PUBH 4103 Module 5 Daycares PDF

PUBH 4103 Module 5 Daycares Daycares a) formal programs - established locations, usually relatively large, usually licensed, may be subsidized, full day and part day programs (include nursery schools) b) family programs - informal, may be licensed (sometimes not), small scale operations c) si...

PUBH 4103 Module 5 Daycares Daycares a) formal programs - established locations, usually relatively large, usually licensed, may be subsidized, full day and part day programs (include nursery schools) b) family programs - informal, may be licensed (sometimes not), small scale operations c) sick child care - only look after sick children - very expensive  Day Care Regulations (Day Care Act) Section 28 (3) states that: A licensee must follow Provincial guidelines for promoting and maintaining health and safety and preventing and controlling CD’s (4) states the requirements are met for: Clean and sanitary conditions Suitable ventilation and free from odours Hand washing Toys, mats, highchairs, cribs etc. are sanitized Daily checks for hazards First aid kits Etc. Daycare Collaboration EHO’s/PHI’s Licensing officers May be from another department Depending on province PH nurses MOH Fire, Accessibility, Role of PHI/EHO Food facility Play rooms Outdoor play areas Bathroom facilities Hot water temperature Handwashing Diaper changing area Environmental Factors Environmental Cleaning Hazard: Shared equipment (playpen, diaper change tables etc.) Routine daily cleaning of shared equipment, disinfection. Increases when someone is sick. Change tables washed, sanitized between uses Hazard: Carpet (kids spend a lot of time next to the floor) Carpet hard to clean, vacuums sometimes recirculate dirt Vacuum with exhaust to outside (not near fresh air intakes) Should steam clean regularly  Environmental Factors Food Preparation Hazard: Food Borne Disease (Salmonella, E. coli, Campylobacter) Follow safe food handling as per regulations, codes etc. Encourage staff to report outbreaks of FBI Encourage proper hand hygiene Hazard: inappropriate sanitizing of shared cups/utensils In order to sanitize appropriately, must meet temperature recommendations or chemical concentration recommendations (mechanical or manual)  Environmental Factors General Sanitation Hazard: inadequate hand washing facilities in kitchen area Requires separate sink Shared cloth towels Use paper towels Poorly planned diaper change areas Located next to sink Storage area provided near table for supplies Diapers Disposable Cloth diapers Environmental Factors Hazard: malfunctioning toilets Fix immediately Hazard: inadequate air exchanges Should meet local codes and enable a clean environment for staff and children  Environmental Factors Sharing personal items Hazard: sharing cots, mats, toothbrushes Don’t share, separate for each child and label Recreational areas Hazard: wading pools Clean and dry daily, new water everyday Hazard: sand boxes (outdoor) Cover and inspect Hazard: mud play Clean mud? Cleaning afterwards Benefits Environmental Factors Water temperature (max 43C) Hazard: scalding 60C burns skin in 5 seconds, 70C in 1 second Ensure thermostat for water set accordingly Animals Hazard: rabies, salmonella Small animals Talcum powder Hazard: inhalation from exposure/spills, can lead to respiratory issues Safety Hazard: balloons are largest cause of non-food choking Exclude, when serving hotdogs/grapes slice lengthwise Hazard: play spaces (playgrounds, chains on swings) – CSA standards Other safety issues Toys – small parts Scarves, strings on hood may cause strangulation hazard Railings Electric shock Falling Drowning Transportation Storage of hazardous materials  Diaper Changing Area used only for purpose Materials should be smooth, non-absorbent and easily cleanable Raised edge to prevent any falls (or roll-offs) Next to sink, accessible to staff not children Clean and disinfect after each use (soap and water, rinse with water, use a disinfection solution (according to manufacturer’s instructions) Giardia and Cryptosporidium Procedure for diapering a child 1. Organize supplies (within reach – diaper and clothes, wipes, ointment, trash bag) 2. Place disposable covering on diapering table 3. Gloves, pick up child and lay on table 4. Remove soiled diaper and clothes 5. Dispose of soiled materials of in plastic-lined trash can or put in bag for parents (re-useable). Depends on how dirty the child is. 6. Dispose of cover on diapering table Procedure… 7. Remove gloves and throw out 8. Diaper and dress the child 9. Wash your hands and the baby’s hands under running water 10. Return child to activity area 11. Wash and disinfect diapering surface 12. Wash hands again  Diarrheal Outbreak most common condition next to upper respiratory infection hand washing most effective means of preventing diarrhea - staff and children water play areas and wet sand tables - curtail activities during outbreak no play dough during outbreak - wading pools discouraged disinfect all toys /equipment consider using single service dishes don’t rinse or handle cloth diapers Policies designed to reduce risk o Employees o Pre-employment screening/history (vaccines, etc.) o guidelines for work - suffer from diarrhea - don’t work with kids o employee education o Children o screening to find out who would be at risk (vaccines, disease history) o guidelines for exclusion o keep record of illness o Separate diapered Prominent in Daycares Conjunctivitis – direct contact Exclude/cohort, medical evaluations, water others, notify families, enforce handwashing, avoid sharing towels Giardiasis – fecal/oral, person to person, enabled by vehicles (food/water) Notify MOH, exclude/cohort, treat symptoms, notify families Herpes simplex (cold sores) – Direct Prevent contact with very young, hand washing, discourage kissing and cup sharing …Daycares Influenza – direct contact with droplet aerosol Exclude when febrile, vaccinate, notify MOH and families Reye’s syndrome – associated with ASA (i.e. aspirin) (children, teens recovering from viral infection) Confusion, seizures, loss of consciousness, swelling of the liver and brain …Daycares Streptococcal infection (Strep Throat) Direct contact with respiratory secretions Exclude until 24 hours after antibiotic treatment, enforce hygiene practices, notify MOH and families Varicella (Chicken pox) – direct contact and droplet aerosols Vaccinate, exclude until lesions are dry, notify MOH, families and exclude immunocompromised childre Schools Schools Issues often found at schools Lice Bedbugs Scabies Meningococcal disease Norovirus influenza Bedbugs Not a health hazard Nuisance but may cause secondary skin infections/allergic reactions Stress, anxiety, loss of sleep and spend a lot of money in order to rid themselves of bedbugs Requires double spray, once for the adults and because the eggs are resistant to the spray, you wait until the eggs hatch and respray Dogs that can be trained in order to find Lice Head lice Infestation – pediculosis Close person-person contact Nuisance, may cause irritation that leads to infection Body lice live and lay eggs on clothing and only move to the skin to feed and known to cause disease Attention to hygiene and regular cleaning of clothes is the effective treatment for such infestations Pubic Lice (crab – claws and body shape) Smallest of the lice, can be attached to any coarse hair Treatments are available Scabies Caused by Sarcoptes scabiei (burrowing mite) leads to itching Contagious and transmission is through close physical contact (sexually transmitted too) Can be killed with treatments but may experience itching for weeks Secondary skin infections Meningitis Bacterial Meningococcal meningitis Hemophilus meningitis Pneumococcal meningitis Neonatal meningitis Viral Caused by different organisms Inflammation of the meninges Meningococcemia Caused by Neisseria meningitidis bacteria 5-10% of the population are asymptomatic carriers Spread person to person and through droplets Fever, headache, muscle pain, nausea, rash with red or purple spots (occasionally) increases to unconsciousness, bleeding under the skin and shock Vaccinations are available Hemophilus meningitis Hemophilus influenzae Serotypes a-f and b is the most pathogenic Hib can also present as lower respiratory infection Fever, vomiting, stiff neck Immunizations available Pneumococcal meningitis Streptococcus pneumoniae High fatality rate Sudden, high fever, coma Pneumococci are found in upper respiratory tract of healthy people Children are more often carriers than adults Neonatal meningitis Seizures, poor feeding, respiratory distress first 28 days of life Caused by bacteria, viruses and fungi Group B streptococci E. coli Listeriosis Organisms acquired from the birth canal Septicemia may occur Viral meningitis Fever, rash, lasting around 10 days Symptoms can last