Effective Date of Rule: Immediately.

     Purpose: The department of early learning (DEL) is amending WAC 170-151-230 School-age child care centers, 170-295-3060 Child care centers and 170-296-0870 Family home child care, regarding the use of hand sanitizer gels with children in DEL-licensed child care. The emergency rules would allow licensed child care providers to administer "over-the-counter" hand sanitizer gels with children over twelve months of age after obtaining written authorization from the child's parent or guardian. This filing continues the emergency rules filed on October 22, 2009, as WSR 09-22-011.

     Citation of Existing Rules Affected by this Order: Amending WAC 170-151-230, 170-295-3060, and 170-296-0870.

     Statutory Authority for Adoption: RCW 43.215.200.

     Other Authority: Chapter 43.215 RCW.

     Under RCW 34.05.350 the agency for good cause finds that immediate adoption, amendment, or repeal of a rule is necessary for the preservation of the public health, safety, or general welfare, and that observing the time requirements of notice and opportunity to comment upon adoption of a permanent rule would be contrary to the public interest.

     Reasons for this Finding: Continuation of these emergency rules is needed while DEL completes the permanent rule-making process. A CR-101 preproposal notice was filed as WSR 09-22-012, and the department continues to solicit recommendations on draft rules from health professionals, child care providers, parents and the public. DEL anticipates filing proposed rules, holding public hearings, and adopting the permanent rules in spring 2010.

     The rule is needed to protect the health and safety of children in DEL-licensed child care. Controlling the spread of potentially pandemic influenza - such as the H1N1 flu virus - remains a statewide, national and worldwide concern. According to the federal Centers for Disease Control and Prevention (CDC), in 2009 children under five years old had the highest hospitalization rate for H1N1 influenza nationwide, and in 2009 this age group had the second highest rates of H1N1 infection overall. The CDC also notes that children under two years old also face a highest risk of severe complications from seasonal flu viruses.*

     If used when hand washing with soap and warm water is not available, alcohol-based hand sanitizer gels are considered effective in limiting the spread of viruses and bacteria. However, the current DEL child care licensing rules present a barrier to using hand sanitizing gels.

     Alcohol-based hand sanitizer gels are regulated by the United States Food and Drug Administration as over-the-counter (OTC) drugs. Under DEL rules, OTC drugs are considered "nonprescription medications." The current rules list specific nonprescription medications that may be administered in DEL-licensed child care with parent or guardian written permission. The lists do not include hand sanitizing gels. The licensee must obtain a physician's written authorization - specific to each child - before allowing the child to use hand sanitizer gels. The emergency rules would permit use of hand sanitizer gels to children over twelve months old with the child's parent or guardian written permission.

     The World Health Organization (WHO) on February, 5 2010** reported that although the incidence of H1N1 flu is declining, almost half of the H1N1 deaths worldwide have occurred in North and South America. The United States is among the countries where the WHO considers the H1N1 virus to remain "widespread." WHO is continuing the worldwide Phase 6 pandemic alert for the H1N1 influenza virus issued in June 2009. The Washington state department of health has filed emergency rules (WSR 10-03-053, filed January 15, 2010) requiring heightened surveillance of H1N1 cases statewide, and DOH has urged DEL to revise its rules on an emergency basis regarding the administration of alcohol-based OTC hand sanitizer in DEL-licensed child care facilities during the current outbreak of H1N1 and other seasonal influenza.

     *Source: "Technical Report for State and Local Public Health Officials and Child Care and Early Childhood Providers on CDC Guidance on Helping Child Care and Early Learning Programs Respond during the 2009-2010 Influenza Season." Centers for Disease Control and Prevention. September 4, 2009.

     **Source: "Pandemic (H1N1) 2009 - Update 86" World Health Organization. Weekly Update - February 5, 2010, http://www.who.int/csr/don/2010_02_5/en/index.html.

     Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 0, Amended 0, Repealed 0; or Recently Enacted State Statutes: New 0, Amended 0, Repealed 0.

