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Infection prevention and control
Best practice advice for nurseries and childcare settings
Infection prevention and control is everyone’s responsibility. This publication has been developed by the Public Health Agency (PHA) to provide nurseries and other childcare settings with infection prevention and control best practice advice.
It will provide staff with simple, practical advice on the day-to-day implementation of good infection prevention and control practices, as well as specific actions to take in the event of outbreaks of infection.
Best practice advice for nurseries and childcare settings 3
Page
Foreword 4
Acknowledgements 5
Introduction 6
Thepremises 7
Training 7
Glossaryofterms 8
Generalprinciplesofinfectionpreventionandcontrol 9
Handhygiene 11
Exclusionofstaff 14
Exclusionofchildren 15
Immunisation 16
Decontamination 17
Toysandplayequipment 19
Children’spersonalitems 20
Toilets,pottiesandnappychanging 22
Laundryandchildren’sclothing 24
Foodhygiene 25
Petsandfarmvisits 26
Outbreaksofinfection 27
Bibliography 29
ContactdetailsforHealthandSocialCareearlyyearsteams 30
Contents
4 Best practice advice for nurseries and childcare settings
Foreword
Itisimportantthatbasicinfectionpreventionandcontrolprinciplesareembeddedatanearlyageandsimpleproceduressuchasgoodhandhygieneshouldbeencouragedwithchildreninnurseriesandchildcaresettings.
Outbreaksofinfectionhaveoccurredinchildcaresettingsandveryoftenwhenthishappens,theyattractahighlevelofpublicity.Thisisapracticalguidetopreventingandcontrollinginfection,aimedateveryonecaringforchildrenandcurrentlyregisteredbyearlyyearsteamsinHealthandSocialCareTrusts(HSCTs).
Theadvicewithinthisdocumentappliestoplaygroups,daynurseries,crèches,twoyearoldprogrammesandout-of-schoolgroups.Theadviceisalsorecommendedtochildmindersasbestpracticethatshouldbeadoptedasfarasreasonablypossible.
Generalguidanceontheday-to-dayimplementationofgoodinfectionpreventionandcontrolpractices,andspecificactionstotakeintheeventofoutbreaksofinfection,areincluded.Usefullinkstootheradviceandfurtherinformationarealsoprovided.
Best practice advice for nurseries and childcare settings 5
Acknowledgements
ThispublicationhasbeenproducedbythehealthprotectionservicewithinthePHA.AworkinggroupwasformedwithrepresentativesfromthePHAandkeystakeholdersfromotherorganisationswhoprovidedtheirspecialistexpertopinion.
Wethankallthosewhocontributedtothispublication.Inparticular,wethankthefollowing:
• membersoftheworkinggroupwhorepresented earlyyearsteamsinHSCTsinNorthernIreland;
• membersoftheworkinggroupwhorepresented environmentalhealthdepartmentsfromlocal councilsinNorthernIreland;
• healthprotectionstaffwithinthePHA.
Document prepared by:
CarolineMcGearySeniorInfectionPreventionandControlNursePublicHealthAgency2ndFloor12–22LinenhallStreetBelfastBT28BS
6 Best practice advice for nurseries and childcare settings
Introduction
Infectionscanspreadeasilyinchildcaresettingswherelargenumbersofchildren,whoarevulnerabletoinfectionbecausetheirimmunitymaynotbefullydeveloped,comeintoclosecontact.
Infectionpreventionandcontrolinnurseriesandchildcaresettingsisamatterofgreatimportanceto:
• parents–whowanttobeassuredthatthecare theirchildrenarereceivingisprovidedina clean,safeenvironment;
• stafflookingafterchildren–whomaythemselvesbe exposedtogreaterriskofinfection;
• childcareproviders–whohavelegalresponsibilities toensurethehealthandsafetyoftheirstaffandthe childrenforwhomtheyprovidechildcareservices.
Infectionpreventionandcontroliseveryone’sresponsibilityandweallhaveanimportantroletoplay.Althoughinfectionscanspreadeasilyinchildcaresettings,thegoodnewsisthatcontrollingtheriskofinfectionisrelativelystraightforwardandsimplemeasures,suchasregularhandwashing,canusuallyreducetherisks.
Remember:
Infectionsareonlyoneofthehazardsthatchildrenandstaffmaybeexposedtowithinchildcaresettings.Foradviceonotherhealthandsafetyhazardsandfoodsafetyissues,youshouldcontacttheenvironmentalhealthdepartmentofyourlocalcouncil.
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Childcarepremisesarerequiredtoregisterwiththeenvironmentalhealthdepartmentoftheirlocalcouncilatleast28daysbeforeopeningandkeeptheminformedofanychanges.
Regulation(EC)No.852/2004statesthatthefollowingpeoplearenotpermittedtohandlefoodorenteranyfood-handlingareainanycapacityifthereisanylikelihoodofdirectorindirectcontamination:
•anyonewhosuffersfromor carriesadiseaselikelytobe transmittedthroughfood;
•anyoneafflictedwith,for example,infectedwounds,skin infections,soresordiarrhoea.
Anypersonsoaffectedandemployedinafoodbusiness,andwhoislikelytocomeintocontactwithfood,istoimmediatelyreporttheillnessorsymptoms,andifpossibletheircauses,tothefoodbusinessoperator.
The Control of Substances Hazardous to Health (COSHH) Regulations (NI) 2003provideaframeworkofactionsdesignedtocontroltheriskfromarangeofhazardoussubstancesincludingbiologicalagentsassociatedwithinfection.Youarethereforelegallyrequiredtoassessrisksandimplementcontrolmeasures.Thisdocumentcanbeusedbyyouinyourriskassessmenttodetermineifthecontrolsyoualreadyhaveinplaceareadequate.GuidanceonCOSHHcanbeobtainedfromtheHealthandSafetyExecutivewebsiteat:www.hse.gov.uk/coshh/index.htmorfromtheenvironmentalhealthdepartmentofyourlocalcouncil.
Best practice advice for nurseries and childcare settings 7
The premises
Training
Thelayout,design,constructionandsizeofthepremisesmustpermitadequatemaintenance,cleaningandworkingspaces.
• Thebuildingshouldbetotallypestproof.
• Suitablylocatedwashhandbasinsshouldbeprovidedin allareasandsuppliedwithrunningwarmandcold water,soapanddisposablehanddryingtowels.
