Managing communicable disease and sick child exposures

Recent concerns over the Ebola virus, Enterovirus D68, and the onset of flu season are real time issues for youth serving programs. Child care facilities, private schools and other youth serving organizations can help prevent the onset of communicable diseases by providing information to parents, guardians, and the youth you serve; in addition to an aggressive cleaning and sanitizing protocol. Cleaning and sanitizing efforts should not just involve the classrooms, bathrooms and other building areas. It must also include methods of transportation, where germs and viruses can also be spread.

With many fears surrounding Ebola it is important to keep in mind; the Center for Disease Control outlines the following

You can only get Ebola from:

  1. Touching the blood or body fluids of a person who is sick with or has died from Ebola.
  2. Touching contaminated objects, like needles.
  3. Touching infected animals, their blood or other body fluids, or their meat.
You can stay abreast of Ebola at www.cdc.gov/vhf/ebola/.

Caring for Our Children: National Health and Safety Performance Standards, Standard 3.2.3.4: Prevention of Exposure to Blood and Body Fluids states:
Child care facilities should adopt the use of Standard Precautions developed for use in hospitals by The Centers for Disease Control and Prevention (CDC). Standard Precautions should be used to handle potential exposure to blood, including blood-containing body fluids and tissue discharges, and to handle other potentially infectious fluids.
In child care settings:
  1. Use of disposable gloves is optional unless blood or blood containing body fluids may contact hands. Glovesare not required for feeding human milk, cleaning up of spills of human milk, or for diapering;
  2. Gowns and masks are not required;
  3. Barriers to prevent contact with body fluids include moisture-resistant disposable diaper table paper, disposable gloves, and eye protection.
Caregivers/teachers are required to be educated regarding Standard Precautions to prevent transmission of bloodborne pathogens before beginning to work in the facility and at least annually thereafter. Training must comply with requirements of the Occupational Safety and Health Administration (OSHA).

Procedures for Standard Precautions should include:
  1. Surfaces that may come in contact with potentially infectious body fluids must be disposable or of a material that can be disinfected. Use of materials that can be sterilized is not required.
  2. The staff should use barriers and techniques that:
    • Minimize potential contact of mucous membranes or openings in skin to blood or other potentially infectious body fluids and tissue discharges; and
    • Reduce the spread of infectious material within the child care facility. Such techniques include avoiding touching surfaces with potentially contaminated materials unless those surfaces are disinfected before further contact occurs with them by other objects or individuals.
  3. When spills of body fluids, urine, feces, blood, saliva, nasal discharge, eye discharge, injury or tissue discharges occur, these spills should be cleaned up immediately, and further managed as follows:
    • For spills of vomit, urine, and feces, all floors, walls, bathrooms, tabletops, toys, furnishings and play equipment, kitchen counter tops, and diaper-changing tables in contact should be cleaned and disinfected.
    • For spills of blood or other potentially infectious body fluids, including injury and tissue discharges, the area should be cleaned and disinfected. Care should be taken and eye protection used to avoid splashing any contaminated materials onto any mucus membrane (eyes, nose, mouth);
    • Blood-contaminated material and diapers should be disposed of in a plastic bag with a secure tie;
    • Floors, rugs, and carpeting that have been contaminated by body fluids should be cleaned by blotting to remove the fluid as quickly as possible, then disinfected by spot-cleaning with a detergent-disinfectant. Additional cleaning by shampooing or steam cleaning the contaminated surface may be necessary. Caregivers/teachers should consult with local health departments for additional guidance on cleaning contaminated floors, rugs, and carpeting.
Prior to using a disinfectant, clean the surface with a detergent and rinse well with water. Facilities should follow the manufacturer’s instruction for preparation and use of disinfectant. If blood or bodily fluids enter a mucous membrane (eyes, nose, mouth) the following procedure should occur. Flush the exposed area thoroughly with water. The goal of washing or flushing is to reduce the amount of the pathogen to which an exposed individual has contact. The optimal length of time for washing or flushing an exposed area is not known. Standard practice for managing mucous membrane(s) exposures to toxic substances is to flush the affected area for at least fifteen to twenty minutes. In the absence of data to support the effectiveness of shorter periods of flushing it seems prudent to use the same fifteen to twenty minute standard following exposure to bloodborne pathogens.

