Preventing the Spread of Communicable Disease in Child Care

Written by Ann McKitrick, with Nicole Swanberg Slide 1: Introduction Welcome to Preventing the Spread of Communicable Disease in Child Care. This 1- hour course will help you learn about communicable diseases and how to protect your children from illness. We will look at symptoms and action steps for the most common diseases, proper cleaning techniques, and how to prevent the spread of these diseases. We will also look at ways to teach children about health through classroom activities. Slide 2: Learning Objectives Let s take a few minutes to go over the learning objectives for this course. After completing this course, you should be able to: Define the term communicable disease Understand the difference between treatment for viral and bacterial infection Identify symptoms and actions steps for common communicable diseases Slide #3: Learning Objectives (continued) Describe how to prevent the spread of communicable diseases Demonstrate proper cleaning techniques of toys, food, and common areas Teach children about wellness using age appropriate resources Throughout the training, you ll occasionally be asked to answer questions to insure your understanding. If you are unable to answer the questions correctly, you might want to back up and listen again. Slide 4: Defining Communicable Diseases Communicable diseases are highly contagious and spread from one person to another or from an animal to a person. They are spread through airborne viruses or bacteria. They can also spread through bodily fluid, such as saliva, mucus or blood. Synonyms for communicable include contagious and infectious. It s important to remember that communicable diseases come in many forms and are highly transmittable from one person to another. 1

Young children, because of their weaker immune systems, have a higher tendency to become sick. The spread of diseases is accelerated in the childcare setting because of the nature of the environment. Toys are constantly being shared, fingers are going into mouths and children are in close contact with one another. It s our job supervise children as they play and teach hand washing, hygiene, and ways to minimize the spreading of germs. Viral and bacterial infections have many similarities and symptoms (coughing, sneezing, fatigue, vomiting, etc.), but should be treated differently. Viral infections are not treated with antibiotics, but for some infections, medicine can be prescribed to help mitigate the symptoms. Keeping hydrated is one of the most important aspects of the recovery process. Bacterial infections are usually treated with antibiotics. Slide 5 & 6: Review question Slide 7: Common Communicable Diseases Let s take a look at common communicable diseases in childcare. Remember, because they are highly contagious, those who are exposed run a high risk of contracting these diseases. For this training we will focus on some of the more common diseases found in the childcare setting: 1. Pink eye 2. Chickenpox 3. Influenza 4. Common cold 5. Strep throat Slide 8: Risk in the Childcare Setting This is Marcus. Imagine for a moment that Marcus played with his friend, Raymond for most of the day at school. When Raymond s mom comes to pick him up, she comments on his runny nose and watery eyes. Marcus has shared toys with him most of the day. It s likely he s touched the toys and then put his finger in his mouth or rubbed your eye. Is he at risk for the same sickness now? 2

The answer is yes! Children do not realize this because often they have not yet learned about hygiene and being healthy. For many, this is their first experience being with lots of other kids in close quarters. They may not know how to wash their hands thoroughly. They may put their fingers in their nose and mouth after touching shared toys. They may sneeze all over the common area rug without covering their nose and mouth. This is why education and modeling are key elements to preventing the spread of communicable diseases in the childcare setting. Slide 9: Statistics In order to gain insight on the importance of learning about the spread of illness, let s look at a few statistics. Each year, an average of 20,000 children younger than 5 years are hospitalized because of flu-related complications. Influenza causes more hospitalizations among young children than any other vaccine-preventable disease. Chickenpox focuses on kids, most commonly attacking those younger than 15. Strep throat is most common in school-age children. Children contract an average of 6-10 colds each year. Slide 19 & 11: Review question Slide 12: Communicable Diseases: Symptoms and Treatments No doubt, if you ve worked with children for a while, you ve had experience dealing with contagious illness that spread through a classroom, including being exposed yourself. One of the best ways to prevent children coming to school sick is to have a health check each morning on arrival, while the parent is still there. This is a quick visual check, looking for nasal discharge, watery eyes, flushed face, lethargy or fever. You ll have a moment to ask the parent if you see that the child looks tired or ill. It may be something as simple as not getting enough sleep but knowing that you ll check every day increases awareness about not taking a child with symptoms to child care. Now let s take a look at the most common diseases, how to identify them, and how to treat them. Slide 13: Pink eye 3

Conjunctivitis, or pink eye is the one of the most common contagious illnesses among children. Spread by hand-to-hand contact, pink eye transfers fast because we touch our eyes all the time. Even getting a little bit of the virus on the tip of your fingers, touching a toy and then touching your eye can spread pink eye. This disease causes redness, itching, and swelling, of the eyelid and a clear, white, yellow, or green liquid to collect in the tear ducts of the eyes. Pink eye may start in one eye, but because of its contagious nature, many people develop pink eye in both eyes. Having pink eye usually doesn t hurt, but it the itching can be annoying! Slide 14: Causes and Symptoms Several different things can cause pink eye: Viruses, which are often associated with symptoms of upper respiratory infections such as a sore throat or cold. Bacteria. This is actually one of the leading causes of children missing school. Allergens, such as pet dander of dust mites, usually irritate both eyes. This usually occurs in people who already have some sort of seasonal allergy. It is the body s way of trying to flush the allergen out. Each type of pink eye has a different set of symptoms, based on the cause. Watery and itchy eyes and sensitivity to light characterize viral pink eye, caused by viruses. This is highly contagious and can be spread through coughing or sneezing. Bacterial pink eye is characterized by a sticky yellow-green discharge that occurs in the tear ducts of one or both eyes. This is also highly contagious and spread by direct contact. Pink eye caused by allergens has a different set of symptoms. Watery and itchy eyes are often accompanied with a burning sensation and a runny or stuffy nose and light sensitivity. Pink eye caused by allergens is not contagious. Slide 15: Treatment of Pink Eye Pink eye is often mild and very treatable. For each type of pink eye, there are different treatment methods. Viral pink eye will run its course over several days and no medical treatment is required. Applying a cold washcloth to the eyes several times a day can mitigate symptoms. Bacterial pink eye requires you to see your eye doctor to have antibiotic eye drops or ointments prescribed. Allergen pink eye usually clears up with the use of your normal allergy medicine. 4

Children and teachers with viral or bacterial pink eye may return to the classroom once they have clearance from a doctor, or they are symptom free. Coming back to class before this will expose others to the disease. Slide 16: Pink eye prevention So how can you keep the children in your class safe? Clean shared spaces frequently and sanitize hands often. Cover your nose and mouth while coughing and never share items such as washcloths or hand towels. If you suspect a child in your class has developed pink eye, follow the procedures at your school for notifying parents and take extra steps to sanitize your classroom. Slide 17 & 18: Review question Slide 19: Chicken pox Chickenpox is a viral infection that causes outward red blotches on the skin that are very itchy and highly contagious. Slide 20: Causes and Symptoms Chickenpox is caused by a virus and is extremely contagious if you have not had chicken pox already. Symptoms of chicken pox include a blister-like rash, itching, fatigue and fever. The chicken pox rash usually appears first on the head, which then spreads to the body with raised red spots, blisters, and then hard-crusted spots. Two to three crops of blisters may develop in the course of the illness. Slide 21: Treatment There is a required chicken pox vaccine and most children have had it! If a child has had the vaccine, they may have a mild case if exposed to chickenpox. For the child who is not vaccinated there are home remedies to alleviate the symptoms, such as oatmeal baths. If someone is infected with chicken pox, it usually takes about 10 days after the first symptoms before all blisters have crusted over. This is when the child with chickenpox can return to day care. It s also important to note that pregnant women exposed to chickenpox should consult their doctor. Slide 22: Influenza 5

Influenza is a common viral infection that attacks the upper respiratory system. Young children are especially susceptible to this disease. We have to be cautious during flu season, making sure that sick children are properly diagnosed, as influenza can lead to hospitalization when severe. Slide 23: Causes and Symptoms A virus causes influenza. At first, the flu may seem like a common cold with a runny nose, sneezing, and sore throat, so it s important to know the differences between the two. You usually feel much worse with the flu. Common symptoms of influenza are a high fever (over 100 degrees), sore throat, achiness, chills and sweats, dry cough, congestion, and fatigue, which come on very quickly. Young children may also have nausea, vomiting or diarrhea. Slide 24: Treatment: Once exposed, it can take 1-4 days until the onset of symptoms. For those who catch the flu, a doctor can prescribe an anti-viral medication, which may diminish the severity and length of the illness. Exclusion from school is required and children may return to school once they are fever free. Slide 25: Prevention A good way to prevent the flu is to get vaccinated every year. It s recommended that anyone over the age of 6 months receive a vaccination every year, especially young children, those who work with children and the elderly. You can help prevent the flu by avoiding close contact with others, washing your hands often, avoiding touching your nose and mouth and practicing good hygiene. And very important, stay home if you are sick! Slide 26: Common cold We are all familiar with the common cold, especially those of us who work with young children. Research tells us that adults have an average of 3-4 colds per year and children average 6-10, even up to 12 per year for those in childcare. Colds are spread through contact with the respiratory secretions of those infected, and usually last 1-5 days. Unless accompanied by a fever, children with a cold are not required to stay home which helps us understand why they are so easily spread! Slide 27 & 28: Review question 6

