Policy on Infection Control

Transcription

1 Links to Policy and Guidance: Health and Safety Policy Medication and Illness Policy Staff Sickness Policy Nappy Changing Policy Head Lice policy and procedure Use of dummy, teethers and bottles policy Food Handling Policy Policy on Infection Control Links to Legislation Public Health England Guidance on Infection Control on Schools and other Childcare Settings (2016) What this policy covers 1. Contagious and Notifiable Diseases 2. Rashes and skin infections 3. Diarrhea and Vomiting related illnesses 4. Respiratory Infections 5. Other infections and ailments 6. Procedures for good hygiene practice in the nursery: -Hand washing -Toilets and potty training -Nappy changing -Personal protective equipment -Body fluid spillages -Cleaning the nursery environment -Laundry -Cleaning equipment -Clinical waste -Sharps disposal -Baby feeding equipment -Food and kitchen hygiene -Sharps, injuries and bites -Animals in school (Permanent or visiting) -Outings to farms and zoos -Vulnerable children -Female staff and pregnancy 7. Head Lice summary 8. Immunization of staff and children, and Immunization schedule OUR STATEMENT AND AIMS At Elephant and Castle Day Nursery it is our aim to minimize the spread of infection for staff and children through the implementation of controls which reduce the transmission and spread of germs. We aim to promote and maintain the health of children and staff through the control of infectious illnesses. We aim to control infection by providing on- going infection control training for staff (hand washing, food hygiene, cleaning). Exclusion guidelines as recommended by Public Health England apply in the case of all suspected infectious conditions. These guidelines will be distributed to all parents and staff. Parents will be informed should staff, children or visitors to the nursery report the presence of any contagious condition to the nursery. 1. Contagious and Notifiable diseases We need to be notified immediately if a child has a contagious illness, even if it has yet to be confirmed by a doctor. If your child has a contagious illness we must have written confirmation from your doctor that your child is fit to return to 1

2 nursery, the nursery reserves the right to contact the child s GP via telephone/letter/ to determine if the child is fit to return to nursery. All members of staff have a duty to ensure that they do not attend the session if they have a serious infectious illness, this will assist us to prevent the spread of any infectious illness. Procedure for dealing with infectious/ communicable or notifiable diseases 1. Any child found to be unwell will be sent home. Parents/carers will be contacted and appropriate advice given by a Manager or Team Leader. 2. Parents/carers must be informed verbally and in writing as soon as possible if any infectious or notifiable diseases are detected on the nursery s premises (- see exceptions for Head Lice). 3. The nursery has a duty to contact the Environmental Health Agency when two or more infectious cases arise on The nursery will liaise regularly with the Agency, and follow the procedures and guidelines as set by the Agency as well as the nursery s own Emergency Procedures on Outbreaks of Infection, including applying the Exclusion policy listed below. 4. Children will be allocated a quiet area on the day, away from other children- where they can wait for their parents or carers to collect them during an outbreak. 5. When the nursery becomes aware, or is formally informed of the notifiable disease, the manager informs OFSTED and acts on the advice given by the Environmental Health Agency. [There may be occasions when these exclusion times are extended due to regional outbreaks or contagious illnesses]. 6. The nursery can refuse to accept a child back if they do not/until such time as they receive a doctor s note confirming that the child is fit to return and no longer poses any risk of infecting the other children or staff at the setting. In addition OFSTED must be notified of: any food poisoning incident affecting two or more children cared for on the premises any child having meningitis an outbreak on the premises of any Notifiable Disease identified as such in the Public Health Infectious Diseases Regulations Rashes and skin infections Infection or complaint Recommended period to be kept Comments away from nursery Athlete s foot None Athlete s foot is not a serious condition. Treatment is recommended Chickenpox Until all vesicles have crusted over,7 days from when the rash appears 2 See: *Vulnerable Children and Female Staff Pregnancy Symptom: May be a slight fever, headache, nausea, spots appear on the 2nd day starting on the back. Cold