Communicable Disease & Epidemiology

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Chickenpox


Infection Control

hand  HAND WASHING IS THE #1 WAY TO PREVENT THE SPREAD OF INFECTION.

Daycare centers provide a unique setting for the transmission of communicable diseases. Preschool aged children, who are susceptible to virtually every infection, congregate daily with their peers. Each child brings viruses, bacteria, and parasites from his or her own family to share. A child who is sick may infect adult workers and other children in the daycare setting. Children who get sick due to exposure in a childcare setting may in turn infect their own parents and siblings. Therefore, the need to develop and implement infection control guidelines to limit the spread of communicable disease in preschool and other childcare settings is crucial. The following information is provided to address a variety of diseases including respiratory, gastro-intestinal, parasitic, blood borne (and other body fluid) infections.

Sources of Infection

Communicable diseases are illnesses caused by germs, such as bacteria, viruses, or parasites and are spread by an infected person, animal or object to another person. In order to know how to prevent illness, it is important to know how disease is spread.

Fecal-Oral

Diseases spread by contact with human stool.
Examples include infections with giardia, rotavirus, hepatitis A, salmonella, norovirus (Norwalk-like virus) and campylobacter.

Airborne

Diseases spread by droplets from the nose, throat and mouth.
Examples include the common cold, chicken pox, influenza, measles and pertussis (whooping cough).

Body Fluids

Diseases spread by direct contact with body fluids, such as blood, urine, saliva or vomit.
Examples include hepatitis B, HIV and pinkeye.

Person-to-person Contact & Contact with Contaminated Items

Diseases spread by direct contact with infected skin or contact with contaminated objects such as toys, clothing, bedding etc.
Examples include ringworm, scabies and lice.

Infection Control Procedures

It is important to have written infection control procedures for staff to follow. Using proper procedures for handwashing, diaper changing and food preparation will minimize the spread of communicable disease.

Hand Washing
hand  HAND WASHING IS THE #1 WAY TO PREVENT THE SPREAD OF INFECTION.

Hand washing is the mechanical removal of infectious agents. Hand washing should be done using warm water and liquid soap. Rub hands together for at least 15 seconds making sure to scrub the backs of hands, wrists, between fingers and under fingernails. Rinse well under warm water and use a paper towel to dry your hands. Do not dry hands with a cloth towel as this may harbor bacteria. Use hand lotion to prevent drying and cracking of skin, where germs can hide.

It is important to wash your hands at the following times:
Before… After…
Starting work Eating or drinking
Preparing food Preparing food
Serving food Visiting the restroom
Eating Assisting a child in restroom
Dressing an injury Dressing an injury
Taking a medication Coughing or sneezing
  Wiping a child’s nose
  Changing diapers
Diaper Changing

The diaper changing area is one of the places where disease-causing germs are most likely to live and spread. Therefore it is important to use good infection control measures when performing this task. Hygienic precautions, especially hand washing and surface cleansing, should be meticulous during the changing and disposing of diapers. Disposable diapers are recommended. Hand washing facilities including clean towels must be available near the diaper changing area.

Disposable gloves may be used if so desired or available. The diaper changing area should never be located near a food preparation area and hand washing should never be done at the same sink used for food preparation.

Diaper changing procedure should include having the supplies readily accessible before starting the process. Place a disposable sheet (wax paper, paper bag, computer paper, etc.) on the changing table before placing the child on the surface. The disposable sheet will help prevent germs from contaminating the table. Remove the soiled diaper. (Soiled disposable diapers should be placed in a plastic bag or plastic lined receptacle. Soiled cloth diapers should be placed in a plastic bag and labeled for parents to take home with the child at the end of the day.) Wash the child’s hands. Disinfect the diaper changing station with sanitizing solution and then wash your hands.

