Rashes and skin infections

Transcription

1 Responding To Children Who Are Ill Or Infectious - Policy & Procedures 2015 This policy (and procedures) is made available to parents on our website and available from Reception. We welcome parental feedback for all of our policies & procedures. Throughout, the term parent refers to those with legal, parenting, or caring responsibility for the child. 1. Our first priority is the welfare and protection of all children, parents, members of staff and visitors. 2. We ask all parents to help prevent the spread of infections by keeping infectious and ill children away from the Playscheme until they have recovered. Table 1 indicates the recommended exclusion periods for parents to follow. 3. In the unfortunate event that a child is ill, our policy is fairer and more flexible than the industry norm. Although no refunds can be given for absences, we will credit missed sessions for future ones up to one year, providing: The absence is due to an illness that requires exclusion as per Table 1. We receive parental notification on the first day of illness. We receive validation with a doctor s note only if the exclusion period is greater than 48 hours. Table 1 Infection and exclusion periods. Source: Public Health England (Sept 2014) Rashes and skin infections Infection or complaint Recommended period to Comments be kept away from the Playscheme Athlete s foot None Athlete s foot is not a serious condition. Treatment is recommended Chickenpox Until all vesicles have crusted over See: Vulnerable Children and Female Staff Pregnancy 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 (as per Green Book ) Preventable by immunisation (MMR x2 doses). See: Female Staff Pregnancy Hand, foot and mouth None Contact your local HPT if a large number of children are affected. Exclusion may be considered in some circumstances Impetigo Until lesions are crusted and healed, or 48 hours after starting Antibiotic treatment speeds healing and reduces the infectious period antibiotic treatment Measles* Four days from onset of rash Preventable by vaccination (MMR x2). See: Vulnerable Children and Female Staff Pregnancy Molluscum contagiosum None A self-limiting condition Ringworm Exclusion not usually required Treatment is required Roseola (infantum) None None Scabies Child can return after first Household and close contacts require treatment Scarlet fever* Slapped cheek/fifth disease. Parvovirus B19 Shingles treatment Child can return 24 hours after starting appropriate antibiotic treatment Antibiotic treatment is recommended for the affected child None (once rash has developed) See: Vulnerable Children and Female Staff Pregnancy Exclude only if rash is weeping and cannot be covered Can cause chickenpox in those who are not immune, ie have not had chickenpox. It is spread by very close contact and touch. If further information is required, contact your local PHE centre. See: Responding To Children Who Are Ill Or Infectious July 2015 Page 1 of 6

2 Vulnerable Children and Female Staff Pregnancy Warts and verrucae None Verrucae should be covered in swimming pools, gymnasiums and changing rooms Diarrhoea and vomiting illness Diarrhoea and/or vomiting E. coli O157 VTEC Typhoid* [and paratyphoid*] (enteric fever) Shigella (dysentery) Cryptosporidiosis 48 hours from last episode of diarrhoea or vomiting Should be excluded for 48 hours from the last episode of diarrhoea. Further exclusion may be required for some children until they are no longer excreting Exclude for 48 hours from the last episode of diarrhoea Respiratory infections Flu (influenza) Until recovered See: Vulnerable Children 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 Exclusion from swimming is advisable for two weeks after the diarrhoea has settled Tuberculosis* Always consult your local PHE centre Requires prolonged close contact for spread Whooping cough* (pertussis) Other infections Five days from starting antibiotic treatment, or 21 days from onset of illness if no antibiotic treatment Preventable by vaccination. After treatment, noninfectious coughing may continue for many weeks. Your local PHE centre will organise any contact tracing necessary Conjunctivitis None If an outbreak/cluster occurs, consult your local PHE centre Diphtheria * Glandular fever Exclusion is essential. Always consult with your local HPT None Family contacts must be excluded until cleared to return by your local PHE centre. Preventable by vaccination. Your local PHE centre will organise any contact tracing necessary Head lice None Treatment is recommended only in cases where live lice have been seen Hepatitis A* Exclude until seven days after onset of jaundice (or seven days after symptom onset if no jaundice) In an outbreak of hepatitis A, your local PHE centre will advise on control measures Hepatitis B*, C*, HIV/AIDS None Hepatitis B and C and HIV are bloodborne viruses that are not infectious through casual contact. For cleaning of body fluid spills see: Good Hygiene Practice Responding To Children Who Are Ill Or Infectious July 2015 Page 2 of 6

