Health practices that reduce the spread of communicable diseases are the central topic of this learning tool. Designed for Head Start health managers, health staff, and other program staff, it presents basic information about health screenings and immunizations, infection control precautions, and daily infection control practices such as hand washing. Questions for group discussion or individual reflection are included.
The following is an excerpt from Preventing and Managing Communicable Diseases.
Special Health Needs
Universal Infection Control Precautions
Diapering and Toileting
Cleaning and Disinfecting
Disposal and Laundry
Other Hygiene Issues
Questions for Discussion/Reflection
- Health screenings and immunizations-for all children, family members, and staff-are important to prevent the spread of diseases.
- You can't tell by looking at people whether they carry a communicable disease. To prevent the spread of diseases, we must take the same infection control precautions at all times with all people.
- Staff, children, and parents should follow daily infection control practices to prevent the spread of disease:
- Wash hands at proper times and with the proper technique.
- Use latex or vinyl gloves for contact with blood.
- Clean and disinfect objects and surfaces regularly.
- Prepare and handle food in a sanitary manner.
- Dispose of wastes properly.
- Provide fresh air and ventilation.
A. Health Maintenance
The best defense against communicable disease is a healthy body. Intact skin is an excellent barrier to germs. A strong immune system fights off most of the germs that enter the body. When we take care of our bodies with proper nutrition, exercise, and rest, our bodies can usually take care of us.
All children and adults should have periodic health screenings. This helps identify special health needs and makes treatment to prevent further health problems possible. The health screening items most relevant to communicable disease are:
- Immunizations (or vaccines) protect children and adults against serious illnesses. For the best protection, children should begin getting immunizations at birth and receive the entire series within the first 15 to 18 months of life. Currently, it is recommended that children be immunized against the following diseases:
- Pertussis (whooping cough)
- Haemophilus influenza B
- Rubella (German measles)
- Hepatitis B
- Varicella (Chicken pox)
Staff and parents should consult their health care provider about the following immunizations: polio, measles, mumps, rubella, tetanus, diphtheria, hepatitis B, influenza, pneumococcus, and chicken pox.
Note: Since new immunizations can become available any time, consult your local public health authorities to learn the most current recommendations.
- Tuberculin (TB) Test Tuberculosis (TB) is a communicable disease that can cause cough, pneumonia, fevers, weight loss, and even death. Young children, seniors, and people with health problems are especially at risk. TB spreads by coughing. The infection enters the lungs and may cause no symptoms for years.
Young children and adults working with children should get tested periodically for TB. The recommended test, Mantoux or PPD, involves an injection on the forearm. After 2-3 days, the site is checked for swelling indicating TB infection. If there is a reaction, further evaluation including a chest x-ray is needed to determine treatment and follow-up. When TB is identified early, it usually can be treated successfully with antibiotics.
B. Special Health Needs
Children and adults may have special health needs related to communicable diseases:
- Some health conditions weaken the body's immunity and make the person more susceptible to complications from communicable diseases. Examples of such conditions include diabetes, sickle cell anemia, asthma/lung disease, heart defects, kidney disease, HIV/AIDS, cancer chemotherapy, organ transplant, and steroid medications.
- Some medical equipment and procedures make a person vulnerable to infection. Examples include feeding tubes, tracheostomy, ventricular (brain) shunt, urinary catheterization, and intravenous lines.
- Pregnant women are at risk for certain communicable diseases that can cause miscarriage, birth defects, or illness in the newborn. Examples include rubella (German measles), measles, mumps, hepatitis B, cytomegalovirus (CMV), herpes, parvovirus (fifth disease, "slap cheek"), chicken pox, and HIV.
- Some people carry "chronic" infectious diseases for many years or for life. Examples include herpes, hepatitis B, HIV, CMV, and salmonella.
- Some children have conditions or behaviors that increase the spread of germs. For example, mouthing behaviors in older children can increase their chances of getting sick. Drooling, biting, and having older children in diapers can increase the spread of germs to other children and adults.
Head Start programs should be aware of the specific immunizations, medications and precautions needed for children and staff with special health needs.
C. Universal Infection Control Precautions
"Infection control" practices help reduce the spread of illnesses caused by germs. "Universal precautions" means using the same infection control practices-such as hand washing, using gloves, and cleaning and disinfecting-when dealing with the blood or body fluids of all children and adults, at all times.
It isn't enough to take precautions only when someone looks sick. People can carry and spread infections when they appear sick and when they appear healthy. Many infections (e.g., colds, flu, chicken pox, hepatitis A) are contagious in the day or two before symptoms develop. People can carry some infections (e.g., hepatitis B, HIV, CMV, giardia) without any symptoms for a long time.
Universal infection control precautions are effective in preventing the spread of illness. For example, careful hand washing has been shown to reduce the incidence of diarrhea in early childhood programs by half.
- Hand washing: This is the most important infection control measure. Staff, children, and parents should wash their hands:
BEFORE AND AFTER
- preparing and serving food, feeding children, and eating/drinking
- taking or giving medication
- doing mouth/eye care and medical procedures
- toileting, diapering, assisting a child at the toilet, and handling soiled clothes
- touching blood, skin lesions, eye discharge, saliva, vomit, urine, stool, and mucus (including wiping noses)
- playing or working outdoors
- handling animals
- cleaning up
- Gloves: When caregivers deal with blood and body fluids, the best protection is intact skin and hand washing. Disposable latex or vinyl gloves provide added protection.