sores, (Herpes simplex) None Avoid kissing and contact with the sores. Cold sores are generally mild and self-limiting German measles (rubella) * Four days from onset of rash *Preventable by immunization (MMR x2 doses). See: Female Staff Pregnancy. Hand, foot and mouth disease Impetigo During acute phase and while rash and ulcers are present/raw looking Until lesions are crusted and completely healed, or 48 hours after starting antibiotic treatment Contact your local HPT if a large number of children are affected. Exclusion may be considered in some circumstances. Contagious, spread by hands and by objects touched. Antibiotic treatment speeds healing and reduces the infectious period Symptom: Blisters, spreading at the

3 edges which are raised, thick yellow crust when blisters break. Measles 7 days after rash appears * Preventable by vaccination (MMR x2). See: Vulnerable Children and Female Staff Pregnancy Symptoms: Cold, Cough, Fever or chill, Sore eyes, white spots in mouth (1 or 2 days), rash after 2 or 3 days on face, weak chest. German Measles Minimum 4-12 days from appearance of rash. Symptoms: May have fever, sore throat, stiff neck, Rash after 1-2 days usually starts on face Molluscum contagiosum None A self-limiting condition Ringworm Treatment is required until the patch is dry (not raw looking) it begins to - flake and treatment has been applied. Symptom: (Body) Round red areas with a raised border. Contagious spread by scratching and material under finger nails. Treatment is required; patch may be required to be covered with e.g. long sleeves. Roseola (infantum) None None Scabies Child can return after first treatment Mites spread rapidly by contact from clothing or bedding. Household and close contacts require treatment. Symptom: Intense itching, blistering, pin point blood crusts. Scarlet fever + streptococcal infection of the throat Slapped cheek/fifth disease. Parvovirus B19 Shingles * Child can return three days after starting appropriate antibiotic treatment None (once rash has developed) Exclude only if rash is weeping and cannot be covered Antibiotic treatment is recommended for the affected child. * See: Vulnerable Children and Female Staff Pregnancy * Can cause chickenpox in those who are not immune, i.e. have not had chickenpox. It is spread by very close contact and touch. If further information is required, contact your local PHE centre. See: Vulnerable Children and Female Staff Pregnancy. Warts and verrucae None Verrucae should be covered in swimming pools, gymnasiums and changing rooms 3. Diarrhea and Vomiting related illnesses Infection or complaint Recommended period to be kept away from nursery Diarrhea and/or vomiting 24 hours following runny tummy. 48 hours from last episode of serious diarrhea or vomiting E. coli O157 VTEC Should be excluded for 48 hours from Typhoid* [and paratyphoid*] the last episode of diarrhea. Further (enteric fever) exclusion may be required for some Shigella (dysentery) children until they are no longer excreting Typhoid fever-until declared free from infection by a doctor. 3 Comments -See Respiratory infections Further exclusion is required for children aged five years or younger and those who have difficulty in adhering to hygiene practices. Children in these categories should be excluded until there is evidence of microbiological clearance. This guidance may also apply to some contacts who may also require microbiological clearance. Please consult your local PHE centre for further advice

4 Cryptosporidiosis Exclude for 48 hours from the last episode of diarrhea Exclusion from swimming is advisable for two weeks after the diarrhea has settled 4. Respiratory infections Infection or complaint Recommended period to be kept Comments away from nursery Flu (influenza) Until recovered See: Vulnerable Children Viral Gastroenteritis Varies dependant on organism 48 hours from last episode of Diarrhea or Vomiting. * See: Vulnerable Children and Female Staff Pregnancy. Tuberculosis * Always consult your local PHE centre Until declared free from infection by a doctor. 