Communicable Diseases Ohio State Regulations

Communicable Communicable DiseasesDiseases

Ohio State Regulationsfor Child Care Centers

Prevention/Control

How communicable How communicable disease is spread.disease is spread.

Unit One

MicroorganismsMicroorganisms

• Small, living plants or animals• Not visible with the human eye• Microbes, organisms, germs• Everywhere in environment• Most harmless; some beneficial

PathogenPathogen

• Microorganisms which are capable of causing disease– Bacterial Infections– Viral Infections– Fungal Infections– Parasitic Infestations

PathogenPathogen

• Microorganisms which are capable of causing disease– Bacterial Infections– Viral Infections– Fungal Infections– Parasitic Infestations

Pathogen Reservoir

Exit

Transmission

EntranceHost

Chain of InfectionChain of Infection

Chain of InfectionChain of Infection

TransmissionOrganism

ExitPortal

EntryPortal

Reservoir Host

Host Reservoir

Modes of TransmissionModes of Transmission• Direct Contact- e.g. skin to skin

• Mouth and Nose - e.g. coughs, sneezing

• Fecal-oral - e.g. the “door knob”

• Sexual

• Blood

Modes of TransmissionModes of Transmission• Direct Contact- e.g. skin to skin

• Mouth and Nose - e.g. coughs, sneezing

• Fecal-oral - e.g. the “door knob”

• Sexual

• Blood

Transmission Patterns in Transmission Patterns in Child Care SettingsChild Care Settings

• Fecal-Oral

• Respiratory

• Direct Contact

Contributing FactorsContributing Factors• Large numbers of children from

different families

• Many children cared for by small number of caregivers

• Poor hygiene habits of young children

Contributing FactorsContributing Factors• Large numbers of children from

different families

• Many children cared for by small number of caregivers

• Poor hygiene habits of young children

Contributing FactorsContributing Factors• Mixing children in diapers with

toilet-trained children

• Circulating staff from one group to other groups

• Caregivers who also prepare food for children

continued

Contributing FactorsContributing Factors

• Probably most important:Not practicing adequate hygiene measures

Hand washing is the single most effective way to stop the spread

of disease.

continued

Prevention and ControlPrevention and Control

Unit Two

Why is prevention and Why is prevention and control important?control important?

• Communicable diseases lead to serious consequences– pneumonia, meningitis, vision/hearing loss– death

• Communicable diseases spread to other people

PreventionPrevention• Immunizations

– One of the best methods to prevent disease

– Not available for all diseases

ControlControl• Control measures must be

practiced ALL the time

– Children may be contagious without symptoms

– It is impossible to know which children are contagious

– Asymptomatic children can still transmit disease

Video

Control MeasuresControl Measures

• Handwashing

• Diapering

Control MeasuresControl Measures

• Separating children into groups

Proposed Regulations – If groups of children include any child who is less than 21/2 years of age, the space where these groups receive care shall be separated from other groups (5101:2-12-13).

Continued

Control MeasuresControl Measures• Separation or exclusion of ill child

– Prevents transmission of pathogens

– Depends on the type of symptoms and/or their severity

Continued

Immediate isolation and Immediate isolation and exclusion (per regulations)exclusion (per regulations)

• Diarrhea• Severe coughing

causing the child to become red or blue in the face

• Difficult or rapid breathing

• Yellowish skin or eyes• Conjunctivitis

• Temp. of 100 F (axil) in combination with any other signs of illness.

• Untreated infected skin patches

• Usually dark urine and /or grey or white stool

• Stiff neck

Isolate and ObserveIsolate and Observe(per regulations)(per regulations)

• Unusual spots or rashes• Sore throat or difficulty swallowing• Elevated temperature• Vomiting• Evidence of lice, scabies, or other

parasitic infestation

Control MeasuresControl Measures• Disposal of soiled items

– tissues– items used to soak up blood

• Disinfection– Kills pathogens before they can enter

another person

Continued

Cleaning and DisinfectionCleaning and Disinfection

• Clean/Sanitize– 1 tablespoon of bleach per gallon of

water. Use on toys, utensils, play tables, food prep and eating surfaces. Rinse after two minutes of contact time

Cleaning and DisinfectionCleaning and Disinfection

• Disinfection– 1/4 cup of bleach per gallon of

water. Use in the diapering area, bathrooms, floors and frequently touched areas such as doors. Rinse after two minutes of contact time.