• Thereshouldbesuitablelightingandventilation.
• Facilitiesshouldbeprovidedforthestorageofcleaning equipmentandchemicals.
• Suitablearrangementsshouldbeinplaceforthe storageanddisposalofwaste.
• Externalwastestorageareasshouldbekeptcleanand tidyandallwastereceptaclesshouldhaveatight fittinglid.
• Surfacesshouldbekeptdryandspillsshouldbe cleanedupimmediatelywhentheyoccurusing appropriatecleaningmaterials.
Itisimportantthatallmembersofstaffhaveaclearunderstandingoftheirroleinpreventingthespreadofinfection.Staffshouldreceiveappropriatetrainingandsupervision.Theyshouldbefamiliarwiththepoliciesandproceduresthatareinplacetopreventandcontrolinfectioninchildcaresettings.Itisimportantthattheyreceivetrainingonthisdocumentanditisrecommendedthatarecordofsuchtrainingiskept.
8 Best practice advice for nurseries and childcare settings
Glossary of terms
Antibiotic: Amedicineorchemicalthatcandestroyharmfulbacteriainthebodyorlimit theirgrowth.
Cleaning: Theremovalofdirtfromtheenvironmentandequipment.
Contamination: Thepresenceofmicroorganismsorforeignmatter,suchaschemical,physical orallergenicmaterials,onasurfaceorinafluidormaterial.
Decontamination:Theremovalofmicroorganismsorforeignmatter(orboth)fromcontaminated materialsorlivingtissue,renderingitsafe.
Detergent: Asubstanceintendedtoassistcleaningbyremovingdirtandgrease,butwhich doesnotreducemicroorganismstoasafelevel.
Disinfection: Aprocessthatreducesmicroorganismstoasafelevel.
Hypochlorite: Anoxyacidofchlorine(HClO)containingmonovalentchlorine,whichactsasan oxidisingorreducingagent.
Immunisation: Asafewayofprotectingpeoplefrominfectiousdiseasesandthecomplications thatmightoccurfollowingsomeinfectiousdiseases.
Immunity: Theresistanceofahosttoaspecificinfectiousagent.
Medication: Adrugorothersubstancethatisusedasamedicine.
Microorganism: Amicroscopicentitycapableofreplication.Itincludesbacteria,virusesandthe microscopicformsofalgae,fungi,mouldandprotozoa.
Germ: Amicroorganismcapableofproducingdisease.
Pest proof: Ensuringthatpremisesareprotectedagainsttheentryofunwantedpestssuch asrodents.
Vaccine: Apreparationusinganon-infectiouselementorrelativeofaparticularvirusor bacteria,andadministeredwiththeintentionofhaltingtheprogressofan infection,orcompletelypreventingit.
Best practice advice for nurseries and childcare settings 9
General principles of infection prevention and control
The cause of infectionInfectionsarecausedbymicroorganisms,includingbacteria,fungiandviruses.Therearemanytypesofmicroorganisms.Theyarefoundeverywhereandmostareharmless.However,certainmicroorganisms,calledgerms,cancauseharminthosevulnerabletoinfection.Childrenandthosewhocareforthemmaybeexposedtotheseharmfulmicroorganismswithinchildcaresettings.
1. Germ:Anymicroorganismcapableofproducingdisease,egflu
virus,E.coli,salmonella.
4. Spread of germs: Howgermsspreadfromthe
sourcetothevulnerableperson,egonhands,
surfaces,toys.
2. Source of infection:Aplacewheregermscansurviveandreproduce,eg
humans(nose,stomachetc),rawfood,contaminated
water.
3. Exit point:Thepathgermscantaketo
leavethesource,egsneezing,vomiting,diarrhoea.
6. Vulnerable person: Apersonwhocannotresistgerms
invadingthebody,multiplying,andresultingininfection,egbabies,
youngpeople,peoplewithmedicalconditions.
5. Entry point:Thepathgermscantaketo
enterthevulnerableperson,egthrougheyes,noseor
mouthaftertouchingtoys,surfacesetc.
The chain of infectionTheprocessofinfectioncanberepresentedasachain,alongwhichmicroorganismsaretransmittedfromasourcetoavulnerableperson.
Breakingalinkinthischainatanypointwillcontroltheriskofinfectionbypreventingthetransmissionofthegermtothevulnerableperson.Thiscanbeachievedbyremovingthesourcesofinfection,preventingthetransmissionofmicroorganismsandreducingaperson’svulnerability.
10 Best practice advice for nurseries and childcare settings
Sources of infectionThehumanbodymayactasasourceofinfection.Theskin,bloodandbodyfluidsmayplayakeyroleinthespreadofinfection.Peoplesufferingfromcertaininfectionsshould,therefore,beexcludedfromthechildcaresetting(pleaseseesectionson‘Exclusionofstaff’and‘Exclusionofchildren’).
Theenvironmentincludesboththephysicalstructureofthepremises(internalandexternal)andtheequipmentprovidedforuse.Theenvironmentmustbemaintainedinacleanconditionandallequipmentusedinitmustbecapableofbeingeffectivelycleanedand,wherenecessary,disinfected(pleaseseesectionon‘Decontamination’).
Contaminatedfoodandwatercanbeasourceofinfectioninchildcaresettings.Highstandardsoffoodhygieneareessential(pleaseseesectionon‘Foodhygiene’).
Animals,includingpets,cancarrymicroorganismsthatcausedisease(pleaseseesectionon‘Petsandfarmvisits’).
Preventing the transmission of microorganismsForinfectiontooccur,microorganismshavetogetfromthesourcetothevulnerableperson.However,microorganismscannotmoveontheirown;theyrequireavehicletotransferfromthesourcetotheperson.Themostcommonvehiclesareourhands.Coughsandsneezesareadeliveryvehicleforrespiratoryinfections.Itisimportant,therefore,thatwetakeappropriateprecautionstopreventthetransmissionofmicroorganismsandhandhygieneisthemosteffectivemeansofpreventingthespreadofinfections(pleaseseesectionon‘Handhygiene’).
Reducing a person’s vulnerability Oncemicroorganismshavereachedaperson,theymustbeabletoenterthebodytocauseinfection.Theskinandtheliningsofthemouth,throat,gutandairwaysallprovideabarriertoinfection.Itisimportant,therefore,tocoverallcutsandabrasionswithawaterproofdressing.Ifamicroorganismdoesmanagetocrossthebarrier,thenextlineofdefenceistheimmunesystem.Theoutwardsignsandsymptomsofdisease,suchasfeversorrashes,arearesultofthiscontest.Immunisationisasafeandeffectivewayofreducingthevulnerabilityofpeopletoinfection(pleaseseesectionon‘Immunisation’).
