Beyond the Fundamentals: HEALTHY AND SAFE ENVIRONMENTS Recognizing and Preventing Infectious Disease in Child Care Settings (3 hours) Peggy Poppe - April 2011 Table of contents for this document A Instructor Qualifications B Northern Lights Early Childhood Competencies related to this module C Module outline D Sample Agenda E Sample Activities F Background Information for Instructors A Instructor Qualifications: Health Care Professionals with Knowledge of National Child Care Health and Safety Standards as outlined in Caring for Our Children http://nrckids.org/CFOC/HTMLVersion/TOC.html, Vermont Child Care Licensing regulations and regulations and knowledge of the context of working with children and families from birth through school age in group care Note to the instructor: This is an outline of consistent, yet flexible curriculum to use to teach early childhood professionals across Vermont about the specific Northern Lights Core Competencies for Early Childhood Professionals listed in the “Outline of content and Northern Lights Core Competencies for Early Childhood Professionals” The materials here are not intended to be a “canned” curriculum, but rather a guide to use as you plan for instructing on these concepts This curriculum outline and agenda correspond with the core competencies The outline of topics must be addressed; however, the teaching methodology and format of delivery are flexible Links to model lesson plans as well as sample activities are provided as resources Background information about the topic is provided as a reference for talking points Information changes periodically The instructor is expected to check current resources to assure that information is current and up to date For further information, please contact the Vermont Northern Lights Career Development Center (http://northernlightscdc.org ) B Northern Lights Core Competencies for Early Childhood Professionals: The following list of competencies relates to this training Professionalism And Program Organization • Identifies local, state, and national organizations that advocate for children, families, and early childhood professionals Families And Communities : Community Involvement and Resources Beyond the Fundamentals: Healthy and Safe Environments – Recognizing & Preventing Infectious Diseases pg of 16 • Demonstrates knowledge of community resources that support children and families Healthy And Safe Environments : Healthy Environments and Health Needs • Demonstrates and provides instruction for new staff and volunteers on hand washing, diapering, toileting, and sanitation practices • Demonstrates and provides instruction for new staff and volunteers on hand washing, diapering, toileting, and sanitation practices • Develops and implements policies regarding exclusion and readmission of sick children • Follows up with parents about maintaining accurate immunization records C Module Overview Recognizing and Preventing Infectious Diseases in Child Care Settings: Time Objectives Training Techniques Equipment Topics/ Content hours This training is designed so that participants will acquire the knowledge and skills needed for them to: • Describe factors that impact the spread of infections: type of infection, route of transmission, and personal risks • Identify practices that prevent the spread of infectious disease in childcare programs • Review and adapt an infection control policy for a child-care program which is in compliance with Vermont Licensing rules and regulations Lecture, small group work, video, repeat demonstration DVD, sink, LCD projector and lap top computer Infections in Child Care Settings • Factors causing increased exposure • Types of infections • Routes of infection • Risks to children and staff Prevention strategies • Daily Health Check • Exclusion practices • Immunizations children and staff • Hand washing • Sanitizing surfaces • Diapering procedure/toileting • Reportable diseases to VDH and informing parents • Blood Borne Pathogens requirement • Infection Control Policies • Considerations for staff of child bearing age • Vermont Licensing Beyond the Fundamentals: Healthy and Safe Environments – Recognizing & Preventing Infectious Diseases pg of 16 Key References Model Lesson Plans Model Lesson Plans (cont.) Caring for Our Children http://nrckids.org/CFOC/HTMLVersion/TOC.html Early Childhood Program Licensing Regulations State of Vermonthttp://dcf.vermont.gov/sites/dcf/files/pdf/cdd/care/Early_Child hood_Program.pdf (section V G) Health and Safety in the Child Care Setting: Prevention of Infectious Diseases.http://www.ucsfchildcarehealth.org/pdfs/Curricula/idc2book pdf Managing Infectious Diseases in Early Education and Child Care Settings, 2010 http://www.healthychildcare.org/InstructorsManualID.html Preventing and Managing Illness in ECE Programs http://www.ucsfchildcarehealth.org/pdfs/Curricula/CCHA/9_CCHA_Ill nessPrev_0506.pdf Sample Activities Symptoms of Illness Activity Hand washing Activity Infectious Disease Policy Activity Handouts for Participants Handout B Handout C Hand washing Checklist