Recognizing communicable diseases
Recognizing the signs of other communicable diseases can allow you to react in a timely manner to help prevent a potential outbreak at your center and school. A quick reference chart developed by the Virginia Department of Health - Communicable Disease Reference Chart for School Personnel provides insight on incubation period, transmission, common symptoms and recommendations for controlling the spread of nineteen communicable diseases frequent to school-aged children. This guide is available at: vdh.virginia.gov.

While the recommendations section of this chart applies only to school-aged children, programs that service preschool and early education can use this guide to quickly identify symptoms and reference how these common diseases are also transmitted.

Preparing for infectious disease outbreaks or pandemic influenza
Having a practiced emergency action plan in place will increase your success in managing a potential crisis or communicable disease outbreak within your program. The American Academy of Pediatrics provides the following preparedness recommendations.

Steps for Improving Preparedness
  • Develop a written emergency/disaster plan that includes a process and timeline for updating this document
  • Identify “trusted sources” of health information (CDC, health department, community pediatrician, and child care health consultant)
  • Establish protocols/assignments for communication systems that can be used in an emergency. This would include a process to share key information as well as an immediate alert plan. Compile and maintain a list of community contacts and key phone numbers in advance to be ready to communicate during an emergency
  • Determine who will monitor information and health alerts and report back on key findings
  • Develop a process for sharing key information with staff, parents, and children during an emergency
  • Prepare template handouts for staff and parents in advance
  • Discuss the process for ordering supplies (and maintaining inventory) during times of staff absences or when there is an increased need for certain hygiene or cleaning supplies
  • Use seasonal influenza as an opportunity to practice preparedness and response efforts
  • Collaborate with community partners on preparedness activities or contingency planning
  • Review criteria for and steps involved in facility closure
  • Implement steps to support families and employees to develop personal preparedness plans
Increasing awareness with communication
Two resources for information to support your efforts can be obtained through the Center for Disease Control (CDC) www.cdc.gov and the American Academy of Pediatrics via healthychildren.org at healthychildren.org. Healthychildren.org offers parents insight on what they can do to possibly control the spread of communicable diseases in their child’s school or child care programs. You can direct parents or guardians to this site for help with a variety of concerns, such as: Questions to Ask Your Child’s School or Child Care Program, Reducing Disease Transmission, When to Keep Your Child Home and Measures Promoting Good Hygiene.

Providing parents and guardians with information will help you maintain a higher level of accountability for taking appropriate actions to reduce the spread of communicable disease at your program. The CDC’s data base of information provides great resources to use for educating staff and to use with children. Because these resources are multilingual, they can serve as a great resource to educate non-English speaking cliental.

http://www.cdc.gov/flu/freeresources/print-family.htm#pictograms


Cleaning and sanitizing to prevent the spread of communicable diseases
Keeping your facility germ free helps to fight any potential communicable disease transmissions at the front-line. According to Caring for Our Children: National Health and Safety Performance Standards - one of the most important steps in reducing the spread of infectious diseases in child care settings is cleaning, sanitizing or disinfecting surfaces that could possibly pose a risk to children or staff. Routine cleaning with detergent and water is the most common method for removing some germs from surfaces in the child care setting. However, most items and surfaces in a child care setting require sanitizing or disinfecting after cleaning to further reduce the number of germs on a surface to a level that is unlikely to transmit disease.

There are numerous products available to help you clean and sanitize such as “green cleaning products,” commercial cleaning/disinfecting products and diluted bleach solutions. Always confirm the solution you are using is appropriate for use in an environment that services children and meets state and local licensing agencies regulations. Additionally, refer to the guidelines provided by the manufacturer to ensure proper contact time for cleaning surfaces.

If you are considering using a low cost alternative such as bleach, the following recommendations from the California Childcare Health Program – Health and Safety Notes, Sanitize Safely and Effectively: Bleach and Alternatives in Child Care Programs can serve as a useful reference.