Food Preparation

Sanitary conditions are important and should be stressed wherever food is prepared or eaten. Food preparation areas require sinks and towel supplies separate from the diaper changing facilities. Hands must be washed before food and formula preparation and before feeding an infant. Food should be refrigerated and any unused food or formula discarded within 24 hours. General sanitation rules include washing hands before preparing food. Wash and sanitize food contact surfaces (cutting boards, prep tables, utensils, etc.) between each use to prevent cross-contamination. Cross-contamination is the transfer of harmful organisms from one food product to another by means of a non-food surface such as utensils, equipment, dishes, cutting boards and human hands. Wash, rinse and sanitize dishes. This can be done in a 3-compartment sink or in a dishwasher. Wash hands frequently when preparing or serving food. Cuts and burns should be protected with a non-absorbent covering such as a glove or a finger cot.

Cleaning & Sanitizing

Cleaning is the removal of physical debris. Sanitizing is the killing of disease-causing organisms. Both are important in preventing illness. You should use an approved chemical sanitizer to kill bacteria. We recommend diluted bleach because it is readily available and inexpensive. Read and follow the instructions for diluting with water and contact time. Never mix bleach with cleaners containing ammonia; they combine to form harmful vapors.

Handling Body Fluids

Some germs are spread through body fluids. Intestinal tract infections are spread through the stool. Respiratory tract infections spread through coughs, sneeze and runny noses. Therefore, it is important to handle body fluids in a way which prevents the spread of illness. Individuals with an illness do not always show signs of sickness. Therefore, you should assume that all individuals are potential carriers of a communicable disease. Policies should be established for staff to follow to ensure that body fluids are handled in the most safe and sanitary fashion. Steps should be followed to prevent contact with and the spread of disease-causing organisms when cleaning up blood, vomit or other body fluids. These steps include wearing gloves and blot up the spill. Disinfect the area with a sanitizing solution of ¼ cup bleach to 1 gallon of water. Disinfect any items used during the sanitizing process (brushes, mops, pails etc.). Dispose of gloves and rags that were used and wash hands.

Environmental Cleaning

Individual bedding should be washed at least weekly. Other surfaces should be cleaned between use or daily, depending on the item. Carpets can be difficult to keep clean. Carpets that have been contaminated (eg. with vomit or urine) are considered high risk for transmitting germs even if they have been cleaned thoroughly, until they are completely dry.

When cleaning absorbent materials such as carpeting, rugs and sofas, first blot up the spill. Spray sanitizing shampoo on the surface. Use a brush to scrub the spill. Allow the shampoo to air dry and vacuum. Soak the brush in sanitizing solution and rinse with warm water. Another option would be to sprinkle sanitizing powder on the spill, let the powder dry and vacuum.

Toys & Play Equipment

In the child care setting, toys and play equipment may be shared by many children and the potential for transmitting infections is obvious. Toys are especially challenging because of the varying materials and textures involved. In general, soft, cuddly toys should be avoided because washing is more difficult. Infants may play with washable toys that are disinfected before and after use by another infant.

Cleaning non-absorbent toys:
When cleaning non-absorbent toys such as blocks or plastic toys, wash them with soap and water. Rinse in a dilute (1:10 to 1:100) bleach solution. Air dry.

Cleaning absorbent toys:
When cleaning absorbent toys such as stuffed animals or play clothes, wash them in a washing machine. Bleach should be used if possible. Air dry or machine dry.

Cleaning Bath toys:
Bath toys include any toy used in the bathtub that may hold stagnant water in it. When cleaning a bath toy squeeze out the water that may be inside the toys. The inside of the toys should be sanitized with the same solution that is used in the non-absorbent toys and the same procedure should be followed. These toys should be avoided if possible.

Recommendations for Personnel

All personnel working in the daycare setting should receive specific training and ongoing supervision regarding infection control. The following topics should be included in this training:

  • Disease transmission and prevention
  • Principles and practice of hygiene
    • Hand washing
    • Diapering changing
    • Food handling preparation, and feeding
    • Cleaning and sanitizing
  • First aid and cardiopulmonary resuscitation
  • Maintenance of daily records on each infant, based on information from staff and parents including immunization records and daily medication regime.

Staff who are sick with the following illness should not take care of infants:

  • Diarrhea and/or vomiting
  • Any vaccine preventable disease such as Measles, mumps, rubella or chickenpox
  • Contagious skin infections
  • Active pulmonary tuberculosis
  • Head colds and coughs
  • Cold sores on lips

Parental Advice

Infants at daycare centers are prone to more frequent illnesses than are infants cared for at home and older children.

