UPDATES ON INFECTION CONTROL INSPECTIONS IN CHILD CARE CENTRES October 12, 2016 Kelly-Anne Colling Public Health Services Julie Gordon Infectious Diseases Program
Health Protection and Promotion Act • The Health Protection and Promotion Act (HPPA) is legislation in the province of Ontario. It is a law. • Section 5 of the HPPA identifies the minimal level of public health programs and services that the Board of Health must provide • Section 7 indicates that the Ministry of Health and Long- Term Care may “publish guidelines for the provision of mandatory health programs and services, and every board of health shall comply with the published guidelines.” 2 Public Health Services Infectious Diseases Program
Ontario Public Health Standards • Standards establish requirements for fundamental public health programs and services • Many of the standards are supported by specific protocols i.e. Infection Prevention and Control in Child Care Centres, 2016 • Protocols specify the minimum expectations for public health programs and services • Requirement 14 under the Infectious Diseases Program Standards – “The board of health shall inspect settings associated with risk of infectious diseases of public health importance in accordance with Infection Prevention and Control in Child Care Centres Protocol, 2016” 3 Public Health Services Infectious Diseases Program
Requirements under the Standards • Requirements include: • Routine inspections of licensed child care centres • Respond to complaints related to infection prevention and control • Utilize risk-based approaches to determine the frequency of inspection • Assist operators in the management of infectious disease outbreaks • Consult and educate operators and staff on topics related to infection control and food safety 4 Public Health Services Infectious Diseases Program
• Consult and assist with infection prevention and control policies regarding: • hand hygiene • General hygiene and disinfection practices • Health evaluation of children for signs of illness • Diapering procedures/toileting • Communication with parents and staff regarding illness , exclusion and infection prevention and control practices • Up-to-date immunization records • Resident and/or visiting animals 5 Public Health Services Infectious Diseases Program
Infection Prevention and Control • Consultations have begun to review policies and procedures related to infection prevention and control • Reportable diseases are still required to be reported to Public Health Services at 905-546-2063 • O. Reg 559/91 outlines the reportable diseases 6 Public Health Services Infectious Diseases Program
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Documentation of Illness • Health evaluation records should be made daily for each child • Signs and symptoms of illness and/or absences should be recorded • Compare current rates of illness/absence with those from last month and/or last year to determine if your rate is above normal for your centre • If you suspect that your illness/absence rate is above baseline for your centre, contact Hamilton Public Health Services intake line at 905-546-2063 to discuss control measures with a Public Health Inspector 8 Public Health Services Infectious Diseases Program
Ill Children • If a child becomes ill while at the centre, • Signs and symptoms are to be noted in the child’s record • The parent/caregiver is to be contacted to pick up the child • Child is to be segregated from well children until they are able to be picked up • The length of exclusion from the child care centre is disease dependent • Staff illness • Ill staff are not to provide child care or work in the kitchen as they may spread illness to children and other staff • The same exclusion guidelines apply to children and staff/volunteers • Staff should be made aware of the exclusion policies when employment begins 9 Public Health Services Infectious Diseases Program
The following are examples of illness which DO NOT require exclusion • Cold sores • Ear infections • Hand foot and mouth disease • Head lice • Parvovirus B19 – fifth disease, slapped face syndrome, erythema infectiosum • Thrush • Fever (alone) 10 Public Health Services Infectious Diseases Program
