Responding to Crypto Outbreaks at Childcare Facilities

Intensified Cryptosporidiosis (Crypto) Control Measures for the Childcare Setting

Cryptosporidium is resistant to chlorine disinfection so it is tougher to kill than most disease-causing germs. The usual disinfectants, including most commonly used bleach solutions, have little effect on the parasite. An application of hydrogen peroxide seems to work best.

If an outbreak of Crypto occurs in the childcare setting:

  • Educate staff and parents
    • Inform all staff about the ongoing outbreak, the symptoms of Crypto, how infection is spread, and control measures to be followed.
    • Inform parents about the ongoing outbreak, the symptoms of Crypto, how infection is spread, outbreak control policies, and needed changes in hygiene and cleanliness.
    • Notify parents of children who have been in direct contact with a child or an adult caregiver with diarrhea. Parents should contact the child’s healthcare provider if their child develops diarrhea.
    • Inform staff and parents of children about Crypto’s potential to be a severe disease in people with weakened immune systems. Immunocompromised persons should consult their healthcare provider for further guidance.
  • Exclude any child with diarrhea from the childcare setting until the diarrhea has stopped.
    • Children who are infected with the parasite but who do not have diarrhea may be allowed to return.
    • Recently returning children can be grouped together in one classroom to minimize exposing uninfected children to the parasite.
    • Move adults with diarrhea to jobs that minimize opportunities for spreading infection (for example, administrative work instead of food preparation).
  • Terminate all water play or swimming activities — this includes any play or activities involving water tables, temporary inflatable or rigid fill-and-drain swimming pools and slides, or public pool visits. The water can become contaminated and facilitate the spread of germs.
    • Exclude children diagnosed with Crypto from water-play and swimming activities for an additional 2 weeks after their diarrhea has resolved.
  • Practice good hygiene.
    Note: The hand-washing and diapering measures outlined should be routine but are especially important during outbreaks.
    • Good hand washing means:
      1. Wet your hands with clean, running water (warm or cold), turn off the tap, and apply soap. Use warm water if it is available.
      2. Lather your hands by rubbing them together with the soap. Be sure to lather the backs of your hands, between your fingers, and under your nails.
      3. Scrub your hands for at least 20 seconds. Need a timer? Hum the “Happy Birthday” song from beginning to end twice.
      4. Rinse hands well under clean, running water.
      5. Dry your hands using a clean towel or air dry them.

Note: Cryptosporidium is not killed by alcohol gels and hand sanitizers so these materials are of little use in controlling an outbreak.

  • For children:
    • Observe hand washing or assist when needed.
    • Wash children’s hands when they first arrive at the childcare setting, after they use the toilet, after having their diapers changed, and before eating snacks or meals.
  • For adults:
    • Wash hands after using the toilet, after helping a child use the toilet, after diapering a child, and before handling or eating food. Note: Where staffing permits, people who change diapers should not prepare or serve food.
  • Reinforce good diapering practices.
    • Separate diaper-changing areas from children’s play and food preparation areas.
    • Use disposable gloves and change them after each diaper change.
    • Use disposable paper over diaper changing surfaces and change it after each diaper change.
    • Ensure children wear clothing over their diapers to reduce the opportunity for leakage.
    • Wash hands: both yours and the child’s after each diaper change.
  • Disinfect surfaces and objects.

Note: The health department may instruct you to soak contaminated surfaces for 20 minutes with a 3% hydrogen peroxide (99% kill rate) and then rinse them thoroughly. No disinfectant is guaranteed to be completely effective against Cryptosporidium. However, hydrogen peroxide is more effective than standard bleach solutions.

Note: Do not mix hydrogen peroxide and bleach solutions. The two chemicals may react violently. In certain situations (for example, if an outbreak is caused by two or more types of germs), the health department may instruct you or a childcare facility to disinfect surfaces and objects with both hydrogen peroxide and a bleach solution. If so, disinfect with the bleach solution first and thoroughly rinse with water. Then soak with hydrogen peroxide for 20 minutes and thoroughly rinse with water.

Note: Hydrogen peroxide breaks down when exposed to sunlight. Store hydrogen peroxide in dedicated opaque containers — never reuse containers for a different chemical.

  • Disinfect
    • Bathrooms, diaper-changing areas, and food preparation surfaces daily.
    • Toys, tabletops, and high chairs more frequently than usual (at least twice daily).
    • Dishwasher-safe toys in a commercial dishwasher that has a dry cycle or a final rinse that exceeds 113°F for 20 minutes or 122°F for 5 minutes or 162°F for 1 minute.
    • Cloth toys may be washed and heat-dried on the highest clothes dryer heat setting for 30 minutes.
  • Notify the state or local health department about an excessive level of diarrhea or any Crypto cases in a childcare facility. Crypto is a nationally reportable disease.