Best practice advice for nurseries and childcare …...Best practice advice for nurseries and...

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Infection prevention and control Best practice advice for nurseries and childcare settings

Transcript of Best practice advice for nurseries and childcare …...Best practice advice for nurseries and...

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Infection prevention and control

Best practice advice for nurseries and childcare settings

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Infection prevention and control is everyone’s responsibility. This publication has been developed by the Public Health Agency (PHA) to provide nurseries and other childcare settings with infection prevention and control best practice advice.

It will provide staff with simple, practical advice on the day-to-day implementation of good infection prevention and control practices, as well as specific actions to take in the event of outbreaks of infection.

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Best practice advice for nurseries and childcare settings 3

Page

Foreword 4

Acknowledgements 5

Introduction 6

Thepremises 7

Training 7

Glossaryofterms 8

Generalprinciplesofinfectionpreventionandcontrol 9

Handhygiene 11

Exclusionofstaff 14

Exclusionofchildren 15

Immunisation 16

Decontamination 17

Toysandplayequipment 19

Children’spersonalitems 20

Toilets,pottiesandnappychanging 22

Laundryandchildren’sclothing 24

Foodhygiene 25

Petsandfarmvisits 26

Outbreaksofinfection 27

Bibliography 29

ContactdetailsforHealthandSocialCareearlyyearsteams 30

Contents

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4 Best practice advice for nurseries and childcare settings

Foreword

Itisimportantthatbasicinfectionpreventionandcontrolprinciplesareembeddedatanearlyageandsimpleproceduressuchasgoodhandhygieneshouldbeencouragedwithchildreninnurseriesandchildcaresettings.

Outbreaksofinfectionhaveoccurredinchildcaresettingsandveryoftenwhenthishappens,theyattractahighlevelofpublicity.Thisisapracticalguidetopreventingandcontrollinginfection,aimedateveryonecaringforchildrenandcurrentlyregisteredbyearlyyearsteamsinHealthandSocialCareTrusts(HSCTs).

Theadvicewithinthisdocumentappliestoplaygroups,daynurseries,crèches,twoyearoldprogrammesandout-of-schoolgroups.Theadviceisalsorecommendedtochildmindersasbestpracticethatshouldbeadoptedasfarasreasonablypossible.

Generalguidanceontheday-to-dayimplementationofgoodinfectionpreventionandcontrolpractices,andspecificactionstotakeintheeventofoutbreaksofinfection,areincluded.Usefullinkstootheradviceandfurtherinformationarealsoprovided.

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Best practice advice for nurseries and childcare settings 5

Acknowledgements

ThispublicationhasbeenproducedbythehealthprotectionservicewithinthePHA.AworkinggroupwasformedwithrepresentativesfromthePHAandkeystakeholdersfromotherorganisationswhoprovidedtheirspecialistexpertopinion.

Wethankallthosewhocontributedtothispublication.Inparticular,wethankthefollowing:

• membersoftheworkinggroupwhorepresented earlyyearsteamsinHSCTsinNorthernIreland;

• membersoftheworkinggroupwhorepresented environmentalhealthdepartmentsfromlocal councilsinNorthernIreland;

• healthprotectionstaffwithinthePHA.

Document prepared by:

CarolineMcGearySeniorInfectionPreventionandControlNursePublicHealthAgency2ndFloor12–22LinenhallStreetBelfastBT28BS

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6 Best practice advice for nurseries and childcare settings

Introduction

Infectionscanspreadeasilyinchildcaresettingswherelargenumbersofchildren,whoarevulnerabletoinfectionbecausetheirimmunitymaynotbefullydeveloped,comeintoclosecontact.

Infectionpreventionandcontrolinnurseriesandchildcaresettingsisamatterofgreatimportanceto:

• parents–whowanttobeassuredthatthecare theirchildrenarereceivingisprovidedina clean,safeenvironment;

• stafflookingafterchildren–whomaythemselvesbe exposedtogreaterriskofinfection;

• childcareproviders–whohavelegalresponsibilities toensurethehealthandsafetyoftheirstaffandthe childrenforwhomtheyprovidechildcareservices.

Infectionpreventionandcontroliseveryone’sresponsibilityandweallhaveanimportantroletoplay.Althoughinfectionscanspreadeasilyinchildcaresettings,thegoodnewsisthatcontrollingtheriskofinfectionisrelativelystraightforwardandsimplemeasures,suchasregularhandwashing,canusuallyreducetherisks.

Remember:

Infectionsareonlyoneofthehazardsthatchildrenandstaffmaybeexposedtowithinchildcaresettings.Foradviceonotherhealthandsafetyhazardsandfoodsafetyissues,youshouldcontacttheenvironmentalhealthdepartmentofyourlocalcouncil.

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Childcarepremisesarerequiredtoregisterwiththeenvironmentalhealthdepartmentoftheirlocalcouncilatleast28daysbeforeopeningandkeeptheminformedofanychanges.

Regulation(EC)No.852/2004statesthatthefollowingpeoplearenotpermittedtohandlefoodorenteranyfood-handlingareainanycapacityifthereisanylikelihoodofdirectorindirectcontamination:

•anyonewhosuffersfromor carriesadiseaselikelytobe transmittedthroughfood;

•anyoneafflictedwith,for example,infectedwounds,skin infections,soresordiarrhoea.

Anypersonsoaffectedandemployedinafoodbusiness,andwhoislikelytocomeintocontactwithfood,istoimmediatelyreporttheillnessorsymptoms,andifpossibletheircauses,tothefoodbusinessoperator.

The Control of Substances Hazardous to Health (COSHH) Regulations (NI) 2003provideaframeworkofactionsdesignedtocontroltheriskfromarangeofhazardoussubstancesincludingbiologicalagentsassociatedwithinfection.Youarethereforelegallyrequiredtoassessrisksandimplementcontrolmeasures.Thisdocumentcanbeusedbyyouinyourriskassessmenttodetermineifthecontrolsyoualreadyhaveinplaceareadequate.GuidanceonCOSHHcanbeobtainedfromtheHealthandSafetyExecutivewebsiteat:www.hse.gov.uk/coshh/index.htmorfromtheenvironmentalhealthdepartmentofyourlocalcouncil.

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The premises

Training

Thelayout,design,constructionandsizeofthepremisesmustpermitadequatemaintenance,cleaningandworkingspaces.

• Thebuildingshouldbetotallypestproof.