Slide 29: Symptoms It s important for teachers and caregivers to be able to recognize the difference between a cold and the flu. The symptoms of a cold are runny nose, watery eyes, fatigue, coughing and sneezing. Fever and sore throats are not common with a cold. Probably the most distinguishing difference between the two is the onset of the illness. People who get the flu can usually tell you exactly when they got sick to the hour! A cold typically comes on a little more gradually. During cold and flu season, watch your children closely. Having lots of tissues around the classroom, washing your hands frequently and teaching children to cough and sneeze into their elbow will help diminish the spread of colds. And look at this fun art idea for all those empty tissue boxes! What else could you make with empty boxes? Slide 30 & 31: Review question Slide 32: Strep throat Strep throat is a bacterial infection that causes pain and inflammation in the throat. It is spread through coughing, sneezing, or sharing food or drinks. Symptoms of strep throat include fever, sore throat, often with swollen lymph nodes in the neck. It can only be diagnosed through a lab test, so a child that has a sore throat with fever should go see the doctor. Slide 33: Treatment Treatment of strep throat includes taking an antibiotic, increasing fluid intake and getting lots of rest. It usually lasts from 1-3 days and children should not be at school until they been on antibiotic and fever free for 24 hours. Slide 34: Preventing the spread of illness We ve just looked at several of the most common illnesses that you ll encounter in the childcare setting. For a comprehensive look at communicable diseases, see the handout entitled, Communicable Disease Chart and Notes for Schools and Childcare Centers. It s important to be informed and able to screen children if they become ill during the day. Insure that parents know your centers policy regarding sick children. 7

Now let s go over some of the most effective ways to prevent the spread of these diseases. This will help cut down on the time children (and teachers!) spend out of school and reduce the risk of other children becoming sick. Slide 35: Handwashing Handwashing is the single most effective way to prevent the spread of disease. It sounds so simple, but handwashing with soap and clean running water prevents the spread of many diseases and conditions. Let s go over how to properly wash your hands. First, wet your hands with clean, running warm water and apply soap. Lather your hands by rubbing them together with the soap. Be sure to lather the backs of your hands, between your fingers, and under your nails. Scrub your hands for at least 20 seconds. Need a timer? Sing a song from beginning to end twice. Rinse your hands well under clean, running water. Dry your hands using a clean paper towel. Use that same paper towel to turn the faucet off so you don t contaminate your clean hands by touching the faucet. Children should wash their hands regularly, especially after playing outdoors, before eating and after toileting or having a diaper change. Plus anytime their little hands are sticky and dirty from all the great activities you do throughout the day! Slide 36 & 37: Review question Slide 38: Video How to properly wash a child s hands Here s a video demonstrating how you can teach children to wash their hands. As you view the video, ask yourself these questions: Why does the teacher ask the child if they think their hands are dirty? How does the teacher use the light to reinforce what she is saying? https://www.youtube.com/watch?v=vyk4k_0pzmo Slide 39: Modeling Learning to wash your hands properly is one of the most important steps in preventing the spread of diseases. It is also important to remember that you are a role model for 8