Exclude a Child With Any Of The Following Conditions Condition Exclusion Period Chickenpox Afebrile and well enough to participate (regardless of the rash) Diarrhea – unknown cause Until 24 hours after last diarrhea bowel movement Diarrhea – E. coli Until 2 negative stool specimens are taken at least 24 hours apart Until a negative stool specimen is collected at least 24 hours after Diarrhea - Shigella symptoms resolve Diarrhea – Giardia Until symptom free for 24 hours Diarrhea - Norovirus Until 48 hours after last diarrhea bowel movement – Diarrhea Salmonella and Until 24 hours after last diarrhea bowel movement Campylobacter Hepatitis A Until 1 week after onset of jaundice Impetigo Until 24 hours of antibiotics (draining lesions must be kept covered) Influenza Until fever has resolved and child is feeling better Measles Until 4 days after rash appeared Meningitis (bacterial or viral) Until child is recovered, decision to be made by a physician Mumps Until 5 days after symptom began Until 5 days after antibiotics are started, or until 3 weeks if not treated Pertussis (whooping cough) with antibiotics Until 1 full day of antibiotic treatment (if bacterial) or until doctor Pinkeye with discharge approves (if viral). No need to exclude if there is no discharge. Pneumonia Until feeling well enough to participate in regular activities Ringworm (body) Until treatment has started Rubella (German Measles) Until 7 days after onset of rash Scabies Until treatment has been applied Scarlet fever/Strep throat Until 24 hours after starting treatment Tuberculosis - active Call Public Health Services (905) 546-2063 Until the vomiting stops, or it is determined that the vomiting is caused 11 Vomiting by a non-infectious condition Public Health Services Infectious Diseases Program
Outbreaks - Outbreaks occur when the number of ill children/staff with similar symptoms exceeds baseline (the historical average of people off with illness) - Gastroenteritis outbreaks : - Symptoms include diarrhea, vomiting, nausea, weakness - Can be caused by bacteria, viruses or parasites - Norovirus is a common enteric virus we see circulating in our community throughout the year - Respiratory outbreaks : - Symptoms commonly include cough, fever, sore throat, runny nose, fatigue - Rhinovirus, enterovirus and Influenza are examples of respiratory viruses 12 Public Health Services Infectious Diseases Program
What to do in the event of an outbreak? - Begin recording illnesses on the Staff and Student Line List - Provide handwashing reminders to all children and staff. Handwashing is the single most important way to stop the spread of infection - Separate ill children and exclude ill staff and children - Enhanced environmental cleaning and disinfection. Switch to your high-level disinfectant for use during the outbreak - Discontinue sensory play - Call Public Health Services at 905-546-2063 to consult 13 Public Health Services Infectious Diseases Program
Cleaning and Disinfecting • Cleaning and disinfecting are necessary to reduce the spread of germs. Some germs can live for hours, days or weeks on toys and other surfaces, like diaper change tables • Cleaning physically removes soil and germs. Disinfecting kills germs that are left behind. • The product you use for disinfecting will determine the concentration, recommended contact time and the suitability for the items being disinfected. 14 Public Health Services Infectious Diseases Program
Cleaning and Disinfecting • Cleaning schedules are important for maintaining your facility in a clean and sanitary condition. Schedules will be reviewed with your Public Health Inspector at the annual infection control policy consultation 15 Public Health Services Infectious Diseases Program
Sample Cleaning Schedule Item When Mouthed toys Immediately Toys Weekly Dress-up clothes Laundered weekly Electronics Daily Cribs/cots Weekly, unless soiled or shared Bed linens Weekly, unless soiled or shared Dining tables Before and after meals Floors Daily Carpets Vacuum daily, steam clean bi-annually Toilets (seats/rims) Daily Diaper change table After each use High touch surfaces (e.g. door knobs, Daily counters, faucet handles, etc.) 16 Public Health Services Infectious Diseases Program
General Hygiene • Cubby storage areas should be labelled for each child and kept in clean condition • Make-up/face paint should be applied with disposable applicators • Combs/brushes to be labelled for each child or cleaned and disinfected after each use • Potty chairs are not recommended. Potty inserts/seats are preferred and can be easily cleaned and disinfected • Prior to and after all sensory play, children should wash their hands • Water play basins are to be emptied immediately after each session (approx. 2 hrs), cleaned and disinfected • Dry sensory bins (indoor sand) should be discarded monthly and the basin cleaned and disinfected. If confetti, water beads, leaves etc. are used, it should be discarded on a weekly basis 17 Public Health Services Infectious Diseases Program
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