Handout A: Who Has Had This Experience?

Find Someone Who                                                                                                         Sign Here

Opens windows to prevent the spread of illnesses.

Has chapped hands from washing them so much.

Teaches children to cough into their elbow or shoulder.

Carries latex gloves on the playground.

Has seen a child with chicken pox.

Has dealt with a case of giardia in child care.

Has caught conjunctivitis (pink eye) from a child.

Has a child who caught head lice in school.

Missed work this year to take care of a sick child.

Knew someone with a disease that could have been prevented by immunization.

Got a flu shot this year.

Has discussed communicable diseases with a health professional.

Handout B: What Do We Think?

Why do people catch colds?

My ideas:

Other staff person's ideas:

Parent's ideas:

What can we do to reduce the spread of colds?

My ideas:

Other staff person's ideas:

Parent's ideas:

When you catch a bad cold, what do you do to get better? Whom do you ask for advice?

My ideas:

Other staff person's ideas:

Parent's ideas:
 

Module 2 

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Preventing Communicable Diseases

Outcomes

After completing this module, participants will improve their practices to reduce the spread of diseases.

Key Concepts

• 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.

Background Information

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:

1. 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:

· Polio · Measles
· Diphtheria · Mumps
· Tetanus · Rubella (German measles)
· Pertussis (whooping cough) · Hepatitis B
· Haemophilus influenza 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.

2. 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.
 
1. 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

AFTER

• 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

(For proper technique, see Handouts C: Hand Washing and E-l: Hand Washing Checklist)

2. 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).

(For proper technique, see Handout D: Gloving)

3. 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. (For proper techniques, see Handout E-2: Diapering Checklist)

4. 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.

(For schedule and technique, see Handout E-3: Cleaning & Disinfecting Checklist)

5. 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.

6. 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 foodborne 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.

(For details, see Handout E-4: Food Handling Checklist)

7. 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.

8. 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

Activity 1:
Hand Washing:
Doing It Right

Purpose: This activity helps participants perfect their hand-washing skills. For this activity, you will need:

• Sinks, liquid and bar soap, paper and cloth towels, hand lotion, trash can
• A copy of Handout C: Hand Washing, for each participant

 

Step 1: Explain that this exercise looks closely at all of the steps in hand washing to reinforce the proper technique.

Step 2: Review the recommendations for when adults and children should wash their hands (see Background Information).

Step 3: Set up the hand-washing demonstration at an actual sink or at a "pretend sink" with faucets.

Ask for a volunteer to help demonstrate the proper hand washing technique. Explain that she has just helped a child with toileting. Ask her to describe what she is doing at each step.

Step 4: When the volunteer turns on the water, ask:

a. Is hot or cold water better? (Answer-Warm water is preferred for comfort and to help dissolve grease and grime, but cold water works, too.)

b. Is it okay for adults and children to wash hands in a stoppered sink or a bowl? (Answer—You must wash your hands under running water that drains away because standing water can spread germs.)

Step 5: When the volunteer is ready to soap her hands, ask:

a. Which is better, liquid or bar soap? (Answer-Liquid soap is preferred because it is easier to handle, but bar soap is okay.)

b. Is antibacterial soap necessary? (Answer-Antibacterial soap does not add any benefit in hand washing.)

c. What parts of your hands should you scrub? (Answer-Be sure to wash all surfaces. Germs accumulate between the fingers, under fingernails, on jewelry, and around the wrists.)

d. How long should you scrub your hands? (Answer-Scrub hands for at least 1O seconds.)

Step 6: When the volunteer rinses her hands, offer her the towels and ask:

 a. Which is better, a paper or cloth towel? (Answer-A disposable paper towel is preferred since a cloth towel can carry germs.)

Step 7: When the volunteer turns off the water, observe whether she uses the paper towel to turn off the faucet and then throws it in the trash. If she turns off the faucet with her bare hands, ask:

 a. What could be improved in this hand-washing technique? (Answer-Thefaucet is covered with germs because you turned it on when your hands were dirty. Don't touch the dirty faucet with your clean hands. Leave the water running while you dry your hands and turn off the faucet with the paper towel. Then throw the paper towel away.)

b. What kind of trash can is best? (Answer-The trash can should be lined with a disposable plastic bag. Its cover should be tight fitting and operated with a foot pedal, so you don't have to touch the lid, which is full of germs.)

Step 8: Offer the volunteer some hand lotion and ask:

a. Why might it be helpful to use hand lotion? (Answer-If you wash your hands as often and thoroughly as recommended, they may get chapped Maintaining intact skin is important to prevent the spread of diseases.)

Step 9: Thank the volunteer for the demonstration. Distribute Handout

C: Hand Washing, to everyone.

Step 10: Ask participants:

a. What new things did you learn about hand washing?

b. What gets in the way of your following all the recommended steps in hand washing in Head Start?

c. What would make it easier for you to follow the recommendations for hand washing in Head Start?

d. What are some strategies for teaching children to wash their hands properly?