Best practice advice for nurseries and childcare settings 11
Hand hygiene
Theimportanceofcorrecthandwashingmustbetaughtandreinforcedtoallstaffandchildren.Suitableandsufficienthandwashingfacilitiesshouldbeprovidedforeffectivehandhygiene.Thereshouldbedesignatedwashhandbasins,whichshouldnotbeusedforanyotherpurposesuchasfoodpreparationorcleaningofequipment.
Childrenneedtobeencouragedtowashtheirhands,especiallybeforeeatingandaftervisitingthetoilet.Sinks,soapdispensersandpapertoweldispensersshouldbeplacedatasuitableheightforchildren.Childrenwillrequiresupervision,appropriatetotheirstageofdevelopment,toensuregoodpractice.
Handsshouldbewashedusingwarmwaterandliquidsoap,anddriedusingadisposablepapertowel.Disposablepapertowelsshouldbestoredinadispensertoavoidcontamination.Clothandcottontowelsshouldnotbeusedastheyallowthespreadofmicroorganisms.Liquidsoapshouldbeusedratherthanbarsoapasbarsoapsarelikelytobecomecontaminatedandharbourmicroorganisms.
Fingernails,inbetweenfingers,thumbsandwristsarethemostfrequentlymissedareasofthehand.Thesevenstepsofcorrecthandwashingareillustratedinthediagramonpage13.Itisrecommendedthatacopyofthissevensteptechniqueisdisplayedatwashhandbasins.
Tofacilitateeffectivehandhygienewhileworkinginchildcaresettings,staffshoulddothefollowing:
• Wearsleevesabovetheelbow.Ifwearinglongsleeves, theseshouldberolleduptotheelbows.
• Removeanyhandorwristjewellerywiththe exceptionofoneplainband.
• Keepnailsshortandclean.Falsenailsandnailvarnish shouldnotbeworn.
• Donotusenailbrushes.Ifyoumustuseabowlofwater towashchildren’shands,youshouldputfreshwaterinthe bowlforeachchild.
• Keepcutsandabrasionscoveredwithawaterproof dressing.
12 Best practice advice for nurseries and childcare settings
When should hands be washed?• Afterarrivingatwork.
• Whenevertheyarevisiblydirty.
• Afterusingthetoilet.
• Beforepreparing,servingandeatingfood.
• Aftertouchinganypotentiallycontaminatedsurfaces.
• Aftersneezingorblowingyournose.
• Afterhandlingpets.
• Beforeandaftermessyplay.
• Afterhandlingsoiledclothing.
• Afterdealingwithwaste.
• Afterhandlinganybodyfluids.
• Beforeandafternappychanging.
• Attheendoftheworkingday.
• Afterremovingpersonalprotectiveequipment.
• Atanyotherappropriatetimesthroughouttheday.
How should hands be washed?• Wethandsunderwarmrunningwater.
• Applyliquidsoap.
• Rubhandsfollowingthesevensteptechniqueas illustratedinthediagram.
• Rinsehandsthoroughlyunderwarmrunningwater, ensuringallsoapisremoved.
• Dryhandsthoroughlyusingadisposablepapertowel.
• Usepapertoweltoturnoffthetapsifthetapsarenot elbowoperated.
• Disposeofpapertowelintoafootoperatedpedalbinto preventrecontaminationofhandsfromtouchingthelid.
Remember:
Handwashingisthesinglemostimportantmeasureforpreventingthetransmissionofinfection.
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Childrenshouldbeencouragedtolearnthebasicprinciplesofgoodhygiene.Oneofthemostimportantprinciplesishandwashinganditshouldbeadequatelysupervisedbystaff.
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Effectivehanddryingisjustasimportantaswashingbecausewethandsandsurfacestransfermicroorganismsmoreeasilythandryones.
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Staffshouldlookaftertheirhands.Individualhandmoisturisersmaybeusedonapersonalbasis.
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Washhandbasinsshouldbeusedforhandwashingonly.Noplugshouldbepresentandelbowoperatedtapsarepreferable.
Best practice advice for nurseries and childcare settings 13
Hand hygiene
How should hands be washed?• Wethandsunderwarmrunningwater.
• Applyliquidsoap.
• Rubhandsfollowingthesevenstep techniqueasillustratedinthediagram.
• Rinsehandsthoroughlyunderwarm runningwater,ensuringallsoapis removed.
• Dryhandsthoroughlyusingadisposable papertowel.
• Usepapertoweltoturnofftapsiftaps arenotelbowoperated.
• Disposeofpapertowelintoafoot operatedpedalbintoprevent recontaminationofhandsfromtouching thelid.
1
2
3
6
7
5
4
Palms
Backs
Between fingers
Thumbs and webs
Knuckle grip
Fingertips
Wrists
14 Best practice advice for nurseries and childcare settings
Exclusion of staff
Staffwithinfectionscanplacechildrenatrisk,thereforestaffsufferingfromparticularconditionsmustbeexcludedfromtheirwork.
Staffwhopresentwithvomitingand/ordiarrhoeashouldbeexcludeduntiltheyarefreefromsymptomsforaperiodof48hours,withatleastoneformedmotionduringthistime.
StaffwithinfectedwoundsorskininfectionsonexposedpartsoftheirbodyshouldbesimilarlyexcludeduntilthelesionshavehealedortheyhavebeenadvisedbytheirGPthatitissafeforthemtoreturntowork.
Staffwithminorrespiratoryconditions,wherethereispotentialtospreadinfectionssuchascolds,mustexercisegoodrespiratorycoughetiquetteincludinggoodhandhygiene.Staffwithinfluenza,however,shouldbeexcludedfromworkuntiltheirsymptomshaveresolved.
Remember:
Allstaffwhopresentwithvomitingand/ordiarrhoeamustinformtheirsupervisorormanagerimmediatelysotheycanbeexcluded.
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Allchildcaresettingsshouldhaveastaffexclusionpolicyinplaceandallstaffshouldbeawareofitsexistenceandcomplywithit.