4 Requires prolonged close contact for spread. Whooping cough* (pertussis) 21 days from onset of illness Preventable by vaccination. After treatment, non-infectious coughing may continue for many weeks. Your local PHE centre will organize any contact tracing necessary Symptom: Fevers and Catarrh for approx 1 week before cough develops. Poliomyelitis 5. Other infections and ailments Infection or complaint Conjunctivitis Diphtheria Until certified well Recommended period to be kept away from nursery Until treatment commences/ clear discharge from eyes * Exclusion is essential. Always consult with your local HPT 2-5 days. Comments If an outbreak/cluster occurs, consult your local PHE centre Symptom: Sore eyes, inflamed discharge or watering. Family contacts must be excluded until cleared to return by your local PHE centre. Preventable by vaccination. Your local PHE centre will organize any contact tracing necessary. Treatment is recommended only in cases where live lice have been seen Glandular fever infectious Until certified well. mononucleosis Head lice (Pediculosis) Until treatment is applied. There are a range of shampoo treatments. * See: Head Lice Policy Hepatitis A* Exclude until seven days after onset of jaundice (or seven days after symptom onset if no jaundice) and when recovered. In an outbreak of hepatitis A, your local PHE centre will advise on control measures Hepatitis B*, C*, HIV/AIDS Until certified well by a doctor. Hepatitis B and C and HIV are blood borne viruses that are not infectious through casual contact. *For cleaning of body fluid spills see: Good Hygiene Practice Infective hepatitis Meningococcal meningitis*/ septicemia* Sven days from onset Until recovered, and certified well by a doctor. Meningitis C is preventable by vaccination There is no reason to exclude siblings or other close contacts of a case. In case of an outbreak, it may be necessary to provide antibiotics with or without meningococcal vaccination to close school contacts. Your local PHE

5 centre will advise on any action is needed Meningitis* due to other bacteria Until recovered Hib and pneumococcal meningitis are preventable by vaccination. There is no reason to exclude siblings or other close contacts of a case. Your local PHE centre will give advice on any action needed Meningitis viral * Until certified well Milder illness. There is no reason to exclude siblings and other close contacts of a case. Contact tracing is not required MRSA None Good hygiene, in particular hand washing and environmental cleaning, are important to minimize any danger of spread. If further information is required, contact your local PHE centre Mumps* Threadworms Treatment is recommended for the child and household contacts Exclude child for seven days 7 days minimum or until the swelling has subsided None Preventable by vaccination (MMR x2 doses) Symptoms: Fever, sore throat, dry mouth, pain when chewing. Treatment is recommended for the child and household contacts Tonsillitis Until child certified well. There are many causes, but most cases are due to viruses and do not need an antibiotic Antibiotics First 3 days (72 hours) Vaccinations 24 Hours, MMR Vaccine : Hours Food poisoning Salmonella and Dysentery High Temperature 3-5 days 24 hours or until advised by the doctor 24 hours after child feels better * denotes a notifiable disease. If a child or adult is diagnosed suffering from a Notifiable Disease under the (Public Health, Guidance on infection control in schools and other childcare settings) the nursery will report this to the Environmental Health Agency operating in South London. 6. Procedures for good hygiene practice in the nursery Hand washing -Hand washing facilities are always available for children and include hot (not exceeding 43 degrees)and cold water, liquid soap and paper hand towels/or air dryers - Hand washing facilities are available in all toilets, nappy changing areas, kitchens, baby, toddler and pre-school rooms. -Staff and visitors are encouraged to apply hygienic hand rubs approved by the BS EN 1500 standards, as an additional level of protection against cross contamination and bacteria. Hand rubs are available in every classroom, bathrooms, kitchen areas and hallways. -Children are encouraged and reminded to wash their hands after using the toilet, before eating and after playing outside. Staff must wash their hands: before preparing or serving food o before feeding children before eating or drinking after going to the toilet after assisting children at the toilet 5

6 after nappy changing after dealing with any body fluids after cleaning procedures after caring for sick children after handling soiled clothing or items or after dealing with waste after removing disposable gloves and/or aprons Hand washing technique: Wet hands under hot water (not exceeding 430 C for children to prevent scalding), apply liquid soap, rub vigorously paying particular attention to palms, backs, wrists, fingernails and fingers and rubbing between each finger and around the thumbs, rinse, dry thoroughly using disposable paper towels and turn off taps using the paper towel. An aid dryer can also be used to dry hands. Staff should cover all cuts and abrasions with waterproof dressings. As long as hands are washed correctly, there is no need to use an antibacterial soap, an ordinary soap with moisturizers will adequately clean and