
toddlers must space cribs and cots at least three feet apart to avoid 
spreading contagious illness and to allow for easy access to each child.
    (f) First aid kits. (1) Readily available, well-supplied first aid 
kits appropriate for the ages served and the program size must be 
maintained at each facility and available on outings away from the site. 
Each kit must be accessible to staff members at all times, but must be 
kept out of the reach of children.
    (2) First aid kits must be restocked after use, and an inventory 
must be conducted at regular intervals.

(The information collection requirements are approved by the Office of 
Management and Budget (OMB) under OMB Control Number 0970-0148 for 
paragraph (c).)

[61 FR 57210, Nov. 5, 1996, as amended at 63 FR 2313, Jan. 15, 1998]