PROGRAMS

CHILD'S SKILL DEVELOPMENT

Understanding the Spread of Disease

Children in child care are likely to be two or three times higher at risk of getting sick. Prevention of infectious disease in the child care setting will help families and child care providers improve their quality of life and bring savings in time, cost for health care, and cost of work missed.

What Is a Communicable Disease?

Illnesses caused by infection (invasion of the body) with specific germs such as viruses, bacteria, fungus, and parasites are called Infectious Diseases. Communicable diseases are those illnesses that can be spread from one person to another either directly or indirectly. Infectious diseases that commonly occur among children are often communicable and may spread very easily from person to person.

Most illnesses are contagious before their signs and symptoms appear. Some people may pass the germs without having the symptoms or continue passing them even after recovering from the illness.

Why Do Children in the Child Care Setting Have More Illnesses?

Anyone at any age can be infected with communicable illnesses, but young children are at more risk because:

• They have not yet been exposed to many of the most common germs. Therefore, they have not yet built up resistance or immunity to them.
• They also have many habits that promote the spread of germs. For example, they often put their fingers, toys and other objects in their mouths. In this way, germs enter and leave the body and can then infect the child or be passed on to others.
• Close contact between a number of children in the child care setting increases exposure, thus children in the child care setting have two or three times more illnesses than children not in child care.

How Are Illnesses Spread?

Communicable diseases are spread from the source of infection to the exposed, vulnerable person (host). For this transmission to happen, three things are necessary. In other words, contagious illnesses pass through a chain that has three links:

1. Source of germs must be present.
2. Route or (ways) of transmission along which germs can be carried must be present.
3. A host or vulnerable person who is not immune to the germ must be present and come in contact with the germs.

What Can You Do to Keep the Children and Yourself Healthy?

Break the chain of transmission by breaking one of the three links, preferably the weakest one. However, it is better to organize more than one method of control in order to reduce the transmission of infectious disease.

You can control the spread of communicable disease in three ways:

1. Attack the source of infection or the "first link" by identification, treatment and if necessary, isolation of the sick person. In the child care setting this is accomplished by doing a morning health check/observation, and if necessary exclusion, referral and notification of health authorities when required.
2. Attack the route of transmission or the "second link" by personal and general hygiene, healthy behavior or practices, proper disinfection and environmental improvement. In the child care setting this is accomplished by disinfecting toys and surfaces, proper diapering technique, handwashing, ventilation, etc.
3. Protect the vulnerable person or the "third link." In the child care setting this is accomplished by immunization, balanced nutrition, and adopting healthy practices such as proper handwashing, etc.

Major Ways for the Spread of Illnesses or "Routes of Transmission"

1. Through Direct Contact with the Infected Person's Skin or Body Fluids

   Skin infections such as impetigo, ringworm, conjunctivitis (pink eye), scabies and head lice are examples of illnesses and infestations that may be spread by direct contact with infected skin area and fluid from infected sores or infested articles. Superficial bacteria, viral infections or parasites cause these illnesses. They are common, and are usually not serious. Because young children are constantly touching their surroundings and the people around them, these infections are easily spread among children and their caregivers in the child care setting.

2. Through the Air or "Respiratory Transmission" (passing from the lungs, throat, or nose of one person to another person through the air).

   Respiratory illnesses such as the common cold, measles, whooping cough, chickenpox, flu, meningitis, strep throat, etc., are all spread through microscopic, contagious droplets of fluids from the nose, the eyes or the throat. When an infected person talks, coughs, sneezes or blows his/her nose, infectious droplets get into the air where they can be breathed in by another, nearby person. Droplets can also land on hands or objects such as toys or food, and can be touched, mouthed or eaten by other persons. When the germs in these infected droplets come in contact with the nose, eyes, or mouth of an uninfected person, they can multiply in his/her nose and throat and cause infection.

3. Through Stool or "Fecal-Oral Transmission" (transfer of a germ from an infected person's stool - bowel movement - into another person's mouth to infect him/her).

   Contagious diarrheal diseases (such as Giardia, Shigella, Salmonella, Campylobacter), Hepatitis A, and polio are examples of illnesses that are usually spread through exposure to germs in the stool or by what is known as fecal-oral transmission. This means that germs leave the body of the infected person in their stool and enter the body of another person through their mouth.

   In most situations this happens when hands or objects such as toys, which have become contaminated with undetectable amounts of stool, are placed in the mouth. Fecal-oral transmission can also occur if food or water is contaminated with undetectable amounts of human or animal stool, and then is eaten or drunk. Improperly prepared foods made from animals (for example, meat, milk and eggs) are often the source of infection with Campylobacter, E. Coli and Salmonella. Some infections, such as Salmonella and Campylobacter, may be spread through direct exposure to infected animals.

4. Through Contact with Blood or "Blood Transmission"

Blood infections are spread when blood (and sometimes other body fluids) from a person with an infection gets into the bloodstream of an uninfected person.