Points to Consider:

• Hand washing is the most important practice to prevent the spread of disease in Head Start.
• The most common problem in hand washing is contaminating your clean hands from the dirty faucets. To prevent this:
• Turn off the faucets with a paper towel.
• Clean and disinfect the faucets daily.
• When renovating or building child care facilities, consider installing sinks with faucets operated by elbow, knee, or foot pedals or by electronic sensors.
• There are many reasons why hand washing is not done properly in Head Start-being in a rush, not having accessible sinks, running out of soap or paper towels, not knowing the proper technique, and not understanding the importance of each step. Some strategies to improve hand washing include:
• displaying hand-washing posters throughout the center
• reviewing facilities to ensure access to sinks
• making sure supplies are stocked

having periodic monitoring and in-service training on hand washing techniques

Activity 2:
The Art of
Gloving

Purpose: This activity helps participants perfect their technique in using gloves.

For this activity, you will need:

• Latex or vinyl gloves for each participant and the trainer
• Red paint (water-based)
• Plastic bags
• Diaper wipe
• A copy of Handout D: Gloving, for each participant

Step 1: Explain that this exercise helps us learn the proper technique for using gloves.

Step 2: Review the importance of using gloves and when to use them (see Background Information).

Step 3: Tell participants to imagine that you are caring for a child who got a bloody nose on the playground. Put on the gloves. Cover your hands with red paint representing the blood and germs.

Step 4: Explain that the bleeding has stopped, and you are walking the child back to the classroom. Touch the door, another child, or your face,

• Ask: What is wrong with this? (Answer-Once the gloves are dirty, remove them and discard them promptly. Be careful that you don't contaminate yourself, objects or other people with the dirty gloves.)

Step 5: Say: Oh no, another child just skinned her knee! It's lucky that I still have my gloves on.

• Ask: What's wrong with this? (Answer-You must put on a fresh pair of gloves before each procedure. If you reusegloves, you spread germs from one child to another.)

Step 6: Say: There's really nothing to taking off gloves, right? Remove the gloves incorrectly, grabbing the gloves at the wrists, and getting paint on your hands.

• Ask: What's wrong with this? (Answer-If you remove gloves incorrectly, you contaminate your hands.)

Step 7: Slowly, demonstrate how to remove gloves correctly:

• Grab the first glove at the palm of the hand—only touch dirty surfaces to dirty surfaces.
• Grab the second glove underneath at the wrist—only touch clean surface to clean surfaces—and remove by turning it inside-out, with the dirty outer surface inward.
• Dispose of the dirty gloves immediately in a plastic bag or plastic-lined trash can.
• Wash your hands afterward.

Step 8: Distribute a pair of gloves and Handout D to each participant.

Step 9: Have participants pair up to practice putting on and removing the gloves correctly. Partners should observe and help each other.

Step 10: After a few minutes, offer them the chance to cover their gloves in paint and test their technique in removing the gloves. Give them a plastic bag to dispose of the gloves and diaper wipes to clean their hands.

Step 11: Ask:

• What did you learn from this activity?
• How can Head Start help staff use gloves correctly?

Points to Consider

Gloves are important to protect staff, children, and families from the spread of disease.

• Gloves provide protection only when used correctly. If you use gloves incorrectly, you actually risk spreading more germs than if you didn't use gloves at all.
• Using gloves might seem simple, but staff members need to learn and practice the proper technique. Don't develop carelessness or a false sense of security when using gloves.
• To use gloves at the proper times, we need to prepare in advance by making gloves accessible where they may be needed-the playground, first aid kit, diaper changing table, and with cleaning supplies. The closer at hand gloves are-in an apron pocket or a fanny pack-the more likely they are to be used.
• For special medical procedures such as tube feeding or tracheostomy care, be sure to wash your hands before putting on gloves to avoid spreading germs to the child.

 Activity 3:
Checking Up on
Infection Control

Purpose: This activity helps programs review their infection control practices, identify problems, and make plans for improvement.

This activity is particularly helpful for the management team, classroom teachers, aides, and food service workers. You will need:

• Copies of Handouts E:1-4: checklists on Hand Washing, Diapering, Cleaning and Disinfecting, and Food Handling, for each participant
• Pens/pencils

Step 1: Explain that there are many details involved in preventing the spread of germs. This activity helps assess infection control practices and identify how to do them better.

Step 2: Distribute Handouts E: 1-4. Have participants spend 3 0-40 minutes observing their program's infection control practices. Instruct them to complete the yes/no part of the checklist but leave the "Comments" section blank for now.

Step 3: Bring the participants back together. Have participants review their checklists. Congratulate them for each "Yes" item. For every "No" item, discuss:

a. Why is this practice important to prevent the spread of germs?

b. Is this a practice that you want to improve?

c. What can get in the way of doing this correctly?

d. What do you need to make the improvement? In the "Comments" section:

• List your suggestions for improvement (e.g., revising the policy, training other staff, posting instructions, getting supplies).
• What do you need to make the change?
• Who will take responsibility for the change?
• Set a timeline for making the changes.