To safely prepare bleach dilutions:
  • Dilute bleach with cool water and do not use more than the recommended amount of bleach.
  • Make a fresh bleach dilution daily; label the bottle with contents and the date mixed.
  • Wear gloves and eye protection when diluting bleach.
  • Use a funnel.
  • Add bleach to the water rather than water to bleach to reduce fumes.
  • Make sure the room is well ventilated.
  • Never mix or store ammonia with bleach or products that contain bleach.
To safely use bleach solutions:
  • Apply the bleach dilution after cleaning the surface with soap or detergent and rinsing with water.
  • Allow for a two-minute contact time or air dry.
  • Sanitize with bleach when children are not present.
  • Ventilate the room and allow the surfaces to completely dry before allowing children back into the area.
  • Store all chemicals in a secure area, out of reach of children and in a way that they will not tip and spill.
Recommended Bleach Dilutions
For food contact surface sanitizing (refrigerators, freezers, plastic cutting boards, stainless cutlery, dishes, glassware, countertops, pots and pans, stainless utensils, toys that have been mouthed, high chair trays)
  • 1 Tablespoon of bleach to a gallon of water.
  • Let stand for 2 minutes or air dry.
For nonporous surface sanitizing and disinfecting
  • 1/4 cup of bleach to one gallon of water or 1 tablespoon per quart.
  • Let stand for 2 minutes or air dry.
If you have an event, Caring for Our Children: National Health and Safety Performance Standards outlines the following:

Treat urine, stool, vomit, blood, and body fluids, except for human milk, as potentially infectious. Spills of body fluid should be cleaned up and surfaces disinfected immediately.
  • For small amounts of urine and stool on smooth surfaces, wipe off and clean away visible soil with a little detergent solution. Then rinse the surface with clean water.
  • Apply a disinfectant following the manufacturer’s instructions.
For larger spills on floors, or any spills on rugs or carpets:
  • Wear gloves while cleaning. While disposable gloves can be used, household rubber gloves are adequate for all spills except blood and bloody body fluids. Disposable gloves should be used when blood may be present in the spill; d) Take care to avoid splashing any contaminated material onto the mucous membranes of your eyes, nose or mouth, or into any open sores you may have;
  • Wipe up as much of the visible material as possible with disposable paper towels and carefully place the soiled paper towels and other soiled disposable material in a leak proof, plastic bag that has been securely tied or sealed. Use a wet/dry vacuum on carpets, if such equipment is available;
  • Immediately use a detergent, or a combination detergent/disinfectant to clean the spill area. Then rinse the area with clean water. Additional cleaning by shampooing or steam cleaning the contaminated surface may be necessary;
  • For blood and body fluid spills on carpeting, blot to remove body fluids from the fabric as quickly as possible. Then disinfect by spot-cleaning with a combination detergent/disinfectant, and shampooing, or steamcleaning the contaminated surface;
  • If directed by the manufacturer’s instructions, dry the surface;
  • Clean and rinse reusable household rubber gloves, then apply disinfectant. Remove, dry and store these gloves away from food or food surfaces. Discard disposable gloves;
  • Mops and other equipment used to clean up body fluids should be:
    • Cleaned with detergent and rinsed with water;
    • Rinsed with a fresh disinfectant solution;
    • Wrung as dry as possible;
    • Air-dried.
  • Wash your hands afterward, even though you wore gloves;
  • Remove and bag clothing (yours and those worn by children) soiled by body fluids;
  • Put on fresh clothes after washing the soiled skin and hands of everyone involved.
Having a plan should also include managing a crisis. A Guide to Crisis Management is a supportive Markel Safety 1st Guide designed to help you plan an effective crisis response.

Resources:
  • American Academy of Pediatrics, American Public Health Association, National Resource Center for Health and Safety in Child Care and Early Education. 2011. Caring for our children: National health and safety performance standards; Guidelines for early care and education programs. 3rd Edition. Elk Grove Village, IL: American Academy of Pediatrics; Washington, DC: American Public Health Association.
  • The California Childcare Health Program – Health and Safety Notes, Sanitize Safely and Effectively: Bleach and Alternatives in Child Care Programs
  • Virginia Department of Health - Communicable Disease Reference Chart for School Personnel, vdh.virginia.gov/Epidemiology/documents/pdf/Communicable_Disease_Chart.pdf
  • Center for Disease Control (CDC) cdc.gov
  • Preventing the Spread of Illness in Child Care or School; healthychildren.org., American Academy of Pediatrics, 22 Sept. 2014

The information provided in this article is intended for general informational purposes only and should not be considered as all encompassing, or suitable for all situations, conditions, and environments. Please contact us or your attorney if you have any questions.

For safety or risk management questions or suggestions, please contact Markel.

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