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FAPS Policies: Dealing with Infectious Diseases Policy Dealing with Infectious Diseases Policy Education and Care Services National Law (ACT) Act 2011 Education and Care Services National Regulations 2011 Regulation 88 Infectious Diseases National Quality Standard Quality Area 2 Children’s Health and Safety Standard 2.1 Each child’s health is promoted. Element 2.1.1 Each child’s health needs are supported. Element 2.1.3 Effective hygiene practices are promoted and implemented. Element 2.1.4 Steps are taken to control the spread of infectious diseases and to manage injuries and illness, in accordance with recognised guidelines. Standard 2.3 Each child is protected. Element 2.3.1 Children are adequately supervised at all times. Element 2.3.2 Every reasonable precaution is taken to protect children from harm and any hazard likely to cause injury. Element 2.3.3 Plans to effectively manage incidents and emergencies are developed in consultation with relevant authorities, practised and implemented. Quality Area 6 Collaborative Partnerships with families and Communities Standard 6.2 Families are supported in their parenting role and their values and beliefs about child rearing are respected. Standard 6.3 The service collaborates with other organisations and service providers to enhance children’s learning and wellbeing. Aim This policy will provide clear guidelines and procedures to follow when: • a child shows symptoms of an infectious disease • a child has been diagnosed with an infectious disease • managing and minimising the spread of infectious diseases, illnesses and infestations (including head lice) • managing and minimising infections relating to blood-borne viruses. Rationale Preschools and other early childhood services provide the opportunity for large groups of children to be together at the same time, allowing potential opportunities for infectious diseases to spread. It is virtually impossible to prevent the spread of all infections. However we can minimise illness, particularly serious and infectious conditions, by having health and hygiene procedures in place that can reduce numerous infectious diseases, as well as by excluding sick persons1 from the centre. The French-Australian Preschool supports the Immunise Australia Program and National Immunisation Program (NIP), which is currently recommended by the National Health and Medical Research Council (NHMRC) and supported by the Commonwealth Government. 1 Sick persons refer to any member within the preschool community that is not of complete satisfactory health and is present at the preschool. This includes staff, families and children. 1 FAPS Policies: Dealing with Infectious Diseases Policy Definitions Exclusion period: The period recommended by the Department of Health for excluding any person from attending a children’s service to prevent the spread of infectious diseases through interpersonal contact (Refer to Appendix I). Infection: The invasion and multiplication of micro-organisms in bodily tissue. Infestation: The lodgement, development and reproduction of arthropods (such as head lice), either on the surface of the body of humans or animals, or in clothing. Infectious disease: A disease that can be spread, for example, by air, water or interpersonal contact. An infectious disease is designated by a health authority as a disease that would require the infected person to be excluded from an education and care service. Medication: Any medicine prescribed by a medical practitioner that is administered for the treatment of an illness or medical condition. Recommended minimum exclusion period: The period recommended by the Department of Health for excluding any person from attending a children’s service to prevent the spread of infectious diseases through interpersonal contact. Serious incident: An incident resulting in the death of a child, or an injury, trauma or illness for which the attention of a registered medical practitioner, emergency services or hospital is sought or should have been sought. Implementation Strategies and Procedures In relation to Management Management is responsible for: • preventing the spread of vaccine-preventable diseases through monitoring immunisation records and complying with recommended exclusion guidelines and timeframes for children and educators/staff. • ensuring that where there is an occurrence of an infectious disease at the service, reasonable steps are taken to prevent the spread of that infectious disease. • ensuring that where there is an occurrence of an infectious disease at the service, a parent/guardian or authorised emergency contact of each child at the service is notified of the occurrence as soon as is practicable. • providing access to information and resources for parents/guardians to assist in the identification and management of infectious diseases and infestations. • ensuring that information from the Department of Health about the recommended minimum exclusion periods (is displayed at the service, is available to all stake holders and is adhered to in the event of an outbreak of an infectious disease (as designated by the Department of Health). • providing staff, families and relevant members of the preschool community with sufficient relevant information regarding health practises related to the preschool. • ensuring that health records for the children are up to date. • ensuring that staff are entitled to the required number of sick days as per their employment awards and agreement. • ensuring any policies or procedures relating to health or infectious diseases are developed, reviewed, implemented and maintained on a regular basis, with consultation to information from recognised authorities. 