• Suitablylocatedwashhandbasinsshouldbeprovidedin allareasandsuppliedwithrunningwarmandcold water,soapanddisposablehanddryingtowels.

• Thereshouldbesuitablelightingandventilation.

• Facilitiesshouldbeprovidedforthestorageofcleaning equipmentandchemicals.

• Suitablearrangementsshouldbeinplaceforthe storageanddisposalofwaste.

• Externalwastestorageareasshouldbekeptcleanand tidyandallwastereceptaclesshouldhaveatight fittinglid.

• Surfacesshouldbekeptdryandspillsshouldbe cleanedupimmediatelywhentheyoccurusing appropriatecleaningmaterials.

Itisimportantthatallmembersofstaffhaveaclearunderstandingoftheirroleinpreventingthespreadofinfection.Staffshouldreceiveappropriatetrainingandsupervision.Theyshouldbefamiliarwiththepoliciesandproceduresthatareinplacetopreventandcontrolinfectioninchildcaresettings.Itisimportantthattheyreceivetrainingonthisdocumentanditisrecommendedthatarecordofsuchtrainingiskept.

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8 Best practice advice for nurseries and childcare settings

Glossary of terms

Antibiotic: Amedicineorchemicalthatcandestroyharmfulbacteriainthebodyorlimit theirgrowth.

Cleaning: Theremovalofdirtfromtheenvironmentandequipment.

Contamination: Thepresenceofmicroorganismsorforeignmatter,suchaschemical,physical orallergenicmaterials,onasurfaceorinafluidormaterial.

Decontamination:Theremovalofmicroorganismsorforeignmatter(orboth)fromcontaminated materialsorlivingtissue,renderingitsafe.

Detergent: Asubstanceintendedtoassistcleaningbyremovingdirtandgrease,butwhich doesnotreducemicroorganismstoasafelevel.

Disinfection: Aprocessthatreducesmicroorganismstoasafelevel.

Hypochlorite: Anoxyacidofchlorine(HClO)containingmonovalentchlorine,whichactsasan oxidisingorreducingagent.

Immunisation: Asafewayofprotectingpeoplefrominfectiousdiseasesandthecomplications thatmightoccurfollowingsomeinfectiousdiseases.

Immunity: Theresistanceofahosttoaspecificinfectiousagent.

Medication: Adrugorothersubstancethatisusedasamedicine.

Microorganism: Amicroscopicentitycapableofreplication.Itincludesbacteria,virusesandthe microscopicformsofalgae,fungi,mouldandprotozoa.

Germ: Amicroorganismcapableofproducingdisease.

Pest proof: Ensuringthatpremisesareprotectedagainsttheentryofunwantedpestssuch asrodents.

Vaccine: Apreparationusinganon-infectiouselementorrelativeofaparticularvirusor bacteria,andadministeredwiththeintentionofhaltingtheprogressofan infection,orcompletelypreventingit.

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Best practice advice for nurseries and childcare settings 9

General principles of infection prevention and control

The cause of infectionInfectionsarecausedbymicroorganisms,includingbacteria,fungiandviruses.Therearemanytypesofmicroorganisms.Theyarefoundeverywhereandmostareharmless.However,certainmicroorganisms,calledgerms,cancauseharminthosevulnerabletoinfection.Childrenandthosewhocareforthemmaybeexposedtotheseharmfulmicroorganismswithinchildcaresettings.

1. Germ:Anymicroorganismcapableofproducingdisease,egflu

virus,E.coli,salmonella.

4. Spread of germs: Howgermsspreadfromthe

sourcetothevulnerableperson,egonhands,

surfaces,toys.

2. Source of infection:Aplacewheregermscansurviveandreproduce,eg

humans(nose,stomachetc),rawfood,contaminated

water.

3. Exit point:Thepathgermscantaketo

leavethesource,egsneezing,vomiting,diarrhoea.

6. Vulnerable person: Apersonwhocannotresistgerms

invadingthebody,multiplying,andresultingininfection,egbabies,

youngpeople,peoplewithmedicalconditions.

5. Entry point:Thepathgermscantaketo

enterthevulnerableperson,egthrougheyes,noseor

mouthaftertouchingtoys,surfacesetc.

The chain of infectionTheprocessofinfectioncanberepresentedasachain,alongwhichmicroorganismsaretransmittedfromasourcetoavulnerableperson.

Breakingalinkinthischainatanypointwillcontroltheriskofinfectionbypreventingthetransmissionofthegermtothevulnerableperson.Thiscanbeachievedbyremovingthesourcesofinfection,preventingthetransmissionofmicroorganismsandreducingaperson’svulnerability.

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10 Best practice advice for nurseries and childcare settings

Sources of infectionThehumanbodymayactasasourceofinfection.Theskin,bloodandbodyfluidsmayplayakeyroleinthespreadofinfection.Peoplesufferingfromcertaininfectionsshould,therefore,beexcludedfromthechildcaresetting(pleaseseesectionson‘Exclusionofstaff’and‘Exclusionofchildren’).

Theenvironmentincludesboththephysicalstructureofthepremises(internalandexternal)andtheequipmentprovidedforuse.Theenvironmentmustbemaintainedinacleanconditionandallequipmentusedinitmustbecapableofbeingeffectivelycleanedand,wherenecessary,disinfected(pleaseseesectionon‘Decontamination’).

Contaminatedfoodandwatercanbeasourceofinfectioninchildcaresettings.Highstandardsoffoodhygieneareessential(pleaseseesectionon‘Foodhygiene’).

Animals,includingpets,cancarrymicroorganismsthatcausedisease(pleaseseesectionon‘Petsandfarmvisits’).

Preventing the transmission of microorganismsForinfectiontooccur,microorganismshavetogetfromthesourcetothevulnerableperson.However,microorganismscannotmoveontheirown;theyrequireavehicletotransferfromthesourcetotheperson.Themostcommonvehiclesareourhands.Coughsandsneezesareadeliveryvehicleforrespiratoryinfections.Itisimportant,therefore,thatwetakeappropriateprecautionstopreventthetransmissionofmicroorganismsandhandhygieneisthemosteffectivemeansofpreventingthespreadofinfections(pleaseseesectionon‘Handhygiene’).