     Number of Sections Adopted at Request of a Nongovernmental Entity: New 0, Amended 0, Repealed 0.

     Number of Sections Adopted on the Agency's Own Initiative: New 0, Amended 3, Repealed 0.

     Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 0, Amended 0, Repealed 0.

     Number of Sections Adopted Using Negotiated Rule Making: New 0, Amended 0, Repealed 0;      Pilot Rule Making: New 0, Amended 0, Repealed 0; or Other Alternative Rule Making: New 0, Amended 3, Repealed 0.

     Date Adopted: February 17, 2010.

Dr. Elizabeth M. Hyde

Director

OTS-2705.1

AMENDATORY SECTION(Amending WSR 06-15-075, filed 7/13/06, effective 7/13/06)

WAC 170-151-230   What requirements must I meet for medication management?   You may have a policy of not giving medication to the child in care. If your center's health care plan includes giving medication to the child in care, you:

     (1) Must give medications, prescription and nonprescription, only on the written approval of a parent, person, or agency having authority by court order to approve medical care;

     (2) Must give prescription medications:

     (a) Only as specified on the prescription label; or

     (b) As authorized, in writing, by a physician or other person legally authorized to prescribe medication.

     (3) Must give the following classifications of nonprescription medications, with written parent authorization, only at the dose, duration, and method of administration specified on the manufacturer's label for the age or weight of the child needing the medication:

     (a) Antihistamines;

     (b) Nonaspirin fever reducers/pain relievers;

     (c) Nonnarcotic cough suppressants;

     (d) Decongestants;

     (e) Anti-itching ointments or lotions, intended specifically to relieve itching;

     (f) Diaper ointments and powders, intended specifically for use in the diaper area of the child; ((and))

     (g) Sun screen; and

     (h) Hand sanitizers.

     (4) Must give other nonprescription medication:

     (a) Not included in the categories listed in subsection (3) of this section; or

     (b) Taken differently than indicated on the manufacturer's label; or

     (c) Lacking labeled instructions, only when disbursement of the nonprescription medication is as required under subsection (4)(a), (b), and (c) of this section:

     (i) Authorized, in writing, by a physician; or

     (ii) Based on established medical policy approved, in writing, by a physician or other person legally authorized to prescribe medication.

     (5) Must accept from the child's parent, guardian, or responsible relative only medicine in the original container, labeled with:

     (a) The child's first and last names;

     (b) The date the prescription was filled; or

     (c) The medication's expiration date; and

     (d) Legible instructions for administration, such as manufacturer's instructions or prescription label.

     (6) Must keep medication, refrigerated or nonrefrigerated, in an orderly fashion and inaccessible to the child;

     (7) Must store external medication in a compartment separate from internal medication;

     (8) Must keep a record of medication disbursed;

     (9) Must return to the parent or other responsible party, or must dispose of medications no longer being taken; and

     (10) May, at your option, permit self-administration of medication by a child in care if:

     (a) The child is physically and mentally capable of properly taking medication without assistance;

     (b) You include in the child's file a parental or physician's written statement of the child's capacity to take medication without assistance; and

     (c) You have stored the child's medications and other medical supplies so the medications and medical supplies are inaccessible to other children in care.

[06-15-075, recodified as § 170-151-230, filed 7/13/06, effective 7/13/06. Statutory Authority: Chapter 74.15 RCW and RCW 34.05.395. 02-13-073, § 388-151-230, filed 6/14/02, effective 7/15/02. Statutory Authority: RCW 74.15.020. 01-02-031, § 388-151-230, filed 12/22/00, effective 1/22/01. Statutory Authority: Chapter 74.15 RCW. 93-02-020 (Order 3493), § 388-151-230, filed 12/30/92, effective 1/30/93.]