California Child Care Health Program Survival Tips Posters http://www.ucsfchildcarehealth.org/html/pandr/postersmain.htm California Child Health Program Fact Sheets for Families http://www.ucsfchildcarehealth.org/html/pandr/factsheetsmain.htm Introduction to Infectious Diseases Unit 1: Instructional Activities for ages 2-6 http://www.pkids.org/files/pdf/idw/261.pdf Handouts for Families Classroom Ideas for Teachers Book: Germs are not for Sharing by Elizabeth Verdick Beyond the Fundamentals: Healthy and Safe Environments – Recognizing & Preventing Infectious Diseases pg of 16 D Sample Agenda (3 hours) Beyond the Fundamentals: Healthy and Safe EnvironmentsRecognizing and Preventing Infectious Diseases Time Content 10min Welcome /Introductions 10min 20min Ice Breaker Overview of Communicable Diseases in Child Care (why are staff and children at risk? Routes of infection) Types of Infections Staff risks Exclusion guidelines 20 Method 20 15 30 Prevention strategies: Daily Health Check Exclusion Immunizations children and staff Reportable diseases to VDH and Informing parents Sanitizing Break Lecture/Power Point Symptoms of Illness Activity Lecture /discussion Power Point AAP video segments Review handouts Hand washing Activity and checklist Hand washing 15 10 20 Classroom ideas Diapering Demonstration Blood Borne Pathogens Standard Policies in Child Care Settings/why/components Required policies (licensing/standards) 10 Demonstration: Ask someone to review steps in Licensing regulations and demonstrate using a doll (highlight frequently missed steps) AAP slide diapering area /discussion Power Point Lecture Lecture Hand washing Policy Activity Discussion Implementing and communicating policies to parents Wrap up E Sample Activities Symptoms of Illness Activity Beyond the Fundamentals: Healthy and Safe Environments – Recognizing & Preventing Infectious Diseases pg of 16 - Facilitator Instructions - Instructions: Participants can work individually or in pairs Ask each group of two or three choose one of the following illnesses Assure that all illnesses are covered • • • • • • • Rotavirus (pg 127) Parvovirus/Fifths Disease (pg 75-76) CMV (pg 63) Chickenpox/Varicella (pg 61-62) Impetigo (pg 91) MRSA (pg.111) Any other of special interest Ask each small group to review the illnesses in the materials provided and summarize the following points for the group (Use the Managing Infectious Diseases in Child Care and Schools or provide other reference material such California Child Care Health Program Illness Sheets http://www.ucsfchildcarehealth.org/html/pandr/illnesssheetsmain.htm) What are the major signs and symptoms? • How long does it take to incubate (time between exposure and illness) • How long is it contagious? • How is it spread? • How is it controlled? • Special roles of Caregivers/teachers? • Should a child with this illness be excluded from care? Under what conditions? (Check Vermont Licensing Regulations) Ask someone form each group to share key points with the larger ITV group Beyond the Fundamentals: Healthy and Safe Environments – Recognizing & Preventing Infectious Diseases pg of 16 Sample Activity Symptoms of Illness Activity Participant Handout Instructions: Work individually or in pairs Choose one of the following illnesses • • • • • • • Rotavirus (pg 127) Parvovirus/Fifths Disease (pg 75-76) CMV (pg 63) Chickenpox/Varicella (pg 61-62) Impetigo (pg 91) MRSA (pg.111) Any other of special interest Use the references provided to answer the following questions and summarize the key points Be prepared to share your findings with the larger group • Describe the illness briefly? (Is it a virus, bacteria or other and other key facts)? • What are the major signs and symptoms? • How long does it take to incubate (time between exposure and illness) • How long is it contagious? • How is it spread? • How is it controlled? • Special roles of Caregivers/teachers? • Should a child with this illness be excluded from care? Under what conditions? (Check Vermont Licensing Regulations) Beyond the Fundamentals: Healthy and Safe Environments – Recognizing & Preventing Infectious Diseases pg of 16 Sample Activity Hand Washing Activity Materials: Sink with soap and paper towels Cornstarch, glitter, cinnamon, and hand lotion, and check list Instructions: Ask for one person to volunteer to spread cornstarch “germs” by apply a liberal amount of cornstarch to their hands and then asking all participants to shake hands with everyone in the group shaking hands with everyone in the group Lead a brief discussion of how the germs spread Then ask participants to practice good hand washing Ask participants to find a partner Ask each person to choose either glitter or cinnamon to wash off his or her hands (Applying hand lotion before applying either glitter or cinnamon works best.) Ask partners to practice hand washing according to the checklist Partners will instruct each other using the checklist as a guide Remind participants that good hand washing is essential for both children and staff They can use the cornstarch and glitter