Minimum Standards and Guidelines for Water, Sanitation and Hygiene in Preschools

2

‘s

Authored By

Eng. Shiromi Karunarathe, Ph.D Senior Lecturer, Faculty of Engineering, SLIIT, Malabe

Dr. Neil Thalagala,Public Health Specialist for Child Development & Special Needs, Family Health Bureau, Ministry of Health           

****************************************************************************************

Consultations by

Eng. Dulip Gunawardhana, Deputy General Manager, National Water Supply & Drainage Board, Mr. Aruna Athukorala, Assistant Director, Children’s Secretariat, State Ministry for Children’s Affairs Ms. Hilda Winartasaputra, Regional WASH Specialist (Asia), Plan International Ms. Nilusha Patabendi, National Advisor, WASH, Plan International Sri LankaMr. Udaya Wanninayake, Engineering Assistant, Plan International Sri LankaMr. Dayananada Thilakaratne, ECCD Specialist, Plan International Sri LankaMembers of the National ECCD Coordination Committee

Cover page: Arch. Roshan Chandraratne

Drawings: Eng. Shiromi Karunaratne Arch. Roshan Chandraratne

ISBN 978-955-1214-27-2

Abbreviations

ADHD Attention Deficit Hyperactive Disorder

CKD Chronic Kidney Diseases

DW Drinking Water

ECCD Early Childhood Care and Development

GAC Granulated Activated Carbon

MDG Millennium Development Goals

MOH Ministry of Health

NGO Non Governmental Organization

ORS Oral Rehydration Salts

PHI Public Health Inspector

POU Point of Use

RO Reverse Osmosis

SBAC Solid Block Activated Carbon

SLS Sri Lanka Standards

SF Sanitary Facilities

UNESCO United Nations Educational, Scientific and Cultural Organization

UN United Nations

UV Ultra Violet

WASH Water Sanitation & Hygiene

WEF World Economic Forum

WHO World Health Organization

WS Washing Stations

Contents

Message from the Secretary, State Ministry for Children’s Affairs 6 Message from the Director, Children’s Secretariat 7Message from the Country Director, Plan Sri Lanka 8Acknowledgements 9Summary 10Introduction 12 Importance of adequate and child friendly, water supply and 15sanitation facilities and hygiene in preschools Minimum standards and guidelines for water and sanitation 17 facilities in preschools 3.1 Drinking water 18 3.2 Hand foot washing stations 23 3.3 Sanitary facilities 38 3.4 Summary 50Minimum standards and guidelines for hygiene in preschools 51 4.1 Hygiene practices related to personal hygiene 51 4.2 Hygienic practices related to preschool environment 61 4.3 Summary 66References 70

1.02.0

3.0

4.0

List of Figures

Figure 1: Typical features of child friendly drinking water access points 23

Figure 2: Typical features of combined hand and foot washing stations for 25

child friendly use.

Figure 3: Typical features of a child friendly hand washing station 29

Figure 4: Typical features of a child friendly foot washing stand 30

Figure 5: Typical features of a grease trap for hand wash stations 33

Figure 6: Typical layout options for utility areas 44

Figure 7: Typical dimensions for child friendly utilities 44

Figure 8: Typical features of a toilet for differently abled children 45

Figure 9: Water storage options for toilets without pipe borne water 46

Figure 10: Typical access pathways in preschool premises 48

Figure 11: Correct hand washing steps 56

List of Tables

Table 1: Anthropometrical details used for designing of child friendly water and

sanitation facilities 16

Table 2: Effectiveness of selected point of use water treatment techniques for

selected pollutants 20

Table 3: Key features of a child friendly washing stand 31

Table 4: Typical operation and maintenance plan for preschool water and sanitation

facilities 36

Table 5: Calculation of minimum water and sanitation facilities 40

Table 6: Key features of a child friendly toilet 42

Table 7: Quantities of water required in toilets (after UNESCO/WHO, 2009) 47

Table 8: Summary of water and sanitation themes use for developing the guideline 50

Table 9: Good hygienic practices 54

Table 10: The minimum free space and staff requirement for preschool age children 62

Table 11: Matrix for incorporation of child friendly water and sanitation concepts under

three main themes 68

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Message from the Secretary,State Ministry for Children’s Affairs

The State Ministry for Children’s Affairs is dedicated itself to playing a continuing role to ensure the total development of Sri Lankan children in their early childhood. Creation of an enabling environment that facilitates, promotes and stimulates them to learn good hygiene practices from their early childhood is very important for practicing them throughout the lifetime. In this respect, it is very important to provide water and sanitation facilities that are considered age appropriate and specific to the needs of preschool children. Therefore, it is very useful to develop age specific and localized minimum standards and guidelines for water and sanitation facilities to make them easy and comfortable for children in preschools to use.

This valuable book will provide practical, easily accessible standards and guidelines for the development of water sanitation and hygiene programmes in preschools in different set ups. The enabling environment with adequate facilities will contribute to a conducive learning environment in which children can perform better.

I appreciate the contribution of the Children’s Secretariat, which is established for child development under the State Ministry for Children’s Affairs, Ministry of Health, Ministry of Urban Development, Water Supply and Drainage, National Water Supply and Drainage Board, Authors, Plan Sri Lanka and members of the National ECCD Coordination Committee who partnered in many ways to produce the minimum standards and guidelines for water and sanitation facilities for Preschools in Sri Lanka.

Mrs S A D S Subasinghe

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Message from the Director, Children’s Secretariat

Children’s Secretariat is the national level focal institution dedicated to development of children in their early childhood. Coordination and support of early childhood development interventions throughout the country is one of main focuses of the Children’s Secretariat, in which providing resources and technical support for preschool education is embedded.

A number of key factors including good health, nutrition, education, social, emotional and spiritual health and clean environment contribute to the total development of children, while access to clean water, age appropriate water, sanitation and hygiene facilities help create a conducive learning environment for children that ensures their good health and continued learning. Promoting good practices such as hand washing with soap, proper toilet practices, drinking adequate and safe water, consuming hygienic and nutritious food and maintaining clean environment from an early age contribute to sustain them throughout their lifetime.

Preparing minimum standards and guidelines for water, sanitation and hygiene for preschools is very much needed to guide the main stakeholders in the sector to deliver standardized water and sanitation facilities and services to benefit all preschool children in the country.

Mrs. P Chandima Sigera

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Message from the Country Director,Plan Sri Lanka

Creating a healthy and child friendly learning environment for children in early ages is critical for their better growth. The hygienic habits that children learn in their formative years help them to practice this behavior in their families and later in life as productive citizens. That’s how we adults can learn from our children. I am therefore pleased to write few words for the Minimum Standards and Guidelines for Water, Sanitation and Hygiene in Preschools in Sri Lanka. As a child centered international development organization, Plan Sri Lanka is certainly proud to be a part of the joint work in the development of the manual under the leadership of the Children’s Secretariat of the State Ministry of Children’s Affairs, Ministry of Urban Development and Water Supply, and experts in the field of early learning and water and sanitation.

Poor hygiene and sanitation practices contribute to the high incidence of malnutrition and children’s death. Preventing children from non-communicable diseases is one of Plan’s programme interventions to promote children’s wellbeing leading children to reach to their full potential. In doing so, Plan Sri Lanka has been working closely with children in schools and with their communities. A key strategy of this focus, is the provision of inclusive, age appropriate and child friendly water and sanitation services for children in preschools. This includes age appropriate toilets, water points that promote easy and correct use of facilities, safe and clean environment for small children. Further, teaching appropriate skills and practices to promote good hygiene practices among preschools is considered a very essential part in our preschool water, sanitation and hygiene promotion programmes.

I thank the authors, Ministries of Children’s Affairs, Urban Development and Water Supply and Drainage, National Water Supply and Drainage Board, members of the National ECCD Coordination Committee and staff of Plan Sri Lanka for their valuable contribution that ensured the production of this guide.

It is my sincere hope that this guideline be cascaded down to the preschool teachers, parents and preschool authorities at the provincial and divisional levels so that better standards are maintained to ensure health and safety of all preschool children.

Mr Supriyanto

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Acknowledgements

The preparation of this manual involved consultation with practitioners, project implementers, policy makers, government partners, non-government organizations, and corporates those involved in Early Childhood Care and Development (ECCD), members of the National ECCD coordination committee, architects, draftsmen, preschool teachers, parents and children of visited preschools. All their contributions are acknowledged.

Tremendous efforts and time taken by authors to complete this manual with their interest in children and issues that affects them, is appreciated.

The support extended by the Ministries of; Children’s Affairs, Urban Development, Water Supply and Drainage, Health and Education, National Water Supply and Drainage Board, all partners and staff of Plan Sri Lanka is highly appreciated.

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Summary

Clean, age appropriately designed (child friendly) drinking, hand washing, sanitation facilities and effective hygiene education, benefit preschool children enormously. Children with adequate sanitary facilities are better able to learn and more likely to practice good hygiene throughout their lives. Such children are more likely to adopt behaviors that promote hygiene and to become change agents who educate and promote hygienic behavior in their families and as future parents. Early exposure to hygiene education and resulting behaviors is also known to ensure the proper utilization of water, sanitation facilities and adaptation of hygienic practices that prevent illness and promote healthiness. Therefore, preschools should have adequate and safe, water, sanitation and hand washing facilities while educating children on hygiene practices. The preschool should be child-friendly in all aspects.

In Sri Lanka, most preschools are privately owned. Only a percentage of preschools are registered and regulated by provincial preschool educational authorities. Therefore, the exact number of preschools operating in the country is not known.

Out of the registered preschools by Provincial Preschool Authorities, only around 60% are reported to have sufficient water and sanitation facilities, disregarding considerations of age appropriateness of the same. There is a wide variation in the quality standards maintained in the existing facilities. The informal nature of preschool education in Sri Lanka makes maintaining standards of water, sanitation and hygiene, a challenging and difficult task. At present, there are no accepted standards or guidelines specifically set up on the provision of water and sanitation facilities and hygiene education in preschools in Sri Lanka.

Facilities for preschool age children require different dimensions than those of adults. Also when designing such facilities, the different levels of physical strengths, motor skills and preferences of the preschool age children should be considered. Otherwise, the uncomfortable facilities might lead to many unforeseen obstacles for children leading to incorrect usage or refusal to use them at all.

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The document seeks to introduce minimum standards and guidelines for water and sanitation facilities, and hygiene in preschools (for children aged between 3-5 years) with the objective of improving the health of preschoolers by provision of clean water, child-friendly toilets, with hand-washing facilitieswhile promoting long term hygienic behavior in a conducive environment. Sufficiency of safe water, convenient access to water facilities and sufficient water collection points are important aspects considered with respect to drinking water.

Age appropriateness of collection points, convenient accessibility of water use facilities, sufficient water and appropriate disposal of wash water are considered when developing these standards for hand and foot wash stations. Safety, convenient accessibility, age and cultural appropriateness and the robustness are the considerations for sanitary facilities. Children as well as adults need to keep their bodies clean and free of disease causing organisms. Regular actions such as washing the face, brushing teeth, bathing, washing hands, cutting nails, to help keep children’s body free of viruses, bacteria and other parasites as well as make them look presentable and confident are the considerations for promoting good hygienic practices.

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1.0 Introduction

1.1 Purpose and Scope

The word “preschool” is used in this publication to include all public and private sector preschools in rural, peri-urban and urban areas and crèches in plantations.

Standards and associated guidelines in this publication are based on information gathered using a comprehensive literature review, direct observations and measurements of various preschool settings around the country and consultations held with stakeholders of preschool programmes, including personnel from the State Ministry for Children’s Affairs, Provincial preschool authorities, Non-governmental organizations (NGO) supporting preschool education in the country, preschool teachers and health and WASH (water, sanitation and hygiene) experts.

The standards and guidelines reflect the minimum standards that should be adhered to, in any preschool setting. Therefore they seek to ensure equity across different regions and sectors in terms of minimum facilities and practices that impact on basic water, sanitation and hygienic standards meant for preschool children. Practice disparities in terms of sector, ethnicity, culture and religion were taken in to account when developing standards and guidelines. Hence, they represent a set of generic standards and guidelines that are applicable in most settings around the country.

1.2 Audience

These standards and guidelines are prepared for use by Early Childhood Care and Development (ECCD) authorities, local authorities, planners, teaching staff, management boards, owners of private preschools and various bodies who construct water and sanitation facilities in Sri Lanka. They can utilise the standards and guidelines given in this guide when upgrading existing facilities or planning and building new facilities in preschool environments. They are expected to implement such action plans in a participatory manner. They can adapt the standards to be suitable for the local context while maintaining the minimum required standards. It is always encouraged to aim for higher standards whenever possible while maintaining

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the stipulated minimum standards and guidelines for age appropriate, child friendly design criterion which are acceptable and accessible for children.

1.3 Setting

The authors acknowledge the existence of different economic, social and cultural settings where preschools are located. The guidelines have attempted to address the needs and requirements of all sectors by proposing a minimum standard to be maintained. The emphasis is given to have affordable water and sanitation solutions which are effective, simple and robust when designed, constructed, used and maintained. While primarily the emphasis is given to water and sanitation facilities and hygiene education in preschools, some of the considerations pertaining to daycare centers may also be covered.

1.4 Relation to national standards and codes of practices

The guidelines are intended to support and complement existing national/local standards and codes of practices related to water and sanitation and shall not in any way modify no substitute them.

1.5 Rationale used for developing minimum standards for preschools

In Sri Lanka, most preschool are privately owned and there is a wide variation in the standards of water, sanitation and hygiene (WASH) facilities. This informal nature of preschool education in Sri Lanka makes maintaining water, sanitation and hygiene related standards a challenging and difficult task. This situation emphasizes the need of immediate action and attention for developing minimum standards with supportive guidelines for inclusive WASH facilities in preschool setups. It is also not very practical to use international standards for such facilities as anthropometry of children vary per region.

Facilities for preschoolers should be inviting and not appear threatening. The facilities should also reflect cleanliness.

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This can be achieved by ergonomically correct designing of facilities. The ergonomics of the educational facilities involves such factors as anthropometry, thermal comfort, visual comfort, acoustical comfort, color, and safety and can be achieved by considering the aspects such as, appropriate dimensioning which promotes the feeling of safety and comfort for specific age categories in hand washing stations, urinals, taps, squatting pans, commodes etc. Use of appropriate color schemes (light colors and pastel shades), sufficient natural light and ventilation will also enhance the inviting nature of such facilities.

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2.0 Importance of adequate and child friendly water supply, sanitation facilities and hygiene in preschools

Child-friendly hygiene and sanitation facilities in preschools are ‘interactive’ spaces that stimulate children’s learning and development. The child-friendly hygiene and sanitation solutions should be provided in all sectors and levels of preschools in the country as affordable cost effective solutions with no compromise on quality.

It is very important to have appropriate dimensions (anthropometry) and features in water and sanitation facilities for preschool children. Hygiene and sanitation systems if not properly designed can also be environmental burdens. Therefore, emphasis should be given to have age appropriate designs for such facilities while encouraging hygienic practices.

Anthropometry is the science of measuring the human body, its parts and functional capabilities. An important principle in the ergonomics of the educational facilities is that it shall be designed and scaled to fit the sizes of their users on the basis of their part-body measurements. The basic body measurement is the standing height of the individual. For the purpose of designing and sizing the facilities, two types of part-body measurements are required: static and dynamic measurements, In the absence of such detailed information for preschool children in Sri Lanka, the standing height, leg (a combination of lower and upper) length (a static measurement) and forward reach of the arms (a dynamic measurement) were considered. Table 1 shows anthropometrical details used for designing of child friendly water and sanitation facilities in this guide.

In addition to the safety, comfort and age appropriateness of facilities, adequacy of water supply, ventilation and lighting conditions in toilets, the considerations such as the number of hand washing stations, toilets and urinals should be ensured together with sufficient capacity and minimal waiting time. They should also have regular operation and maintenance plans.

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Table 1: Anthropometrical details used for designing of child friendly water and sanitation facilities

GenderAge (years)

*Height median(mm)

**Forward reach of arms(shoulder to finger

tips) (mm)

**Length of legs (hip to toe) (mm)

Girls 3 950

430.0±0.1 587.5±0.14 1015

5 1095

Boys 3 96

442.5±0.2 580.0±0.24 1035

5 110

*Reference- National Child development records (standing height)

**Reference – A survey done on a sample of more than 30 children (age varying from 3-5 years) from

preschools in Sri Lanka

Protection of the Rights of Persons with disabilities, Act. No. 28 of 1996 (Regulations, No. 1 of 2006), articulates that rights of the differently-abled children has to be safe guarded. As such, the three main types of differently-abled children for whom adaptations in preschool water and sanitation facilities have to be made are: • Blind or poor-sighted children • Children in wheelchairs or with clutches • Children with missing/paralyzed limbs or arms

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3.0 Minimum standards and guidelines for water and sanitation facilities in preschools

The concept of child-friendly water and sanitation facilities can be presented in 10 points. Facilities should:

1. Encourage hygienic behavior and adequate water conservation concepts 2. Have appropriate dimensioning for children3. Offer enough capacity and minimal waiting time 4. Use appropriate locations for young children5. Address the needs for differently abled children 6. Stimulate children’s learning and development and inculcate good habits7. Be established with the involvement of key stakeholders8. Be low-cost/ affordable solutions without compromising quality9. Incorporate adequate environmental conservation attributes10. Have appropriate operation and maintenance plans

Hence the standards for water and sanitation facilities in this guide were developed under the following three themes with a set of guidelines for ease of implementation:

Drinking water- Safe water in sufficient quantities, available at all times for drinking by children and staff, age appropriate-convenient access and economical water use facilities, with sufficient water collection points

Hand and foot washing stations- age appropriate, convenient access and economical water use facilities, with appropriate quality water, available at all times in sufficient quantities, sufficient water collection points, appropriate disposal of wash water

Sanitary facilities- Sufficient (with minimum waiting), accessible, age appropriate, inviting, secure, robust and economical, with appropriate quality water, culturally appropriate and environmentally friendly toilets for preschool children and staff.

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3.1. Drinking water (DW)

Standard - water for drinking should be of appropriate quality, available in sufficient quantities at all times for drinking by children and staff while the water facilities and collection points are age appropriate with convenient access and provided in sufficient numbers

The primary importance of design and construction of water and sanitation facilities in preschools is to promote personal hygiene while ensuring safety of very young children aged 3-5 years. In most preschools in Sri Lanka, children bring their own drinking water from home. However, it would be appropriate to maintain an uncontaminated drinking water source in all preschools.

3.1.1 Guideline- DW 1 - Water quality

Water provided for drinking for preschool children should be of acceptable quality (should comply with SLS 614 (2013) for potable water standards) and drinking water sources should be monitored regularly to ensure safe drinking water is available at all times

The water provided by the preschool should be treated using an appropriate technique for the specific area of the country. In most areas of the country, adequate quality of drinking water can be consummated by boiling the water obtained from protected water sources (deep wells, boreholes, springs etc) or from a treated supply (treated and chlorinated water). However, in other areas where specific treatment is needed, further filtering and treating using commercially available filters (working on the principles such as Ceramic candle, Reverse Osmosis (RO), Activated carbon filters etc.) is recommended.

Table 2 shows the effectiveness of some Point of Use (POU) water treatment techniques for selected pollutants such as E.coli or other bacteria, calcium and magnesium, arsenic, fluoride, iron or manganese, nitrates, other organics and inorganic, chlorine, pesticides, herbicides, insecticides and volatile organic carbon. The selection of the type of treatment device should

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be based on the water quality parameters of the water source. Water for drinking, hand washing, food preparation and dish washing should be of the same quality, particularly if there are no specific drinking water points.

Children of all ages, particularly young ones, are more susceptible than adults to the harmful effects of contaminants. Therefore, local authorities with the help of Public Health Inspectors (PHI) of the area should be involved in monitoring the water quality (physical, chemical and biological parameters as per SLS 614 (2013) for potable water) of the water used in preschools at regular intervals (minimum - once in six months) as part of a routine surveillance and control program.

3.1.2 Guideline - DW 2 - Storage

Safe drinking water stored appropriately in sufficient quantities

Water for drinking and similar purposes should be stored safely in storage tanks (overhead or otherwise) or appropriate containers. Attention should be paid to the material of the container used for storing water. Containers made out of clay (for storing in small quantities), block/brick/concrete tanks rendered with cement or tiled, fiberglass, stainless steel or food grade plastics (which are specially made for water storage) are possible options. Storage tanks should be thoroughly cleaned on a regular basis.

3.1.3 Guideline- DW 3 - Water quantity (per person per day)

Water available in sufficient quantities at all times for drinking by both children and staff

Sufficient water should be available at all times for drinking, hand washing, food preparation and dish washing. According to WEF/UNESCO/WHO 1999, day schools may allow minimum of 5 liters of water per person per day for all school children and staff. This would include the needs of drinking, hand washing, food preparation and dish washing. 1.5 liters of clean water per child per day is recommended for drinking purposes only (based on Holliday - Segar formula and Median weight for age)

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Table 2: Effectiveness of selected point of use water treatment techniques for selected pollutants

Treatment

technique

Ecoli or other

bacteria

Hard water

(Calcium and

Magnesium)

Arsenic FluorideIron or

manganeseNitrates

Other

inorganicChlorine

Pesticides,

herbicides,

insecticides

Volatile

organic

carbon

Other

organics

Distillation R R R R R R R R S S S

Reverse Osmosis (RO) R R R-S R R R R-S S-M R-S S S

Ceramic filter S-RR if

precipitated

Granulated Activated

Carbon (GAC) filter

R if

precipitatedR R-S S R-S

Solid Block Activated

Carbon (SBAC) filter with

sub-micron pores

S-RR if precipi-

tatedR R-M R M

“Pitcher” filter - usu-

ally uses GAC & perhaps

other materials like ion

exchange resins

R if

precipitatedM R M-S M-S M-S

Boiling (at least more than

5 minutes)D C C C C C C R S S

UV disinfection D

Key to level of effectiveness

D-Disinfection - Effectiveness depends on the appropriate dose and contact time of the disinfection agent.R-Mostly Removed - If the device is performing correctlyS-Some Removal - may depend on the form of the chemical (the contaminant) is in at the time of treatment, Iron and arsenic are examples.

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Table 2: Effectiveness of selected point of use water treatment techniques for selected pollutants

Treatment

technique

Ecoli or other

bacteria

Hard water

(Calcium and

Magnesium)

Arsenic FluorideIron or

manganeseNitrates

Other

inorganicChlorine

Pesticides,

herbicides,

insecticides

Volatile

organic

carbon

Other

organics

Distillation R R R R R R R R S S S

Reverse Osmosis (RO) R R R-S R R R R-S S-M R-S S S

Ceramic filter S-RR if

precipitated

Granulated Activated

Carbon (GAC) filter

R if

precipitatedR R-S S R-S

Solid Block Activated

Carbon (SBAC) filter with

sub-micron pores

S-RR if precipi-

tatedR R-M R M

“Pitcher” filter - usu-

ally uses GAC & perhaps

other materials like ion

exchange resins

R if

precipitatedM R M-S M-S M-S

Boiling (at least more than

5 minutes)D C C C C C C R S S

UV disinfection D

Key to level of effectiveness

D-Disinfection - Effectiveness depends on the appropriate dose and contact time of the disinfection agent.R-Mostly Removed - If the device is performing correctlyS-Some Removal - may depend on the form of the chemical (the contaminant) is in at the time of treatment, Iron and arsenic are examples.

M- Depends on the manufacturer. Particularly for activated carbon filters, special manufacturing processes can increase the level of specific contaminants removed. C-Boiling concentrates those contaminants not removed or killed, which is anegative impact

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3.1.4 Guideline - DW 4 - Water access points

Sufficient number of age appropriate water facilities and access points should be conveniently located to be accessed by all including those with disabilities

An adequate number of water access points should be available in preschools to allow convenient access to all, including those with disabilities, at all times. One drinking water access point for every 15-20 children is recommended (Minimum Standards of ECCD Centers, UNICEF). Drinking water should be provided at clearly marked points, preferably color coded, separately from water provided for hand washing and other purposes even if it is from the same supply.

Treated drinking water (non point of use treatment) may be provided from a piped water system or via a covered container with a tap, preferably or directly via a point of use water treatment facility (such as filters, Reverse Osmosis (RO) systems etc.), with a dispenser as a stand-alone system. A container without a tap or a nozzle may have the chances of water contamination when cups are introduced into it for collection.

Water points should be sufficiently close (within 10-15 m of all users) and at a suitable height (60-70 cm above the floor level) for users to encourage them to use water as often as required.(Figure 1)

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Figure 1: Typical features of child friendly drinking water access points

3.1.5 Guideline – DW 5 - Operation and maintenance of drinking water facilities

Drinking water facilities should be maintained regularly to ensure safe drinking water available at all times

Storage tanks and point of use water treatment facilities should be cleaned on a regular basis. Maintenance and cleaning of point of use water facilities should be carried out as per the given instructions.

3.2 Hand/foot washing stations (WS)

Standard - Water for washing stands should be of appropriate quality, available in sufficient quantities at all times; while water facilities and collection points are sufficient in number, and age appropriate with convenient access with appropriate disposal techniques of wash water (preferably with secondary use) resulting in minimum environmental impact

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Hand and foot washing stations provide a significant contribution to hygiene of preschool children.

3.2.1 Guideline - WS 1 - Water quality

Water provided for hand and foot washing for preschool children should be of acceptable quality and water sources used should be monitored regularly to ensure safe water is available at all times

Water for hand and foot washing stations should be obtained from improved water sources such as protected dug wells, tube wells or public water supply systems. In addition, rain water without disinfection may be acceptable for hand/foot washing, if the rainwater catchment surface, collection system and storage tank are correctly operated. The same quality as with water for drinking should be maintained with water used for hand washing.

Local authorities with the help of public health inspectors of the area should be involved in monitoring the water quality of the water used in preschools at regular intervals (minimum - once in six months) as part of a routine surveillance and control program.

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3.2.2 Guideline - WS 2 - Storage

Water should be stored appropriately in sufficient quantities

Figure 2: Typical features of combined hand and foot washing stations for child friendly use.

Water should be stored safely in storage tanks (overhead or otherwise) or appropriate containers near the washing stations. Attention should be paid to the container used for storing water. Containers made out of block/brick/concrete tanks rendered with cement or tiled, fiberglass, stainless steel or plastics (which are specially made for water storage) are possible options. In areas where pipe born water in not available, the storage tanks can be directly fitted with taps and filled manually for child friendly use (Figure 2). Containers previously used for storing chemicals and similar products should never be used to store water for any such purpose.

FOR AN AREA WITHOUT PIPE BORNE WATERHAND / FOOT WASH STATION

HEIGHT TO THE TAP750mm

150-200mmSOAP TRAY

75mm

Y10@225c/cBOTH WAYS

75mm

BRICKS 112mm

ISOMETRIC VIEW

FOR CONCRETE

FOR BRICKS

Y10@225c/cBOTH WAYS

TYPE-B2 USEFUL IDEAS

WITH A COVER75mm 1:1 1/2:3 REIN-FORCED CONCRETE Y10@200c/cNOTE:

NOTE: 112mm BRICK WALLS PLASTERED & CEMENT RENDEREDOR TILED

225mm BRICK PILLERS

HAND WASH STATION(ALL DIMENTIONS AS PER FIGURE05)

HAND WASH STATION(ALL DIMENTIONS AS PER FIGURE03)

STEPS

Section A-A

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3.2.3 Guideline - WS 3 - Water quantity (per person per day)

Water should be available in sufficient quantities at all times for hand and foot washing

According to WEF/UNESCO/WHO 1999, day schools may allow minimum 5 liters of drinking quality water per person per day for all school children and staff. This would include the needs of drinking, hand washing, food preparation and dish washing. The same volumes are recommended in preschools as well.