2 FAPS Policies: Dealing with Infectious Diseases Policy • ensuring that sick persons1 are aware of their responsibilities for maintaining a standard of health whilst employed in the preschool. • deciding with reasoned judgement2 whether a person is well enough to remain at the preschool as intended that day. For example if a sick person displays the potential to infect others or increase in severity, management are permitted to arrange for that person to return home until they have recovered to full health. • ensuring that a child who is not immunised against a vaccine-preventable disease does not attend the service when an infectious disease is diagnosed, and does not return until there are no more occurrences of that disease at the service and the recommended minimum exclusion period has ceased (Regulation 85.2 of the Public Health and Wellbeing Regulations 2009) notifying CPRU within 24 hours of a serious incident, including when a child becomes ill at the service or medical attention is sought while the child is attending the service. • ensuring that appropriate and current information and resources are provided to educators/staff and parents/guardians regarding the identification and management of infectious diseases, blood-borne viruses and infestation. • establishing good hygiene and infection control procedures, and ensuring that they are adhered to by everyone at the service. • providing a head lice notification letter to all patents/guardians when an infestation of head lice has been deducted. In relation to educators: Educators are responsible for: • preventing the spread of infectious disease by ensuring the use of simple hygiene practices such as hand washing and effective cleaning procedures, • encouraging parents/guardians to notify the service if their child has an infectious disease or infestation. • not accepting a child into care if they are not well enough to participate in normal activities, or require special attention because of ill health. • observing signs and symptoms of children who may appear unwell, and informing the Nominated Supervisor. • monitoring any symptoms in children that may indicate the presence of an infectious disease and taking appropriate measures to minimise cross-infection. A child exhibiting the following signs may need to see a medical practitioner: fretful and listless behaviour loss of interest in play loss of appetite tired and flushed appearance vomiting persistent cough complain of headache or stiff neck Frequent scratching of scalp or skin Very dark urine Thick green or bloody discharge from nose crying readily but not easily comforted abnormally quiet and inactive hot to touch feel cold and look pale diarrhoea or loose stools difficulty in swallowing unusual spots or a rash Discharge from eyes Grey or pale faeces Yellow skin or eyes 3 FAPS Policies: Dealing with Infectious Diseases Policy • completing an illness report and contacting parent when their child’s health causes concern, so that they may take him/her home. • contacting parents/guardians and asking them to collect their child/ren if they have had two bouts of diarrhoea during the day. • complying with the policy of the service related to hygiene and the procedures for infection control relating to body fluids(refer to Appendix III). • modelling appropriate behaviour demonstrating positive hygiene and infection control practices. • remaining home during the exclusion period if they have contacted an infectious disease. • maintaining confidentiality at all times . In relation to families Families are responsible for: • keeping their child/ren at home and informing the service if they are unwell or have an infectious disease or infestation or have been in contact with a person who has an infectious disease. • keeping their child/ren at home when an infectious disease has been diagnosed at the service and their child is not fully immunised against that infectious disease, until there are no more occurrences of that disease and the exclusion period has ceased • providing accurate and current information regarding the immunisation status of their child/ren when they enrol, and informing the service of any subsequent changes to this while they are enrolled at the service. • complying with the recommended minimum exclusion periods. • keeping their child/ren at home