Day Care Centers Conducive to the Spread of Infectious Diseases
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Transcript of Day Care Centers Conducive to the Spread of Infectious Diseases
Communicable Diseases at the Communicable Diseases at the Department of Public Health Department of Public Health
Refugee & Im m igrant Health TB Prevention & Control
Cryptospor idiumGiardia
W aterborne
S almonellaE . coli O 157:H7
N orovir us
Foodborne
LegionellaM eningit is
S A RS
Respiratory
RabiesLyme
W est N ile Vir usT ular emia
Zoonotic
EpidemiologyS urveillance
I nf r astr ucture
Emergency Preparedness
Epidem iology Program Im munization Program
Epidem iology and Imm unization HIV /AIDSSurveillance
STD Prevention Integrated Surveillance& Inform atics Services
Bureau of Com municable Disease Control
Settings for SpreadSettings for Spread
Household Day Care Center School Workplace
FactsFacts Approximately 1/5 of the U.S. population attends or works in
schools. (U.S. Dept of Ed, 1999) Some viruses and bacteria can live from 20 minutes up to 2
hours or more on surfaces like cafeteria tables, doorknobs, and desks. (Ansari, 1988; Scott and Bloomfield, 1989)
Nearly 22 million school days are lost annually due to the common cold alone. (CDC, 1996)
Addressing the spread of germs in schools is essential to the health of our youth, our schools, and our nation
Students need to get plenty of sleep and physical activity, drink water, and eat good food to help them stay healthy in the winter and all year.
Day Care CentersDay Care CentersConducive to the Spread of Infectious DiseasesConducive to the Spread of Infectious Diseases
Individual Characteristics Diapered infants & toilet trained children Body secretion control Normal infant behavior
oral environment exploration body part exploration biting
Pool of susceptibles Adult interaction
Day Care Centers Day Care Centers (cont.)(cont.)
Environmental Characteristics Staff:child ratios Crowded quarters/decreased air flow Contaminated toys Direct contact during play Common changing tables
Staff duties changing diapers preparing food
Look what I brought home from Look what I brought home from school, Mommy!!!school, Mommy!!!
Droplet or Respiratory Colds, chickenpox, flu,
parvovirus, strep Viral or bacterial
meningitis Fecal-oral
hepatitis A, shigella,salmonella, giardia, pinworms, coxsackievirus,
Direct contact impetigo, ringworm,
conjunctivitis, scabies, head lice
Infections in Day CareInfections in Day Care
Mode of Transmission
Bacteria Viruses Other (parasites, fungi, infestations)
Fecal-Oral
Campylobacter Salmonella, Shigella
E. coli O157:H7
Enteroviruses
Hepatitis A, Rotavirus Coxsackievirus, Polio
Giardia, Pinworms Cryptosporidium
Respiratory
Hib, Pertussis, TB Meningococcal Dis.
Group A Strep Diphtheria
Adenovirus, Influenzae
Measles, Parvovirus, RSV Rhinovirus, Varicella,
Mumps, Rubella, Roseola
Direct/Indirect
Impetigo
Conjunctivitis
Herpes simplex Conjunctivitis
CMV, Varicella
Lice, Scabies
Ringworm
Contact with blood/urine
CMV
Hepatitis B,C Herpes simplex, HIV
Contact with
Animals
Lyme Disease
Salmonella
Rabies, EEE
Ringworm
Disease TransmissionDisease Transmission
Direct Contact Respiratory or Droplet Bloodborne Fecal-Oral Zoonotic
Stop-spread guidelinesStop-spread guidelines(direct contact)(direct contact)
Follow handwashing & cleanliness guidelines Do not permit the sharing of personal items Provide individual storage areas for outer clothing
items Wash & cover sores, cuts & scrapes promptly and
keep infected eyes wiped dry Notify parents of rashes, sores, runny eyes and
itching for hcp referral
Stop-Spread GuidelinesStop-Spread Guidelines(fecal-oral)(fecal-oral)
Handwashing, handwashing, handwashing Attend to environmental cleaning & sanitation Keep track of # of cases of diarrhea Exclude students with severe diarrhea Discourage the practice of reptiles as classroom
pets Strictly monitor reptile visits
handwashing after any contact with reptile or cage barriers between reptiles and students
Stop-spread guidelinesStop-spread guidelines(droplet spread)(droplet spread)
Follow handwashing & cleanliness guidelines Discourage the sharing of food and do not permit the
sharing of water bottles during sports Air out classrooms daily, even in winter Teach children & staff to cough or sneeze toward the
floor or to one side, away from others Keep a supply of disposable towels and tissues in each
classroom Dispose of used towels or tissues in a step-can with a
plastic liner
ParvovirusParvovirus(Fifth Disease)(Fifth Disease)
5th of 6 similar rash-causing illnesses caused by Parvovirus B19
Symptoms 1st stage (2-3d) = cold or flu-like lasting 2-3 d 2nd stage (7d) = maybe asymptomatic 3rd stage (?) = “slapped cheek” rash
Incubation period 4-14 days to 1st stage 2-3 weeks to rash
Parvovirus Parvovirus Control & Prevention MeasuresControl & Prevention Measures
Do not exclude children - not contagious Use routine hygienic practices
careful handwashing proper disposal of tissues frequent cleaning of toys and other shared objects
Pregnant women rare reports of stillbirths & miscarriages tested for immunity no recommendation to exclude
Parvovirus Parvovirus (cont.)(cont.)