the children in your classroom. Children will be more apt to remember to wash their hands if they see you doing it! Slide 40 & 41: Review question Slide 42: Establishing a cleaning routine Establishing a cleaning routine is very important. What are the cleaning and sanitizing routines in your classroom and school? Take a moment to print and read the handout entitled, Child Care Center Cleaning and Disinfecting Schedule. Do you see anything on this chart that you d like to begin implementing in your room? Note how often things are disinfected. We need to clean frequently and diligently because of high hand-to-mouth contact that can easily become a breeding ground for germs if we are not careful. Why do you think the chart suggests we discard play dough after each use? Why do natural items, such as stones, need to be cleaned only weekly? Take your best guess! Letting fresh air into your classroom is helpful as part of a cleaning routine, if possible. Not only does this help circulate fresh air into the classroom, it also releases stale germfilled air from the room. Slide 43: Making bleach solution One of the more important steps in reducing the spread of illness, is to thoroughly clean surfaces that could possibly pose a risk to children and teachers. Most likely to be contaminated are toys that children put in their mouth, crib rails, food preparation areas and surfaces likely to be contaminated with germs, like diaper changing areas, sinks and toilets. Routine cleaning with soap and water is the more useful method for removing germs from surfaces. Good scrubbing physically reduces the number of germs from the surface, just as hand washing reduces the number of germs on your hands. However some surfaces require the additional step of disinfection to kill germs after cleaning with soap and rinsing with water. Items that can be run through the dishwasher or laundered in hot water do not need further disinfection. The process of disinfection usually requires soaking or drenching the item for several minutes to give the chemical time to kill the germs. One of the most commonly used chemicals for disinfection in childcare is a homemade solution of household bleach 9

and water. It is inexpensive, easy to mix, nontoxic and safe if handled properly and kills most infectious germs. Take a look at the handout entitled, Making Bleach Water Disinfecting Solution for directions on how to make your own bleach water. Slide 44: Try to answer the following questions while viewing the video: Here s a video about disinfecting toys in the childcare center. As you watch, think about these questions: Why is it important to let the infants explore with their mouths and not take it from them right away? What does DHS require in regards to disinfecting solution? Slide 45: Discussion How many of those procedures explained in the video do you do at your childcare facility? If you do not do all of them, it is important to bring the knowledge you have learned from this training back to your work and instruct others on proper cleaning techniques! Slide 46-47: Review question Slide 48: Hard surfaces and common areas Common areas such as rugs, mats, and carpets should be vacuumed daily after the children leave. The floor underneath rugs should be mopped weekly. Hard surfaces, counters, tables, and tiled floors should be cleaned daily as well, with a disinfecting solution. You can also buy wipes that are specifically designed to clean, disinfect, and sanitize hard surfaces. Often these are child-safe, but make sure to check the label first! Slide 49: Food preparation Childcare centers usually have a kitchen where snacks and meals are prepared. Here are some basic cleaning guidelines in the kitchen. 10

Counters and tabletops should always remain clean. Ready-to-eat foods are prepared and kept separately from uncooked products, such as raw meat. Cabinets and refrigerators are clean and uncrowded. Either disposable dishes and utensils are used, or all non-disposable dishes are cleaned in a dishwasher with water heated above 160 F. How does your daycare kitchen stack up? When preparing food, whether it s a lunch that children bring from home or food prepared at the center, ensure that you touch it as little as possible, using utensils rather than your hands for picking up and handling food. Keeping your fingernails cleaned and trimmed prevents the possible spread of disease. Using disposable gloves when handling and serving food is preferred. Always follow health department procedures regarding safe food handling. Slide 50: Toileting and Diapering The bathroom is a breeding ground for germs! It is important to post one teacher nearby to monitor and help when children are using the toilets. Before and after diapering a child, wash your hands! Wash the child s hands too after you change their diaper. After each diaper change, clean the area with disinfecting spray. See the handout entitled, Diaper Changing Procedures for more detailed information about changing diapers. Slide 51-52 Review question Slide 53: Teaching wellness Although it is the adult s responsibility to prevent the spread of diseases, it s also our job to educate children about being responsible for their own hygiene and wellness. Let s take a look at a few ways to incorporate these themes into your lesson plans. We will also go over a few resources that incorporate these themes as well. Slide 54: Glitter hand washing activity In the video we watched about teaching children to wash their hands, the teacher used a black light to demonstrate to the child how dirty her hands were, even when they looked clean. We may not all have a black light to show children the dirt on their hands, but here s an activity that demonstrates the point and it involves glitter, so we know kids will enjoy it! 11