Parents should have prearranged alternative plans for their children in the event of illness. Parents should not take their children to daycare if they are ill. They should always advise the daycare centers of the cause of any illness necessitating their child’s absence.

Parents should be aware that children, even in excellent daycare centers, will probably have more frequent colds and febrile (fever) illnesses, most of which will be minor. However, caregivers may have a difficult time distinguishing minor illness from serious febrile illness in infants less than 3 to 6 months old due to the inability to detect symptoms. Parents should ensure that their children are immunized at the appropriate age.

If you have questions regarding daycare information, contact the Communicable Disease Unit at (616) 632-7228.

When to Keep Your Child Home From School or Daycare

All children should be screened daily and excluded (kept home) from daycare when they have signs and symptoms of illness that may indicate infection. The following is a list of signs and symptoms that should serve as attendance exclusion criteria:

  • Fever, rectal (in infants) or oral temperature greater than 101 F or 38.3 C
  • Rash with fever
  • Diarrhea (loose stools that cannot be contained with a diaper)
  • Vomiting
  • Unusual tiredness
  • Poor feeding
  • Persistent crying or irritability
  • Breathing difficulties or persistent coughing
  • Yellow skin or eyes (jaundice)

When school/daycare staff notice any of the symptoms above, the parents should be contacted and medical attention sought.

Common Infections in Schools & Daycare centers

The following table summarizes common infections found in children. They include bacteria, viruses, and parasites. If your child has one of these infections, use this table as a guide for when to keep them home from daycare.

Glossary of terms used in table below:

Acute: the sudden onset or short initial period of an illness

Asymptomatic: no symptoms

Case: the person who is sick or infected

Contact: a person who has come in contact with the sick or infected case

Exclude: keep your child home

Incubation period: how soon the symptoms of an illness appear after being exposed to the infected person or material

Lesion: open area of the skin where germs and organisms can either enter or ooze out