Points to Consider:

• Following infection control practices routinely is crucial to preventing the spread of communicable diseases. Programs need complete and up-to-date infection control policies, staff training, and proper supplies and facilities.
• Programs should periodically monitor and improve their infection control practices.

 Activity 4:
Why Is
Everyone Sick?

Purpose: This activity helps participants identify practices that contribute to the spread of disease and develop strategies to reduce the spread of disease in Head Start.

This activity is particularly helpful for classroom staff, food service workers, and home visitors. You will need:

• Flip chart paper, marker
• Copies of Appendix handouts: Giardiasis, Pinworms, and of E: 1-4 checklists: Hand Washing, Diapering, Cleaning and Disinfecting, and Food Handling, for each participant
• A copy of Handout Fl -2: Why Is Everyone Sick? for each participant
• Key to Activity 4 (for trainer only)
• Pens/pencils

Step 1: Tell participants to imagine that they are each the new health coordinator for Germtown Head Start. In their orientation, the program director says:

"Whenever anyone in our parent-infant program gets sick, it just seems to go through the whole center. All the children get sick, and their siblings and parents catch it, too. Staff get sick and bring the illness home to their families. Once this year, we had to shut down the program because we didn't have enough staff.

"Most of the illnesses that go around are mild—colds, flu, vomiting, and diarrhea. But we've also had giardiasis and pinworms spread through the center.

"Can you help figure out why these diseases are spreading around and what we can do to keep everyone healthier?"

Step 2: Ask:

a. Are there any diseases mentioned that you need to know more about in order to solve this problem?

b. What resources would you use?

Step 3: Explain that you called your health consultant or local department of public health to discuss the situation, and they sent you information. Distribute handouts from the Appendix: Giardiasis, Pinworms; and handouts E: 1-4: Hand Washing, Diapering, Cleaning and Disinfecting, and Food Handling. Allow a few minutes for review.

Step 4: Ask: Now that you have some background information...

• What staff members would you want to talk with?
• What would you want to ask them?
• What would you want to observe at the program?

Step 5: Distribute Handouts F: 1-2: Why is Everyone Sick? Explain that page 1 is the report from the lead teacher, and page 2 has pictures of what the participants observe in the program.

Step 6: Allow 10-15 minutes to review the handouts. Using the checklists as guides:
 

• In the report, underline practices that spread disease.
• In the pictures, circle items that spread disease.
• In the checklists, check "No" where there are problems with infection control.

Step 8: Ask:

• What strategies would you discuss with the director to implement the changes needed? For example:
• What health policies need to be made?
• What staff training is needed?
• What education is needed for children and parents?
• What changes in the facility are needed?

• What resources would you draw on?

Step 9: Ask:

a. How would you phase in the changes over time?

b. How would you monitor the changes and the impact on disease in the program?

Step 10: Ask:

How can Head Start home visitors use this information when they visit families, observe the facilities and practices in the homes, and discuss health issues with parents?

Points to Consider:

• Communicable diseases spread in Head Start programs because of hygiene practices both in the centers and in homes.
• Program managers should discuss communicable diseases issues with each other, observe staff and parents' practices, and draw on the assistance of local health resources to identify practices that lead to the spread of disease.
• To implement effective infection control and reduce the spread of disease, programs may need to revise their health policies, conduct staff in-service training, provide education for children and parents, make changes in the facility, and do close monitoring and follow up.

Why Is Everyone Sick?                                                         Key to Activity 4
 

Practices That Spread Diseases	Recommendations
Changing diapers on floor where children play, eat, and sleep	Change diapers on elevated changing table near hand washing and away from food area
Not using fresh gloves for each diaper change	Use fresh gloves for each diaper change
Allowing children with diarrhea to attend	Don't let children with diarrhea attend
Disposing of dirty diapers/gloves in open trash can	Dispose of dirty diapers/gloves in plastic-lined, covered step can
Staff, parents, and children not washing hands after diaper changes	Rave staff, parents, and children wash hands after diapering
Leaving milk out on the counter	Refrigerate milk until ready to serve
Staff who change diapers also preparing food and bottles	Moid having people who change diapers prepare food and bottles
Not cleaning and disinfecting mouthed toys	Clean/disinfect mouthed toys
Using potty chair in play area	Have children use toilets in bathroom. Make bathroom/sink accessible
Not cleaning table before and after meals	Clean/disinfect tables before and after meals
Children, staff, and parents washing hands/face in the communal bowl	Have children, staff, and parents wash hands with soap/running water in sink
Children using common washcloth/towel	Use disposable paper towels for washing faces/drying hands
Saving leftover food for next meal	After meals, discard milk and uneaten food that is perishable or has been in a child's mouth or hands
Keeping children indoors all day	Open windows to increase ventilation indoors; increase outdoor play

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