First gather the supplies you ll need a large bowl or bucket for hand washing, soap, glitter and paper towels. We re going to see what happens when we wash our hands. You are going to wash your hands until they re clean. First I m going to put some glitter on your hands. This glitter is like the dirt and germs that we can t see on your hands. Let s see what happens when you wash your hands. Can you get all the dirt and germs off? Put a small amount of glitter on each child s hand. Have them wash their hands like normal and then inspect to see if all the glitter is gone. If they washed their hands thoroughly, it will be gone. If not, show them how to wash their hands and have them try again. Make sure they scrub with soap for 20 seconds! 20 seconds is usually over by the time kids are done with the ABCs or have sung Happy Birthday twice! Slide 55: Hand washing songs Teaching children in a child care setting to sing a "hand washing song" while they wash is a good way to help them measure if they have been scrubbing long enough. Below is an example of a common nursery song that has been converted into a song about hand washing! Use this one or make up your own! Hand washing song to the tune of Row Your Boat Wash, wash, wash your hands, Play our handy game. Rub and scrub and scrub and rub Germs go down the drain! (repeat) Slide 56: Teach good habits One way you can increase awareness in your classroom is to have a bucket or tub designated for children to put toys that they put in their mouth. Of course, infants and toddlers can t do this on the own, but children as young as three can learn to do this! You can introduce the idea during circle time; after a class discussion that addresses ways children can prevent getting sick and help keep others safe at school. Simply instruct children to put any toys that they themselves or see another child put in the mouth into the bucket. You can decide as a class where to locate the bucket in your room. This teaches self-awareness and responsibility. 12

Slide 57 & 58: Review question Slide 59: Books for the classroom Here are a few books written for children that teach about hygiene these would be great for your class library. No More Germs Please! is a book that follows the story of Rachel and Charlotte s play date. They frequently stop and think if they should wash their hands. This book is designed to make the children think and respond to the questions posed throughout the story. Germs Are Not for Sharing is a board book that teaches the basics of not spreading germs: covering your mouth when you sneeze or cough, hug or blow kisses when sick, and washing your hands! In daycare, at home, and everywhere, toddlers need to learn that germs are not for sharing and this book is a great way to start teaching them about wellness! The other books shown would be great choices for your classroom library as well! You will have the opportunity to purchase these books here at Slide 60: Summing it up Now you know how to protect yourself and the children in your class from contagious, infectious diseases that are common in child care and school settings. You will want to keep all the handouts from this training to refer to throughout the school year, as you observe symptoms in children and have to determine what the best next step is. Putting into practice the sanitation practices you ve learned here will help alleviate the spread of contagious illness in your school. And for that, parents and children will be thankful and healthy! Slide 61: Before we go, here s one last video to illustrate just how the spread of communicable diseases happens so easily with young children. This one brings home the point of covering your mouth and nose when you sneeze and the importance of washing hands afterwards enjoy J https://www.youtube.com/watch?v=qkiqa5e-fpg 13

The Sneeze (in slow motion) Slide 61: Review of objectives Here s a review of what you ve learned in this training: 1. The definition of communicable disease 2. The difference between treatment for a viral and bacterial infections 3. How to identify symptoms of common communicable diseases 4. How to prevent the spread of communicable diseases 5. How to properly clean toys, food, and common areas 6. Ways to teach children about wellness using age appropriate activities Slide 62: References References 1. Center for Disease Control. 2015. 2. Child Centre Cleaning and Disinfecting Schedule. Durham Region Health Department. 3. Food Handling and Preparation in the Childcare Setting. WebMD. 2015. 4. A Quick Guide to Common Childhood Diseases. BC Centre for Disease Control. 2009. 5. Tips for Cleaning Childcare Facilities the Safe and Healthy Way. Connecticut Department of Public Health. 2013. 6. Using Hand Washing Songs to Encourage Children in Child Care to Wash Hands Thoroughly. Extension. 2012. 7. Texas State Department of Health, Communicable Disease Chart and Notes for Schools and Childcare Centers, 2012 Slide 63: One more thing Before we end, please take this short quiz about our training. This meets the requirements of the Texas Minimum Standards for Child Care Centers. You may repeat the quiz until you make 80% of the questions correct. 14

Slide 64: Conclusion Congratulations, you have completed this course and may print your certificate. I hope that this information helps you understand how to keep yourself and the children in your school healthy by understanding how communicable diseases are spread. Please feel free to contact me at the email address listed if you have any further questions or comments. 15