Communicable and Zoonotic Disease Control Safe & Effective Cleaning May 2010 Pacific NW Association of Independent S

1. Communicable and Zoonotic Disease Control Safe & Effective Cleaning May 2010 Pacific NW Association of Independent Schools

2. DOH School Environmental Health and Safety Program Provide technical support & training, develop resources Local Health Jurisdictions (LHJs) Schools: K – 12th grade IAQ Best Practices Manual Asthma Plan implementation - reducing triggers in schools Investigations “Green Cleaning” Rehab the Lab / Hazardous Chemicals Integrated Pest Management (IPM) Healthy High Performing Schools Work with organizations and agencies concerned with SEH&S Website and List Serve DOH Fall 2010 SHE&S Workshops - Free Nov. 2 – Dec. 2, 8:30-3:30 Dave Waddell – 12:30-3:30

3. Communicable (Infectious) Diseases In Schools

4. Infectious Diseases in the US • Every year, schools close due to infectious disease outbreaks • Infectious diseases are illnesses that are transmitted from one person to another via various routes • OSPI/DOH Infectious Disease Guide for School Staff, April 2004 http://www.k12.wa.us/healthservices/pubdocs/InfectiousDiseaseControlGuide3-11-04.pdf

5. Common Routes of Transmission • Person-to-Person • Contaminated surfaces • Foodborne • Waterborne

6. Infectious Diseases and Children • Children and youth are particularly efficient vectors for disease transmission. • Children have less developed immune systems than adults. • Children may not be fully immunized against vaccine-preventable diseases (or require boosters). • Schools tend to be densely packed environments. • School environments may not be routinely cleaned and disinfected in a manner that reduces possibilities for disease transmission (i.e. playgrounds).

7. Consequences of Infectious Diseases for Schools Students and staff may be affected by illnesses. If handled poorly, community trust in schools is shaken. Depending on the disease, may cause high rates of illness, potentially some deaths in the school community. Absences may cause schools to close for days or weeks – Continuity of Operations plans may need to be enacted.

8. Some Common Infectious Diseases That Affect Schools • Viral Infections • Gastroenteritis – Noroviruses • Influenza • Varicella (Chicken Pox) • Meningitis • Bacterial Infections • E. Coli • MRSA • Strep throat • Meningitis • Fungal Infections • Ringworm

9. MRSA Case • In Fall 2007, the death of a high school football player in Virginia focused the nation on MRSA in Schools • Within a month or two, several more MRSA outbreaks were reported across the nation, closing several schools and triggering cleaning efforts

10. MRSA (Methicillin-Resistant Staphylococcus aureus) • Type of “staph” infection • Often causes skin infections • Resistant to (not killed by) penicillin • Treatable with appropriate antibiotic • Lives on surfaces for days – at least 70!

11. MRSA in High School Athletic Facilities • Journal of EH, Jan/Feb 2010 • 10 high school athletic training facilities • 90% - 2 or more positive surfaces for MRSA • ~50% of surfaces tested positive • Water coolers – 80% • Treatment/taping tables – 70% • Sink faucet handles – 60% • Shower handles – 50% • Ice Machine – 30% • 9 high school wrestling facilities • Wrestling mats – 89% • Locker room benches – 78% • Treatment table – 56% • Doorknob – 44%

12. What does MRSA look like? • Spider bite • Turf burn • Impetigo • Boil • Abscess Source: LA County Health Department Source: Mark Grubb, MD Source: CDC Source: CDC Source: CDC

13. How is MRSA spread? • Skin to Skin Contact • Touching MRSA infected skin • Touching drainage from MRSA skin infection • Surface to Skin Contact • Sharing personal items (skin ointments, razors, bar soap, towels) • Touching unclean sports equipment (weights & benches) and practice surfaces (wrestling mats)

14. What increases the risk of MRSA infection? • Close skin contact w/ someone who has MRSA • Skin disease or injury • Lack of good hygiene • Sharing personal items • Sharing sports equipment • Overcrowded living conditions • Lack access to healthcare • Incorrect use or overuse of antibiotics

15. Controlling MRSA • Washing hands frequently!! • Do not touch other people’s skin lesions. • Report potential skin infections to the coach / nurse. • Use a towel between skin and gym equipment. • Do not share clothes, towels, water bottles, or personal hygiene items. No body cosmetic shaving. • Soap shower right after all practices and competitions. • Wash uniforms with soap/hot water, dry in a hot dryer after each use. • Use alcohol-based hand sanitizer when soap and water are not available.

16. Cleaning for MRSA • Athletic areas are critical, including PE. • Maintaining equipment in good repair. • Developing & following routine schedules for cleaning & disinfecting sports equipment. • Clean and disinfect all hard surfaces that may contact skin at least daily with an EPA-approved disinfectant, including benches, weights, workout machines, floor and wall mats, etc. Before and after use is preferred. • Clean locker rooms and shower areas daily. • Keep soap dispensers full – fragrance free, NOT antibiotic soap. • Have separate cleaning mops (preferably micro-fiber) and buckets for athletic areas.