to teach this skill to children in their care Using the glitter or cinnamon will provide an opportunity for them to try out the materials Classroom Curriculum: Introduction to Infectious Diseases Unit 1: Instructional Activities for ages 2-6 http://www.pkids.org/files/pdf/idw/261.pdf Book: Germs are not for Sharing by Elizabeth Verdick Beyond the Fundamentals: Healthy and Safe Environments – Recognizing & Preventing Infectious Diseases pg of 16 Hand Washing Checklist Check to see that paper towel or single use personal towel is available Turn on warm water 60-120 degrees Moisten hands and apply liquid soap Rub hands together at least 10 seconds rubbing areas between fingers, around nail beds, fingernails, jewelry and back of hands (sing hand washing song) Rinse hands leaving water running while drying hands Dry hands with disposable or single use towel Turn off tap with towel if not automatic Use hand lotion Beyond the Fundamentals: Healthy and Safe Environments – Recognizing & Preventing Infectious Diseases pg of 16 ACTIVITY: REVIEWING A CHILD CARE HEALTH AND SAFETY POLICY Instructions: Read/review the policy Does the policy address the eleven criteria for what a health policy should include The policy should meet the minimum licensing requirements but can exceed them based upon current research and guidelines Provide licensing regulations and copies of related Standards from Caring for Our Children Title Belief Statement Intent Statement Background Procedure/Practice Application Communication References Review 10 Effective Date 11 Review Date Adapted from: Cimino J and The National Training Institute for Child Care Health Consultants Building consultation skills: policy development trainer’s guide: version Chapel Hill (NC): The National Training Institute for Child Care Health Consultants, Department of Maternal and Child Health, The University of North Carolina at Chapel Hill; 2007 _ Beyond the Fundamentals: Healthy and Safe Environments – Recognizing & Preventing Infectious Diseases pg 10 of 16 HAND WASHING POLICY ABC Child Care Center believes that proper hand washing is the most effective way to decrease the spread of communicable disease Frequent hand washing by childcare providers and children is the most effective way to prevent spreading germs (CDC, 2004) This policy is intended to keep children, families, and staff healthier This policy was developed in response to an increase in a communicable disease (This is background information that a particular center wanted to include because there had been a Salmonella outbreak Not every policy will have a background statement.) ABC Child Care Center requires all providers (staff/volunteer) to wash their hands at the following times: o Upon arrival at work o Before preparing or handling food, or feeding children o After using the toilet, assisting children with toileting, or changing diapers o After contact with any bodily fluids or secretions o After handling pets or caring for pets o Before administering any type of medication, or applying ointments/creams o After cleaning surfaces or toys o Whenever hands are visibly dirty o Before leaving work All children attending the program are required to wash their hands: o Upon arrival o Before and after eating o After using the toilet or having diapers changed o After playing outside o After handling or feeding animals/pets, or handling animal cages o When hands are visibly dirty o Before leaving the center Beyond the Fundamentals: Healthy and Safe Environments – Recognizing & Preventing Infectious Diseases pg 11 of 16 This policy applies to staff employed by the program, all volunteers, parents, and all children attending the program Staff and volunteers will receive a written copy of this policy in their orientation packets before their first day at the center All parents will receive a written copy of this policy in the parent handbook A copy of this policy will be posted on the parent bulletin board in each classroom Parents will receive written notification of any necessary updates References Centers for Disease Control and Prevention An ounce of prevention: Keeps the germs away [online] 2004 Available from: URL: http://www.cdc.gov/ncidod/op/handwashing.htm Adapted from: Cimino J and The National Training Institute for Child Care Health Consultants Building consultation skills: policy development trainer’s guide: version Chapel Hill (NC): The National Training Institute for Child Care Health Consultants, Department of Maternal and Child Health, The University of North Carolina at Chapel Hill; 2007 _ Beyond the Fundamentals: Healthy and Safe Environments – Recognizing & Preventing Infectious Diseases pg 12 of 16 Sample Activity Bingo/Jeopardy: Test participants’ comprehension and knowledge by playing Bingo, Jeopardy, or another game To play Bingo, create a grid of 4X4 squares Write a couple of different combinations of the names of infections on the squares, copy them, and distribute a game card and some little scraps of paper, paper clips, pennies, or other game pieces to each person After your