BleachBleach

• Don’t mix with anything except WATER• Keep away from children• Make fresh solution EVERYDAY

– After 24 hours, solution is no longer effective

– Label the bottle with the name of the contents

Management of the ill Management of the ill childchild

Unit Three

Center’s ResponsibilityCenter’s Responsibility

• Observation of the child– Daily health checks

– Child Observation Form

– Take an axillary temperature

Centers ResponsibilityCenters Responsibility

• Determine if isolation of child is indicated prior to discharge

– Decisions regarding whether the child should be discharged immediately and/or isolated for further observation shall be determined by the child care administrator

continued

Center’s ResponsibilityCenter’s Responsibility

• Notification of parent/guardian regarding discharge

– Designated personnel to contact parent/guardian

– If symptoms become severe and/or life threatening EMS should be called

continued

Center’s ResponsibilityCenter’s Responsibility

• Precautions for Center personnel caring for ill child– Correct hand washing technique– Correct cleaning/disposal of linens

etc.– Assure that center personnel are

adequately protected against childhood diseases

continued

Health Risks for Pregnant Health Risks for Pregnant Staff Staff

• Chickenpox or Shingles• Cytomegalovirus (CMV)• Fifth Disease• Rubella

Centers ResponsibilityCenters Responsibility• Notification of Local Health

Department of communicable diseases– Reportable Diseases– For information– Free testing– Recommendation for control of spread

to other children and to staff• Notification of parents of exposure

continued

Parental ResponsibilityParental Responsibility

• Provide Center with phone numbers– Where the parent can be reached– Health care provider– Hospital of choice– Alternate emergency contact persons

Parental ResponsibilityParental Responsibility

• Provide Center with child’s medical history– past serious illness– medication currently taking– any known allergies– copy of immunization record– chronic conditions– history of hospitalization – update annually and when changes occur

continued

Parental ResponsibilityParental Responsibility

• Pick up ill child as soon as possible when notified of discharge

• Notify personnel if child has been exposed to any contagious disease

• Keep child at home if they develop any symptoms of contagious diseases

continued

Parental ResponsibilityParental Responsibility

• Follow through with appropriate medical intervention for ill child

• Provide center with signed authorization for emergency transportation

continued

Caring for the Ill ChildCaring for the Ill Child

Video

Child Care Center Child Care Center Health PoliciesHealth Policies

Unit Four

Minimum Policy Minimum Policy StatementsStatements

• Medical and dental emergency plans• Management of communicable diseases• Maintenance of health records• Administration of medication• Employee health records• Handwashing• Child with special health needs

Minimum Policy Minimum Policy StatementsStatements

• Medical and dental emergency plans– Provision of first aid and instruction to staff

in emergency situations– Emergency transportation– Parental notification– Posting emergency phone numbers– Location of first aid kit, dental first aid chart,

children’s records, and names of staff currently trained in first aid and communicable disease

– Purpose and completion of Incident Report

Minimum Policy Minimum Policy StatementsStatements

• Management of communicable diseases– Requirements for health check upon child’s

arrival and procedures to follow if child becomes ill

– Procedures for parent notification– Posting of “Child Day Care Center

Communicable Disease Chart”

Minimum Policy Statements Minimum Policy Statements (Continued)(Continued)

Management of communicable diseases

- Management of the ill child - Handwashing - Release of ill employees

Minimum Policy Minimum Policy StatementsStatements

• Maintenance of health records– Child’s Medical Statement– Child’s Health Record (disease history,

allergies, chronic physical problems, immunizations)

– Child Observation Form– Medication Administration Form– Emergency Transportation Authorization– Incident Reports– Children with special health care needs

require an “individual health plan” in addition to the above

Minimum Policy Minimum Policy StatementsStatements

• Administration of medication– Safe storage, out of reach of children– Administration Procedures– Records

• Documentation• Communication with physician and

parents• Observation for side effects

Six Rights of MedicationSix Rights of MedicationAdministrationAdministration

• The Right Child• The Right Medication• The Right Time• The Right Dose• The Right Route• The Right Documentation

For More Information about For More Information about Administration of Medication:Administration of Medication:

• Call your Regional Licensing Office• _________________________________

• For reference only check the website for “Caring For Our Children” (National Health and Safety Performance Standard for Child Care) nrc.uchsc.edu on pages 137-38, 346,and 363.

Minimum Policy Minimum Policy StatementsStatements

• Employee health records– History– Physical exam before starting

including TB (proposed rule revision requires update every 3 years including TB)

– Immunizations OSHA ruling– Allergies, chronic illnesses

Common Illnesses of Common Illnesses of Children in CentersChildren in Centers

Unit Five

Diabetes MellitusDiabetes Mellitus

• Chronic disorder resulting from a deficiency of insulin, leading to impairment of metabolism

– Hyperglycemia

– Hypoglycemia

Diabetes MellitusDiabetes Mellitus

• Symptoms of Hypoglycemia

– Headache– Blurred vision– Confusion– Slurred speech– Aura– Shaky

continued

Diabetes MellitusDiabetes Mellitus

• Hypoglycemic Emergency

– Immediate treatment is imperative to avoid potential brain damage

– Immediate intake of a concentrated sugar– If in doubt, treat as hypoglycemia – Follow sugar intake with protein snack,

• Approximately ½ hour later

continued

Diabetes MellitusDiabetes Mellitus

• Treatment is a balancing of:

– Insulin

– Diet

– Exercise

continued

Diabetes MellitusDiabetes Mellitus• Center personnel should:

– Follow diet that is prescribed for the child

– Tell the parent if there has been a variation in the diet

– Provide meals and snacks on time

continued

Diabetes MellitusDiabetes Mellitus• Center personnel should:

– Schedule strenuous exercise after meals not just before meals

– Know the symptoms of hypoglycemia

continued

AsthmaAsthma

• Definition

– Hyper-reactivity of airway in response to varying stimuli making breathing more difficult

Video

SeizuresSeizures

• Definition– Chronic condition consisting of

episodic disturbances of consciousness, often involving involuntary motor movements

– Sometimes referred to as “convulsions” or “fits”

SeizuresSeizures• Chronic Management

– Goal is maintenance of normal lifestyle for age

– anticonvulsant medication• Given daily• Side effects: drowsiness, hyperactivity,

rashes• Good oral hygiene

continued

SeizuresSeizures• Emergency Management

– Protect child from injury• Place child on their side

– Do NOT put anything into child’s mouth– Prepare a written record of seizure

• Length of seizure (clocked time)• Extent of involvement• Intensity

– Allow child to rest following seizure

continued

Sickle Cell DiseaseSickle Cell Disease

• Definition

– An inherited, chronic blood disease in which the red blood cells become crescent shaped and function abnormally

Normal Red Blood CellSickle Cells

Shapes of Red Blood CellsShapes of Red Blood Cells

Sickle Cell DiseaseSickle Cell Disease

Sickle Cell DiseaseSickle Cell Disease• Inherited as an autosomal recessive

trait• Overall incidence is 8 out of 100,000

people• Primarily in people of African

Heritage– 1 out of 500 African-Americans affected– 1 out of 1,000-1,400 Hispanic-

Americans

continued

Sickle Cell Diseasecontinued

Sickle Cell DiseaseSickle Cell Disease• Symptoms

– Swelling and pain in the hands and feet– Fatigue, paleness, and shortness of breath– Pain, unpredictable, in any organ or joint– Yellowing of the skin and eyes– Delayed growth and puberty– Infections

continued

Sickle Cell DiseaseSickle Cell Disease• Center personnel should:

– If “crisis” begins, encourage child to drink fluids

– Administer pain medications as directed

– Notify parents at first sign of infection

continued

Communicable DiseasesCommunicable Diseases

• Upper Respiratory Infections

– Colds

– Conjunctivitis

– Strep throat

Communicable DiseasesCommunicable Diseases

• Diarrheal Diseases– Outbreaks

• 2 or more cases within 48 hours• May be defined as more than the center

usually sees• Over-the-counter medications not

usually recommended for young children

continued

Communicable DiseasesCommunicable Diseases

• Serious Viral Diseases– Chickenpox (Varicella)– Croup– Hepatitis A– Influenza– Measles, Mumps, Rubella– RSV

continued

Communicable DiseasesCommunicable Diseases

• Serious Viral Diseases– Chickenpox (Varicella)– Croup– Hepatitis A– Influenza– Measles, Mumps, Rubella– RSV

continued

Communicable DiseasesCommunicable Diseases

• Potentially life threatening diseases

– Meningitis– Whooping cough (Pertussis)

continued

Communicable DiseasesCommunicable Diseases

• Other diseases– STD– Impetigo– Pinworms– Ringworm– Head Lice (infestation)– Herpes simplex (cold sores)

continued

Communicable DiseasesCommunicable Diseases

• Other diseases– STD– Impetigo– Pinworms– Ringworm– Head Lice (infestation)– Herpes simplex (cold sores)

continued