The Centers for Disease Control and Prevention (CDC) and Occupational Safety and Health Administration (OSHA) recommend gloves for contact with blood, mucous membranes (e.g., mouth and eyes), and discharges. Use gloves for:
- Caring for bloody injuries/incidents (e.g., bloody noses),
- Cleaning surfaces and handling items soiled with blood,
- Changing diapers with bloody stool or oozing diaper rash,
- Caring for oozing skin rashes or lesions,
- Providing mouth or eye care and medical procedures,
- Cleaning up large spills of other body fluids (e.g., vomit, urine, and stool).
- Diapering and Toileting: Stool carries germs that cause gastrointestinal illnesses. The germs in stool spread widely among children in diapers and those learning toileting. Adults who diaper and assist children with toileting can also spread germs.
The keys to infection control in diapering/toileting are:
- Diaper children on an elevated surface used only for diapering, away from food preparation, and within reach of hand washing.
- After diapering and toileting, both child and adult must wash their hands.
- Clean and disinfect the diapering surface after each use.
- Clean and disinfect toileting areas daily and when soiled.
- Discard dirty diapers in a covered step can.
- Avoid having staff who change diapers prepare food.
- Cleaning and Disinfecting: Germs inevitably spread to surfaces and objects. That is why surfaces and objects must be cleaned and disinfected on a regular schedule and after soiling with blood or body fluids.
- Cleaning: Use soap and water to wash away visible soil and many germs.
- Disinfecting or sanitizing: Use a special solution (e.g., bleach or other approved disinfectant) to kill germs that remain on the surface after cleaning. They can be effective only if the visible soil, which harbors germs, is cleaned off first.
- Disposal and Laundry: Items soiled with stool, blood, or other body fluids must be disposed of or laundered properly to prevent the spread of disease:
- Discard disposable items (e.g., diapers, gloves, paper towels, tissues) immediately. Trash cans should be:
- within reach of diaper changing, hand washing, and food preparation areas operated by a foot pedal
- tightly covered
- lined with a plastic bag, emptied and disinfected daily
- Seal clothes, bedding, and cloth toys soiled with stool, urine, blood, or other body fluids in a plastic bag until laundering.
- Food Handling: Preparing and eating food is fun and healthy. If food is handled improperly, however, germs can spread to everyone who eats the food. Most food-borne illness causes vomiting and diarrhea, and such illnesses can be especially severe for infants, young children, seniors, and people with immune problems.
The main causes of food-borne illness are using poor hygiene when handling food (e.g., not washing hands, preparing food when ill), not cooking meat and poultry sufficiently, and letting "perishable" foods (e.g., meat, fish, poultry, milk, eggs, mayonnaise) sit out at room temperature.
In every activity that involves food, staff, parents, and children must pay careful attention to food safety:
- Ensure good hygiene, especially hand washing, among food handlers.
- Refrigerate perishable foods until preparation.
- Cook meat and poultry thoroughly.
- Keep hot foods hot and cold foods cold when serving.
- Discard uneaten food from plates, milk from bottles, and family style bowls of perishable food after two hours.
- Clean and disinfect cutting boards, utensils, and tables.
- Air Quality: Most people believe that exposure to cold air can give you a cold. Actually, research shows that fresh air is healthy. When children and adults spend long periods of time together indoors particularly in small, overheated, and poorly-ventilated spaces diseases spread widely. To disperse the germs and reduce the spread of illness:
- Open windows to improve indoor ventilation.
- Maximize outdoor play time.
- Other Hygiene Issues
Kissing: It is important to show children affection without spreading germs to them or catching their illnesses. Don't kiss children on the mouth, give them hugs instead.
Sneezing and coughing: The old adage, "Cover your mouth when you sneeze or cough" may prevent you from spraying saliva, mucus, and germs into the air, but you spray germs onto your hands instead. If you don't wash your hands immediately, then you spread germs when you touch people and objects afterward. A healthier way to sneeze and cough is:
- Into your elbow or shoulder
- Facing down and away from people
Toothbrushes: Since toothbrushes can pick up and spread germs from our mouths, it is important to follow careful hygiene with toothbrushing:
- Have a personal, labeled toothbrush for each child.
- If toothpaste is used, dispense it onto a clean surface (e.g., a piece of paper or the edge of a paper cup) to prevent contaminating the tube from each toothbrush.
- Store toothbrushes with bristles up, not touching other brushes, and allow to air-dry.
- Replace toothbrushes when bristles are splayed and when contaminated. They cannot be disinfected.
Water play tables and portable wading pools: Water play can be fun and refreshing for children. However, water play tables and wading pools can spread disease. For safer water play:
- Give children individual water basins.
- Have children wash their hands before and after using the water basin.
- After each use, empty out the water and clean and disinfect the basin.
- Use sprinklers and hoses instead of wading pools.
Sandboxes: Since cats and other animals may use sandboxes as litter boxes, they can spread germs to children. For healthier sand play:
- Use only sterilized sand and replace it every two years.
- Cover sandboxes when not in use.
- Make sure that children wash their hands after playing in the sand.
Questions for Discussion/Reflection
We've heard some infection control messages such, as "Wash your hands," for years. We may think we know about disease prevention and that there's nothing more we need to learn about it. However, recommendations change (such as immunizations) and new recommendations are made (such as using gloves). And we don't always put the infection control methods we do know into daily practice (such as hand washing).
What factors keep us from practicing infection control?
- Not knowing the procedures
- Not believing they are effective
- Not having the time
- Not having the necessary supplies
- Having other demands that are more urgent.
Preventing Communicable Diseases: Key Concepts, Background Information. Preventing and Managing Communicable Diseases. HHS/ACF/ACYF/HSB. 1996. English.