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Furtherinformationonrespiratoryhygiene/coughetiquetteisavailableat:
www.cdc.gov/flu/professionals/infectioncontrol/resphygiene.htm
Best practice advice for nurseries and childcare settings 15
Exclusion of children
Infectionsarecommonamongchildren,andchildcaresettingsoftenpresentidealsituationsforinfectionstospread.Itisimportantthatanexclusionpolicyisinplace.
• Childrenwhoareillshouldnotattendchildcare.Ifachildbecomesillwhileinchildcare,aparent/guardianshouldbecontactedandaskedtotakethechildhomeassoonaspossible.Thechildshouldbeisolatedfromotherchildrenandcloselymonitoredbyamemberofstaffuntiltheyarecollectedbyaparent/guardian.
• Childrenwithdiarrhoeaand/orvomitingillnessesshouldnotbepresentinchildcaresettings.Concernedparents/guardiansshouldcontacttheirGPforadviceregardingthechild’sillnessand,ifpossible,submitafaecal/vomitussamplefortesting.Theexclusionperiodshouldlastuntilthechildhasbeenfreeofsymptomsofdiarrhoeaand/orvomitingforatleast48hours,andhashadatleastonenormalmotion.
• Thechildcaresettingoperator/managershouldinformthePHAifachildhasbeenexcludedfromthenurseryduetoaninfection.
• Parents/guardiansshouldbeadvisedifthereareknowncasesofinfectionwithinthechildcaresetting.Confidentialityofcasesshouldbemaintainedatalltimes.Itisparticularlyimportantthattheparentsofchildrenwhoseimmunitymaybeimpairedduetoillnessortreatment(egleukaemia,HIV,thoseonsteroidtherapy)areprovidedwiththisinformation.
• Itisalsoimportantthatmothersandstaffwhoarepregnantaremadeawareofthefollowinginfections:chickenpox,measles,rubellaandslappedcheeksyndrome(Fifthdisease).TheyshouldconsultwiththeirGPiftheyhaveanyconcerns.
• Itisgoodpracticethatifachildrequiresantibiotics,theyshouldbeexcludedfromthechildcaresettinguntiltheyhavecompletedatleast48hoursofthetreatment.Itmaytakethechildmuchlongertorecoverfromsomeinfectionsandfeelwellenoughtoattendchildcare.Otherinfectionsaresubjecttospecificexclusionadvice.
Remember:
Allparents/guardiansshouldbemadeawareoftheexclusionpolicyinthechildcaresetting.Itistheresponsibilityofthechildcarestafftoimplementit.
16 Best practice advice for nurseries and childcare settings
Immunisation
Immunityistheabilityofthebodytoprotectitselffrominfectiousdisease.Vaccinesgivelong-termprotectionfromavarietyofinfectiousdiseases.Immunisationorvaccinationisasafewayofprotectingpeoplefrominfectiousdiseasesandthecomplicationsthatmightoccurfollowingsomeinfectiousdiseases.
Itisgoodpracticetoensurethatallchildrenareup-to-datewiththerecommendedvaccinations.PleaseseethePHAwebsitewww.publichealth.hscni.nettoaccesstheroutinechildhoodimmunisationschedule.AdviseparentstocontacttheirGPregardinganymissedimmunisations.
Remember:
Someinfectiousdiseases,egchickenpox,measles,rubellaandslappedcheeksyndrome(Fifthdisease),mayposearisktopregnantwomen,whoarenotimmunetotheseinfections.Women,includingchildcarestaff,whomaybeatriskandareexposedtoordevelopthesediseasesduringpregnancyshouldseekadvicefromtheirGP,midwifeorobstetricianurgently.
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Staffworkinginachildcaresettingshouldensuretheyareup-to-datewiththeirrecommendedimmunisations.PleasenotethattwodosesofMMRvaccinearerequiredtoachieveprotectionagainstmeasles,mumpsandrubella.
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Furtherinformationonimmunisationisavailablefromthefollowingwebsites:
www.publichealth.hscni.net
www.nhs.uk/Planners/vaccinations/Pages/Landing.aspx
www.dh.gov.uk/en/Publichealth/Immunisation/Greenbook/index.htm
Best practice advice for nurseries and childcare settings 17
Decontamination
Acleanenvironmentisessentialinpreventingthespreadofinfection.Itisimportantthattheenvironmentiswellmaintainedandanydamagedsurfacesarereplaced.
Detergentandwarmwaterareadequateformostcleaning.Adetergentisachemicalthatbreaksdowndirtandgreaseandfacilitatescleaning.However,occasionallydisinfectionisalsorequired.
Disinfectionistheprocessofreducingmicroorganismstoasafelevel.Disinfectantchemicalsorsteammaybeusedforthispurpose.Tobeeffective,surfacesthataretobedisinfectedmustbethoroughlycleanedfirst.Disinfectantsmustbeappliedforthecorrectperiodoftime(contacttime)andatthecorrectstrength(concentration).Checkthelabelforthemanufacturer’sinstructions.Itisrecommendedthatchildcaresettingsuseahypochlorite(bleach)solutionanddiluteasperthemanufacturer’sinstructions.
Keeping it clean • Carpetedareasandmatsarenotrecommendedbut,
wherepresent,shouldberegularlyvacuumedandperiodicallysteamcleaned.
• Highchairsandotherfurnitureshouldbemaintainedinacleancondition.
• Topreventcross-contamination,useseparatecleaningequipmentforallareas,egplayareas,toilets,kitchens.Astandardcolourcodingsystemisausefulwayofachievingthis.
• Intheeventofchildrenvomitingorhavingdiarrhoea,itisimportanttocleananddisinfecttheaffectedarea.Clothsusedforcleaningmaybecomevehiclesforcontaminationandshouldbedisposable.Theyshouldbediscardedafteruse.
• Ifnon-disposableclothsareused,theseshouldbemachinewashedonahotcycleattheendofeachday.
• Mopheadsshouldbedetachableandmachinewashableandtheyshouldbereplacedregularly.Theyshouldalsobestoredinvertedtoallowfordrying.Mopbucketsshouldbecleanedfollowinguse,thendriedandstoredupsidedowninadesignatedarea.
Remember:
Allchildcaresettingsshouldhaveawrittencleaningschedule,detailingwhathastobecleaned,whenithastobecleaned,howithastobecleanedandwhoisresponsibleforcleaning.
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Floors,whereyoungchildrencrawlandplay,maypresentahigherriskofinfectionandwillrequiremoreregularcleaning.