for 24 hours after a high temperature, vomiting or diarrhoea. • keeping the child at home for 48 hours in case of an outbreak of diarrhoea. • regularly checking their child’s hair for head lice or lice eggs, regularly inspecting all household members, and treating any infestations as necessary • notifying the service if head lice or lice eggs have been found in their child’s hair and when treatment was commenced. • providing a medical certificate when the child returns to school after an illness, stating that the child is free from infection(in the case of an infectious disease). Sources http://www.acecqa.gov.au/First-aid-qualifications-and-training https://www.coag.gov.au/sites/default/files/early_years_learning_framework.pdf St John’s Ambulance Australia http://stjohn.org.au/first-aid-training ACT Health http://health.act.gov.au/publications/fact-sheets/ Department of Health Immunise Australia Program and National Immunisation Program Schedule, http://www.immunise.health.gov.au/ and http://www.health.gov.au/internet/immunise/publishing.nsf/content/nips-ctn 4 FAPS Policies: Dealing with Infectious Diseases Policy National Health and Medical Research Council (NHMRC), https://www.nhmrc.gov.au/guidelines/publications/ch55 Staying healthy in childcare www.nhmrc.gov.au/_files_nhmrc/file/guidelines/sub47.pdf National Work Health and Safety http://www.comlaw.gov.au/Details/c2011a00137/Html/Text#_Toc309986347 Public Health and Wellbeing Regulations 2009, http://www.legislation.vic.gov.au/Domino/Web_Notes/LDMS/PubStatbook.nsf/b0 5145073fa2a882ca256da4001bc4e7/A3B0A9845FD0980ACA25768D002AB0B5/$F ILE/09-178sr.pdf Related Policies Administration of First Aid Policy Dealing with Medical Conditions Policy Administration of Medication Policy Work, Health and Safety Policy Incident, Injury, Trauma and Illness Policy. Developed: January 2010 Approved by board: 23rd February 2010 Next date for review: January 2012 (not reviewed) Reviewed : August 2014 Approved by Board: October 2014 Next date for review: October 2018 5 FAPS Policies: Dealing with Infectious Diseases Policy APPENDIX I Sourced from: ACT Department of Education and Training: Infectious Diseases – Outbreak Procedures and Exclusion Periods Policy: Condition Exclusion of person with condition Exclusion of persons in contact with condition Amoebiasis (entamoeba histolytica) Exclude until diarrhoea ceases Not excluded *Campylobacteriosis Exclude until diarrhoea ceases Not excluded Chicken pox (varicella and herpes zoster) Exclude until the last blister has scabbed over. The child should not continue to be excluded by reason only of some remaining scabs. Not excluded Any child with an immune deficiency (eg with leukaemia, or as a result of receiving chemotherapy) should be excluded for their own protection and seek urgent medical advice and varicella-zoster immunoglobulin (ZIG), if necessary. Conjunctivitis (acute infectious) Exclude until discharge from eyes ceases. Not excluded *Cryptosporidiosis Exclude until diarrhoea ceases Not excluded Diarrhoea Exclude until diarrhoea ceases Not excluded *#Diphtheria Exclude until— (a) at least 2 negative throat swabs have been taken (the first not less than 24 hours after cessation of antibiotic treatment and the second not less than 48 hours later), and Exclude family and household contacts until approval to return has been given by the Chief Health Officer. (b) a certificate is provided by a medical practitioner recommending that the exclusion should cease. Giardiasis Exclude until diarrhoea ceases Not excluded *#Haemophilius influenza type b (Hib) Exclude until a certificate is provided by a medical practitioner recommending that the exclusion should cease. Exclude if— (a) child is unwell, or Not excluded Hand, Foot and Mouth disease *Hepatitis A Herpes (cold sores) Impetigo (school sores) Influenza and influenzalike illnesses (b) child is drooling, and not all blisters have dried or an exposed weeping blister is not covered with a dressing. Exclude for at least 7 days after the onset of jaundice and a certificate is provided by a medical practitioner recommending that the exclusion should cease. Exclude young children unable to comply with good hygiene practices while the lesion is weeping. Lesion to be covered by a dressing in all cases, if possible. Exclude until appropriate treatment has commenced and sores on exposed surfaces are covered with a watertight dressing. Exclude until well *Leprosy Exclude until approval to return has been given by the Chief Health Officer. *#Measles Exclude for at least 4 days after the rash appears. Not excluded Not excluded Not excluded Not excluded Not excluded Not excluded (a) Immunised contacts not excluded. (b) Exclude non-immunised contacts until 14 days after the first day of appearance of the rash in the index case. (b) Non-immunised contacts immunised with measles vaccine within 72 hours after their first 6 FAPS Policies: Dealing with Infectious Diseases Policy contact with the index case are not excluded after being immunised. (d) Non-immunised