kill germs. Toilets and potties: Toilet areas, including toilet handles, doors, toilet seats and wash hand basins are cleaned frequently throughout the day in accordance with the cleaning schedule and immediately if soiled. Potties are emptied into the toilet, cleaned (with hot water and detergent) and disinfected. Each child has their own individual potty. Trainer seats are thoroughly cleaned after each use. Nappy Changing Nappy changing is only carried out in the designated nappy changing areas. Parents will provide creams or lotions for their child, these will be labeled, registered and will not be shared. The nappy changing area is cleaned in accordance with the cleaning schedule. The area used for changing should be disinfected after each use using an appropriate anti bacterial spray/detergent or antibacterial wipes and dried thoroughly after use using paper towels. Used paper towels, disposable gloves and aprons should be disposed off in yellow clinical plastic bags. Soiled nappies should be individually bagged and tied, placed into a yellow clinical bag inside a lidded bin and emptied each day.-see nappy Changing Policy. Changing mats are regularly checked to ensure the cover is not cracked or torn. Changing mats will be discarded of in such an event. Personal protective equipment (PPE) will be worn during nappy changing and toileting including disposable gloves and disposable aprons, see Personal Protective Equipment. In cases where cloth nappies are used, the nappy should be sealed in a bag and placed into a bag supplied by the child s parents and left securely for collection. Personal protective equipment (PPE) Disposable non-powdered vinyl or latex-free CE-marked gloves and disposable plastic aprons must be worn where there is a risk of splashing or contamination with blood/body fluids (for example, during nappy changing). Goggles should also be available for use if there is a risk of splashing to the face. Correct PPE should be used when handling cleaning chemicals. Staff s fabric tabards need to be washed and disinfected in a hot washing cycle on a weekly basis or sooner as required. Body Fluid Spillage Spills of blood, vomit, urine or excreta such as nasal and eye discharges will be cleaned up as quickly as possible. The area will be sectioned off if possible until the spill has been dealt with. Disposable plastic gloves are worn when cleaning up any bodily fluid spillage. Paper towels are used to clean up spillages and placed directly into a yellow waste plastic bag for disposal. A product that combines both a detergent and disinfectant is used for cleaning and disinfection of bodily fluid spillages. Use as per manufacturer s instructions and ensure it is effective against bacteria and viruses and suitable for use on the affected surface. Ordinary household bleach freshly diluted (1 to 10 parts water) can also be used in areas that are not designated for children. (This solution should not make contact with skin. If accidental contact does occur, the skin, eyes or mouth should be flushed with cold water). If possible and safe to do so, diluted bleach will be poured directly over the spill; it will then be covered and mopped up with disposable paper towels. Never use mops for cleaning up blood and body fluid spillages use disposable paper towels and discard clinical waste as described below. A spillage kit should be available for blood spills. Disposable paper towels and gloves are disposed of in a yellow waste plastic bag and sealed. 6

7 A supply of bleach and plastic bags are kept together in a secure place in each room/ cleaning cupboard in case of such an incident. Cleaning of the environment All areas of the nursery are cleaned regularly in accordance with a documented cleaning policy and cleaning schedule/rota. The nursery has produced a series of cleaning schedules- see below. These prescribe how equipment and toys should be cleaned, and when, and will follow national guidance. For example use color coded cleaning equipment, COSHH and correct decontamination of cleaning equipment. Please consult one of the following rotas/ schedules: -Classroom cleaning schedule: This details every day equipment present in a classroom environment e.g. toys, blankets, bed sheets, tables and chairs. It describes how such equipment is to be cleaned and sterilized, and who is responsible for overseeing this. -Kitchen and Eating Areas schedule: This details everyday items present in a kitchen or eating area e.g. cutlery, sinks, dishes, high chars. It describes how such equipment should be cleaned and sterilized, and who is responsible for overseeing this. -Health and Safety Checklist; This is a rota that shows what general health and safety checks need to be