Reducing a person’s vulnerability Oncemicroorganismshavereachedaperson,theymustbeabletoenterthebodytocauseinfection.Theskinandtheliningsofthemouth,throat,gutandairwaysallprovideabarriertoinfection.Itisimportant,therefore,tocoverallcutsandabrasionswithawaterproofdressing.Ifamicroorganismdoesmanagetocrossthebarrier,thenextlineofdefenceistheimmunesystem.Theoutwardsignsandsymptomsofdisease,suchasfeversorrashes,arearesultofthiscontest.Immunisationisasafeandeffectivewayofreducingthevulnerabilityofpeopletoinfection(pleaseseesectionon‘Immunisation’).

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Hand hygiene

Theimportanceofcorrecthandwashingmustbetaughtandreinforcedtoallstaffandchildren.Suitableandsufficienthandwashingfacilitiesshouldbeprovidedforeffectivehandhygiene.Thereshouldbedesignatedwashhandbasins,whichshouldnotbeusedforanyotherpurposesuchasfoodpreparationorcleaningofequipment.

Childrenneedtobeencouragedtowashtheirhands,especiallybeforeeatingandaftervisitingthetoilet.Sinks,soapdispensersandpapertoweldispensersshouldbeplacedatasuitableheightforchildren.Childrenwillrequiresupervision,appropriatetotheirstageofdevelopment,toensuregoodpractice.

Handsshouldbewashedusingwarmwaterandliquidsoap,anddriedusingadisposablepapertowel.Disposablepapertowelsshouldbestoredinadispensertoavoidcontamination.Clothandcottontowelsshouldnotbeusedastheyallowthespreadofmicroorganisms.Liquidsoapshouldbeusedratherthanbarsoapasbarsoapsarelikelytobecomecontaminatedandharbourmicroorganisms.

Fingernails,inbetweenfingers,thumbsandwristsarethemostfrequentlymissedareasofthehand.Thesevenstepsofcorrecthandwashingareillustratedinthediagramonpage13.Itisrecommendedthatacopyofthissevensteptechniqueisdisplayedatwashhandbasins.

Tofacilitateeffectivehandhygienewhileworkinginchildcaresettings,staffshoulddothefollowing:

• Wearsleevesabovetheelbow.Ifwearinglongsleeves, theseshouldberolleduptotheelbows.

• Removeanyhandorwristjewellerywiththe exceptionofoneplainband.

• Keepnailsshortandclean.Falsenailsandnailvarnish shouldnotbeworn.

• Donotusenailbrushes.Ifyoumustuseabowlofwater towashchildren’shands,youshouldputfreshwaterinthe bowlforeachchild.

• Keepcutsandabrasionscoveredwithawaterproof dressing.

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12 Best practice advice for nurseries and childcare settings

When should hands be washed?• Afterarrivingatwork.

• Whenevertheyarevisiblydirty.

• Afterusingthetoilet.

• Beforepreparing,servingandeatingfood.

• Aftertouchinganypotentiallycontaminatedsurfaces.

• Aftersneezingorblowingyournose.

• Afterhandlingpets.

• Beforeandaftermessyplay.

• Afterhandlingsoiledclothing.

• Afterdealingwithwaste.

• Afterhandlinganybodyfluids.

• Beforeandafternappychanging.

• Attheendoftheworkingday.

• Afterremovingpersonalprotectiveequipment.

• Atanyotherappropriatetimesthroughouttheday.

How should hands be washed?• Wethandsunderwarmrunningwater.

• Applyliquidsoap.

• Rubhandsfollowingthesevensteptechniqueas illustratedinthediagram.

• Rinsehandsthoroughlyunderwarmrunningwater, ensuringallsoapisremoved.

• Dryhandsthoroughlyusingadisposablepapertowel.

• Usepapertoweltoturnoffthetapsifthetapsarenot elbowoperated.

• Disposeofpapertowelintoafootoperatedpedalbinto preventrecontaminationofhandsfromtouchingthelid.

Remember:

Handwashingisthesinglemostimportantmeasureforpreventingthetransmissionofinfection.

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Childrenshouldbeencouragedtolearnthebasicprinciplesofgoodhygiene.Oneofthemostimportantprinciplesishandwashinganditshouldbeadequatelysupervisedbystaff.

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Effectivehanddryingisjustasimportantaswashingbecausewethandsandsurfacestransfermicroorganismsmoreeasilythandryones.

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Staffshouldlookaftertheirhands.Individualhandmoisturisersmaybeusedonapersonalbasis.

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Washhandbasinsshouldbeusedforhandwashingonly.Noplugshouldbepresentandelbowoperatedtapsarepreferable.

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Best practice advice for nurseries and childcare settings 13

Hand hygiene

How should hands be washed?• Wethandsunderwarmrunningwater.

• Applyliquidsoap.

• Rubhandsfollowingthesevenstep techniqueasillustratedinthediagram.

• Rinsehandsthoroughlyunderwarm runningwater,ensuringallsoapis removed.

• Dryhandsthoroughlyusingadisposable papertowel.

• Usepapertoweltoturnofftapsiftaps arenotelbowoperated.

• Disposeofpapertowelintoafoot operatedpedalbintoprevent recontaminationofhandsfromtouching thelid.

1

2

3

6

7

5

4

Palms

Backs

Between fingers

Thumbs and webs

Knuckle grip

Fingertips

Wrists

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14 Best practice advice for nurseries and childcare settings

Exclusion of staff

Staffwithinfectionscanplacechildrenatrisk,thereforestaffsufferingfromparticularconditionsmustbeexcludedfromtheirwork.

Staffwhopresentwithvomitingand/ordiarrhoeashouldbeexcludeduntiltheyarefreefromsymptomsforaperiodof48hours,withatleastoneformedmotionduringthistime.

StaffwithinfectedwoundsorskininfectionsonexposedpartsoftheirbodyshouldbesimilarlyexcludeduntilthelesionshavehealedortheyhavebeenadvisedbytheirGPthatitissafeforthemtoreturntowork.

Staffwithminorrespiratoryconditions,wherethereispotentialtospreadinfectionssuchascolds,mustexercisegoodrespiratorycoughetiquetteincludinggoodhandhygiene.Staffwithinfluenza,however,shouldbeexcludedfromworkuntiltheirsymptomshaveresolved.

Remember:

Allstaffwhopresentwithvomitingand/ordiarrhoeamustinformtheirsupervisorormanagerimmediatelysotheycanbeexcluded.

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Allchildcaresettingsshouldhaveastaffexclusionpolicyinplaceandallstaffshouldbeawareofitsexistenceandcomplywithit.