up to a year Weakness, insomnia, personality changes Enteroviruses, measles, herpes simplex, varicella and leptospirosis (bacterial disease – causes aseptic meningitis) Public Health prevention would depend on the organism Influenza Influenza Influenza A and B Spread through sneezing, coughing, talking and you can become infected if the droplets land on your mouth, eyes or nose or by fomites Symptoms include high fever, cough, muscle aches, headache, chills, sore throat, diarrhea, vomiting A cold is different with symptoms like runny nose, sneezing, cough, sore throat Influenza Usually occurs during winter months where people are inside more often (helps with the spread) Crowded conditions, large group events or travelling on cruise ships increases the risk of becoming ill Vaccination helps to protect you if you are exposed to the virus, helps protect other people (6 months or younger cannot get vaccine) Influenza Vaccinations usually have both strands in order to protect a person Type of virus changes from year to year Immunocompromised, very young and very old are most at risk To prevent, wash your hands, cough and sneeze into arm, avoid touching face, clean/disinfect objects regularly, physical activity, plenty of rest and eating foods that are good for you Long Term Care Facilities Long Term Care Facilities Risks include: Nosocomial infections BBP’s (blood borne pathogens) STI/STD’s FBI’s (food borne illnesses) Patient-patient transmission Staff-patient and vice versa IAQ Inadequate hygiene procedures (cleaning, disinfecting, hand washing) Inadequate facilities  Food Borne Illnesses Critical in every establishment, the majority of FBI’s are discussed in other courses such as Food Hygiene, Food Quality and Food Borne Diseases. Due to the population they serve, LTCF’s are usually ranked medium to high risk Number of people Immunocompromised Types of food being prepared Transportation of food (sometimes from other sites) Cleaning requirements Facility ALL play a role in CD transmission Illnesses of interest Norovirus Salmonella Campylobacter E. coli Giardia and Cryptosporidium (water) Respiratory infections Nosocomial infections Inspection Food Facility as per regulations There are various standards and codes in relation to size of each persons room, common living areas, bathroom requirements etc. This is to ensure appropriate amount of living space for each resident of the facility Ventilation maintenance and upkeep necessary Allow for easy cleaning and maintenance of the facility To help prevent the spread of CD’s Inspection Logs of any activities taking place that has an impact on air quality (when was the last time they cleaned their system?) Logs of any Pest Control Maintenance that has occurred Records of past outbreaks, ongoing outbreaks or general health related information about the facility Records of cleaning duties, activities etc. If something is lacking, there should be a paper trail to show you where something was missed Maybe they do not have paperwork which signals another issue (lack of SOP’s, Cleaning duties etc.) Inspection Talk to employees as you go through and ask them questions! Do they know how to disinfect a therapy tub effectively? Do they clean it out efficiently after each use or on a regular basis? What are there cleaning practices for a specific task…do they know which chemical they are using and about MSDS’s? specific instructions on bottles should be followed to ensure efficacy  Inspection General cleanliness of the facility Look under shelves and in corners to see if they do put in effort to clean all areas Common washrooms – do they have personal items? Infection prevention control No sharing of personal items should be allowed Personal washrooms – are they cleaned on a regular basis? Resident rooms State of the facility (leaks? Missing floor pieces? Obvious issues that may lead to infestation, mould, CD transmission) Inspection You are there to work with them to ensure the health and safety of the residents Education will play a giant role in your duties, and while LTCF’s usually have people trained to know specific duties and tasks required to minimize illness or transmission of illness, and they are very knowledgeable, it just takes a bit of a conversation to know if you can be of assistance in order to increase awareness around CD control Outbreaks usually handled in the same way as an acute care facility, discussed in CDC part 1