contacts who are given normal human immunoglobulin (NHIG) within 7 days after their first contact with the index case are not excluded after being given NHIG. Not excluded Meningitis (bacterial) Exclude until well *Meningococcal infection Exclude until adequate carrier eradication therapy has commenced. *#Mumps Exclude for 9 days after onset of symptoms, or until parotid swelling goes down (whichever is sooner). *#Poliomyelitis Exclude for at least 14 days after onset of symptoms and until a certificate is provided by a medical practitioner recommending that the exclusion should cease. Exclude until effective treatment has commenced. Not excluded Exclude until diarrhoea ceases Not excluded *#Rubella (German measles) Exclude for 4 days after the appearance of the rash. *Salmonellosis Exclude until diarrhoea ceases Not excluded Female staff of child-bearing age should ensure that their immune status against rubella is adequate. Not excluded *Shigellosis Exclude until diarrhoea ceases Not excluded Streptococcal infection (including scarlet fever) Exclude until the person has recovered or has received antibiotic treatment for at least 24 hours. Not excluded *Tuberculosis Exclude until approval to return has been given by the Chief Health Officer. Not excluded *Typhoid and paratyphoid fever Exclude until a certificate is provided by a medical practitioner recommending that the exclusion should cease. (a) Not excluded unless the Chief Health Officer notifies the person in charge of the school. (a) If the Chief Health Officer gives notice, exclusion is subject to the conditions in the notice. *#Whooping cough (pertussis) Exclude for 21 days from start of cough, or for at least 5 days after starting a course of antibiotics recommended by the Chief Health Officer. Worms (intestinal) Exclude until diarrhoea ceases Exclude non-immunised household, home based child care and close child care contacts under 7 years old for 14 days after the last exposure to infection, or until 5 days after starting a course of antibiotics recommended by the Chief Health Officer (whichever is sooner). Not excluded Ringworm, scabies, pediculosis (lice), trachoma Rotavirus (a) Not excluded if receiving rifampicin or other antibiotic treatment recommended by the Chief Health Officer. (b) Otherwise, excluded until 10 days after last contact with the index case. Not excluded Not excluded http://www.det.act.gov.au/__data/assets/pdf_file/0010/585109/Infectious_Diseases. pdf A parent/carer of a child with a listed exclusion condition, or a child who has been in contact with a listed exclusion condition must notify the school principal or principal carer as soon as possible. *These conditions must be notified by medical practitioners to the Chief Health Officer. 7 FAPS Policies: Dealing with Infectious Diseases Policy APPENDIX II Sourced from FAPS Staff Handbook STAFF LEAVE ENTITLEMENTS FOR INFECTIOUS DISEASE Disease Leave with pay Chicken Pox (varicella) 5 working days Cold Sores 2 working days Conjunctivitis 2 working days German Measles (rubella) 5 working days Head Lice 1 working day Hepatitis A 5 working days Hepatitis (other) as decided by medical practitioner Impetigo 2 working days Measles (morbelli) 10 working days Mumps 10 working days Rheumatic Fever as decided by medical practitioner Ringworm 2 working days Scabies 1 working day Scarlet Fever 10 working days Streptococcal Infection 1 working day (Active) Tuberculosis 20 working days or as decided by medical practitioner Whooping Cough 10 working days 8 FAPS Policies: Dealing with Infectious Diseases Policy Appendix III Safe handling and Cleaning of body fluids (urine, blood, vomit)or materials in contact with body fluids Workers work on the presumption that all blood and body fluids are infectious, and follow the "rules" whenever in contact with them. The ‘rules’ are: • • • • • • Disposable gloves must be worn when cleaning hazardous spills. Care must be taken by staff member who is cleaning the hazardous spill not to expose their own skin wounds, sores or mucous membranes (eyes, mouth or nose) to the body fluids. A body fluids cleaning kit for the staffs’ protection will be available for cleaning hazardous spills is situated in the laundry cupboard. This contains disposable gloves, aprons, masks and protective eye wear. Surfaces such as carpets must thoroughly sprinkled with Bio-Waste® infectious waste absorbent. When the spill has been absorbed; it must be swept up with dust pan and brush, placed in a double plastic bag and dispose in a bin that children have no access to. The area must be then thoroughly washed with hot soapy water. Cloths used for cleaning hazardous spills must be thrown out after use. The dust pan and brush must be washed thoroughly with hot soapy water. To avoid cross-contamination ensure that the spill must be isolated by keeping children away from the area until the spill has been cleaned and thoroughly dried (making a temporary barrier using chairs or other resources). Hands must be washed after cleaning hazardous spills. 9