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Furtherinformationonrespiratoryhygiene/coughetiquetteisavailableat:

www.cdc.gov/flu/professionals/infectioncontrol/resphygiene.htm

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Best practice advice for nurseries and childcare settings 15

Exclusion of children

Infectionsarecommonamongchildren,andchildcaresettingsoftenpresentidealsituationsforinfectionstospread.Itisimportantthatanexclusionpolicyisinplace.

• Childrenwhoareillshouldnotattendchildcare.Ifachildbecomesillwhileinchildcare,aparent/guardianshouldbecontactedandaskedtotakethechildhomeassoonaspossible.Thechildshouldbeisolatedfromotherchildrenandcloselymonitoredbyamemberofstaffuntiltheyarecollectedbyaparent/guardian.

• Childrenwithdiarrhoeaand/orvomitingillnessesshouldnotbepresentinchildcaresettings.Concernedparents/guardiansshouldcontacttheirGPforadviceregardingthechild’sillnessand,ifpossible,submitafaecal/vomitussamplefortesting.Theexclusionperiodshouldlastuntilthechildhasbeenfreeofsymptomsofdiarrhoeaand/orvomitingforatleast48hours,andhashadatleastonenormalmotion.

• Thechildcaresettingoperator/managershouldinformthePHAifachildhasbeenexcludedfromthenurseryduetoaninfection.

• Parents/guardiansshouldbeadvisedifthereareknowncasesofinfectionwithinthechildcaresetting.Confidentialityofcasesshouldbemaintainedatalltimes.Itisparticularlyimportantthattheparentsofchildrenwhoseimmunitymaybeimpairedduetoillnessortreatment(egleukaemia,HIV,thoseonsteroidtherapy)areprovidedwiththisinformation.

• Itisalsoimportantthatmothersandstaffwhoarepregnantaremadeawareofthefollowinginfections:chickenpox,measles,rubellaandslappedcheeksyndrome(Fifthdisease).TheyshouldconsultwiththeirGPiftheyhaveanyconcerns.

• Itisgoodpracticethatifachildrequiresantibiotics,theyshouldbeexcludedfromthechildcaresettinguntiltheyhavecompletedatleast48hoursofthetreatment.Itmaytakethechildmuchlongertorecoverfromsomeinfectionsandfeelwellenoughtoattendchildcare.Otherinfectionsaresubjecttospecificexclusionadvice.

Remember:

Allparents/guardiansshouldbemadeawareoftheexclusionpolicyinthechildcaresetting.Itistheresponsibilityofthechildcarestafftoimplementit.

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16 Best practice advice for nurseries and childcare settings

Immunisation

Immunityistheabilityofthebodytoprotectitselffrominfectiousdisease.Vaccinesgivelong-termprotectionfromavarietyofinfectiousdiseases.Immunisationorvaccinationisasafewayofprotectingpeoplefrominfectiousdiseasesandthecomplicationsthatmightoccurfollowingsomeinfectiousdiseases.

Itisgoodpracticetoensurethatallchildrenareup-to-datewiththerecommendedvaccinations.PleaseseethePHAwebsitewww.publichealth.hscni.nettoaccesstheroutinechildhoodimmunisationschedule.AdviseparentstocontacttheirGPregardinganymissedimmunisations.

Remember:

Someinfectiousdiseases,egchickenpox,measles,rubellaandslappedcheeksyndrome(Fifthdisease),mayposearisktopregnantwomen,whoarenotimmunetotheseinfections.Women,includingchildcarestaff,whomaybeatriskandareexposedtoordevelopthesediseasesduringpregnancyshouldseekadvicefromtheirGP,midwifeorobstetricianurgently.

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Staffworkinginachildcaresettingshouldensuretheyareup-to-datewiththeirrecommendedimmunisations.PleasenotethattwodosesofMMRvaccinearerequiredtoachieveprotectionagainstmeasles,mumpsandrubella.

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Furtherinformationonimmunisationisavailablefromthefollowingwebsites:

www.publichealth.hscni.net

www.nhs.uk/Planners/vaccinations/Pages/Landing.aspx

www.dh.gov.uk/en/Publichealth/Immunisation/Greenbook/index.htm

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Decontamination

Acleanenvironmentisessentialinpreventingthespreadofinfection.Itisimportantthattheenvironmentiswellmaintainedandanydamagedsurfacesarereplaced.

Detergentandwarmwaterareadequateformostcleaning.Adetergentisachemicalthatbreaksdowndirtandgreaseandfacilitatescleaning.However,occasionallydisinfectionisalsorequired.

Disinfectionistheprocessofreducingmicroorganismstoasafelevel.Disinfectantchemicalsorsteammaybeusedforthispurpose.Tobeeffective,surfacesthataretobedisinfectedmustbethoroughlycleanedfirst.Disinfectantsmustbeappliedforthecorrectperiodoftime(contacttime)andatthecorrectstrength(concentration).Checkthelabelforthemanufacturer’sinstructions.Itisrecommendedthatchildcaresettingsuseahypochlorite(bleach)solutionanddiluteasperthemanufacturer’sinstructions.

Keeping it clean • Carpetedareasandmatsarenotrecommendedbut,

wherepresent,shouldberegularlyvacuumedandperiodicallysteamcleaned.

• Highchairsandotherfurnitureshouldbemaintainedinacleancondition.

• Topreventcross-contamination,useseparatecleaningequipmentforallareas,egplayareas,toilets,kitchens.Astandardcolourcodingsystemisausefulwayofachievingthis.

• Intheeventofchildrenvomitingorhavingdiarrhoea,itisimportanttocleananddisinfecttheaffectedarea.Clothsusedforcleaningmaybecomevehiclesforcontaminationandshouldbedisposable.Theyshouldbediscardedafteruse.

• Ifnon-disposableclothsareused,theseshouldbemachinewashedonahotcycleattheendofeachday.

• Mopheadsshouldbedetachableandmachinewashableandtheyshouldbereplacedregularly.Theyshouldalsobestoredinvertedtoallowfordrying.Mopbucketsshouldbecleanedfollowinguse,thendriedandstoredupsidedowninadesignatedarea.

Remember:

Allchildcaresettingsshouldhaveawrittencleaningschedule,detailingwhathastobecleaned,whenithastobecleaned,howithastobecleanedandwhoisresponsibleforcleaning.

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Floors,whereyoungchildrencrawlandplay,maypresentahigherriskofinfectionandwillrequiremoreregularcleaning.

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Practicea‘cleanasyougo’policyatalltimes,iecleanupspillagesetcimmediatelyastheyoccur.

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Frequentlytouchedsurfaces,egtoilethandles,doorhandles,lightswitchesandtaps,mayrequiremoreregularcleaningordisinfection.

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18 Best practice advice for nurseries and childcare settings

Cleaning of blood and other body fluids Bloodandotherbodyfluidspillages(egvomitandfaeces)mayposeariskofinfectiontochildrenandstaffand,therefore,mustbecleanedupimmediately.Spillagekitsareadvisedforusewhenrequired.Thesekitscanbepurchasedormadeup.Thefollowingflowchartoutlineswhatactionsshouldbetaken:

Remember:

Spillagekitsshouldcontainplasticbags,disposableglovesandaprons,disposablecloths,papertowelsandahypochloritedisinfectant.

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Itisrecommendedthatallchildcaresettingshaveadisinfectionpolicyinplaceforcleaningupbloodandbodyfluids.

Bloodandvisiblybloodstainedbodyfluids

Largespill(30mlsormore)

Coverthespillagewithpapertowelstoabsorb

Liftthesoiledpapertowelsanddisposeas

clinicalwaste

Liftthesoiledpapertowelsanddisposeas

clinicalwaste

Disinfectwithhypochloritesolution

1,000ppm

Rinseanddry

Cleanareawithneutraldetergentandwater(ifblood

presentdisinfectwithhypochloritesolution

10,000ppm)

Cleanareawithneutraldetergentandwater

Removeglovesandplasticapron(andmaskifapplicable)anddisposeofasclinicalwaste

Immediatelywashhandswithsoapandwater,rinseanddrythroughly

Pourhypochloritesolution10,000ppm

andleavetosoak3-5minutescontact

timetoallowfordisinfection

Liftthesoiledpapertowelsanddisposeas

clinicalwaste

Cleantheareawithaneutraldetergentandwater,rinseanddry

Smallspillorsplash

Wipewithadisposablecloth

soakedinhypochloritesolution10,000ppm

Bodyfluidsnotvisiblybloodstained

Coverspillagewithpapertowelstoabsorb

Coverspillagewithpapertowelstoabsorb

Putondisposableglovesandapron(andmaskifsplashrisk)

Urine

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Best practice advice for nurseries and childcare settings 19

Toys and play equipment

Toysareveryimportantforthesocialandeducationaldevelopmentofachild.However,theycanbecomecontaminatedwithmicroorganismsfromunwashedhandsandbodyfluids.Safetyshouldbeoneofthemainconsiderationswhenchoosingtoysandplayequipmentforchildcaresettings.

DoEnsurethatalltoysandplayequipmentinthechildcaresettingcanbeeasilycleaned/decontaminated.

Haveaclearcleaningscheduleinplaceexplainingwhenandhowtoysandplayequipmentshouldbecleaned,whatcleaningproductsarerequiredandwhoisresponsibleforcleaning.

Refertothemanufacturer’sinstructionswhencleaningtoysandplayequipment.

Checktoysregularlyfordamageanddiscardthemifrequired.

Hard/plastictoysshouldbecleanedanddisinfected.Theyshouldbethoroughlyrinsedanddried.

Washsofttoysinawashingmachineatthehighestpossibletemperature,asperthemanufacturer’sinstructions.

Storealltoysinaclosedcupboardorincleanwashablecontainers.

Toysthatarevisiblysoiledshouldberemovedfromtheplayareaandcleanedanddisinfectedimmediatelyasperthemanufacturer’sinstructions.

Waterplaypoolsshouldbeemptiedaftereveryuse,cleanedwithwarmsoapywater,disinfectedandthoroughlydried.

Sandpitsshouldbecoveredwhennotinuse,cleanedregularlyandthesandreplacedasnecessary(atleasteverythreemonths).Sandthatspillsontothefloorshouldbediscardedandsandshouldbesievedregularly.

Ensurehandsarewashedandskinlesionsarecoveredbeforeandafterusingplaydough/Plasticine.Ideally,playdoughshouldbepreparedanddiscardedonthedayofuse.

Don’tPuttoysbackintostorageiftheyarevisiblydirty.

Keeptoyswithsharpedgesorroughsurfacesthataredifficulttoclean.

Remember:

Itisimportantthathandsarewashedwithsoapandwaterafteranyoutdooractivity.

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Handsshouldbewashedwithsoapandwaterbeforeandafterplayingwithsand,waterandplaydough.

.....................................................

Childrenshouldnottaketoysintothetoiletarea.

.....................................................

Followthemanufacturer’sinstructionswhenwashingtoys.

.....................................................

Discouragechildrenfromputtingsharedtoysintotheirmouths–washhandscorrectlyaftertouchinganycontaminatedtoys.

.....................................................

Awrittenrecordofcleaningtoysshouldbekeptondisplay.Thisshouldincludethedate,toycleanedandsignatureofthepersonwhocleanedthetoy.

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20 Best practice advice for nurseries and childcare settings

Children’s personal items

Children’spersonalitemsshouldnotbesharedwithotherchildren.Allpersonalitemsshouldbestoredinanappropriatecontainerdisplayingthechild’sname.

Toothbrushes and dental hygiene• Itisimportanttoencouragechildrentobrushtheir

teethbutstaffmustbeawarethatatoothbrushcouldtransmitinfection.

• Eachchildshouldhavetheirowntoothbrushandchildrenshouldnotbeallowedtoshareorborrowtoothbrushes.

• Appropriateamountsoftoothpasteshouldbedispensedontoacleansurface,egpapertowelorplate,beforebeingcollectedonthetoothbrush.Thereshouldbesufficientspacebetweenthetoothpastetoallowcollectionwithoutcross-contamination.

• Childrenshouldnotbepermittedtoeatorlicktoothpastefromthetube.

• Afteruse,toothbrushesshouldbethoroughlyrinsed.Allowthemtoair-dry,storingtheminanuprightpositionwithsufficientspacebetweenthemtoavoidcross-contaminationwithothertoothbrushes.

• Toothbrushholdersshouldbecleanedregularlyandtoothbrushesshouldbereplacedeverythreetofourmonths,orsoonerifbristlesappearwornorsplayed.

• Ensuretoothbrushesandtoothpastearestoredwheretheyareprotectedfromcontamination,ienotinthetoiletarea.