Transmitted by respiratory route sneezing, talking, coughing, touching secretions infectious before rash & usually not infectious
when rash appears 50% of people infected by adulthood Diagnosis
symptoms immunity by blood test
PediculosisPediculosis(head lice)(head lice)
Lice tiny insects that live on hair but cannot survive away from
the scalp for more than 48 hours Transmission
they crawl from person to person directly or through shared items
Diagnosis by observation Treatment
removing lice from individuals, surroundings & personal items
Pediculosis Pediculosis Control & PreventionControl & Prevention
Refer students with active head lice to their health care provider
Exclude infested students until treated (check school or town “no nit” policy)
Treat personal items and surroundings in school environment wash, dry, quarantine, vacuum
Discuss notification guidelines Check student heads in affected classrooms
regularly
Salmonella sp.Salmonella sp.
Bacteria that must be swallowed (fecal-oral) Incubation period: 12 - 36 hrs Sx: Diarrhea, cramps, nausea, vomiting,
headache, fever, chills, dehydration Duration: few days - few weeks. May be fatal. Sources: undercooked foods of animal origin
i.e. eggs, milk, beef, poultry. Reptiles, other people with salmonella
Seasonal variation
Reptile SalmonellosisReptile Salmonellosis
All reptiles shed salmonella in their feces Increased popularity of reptiles as pets in
households and classrooms Special risk to infants, children,
immunocompromised, pregnant women and the elderly
Lack of awareness
Two Excedrin HeadachesTwo Excedrin Headaches
Hepatitis A fecal-oral transmission long incubation period symptoms in younger
children infectious before
symptoms immune globulin for
prevention
Meningococcal Illness salivary spread serious,10% fatal hysteria producing antibiotics for prevention
E. coliE. coli O157:H7 O157:H7
First identified as human pathogen in 1982 Incubation period: 48 - 96 hrs Symptoms
diarrhea (bloody), cramps, headache 2-7% develop HUS
Duration: 6 - 8 days Imp. foods: beef, raw milk, apple cider
E. coliE. coli O157:H7 in Massachusetts O157:H7 in Massachusetts
1991 - Southeastern Ma. apple cider implicated 23 cases 4 cases HUS no deaths
1995 - Barnstable County hamburger implicated 9 primary cases 1 primary and 1 secondary HUS
Field Trip SafetyField Trip Safety
Traveling animals shows & exhibits reptiles - salmonella bats, raccoons, skunks - rabies
Field trips farms, zoos, orchards
no raw milk no unpasteurized apple juices & cider strict supervision, limited animal contact handwashing
Tools for TeachingTools for Teaching
Handwashing posters Handwashing brochures Handwashing demonstrations Glo-Germ
Hand Hygeine 101Hand Hygeine 101
Cleaning visibly soiled hands Use either a non-antimicrobial or antimicrobial
soap Wet hands first with water, apply soap to hands
and rub hands together vigorously for at least 15 seconds covering all surfaces of hands & fingers
Rinse hands with water and dry thoroughly with a disposable towel
Use towel to turn off faucet
Hand Hygiene 101Hand Hygiene 101
Cleaning hands not visibly soiled May use alcohol based gel Apply product to palm of one hand and rub
hands together, covering all surfaces of hands and fingers, until hands are dry.
Wear gloves when contact with blood or other potentially infectious materials, mucous membranes, and non-intact skin could occur.