Infection Modes of Transmission Incubation Period Case Contact
Campylobacter enteritis Contaminated food or water;
Undercooked chicken or pork;
Feces
 Usually 2 – 5 days, with a range of 1 – 10 days Exclude until 48 hours after treatment initiated or until asymptomatic, whichever is shorter. No exclusion required.
Chickenpox Infected lesions; Respiratory secretions; Airborne spread Usually 14 – 16 days with a range of 10 – 21 days Exclude until lesions are dry and crusted. Usually 5 days in unimmunized children or 1-4 days in previously immunized children. Exclude immunosupressed children during outbreak.
Conjunctivitis (pinkeye) Discharge from the eye; Respiratory secretions 24 – 72 hours Exclude until 24 hours after treatment initiated. No exclusion required.
E. coli 0157:H7 Feces;Contaminated food;Undercooked beef Usually 3 – 4 days with a range of 1 – 8 days Exclude until 2 successive negative stool samples, 48 hours after last dose of antimicrobials or until 10 days after symptoms end. No exclusion required unless symptomatic.
Fifth Disease Respiratory secretions Usually 4 – 14 days with a range of 4 – 21 days No exclusion required. No exclusion required.
German measles (Rubella) Respiratory secretions;Direct contact;Droplet spread Usually 14 – 17 days with a range of 12 – 23 days Exclude until 7 days after onset of rash. Those who are pregnant and not immunized should seek medical advice.
Giardia lamblia Feces;Contaminated food or water Usually 3 – 25 days or longer Exclude until asymptomatic. No exclusion required.
Haemophilus influenza Respiratory secretions Unknown, possibly 2 – 14 days Exclude during acute illness and until treated Seek physician’s advice concerning prophylaxis.
Hand-foot-mouth disease Feces;Respiratory secretions 3 – 6 days No exclusion required. No exclusion required.
Hepatitis A Feces Usually 25 –30 days with a range of 15 – 50 days Exclude until 7 days after onset of illness. Prophylaxis should be considered for staff and children.
Hepatitis B Primarily blood Usually 45 – 180 days with a range of 2 weeks to 6 –9 months. No exclusions required.If child has behavioral (eg. biting) or medical (eg. blood condition) risk factors, consult a physician. No exclusion required.
Herpes simplex virus Infected secretions 3 – 5 days Exclude until skin lesions are dry and crusted. No exclusion required.
Impetigo Lesion secretions Variable and indefinite, usually 4 – 10 days Exclude until 24 hours after treatment initiated. No exclusion required.
Influenza Respiratory secretions;Airborne spread 1 – 3 days Exclude until able to tolerate general activity. No exclusion required.
Lice Infested area Approximately 7 – 10 days after eggs hatch Exclude until treated. Examine for infestation and seek treatment if needed.
Measles Respiratory secretions Usually 10 – 12 days with a range of 7 – 21 days Exclude until 4 days after onset of rash. Exclude immediately if symptoms begin and consult a doctor.
Meningitis
Bacteria (Neisseria Meningitis, Streptococcus Pneumoniae) 		Respiratory secretions Usually 3 – 4 days with a range of 2 – 10 days Exclude during acute illness and until treated. Seek physician’s advice concerning prophylaxis. Dependent on type of Bacteria.
Meningitis
Viral (Aseptic) 		Varies Varies No exclusion required. No exclusion required.
Mononucleosis,infectious Saliva; Contaminated toys or objects Usually 30 – 50 days Exclude until able to tolerate general activity. No exclusion required.
Mumps Respiratory secretions;Airborne spread Usually 15 – 18 days with a range of 12 – 25 days Exclude until 9 days from onset of parotid gland swelling, less if swelling subsides. Susceptible contacts should seek physician’s advice.
Sore throat
Nonspecific 		Respiratory secretions 12 – 72 hours Exclude only if child has fever or is unable to participate in general activities. No exclusion required.
Sore throat
Streptococcal 		Respiratory secretions; Direct contact 1– 4 days Exclude until 24 hours after treatment is initiated No exclusion required.
Pinworms Feces; Contaminated objects, clothing, house dust, etc. 2 weeks – 2 months Exclude until treated No exclusion required.
Respiratory infections
(upper respiratory infections, colds, bronchitis) 		Respiratory secretions 12 – 72 hours Exclude only if child has fever or is unable to participate in general activities. No Exclusion required.
Roseola Probably respiratory secretions Usually 10 days with a range of 5 – 15 days Exclude until rash has disappeared. No exclusion required.
Rotavirus Feces; Respiratory secretions 24 – 72 hours Exclude until asymptomatic. No exclusion required.
Salmonellosis Feces;Contaminated food;Raw and undercooked eggs and egg products. Usually 12 – 36 hours with a range of 6 – 72 hours Exclude until diarrhea ceases No exclusions required unless symptomatic.
Scabies Infested areas 2 – 6 weeks; 1 – 4 days after reexposure. Exclude until 24 hours after treatment initiated. Direct inspection of body.
Scarlet fever Respiratory secretions 1 – 4 days Exclude until 24 hours after treatment initiated. No exclusion required.
Shigellosis Feces Usually 1 – 3 days with a range of 1 – 7 days Exclude until 2 negative successive stool samples or after completion of 5 days of antibiotics. Exclusion not required.
Tuberculosis Respiratory secretions; Airborne spread 2 – 10 weeks Exclude until physician advises return. Seek physician’s advice concerning prophylaxis.
Whooping cough (pertussis) Respiratory secretions Usually 7 – 10 days with a range of 6 – 21 days Exclude until 5 days after treatment initiated. Seek physician’s advice concerning prophylaxis.

References

Donowitz, Leigh G. (1999). Infection Control in the Child Care Center and Preschool (pp. 71-75). Pennsylvania: Lippincott Williams & Wilkins.

American Academy of Pediatrics. Pickering LK, ed. Red Book: 2003 Report of the Committee on Infectious Diseases. 26th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2003.

Head Lice

Michigan Head Lice Manual – The Michigan Department of Community Health (MDCH) and the Michigan Department of Education (MDE) jointly prepared this comprehensive guide to identify, treat, manage and prevent head lice infestations within school communities.