Remember:

Theappropriateamountsoffluoridetoothpasteare:

• childrenagedunderthree yearsshouldusenomore thanasmearoftoothpaste containingnolessthan1,000 partspermillionfluoride;

• childrenagedthreeyearsand overshouldusenomore thanapea-sizedamountof toothpastecontainingnoless than1,000partspermillion fluoride.

.....................................................

Encouragechildrentobrusheachsurfaceofeverytooth.

.....................................................

Encouragechildrentospitouttoothpasteresidueafterbrushinganddiscouragethemfromswallowingtoothpaste.

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Best practice advice for nurseries and childcare settings 21

Dummies• Dummies/teethingringsshouldbeclearlylabelled

foreachchild.

• Sharingofdummies/teethingringsshouldnotbeallowedasthiscouldtransmitinfection.

• Ifadummy/teethingringfallsonthefloor,itshouldbewashedanddisinfectedbeforethechildputsitbackintheirmouth.

• Dummies/teethingringsshouldbestoredinacleandrycontainerwhennotbeingused.Thecontainershouldbeclearlylabelledwiththechild’sname.

Medication• Parents/guardianswholeavemedicationintothe

childcaresettingshouldbeaskedtoleavethecompletepackagingwithclearinstructions.

• Medicationtobetakenbyachildmustbeclearlylabelledwiththechild’sname,thedosagetobetakenandthetimeitistobetaken.

• Medicationsshouldneverbesharedwithotherchildren.

• Childrenshouldonlybegivenmedicationthathasbeenprescribedbyadoctor.Non-prescribedmedicationshouldonlybegivenwithparental/guardianconsent.

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22 Best practice advice for nurseries and childcare settings

Toilets, potties and nappy changing

ToiletsChildrenwillonlydevelopgoodhygienepracticeswhenusingthetoiletiftheyareprovidedwiththeappropriateadviceandadequatefacilities.

• Toiletareasshouldbekeptcleanatalltimesastheyarelikelytobecontaminatedwithmicroorganisms.Toiletareasshouldbecheckedregularlythroughoutthedayandcleanedanddisinfectedasrequired(thisincludesdoorhandles,tapsandflushhandles).

• Youngchildrenshouldbesupervisedwhenusingthetoiletandwashingtheirhands.

• Child-sizetoiletsshouldbeavailableforyoungchildrenandalltoiletsshouldbefittedwithatoiletseatandlidtominimiseaerosolspreadofcontentswhenflushing.

• Thereshouldbeadequatesuppliesoftoilettissueinalltoilets.

• Washhandbasinsshouldbeatasuitableheightforchildren.

PottiesPottiesshouldbekeptinthetoiletareaandshouldnotbeallowedintheplayarea.

• Afteruse,thecontentsofthepottyshouldbeemptieddownthetoilet(turnheadawaywhenemptyingpottycontents).Thetoiletlidshouldbeclosedbeforeflushingtominimiseaerosolspreadofcontents.

• Afteremptying,pottiesshouldbewashed,disinfectedanddriedthoroughlywithdisposabletowels/roll.Handsshouldthenbewashedwithsoapandwater.

• Pottiesshouldbestoredseparatelyupsidedownandnotstackedinsideoneanother.

• Pottiesshouldnotbewashedinwashhandbasins.

• Pottiesthatarecrackedordamagedshouldbedisposedofastheycannotbecleanedeffectively.

• Individualchildren’spottieseliminatetheriskofspreadinginfectiontootherchildrenandshouldbeconsidered.

• Childrenshouldbediscouragedfromplayingwithtoysinthetoiletorpottyarea.Iftoysareusedinthisareaduringpottytraining,theymustbecleanedanddisinfectedafteruse.

Remember:

Childrenshouldbesupervisedtoensurethattheywashtheirhandsafterusingthetoiletorapotty.

.....................................................

Handwashingfacilitiesshouldbeavailableintheimmediatenappychangingarea.

.....................................................

Wearingglovesisnotasubstituteforhandhygieneandhandsshouldbewashedimmediatelyaftergloveshavebeenremoved.

.....................................................

Parents/guardiansshouldbeinformedifanappyrashappears.

.....................................................

Individualcreamsandlotionsshouldbelabelledwiththechild’snameandneverbesharedwithotherbabies/children.

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Best practice advice for nurseries and childcare settings 23

NappiesAllchildcaresettingsthatacceptchildrenwhoarestillinnappiesmusthaveappropriatedesignatedfacilitiesfornappychanging.Thesefacilitiesmustbeseparatetofoodpreparationandservingareasandchildren’splayareas.

• Itisrecommendedthatanewdisposableapronandpairofglovesarewornforeachnappychange.

• Putonglovesandanapronimmediatelybeforethetaskandremovethemassoonasthetaskiscomplete.

• Alwayswashhandsbeforeandafterusinggloves.

• Changingmatsshouldhaveasealedplasticcoveringandbefrequentlycheckedforcracksortears.Ifcracksortearsarefound,thematshouldbediscarded.

• Thematshouldbecleaned,disinfectedanddriedthoroughlyaftereachnappychange.

• Disposabletowels/rollshouldbeplacedontopofthechangingmatforaddedprotection.Thesedisposabletowels/rollmustbediscardedaftereachnappychange.

• Cleannappiesshouldbestoredinacleandryplace.

• Soilednappiesshouldbeplacedina‘nappysack’orplasticbagbeforebeingplacedinthebin.Binsneedtobefoot-pedaloperated,regularlyemptiedandplacedinanappropriatewastecollectionarea.

• Eachchildshouldhavetheirowncreamsandlotions.Thesecanbesuppliedbytheparent/guardianandshouldbeclearlylabelledwiththechild’sname.Whenapplyingcreamsforrashes,aglovedhandorspatulashouldbeused.

• Staffshouldensuretheyhavealltheequipmenttheyneedandaccesstofreshwaterbeforeeachnappychange.

• Childrenorbabiesshouldneverbeleftaloneonanappychangingtable/bench.

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24 Best practice advice for nurseries and childcare settings

Laundry and children’s clothing

LaundryLinenandclothingcanbeapotentialsourceofinfection.

• Laundryshouldbedoneinaseparatedesignatedarea.

• Washingmachinesshouldnotbelocatedinfoodpreparationareasorchildren’splayareas.

• Thereshouldbeenoughspacetokeepcleananddirtylinenseparate.