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Practicea‘cleanasyougo’policyatalltimes,iecleanupspillagesetcimmediatelyastheyoccur.
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Frequentlytouchedsurfaces,egtoilethandles,doorhandles,lightswitchesandtaps,mayrequiremoreregularcleaningordisinfection.
18 Best practice advice for nurseries and childcare settings
Cleaning of blood and other body fluids Bloodandotherbodyfluidspillages(egvomitandfaeces)mayposeariskofinfectiontochildrenandstaffand,therefore,mustbecleanedupimmediately.Spillagekitsareadvisedforusewhenrequired.Thesekitscanbepurchasedormadeup.Thefollowingflowchartoutlineswhatactionsshouldbetaken:
Remember:
Spillagekitsshouldcontainplasticbags,disposableglovesandaprons,disposablecloths,papertowelsandahypochloritedisinfectant.
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Itisrecommendedthatallchildcaresettingshaveadisinfectionpolicyinplaceforcleaningupbloodandbodyfluids.
Bloodandvisiblybloodstainedbodyfluids
Largespill(30mlsormore)
Coverthespillagewithpapertowelstoabsorb
Liftthesoiledpapertowelsanddisposeas
clinicalwaste
Liftthesoiledpapertowelsanddisposeas
clinicalwaste
Disinfectwithhypochloritesolution
1,000ppm
Rinseanddry
Cleanareawithneutraldetergentandwater(ifblood
presentdisinfectwithhypochloritesolution
10,000ppm)
Cleanareawithneutraldetergentandwater
Removeglovesandplasticapron(andmaskifapplicable)anddisposeofasclinicalwaste
Immediatelywashhandswithsoapandwater,rinseanddrythroughly
Pourhypochloritesolution10,000ppm
andleavetosoak3-5minutescontact
timetoallowfordisinfection
Liftthesoiledpapertowelsanddisposeas
clinicalwaste
Cleantheareawithaneutraldetergentandwater,rinseanddry
Smallspillorsplash
Wipewithadisposablecloth
soakedinhypochloritesolution10,000ppm
Bodyfluidsnotvisiblybloodstained
Coverspillagewithpapertowelstoabsorb
Coverspillagewithpapertowelstoabsorb
Putondisposableglovesandapron(andmaskifsplashrisk)
Urine
Best practice advice for nurseries and childcare settings 19
Toys and play equipment
Toysareveryimportantforthesocialandeducationaldevelopmentofachild.However,theycanbecomecontaminatedwithmicroorganismsfromunwashedhandsandbodyfluids.Safetyshouldbeoneofthemainconsiderationswhenchoosingtoysandplayequipmentforchildcaresettings.
DoEnsurethatalltoysandplayequipmentinthechildcaresettingcanbeeasilycleaned/decontaminated.
Haveaclearcleaningscheduleinplaceexplainingwhenandhowtoysandplayequipmentshouldbecleaned,whatcleaningproductsarerequiredandwhoisresponsibleforcleaning.
Refertothemanufacturer’sinstructionswhencleaningtoysandplayequipment.
Checktoysregularlyfordamageanddiscardthemifrequired.
Hard/plastictoysshouldbecleanedanddisinfected.Theyshouldbethoroughlyrinsedanddried.
Washsofttoysinawashingmachineatthehighestpossibletemperature,asperthemanufacturer’sinstructions.
Storealltoysinaclosedcupboardorincleanwashablecontainers.
Toysthatarevisiblysoiledshouldberemovedfromtheplayareaandcleanedanddisinfectedimmediatelyasperthemanufacturer’sinstructions.
Waterplaypoolsshouldbeemptiedaftereveryuse,cleanedwithwarmsoapywater,disinfectedandthoroughlydried.
Sandpitsshouldbecoveredwhennotinuse,cleanedregularlyandthesandreplacedasnecessary(atleasteverythreemonths).Sandthatspillsontothefloorshouldbediscardedandsandshouldbesievedregularly.
Ensurehandsarewashedandskinlesionsarecoveredbeforeandafterusingplaydough/Plasticine.Ideally,playdoughshouldbepreparedanddiscardedonthedayofuse.
Don’tPuttoysbackintostorageiftheyarevisiblydirty.
Keeptoyswithsharpedgesorroughsurfacesthataredifficulttoclean.
Remember:
Itisimportantthathandsarewashedwithsoapandwaterafteranyoutdooractivity.
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Handsshouldbewashedwithsoapandwaterbeforeandafterplayingwithsand,waterandplaydough.
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Childrenshouldnottaketoysintothetoiletarea.
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Followthemanufacturer’sinstructionswhenwashingtoys.
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Discouragechildrenfromputtingsharedtoysintotheirmouths–washhandscorrectlyaftertouchinganycontaminatedtoys.
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Awrittenrecordofcleaningtoysshouldbekeptondisplay.Thisshouldincludethedate,toycleanedandsignatureofthepersonwhocleanedthetoy.
20 Best practice advice for nurseries and childcare settings
Children’s personal items
Children’spersonalitemsshouldnotbesharedwithotherchildren.Allpersonalitemsshouldbestoredinanappropriatecontainerdisplayingthechild’sname.
Toothbrushes and dental hygiene• Itisimportanttoencouragechildrentobrushtheir
teethbutstaffmustbeawarethatatoothbrushcouldtransmitinfection.
• Eachchildshouldhavetheirowntoothbrushandchildrenshouldnotbeallowedtoshareorborrowtoothbrushes.
• Appropriateamountsoftoothpasteshouldbedispensedontoacleansurface,egpapertowelorplate,beforebeingcollectedonthetoothbrush.Thereshouldbesufficientspacebetweenthetoothpastetoallowcollectionwithoutcross-contamination.
• Childrenshouldnotbepermittedtoeatorlicktoothpastefromthetube.
• Afteruse,toothbrushesshouldbethoroughlyrinsed.Allowthemtoair-dry,storingtheminanuprightpositionwithsufficientspacebetweenthemtoavoidcross-contaminationwithothertoothbrushes.
• Toothbrushholdersshouldbecleanedregularlyandtoothbrushesshouldbereplacedeverythreetofourmonths,orsoonerifbristlesappearwornorsplayed.
• Ensuretoothbrushesandtoothpastearestoredwheretheyareprotectedfromcontamination,ienotinthetoiletarea.