Controlling Spread through Controlling Spread through Isolation and/or QuarantineIsolation and/or Quarantine
Isolation Separation of persons who have a specific
infectious disease, and are infectious, from the general population
Quarantine Separation and restriction of movements of
persons who have been exposed to an infectious agent but are not yet ill
Legal AuthorityLegal Authority
The Massachusetts Department of Public Health in cooperation with local public health authorities, has the legal authority to enforce isolation and quarantine (105 CMR 300.200)
Federal isolation and quarantine orders are issued through executive order of the President.
Cleaning & SanitizingCleaning & Sanitizing
Routine cleaning with detergent and water is most useful for removing germs from surfaces
Additional step of sanitizing kills germs on surfaces
BleachBleach Household bleach with water
Effective, economical, convenient and readily available Weakened by heat and sunlight Make new each day and discard leftover
Choose household bleach 5.25% hypochlorite (regular) 6.00% hypochlorite (ultra)
Recipe for use on surfaces that have been detergent-cleaned and rinsed (CT=2 minutes)
¼ cup bleach + 1 gallon cool water 1 TBS. Bleach + 1 quart cool water
Recipe for submerging of eating utensils detergent-cleaned and rinsed (CT=1 minute)
1 TBS. Bleach + 1 gallon cool water
Using SanitizersUsing Sanitizers Application
Spray bottle Cloths Dipping
Use appropriate concentration Follow directions to ensure sufficient contact time
Air-dry bleach sanitized surfaces Other chemicals may require additional fresh water rinsing
Label spray bottles and containers with name, dilution and date
Keep out of reach of children
Cleaning for PreventionCleaning for Prevention
Clean frequently touched surfaces, toys, and commonly shared items at least daily and when visibly soiled.
Use an Environmental Protection Agency (EPA)-registered household disinfectant labeled for activity against bacteria and viruses, an EPA-registered hospital disinfectant, or EPA-registered chlorine bleach/hypochlorite solution.
Always follow label instructions when using any EPA-registered disinfectant. If EPA-registered chlorine bleach is not available and a generic (i.e., store brand) chlorine bleach is used, mix ¼ cup chlorine bleach with 1 gallon of cool water.
Keep disinfectants out of the reach of children.
Cleaning for PreventionCleaning for Prevention Care providers and children should use soap and water to wash
hands when hands are visibly soiled, or an alcohol-based hand rub when soap and water are not available, and hands are not visibly soiled.
Children should wash hands with soap and water 15-20 seconds (long enough for children to sing the “Happy Birthday” song twice).
Care providers should wash their hands between contacts with infants and children, such as before meals or feedings, after wiping the child’s nose or mouth, after touching objects such as tissues or surfaces soiled with saliva or nose drainage, after diaper changes, and after assisting a child with toileting.
Care providers should wash the hands of infants and toddlers when the hands become soiled.
Cleaning for PreventionCleaning for Prevention Oversee the use of alcohol-based hand rubs by children
and avoid using these on the sensitive skin of infants and toddlers.
Keep alcohol-based hand rubs out of the reach of children to prevent unsupervised use.
Keep sink locations and restrooms stocked with soap, paper towels or working hand dryers.
Keep each child care room and diaper changing area supplied with alcohol-based hand rub when sinks for washing hands are not readily accessible.
Cleaning for PreventionCleaning for Prevention
Advise children and care providers to cover their noses and mouths with a tissue when sneezing or coughing, and to put their used tissue in a waste basket.
Make sure that tissues are available in all nurseries, child care rooms, and common areas such as reading rooms, classrooms, and rooms where meals are provided.
Encourage care providers and children to wash their hands or use an alcohol-based hand rub as soon as possible, if they have sneezed or coughed on their hands.
Five Commandments of Five Commandments of Infectious Disease ControlInfectious Disease Control
Prevent illness from spreading Require immunizations Report some illnesses (city/town or state)
individual illnesses outbreaks
Exclude, cohort or treat some children and/or staff Be prepared
hire health care consultant inform parents about policies
State Health Dept.State Health Dept.
Videos Pamphlets Control materials Human Resources - us!
617-983-6800 (24/7)
MDPH Educational Materials:MDPH Educational Materials:HandwashingHandwashing
Check out all the information on the internet!
MA Department of Public Health’s Web Page Address:
http://www.state.ma.us/dph/Centers for Disease Control & Prevention’s Web Page Address
http://www. cdc.gov/http://www.cdc.gov/germstopper/resources.htm