Standard/Universal Precautions for Child Care Providers Holly Clendenin, RN, CCHC State Trainer

1. Standard/Universal Precautions for Child Care Providers Holly Clendenin, RN, CCHC State Trainer

2. What are Standard Precautions? Standard precautions include general methods of infection prevention for both children and adults in the early education and child care setting.

3. Why are Standard Precautions needed in the child care setting? Standard precautions reduce the risk of spreading germs (bacteria and viruses) that can cause infection, even when those spreading the micro-organisms do not appear to be ill.

4. How are infections spread? 1. Airborne or respiratory route 2 .Direct contact route 3. Fecal-oral route 4. Blood contact route

5. Germs are spread by droplets through Nose Mouth Sinuses Throat Lungs Contaminated tissues Examples: TB, Colds, flu, Strep Throat Chicken Pox, Measles Airborne or respiratory route

6. Direct contact route • Germs are spread by directly touching an infected area or body fluid such as Saliva Mucous Eye drainage Pus or discharge from a sore Examples: Conjunctivitis (pink eye), impetigo, Strep throat MRSA, chicken pox, Meningitis

7. Fecal- Oral Route • Germs are transferred from stool to host by Hands Food Mouthed toys Toilet Diapers Examples: Hand foot and mouth disease, rotavirus, Hepatitis A, Shigella, Salmonella, Giardia, Meningitis,

8. Hepatitis A (HAV) • Spread by fecal- oral route • A viral infection causing liver inflammation • An acute , usually self limiting illness

9. Hepatitis A Symptoms • Children younger than 6, usually have few or no symptoms • Older children and adults can have fever, jaundice, abdominal discomfort and occasional diarrhea, fatigue, dark brown urine, loss of appetite and nausea

10. Hepatitis A How is it controlled? • A Hepatitis A vaccination is recommended for all children 12 months and older( two doses; an initial dose and a 2nd dose 6-18 month later) • In an outbreak situation, vaccination for those not previously immunized is recommended. Occasionally immune globulin shots are suggested for contacts • Report to local health department within 24 hours

11. Hepatitis A What can you do to prevent ? • Wash your hands especially after diapering or taking children to the bathroom • Wash children’s hands and yours before eating or preparing food • Clean and sanitize surfaces (with bleach solutions) in all areas

12. Blood contact route • Transmission can occur when a person comes in contact with Blood or body fluid containing blood EXAMPLES: Hepatitis B Hepatitis C Hepatitis D HIV/AIDS

13. How are blood borne infections spread in child care? • Bleeding injuries • Bloody nose • Biting • Open draining sore • Loose tooth (bleeding) • Changing band-aids or dressings • Any task that involves visible blood • Performing CPR

14. Hepatitis B (HBV) • A viral infection causing liver inflammation that can lead to serious illness, lifelong infections, liver disease and liver cancer • It is blood borne infection • Most people recover fully, but some carry the virus for a lifetime

15. Hepatitis BSymptoms • Young children may show few or no symptoms • Flu-like symptoms such as headache, muscle aches, loss of appetite, nausea and vomiting, • Weakness and fatigue • Joint pain • Jaundice -yellowing of skin and whites of eyes, dark urine

16. Hepatitis BHow is it spread? • Blood or body fluids containing blood • Sharing any equipment to inject drugs • Sexual contact • Tattooing or body piercing • Contact with open sores • Children born to infected mothers

17. Hepatitis B How is it controlled? • It is a vaccine-preventable disease. Infants should receive vaccine at or soon after birth, with additional doses of the vaccine according to the routine immunization schedule • Cover open wounds or sores • Do not permit sharing of pacifiers or toothbrushes • Observe standard precautions • Report the infection to the local health department within 1 business day

18. Hepatitis C (HCV)How is it spread? • Blood or body fluids containing blood • Sharing any equipment to inject drugs • Tattooing or body piercing • Sexual exposure-can occur but less likely • Infected during childbirth –this is rare

19. Hepatitis CSymptoms Young children infected with Hepatitis C would most likely not have symptoms. Only 20% of adults have symptoms when first infected. Symptoms may include • Jaundice • Fatigue • Abdominal pain

20. Hepatitis C is Not spread by • Sneezing • Hugging • Kissing • Coughing • Food or water • Sharing eating utensils or • Drinking glasses or casual contact

21. Hepatitis CHow is it controlled? • There is no vaccine to protect against Hepatitis C • People with Hepatitis C should be vaccinated against Hepatitis A and all children should be vaccinated against Hepatitis B • Report to local health department within 5 business days

22. Hepatitis D (HDV) • Also transmitted through the blood, but only occurs in those previously infected with Hepatitis B • It can be a more severe disease • Managed just like Hepatitis B • No vaccine available for Hepatitis D