Remember:
Theappropriateamountsoffluoridetoothpasteare:
• childrenagedunderthree yearsshouldusenomore thanasmearoftoothpaste containingnolessthan1,000 partspermillionfluoride;
• childrenagedthreeyearsand overshouldusenomore thanapea-sizedamountof toothpastecontainingnoless than1,000partspermillion fluoride.
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Encouragechildrentobrusheachsurfaceofeverytooth.
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Encouragechildrentospitouttoothpasteresidueafterbrushinganddiscouragethemfromswallowingtoothpaste.
Best practice advice for nurseries and childcare settings 21
Dummies• Dummies/teethingringsshouldbeclearlylabelled
foreachchild.
• Sharingofdummies/teethingringsshouldnotbeallowedasthiscouldtransmitinfection.
• Ifadummy/teethingringfallsonthefloor,itshouldbewashedanddisinfectedbeforethechildputsitbackintheirmouth.
• Dummies/teethingringsshouldbestoredinacleandrycontainerwhennotbeingused.Thecontainershouldbeclearlylabelledwiththechild’sname.
Medication• Parents/guardianswholeavemedicationintothe
childcaresettingshouldbeaskedtoleavethecompletepackagingwithclearinstructions.
• Medicationtobetakenbyachildmustbeclearlylabelledwiththechild’sname,thedosagetobetakenandthetimeitistobetaken.
• Medicationsshouldneverbesharedwithotherchildren.
• Childrenshouldonlybegivenmedicationthathasbeenprescribedbyadoctor.Non-prescribedmedicationshouldonlybegivenwithparental/guardianconsent.
22 Best practice advice for nurseries and childcare settings
Toilets, potties and nappy changing
ToiletsChildrenwillonlydevelopgoodhygienepracticeswhenusingthetoiletiftheyareprovidedwiththeappropriateadviceandadequatefacilities.
• Toiletareasshouldbekeptcleanatalltimesastheyarelikelytobecontaminatedwithmicroorganisms.Toiletareasshouldbecheckedregularlythroughoutthedayandcleanedanddisinfectedasrequired(thisincludesdoorhandles,tapsandflushhandles).
• Youngchildrenshouldbesupervisedwhenusingthetoiletandwashingtheirhands.
• Child-sizetoiletsshouldbeavailableforyoungchildrenandalltoiletsshouldbefittedwithatoiletseatandlidtominimiseaerosolspreadofcontentswhenflushing.
• Thereshouldbeadequatesuppliesoftoilettissueinalltoilets.
• Washhandbasinsshouldbeatasuitableheightforchildren.
PottiesPottiesshouldbekeptinthetoiletareaandshouldnotbeallowedintheplayarea.
• Afteruse,thecontentsofthepottyshouldbeemptieddownthetoilet(turnheadawaywhenemptyingpottycontents).Thetoiletlidshouldbeclosedbeforeflushingtominimiseaerosolspreadofcontents.
• Afteremptying,pottiesshouldbewashed,disinfectedanddriedthoroughlywithdisposabletowels/roll.Handsshouldthenbewashedwithsoapandwater.
• Pottiesshouldbestoredseparatelyupsidedownandnotstackedinsideoneanother.
• Pottiesshouldnotbewashedinwashhandbasins.
• Pottiesthatarecrackedordamagedshouldbedisposedofastheycannotbecleanedeffectively.
• Individualchildren’spottieseliminatetheriskofspreadinginfectiontootherchildrenandshouldbeconsidered.
• Childrenshouldbediscouragedfromplayingwithtoysinthetoiletorpottyarea.Iftoysareusedinthisareaduringpottytraining,theymustbecleanedanddisinfectedafteruse.
Remember:
Childrenshouldbesupervisedtoensurethattheywashtheirhandsafterusingthetoiletorapotty.
.....................................................
Handwashingfacilitiesshouldbeavailableintheimmediatenappychangingarea.
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Wearingglovesisnotasubstituteforhandhygieneandhandsshouldbewashedimmediatelyaftergloveshavebeenremoved.
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Parents/guardiansshouldbeinformedifanappyrashappears.
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Individualcreamsandlotionsshouldbelabelledwiththechild’snameandneverbesharedwithotherbabies/children.
Best practice advice for nurseries and childcare settings 23
NappiesAllchildcaresettingsthatacceptchildrenwhoarestillinnappiesmusthaveappropriatedesignatedfacilitiesfornappychanging.Thesefacilitiesmustbeseparatetofoodpreparationandservingareasandchildren’splayareas.
• Itisrecommendedthatanewdisposableapronandpairofglovesarewornforeachnappychange.
• Putonglovesandanapronimmediatelybeforethetaskandremovethemassoonasthetaskiscomplete.
• Alwayswashhandsbeforeandafterusinggloves.
• Changingmatsshouldhaveasealedplasticcoveringandbefrequentlycheckedforcracksortears.Ifcracksortearsarefound,thematshouldbediscarded.
• Thematshouldbecleaned,disinfectedanddriedthoroughlyaftereachnappychange.
• Disposabletowels/rollshouldbeplacedontopofthechangingmatforaddedprotection.Thesedisposabletowels/rollmustbediscardedaftereachnappychange.
• Cleannappiesshouldbestoredinacleandryplace.
• Soilednappiesshouldbeplacedina‘nappysack’orplasticbagbeforebeingplacedinthebin.Binsneedtobefoot-pedaloperated,regularlyemptiedandplacedinanappropriatewastecollectionarea.
• Eachchildshouldhavetheirowncreamsandlotions.Thesecanbesuppliedbytheparent/guardianandshouldbeclearlylabelledwiththechild’sname.Whenapplyingcreamsforrashes,aglovedhandorspatulashouldbeused.
• Staffshouldensuretheyhavealltheequipmenttheyneedandaccesstofreshwaterbeforeeachnappychange.
• Childrenorbabiesshouldneverbeleftaloneonanappychangingtable/bench.
24 Best practice advice for nurseries and childcare settings
Laundry and children’s clothing
LaundryLinenandclothingcanbeapotentialsourceofinfection.
• Laundryshouldbedoneinaseparatedesignatedarea.
• Washingmachinesshouldnotbelocatedinfoodpreparationareasorchildren’splayareas.
• Thereshouldbeenoughspacetokeepcleananddirtylinenseparate.
• Thereshouldbeadequatedryingfacilities–atumbledryerispreferable.