Hepatitis B and HIV/AIDS (Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome) are two serious viral infections spread by contact with infected blood. The viruses that cause these illnesses can be spread when blood containing the virus enters the blood stream of another person. This can happen when the skin is accidentally or intentionally punctured accidentally or by a contaminated needle. Spread can also occur when infected blood comes in contact with skin that has open sores, is damaged by conditions such as eczema, or with a broken surface of the mucous membranes (such as the inside lining of the mouth, eyes, nose, rectum or genitals). An infected mother can also transmit these infections to her newborn infant. Once these viruses enter a person's body, they may stay for months or years. This person may appear to be healthy but can still spread the viruses.

How to Reduce the Spread of Illnesses through Direct or Indirect Contact

To reduce the spread of superficial skin infections, follow these handwashing and cleanliness guidelines:

• Make sure staff and children wash their hands after contact with any body fluids. Wear disposable gloves when possible.
• Use free-flowing water for handwashing. Do not use basins or stoppered sinks, which can become contaminated with the germs.
• Use liquid soap dispensers whenever possible.
• Always use disposable tissues or towels for wiping and washing.
• Never use the same tissue or towel for more than one child.
• Dispose of used tissues and paper towels in a lined, covered step can which is kept away from food and child care materials.
• Wash and disinfect toys at least daily. Wash or vacuum frequently used surfaces (tables, counters, furniture and floors) in the program daily.
• Make sure that each child has his/her own crib or mat and does not switch.
• Do not allow children to share personal items such as combs, brushes, blankets, pillows, hats or clothing.
• Store each child's dirty clothing separately in plastic bags and send it home for laundering.
• Wash and cover sores, cuts or scrapes promptly and wipe away eye discharge.
• Report rashes, sores, running eyes and severe itching to the parent(s) so they can contact their health care provider(s).

How to Reduce the Spread of Respiratory Illnesses

Handwashing and cleanliness in the program are essential for stopping the spread of all respiratory tract disease. You should:

• Ensure that staff and children wash their hands after wiping or blowing noses; after contact with any fluids from nose, throat, or eye; and before preparing or eating food.
• Do not allow food or eating utensils to be shared.
• Wash and disinfect any mouthed toys and frequently used surfaces (such as tables) at least once daily.
• Wash eating utensils carefully in hot, soapy water; then disinfect and air dry. Use a dishwasher whenever possible.
• Use disposable cups whenever possible; when reusable cups must be used, wash them in hot, soapy water after each use.
• Air out the facility daily, even in winter, and encourage outdoor play.
• Teach children and staff to cough or sneeze into their sleeve. If they sneeze or cough into a hand or tissue, they must properly dispose of the tissue and wash their hands.
• Wipe runny noses and eyes promptly, and wash hands afterwards.
• Use disposable towels/tissues.
• Dispose of towels/tissues contaminated with fluids from nose, throat or eye in a covered container with a plastic liner. Keep them away from food and materials used in child care.
• Do not kiss on the lips; instead give big hugs or kisses on the forehead.

How to Reduce the Spread of Infections through Stools

Since children and staff who have digestive illnesses don't always feel sick or have diarrhea, the best method for preventing the spread of these diseases is to have a constant "prevention program" (universal precautions) in place at your program. The Hepatitis A virus, rotavirus, and Giardia Lamblia cysts can all survive on surfaces for periods ranging from hours to weeks.

Practice the following:

• Strict enforcement of all handwashing for adults and children
• Environmental sanitation with focus on diapering, toileting and food preparation areas
• Exclusion guidelines: Excluded children and staff may come back after treatment and when the consistency of diarrhea improves and can be contained by the diaper or pants, or with approval of the child's health provider.

How to Reduce the Spread of Diseases through Blood Contact

You should treat all blood and body fluids as if they were contagious. Always wear protective gloves when handling blood or body fluids containing blood. If gloves are not available, maintain a barrier between the blood and one's hand through the use of thick towels or gauze.

Prevention is critical! Transmission of illnesses spread through blood is very rare in the child care setting, and illnesses such as HIV/AIDS are not spread by casual, daily contacts with infected persons. However, HIV can be transmitted where there is blood contact. For example:

1. Touching blood while giving first aid with hands or body surfaces that have cuts or open sores
2. Collision accidents where the skin of both people is broken and blood is exchanged
3. Cleaning up blood after an accident with hands that have cuts or open sores
4. Biting. The only way blood-to-blood exchange can happen through biting is for the following events to occur:

   1. There is an injury to the mouth of the biter.
   2. The bite creates a wound so serious that the skin is broken and blood flows.
   3. Blood is exchanged.
   4. One of the children involved is infected with HIV.

The best method for preventing the spread of all types of infections, including HIV and Hepatitis B, is good infection control practices called "Universal Precautions."

The infection control practices listed below should be followed for all children, whether or not they are infected with bloodborne illnesses.

• Proper handwashing
• Proper use of gloves
• Proper disposal of waste and contaminated materials such as gloves, paper towels and bandages
• Proper disinfection and cleaning with bleach solution
• Proper care of soiled clothing
• Immunization for all children and staff against Hepatitis B
• Teaching all children not to touch any blood except their own

Examples of How Some Childhood Infectious Diseases Are Spread

Through Air or Respiratory Transmission:

Through Stool or Fecal-Oral Transmission:

Through Direct Contact:

Through Blood Transmission: