Under State Licensing requirements, childcare operators must prevent infectious disease with required disinfection and sanitizing for specific operations. In practice, this has led to the frequent use of bleach, often in an over-concentrated dilution. The state’s occupational asthma surveillance has 72 confirmed cases of work-related asthma associated with bleach exposure. Of those confirmed cases that the program can classify, 38% are new onset asthma.

A 2008 child care stakeholder meeting convened by a childcare quality assurance group in San Francisco, Gateway to Quality, determined that all participants wanted safer, less toxic commercial products that comply with state childcare licensing requirements for disinfection. California’s Strategic Plan for Asthma also calls for the promotion, education and enforcement of regulations that address asthma management and indoor air quality issues in child care.

The San Francisco Asthma Task Force (SFATF) has made substantial headway in undertaking the challenge of supporting child care providers in reducing the overuse of bleach to meet infection control requirements. The SFATF received funding from CAFA and the San Francisco Foundation to support information gathering and a pilot project entitled “Reducing the Overuse of Bleach & Introducing Alternative Products in Childcare Settings.” The primary goals of the project are to (1) Reduce the overuse of bleach and identify acceptable bleach alternatives for disinfection requirements; (2) Promote sanitizing and disinfecting methods that reduce human exposure to asthma triggers.

With the support of Breathe California, Golden Gate Public Health Partnership, the San Francisco Department of Public Health Children’s Environmental Health Promotion (CEHP) division has taken the lead on this initiative. Two project consultants from CEHP led the effort with childcare operators and coordinated feedback from our stakeholder team. An environmentally preferable purchasing consultant on contract to the San Francisco Department of the Environment investigated alternative disinfectant products. The findings to date are as follows:

–Convened a work group of key stakeholders as partners and obtained consensus on protocols, sites and materials to be used for pilot testing;

–Observed many deficiencies and irregularities in current cleaning, sanitizing and disinfecting practices in a representative sampling of childcare settings, including the over-concentration of bleach for disinfecting;

–Analysis of CA Childcare Licensing Regulations for disinfecting, in relation to American Academy of Pediatrics Caring for Our Children Guidelines, ECERS scale used by Gateway to Quality assessors and EPA pesticide registration labels for bleach products such as Clorox brand bleach indicates inconsistent and unclear guidance being provided to childcare operators;

–Identified enhanced methods for accuracy of bleach dilutions that would reduce the overuse of bleach, such as portion-controlled pumps for concentrate and timers for disinfectant dwell times;

–Engaged Department of Public Health Childcare Health Consultant Program nurses in reviewing educational materials to be used for pilot testing, including trilingual training materials (English, Spanish and Chinese), a project orientation slideshow and illustrated placards showing product use within the childcare operation;

–Identified asthma-safe alternatives to bleach that are EPA-registered disinfectants appropriate to the specific applications needed in childcare settings, and are beginning to test their ease of use at 7 sites for childcare operators.

–By the end of this first year we hope to better understand which options are most feasible and practical for child care sites to implement.

The pilot project will have a direct impact on the successful work we are doing with San Francisco Unified School District (SFUSD) to support their transition to green custodial cleaning products and practices. With the support of City funds and commitment of SFUSD Custodial management, SFATF procured washing machines and micro fiber mops for over 46 schools who are piloting the use of Alpha HP to replace the majority of their custodial cleaning products. Outcomes of the childcare pilot will allow us to better recommend alternatives to bleach overuse that can support SFUSD’s full transition to green custodial cleaning products for all schools and child development centers.

We look forward to releasing our final report to include recommendations for reducing the overuse of bleach. We will build on that partnership’s momentum and success to create a sustainable model for training child care providers and supporting their implementation of the project recommendations for asthma-safe disinfection practices. Our hope is to expand upon this project and that a broad group of local, regional and statewide asthma and childcare partners will be engaged in advocating for changes in State policy and regulation that will best support asthma-safe disinfection practices in the near future.

For more information and to review materials developed so far from this project please visit our website at //www.sfgov.org/asthma and select “Our Work” and then select “In Child Care Settings.”

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