17. MRSA Resources Tacoma-Pierce County Health Department www.tpchd.org/mrsa Washington State Department of Health http://www.doh.wa.gov/Topics/Antibiotics/MRSA.htm Centers for Disease Control and Prevention www.cdc.gov/ncidod/dhqp/ar_mrsa_ca.htm

18. Noroviruses • Noroviruses are a group of single-stranded RNA, nonenveloped viruses that cause acute gastroenteritis in humans. • CDC estimates that 50% of all foodborne outbreaks of gastroenteritis can be attributed to noroviruses • Noroviruses are transmitted through the fecal-oral route, by consumption of fecally contaminated food or water, direct person-to-person spread, or environmental and fomite contamination. • Quaternary compounds are NOT effective against Noroviruses

19. Norovirus • 24-48 hour incubation period • Sudden onset vomiting, diarrhea, cramping • Low-grade fever • Symptoms last 1-2 days • Viruses in stool and vomit • Can shed virus for days to 2 weeks after symptom free • Highly contagious (10 viruses can cause illness) • Lives for days on surfaces, where it can be “picked up” by others – at least 7!

20. Animals In Schools

21. ZoonoticDiseases • Salmonella • Reptiles • Chicks • Owl Pellets • Psittacosis (parrot fever) • Rabies • West Nile Virus • Hanta Virus • Lice • Classroom Pets • DOH Zoonotic Disease http://www.doh.wa.gov/ehp/ts/ZOO.HTM http://www.nasphv.org/documentsCompendiaAnimals.html

22. Guidelines for Animals in Schools • Health and Safety Guide K-12 Schools in Washington, Second Edition • Section O: Animals in Schools • Appendix F: Animals in the Classroom • NASPHV Compendium of Measures to Prevent Disease Associated with Animals in Public Settings, 2009 - • Appendix D: Guidelines for Animals in School and Childcare Settings • Animals are effective and valuable teaching aids, but safeguards are required to reduce the risk for infection and injury. • www.nasphv.org/Documents/AnimalsInPublicSettings.pdf

23. Public contact with animals should occur in settings where measures are in place to: • Reduce the potential for injuries • Reduce disease transmission • Increase the probability that incidents / problems identified with animal contact settings will be • 1) reported • 2) documented • 3) handled appropriately

24. Injuries • Injuries associated with animals in public settings: • Bites • Kicks • Falls • Scratches • Stings • Crushing of the hands or feet • Being pinned between the animal and a fixed object. • *Extreme example: a Kansas teenager was killed while posing for her senior year photo with a tiger being restrained by its handler at an • animal sanctuary

25. Health Risks Associated with Animal Contact • Enteric diseases • Allergies • Injuries • Rabies exposures • Infections

26. Classroom pets Animal visits Dissection owl pellets road kill Habitat projects reptiles amphibians fish What’s happening in class?

27. Classroom “dissections” Owlpellets Road Kill Where’s the gloves? Biohazard protections?

28. Playgroundvisitors

29. Chicks and Ducklings • Chicks and ducklings are inappropriate in schools due to high risk of salmonellosis and campylobacteriosis

30. Reptiles and Amphibians • All reptiles and amphibians can carry salmonella • Students under 12 should be prohibited from handling reptiles and amphibians • No turtles under 4 inches in length are allowed in schools • Discourage children from “kissing” or having them in close contact with their faces • Instruct any child handling them to wash their hands immediately afterwards

31. Parrots, Parakeets, Cockatiels, and MacawsPsittacosis (Parrot Fever) • Infection that can cause pneumonia and other serious health problems • Inhalation of dust from dried droppings andsecretions, and dust from feathers • Pet birds should never • Brought to school showing signs of illness • Be allowed to fly free in a classroom • Be handled by children • Their waste must be contained in their clean cages • Birds permanently housed on school property in cages should be treated prophylactically for psittacosis for 45 days prior to entering the premises.

32. School Guidelines PROPER HAND WASHING!! • Educate students of all ages in proper hand washing techniques after handling animals. • Have a school policy and procedures on animals.

33. Rabies • Contact with rabid mammals can expose persons to rabies virus through: • bites • contamination of mucous membranes • (splashes, rubbing eyes, etc.) • scratches, wounds contaminated with • infected saliva or nervous tissue. • * Note: • Although no human rabies deaths caused by animal contact in public exhibits have been recorded, multiple rabies exposures have occurred, requiring extensive public health investigation and medical follow-up ($$$$ and worry and pain – Montana elementary school and the dead bat.)

34. RabiesSchool Guidelines • Stray animals should never be brought onto school campuses because the health and vaccination status of these animals is seldom known. • Verified rabies vaccination is required for all dogs, cats, and ferrets which are brought onto school property for instructional purposes. • Puppies and kittens under 3 months and not vaccinated against rabies should not be handled by children or at school.