• Thereshouldbeadequatedryingfacilities–atumbledryerispreferable.

• Sheetsusedforsleepingmatsorcotsshouldbededicatedtoanindividualchildforoneweekandlaunderedwhenrequired.

• Iflinenissoiled/infected,itshouldbeplaceddirectlyintothewashingmachine.Thelaundryoperatorshouldwearglovesandadisposableapronandwashtheirhandsproperlyatappropriatetimesthroughoutthecourseofashift.Ifpossible,adedicatedwashhandbasinshouldbeprovidedwithinthelaundry.

• Launderingclothesatthehighestpossibletemperature(asperthemanufacturer’sinstructions),tumbledryingandironingisrecommended.Theheatinvolvedinalloftheseprocesseswillhelpkillanymicroorganismsthatmaybepresent.

Children’s personal clothing• Whenhandlingsoiledchildren’sclothing,staffshould

alwayswearglovesandadisposableapron.

• Soileditemsshouldbeplacedintoaclearplasticbagandsealed.Bagsshouldbestoredinasafeplace,awayfromfoodpreparationandeatingareasandchildren’splayareas.

• Explaintoparentsthatwashingtheclothesinchildcaresettingscanexposechildrenandstafftomicroorganisms,whichcancauseinfection.Adviseparentsthatwhilereceivingsoiledclothesisunpleasant,thispolicyprotectsthehealthofbothchildrenandstaff.

Remember:

Donotrinse,soakorwashsoiledchildren’sclothing.

.....................................................

Allchildcaresettingsshouldhavealaundrypolicyinplace.

.....................................................

Laundryequipmentshouldberegularlyservicedandrecordsofthisservicingshouldbekept.

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Best practice advice for nurseries and childcare settings 25

Food hygiene

Foodhygieneisessentialtopreventthespreadofgastrointestinalinfections.Forinformationonanyfoodsafetyissues,contacttheenvironmentalhealthdepartmentofyourlocalcouncil.

Formula milkBeforeyouprepareafeed,youshouldcleanworktopsandwashyourhands.Youshouldcleanandsterilisebottlesandteatsbeforeyouusethem.Followthemanufacturer’sinstructionsonhowtodothis.Formoreinformationonsterilisingbottles,seethePHA’sbottlefeedingleafletat:www.publichealth.hscni.net/publications/bottlefeeding-0

Ideally,youshouldmakeupformulamilkfreshlyforeachfeed.Ifthereisanymade-upformulamilkleftafterafeed,throwitaway.

Whenpreparingafeed,boilfreshtapwaterandletitcool.Alwaysputtheboiledwaterinthebottlebeforeaddingthepowder.Cooltheformulaquicklytofeedingtemperaturebyholdingthebottleundercoldrunningwater(withthecapon).

Baby foodIfyouareusingboughtbabyfood,followthemanufacturer’sinstructionsonpreparation,storageandserving.Ifyoumakeyourownbabyfood(oraparent/carerbringshome-madebabyfood),itisveryimportanttocook,cool,store,defrostandreheatitsafely.

Remember:

AnydisinfectantorsanitiserusedwithinthekitchenenvironmentmustmeettheofficialstandardsofBSEN1276:1997orBSEN13697:2001.

.....................................................

Peopleemployedspecificallyforthepreparationandcookingoffoodshouldnotbeinvolvedincleaningdutiesinthenappychangingandtoiletareas.

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Formoreinformationongoodfoodhygieneandkeepingfoodsafe,referto:www.food.gov.uk/goodbusiness

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Generalinformationonfoodhygieneisavailableat:www.food.gov.uk/

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26 Best practice advice for nurseries and childcare settings

Pets and farm visits

Whilechildrencangetmuchpleasureandeducationalbenefitfrompets,theseanimalscanbeapotentialsourceofinfection.Itisimportant,therefore,thatappropriatehygienepracticesarefollowed.

• Givesomeoneresponsibilitytolookafterpets.

• Ifanypetsappearunwell,donotallowchildrentoplaywiththemandseekveterinaryadvice.

• Maintainpets’livingareasinacleancondition.

• Washyourhandsaftercontactwithpets.

• Alwayssupervisechildrenwhentheyarewithpets.

• Ensurechildrenareawarethatpetscancarrymicroorganismsandthattheyshouldalwayswashtheirhandsafteranycontactwiththem.

• Discouragechildrenfromkissingpetsandallowingpetstolicktheirface.

• Keeppetsoutofthekitchenandawayfromallsurfaceswherefoodispreparedorconsumed.

• Animalfoodmustnotbestoredwithfoodintendedforhumanconsumption.

Visits involving animalsVisitstofarmsandzoosarebotheducationalandenjoyableforchildren,butitshouldberememberedthatanimalscarrymanydifferentinfectiousdiseases,someofwhichcanbepassedtohumans.Itisessential,therefore,thathygieneprecautions,iehandhygiene,aretakenduringandaftersuchvisits.Itisadvisedthatpriortoanyvisit,ariskassessmentofthepremisesshouldbeundertaken.

Remember:

Touchingorfeedingfarmanimalscanbeasourceoflife-threateninginfection,particularlyinyoungchildren.Theonlywaytoeliminatethisriskentirelyisforchildrentoavoidcontactwithanimalsandtheirfaeces.Itisthecarer’schoicewhetherthechildisallowedtotouchorfeedtheanimals......................................................

Carersshouldsupervisethewashingofchildren’shandsimmediatelyafterleavingtheanimalcontactarea,beforeeatingordrinkingonthefarm,andafterremovingfootwear......................................................

Sanitisinghandgelsdonotprovideadequateprotectionalone.Theyarenotasubstituteforthoroughhandwashingwithsoapandwater......................................................

Thisadviceisalsorelevantinsituationswhereanimalsaretakenintonurseriesandchildcaresettings......................................................

Furtherinformationonpetsandfarmvisitsisavailablefromthefollowingwebsites:www.hse.gov.ukwww.hseni.gov.ukwww.safefood.euTheHealthandSafetyExecutive(HSE)informationsheetPreventingorcontrollingillhealthfromanimalcontactatvisitorattractionsisalsoavailableat:www.hseni.gov.uk/news.htm?id=8897&preventing-or-controlling-ill-health-from-animal-contact-at-visitor-attractions

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Best practice advice for nurseries and childcare settings 27

Outbreaks of infection

Anoutbreakisdefinedas“having two or more children or staff with an infection, caused by the same microorganism, at the same time in the same place”.