carried out in the nursery day, this includes matters such as checking for open windows, inspecting electrical equipment and first aid equipment. The rota ensures that internal and external hazards are spotted and dealt with quickly. These rotas/ schedules are displayed in strategic areas around the nursery including the kitchen, bathrooms and laundry room. Summary: Toilets and hard contact surfaces (playroom tables) be cleaned frequently. Playroom tables are cleaned before being used for meal and snack times. We will monitor cleaning contracts and ensure cleaners are appropriately trained with access to PPE. Toys and equipment will be cleaned according to the toy cleaning programme (see classroom cleaning schedule). Toys and equipment will be cleaned with hot water and detergent and disinfectant. Cleaning equipment will be disinfected on a weekly basis. Laundry Laundry should be dealt with in a separate dedicated facility. Soiled linen should be stored and washed separately at the hottest wash the fabric will tolerate. Wear PPE when handling soiled linen. Children s soiled clothing should be bagged to go home, in a nappy sack, and left on the child s peg, never rinsed by hand. Linen including bed sheets and blankets, used for cots and sleep mats are washed after each use and as per the cleaning schedule (see Classroom Cleaning Schedule). Cleaning equipment Mops for cleaning should be disinfected in bleach weekly. Cleaning cloths used in the playrooms, kitchen and sanitary accommodation are to be stored and washed separately. They must be washed on a hot cycle once a week. All cleaning equipment is kept separate to each area and easily distinguished e.g. color coded. A color coded list of equipment for cleaning is displayed in strategic areas including the cleaning cupboard and bathrooms. Color coding means cleaning equipment should only be used for the purpose intended. Clinical waste Always segregate domestic rubbish (black bin bags) and clinical waste rubbish (yellow bin bags), in accordance with local policy. Used nappies/pads, gloves, aprons and soiled dressings should be stored in correct yellow clinical waste bags. All other waste should be discarded into black bin bags. All clinical waste bags must be removed by the cleaner in charge. All clinical waste bags should be less than two-thirds full and stored in a dedicated, secure area while awaiting collection. Bins must be emptied each day. They must be removed off the premises by a registered waste contractor. Sharps disposal Sharps should be discarded straight into a sharps bin conforming to BS 7320 and UN 3291 standards. 7

8 Sharps bins must be kept off the floor (preferably wall-mounted) and out of reach of children. Please consult the health and safety representative and wear correct PPE in the event that any other sharp equipment needs to be removed, please follow procedures as set out in the Health and Safety policy regarding reporting faulty equipment. Baby Feeding Equipment If powdered milk is prepared, correct procedures for sterilizing the equipment used must be followed. Bottles, teats and bottle brushes are washed thoroughly before sterilizing. Feeding equipment is sterilized using a sterilizing solution or tablet (which is changed daily and mixed according to manufacturers instructions) or steam sterilizer. If a dummy or bottle falls on the floor or is picked up by another child, this is cleaned immediately and sterilized where necessary. When discouraging the dummy staff will have a designated place for the dummies and teethers to be stored: in individual hygienic dummy boxes labeled with the child s name to prevent cross-contamination with other children, which the child will be aware of. For more details see Use of Dummies, Bottles and Teethers Policy. Food and Kitchen Hygiene Staff involved in toileting children or nappy changing are not involved in food handling. Staff will not engage in any aspects of minding children while preparing food. Correct protective equipment will be worn. When serving food all staff are required to wear disposable plastic aprons and protective caps. Staff should try to minimize direct contact with raw food by the use of tongs, utensils and the safe use of disposable gloves. Hygienic Hand Rubs meeting the BS EN 1500 standard can provide an additional level of protection against cross contamination and are recommended after hand washing where there is an increased risk of cross contamination, e.g. when raw foods have been handled prior to hand washing. It should be noted that hygienic hand rubs should never be used as a replacement for hand washing. Hand rubs are available in all kitchen areas, bathrooms, classrooms and hallways. Food handlers are trained