• Sheetsusedforsleepingmatsorcotsshouldbededicatedtoanindividualchildforoneweekandlaunderedwhenrequired.
• Iflinenissoiled/infected,itshouldbeplaceddirectlyintothewashingmachine.Thelaundryoperatorshouldwearglovesandadisposableapronandwashtheirhandsproperlyatappropriatetimesthroughoutthecourseofashift.Ifpossible,adedicatedwashhandbasinshouldbeprovidedwithinthelaundry.
• Launderingclothesatthehighestpossibletemperature(asperthemanufacturer’sinstructions),tumbledryingandironingisrecommended.Theheatinvolvedinalloftheseprocesseswillhelpkillanymicroorganismsthatmaybepresent.
Children’s personal clothing• Whenhandlingsoiledchildren’sclothing,staffshould
alwayswearglovesandadisposableapron.
• Soileditemsshouldbeplacedintoaclearplasticbagandsealed.Bagsshouldbestoredinasafeplace,awayfromfoodpreparationandeatingareasandchildren’splayareas.
• Explaintoparentsthatwashingtheclothesinchildcaresettingscanexposechildrenandstafftomicroorganisms,whichcancauseinfection.Adviseparentsthatwhilereceivingsoiledclothesisunpleasant,thispolicyprotectsthehealthofbothchildrenandstaff.
Remember:
Donotrinse,soakorwashsoiledchildren’sclothing.
.....................................................
Allchildcaresettingsshouldhavealaundrypolicyinplace.
.....................................................
Laundryequipmentshouldberegularlyservicedandrecordsofthisservicingshouldbekept.
Best practice advice for nurseries and childcare settings 25
Food hygiene
Foodhygieneisessentialtopreventthespreadofgastrointestinalinfections.Forinformationonanyfoodsafetyissues,contacttheenvironmentalhealthdepartmentofyourlocalcouncil.
Formula milkBeforeyouprepareafeed,youshouldcleanworktopsandwashyourhands.Youshouldcleanandsterilisebottlesandteatsbeforeyouusethem.Followthemanufacturer’sinstructionsonhowtodothis.Formoreinformationonsterilisingbottles,seethePHA’sbottlefeedingleafletat:www.publichealth.hscni.net/publications/bottlefeeding-0
Ideally,youshouldmakeupformulamilkfreshlyforeachfeed.Ifthereisanymade-upformulamilkleftafterafeed,throwitaway.
Whenpreparingafeed,boilfreshtapwaterandletitcool.Alwaysputtheboiledwaterinthebottlebeforeaddingthepowder.Cooltheformulaquicklytofeedingtemperaturebyholdingthebottleundercoldrunningwater(withthecapon).
Baby foodIfyouareusingboughtbabyfood,followthemanufacturer’sinstructionsonpreparation,storageandserving.Ifyoumakeyourownbabyfood(oraparent/carerbringshome-madebabyfood),itisveryimportanttocook,cool,store,defrostandreheatitsafely.
Remember:
AnydisinfectantorsanitiserusedwithinthekitchenenvironmentmustmeettheofficialstandardsofBSEN1276:1997orBSEN13697:2001.
.....................................................
Peopleemployedspecificallyforthepreparationandcookingoffoodshouldnotbeinvolvedincleaningdutiesinthenappychangingandtoiletareas.
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Formoreinformationongoodfoodhygieneandkeepingfoodsafe,referto:www.food.gov.uk/goodbusiness
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Generalinformationonfoodhygieneisavailableat:www.food.gov.uk/
26 Best practice advice for nurseries and childcare settings
Pets and farm visits
Whilechildrencangetmuchpleasureandeducationalbenefitfrompets,theseanimalscanbeapotentialsourceofinfection.Itisimportant,therefore,thatappropriatehygienepracticesarefollowed.
• Givesomeoneresponsibilitytolookafterpets.
• Ifanypetsappearunwell,donotallowchildrentoplaywiththemandseekveterinaryadvice.
• Maintainpets’livingareasinacleancondition.
• Washyourhandsaftercontactwithpets.
• Alwayssupervisechildrenwhentheyarewithpets.
• Ensurechildrenareawarethatpetscancarrymicroorganismsandthattheyshouldalwayswashtheirhandsafteranycontactwiththem.
• Discouragechildrenfromkissingpetsandallowingpetstolicktheirface.
• Keeppetsoutofthekitchenandawayfromallsurfaceswherefoodispreparedorconsumed.
• Animalfoodmustnotbestoredwithfoodintendedforhumanconsumption.
Visits involving animalsVisitstofarmsandzoosarebotheducationalandenjoyableforchildren,butitshouldberememberedthatanimalscarrymanydifferentinfectiousdiseases,someofwhichcanbepassedtohumans.Itisessential,therefore,thathygieneprecautions,iehandhygiene,aretakenduringandaftersuchvisits.Itisadvisedthatpriortoanyvisit,ariskassessmentofthepremisesshouldbeundertaken.
Remember:
Touchingorfeedingfarmanimalscanbeasourceoflife-threateninginfection,particularlyinyoungchildren.Theonlywaytoeliminatethisriskentirelyisforchildrentoavoidcontactwithanimalsandtheirfaeces.Itisthecarer’schoicewhetherthechildisallowedtotouchorfeedtheanimals......................................................
Carersshouldsupervisethewashingofchildren’shandsimmediatelyafterleavingtheanimalcontactarea,beforeeatingordrinkingonthefarm,andafterremovingfootwear......................................................
Sanitisinghandgelsdonotprovideadequateprotectionalone.Theyarenotasubstituteforthoroughhandwashingwithsoapandwater......................................................
Thisadviceisalsorelevantinsituationswhereanimalsaretakenintonurseriesandchildcaresettings......................................................
Furtherinformationonpetsandfarmvisitsisavailablefromthefollowingwebsites:www.hse.gov.ukwww.hseni.gov.ukwww.safefood.euTheHealthandSafetyExecutive(HSE)informationsheetPreventingorcontrollingillhealthfromanimalcontactatvisitorattractionsisalsoavailableat:www.hseni.gov.uk/news.htm?id=8897&preventing-or-controlling-ill-health-from-animal-contact-at-visitor-attractions
Best practice advice for nurseries and childcare settings 27
Outbreaks of infection
Anoutbreakisdefinedas“having two or more children or staff with an infection, caused by the same microorganism, at the same time in the same place”.