3 Meningococcal meningitis*/ septicaemia* Meningitis* due to other bacteria Until recovered Until recovered 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 centre will advise on any action is needed 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* None 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 handwashing and environmental cleaning, are important to minimise any danger of spread. If further information is required, contact your local PHE centre Mumps* Exclude child for five days after onset of swelling Preventable by vaccination (MMR x2 doses) Threadworms None Treatment is recommended for the child and household contacts Tonsillitis None There are many causes, but most cases are due to viruses and do not need an antibiotic * denotes a notifiable disease. It is a statutory requirement that doctors report a notifiable disease to the proper officer of the local authority (usually a consultant in communicable disease control). In addition, organisations may be required via locally agreed arrangements to inform their local PHE centre. Regulating bodies (for example, Office for Standards in Education (OFSTED)/Commission for Social Care Inspection (CSCI)) may wish to be informed. Avon, Gloucestershire & Wiltshire PHE Centre: Rivergate House, 2 Rivergate, Bristol BS1 6EH. Telephone Vulnerable Children Some medical conditions make children vulnerable to infections that would rarely be serious in other children e.g. those being treated for leukaemia or other cancers, those on steroids by mouth and those with conditions that seriously reduce immunity. They are particularly vulnerable to chicken pox or measles and if exposed to either of these the parent/carer must be informed promptly and further medical advice sought. 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 child settings 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 immunisations, for example pneumococcal and influenza. Female Staff & Parents 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 Responding To Children Who Are Ill Or Infectious July 2015 Page 3 of 6

4 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 Procedures To Be Followed When A Child Becomes Unwell Whilst In Our Care: 1. It may be obvious that a child is unwell by their symptoms - e.g. vomiting. 2. Adopting a First Aid response, the Inclusive Practice section of the Group Sheet supported by the child s Registration Form will be promptly checked to confirm if the child has any known allergies or other conditions, which may provide potential causes for the symptoms. 3. Even though there is a potential for fictitious illness, a phenomenon normally presented by children in response to feeling unsure, the priority must be following procedure as if the child is unwell, ill or infectious. 4. Any child that is unwell will be kept clear from other children and will remain under the care of a nominated member of staff. 5. The nominated member of staff must ensure the safety of the child and themselves, as well as other persons by considering Part A in the illness / infectious risk assessment (Table 2.) 6. Support for the child will be appropriate for their age/stage of development, understanding and consideration of particular requirements in meeting any specific or additional needs. 7. The child s parent will be contacted and informed that their child is unwell. The parent will be asked to make arrangements to collect their child from the Playscheme as soon as possible. For the benefit of the child who is unwell and the protection of others, the child should be collected within one hour from notification. The parent will be informed of this timescale and asked to make arrangements accordingly. The parent may wish to speak with their child and this will be arranged. 8. In the event that a parent is unobtainable, the person named under Emergency Contact on the child s Registration Form will be contacted. If still unobtainable, then attempts will continue to be made to contact a parent. 9. In the period between contacting a parent (or authorised adult) and the child being collected, a Record Of Accident/Incident/Occurrence should be completed, or as soon as reasonably practicable. The person collecting the child should sign upon collection. 10. If the signs & symptoms of the child is such that emergency assistance or medical advice is necessary this will be obtained having first checked the child s Registration Form for parental consent. Details of any important information (known allergies, medical conditions and whether the child is on any form of medication) will be to hand for the benefit of any emergency assistance or medical advice sought. 11. If parental consent has not been provided, the parent will have provided a course of action that is to be followed. Responding To Children Who Are Ill Or Infectious July 2015 Page 4 of 6