presentation, wrap up by asking questions which participants answer by playing Bingo The winner(s) could assist you with another activity in the session Beyond the Fundamentals: Healthy and Safe Environments – Recognizing & Preventing Infectious Diseases pg 13 of 16 F Background Information for Instructors to Use in Preparing Presentations: Materials adapted and used with permission from: National Training Institute for Child Care Health Consultants Staff Caring for the health and safety of child care staff Chapel Hill, NC: National Training Institute for Child Care Health Consultants, Department of Maternal and Child Health, The University of North Carolina at Chapel Hill; 2003 Factors That Increase the Spread of Infection in Child Care Settings: Childcare brings children together in close contact for routine care, play, and learning Some characteristics unique to group childcare also increase the risk of transmission of infectious disease to the staff Child care staff acquire infectious diseases at a higher rate than adults who have less contact with children because of their exposure to the diseases that the young children they work with have Children are at risk because infants have immature immune systems that make them especially vulnerable to infections that they can then transmit to others Children’s touching of each other, and sharing personal belongings, toys, and classroom materials contributes to the spread of infection Young children explore objects orally as well as manually and visually, which is developmentally appropriate but increases exposure Infants and young children require hands-on care, and close contact for routine activities such as feeding, diapering, and cuddling They also need assistance with wiping their noses or washing their hands Children in childcare are typically unrelated and each child contributes his/her own set of pathogens to the environment Thus, the more children in the group, the greater the likelihood that more infectious agents will be introduced and shared with other children and staff Staff who care for both infants and toddlers/preschoolers are at greater risk than those who care for only one of these age groups because of their exposure to enteric agents from infants and respiratory tract agents from toddlers/preschoolers Children and/or staff who attend childcare when they are mildly ill increase the risk of transmitting the infection to all others present Beyond the Fundamentals: Healthy and Safe Environments – Recognizing & Preventing Infectious Diseases pg 14 of 16 Infections with Potentially Severe Outcomes for Child Care Staff: CMV (Cytomegalovirus) Congenital CMV poses serious risks for the developing fetus It is one of the major viral causes of congenital infection resulting in severe birth defects in the United States and worldwide The more serious defects to the fetus include hearing loss, mental retardation, cerebral palsy and visual disturbances Staff who are pregnant should receive health counseling about the possible risks of CMV infection to their unborn children Testing for serum antibodies to CMV is recommended for any female childcare workers of childbearing age Hepatitis A Fewer than 5% of children under three and fewer than 10% of children under six with Hepatitis A develop jaundice On the other hand, more than 75% of older children and adults with the infection develop jaundice Varicella-zoster (chickenpox) A vaccine for varicella-zoster has been available since 1995 and is strongly recommended for child care workers who not have a documented record of previous infection with the disease, or negative blood tests for immunity (CDC, 2001a) When outbreaks of chickenpox occur in the childcare setting, susceptible providers are especially vulnerable If infection occurs during pregnancy, varicellazoster carries the potential for harm to fetal development When an outbreak occurs, the CDC (2001a) and American Academy of Pediatrics (2000) recommend that all non-pregnant susceptible persons, 12 months and older, receive the varicella-zoster vaccine within 72 hours after exposure to the disease Parvovirus B19 Parvovirus B19 is a common infection; about 50% of adults have previously been infected and acquired immunity The most common illness associated with Parvovirus B19 is fifth disease In children, fifth disease is manifest as a mild rash on the face, trunk, and limbs In adults, the illness can be more severe and is sometimes associated with joint pain and/or swelling in addition to a rash For women who are pregnant, however, the situation can be serious Generally, infection during pregnancy produces only a mild illness in women and seldom has adverse effects on fetal development However, in 4-10% of previously uninfected women, infection during pregnancy results in severe anemia to the fetus and subsequent miscarriage (Reves and Pickering, 1992; CDC, 2001b) The risk for miscarriage is highest in the second trimester of pregnancy (Pass, 1991) Child care workers are at greater risk for exposure to Parvovirus B19 because the disease is spread through respiratory secretions, such as saliva or nasal secretions, which may be easily passed from one child to another, and from children to staff, through close contact, shared toys, handling of bodily fluids, etc (Reves and Pickering, 1992) The situation with Parvovirus B19 is much like that of CMV The risk for fetal infection is low, but if infection occurs, the potential exists for a Beyond the Fundamentals: Healthy and Safe Environments – Recognizing & Preventing Infectious Diseases pg 15 of 16 devastating outcome There is no vaccine for Parvovirus B19, again probably because the rate of adverse outcomes to infected adults, children, and fetuses is low Education about the health risks of infection with Parvovirus B19 for female childcare staff of childbearing age is recommended (Reves and Pickering, 1992; CDC, 2001c) Staff who are pregnant who have a documented Parvovirus B19 infection should consult with a physician Blood borne infections (Hepatitis B, Hepatitis C and HIV) though infrequent in childcare settings have potential for severe outcomes and are considered occupational risk factors for child care workers Hepatitis B, Hepatitis C, and Human Immunodeficiency Virus (HIV) are viruses transmitted through direct contact with blood or body fluids of an infected person The risk of transmitting these diseases in the childcare setting is very low Vaccination for Hepatitis B is recommended for childcare staff and the children in their care Mild Infectious Illnesses • Respiratory and gastrointestinal tract infections are the most common illnesses reported among children in childcare, and researchers believe these infections represent the bulk of illnesses transmitted from children to child care staff (Cordell, 2001; Holmes, et al, 1996) Prevention Measures for Staff: • Immunizations: See up-to-date immunization schedules for adults and children Vermont Department of Health http://healthvermont.gov/hc/imm/public.aspx • Tuberculosis Screening In addition to these recommendations, the Caring For Our Children standards (2nd ed 2002) require that potential childcare staff employees receive tuberculosis screening by Mantoux intradermal skin testing prior to initial employment Staff with negative skin tests not require re-screening on a regular basis unless it is required by local or state health departments Staff members with positive skin tests and/or those who develop an illness consistent with tuberculosis must be under the care of a physician • Disease Management Practices (Refer to Vermont Child Care Licensing Regulations) To reduce the incidence of these illnesses, the infectious disease research and government regulations indicate the following procedures for staff: o Hygienic procedures for hand washing, diapering, food preparation and Beyond the Fundamentals: Healthy and Safe Environments – Recognizing & Preventing Infectious Diseases pg 16 of 16 cleaning and sanitation of the environment and toys in the child care setting Maintain frequent and proper hand washing among staff o Exclusion criteria and procedures for both ill staff and children In a statewide survey of 446 randomly selected childcare staff members in Wisconsin (78 directors, 236 teachers, and 132 family providers), Gratz and Claffey (1996) found that 87% of staff reported working when ill The Caring For Our Children standards (2nd ed 2002) list 18 conditions that should result in the temporary exclusion of a staff member for reasons of preventing the spread of illness o The OSHA Blood borne Pathogen standard 1910.1030 requires that any workplace that exposes employees to blood borne pathogens must have a written exposure prevention plan that explains the requirements of the that specific workplace While general guidelines may exist, each plan must be tailored to the unique characteristics of its own setting o Staff who are pregnant are especially vulnerable to infectious diseases Staff who are pregnant or staff who are considering pregnancy should consult with their health care providers for advice about immunizations and other measures to promote a healthy pregnancy while working in the child care setting Gratz and Boulton (1994) add that child care facilities with staff who are pregnant should pay special attention to the following recommendations: o Maintain use of gloves when handling blood or body fluids o Establish dependable communication between parents and staff for information about possible exposures to illnesses ... with parents about maintaining accurate immunization records C Module Overview Recognizing and Preventing Infectious Diseases in Child Care Settings: Time Objectives Training Techniques Equipment... Health and Safety in the Child Care Setting: Prevention of Infectious Diseases.http://www.ucsfchildcarehealth.org/pdfs/Curricula/idc2book pdf Managing Infectious Diseases in Early Education and Child. .. Healthy and Safe Environments – Recognizing & Preventing Infectious Diseases pg of 16 D Sample Agenda (3 hours) Beyond the Fundamentals: Healthy and Safe EnvironmentsRecognizing and Preventing Infectious