3.2.4 Guideline - WS 4 - Water access points

A sufficient number of age appropriate washing stands for hand and foot washing should be conveniently located to be accessed by all including those with disabilities

Hand washing stations should be available within a preschool - at least one per 15-20 children and foot washing stations one per 20-30 children placed at an appropriate location at suitable heights for the age, providing sufficient lateral space for comfortable use if installed in rows (minimum standards for ECCD centers, UNICEF). The number should be sufficient to allow convenient access to all including those with disabilities at all times. Washing stands should be sufficiently close (within 30m of all users) to the classrooms and with or without in association with toilets and recommended guidelines may be used to make sure the age appropriateness and user friendliness of the facilities (figure 3&4, table 3).

As with other hygiene behaviors, such as correct use of toilets, hand washing with soap at critical times (especially after defecation and before eating), often requires helping and guiding the children with correct hand washing steps. Pictures illustrating the correct hand washing steps should be displayed near the hand washing stations while the teachers and staff can guide them. Soap should be made available at all wash points in a way that it would be convenient to use by the children while preserving the same.

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It would be preferable to have hand and foot washing stations separately yet at close proximities as children prefer a clean environment without a wet floor around the hand washing stations. It will also minimize the classrooms getting dirty and wet after children use the hand washing stations.

It is also desirable to locate both hand and foot washing stations near the toilet area as children need to use them immediately after using the toilets. Also, if space and resources permit, stand alone hand washing stations can be located in other areas in the preschool (attached to classrooms, in the garden etc.)

If tap services are not available water should be kept collected in water containers that can be covered and a clean cup/pan with a handle should be placed to get water from the container.

(a) Child friendly hand washing stand with one tap

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(b) Child friendly hand washing stand with more than one tap -Type 1

(c) Child friendly hand washing stand with more than one tap - Type 2

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(d) Child friendly hand washing stand with more than one tap - Type 3

Figure 3: Typical features of child friendly hand washing station

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(a) Child friendly foot washing stand with one tap

(b) Child friendly foot washing stand with more than one tap.

Figure 4: Typical features of child friendly foot washing stands

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3.2.5 Guideline-WS 5- Washing stand fittings

A washing stand should have age appropriate features and dimensioning with robust fittings

Table 3: Key features of a child friendly washing stand

Attribute Important aspects/dimensions*Suggested

dimensions (mm)

SafeHeight of the stand

Hand washing- Foot washing-

450-600 (tap level)450-600 (tap level)

Easy to Use • Height of fittings (can taps, ladles, soap, etc. be reached)

• Reach to the tap from front the edge

• Distance between water points (taps) when arranged in a row for foot washing

hand washing (for type 3)

550-700

400-450

450-600450-600

Maintenance friendly

• Tiled with adequate slope for rapid drainage in correct direction

• Easy to clean, robust fixtures

√ √

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Pleasant and encouraging

• More sunlight/ventilation using appropriately sized and positioned fanlights and raised roof level if located inside a building.

• Differently able children’s require-ments are included in design and construction.

• Colours used for paints tiles, wash basins of pastel shades

Minimum of 1/7th of the floor area to be provided for openings (windows and fanlights)√

White and pastel shades

*All the dimensions of the facilities were decided based on anthropometrical measurements relevant to the preschool age children in Sri Lanka. (Details are given in Table 1) / √- aspect should be consideredtable 3 should be refereed in conjunction with figures 3&4

Proper dimensioning of wash stands are of primary importance, especially for preschool age children as the standard heights and sizes (used for adults) would be difficult for them to use. The hand washing stations can be made using the fittings available in the market (wash basins, bowls etc.) and positioning at appropriate heights, or locally constructing using the appropriate materials. Such facilities should be easy to clean and maintain, and robust for use by preschool age children who are very inquisitive and not yet competent users.

Foot washing stand taps should also be positioned at appropriate height to suit the children as suggested in the drawings. A foot washing bay would help the place to be clean while it would collect all wash water and direct it to the discharge point.

Alternatively, in resource scarce areas, simple and low cost hand washing points can be made in various ways including the following (WHO, 1997b);

• A pitcher of water and basin (one person can pour the water for another to wash their hand; the wash water falls into a basin).

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• A small tank (e.g. a plastic drum/barrel which did not contained any chemicals of hazardous material previously) fitted with a tap, set on a stand and filled using a bucket, with small soakway or a basin under the tap to catch the wash water.

• A “tippy-tap” made from a hollow gourd or plastic bottle that is hung on a rope and that pours small stream of water when it is tipped or other water saving devices.

3.2.6 Guideline - WS 6 - Management of waste water

Waste water generated from wash points should be disposed of in an appropriate manner (promoting reuse) causing least environmental impacts

Figure 5: Typical features of a Grease trap for hand washing stations

chamber 1 chamber 2

Stainless steel for chamber 1

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Waste water may be generated from hand and foot washing stands and kitchen in preschool. Methods should be devised to efficiently dispose of the waste water generated from all points; hand washing stands, foot washing stands and kitchen. Waste water from foot washing stations can be directly disposed to the environment without any further treatment as it may contain only grit. However, waste water discharged from hand washing stands and kitchen may contain oil and biodegradable matter as children wash hands after meals. These should be equipped with grease traps (figure 5), which should be checked and cleaned (if necessary) weekly to ensure the system operates correctly. All systems that infiltrate wastewater into ground must be cited so as to avoid contaminating ground water. All efforts should be made to reuse the wastewater discharged from these points for gardening and cleaning to enhance the sustainability.

3.2.7 Guideline – WS 7 - Operation and maintenance of the washingstand facilities

Washing facilities should be maintained regularly to ensure washing stands are operational at all times

Storage tanks should be cleaned on a regular basis. The washing stands should be cleaned at least once a day, preferably before the beginning of the preschool sessions, by using appropriate material. Maintenance of such facilities should be carried out on regular basis in accordance with a routine checklist for cleaning and maintenance. Table 4 shows a typical checklist that can be modified according to the requirements and used for operation and maintenance of washing (hand and foot) as well as sanitation facilities in a preschool environment.

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Table 4: Typical operation and maintenance plan for preschool water and sanitation facilities

Activity

Minimum cleaning and maintenance interval

(e.g. twice daily, daily, weekly, occasionally)

Responsible personMaterials, parts, tools, and equipment needed

per week month or year (soap, brushes, spare parts, etc.)

Supply of soap, filling of water reservoirs Once a day √ Soap, Container, soap holder

Supply of detergents, brushes, mops etc.As and when require but stocks can be maintained weekly or monthly

√ Detergents, brushes, mops

Cleaning of water supply facilities (drink-ing and wash stands), preschool yard

Once a day √ Detergents, brushes

Cleaning of water storage tanks Once a month √Detergents, brushes, lid or cover, bucket or pitcher

Cleaning of toilets Twice a day √Detergents, brushes, mops, buckets, toilet pa-pers, towel, slippers

Supervision:inspection formaintenance needsand repairs as well as checking if the toilet pits are full or septic tanks need to be cleaned

Once a week√ Monitoring and Recording book

Maintenance: minor repairsmajor repairsemptying of pits

One a weekOnce a monthOnce a week

√ Monitoring and Recording book

Monitoring and evaluation of use Monitoring - dailyEvaluation - once a year

√ Monitoring and Recording book

Table 3 modified after Mooijman, et al., (2010), page 186.

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Table 4: Typical operation and maintenance plan for preschool water and sanitation facilities

Activity

Minimum cleaning and maintenance interval

(e.g. twice daily, daily, weekly, occasionally)

Responsible personMaterials, parts, tools, and equipment needed

per week month or year (soap, brushes, spare parts, etc.)

Supply of soap, filling of water reservoirs Once a day √ Soap, Container, soap holder

Supply of detergents, brushes, mops etc.As and when require but stocks can be maintained weekly or monthly

√ Detergents, brushes, mops

Cleaning of water supply facilities (drink-ing and wash stands), preschool yard

Once a day √ Detergents, brushes

Cleaning of water storage tanks Once a month √Detergents, brushes, lid or cover, bucket or pitcher

Cleaning of toilets Twice a day √Detergents, brushes, mops, buckets, toilet pa-pers, towel, slippers

Supervision:inspection formaintenance needsand repairs as well as checking if the toilet pits are full or septic tanks need to be cleaned

Once a week√ Monitoring and Recording book

Maintenance: minor repairsmajor repairsemptying of pits

One a weekOnce a monthOnce a week

√ Monitoring and Recording book

Monitoring and evaluation of use Monitoring - dailyEvaluation - once a year

√ Monitoring and Recording book

Table 3 modified after Mooijman, et al., (2010), page 186.