However,asinglecaseofaseriousdiseasemayalsorequireanoutbreakresponse,egE.coliO157,diphtheriaormeasles.
Ifyoususpectthereisanoutbreakofinfection,youshouldcontactthehealthprotectiondutyroomatthePHA.
Examplesofwhenthiswouldbeappropriateare:
• asuddenincreaseinthenumberofabsentchildren orstaffwithsymptomsofdiarrhoeaand/orvomiting;
• morethanoneparentadvisingthechildcaresetting thattheirchildhassymptomsofdiarrhoeaand/or vomiting;
• morethanonememberofstaffadvisingthechildcare settingthattheyhavesymptomsofdiarrhoeaand/or vomiting;
• morethanonechildorstaffmemberexhibiting similarsymptomsofanundiagnosedrash;
• morethanonechildorstaffmemberexhibiting similarsymptomsofanyotherkind.
Remember:
Ifmorethanonechildorstaffmemberexperiencessymptomsofdiarrhoeaand/orvomiting,andthereisapossibilitythattheillnessisfood-related,yourlocalenvironmentalhealthofficerwillbeinformedbythehealthprotectiondutyroomatthePHA.
Health protection duty roomPublicHealthAgency4thFloor,12–22LinenhallStreet,BelfastBT28BS
Open9am–5pmMondaytoFridayTel:02890553994or02890553997Fax:02890553930E-mail:[email protected]
Outofhours(evenings,weekendsandbankholidays):contactBelfastAmbulanceControlon02890404045andaskthemtopagethefirston-callpublichealthdoctor.
28 Best practice advice for nurseries and childcare settings
Thefollowingflowchartoutlinestheactionstobetakenifanoutbreakofinfectionissuspectedorconfirmed:
Twoormorechildrenpresentingwithvomitingand/or
diarrhoea
Twoormorestaffpresentingwithvomitingand/or
diarrhoea
ContactthePublicHealthAgencydutyroom,12-22LinenhallStreet,BelfastTelephone:02890553994or02890553997
Fax:02890553930Email:[email protected]
Isolatetheaffectedcase/sawayfromotherchildrentopreventfurtherspreadofinfection.
Thechildshouldbecloselymonitoreduntilcollectedfromthepremises.
Contactparent/guardiantocollectchild/childrenfromthepremises.
Ensuredetailedrecordsaremaintained,whichshouldinclude: •names; •symptoms; •date,timeandlocationofchildwhensymptomsoccured; •listofcontacts; •dateandtimeofchild’slastattendanceatthefacility.
Alistofotherchildrenwhohavepotentiallybeenexposedshouldalsobekept.
Ensurethatparents/guardiansareinformedaboutthepossibleorconfirmedoutbreakofinfectionandthatthoseaffectedareexcludeduntiltheyaresymptomfreefor48hours(seepage15).
Encourageparentstosubmitafaecal(stool)orvomitussamplefromchildtotheirGP.
Ensurethattheenvironmentiscleanedanddisinfectedasperflowchartoutliningthemanagementofbloodandbodyfluids(seepage18).
Best practice advice for nurseries and childcare settings 29
Bibliography
WesternHealthandSocialCareTrust.Infectioncontrolguidelinesforchildcaresettings.Availableat:www.westerntrust.hscni.net/pdf/Infection_Control_Guidelines_for_Child_Care_Settings.pdfAccessed14October2010.
HealthandSafetyExecutive.ControlofSubstancesHazardoustoHealth(COSHH).Availableat:www.hse.gov.uk/coshh/index.htmAccessed18October2010.
FoodStandardsAgency.Regulation(EC)852/2004onthehygieneoffoodstuffs.Availableat:www.food.gov.uk/foodindustry/regulation/europeleg/eufoodhygieneleg/Accessed18October2010.
DepartmentofHealth,SocialServicesandPublicSafety.TheNorthernIrelandRegionalInfectionPreventionandControlManual.October2008.Availableat:www.infectioncontrolmanual.co.niAccessed8October2010.
HealthProtectionAgency.Guidanceoninfectioncontrolinschoolsandotherchildcaresettings.April2010.Availableat:www.hpa.org.uk/web/HPAwebFile/HPAweb_C/1194947358374Accessed8October2010.
CentersforDiseaseControlandPrevention.Respiratoryhygiene/coughetiquetteinhealthcaresettings.1August2009.Availableat:www.cdc.gov/flu/professionals/infectioncontrol/resphygiene.htmAccessed27October2010.
FoodStandardsAgency.Saferfood,betterbusiness.Availableat:www.food.gov.uk/Accessed1November2010.
PublicHealthAgency.Bottlefeeding.February2011.Availableat:www.publichealth.hscni.net/publications/bottlefeeding-0Accessed26November2010.
HealthandSafetyExecutive.Preventingorcontrollingillhealthfromanimalcontactatvisitorattractions.March2011.Availableat:www.hse.gov.uk/pubns/ais23.pdfAccessed3December2010.
30 Best practice advice for nurseries and childcare settings
Contact details for Health and Social Care (HSC) early years teams
HSCT Early years contact
Belfast HSCT HilaryWalker Tel:02890803606 Fairview1 Email:hilary.walker@ MaterHospitalSite belfasttrust.hscni.net 47/51CrumlinRoad Belfast BT146AB
Northern HSCT KateKelly Tel:02894424600 AlderHouse Email:kate.kelly@ AntrimAreaHospitalSite northerntrust.hscni.net BushRoad Antrim BT412QB
South Eastern HSCT PhilipFriel Tel:02891468521 BangorAdminBuilding Email:philip.friel@ NewtownardsRoad setrust.hscni.net Bangor BT204LB
Western HSCT PatArmstrong Tel:02871272112 WesternHealthandSocialCareTrust Email:pat.armstrong@ RiverviewHouse westerntrust.hscni.net AbercornRoad Londonderry BT486SB
Southern HSCT CiaranEastwood Tel:02838333747 SouthernHealthandSocialCareTrust Email:ciaran.eastwood@ 2OldLurganRoad southerntrust.hscni.net Portadown CountyArmagh BT625SG
Best practice advice for nurseries and childcare settings 31
Public Health Agency
OrmeauAvenueUnit
18OrmeauAvenue
BelfastBT28HS
Tel:02890311611
Textphone/TextRelay:1800102890311611
www.publichealth.hscni.net
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