and verified as competent in an effective hand washing technique, by the means of continuous training and supervision. See food Handling Policy for more information Sharps, injuries and bites If skin is broken, wash thoroughly using water if possible. Staff: Any cuts or weeping wounds should be covered by a dressing that is waterproof to protect both the staff member s hands and the children so that bacteria is not spread. Children: The parents should be contacted and advised to take the child to a GP or occupational health or go to A&E immediately. Contact your local HPT for advice, if unsure. The cut or wound may need to be covered by a dressing so that bacteria is not spread. Staff are expected to act in line with the Medication and Illness policy at all times when reporting and dealing with illness or medication. Animals in school (permanent or visiting) Animals may carry infections, so hands must be washed after handling any animals. Children must wash their hands after playing with pets. Animals living quarters are kept clean and away from food areas Waste should be disposed of regularly, and litter boxes not accessible to children. Children should not play with animals unsupervised. The play area is inspected before use and cleaned of any pet droppings or soil. All pet animals are free of disease and have appropriate health checks Children will never be left alone with a pet. Veterinary advice should be sought on animal welfare and animal health issues and the suitability of the animal as a pet. Reptiles are not suitable as pets in schools and nurseries, as all species carry salmonella. Outings to farms or zoos Children will wash and dry their hands after contact with animals, animals cages as well as before eating and when leaving the farm/zoo. All meal breaks will be taken in designated areas away from where the animal s kept. Children will be constantly supervised during their visit to the farm or zoo. The importance of hand washing will be reiterated to the children by staff throughout the visit. 8

9 Please contact the local environmental health department, which will provide you with help and advice when you are planning a visit to a farm or similar establishment. For more information see Vulnerable children Some medical conditions make children vulnerable to infections that would rarely be serious in most children, these include those being treated for leukaemia or other cancers, on high doses of steroids and with conditions that seriously reduce immunity. Schools and nurseries and child minders will normally have been made aware of such children. These children are particularly vulnerable to chickenpox, measles or parvovirus B19 and, if exposed to either of these, the parent/carer should be informed promptly and further medical advice sought. It may be advisable for these children to have additional immunizations, for example pneumococcal and influenza. Female staff pregnancy If a pregnant woman develops a rash or is in direct contact with someone with a potentially infectious rash, this should be investigated according to PHE guidelines by a doctor The greatest risk to pregnant women from such infections comes from their own child/children, rather than the workplace. Some specific risks are: chickenpox can affect the pregnancy if a woman has not already had the infection. Report exposure to midwife and GP at any stage of exposure. The GP and antenatal carer will arrange a blood test to check for immunity. Shingles is caused by the same virus as chickenpox, so anyone who has not had chickenpox is potentially vulnerable to the infection if they have close contact with a case of shingles. German measles (rubella). If a pregnant woman comes into contact with German measles she should inform her GP and antenatal carer immediately to ensure investigation. The infection may affect the developing baby if the woman is not immune and is exposed in early pregnancy Slapped cheek disease (parvovirus B19) can occasionally affect an unborn child. If exposed early in pregnancy (before 20 weeks), inform whoever is giving antenatal care as this must be investigated promptly Measles during pregnancy can result in early delivery or even loss of the baby. If a pregnant woman is exposed she should immediately inform whoever is giving antenatal care to ensure investigation. 