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3.3 Sanitary facilities (SF)

Standard – Preschool children should have access to clean, safe, age appropriate sanitary facilities available at all times. In order to ensure the said features, the sanitary facilities should be constructed using appropriate designs, construction material and robust fixtures with identified cleaning and maintenance plans.

It is very important to have appropriate dimensions and features in water and sanitation facilities designed for preschool children. According to the Disabled Persons (Accessibility) Regulations, No. 1 of 2006, it is necessary to consider the rights of the differently abled children in the preschool environment. As such, in addition to the considerations on user friendliness, safety and age appropriateness for children in general, special features necessary for differently abled children as mentioned below are considered in addition;

• Blind or poor-sighted children: special grips and guiding systems as well as proper lighting for poor-sighted children

• Children in wheelchairs or with clutches: no entrance steps, wider doors, special grips or foldable seats

• Children with missing limbs/arms or paralyzed limbs/arms: equipment such as lids, taps and knobs that can be opened with one hand, are not heavy or can be operated with the foot.

3.3.1 Guideline –SF 1-Accessibility of toilets

Toilets should be available in preschools to allow convenient and safe access with minimum waiting time to all, including those with disabilities

According to a report on the ‘Institutional Framework for Early Childhood Care and Development (ECCD) in Eastern Province Pre-school Module’ (Batticaloa District, 2009) minimum of one toilet per 15-20 children should be available in preschools to allow convenient access to all including those with disabilities at all times. Being on par with this standard as well as considering aspects such as minimizing the waiting time, a guideline for calculating the minimum number of sanitary facilities for preschools is given in table 5.

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Toilets can be placed inside or outside the preschool building depending on the circumstances. A most simple toilet block/complex would comprise of a toilet, urinal for boys and a hand and foot washing station. Use of urinal is cost effective and requires less amount of water. In either case, toilets should be closely located (no more than 30m from all users) to the classrooms and playing areas, to ensure that they can be used conveniently and safely (WHO, 2009). Entrances should be positioned to provide sufficient privacy and at the same time doors should be positioned in such a way that the teachers can supervise and if necessary assist the children easily and ensure safety. Also considerations such as social, environmental, religious and cultural beliefs and aspects would be useful in deciding a location. Further, the location of toilets should also take into account the need to minimize odors (taking prevailing wind direction into account) and avoid contamination of water supplies and food.

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Table 5: Calculation of minimum water and sanitation facilities

Student number

Toilets for children

UrinalsToilets for children

No. Taps (for hand washing)

No. Taps (for foot washing)

0-30 1 1 1 1-2 1

31-60 2 2 1 3-4 2-3

61-90 3 3 1 5-6 3-4

91-120 4-5 3 1-2 7-8 4-5

121-150 5-6 3-4 1-2 9-10 5-6

*Modified after institutional framework for early childhood care and development. (ECCD) in

eastern province pre school modules (baticoloa District 2009)

Doors should not be lockable from inside (be opened from outside) to ensure the safety of young children of preschool age. Locks can be fixed outside to secure them during the after-hours.

3.3.2 Guideline – SF 2 - Features of the facility

Sanitation facilities for preschool children should be age appropriate, accessible and comfortable to be used.

Heights of urinals, wash basins, tap posts, mirrors, soap holders should be age appropriate (Table 6). Squatting pans should be appropriate in size (smaller than the adult sizes) with a small pedestal as children are scared of falling into the hole. Use of squatting pans in place of commodes is a preferable option in water and/or resource scarce situations, and will promote reduced water utilization, lower cost of installation and also better hygiene. On the other hand, commodes are easy to use. Toilet fixtures and materials

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should be carefully selected and properly installed to ensure minimum maintenance and maximum utilization and durability. Typical preschool toilet layout and standard dimentions for utility areas are shown in figures 6 and 7, respectively.

Children usually need more space to move and use facilities inside the toilets. They prefer adequate ventilations and light, as some children are scared of darkness. Children of preschool age needs assistance and support to use the facility sometimes and hence needs more internal space.

Ventilation and sunlight are also needed to prevent unpleasant odours and keep the toilets clean and dry. Toilets without adequate ventilation and lighting promote an environment favorable for the spread of germs. Adequate light and ventilation with at least two openings can be achieved through provision of suitably sized fanlights and correct positioning. Areas facing South, South East and South West, receive the most natural light throughout the day and year. A toilet with good ventilation and sunlight will encourage children to use the facility (Table 6).

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Table 6: Key features of a child friendly toilet

Attribute Important aspects/dimensions

*Suggested dimensions (mm)

Safe

• Non slippery floor tiles / foot rests• ¾ doors or half partitions • Hand rails (along steps, ramp, in the

toilets)

√850-1100√

Easy to Use

• Height of seats (if seats are being used)

• Height of urinals• Distance between the foot rests of

squatting platforms• Distance from the squatting platform

to the walls (girls need more space to squat comfortably than boys)

• Height of hooks, door knobs • Height of locks1

• Height of steps • Height of hand rails of stairs • Size of squatting pan • Outward opening doors/sliding doors• Light weight door sashes• Bidet showers/Bucket and a small cup

with a handle with a low tap• Cistern flushing system if resources

are permitting• Angle of the ramp• Width of the ramp

350-500

450-500<200

250-300

800-900>1500≤ 150500-600√√√√√√

1:12900-1000

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Maintenance friendly

• Tiled walls• Floor tiles not too rough• Robust fixtures

√√√

Pleasant and encouraging

• Spacious enough for a wheel chair to be allowed in

• More sunlight/more ventilation by bigger fanlights and raised roof level

• Colours used for wall paints, tiles, wash basins etc.

(Interior and exterior walls may be painted with characters from folk tales and animals or pictures with good hygiene practices).

√

Minimum of 1/7th of the floor area to be provided for openings (windows and fanlights)

White and pastel shades(with a reflec-tion factor of > 60%)

*All the dimensions of the facilities were decided based on anthropometrical measurements

relevant to the preschool age children in Sri Lanka. (Details are given in Table 1)

1 Door locks should be out of reach of children

√ Aspect should be considered

Table 6 should be referred in conjunction with figures 6,7 and 8.

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Figure 6. Typical layout options for utility areas

(a) Typical features of facilities with commodes

(b) Typical of facilities with urinals

Figure 7: Typical dimensions for child friendly utilities

SECTION A-A

URINAL

800-900mmA

A

HALF PARTITIONS(MELAMINE BOARDS)HEIGHT 1000-1200mm

URINAL

ALL SERVICE LINES TO BE SENT OUTSIDEAND KEEP ACCESSIBLE FOR EASY MAINTENANCE

NOTE:

FLOORS AND WALLS ARE TILED

CHILD TOILETURINAL

PLAN VIEW

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Types of floor tiles should be rough enough to avoid slipping and smooth enough and hard wearing to be cleaned with water and cleaning products (detergents) and keep the floor dry and clean. Doors should be opened to the outside and reach down to the floor level with 25-50 mm clearance to minimize contact with water, and whenever applicable, have a spacein-between the top of the door frame and top of the door in order to give the feeling of security and also to be used in an emergency.

At least one toilet should be made accessible for staff and children with disabilities. This includes level or ramped access with no steps, a wide door and sufficient space inside for a wheel chair use or helper to maneuver, as well as the provision of support structures such as handrail and a toilet seat (figure 8). It may also be appropriate to provide separate toilets for staff whenever possible.

Figure 8: Typical features of toilet for differently abled children.

DISABLE FRIENDLY TOILETTYPICAL SZES FOR TOILETS

1600-1800mmA

A

B

B

PLAN VIEW

450

900-1000mm

200-300mm

SECTION B-B

HAND-RAIL800-850mmHEIGHT

HAND-RAIL800-850mmHEIGHT

WASH BASIN

HAND BIDET

FOLDABLE HNADLE800-850mmHEIGHT

SECTION A-A

400-500mm

HAND-RAIL800-850mmHEIGHT

750mm

SIZE OF A WHEEL CHAIR

900-1000mm

ENTRANCE DOOR

25-50mm DROP

RAMPSISOMETRIC VIEW

LEVER TYPETAP

SLOPE OF THE RAMP 1:12

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3.3.3 Guideline –SF 3-Water quality

Water provided in toilets for preschool children should be of acceptable quality

Water used for sanitation, cleaning floors and other surfaces need not be of such high quality as drinking water. However, acceptable quality (free of major contamination) should be maintained as water in toilets will be used for anal washing of young children as well. Rain water without disinfection may be acceptable if the rainwater catchment surface and storage tank are correctly operated.

3.3.4 Guideline –SF 4-Storage

Water should be stored appropriately in sufficient quantities

Figure 9: Water storage options for toilets without pipe borne water

Water is required for correct use and maintenance of toilets. Water should be stored in storage tanks (overhead or otherwise to create a sufficient water head for water fixtures to work properly - figure 9). Hand bidets provide the convenient access for water for anal washing. However, when such facilities

WATER SUPPLY SYSTEMS FOR TOILETSWHEN PIPE BORN WATER IS NOT AVAILABLE

MINIMUM HEIGHT1000-1500mm

STEPS

WATER TANK500L

WATER CAN BE FILLEDMANUALLY

HARVESTED RAIN WATERDIRECTED TO TANK

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are not possible due to technical reasons (inadequate pressure head), water buckets and cups with a handle can be provided in the toilets. Overhead or wall side water storage tanks may be appropriate when facilities are available to fill them by pumping or gravity. In other cases manual filling may be done. Storage tanks should be cleaned on a regular basis.