5 12. If the child has what appears to be an infectious illness, a note will be on display in reception informing parents that a (unnamed) child has been ill and a brief description e.g. Just to let you know that a child was sent home today with a chicken pox like rash. Table 2 Illness / Infection Risk Assessment Part A Environmental (Action to be taken to alter the immediate environment) To reduce transmission from a symptomatic To reduce the risk of healthy/susceptible people individual to healthy/susceptible people. becoming infected. Children s Registration Forms providing Provide parents with ill / infectious procedures. information about individual children - can Cover hygiene in Golden Rules with children. identify children considered more vulnerable to Remind to wash hands regularly and thoroughly. transmission. Do not assume children know how to wash their Procedure to be implemented re ill/infectious hands correctly. child. Dedicated daily cleaning schedule and rostra Isolate child with nominated person ensuring increase environmental cleaning in event of safety of nominated person. infectious / ill children. E.g. attention to toilets, door Sit/stay at least one metre away of child unless handles, taps etc. assistance is required. Monitor drinks stations ensure dirty cups do not Use personal protective equipment when cross-contaminate clean cups. assisting child. Gloves not essential as long as hand cleaning is carried out frequently. (Can be used as a reminder for staff not to touch their own face whilst with the child) Warm water, detergent & disinfectant to be used to clean aspects of area where child has been isolated e.g. table where child is sitting. PPE (Including gloves) to be worn when cleaning vomit or toilets. Area to be thoroughly cleaned with warm water, detergent and disinfectant. PPE to be removed and disposed of in correct disposal point not general waste bins. Part B Organisational (Measures taken to modify the organisation/pattern of daily life) Training for staff provided on the signs / Training for staff provided on the signs / symptoms of illness symptoms of illness (e.g. flu) (e.g. flu) Provide information for parents. Information provided to parents regarding good hygiene Procedures in place for ill / infectious (e.g. hand washing) children & staff. Minimise frequency of interactions so far as reasonably practicable e.g. different groups having break in different rooms. Identify individuals who may be at particular risk of the effects of illness (e.g. flu) and re-deploy where contacts are minimal so far as reasonably practicable. Introduce play opportunities that can promote good hygiene & healthy lifestyles. E.g. poster designs, role-play. Cover hygiene in Golden Rules with children. I like cheese & pickle I don t like. Children to take responsibility for their own well-being. Part C Individual (Actions taken at the level of the individual to modify behaviour) Good hygiene practice to be adhered by all at the Playscheme. Procedures in place for ill / infectious children & staff. Good hygiene practice for all in Playscheme. Children encouraged in an age/stage appropriate way. Instructions on correct hand washing. Do not assume children know how to wash hands correctly & thoroughly. Responding To Children Who Are Ill Or Infectious July 2015 Page 5 of 6

6 List Of Notifiable Diseases Provided By Public Health England Diseases notifiable to local authority proper officers under the Health Protection (Notification) Regulations 2010:: Acute encephalitis Acute infectious hepatitis Acute meningitis Acute poliomyelitis Anthrax Botulism Brucellosis Cholera Diphtheria Enteric fever (typhoid or paratyphoid fever) Food poisoning Haemolytic uraemic syndrome (HUS) Infectious bloody diarrhoea Invasive group A streptococcal disease Legionnaires disease Leprosy Malaria Measles Meningococcal septicaemia Mumps Plague Rabies Rubella Severe Acute Respiratory Syndrome (SARS) Scarlet fever Smallpox Tetanus Tuberculosis Typhus Viral haemorrhagic fever (VHF) Whooping cough Yellow fever The child s GP will honour their statutory duty of notification. In order for us to honour ours, (i.e. notifying Ofsted), parents should inform us if their child has been diagnosed with any of the notifiable diseases above. Ofsted National Business Unit, Piccadilly Gate, Store Street, Manchester, M1 2WD Responding To Children Who Are Ill Or Infectious July 2015 Page 6 of 6