7. Head lice- [A summary] ( Please see full Head Lice Policy for more details). Head lice are small brown insects about the size of a sesame seed which are usually found close to the scalp; they cannot fly, jump or hop and are spread where heads touch each other. Head lice may be apparent without inspecting a child s head; it may be obvious to the human eye that moving head lice are present. (Nits are not the same as lice. They are the empty white egg shells which stick to the hair). Despite common belief, the main source or reservoir for head lice infection is not the school/nursery but carriers in the general community, often adults, who have become desensitized to lice. They may have few symptoms and be unaware of their infection. Signs of head lice Itchy head Rash on the scalp Black specks that look like dust on their pillow (head lice droppings) Detection Head lice can t be prevented but regular checking ensures early detection and treatment if necessary. The best detection method is wet combing. Parents and carers should aim to check their children s hair once a week during hair washing. You need your usual shampoo, ordinary conditioner and a louse detection comb. Remember that you are looking for living moving head lice the only evidence that your child has a head lice infection. The comb must be fine enough to catch the lice. Your pharmacist should be able to recommend a suitable one. Treatment Treatment should be carried out only when lice are found or strongly suspected, i.e. when there has been prolonged head-to-head contact with an infected person. Lotions may be obtained from the GP, local pharmacist, or the local health centre/clinic. Children will not be singled out, they can remain in nursery, with support being offered to the parent at the end of the nursery day by way of a head lice information leaflet containing advice on head lice and nit detection, treatment and prevention, or, in those cases where resistant and/or recurrent infections may be in evidence, 9

10 the Nursery Manager should request the help of a general practitioner in giving additional support/advice to parents, sometimes on an individual basis. General Practitioners and Pharmacists are another source of support for parents. Prevention at all times will be stressed by staff which includes: Parents/carers are advised to check their children s hair weekly using a fine tooth plastic or detector comb (detection combing) particularly if their child attends a school or nursery. Children and adults should comb their hair twice a day with normal shampooing and conditioning. This will prevent any infection being established (wet combing). Treating head lice infections quickly and effectively with shampoos and lotions. Staff should check themselves regularly for head lice and treat whenever necessary. The nursery can request confirmation from the child s GP that effective treatment of head lice has occurred prior to the child returning at nursery if there has been ongoing infestation with an individual child and staff are concerned that treatment is ineffective. 8. Immunizations Immunization status should always be checked at school entry and at the time of any vaccination. Parents should be encouraged to have their child immunized and any immunization missed or further catch-up doses organized through the child s GP. For the most up-to-date immunization advice see the NHS Choices website at or the school health service can advise on the latest national immunization schedule. Staff immunizations All staff should undergo a full occupational health check before starting employment; this includes ensuring they are up to date with immunizations, including MMR. Female staff who have not been vaccinated against rubella should speak to their GP about vaccination or a Rubella antibody test. Please see the nursery s Employment Medical Questionnaire provision. Immunization schedule Two months old Diphtheria, tetanus, pertussis, polio One injection Given orally and Hib (DTaP/IPV/Hib) Pneumococcal (PCV13) Rotavirus vaccine Three months old Diphtheria, tetanus, pertussis, polio One injection Given orally and Hib (DTaP/IPV/Hib) Meningitis C (Men C) Rotavirus vaccine Four months old Diphtheria, tetanus, pertussis, polio One injection and Hib (DTaP/IPV/Hib) Pneumococcal (PCV13) Between months old Hib/meningitis C Measles, mumps One injection and rubella (MMR) Pneumococcal (PCV13) Two, three and four years old Influenza (from September) Nasal spray or one injection Three years and four months old or soon after Diphtheria, tetanus, pertussis, polio (DTaP/IPV or dtap/ipv) Measles, One injection One injection Girls aged 12 to 13 years Around 14 years old mumps and rubella (MMR) Cervical cancer caused by human papilloma virus types 16 and 18. HPV vaccine Tetanus, diphtheria, and polio (Td/IPV) Meningococcal C (Men C) Two injections given 6-24 months apart One injection One injection This is the complete routine immunization schedule. Children who present with certain risk factors may require additional immunizations. Some areas have local policies check with your local PHE centre. Revised March