3.3.5 Guideline –SF 5-Water quantity (per person/day)

Water should be available in sufficient quantities at all times for flushing, and cleaning

Table 7: Quantities of water required in toilets (after UNESCO/WHO, 2009)

Nature of facilityMinimum water quantity (Liters per person per day)

Flushing toilets 10.0-20.0

Pour toilets 1.5-3.0

Anal washing 1.0-2.0

The water quantities shown in Table 7 may be used for planning and designing of water supply systems in preschools. The actual quantities of water required will depend on a number of factors such as climate, availability and type of water-use facilities and local water use practices.

3.3.6 Guideline – SF 6 - Water access points

Water access points should be constructed with age appropriate dimensions and conveniently located to be accessed by all including those with disabilities

Toilets should have convenient water access points inside and hand washing facilities outside with soap or suitable alternatives. Considering the very young age of the preschool children, it is preferable to use an appropriate flushing system. Pour flushing is an option, which reduces the water usage

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when compared with cistern flushing, however, preschool age children might find the former difficult to handle. The height of the tap located inside the toilet should be appropriate to the height of the preschool children (figure 7) while an accompanied bidet shower would help them to clean themselves easily, without spilling water.

3.3.7 Guideline – SF 7 - Access path ways when toilets are located outside the preschool building

Raised access pathways should be paved with suitable paving material to facilitate safe and convenient access to the toilet for all and in all weather conditions.

If the toilet is located outside the preschool building, access pathways should be provided. Access pathways from class rooms to the toilet can help to keep the toilet floor clean and dry without mud and sand, as well as avoiding wet toilets which can be slippery for children. Access pathways can be paved using suitable material (such as commercially available paving blocks, bricks, rubble etc.) and preferably cover with a simple roof for easy access during rain (figure 10).

Figure 10: Typical access pathways in preschool premises

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3.3.8 Guideline – SF 8 - Disposal of wastewater

Most appropriate wastewater disposal option would be a properly built and functioning sewer system. However, if such options are unavailable, next best option would be a properly designed septic tank with a soakage pit with or without infiltration trenches to dispose wastewater generated from toilets. All infiltration systems should be located at least 50 feet from the ground water source and at least 1.5 m above the ground water table to avoid contamination. The design and construction of septic tanks and associated effluent disposal systems should be carried out in accordance with SLS 745: Part 1:2004 (small systems) and 745: Part 2: 2009 (large systems).

3.3.9 Guideline – SF 9 - Operation and maintenance plans

Toilets should have adequate operation and maintenance plans to ensure the facilities are hygienic to use and functioning at all times.

A well-designed facility will lose its effect if it is not properly looked after. A good Operation and Maintenance (O&M) plan will not only indicate who is responsible for cleaning and maintenance but also the costs involved. Toilets have to be hygienic to use and easy to clean and should not become disease transmission centers. A proper cleaning and maintenance routine would ensure that clean and functioning toilets are available at all times. It is necessary to keep the toilet floors unsoiled to make the environment inviting for children. At least twice a day, all exposed surfaces should be cleaned with a disinfectant and a brush should be used to remove visible soiling. Strong disinfectants should not be used in large quantities as this is unnecessary and also may be a threat on indoor air quality related problems with young children. All toilet facilities need regular maintenance to make them functional at all times. A regular maintenance checklist should be maintained to ensure the proper functionality and necessary actions to be taken appropriately. (Table 4) Toilet facilities can be kept locked after school hours and vacations to prevent stray animals coming in and also any possible usage by outsiders.

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3.4 Summary

Table 8 summarizes how child-friendly water and sanitation concepts can be incorporated in preschool environments under three main themes as explained in sections from 3.1 to 3.3 under 21 guidelines (Drinking water-5 guidelines, Hand/Foot washing stations - 7 guidelines and Sanitation facilities – 9 guidelines).

Table 8: Summary of water and sanitation themes used for developing the guideline

1Drinking water (DW)Hand/foot washing stations (WS)

Sanitary facilities (SF)

1 -Water Quality

2 -Storage

3 -Water Quantity

(per person per day)

4 -Water access points

5 - Operation and

maintenance of the

drinking water facilities

1-Water quality

2-Storage

3-Water quantity

(per person per

day)

4-Water access points

5- Washing stand

fittings

6- Management of

wastewater

7- Operation and main-

tenance of the washing

stand facilities

1-Accessibility of toilets

2-Features of the facility

3-Water quality

4-Storage

5-Water Quantity

(per person/day)

6-Water access points

7-Access path ways when

toilets are located

outside the preschool

building

8-Disposal of wastewater

9-Operation and

maintenance plans

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4.0 Minimum standards and guidelines for hygiene in preschools

Hygiene means practices used to break the chain of infection transmission in the home and community environments. A preschool age child spends 3-4 hours in the preschool environment,hence the preschools can play a key role in a child’s life in relation to hygiene. They can be explained under three main concepts;

1. Ensure preschool children remain healthy by promoting hygienic practices in the preschool

2. Impart knowledge and skills related to hygiene by using age appropriate child friendly approaches and conducive environment.

3. Involve and motivate parents to ensure that preschool children implement similar hygienic practices at household level as well.

This section discusses hygienic practices and standards and guidelines relevant to the above three concepts under 2 main themes.

1. Hygienic practices related to the personal hygiene. 2. Hygienic practices related to the preschool environment

Hygiene and health goes with stimulations, opportunities for exploring and interactions with learning material, environment and role models. As young children learn by doing and enjoy learning new skills.

4.1 Hygiene practices related to personal hygiene (PH)

Personal hygienic aspects of preschool children such as hand washing, water/ food safety and medical hygiene should be promoted and taken care of at all times

Preschool children need to practice most personal hygiene activities (Table 9) by themselves and know negative and positive results of performing the practices. However, they have to be supervised by a caring adult. Parents and preschool teachers can make use of cleaning times to make children aware about why they should get used to cleaning themselves thoroughly and regularly. Once children understand reasons for a particular action as well as the benefits entailed, it becomes easier to establish healthy practices in them. Parent and preschool teachers should demonstrate how cleaning

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can be done in a correct manner that encourages children to do so on their own and praise them when they are successful.

Use of clean clothes and wearing appropriate foot wear is also important to prevent illnesses. Cloths can acquire various microorganisms when children play in classroom, outdoors or when they are in close contact with other children or adults who are suffering from contagious illnesses. Hence, clothes should be cleaned regularly. Wearing shoes can prevent transmission of hookworm infections and protect children from wounds, snake bites, etc..

Contaminated food and water are well known reasons for illnesses such as viral diarrhoea, dysentery, typhoid, and roundworm infections. Preschool children are particularly susceptible to these illnesses. Food and water can also be the vehicles through which various toxic substances such as arsenic, lead etc. enter the child’s body. Long term exposure to these substances can adversely affect the child’s development and result in subsequent health hazards such as cancers.

4.1.1 Guideline PH 1- Personal hygiene

Preschool children should enthusiastically accept and implement personal hygiene practices such as brushing teeth, cutting nails, regular washing of body and hair, face washing, hand washing, and wearing clean cloths, wearing shoes or slippers that keeps them out of common illnesses affected due to poor personal hygiene

• The actions related to the personal hygiene mostly occur at homes. The preschool teacher’s role would be to make children aware of these habits and instill a sense of need so that they adopt these hygienic behaviors at home. Imparting this kind of information to children requires the use of child friendly approaches such as games, storytelling, role play and participatory activities. For example use of indirect approaches such as discussing with children about the things that a large doll should do at home once the doll wakes up in the morning, can be expected to get the attention and enthusi-asm of children to these matters.

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• Parents should be motivated and made partners in this task. Teachers should organize awareness sessions with parents on personal cleanliness and other relevant hygienic measures should be continued at home, and request parents to supervise children regularly on maintaining their personal cleanliness at home.

• Preschool should have a dress-code (depending on the affordability for par-ents) and parents should be requested to ensure children are given clean clothes to wear to the preschool.

• Preschool teachers should inspect all children for personal cleanliness including hair, body, teeth and nails and discuss with parents and try to improve shortcomings.

• Children should be encouraged to wear shoes/ slippers whenever possible, especially those with wounded feet. Parents should be made aware of the benefits of regular wearing of shoes by children for prevention of worm infections.

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Table 9: Good hygienic practices

Part of the Body Hygiene practice

Hair and face • Washing face and hair with water and soap.• Use of the towel

Mouth

• Teeth and gums should be cleaned twice a day. • Use a brush, or a stick, or finger wrapped with a

piece of rough cloth.• If no toothpaste is available, use salt, charcoal or

just plain water.

Body • Bathe daily and wash the body with soap.• Change the clothes and underwear daily.

Hands • Wash both hands with soap/ash at critical times as

mentioned 4.1.2.• Cut nails and wash with soap.

Feminineand malehygiene

• Clean genitals and surrounding skin (for girl and boy) and wipe from front to back

• Drink water and urinate frequently

Feet • Wear shoes or slippers

4.1.2 Guideline PH 2- Hand hygiene

Preschool children should wash their hands with soap on regular basis in 5 occasions, while in the preschool and at home while preschool teachers should also set examples to children by adopting hand washing with soap in 9 occasions.

