Thursday, September 10, 2020

Free CMV training includes OSHA Advisories in Child Care/Educational Settings (also helps reduce transmission of coronavirus)


Lisa Saunders, a licensed childcare provider, learned she was putting her pregnancy at increased for cytomegalovirus (CMV) after her daughter Elizabeth (seen above) was born with microcephaly, a small damaged brain, in 1989. 

Dear Employer/Policy Maker/Workers Union/Infection Prevention Trainer/Legislator:

Below you will find links to free workshops and flyers to help you educate your Childcare Workers/Educators about CMV. OSHA's action regarding CMV in the workplace is found at: Congenital CMV is the most common infectious cause of birth defects in the U.S. according to the Centers for Disease Control and Prevention (CDC).

CMV is often spread by toddlers--especially those in a group care setting--to each other, their child care providers and families. The CDC states: “The saliva and urine of children with CMV have high amounts of the virus. You can avoid getting a child’s saliva in your mouth by, for example, not sharing food, utensils, or cups with a child. Also, you should wash your hands after changing diapers. These cannot eliminate your risk of getting CMV, but may lessen the chances of getting it” (

Licensed child care facilities already teach effective sanitizing techniques, but those methods can only reduce the transmission of CMV if workers are motivated to follow them--like I would have been less inclined to save time by wiping away saliva with diaper wipes if I had known my pregnancy was at increased risk for CMV. Nellie Brown, MS, CIH, Certified Industrial Hygienist, and Director, Workplace Health and Safety Program, Worker Institute, Cornell University – ILR School, states,  “I think that it is important to note that there is value to paying attention to the procedures we use to prevent CMV transmission – they will help to lower our risk for other diseases, too, including coronavirus, SARS-CoV-2.” Brown is the author/presenter of the new workshop for employers, "Occupational Exposure to Cytomegalovirus (CMV): Preventing Exposure in Child Care and Educational Settings, Including OSHA Advisories".

The American Academy of Pediatrics states in Caring for Our Children: National Health and Safety Performance Standards; Guidelines for Early Care and Education Programs,: "Female employees of childbearing age should be referred to their primary health care provider or to the health department authority for counseling about their risk of CMV infection. This counseling may include testing for serum antibodies to CMV to determine the employee’s immunity against CMV infection…it is also important for the child care center director to inform infant caregivers/teachers of the increased risk of exposure to CMV during pregnancy” (Standard Staff Education and Policies on Cytomegalovirus (CMV), modified 3/31/17,

Potential Cost of Not Warning Workers about CMV:

In New South Wales, “a childcare worker and her severely disabled son were awarded $4.65 million. A Court of Appeal ruled that the child's disabilities resulted from the woman being infected with cytomegalovirus (CMV) at work (Hughes v SDN Children's services 2002)” (Queensland Government, Australia, 2017). Meridian Lawyers of Australia stated: "The allegations of negligence were that Sydney Day Nursery breached its duty of care to Linda failing to warn her of the risks of CMV in circumstances where the centre knew or ought to have known of the risks of CMV to pregnant women…" (Suggested policy of Meridian Lawyers of Australia found at:

Please make the following free resources available to your directors/workers:


Centers for Disease Control and Prevention (CDC):

“CMV Fact Sheet for Pregnant Women and Parents



National CMV Foundation:

Flyers on several CMV related topics at:

One I recommend for classroom walls: “Are You Pregnant?”:


For Employers: Nellie Brown’s presentation is available as the following:

  1. Publication: "Brown, N. J. (2019, November). Occupational exposure to cytomegalovirus (CMV): Preventing exposure in child care and educational settings, including OSHA advisories. Ithaca, NY: Cornell University, ILR School. Available from:
  2. Vimeo:
  3. Download video workshop:

For Caregivers/Teachers/Educators: "CMV Training Module Video": (This work was supported by the AUCD and the LEND Pediatric Audiology Program made possible through a Cooperative Agreement with the Health Resources and Services Material Child Health Bureau (MCHB) grant awarded to the University of Connecticut A.J. Pappanikou Center for Excellence in Developmental Disabilities (Grant #3T73MC30115-01-01) in consultation with Child Care Providers Education Committee from the National CMV Foundation).


"There is more than one ‘C virus’ out there. It's called cytomegalovirus or CMV,” says Gail J. Demmler-Harrison, MD, Professor, Baylor College of Medicine. A pediatric infectious diseases expert with over 30 years experience and expertise in diagnosis and management of children with congenital CMV at Texas Children’s Hospital,  Dr. Demmler-Harrison states: "Congenital CMV continues to be the most common congenital viral infection in this country, affecting thousands of babies each year, year after year, and it is a common cause of hearing loss, vision loss, and disabilities in our children."  In her article,“CMV In Pregnancy: What Should I Know?”, she writes, “Approximately 1-4% of all pregnant women will experience a primary CMV infection during their pregnancy. If you work in a child care setting, the risk increases to approximately 10%. If you have a toddler at home who is actively infected with CMV and shedding CMV in their saliva or urine, the risk is even higher, approaching 50% in some studies” (Texas Children’s Hospital, 2014). (Watch/read her interview in the New York Times article, 

CMV Is a Greater Threat to Infants Than Zika, but Far Less Often.



I am a former licensed in-home child care provider who was unaware of my occupational risk for CMV until it was too late to help my daughter, Elizabeth, born severely disabled by congenital CMV. Surveys show that most child care providers do not know about CMV and many acknowledge using diaper wipes to clean (Thackeray and Magnusson, 2016). Diaper wipes do not effectively remove CMV from hands (Stowell et al., 2014). I helped Connecticut to pass a CMV testing law in 2015.

Thank you in advance for protecting the unborn children of your workers! 


Lisa Saunders

Baldwinsville, New York

PSA: "Had I known (about CMV)  

Learn more about Lisa: Cornell Alumni MagazineIn Memory of Elizabeth: Her daughter's death from a preventable disability spurs Lisa Avazian Saunders '82 into action (2015)

Lisa is the author of:    

  1. Help Childcare Providers Fight CMV: Protect Newborns from #1 Birth Defects Virus
  2. Once Upon a Placemat--A Table Setting Tale: Coloring Book and CMV Prevention Tool
  3.  Anything But A Dog!: The Perfect Pet For A Girl With Congenital Cmv  


The Child Care and Development Block Grant Act of 2014 has created regulatory changes. The Administration for Children and Families published Caring for our Children Basics (based on Caring for Our Children) in 2015 to “align basic health and safety efforts across all early childhood settings." In the section, “Prevention of Exposure to Blood and Body Fluids,” it states: “Caregivers and teachers are required to be educated regarding Standard Precautions [developed by CDC] before beginning to work in the program and annually thereafter. For center-based care, training should comply with requirements of the Occupational Safety and Health Administration (OSHA).”

The book, Model Child Care Health Policies, includes a sample document to be signed by staff (paid or volunteer) to show “Acceptance of Occupational Risk by Staff Members,” which includes “exposure to infectious diseases (including infections that can damage a fetus during pregnancy)” (p. 116). (Available as pdf at: )   Model Child Care Health Policies states that programs should describe their commitment “to best practice, as indicated in CFOC3 [Caring For Our Children 3rd Edition, which includes CMV education]...A policy might specify intended compliance with accreditation standards, such as those of the National Association for the Education of Young Children (NAEYC) ( [which mentions CMV as an “occupational hazard”] for center-based care or the National Association for Family Child Care (" (page xviii). (Pennsylvania Chapter of the American Academy of Pediatrics. Model Child Care Health Policies, 5th Edition, Aronson, SS, ed. (2014). Elk Grove Village, IL.

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