I have only had it once the first year I opened ~ just the one child got it and it did not spread to anyone else thankfully and while it has been through the community lots this past few years we have been strong enough immunity to ward it off.

For me I would only exclude if the child still had a 'fever' (due to risk of fever related seizure ) or if the blisters were causing the child discomfort to the level they were not able to participate in the regular program ~ the Public Health Unit for my city does not require exclusion for HFM because by the time the spots themselves appear the 'most contagious' period has ended and well it remains contagious for WEEKS after the spots disappear as it is carried in bodily fluids and feces for up to 6 weeks anyway so 'exclusion' is not going to prevent the spread.

I did 'discontinue' communal sensory play during her outbreak period until the blisters were healed but other than that I did not do any thing 'extra' as far as normal cleaning of surfaces and so forth.