Preschool children are very active in the environment. As a result, they are constantly exposed to various types of microorganisms producing above illnesses. These germs are deposited on their cloths, skin and particularly

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on their hands. Of all parts of the body, the hand can be considered as the dirtiest. Hence, hand washing can be considered as one of the most effective healthy practices for preventing diarrhea and acute respiratory infections. Keeping nail tips short by regular trimming also helps to prevent oil, dirt and microbial organisms collecting under nail tips and therefore make hand-washing more effective.

• Make sure that children are aware of the need for hand washing with soap and motivated to wash hands at the following occasions:

1. Before eating 2. After using the toilet3. After blowing the nose, coughing, or sneezing4. After touching animals such as dogs , cats, cows, animal feed, or

animal waste5. After touching garbage and playing in outdoor with clay, mud or sand

• This can be organized by practicing and demonstrating hand washing with children while in the preschool and getting them to wash hands with soap by themselves. Displaying pictorial instructions and frequent reminders, praises for washing hands can reinforce the learning.

• Children should be encouraged and supervised while they wash their hands. Proper techniques of hand washing should be demonstrated to them by preschool teachers/parents until they grasp the concept adequately.

• To be effective, hand washing should be carried out in five simple steps (figure 11).

1. First step - wetting hands and applying soap. It is preferable to use running water rather than water collected in a bucket for hand washing. If taps are not available, another person should be present to pour water on the hands.

2. Second step - soap should be applied to the palms, back of the hands, between fingers, and under finger nails.

3. Third step - all surfaces of the hand should be scrubbed for minimum of 20 seconds.

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4. Fourth step - hands should be thoroughly rinsed with an adequate amount of clean running water to remove all soap.

5. Final step - a clean towel is used to dry hands. Using a dirty towel to dry hands will waste all the efforts made for washing hands. Using soap is very important in hand washing.

Figure 11. Correct hand washing steps

• Regular supply of soap for hand washing in preschools is important. Soap helps to dissolve the dirt, protein and natural oil on the skin surface. Microorganisms are usually attached to these substances and when soap is used it facilitates the removal of microorganisms along with these substances. If soap is not available wood ashes may be an alternative.

• It is also important that preschool teachers and any other adults (parents, helpers) attending preschool also wash hands, whenever they encounter above mentioned 5 occasions as well as they encounter the following occasions:

6.Before, during, and after preparing food, or milk for children, 7.Before and after caring for a child who is sick 8.Before and after treating a cut or wound of a child 9.After cleaning up a child who has used the toilet

It is important to have child friendly, water dispensing facilities are placed in all critical points such as near toilets, eating rooms, classrooms, garden or playing area etc. Guidelines for providing child friendly water dispensing facilities for washing are illustrated in section 3.2

(a)

(e) (f) (g) (h)

(b) (c) (d)

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4.1.3 Guideline PH 3- Water hygiene

In order to preserve health and promote development, children should consume adequate amount of safe water, adopt hygienic practices related to the prevention of water borne and water related diseases and be aware of the importance of water for life.

Use of boiled, cooled and filtered safe drinking water and practicing hand washing with soap before eating should be considered a mandatory practice in preschools. This can be done by boiling water for 1 minute and adding 1 minute per 1000 meters of elevation. and allowing to cool. Further details of how to obtain safe and good quality drinking water are explained in section 3.1.

• Drinking an adequate amount of fluids in the forms of water and other nutritional drinks is an essential requirement for a developing child. Water is required for maintaining metabolic processes, growth and other bodily processes. Hence, preschool teachers should have an understanding of the daily fluid requirement of the child. It is important to have understanding of the amount of fluid requirement of a child. Usually a child spends one third to half of his/her time awake in preschool. Hence, measures should be taken to ensure that child consume at least one third of its daily fluid requirement (in the form of water and other fluids) while in pre-school. The daily requirement of drinking fluid requirements for a preschool child can be varied from 1200 ml to 1500 ml depending on the age varying from 3 to 5 years, respectively.

• This can be simplified such as an average 300 ml, 400ml , and 500 ml of fluids either in forms of water, milk, or other drinks such as fruit juices should be drunk by preschool children in the 3rd , 4th and the 5th year respectively. Preschool teachers should monitor children to ensure that they take adequate amount of fluids.

• An adult should be there to offer drinking water to preschool children whenever they need it. Clean cups should be used for drinking water by children.

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• Preschool teachers should focus on the importance of water to life through child friendly educational approaches. Repeated focus and serving as models and discussions can be expected to ensure children will adopt positive attitudes on drinking adequate amount of safe clean water, using water for cleaning purposes and importance of preserving the water sources.

4.1.4 Guideline PH 4- Food safety

An adequate amount of safe and nutritionally sound food should be consumed by preschool children

• If the food is brought from home, guidelines/menus regarding the type and amount of food should be prepared for parents. This should be prepared to cover the basic nutritional requirements of the preschool aged child. The menu should allow sufficient options so that a choice is available for parents and menu items should reflect the locally available foods. It is recommended to get the advice of the area Public Health Midwife (PHM) and Medical Officer of Health (MOH) on the nutritional requirements and prepare nutritionally and culturally appropriate menus.

• The preschool should organize a training/awareness for parents on the food hygiene and nutrition at the beginning of each year of enrolment.

• If the food is prepared in the preschool, several important guidelines should be observed;

1. Persons who prepare the food should be aware of the food safety measures.

2. Food should be cooked in a freshly cleaned and air dried utensils. 3. Food items should be thoroughly washed before cooking. 4. Measures should be taken to prevent flies, vermin or pets coming in

contact with food items and utensils. 5. Water taken from a safe source such as protected well or public

water supply should be used for cooking. 6. If raw food such as vegetable salad, fruit are to be given they should

be cleaned using boiled cooled/filtered water. 7. The pantry surfaces where the food is kept should be daily cleaned

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using soap and water and dried using a clean piece of cloth. This cloth should be daily washed.

8. Flies, other vermin, dogs and cats and any other pet should be kept away from food preparation and storage areas.

9. Cooked and raw food items should not touch each other. Prepared food should always be kept in closed containers.

10. Food preparation time should be arranged so that prepared food is not spoiled by the time children consume it. Parents should also be advised on this and organize measures to prevent food being spoiled before consumption.

• Food brought from home should be collected and kept in a separate place, where they can be covered and kept safely. Teachers should make sure food containers of different children are tagged so that they can be identified later.

• Food plates and cups used for children should be cleaned daily using boiled cool water and air dried and stored in a place free of flies and dust.

• Regular meal times should be set up for children and these mealtime should be made to be interactive discussions where the teacher and children discuss various nutritional attributes of food and relevant healthy practices. This kind of child friendly approach indirectly supports the improvement of child’s knowledge and attitudes of food and establish health practices related to food hygiene.

• It is very important to get all children to wash hands with soap under supervision and demonstration by teachers before every meal.

• Children should not be allowed to eat or share food with pets.

• Arrangements should be made to place waste bins for disposing food wastes separately. Children should be allowed to dispose remaining food items in waste bins by themselves in order to improve their practices.

• Preschool teachers should be aware of food allergies of children and be vigilant that such children do not consume the food concerned.

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• Children should not be left alone while they take their meals and should be supervised by their teachers.

• Persons, who have illnesses such as diarrhea, respiratory tract infections, and wounds should not serve food for preschool children.

4.1.5. Guideline PH 5- Toilet hygiene

Preschool children and staff have sufficient access to hygienically maintained toilets and follow correct hygienic practices

• Children should be encouraged to wash their hands using soap and water after defecation, even if they do not engage in anal cleansing. This will promote the establishment of their hand washing behaviors and clean their hands free of germs collected by touching toilet surfaces such as door handles.

• A preschool teacher or a helper should be present when the child is using the toilet to undress, and clean the child after defecation (and hand cleansing). Care should be taken to remove cloths carefully and hang them to prevent contamination in the toilet.

• Adults helping the child to use toilet should also wash their hands with soap and water after the task. They should take care in disposing feces in to the toilet and flushing.

• The toilet should be flushed and if any spilling has occurred the toilet floor should be cleaned and disinfected immediately.

• In addition, toilets should be cleaned at least twice a day, ideally after break and after closing or before starting. The floors should be flushed with water, antiseptic solutions applied for a stipulated time and then flushed with water again. Toilets should be free of materials such as debris and cobwebs that scare children or promote the breeding of mosquitoes, cockroaches etc..

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4.2 Hygienic practices related to preschool environment (PE)

Standard – Pre-school children be given access to safe sanitation facilities, class rooms, play areas, garden, and the preschool premises be appropriately maintained to promote preschool child’s health.

• This section focused on the most common environmental hygiene related issues to be handled in Sri Lankan Preschools.

• Preschool classrooms should be regularly cleaned and disinfected, the furniture and other equipment should be organized in a manner that facilitates the free movements of children without the likelihood of injury. Classrooms should be adequately spaced, ventilated and lighted, and furnished with child friendly furniture.

