Keeping Childcare Centers Healthy and Happy!

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Keeping Childcare Centers Healthy and Happy!
Funding for this project is provided by theU.S.
Centers for Disease Control and Prevention (CDC).
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Learning Objectives

• Describe childhood respiratory infections,
  appropriate antibiotic use and antibiotic
  resistance
• Identify when kids should be excluded from
  childcare
• Discuss common diseases found in childcares and
  when to call the local health department

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Learning objectives (cont.)

• Describe steps that need to be taken when a child
  is sick
• Explain the importance of immunizations

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Childhood respiratory Illnesses and the
importance of appropriate antibiotic use
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Respiratory Infections in Child Care

• Infants and toddlers in child care have 6-10
  respiratory infections per year
• Most frequent cause of absence from child care

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Children and the Common Cold

• Children get 3-8 colds per year, more than 10
  if attending child care
• A typical cold lasts 10-14 days
• Normal cold symptoms
• Clear, green, or yellow runny nose
• Sore throat
• Cough
• Fever

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Causes of Respiratory Infections in Children

• Colds, flu, bronchitis and most sore throats
  are caused by
• VIRUSES
• Strep throat is caused by
• BACTERIA
• Ear infections and sinus infections are caused
  by .
• BACTERIA or VIRUSES

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When Are Antibiotics Needed?
Colds and flu Bronchitis/cough
Most sore throats Viral Infections
Antibiotics DO NOTHING !
Strep throat Bacterial Infection

YES
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When Are Antibiotics Needed?

• Ear infections
• Sinus infections
• Viral OR Bacterial
• Infection

SOMETIMES
Antibiotics WILL NOT work when viruses are the
cause of these infections!!
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What Are Antibiotic-Resistant Bacteria?

• When bacteria are overexposed to antibiotics...
• Bacteria can mutate and become resistant to
  antibiotics.

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Rising Rate of Serious Infections Resistant to
Antibiotics
28
24
21
14
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Bloodstream and other infections caused by
Streptococcus pneumoniae
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Penicillin Resistance Rates in TN1995-2001
48
39
38
Average Percentage
28
27
National/County
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Resistance and Antibiotic Prescribing

• Risk factors for resistant bacteria
• young age (lt 1 year)
• higher socioeconomic status
• day-care attendance
• recent receipt of antibiotics (2-5 times greater
  risk)

Pediatrics 199392761-7.
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What Causes This Problem?

• Antibiotics are prescribed for the wrong reasons!

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Children Often Get Antibiotics for Colds and
Coughs
44
75
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Unnecessary Antibiotic Prescriptions

• For colds 18.0 million
• For coughs 13.0 million
• For fluid in the ear 7.0 million
• For non-strep sore throats 6.5 million
• For green runny noses 6.5
  million
• TOTAL 50 million!!

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What Does This Mean?

• Stronger antibiotics are needed to treat common
  infections
• Some bacteria are now resistant to almost all
  antibiotics
• Serious infections may become untreatable in the
  future
• Antibiotic-resistant bacteria can be spread from
  person to person

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Some Parents/Patients Say ...

• I cant take any more time off from work.
• The doctor gave my child an antibiotic the last
  time he had this problem.
• Lets try an antibiotic so she doesnt get sick
  later.

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Some Doctors Say ...

• Parents are demanding antibiotics.
• I want my patients to be satisfied with their
  medical care.
• Its faster to write a prescription than to
  explain why it isnt needed.

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Some Child Care Providers Say ...

• I cant have sick kids at my child care.
• How do I keep the parents pleased?
• How do I know if its just the sniffles or
  something more serious?

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What Can We Do to Prevent Antibiotic Resistance?

• Let the doctor decide if an antibiotic is needed
• Share information about antibiotic resistance
  with the childrens parents
• Practice good hygiene

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When should children be excluded from childcare?
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Children Must Be Excluded For
Fever
With sore throat, rash, vomiting, diarrhea,
earache, irritability or confusion
Diarrhea
Vomiting
Runny, watery or bloody stool--3 episodes in a
24-hour period
Two or more episodes in a 24-hour period

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Children Must Be Excluded For
Severe Coughing
Red or blue in the face, or high-pitched whooping
sounds
Yellowish Skin or Eyes



Eye Discharge
Possible hepatitis
Yellow or white pus draining from eye
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When Can Children Return to Child Care?

• Follow the states exclusion guidelines
• For some cases of diarrhea, stool culture
  should be negative
• Antibiotics for certain illnesses -- ex. strep
  throat, impetigo

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Communicable Diseases and Infection Control in
Child Care Settings
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When to call your local heath department?
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Contact your local health department if a child
or staff member has

• Shigellosis
• Salmonella
• Rubella
• Pertussis
• Mumps
• Measles
• Hepatitis A

• Foodborne illness
• E. coli
• Diptheria
• Cryptosporidiosis
• Chickenpox
• Campylobacter
• Meningitis

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Shigellosis

• Cause and symptoms
• Diarrheal illness caused by bacteria
• Spread by fecal-oral route
• Symptoms may be mild or severe
• diarrhea - sometimes bloody
• fever
• abdominal cramping
• vomiting

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What should you do if your center has a case of
Shigellosis?

• Contact your local health department
• Exclude the child until diarrhea resolves and 2
  successive stool cultures are negative
• Careful handwashing and disinfect center
• Notify parents

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Chickenpox

• Cause and symptoms
• Varicella zoster virus
• Varicella vaccine is available
• Can be harmful to children with
• weakened immune systems and
• pregnant women
• Aspirin should not be given

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What should you do if your center has a case of
chickenpox?

