[Code of Federal Regulations]

[Title 45, Volume 4]

[Revised as of October 1, 2005]

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



[[Page 127]]



    (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]