• Preschool garden (play areas, other areas) should be well cleaned and free of waste collections and other debris. Possible breeding places for mosquito should be regularly monitored specially during the dengue peaks (after monsoon seasons) and cleaning campaigns should be organized with parents/parent committees. The garden should be free from the risk areas and objects that pose a risk of injury or accidents to children. For example, the garden should not have unprotected wells, coconut trees that are not harvested recently and therefore pose a risk of falling coconuts, dilapidated buildings that might collapse etc.. Preschool garden should be fenced so that children cannot go out of it while playing or be exposed to road traffic or to a rail road unsupervised. There should not be stray pets, cats, cattle, dogs in the preschool premises.

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4.2.1 Guideline PE 1-Preschool premises and staffing

The preschool should provide a child friendly, sufficiently spaced, lighted and ventilated premises and be staffed adequately

• The minimum indoor free play space determines the number of children that can be accommodated in a preschool. Free play area is the space available in the preschool building excluding the area accommodated by non-movable equipment’s such as cupboards, and fitted furniture. The area, where children’s tables and chairs are placed is considered as a part of the free play area. The minimum free space that should be available for a child is as indicated in table 10.

Table 10: The minimum free space and staff requirement for preschool age children

Age of the child (years)

Space requirement (sq. meters)

Staff to student ration

2-3 3 1:8

3-4 2 1:10

4-5 2 1:15

• For example, according to table 10, if a preschool has 30 children, then this

preschool premises indoor free play area should be about 70 sq. meters. • Preschool premises should be decorated with child friendly pictures drawn

or pasted on walls. Play areas should be well equipped to stimulate indoor activities that promote development and mental wellbeing of children.

• Preschool should have adequate trained staff to attend to children. The recommended number of trained staff is as table 10. The minimum number of trained staff in a preschool should not be less than 2 at any time.

• The premises and classroom should be designed to access the maximum natural light as possible. However, if the natural light is not adequate artificial lights should be used.

• There should be good ventilation within the premises. The windows and doors should be kept opened so that adequate ventilation is maintained in

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the class. Measures should be taken to prevent the dust or smoke entering the classrooms.

4.2.2 Guideline PE 2- Cleanliness of premises

Preschool premises should remain free of dust, disease causing organisms, and debris and therefore create a pleasant comfortable and healthy environment that promotes play and learning

All indoor sections such as play area, pantry, and office rooms of the preschool should be cleaned on daily basis. Furniture should be cleaned to remove dust using a wet cloth or if available using a vacuum cleaner. The desk and tables should be kept in order, when the preschool starts. Children should have designated places to keep their bags and play items. The meal containers if brought from home should be collected by the teachers and kept in a separate place.

Children should be trained and encouraged to keep the play items in neat order after the tasks. Teachers should demonstrate, explain the need of being tidy and praise the children to encourage the behavior. The garden and outdoor play areas should be cleaned daily. All the leaves, debris, stones, pieces of wood, should be removed before children arrive in the morning.

There should be proper arrangements to collect, separate and dispose food waste, garden waste, polythene, glass, paper and plastic appropriately. Using waste pit, burying, composting and handing over to local garbage collection systems should be considered depending on the context. The safety of children should always be considered in deciding methods of collection, storing and disposal.

Arranging outdoor play area, creating flowerbeds etc. can be carried out to make the preschool environment attractive and pleasant for children for outdoor activities.

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4.2.3 Guideline PE 3- Safety of preschool premises

Preschool teachers should regularly inspect the entire area of the preschool premises and garden where children spend time for potential risks associated with accidents.

Potential threats in the preschool building include: unprotected electrical wires jutting out of plug points, goods kept on cupboards or unsteady furniture that might fall if a child tries to reach them, threateningly positioned furniture edges, or other equipment which a running child might collide against, sharp edges in the building that might cause injury to a child if fallen against, hot water containers that can be accessed by children, book or other equipment collections that are arranged in disorganized manner that might harbor snakes, any sharp objects such as knives, or outdoor equipment kept unlocked, pesticides, disinfectants, drugs, or fertilizer solutions brought for garden that can be accessed by children.

If found in regular inspection these items should be removed or stored properly so that potential dangers associated with them are removed. Similar inspections should be carried out in the play areas and in the garden. Potential threats in these areas include: Broken play instruments such as swings that might break while the child is using them, stone collections, abandoned equipment, sharp instrument or timber parts which might injure children if they try to play with them or go over them, unprotected wells and coconut trees in the garden, trees having easily broken branches, and mosquito breeding places. If found immediate measures should be taken to remove these items and make the environment safe.

Equipment and machinery should not be placed in the preschool garden. Children might try to use them and be injured. Preschool premises should be fenced or secured with a parapet wall to prevent children running out of it unsupervised. These measures are important to prevent unsupervised children accessing road traffic, rail roads etc.. It makes it easier to ensure the security of children when they play outdoors.

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Children should not be allowed to communicate with outside people and buy any food items from external suppliers while in preschools.

4.2.4 Guideline PH 4- Medical hygiene

Preschool teachers should be aware of and competent in handling medically challenging situations

Sometimes preschool teachers have to attend to sick children. Children who have infectious diseases have to be isolated from other children and preschool teachers should take prompt action to inform their parents and obtain medical attention for sick children. Preschool teachers should be aware of first aid management of common problems such as wheezing, allergic conditions, cut or wounded children and be ready with required responses. Preschool teacher should also be aware of the health condition of every preschool child who attends her/his preschool and be ready to implement appropriate actions if the child develops any medical problem, in collaboration with parents.

Preschool teachers should be knowledgeable and skilled to handle the occasional medically challenging conditions such as fever, diarrhea, wheezing attacks, fits, injury, snake, dog or cat bites etc. Until the parents are informed and the child is referred to a medical institution. Preschools should maintain a register of contact persons (parents/hospital/police) and telephone numbers who may have to be contacted in situations of emergency.

Individual notes have to be maintained for each child with chronic conditions such as wheezing and fits. These notes should be prepared after consultation with parents and if any drugs or devices are needed to handle medical conditions (e.g. drugs , inhalers) they should be kept under the custody of teachers. Preschool teachers should acquire a clear understanding and skills in using them by consulting and discussing with parents. The drugs and devices should be checked for their expiry dates and parents should be asked to renew supplies accordingly.

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Preschool teachers should be aware of, and skilled in supporting children with disabilities. Parents’ advices should be obtained in this regard at the time of enrolment.

Preschool should have facilities to prepare Oral Rehydration Salts (ORS) solutions and if any child develops diarrhea, and have to be kept until parents arrives, children with diarrhea should be offered ORS. If a child develops diarrhea and uses toilet, the toilet should be cleaned using disinfectants before other children use it subsequently. All surfaces (e.g. toilet sheets, door handles, bucket) that come to contact with sick child should be cleaned and disinfected. Children with fever and running nose should be kept away from other children and parent should be informed and requested to keep them home and treated until they recover. This is very important to prevent the spread of illness among other children.

First aid kits should be available in each preschool. The components of it should be regularly checked for date of expiries and diminished contents. Preschool teachers should be aware of basic first aid techniques such as arresting bleeding, handling fits, mouth to mouth resuscitation.

Preschool teachers should also be aware of characteristics, options available, common conditions that requires for them to be given extra care. These conditions include: vision and hearing problems, Cerebral palsy, Autism, learning disorders, ADHD, Epilepsy. This knowledge can help preschool teachers to identify these problems early and advice parents to obtain relevant medical attention. Such knowledge also help them to adapt the preschool educational inputs accordingly.

4.3 Summary

Table 11 summarizes how child-friendly hygienic concepts can be incorporated in pre-school environments under two main themes as explained in sections from 4.1 to 4.2 under 9 guidelines (personal hygiene-6 guidelines and environment hygiene - 3 guidelines).

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Table 11: Matrix for incorporation of child-friendly water and sanitation concepts under main themes

*H

ygie

nic

co

nce

pts

Hygienic practices themes Hygienic practices themes

Personal hygiene Environment hygiene

General hygiene

Hand hygiene

Water hygiene

Food safety

Medical hygiene

Toilet hygiene

Trained staff

Premise cleanliness

Premise safety

1 √ √ √ √ √ √ √ √ √

2 √ √ √ √ √ √

3 √ √ √ √ √ √

*Hygienic concepts

1. Ensure preschool children remain healthy by promoting hygienic practices in the preschool

2. Impart knowledge and skills related to hygiene by using age appropriate child friendly approaches and conducive environment.

3. Involve and motivate parents to ensure that preschool children implement similar hygienic practices at household level as well.

69

Table 11: Matrix for incorporation of child-friendly water and sanitation concepts under main themes

*H

ygie

nic

co

nce

pts

Hygienic practices themes Hygienic practices themes

Personal hygiene Environment hygiene

General hygiene

Hand hygiene

Water hygiene

Food safety

Medical hygiene

Toilet hygiene

Trained staff

Premise cleanliness

Premise safety

1 √ √ √ √ √ √ √ √ √

2 √ √ √ √ √ √

3 √ √ √ √ √ √

*Hygienic concepts

1. Ensure preschool children remain healthy by promoting hygienic practices in the preschool

2. Impart knowledge and skills related to hygiene by using age appropriate child friendly approaches and conducive environment.

3. Involve and motivate parents to ensure that preschool children implement similar hygienic practices at household level as well.

70

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