• Exclude the sick child until all lesions have
  dried and formed scabs
• Notify staff and parents
• Contact your local health department for
  additional preventive measures

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Bacterial Meningitis

• Cause
• serious bacterial infection
• most commonly caused by
• Neisseria meningitidis
• Streptococcus pneumoniae
• Haemophilus influenzae
• Transmitted through close contact

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Bacterial Meningitis

• Symptoms
• fever
• headache
• neck pain or stiffness
• vomiting
• irritability

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What should you do if your center has a case of
bacterial meningitis?

• Contact childs MD to verify type of
  meningitis
• If H. flu is involved review immunization
  records
• Contact your local health department
• Notify all parents and staff
• Closely observe all children and staff
• Exclude until MD release

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Viral Meningitis

• Most cases are viral
• Same symptoms.less severe
• No particular exclusion policy. MD advises when
  child can return to child care setting.

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Pinkeye

• Causes
• bacterial, viral, or allergies
• Symptoms
• red, burning or itching eyes
• white, yellow, clear, or watery

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What should you do if your center has a case of
pinkeye?

• Notify parents and ask that the child be seen
  by an MD
• Monitor other children for symptoms
• Practice good handwashing and hygiene
• Disinfect any contaminated articles
• Exclude child until treatment is started and
  readmission approved by MD

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Head Lice

• Primarily spread through direct head to head
  contact
• Rash may be more noticeable than the insects
• Attach eggs (nits) at the base of a hair shaft

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What should you do if your center has a case of
head lice?

• Exclude child until treated they do not have to
  be nit free to return
• Screen all children in the classroom
• Educate parents regarding use of the same
  recommendations for home

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Infection Control Methods

• Practice Good Hygiene
• Handwashing!!!
• Clean toys and environment
• Sanitary food handling
• Appropriate diapering procedures

• Maintain health records
• Illness records
• Immunizations up-to-date

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How can you help prevent the occurrence and
spread of disease in your center?
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Wash Your Hands!
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Key Times to Wash Your Hands

• Upon arrival to child care center - kids too!
• Before going home - kids too!
• After wiping a childs nose or helping a child
  blow his/her nose
• Before and after handling food/bottles
• After using toilet and after diapering
• After removing gloves

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Handwashing Guidelines

• Use warm, running water and mild, preferably
  liquid, soap
• Wet hands, apply soap to hands, rub thoroughly
  for at least 15 seconds
• Rinse hands and dry with clean disposable towel

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Important Phone Numbers

• Metro Public Health Department
• 340-5632
• Tennessee Department of Health
• 741-7247

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Immunizations

• What all childcare providers should know

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Why Immunize?

• To protect your children and other children
  from disease
• Many diseases have been nearly eliminated due to
  immunizations
• Polio
• Smallpox
• Measles

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How Immunity Works

• Immune system recognizes germs and produce
  antibodies
• Antibodies help destroy germs and protect you
  from future infections
• You first have to get sick before you develop
  immunity

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How Vaccines Help

• Vaccines give you immunity before you get sick
• Vaccines are made from the same germs that cause
  disease
• Vaccine helps body make antibodies to kill off
  present and future germs

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Childhood Immunization Schedule
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Required Immunizations for Childcare Children

• DTaP
• 4 or more doses, age appropriate
• Hep B
• 3 doses, age appropriate
• Hib
• age appropriate
• MMR
• 2 doses given on or after 1st birthday

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Required Immunizations for Childcare Children
(cont.)

• Pneumococcal
• recommended for all children born on or after
  7/1/01
• Polio
• if 3rd dose is given on or after 4th birthday,
  4th dose is not needed
• Varicella (Chicken pox)
• if born after 9/1/98

Not a required vaccine yet due to shortages
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Recommended Immunizations for Childcare Providers

• Flu
• those with chronic health conditions
• providers gt65
• given annually
• MMR
• providers born after 1957 with no evidence of
  immunity
• 1-2 doses recommended

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Recommended Immunizations for Childcare
Providers (cont.)

• Td
• providers who have not had 3 doses in childhood
  and a booster dose in the last 10 years
• Pneumococcal
• 19-64 y.o.- 1 dose for persons with medical
  conditions
• 64 and older- 1 dose

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Recommended Immunizations for Childcare
Providers (cont.)

• Hep A
• Not recommended unless advised by local health
  dept.
• Chickenpox
• those with no history of infection
• Hep B
• providers who may come in contact with blood

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TB screening

• The state only requires TB screening for the
  following high-risk occupational groups
• lab personnel working with TB
• employees of HC facilities with TB cases
• correctional inst. employees
• employees of long-term facilities
• homeless shelter staff
• drug treatment staff

Childcare staff are NOT encouraged to be screened
for TB unless otherwise directed by local health
dept.
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Take Home Messages- Antibiotics

• Antibiotics only treat bacterial infections
  (strep throat, some ear infections, sinus
  infections)
• If we take antibiotics when they are not needed,
  antibiotic-resistant bacteria can develop.
• Antibiotic-resistant infections are more serious
  and harder to treat!
• Good hygiene can keep your center healthy!

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Take Home Messages- Excluding children

• Children must be excluded for
• Fever
• Vomiting
• Diarrhea
• Severe coughing
• Eye discharge
• Yellowish skin/ eyes
• Be sure to follow you centers exclusion
  guidelines
• Some illnesses may require medicine, Dr.s note
  before child can return

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Take Home Messages- When to call your local
health department

• Contact your local health department when
• your center has an infectious disease
• you need current recommendations concerning
  diseases/exclusions

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Take Home Messages- Infection Control

• Practice good infection control methods
• Wash your hands!
• Maintain up to date health records

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Take Home Messages- Immunizations

• Immunizations protect children from diseases
• Immunizations provide immunity before you get
  sick
• It is very important to keep immunizations up to
  date!

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THANK YOU!!