OTS-2706.1

AMENDATORY SECTION(Amending WSR 06-15-075, filed 7/13/06, effective 7/13/06)

WAC 170-295-3060   Who can provide consent for me to give medication to the children in my care?   (1) Parents must give written consent before you give any child any medication. The parent's written consent must include:

     (a) Child's first and last name;

     (b) Name of medication;

     (c) Reason for giving medication;

     (d) Amount of medication to give;

     (e) How to give the medication (route);

     (f) How often to give the medication;

     (g) Start and stop dates;

     (h) Expected side effects; and

     (i) How to store the medication consistent with directions on the medication label.

     (2) The parent consent form is good for the number of days stated on the medication bottle for prescriptions. You may not give medication past the days prescribed on the medication bottle even if there is medication left.

     (3) You may give the following medications with written parent consent if the medication bottle label tells you how much medication to give based on the child's age and weight:

     (a) Antihistamines;

     (b) Nonaspirin fever reducers/pain relievers;

     (c) Nonnarcotic cough suppressants;

     (d) Decongestants;

     (e) Ointments or lotions intended to reduce or stop itching or dry skin;

     (f) Diaper ointments and nontalc powders, intended only for use in the diaper area; ((and))

     (g) Sun screen for children over six months of age; and

     (h) Hand sanitizers for children over twelve months of age.

     (4) All other over the counter medications must have written directions from a health care provider with prescriptive authority before giving the medication.

     (5) You may not mix medications in formula or food unless you have written directions to do so from a health care provider with prescriptive authority.

     (6) You may not give the medication differently than the age and weight appropriate directions or the prescription directions on the medication label unless you have written directions from a health care provider with prescriptive authority before you give the medication.

     (7) If the medication label does not give the dosage directions for the child's age or weight, you must have written instructions from a health care provider with prescriptive authority in addition to the parent consent prior to giving the medication.

     (8) You must have written consent from a health care provider with prescriptive authority prior to providing:

     (a) Vitamins;

     (b) Herbal supplements; and

     (c) Fluoride.

[06-15-075, recodified as § 170-295-3060, filed 7/13/06, effective 7/13/06. Statutory Authority: Chapters 74.12 and 74.15 RCW. 03-14-110, § 388-295-3060, filed 6/30/03, effective 8/1/03.]

OTS-2707.1

AMENDATORY SECTION(Amending WSR 06-15-075, filed 7/13/06, effective 7/13/06)

WAC 170-296-0870   How do I manage medications for children?   You must meet specific requirements for managing prescription and nonprescription medication for children under your care. Only you or another, primary staff person may perform the functions described in this section.

     (1) You must have written approval of the child's parent or legal guardian to give the child any medication. This approval must not exceed thirty days.

     (2) You must:

     (a) Keep a written record of all medications you give a child;

     (b) Return any unused medication to the parent or legal guardian of the child;

     (c) Give certain classifications of nonprescription medications, only with the dose and directions on the manufacturer's label for the age or weight of the child needing the medication. These nonprescribed medications include but are not limited to:

     (i) Nonaspirin, fever reducers or pain relievers;

     (ii) Nonnarcotic cough suppressants;

     (iii) Decongestants;

     (iv) Anti-itching ointments or lotions intended specifically to relieve itching;

     (v) Diaper ointments and talc free powders intended specifically for use in the diaper area of children; ((and))

     (vi) Sun screen; and

     (vii) Hand sanitizers for children over twelve months of age.

     (3) You must not administer any nonprescribed medication for the purpose of sedating a child;

     (4) You must not administer any prescribed medication in an amount or frequency other than that prescribed by a physician, psychiatrist or dentist;

     (5) You must not give one child's medications to another child; and

     (6) You must not use any prescribed medication to control a child's behavior unless a physician prescribes the medication for management of the child's behavior.

[06-15-075, recodified as § 170-296-0870, filed 7/13/06, effective 7/13/06. Statutory Authority: RCW 74.08.090, 74.15.030, chapters 74.12 and 74.15 RCW. 04-18-082, § 388-296-0870, filed 8/31/04, effective 10/1/04.]

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