Sickness and Care

 Helping to stop the spread of germs. This time last year we all had a better understanding the importance of staying home when sick. I would like to remind everyone this is still relevant in 2021. Please remember to wash hands on arrival and departure each day. Each policy is attached for you to read 

Taken from our Heath and Hygiene Policy, Infectious Diseases Policy 

The three steps in the chain of infection

1. The germ has a source.

2. The germ spreads from the source.

3. The germ infects another person.

You can break the chain of infection at any stage.

The way in which a germ spreads is known as its mode of transmission. The modes of transmission that are most likely to affect education and care services are;

• Coughing or sneezing (droplet transmission)
• Breathing contaminated air (airborne transmission)
• Direct contact (contact transmission)
• Animals
• Food

The way that children interact with each other and with adults in education and care services means that diseases can quickly spread in a variety of ways. Children, especially younger children, have close contact with other people through playing or cuddling; they often put objects in their mouths; and they may not always cover their coughs or sneezes. Because some germs can survive on surfaces, children may touch a contaminated surface, then put their hands in their mouth and become infected. If a child has an ill sibling at home, they could also be incubating the illness, and risk bringing germs from home into the education and care service.

Whether or not a person becomes ill in an education and care service depends on three things:

• the type of germ—some viruses, such as measles and norovirus, are very infectious. Others, such as hepatitis B, hepatitis C and human immunodeficiency virus (HIV) are very difficult to spread in education and care services.
• the opportunity for transmission—germs have a greater chance of spreading if, for example, there are inadequate hand-washing facilities, or ill children are not excluded from the education and care service.
• the person's immunity—people who have been immunised against a particular disease, or who have had that disease before, are unlikely to become ill if they come in contact with the disease. People who have not been immunised, or who do not have natural immunity to that disease, have a much higher risk of becoming infected and developing the disease.

The most important ways to break the chain of infection and stop the spread of diseases are:

• Effective hand hygiene

• Exclusion of ill children, educators and other staff

• Immunisation.

Exclusion of ill children, educators and other staff

The aim of exclusion is to reduce the spread of infectious disease. The less contact there is between people who have an infectious disease and people who are at risk of catching the disease, the less chance the disease has of spreading. Excluding ill children, educators and other staff is an effective way to limit the spread of infection in education and care services.

By excluding one ill person, you can protect many other people from becoming ill

The need for exclusion and the length of time a person is excluded depend on:

• How easily the infection can spread
• How long the person is likely to be infectious
• How severe the disease can be

The exclusion procedure

To determine when a person should be excluded:

• Identify whether the symptoms or a diagnosed illness have an exclusion period
• Refer to Table 1.1 for the recommended minimum periods of exclusion
• Advise the parents, or the educator or other staff member, when they may return to the education and care service.

Children, educators and other staff who are unwell should stay home from education and care services. Even if they do not have a condition that requires exclusion, the best place for an ill child to rest and recover is with someone who cares for them.[3]

"Because you care for the children in your group every day, you are probably used to the way each of them looks and behaves when they are healthy. It is useful for educators and other staff to have some understanding of the signs and symptoms that suggest that a young child may be quite ill and need urgent medical attention. These include the following:

• High fever—a high fever in a young child can be a sign of infection and needs to be investigated to find the cause. However, fever by itself is not necessarily an indicator of serious illness
• Drowsiness—the child is less alert than normal, making less eye contact, or less interested in their surroundings.
• Lethargy and decreased activity—the child wants to lie down or be held rather than participate in any activity, even those activities that would normally be of interest.
• Breathing difficulty—this is an important sign. the child may be breathing very quickly or noisily or be pale or blue around the mouth. the child may be working hard at breathing, with the muscles between the ribs being drawn in with each breath.
• Poor circulation—the child looks very pale, and their hands and feet feel cold or look blue.
• Poor feeding—the child has reduced appetite and drinks much less than usual. This is especially relevant for infants.
• Poor urine output—there are fewer wet nappies than usual; this is especially relevant for infants.
• Red or purple rash—non-specific rashes are common in viral infections; however, red or purple spots that do not turn white if pressed with a finger require urgent medical referral because the child could have meningococcal disease.
• a stiff neck or sensitivity to light—this may indicate meningitis, although it is possible for infants to have meningitis without these signs.
• Pain—a child may or may not tell you they are in pain. Facial expression is a good indicator of pain in small infants or children who do not talk. General irritability or reduced physical activity may also indicate pain in young children.

These clinical features cannot be relied on to say for certain that a child is seriously ill, nor does their absence rule out serious illness. the more of the above features that are seen, the more likely it is that the child may have a serious illness. Remember that illness in infants and young children can progress very quickly. If there is any doubt, seek medical advice without delay."[4]

Exclusion

"5^th Edition Staying Healthy Preventing Infectious Diseases in Early Childhood Education and Care Services" Australian Government National Health and Medical Research Council 2013 provides the following guidance on exclusion:

• "Separate the ill child from the other children. If the child is not well enough to participate in activities, contact their parent and send them home. A child who is feeling unwell needs to be with a person who cares for them—this is usually a parent or grandparent.
• While waiting for the parent to arrive, keep the child away from the main group of children, if possible. for example, they could lie on a floor cushion or mat in a corner of the room where you can still comfort and supervise them. After the child leaves, ensure that the mattress or floor cushion is cleaned before it is used again. Some infectious agents can persist on surfaces and may cause infection even if an object looks clean or is wiped clean.
• When caring for an ill child, remember the main ways to break the chain of infection:
  • • Remind a child who is coughing or sneezing to cough or sneeze into their elbow. If the child covers their mouth with their hands, ask them to wash their hands.

• • • If you wipe a child's nose, dispose of the tissue in a plastic-lined rubbish bin and then wash your hands. If you touch a child who might be ill, avoid touching other children until after you have washed your hands.

• • • Encourage parents to tell you when anyone in the family is ill. If someone in the family is ill, watch for signs of illness in the child.

• If a child appears very unwell or has a serious injury that needs urgent medical attention, call an ambulance."[5]

Fevers

"It is usually not necessary to reduce a fever, because fever in itself is not harmful. However, medication is sometimes given to 'bring a fever down' because there is no doubt that fever can make a person feel miserable. Some studies show that giving medication to reduce the fever can actually slow down the body's immune response to infection. In most cases, do not worry about treating the fever itself—instead, focus your attention on the way the child looks and behaves, their level of alertness, and whether there are any other symptoms that indicate serious infection, such as vomiting, coughing or convulsions. Key things to remember about fever:

• The normal temperature for a child is up to 38°C.
• Fevers are common in children.
• If the child seems well and is happy, there is no need to treat a fever.

• If the child is less than 3 months old and has a fever above 38 °C, contact the child's parent and ask them to take the child to a doctor.
• If the child is unhappy, treatment is needed to comfort them. Give clear fluids and, if the parents give permission, paracetamol.

• Watch the child and monitor how they are feeling.
• In some cases, a child may have febrile convulsions, which are physical seizures caused by the fever. They usually last only a few seconds or minutes; however, you should call an ambulance."[6]