23. HIV/AIDS Caused by a virus (HIV) that affects the body and in the most severe infections, progressively destroys the immune system, causing a condition called (AIDS)

24. HIV/AIDSHow is it spread? • Contact of mucous membranes or openings in the skin with infected blood or body fluids that contain blood, semen, and cervical secretions. • Sexual contact • Contaminated needles or sharp instruments • Women infected with HIV can pass the virus to their unborn child. As the virus can be transmitted through breastfeeding, breastfeeding is NOT recommended for infants of infected mothers • Blood-to blood transmission when the infected blood enters the blood stream by blood transfusion, breaks in the skin, mucous, or needle sticks

25. HIV/AIDSSymptoms in children • Failure to grow and develop well • Enlarged lymph nodes • Swelling of salivary glands • Enlargement of liver and spleen • Frequent infections including pneumonia, diarrhea, and thrush • Inflammation of heart, salivary glands, and liver kidneys • Tumors

26. HIV/AIDSCan it be spread in child care? HIV is not spread by the type of contact that occurs in child care and school settings, such as a typical classroom activities, or with surfaces touched by infected people. It is not spread through non-bloody saliva, tears, stool or urine.

27. HIV/AIDSHow is it controlled? Standard/Universal should be followed when blood or body fluids containing blood are handled.

28. HIV/AIDS Parent/ guardians do not have to share information about HIV status of their children. If they do disclose information about their children, this information is not to be disclosed to staff without written permission of the parents.

29. HIV/AIDS • Report to local health Department in 5 business days • All cases of HIV infections/AIDS are reportable to a separate surveillance system in accordance with KRS 211.180(1)b. To report a HIV/AIDS case call 866-510-0008

30. When do you report a disease in child care? The caregiver/teacher should contact the local health department • When a child or staff member who is in contact with others has a reportable disease • If a reportable illness occurs among staff, children or families involved with the program • For assistance in managing a suspected outbreak

31. How do you report a disease? • 902 KAR 2:020 requires health professionals to report the following diseases found at www.Ky.gov (reportable disease) to the local health departments serving the jurisdiction in which the patient resides or to the Kentucky Department for Public Health (KDPH). • Contact your local health department to report an illness. They along with the child’s heath care professional will review the need for using vaccine or immune globulin for contacts in the child care facility and family members. • Lexington-Fayette County Health Department Epidemiology Department 859-899-4238

32. Parent notification • Notify parents that their child has been exposed to the following diseases or conditions

33. Cleaning up blood and body fluids containing blood • Wear disposable gloves on clean hands • Wear eye protection. Gowns and masks are not required in the child care setting • Absorb as much of the spill as you can with paper towels; put the contaminated towels in a plastic bag with a secure tie • Clean contaminated surfaces with soap solution ¼ cup detergent to 1 gallon water and rinse with clean water • Sanitize the clean surface by wetting the entire surface with a spray application of freshly mixed ¼-3/4 cup bleach to 1 gallon water or 1-3T of bleach to 1 quart of water • Leave on surface for at least 2 minutes

34. Cleaning up blood and body fluids containing blood continued • Dispose of all soiled items in plastic bags with secure ties • Soiled clothing should be placed in a plastic bag and sent home with child • If floors, rugs, carpets are contaminated, additional cleaning by shampooing or steam cleaning may be necessary • Mops used to clean up body fluids should be cleaned, rinsed with a disinfecting solution and wrung out and hung up to dry

35. Wear disposable gloves See CCHC gloving poster

36. Gloves • In each classroom • At diaper changing area • With first aid supplies • On transportation vehicles • Latex free gloves are preferred • Wash hands after discarding gloves

37. Wear Eye protection For spills of blood, care should taken and eye protection used to avoid splashing any contaminated materials into mucous membranes (eye, nose, mouth)

38. Cleaning, rinsing and sanitizing CCHC poster

39. Hand Washing See CCHC Hand Washing Poster

40. Make a plan All child care providers should have a written policy regarding Standard Precautions and provide training for all staff. For a sample policy for Standard Precautions download the CCHC policy on Standard precautions from the CCHC website. www.kentucky cchc.org

41. Resources • APHA & AAP (American Public Health Association & American Academy of Pediatrics) 2011.Caring for our children-National health and safety performance: Guidelines for out-of-home child care programs. 3rd edition Washington DC: APHA. • Caring for our children-National health and safety performance: Guidelines for out-of-home child care programs. 3rd edition Washington DC: APHA. • Hennepin County Community Health Department. 2003. Infectious Disease in Childcare Settings and Schools. 5th Edition. • Virginia Department of Health training on Standard and Universal Precautions and Bloodborne Pathogens in Child Care • Child Care Health Consultation website www.kentuckycchc.org

42. Thanks!