35. Bugs at School ? • Head lice • Stinging insects • Ticks • Poisonous spiders

36. Head Lice • Parasitic insect adapted to living mainly on the scalp and neck hairs. • Not a health hazard or responsible for the spread of any disease. • Not a sign of uncleanliness. • Transmitted by direct contact with live louse through head-to-head contact (mostly) or through contact with personal articles such as hats or combs. • “No Nit” policies – not recommended.

37. Stinging InsectsWasps and Hornets • Beneficial insects – eat insects that damage shade trees and crops and house flies • Nests can be in trees, on buildings or underground, depending on species • Attracted to sugary fluids & drinks (sodas) at picnics or in garbage cans

38. Ticks • Hard Ticks: Lyme Disease, Rocky Mountain Spotted Fever • Open forest, sagebrush, grasslands, woodland edges • Soft Ticks: Tick-borne relapsing fever – most common tick-borne disease in WA. • Avoid getting bitten • Wear long pants and a long-sleeved shirt. Tuck your pant legs into socks or boots and shirt into pants • Use tick repellent when necessary, and carefully follow instructions on the label • Buddy Checks

39. Spiders • Black Widow • Common in eastern WA, some on the western side. • Undisturbed piles of wood, outbuildings, • rock piles, hay bales, crawl spaces. • Shy, bite reluctantly – usually when provoked. • Hobo Spider • Mature spiders common from mid-summer • through fall • Uncommon above basements or ground level • Build funnel-shaped webs in dark, moist areas, • wood piles, crawl spaces, perimeters of homes • Bite • Painless • Blister in 15-35 hours • Tissue necrosis • Seek medical care

40. West Nile Virus

41. Mosquito Control Eliminate mosquito larval habitats • For lined or contained water bodies • Remove or circulate the water • Larvae eating fish • Mosquito “dunks” or “bits” – larvicide Bacillus thuringiensis israelensis (Bti) – follow directions • For water bodies that can reach other water bodies • Retention pond with outlet, ditches, pond with stream • Licensed pesticide applicator needed to apply larvicides • May need an NPDES permit • Contact DOH Zoonotic Disease Program at (360) 236-3385 or zd@doh.wa.gov for more information

42. Eliminate Standing Water

43. Online Dead Bird Reporting System • Report any dead crows, jays, or raptors to the WA DOH’s online dead bird reporting website http://www.doh.wa.gov/ehp/ts/Zoo/WNV/reportdeadbird.html

44. Hanta Virus • Sin Nombre virus, Hantavirus Pulmonary Syndrome • Deer mice in North America • WA ST: ~14% of 1,100 tested deer mice • ~6 inches nose to tail, grayish to light brown on top • Large ears, white belly, furry tail • Virus in urine, saliva, droppings • Exposure through inhaling contaminated dust, droppings, dried urine • Pets, snakes, predators not infected, can’t spread • No evidence for person-to-person spread • Average 1-5 cases/year in WA ST • Suspect all rodent contaminated areas

45. Cleaning up Rodent Infested Areas • Wear rubber, latex, vinyl, or nitrile gloves. • Do not stir up dust by vacuuming, sweeping, etc. • Thoroughly wet contaminated areas with 10% bleach. • Soak for 10 minutes, remove soaked materials. • Mop/sponge area with bleach solution. • Steam clean/shampoo upholstered materials/carpet. • Soak dead rodents with bleach solution, double bag with all cleaning materials, dispose. • Clean/Disinfect gloves before removal. • Wash hands thoroughly after removing gloves.

46. Safe And Effective Cleaning

47. Why consider “green cleaning”? • Better for student health • Better for custodial health • Better for the environment • “Green” products “reduce the health and environmental impacts compared to similar products and services used for the same purpose.” Executive Order 13423

48. Asthma & respiratory ailments Quats Bleach Fragrances Eye, nose, throat, and skin irritation Fatigue Reproductive disorders Burns Major organ damage Cancer Dizziness/Headaches Hazardous for Human Health

49. Cleaning Supplies Study • 13 large CA school districts • “Airborne brew of chemicals” • 21 cleaners tested – released • 6 chemicals known to cause asthma • 11 contaminants known, probable, or possible cancer-causing in humans • hundreds of compounds with little or no hazard information • Green cleaners released a lower overall number of measurable air contaminants, particularly lower levels of VOCs • Environmental Working Group, School Cleaning Supplies, November 2009 http://www.ewg.org/files/2009/10/school-cleaners/EWGschoolcleaningsupplies.pdf

50. Elements of a Cleaning Program • Understand the unique requirements of your buildings. • Continuously examine the entire cleaning process and identifying areas needing improvement. • Program should be designed to have a positive impact on cleanliness and the health and performance of occupants.