However,asinglecaseofaseriousdiseasemayalsorequireanoutbreakresponse,egE.coliO157,diphtheriaormeasles.

Ifyoususpectthereisanoutbreakofinfection,youshouldcontactthehealthprotectiondutyroomatthePHA.

Examplesofwhenthiswouldbeappropriateare:

• asuddenincreaseinthenumberofabsentchildren orstaffwithsymptomsofdiarrhoeaand/orvomiting;

• morethanoneparentadvisingthechildcaresetting thattheirchildhassymptomsofdiarrhoeaand/or vomiting;

• morethanonememberofstaffadvisingthechildcare settingthattheyhavesymptomsofdiarrhoeaand/or vomiting;

• morethanonechildorstaffmemberexhibiting similarsymptomsofanundiagnosedrash;

• morethanonechildorstaffmemberexhibiting similarsymptomsofanyotherkind.

Remember:

Ifmorethanonechildorstaffmemberexperiencessymptomsofdiarrhoeaand/orvomiting,andthereisapossibilitythattheillnessisfood-related,yourlocalenvironmentalhealthofficerwillbeinformedbythehealthprotectiondutyroomatthePHA.

Health protection duty roomPublicHealthAgency4thFloor,12–22LinenhallStreet,BelfastBT28BS

Open9am–5pmMondaytoFridayTel:02890553994or02890553997Fax:02890553930E-mail:[email protected]

Outofhours(evenings,weekendsandbankholidays):contactBelfastAmbulanceControlon02890404045andaskthemtopagethefirston-callpublichealthdoctor.

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28 Best practice advice for nurseries and childcare settings

Thefollowingflowchartoutlinestheactionstobetakenifanoutbreakofinfectionissuspectedorconfirmed:

Twoormorechildrenpresentingwithvomitingand/or

diarrhoea

Twoormorestaffpresentingwithvomitingand/or

diarrhoea

ContactthePublicHealthAgencydutyroom,12-22LinenhallStreet,BelfastTelephone:02890553994or02890553997

Fax:02890553930Email:[email protected]

Isolatetheaffectedcase/sawayfromotherchildrentopreventfurtherspreadofinfection.

Thechildshouldbecloselymonitoreduntilcollectedfromthepremises.

Contactparent/guardiantocollectchild/childrenfromthepremises.

Ensuredetailedrecordsaremaintained,whichshouldinclude: •names; •symptoms; •date,timeandlocationofchildwhensymptomsoccured; •listofcontacts; •dateandtimeofchild’slastattendanceatthefacility.

Alistofotherchildrenwhohavepotentiallybeenexposedshouldalsobekept.

Ensurethatparents/guardiansareinformedaboutthepossibleorconfirmedoutbreakofinfectionandthatthoseaffectedareexcludeduntiltheyaresymptomfreefor48hours(seepage15).

Encourageparentstosubmitafaecal(stool)orvomitussamplefromchildtotheirGP.

Ensurethattheenvironmentiscleanedanddisinfectedasperflowchartoutliningthemanagementofbloodandbodyfluids(seepage18).

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Best practice advice for nurseries and childcare settings 29

Bibliography

WesternHealthandSocialCareTrust.Infectioncontrolguidelinesforchildcaresettings.Availableat:www.westerntrust.hscni.net/pdf/Infection_Control_Guidelines_for_Child_Care_Settings.pdfAccessed14October2010.

HealthandSafetyExecutive.ControlofSubstancesHazardoustoHealth(COSHH).Availableat:www.hse.gov.uk/coshh/index.htmAccessed18October2010.

FoodStandardsAgency.Regulation(EC)852/2004onthehygieneoffoodstuffs.Availableat:www.food.gov.uk/foodindustry/regulation/europeleg/eufoodhygieneleg/Accessed18October2010.

DepartmentofHealth,SocialServicesandPublicSafety.TheNorthernIrelandRegionalInfectionPreventionandControlManual.October2008.Availableat:www.infectioncontrolmanual.co.niAccessed8October2010.

HealthProtectionAgency.Guidanceoninfectioncontrolinschoolsandotherchildcaresettings.April2010.Availableat:www.hpa.org.uk/web/HPAwebFile/HPAweb_C/1194947358374Accessed8October2010.

CentersforDiseaseControlandPrevention.Respiratoryhygiene/coughetiquetteinhealthcaresettings.1August2009.Availableat:www.cdc.gov/flu/professionals/infectioncontrol/resphygiene.htmAccessed27October2010.

FoodStandardsAgency.Saferfood,betterbusiness.Availableat:www.food.gov.uk/Accessed1November2010.

PublicHealthAgency.Bottlefeeding.February2011.Availableat:www.publichealth.hscni.net/publications/bottlefeeding-0Accessed26November2010.

HealthandSafetyExecutive.Preventingorcontrollingillhealthfromanimalcontactatvisitorattractions.March2011.Availableat:www.hse.gov.uk/pubns/ais23.pdfAccessed3December2010.

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30 Best practice advice for nurseries and childcare settings

Contact details for Health and Social Care (HSC) early years teams

HSCT Early years contact

Belfast HSCT HilaryWalker Tel:02890803606 Fairview1 Email:hilary.walker@ MaterHospitalSite belfasttrust.hscni.net 47/51CrumlinRoad Belfast BT146AB

Northern HSCT KateKelly Tel:02894424600 AlderHouse Email:kate.kelly@ AntrimAreaHospitalSite northerntrust.hscni.net BushRoad Antrim BT412QB

South Eastern HSCT PhilipFriel Tel:02891468521 BangorAdminBuilding Email:philip.friel@ NewtownardsRoad setrust.hscni.net Bangor BT204LB

Western HSCT PatArmstrong Tel:02871272112 WesternHealthandSocialCareTrust Email:pat.armstrong@ RiverviewHouse westerntrust.hscni.net AbercornRoad Londonderry BT486SB

Southern HSCT CiaranEastwood Tel:02838333747 SouthernHealthandSocialCareTrust Email:ciaran.eastwood@ 2OldLurganRoad southerntrust.hscni.net Portadown CountyArmagh BT625SG

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Best practice advice for nurseries and childcare settings 31

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Public Health Agency

OrmeauAvenueUnit

18OrmeauAvenue

BelfastBT28HS

Tel:02890311611

Textphone/TextRelay:1800102890311611

www.publichealth.hscni.net

05/11