5th Edition Staying Healthy - NHMRC
5th EditionStaying HealthyPreventing infectious diseases inearly childhood educationand care services(updated June 2013)SHIC FRONT COVER v03.indd 15/06/13 9:01 AM
Staying HealthyPreventing infectious diseases in earlychildhood education and care servicesFIFTH EDITION2012(Updated June 2013)
Commonwealth of Australia 2012Paper-based publicationThis work is copyright. You may reproduce the whole or part of this work in unaltered form for your own personal use or, ifyou are part of an organisation, for internal use within your organisation, but only if you or your organisation do not use thereproduction for any commercial purpose and retain this copyright notice and all disclaimer notices as part of that reproduction.Apart from rights to use as permitted by the Copyright Act 1968 or allowed by this copyright notice, all other rights are reservedand you are not allowed to reproduce the whole or any part of this work in any way (electronic or otherwise) without first beinggiven the specific written permission from the Commonwealth to do so. Requests and enquiries concerning reproduction andrights are to be sent to Strategic Communications, National Health and Medical Research Council, GPO Box 1421, CanberraACT 2600 or via email to nhmrc.publications@nhmrc.gov.au.ISBN Print: 1864965541 Commonwealth of Australia 2012Electronic documentThis work is copyright. You may download, display, print and reproduce the whole or part of this work in unaltered form foryour own personal use or, if you are part of an organisation, for internal use within your organisation, but only if you or yourorganisation do not use the reproduction for any commercial purpose and retain this copyright notice and all disclaimer noticesas part of that reproduction. Apart from rights to use as permitted by the Copyright Act 1968 or allowed by this copyright notice,all other rights are reserved and you are not allowed to reproduce the whole or any part of this work in any way (electronic orotherwise) without first being given the specific written permission from the Commonwealth to do so. Requests and enquiriesconcerning reproduction and rights are to be sent to Strategic Communications, National Health and Medical Research Council,GPO Box 1421, Canberra ACT 2600 or via email to nhmrc.publications@nhmrc.gov.au.ISBN Online: 1864965568AcknowledgementsQueensland HealthDr Andrew Langley; Debbie Neucom (RN) Sunshine Coast Public Health Unit, Central Regional Services, Office of theChief Health OfficerNHMRC Project TeamCathy Connor; Tanja Farmer; Marion CareyExpert ReviewersDr Ann Koehler, Communicable Diseases Control Branch, SA HealthDr Kim Drever, Centre Of Community Child Health, Royal Children’s Hospital, MelbourneMs Judy Radich, Early Childhood AustraliaDr Celia Cooper, Microbiology and Infectious Diseases Department, Women’s and Children’s Hospital South AustraliaMs Elise Davis Associate Director, Child Mental Health Promotion, The Jack Brockhoff Child Health and Wellbeing Program,VicHealth Public Health Research Fellow, The McCaughey Centre, Melbourne School of Population Health, The University of MelbourneMs Irene Passaris, Director, Communicable Disease Control Section, Health Protection Service, ACT Health DirectorateMs Paula Spokes, A/Manager, Surveillance, Communicable Diseases Branch, Centre for Health Protection, NSW Ministry of HealthTechnical WritersBiotext, CanberraTo obtain information regarding NHMRC publications :Toll free 13 000 NHMRC (13 000 64672) or call (02) 6217 9000Internet:http://www.nhmrc.gov.auNHMRC Publication reference: CH55Published: November 2012Updated and reprinted: June 2013
Staying Healthy 5th Editioniii6047455. Clean the child’s bottom6. Remove the paper and put it in ahands-free lidded bin2. Place paper on thechange table3. Put disposablegloves on both hands1.2.2Celebration cakes and blowing out candles Always wash your hands after cleaning the nappy change area. Halfway through the day, remove the morning change mat or waterproof sheet, cleanit with detergent and water and leave it to dry, preferably outside in the sun. Use thefresh mat for the afternoon. If faeces or urine spill onto the change surface, clean the surface with detergent andwarm water and leave it to dry. After each nappy change and at the end of each day, wash the surface well withdetergent and warm water, rubbing with paper towel or a cloth as you wash. Put thepaper towel in the bin, or put the cloth aside for washing after each nappy change—there will be many germs on this cloth, and it cannot be used again until it has beenwashed. Leave the change surface to dry. See Section 3.3 for information on how toclean the nappy change table if the child had diarrhoea.This is the best method to keep the nappy change table clean:11. Wash your hands and the child’s hands10. Take the child away from thechange table9. Dress the child8. Place a clean nappy on the child7. Remove your gloves and put them inthe bin12. Clean the change table with detergentand warm water after each nappy change4. Remove the child’s nappy and put in ahands-free lidded bin. Place any soiledclothes in a plastic bag13. Wash your handsCLEANINGCHANGING1. Wash your handsCLEANING13. Wash your hands12. After each nappy change, clean thechange table with detergent and warmwater, then rinse and dry3.6.2Celebration cakes and blowing out candlesensure the nappy change table is cleaned correctly, follow the process on page 45(table 3.3).a To Always wash your hands after cleaning the nappy change area. Halfway through the day, remove the morning change mat or waterproof sheet, cleanit with detergent and water and leave it to dry, preferably outside in the sun. Use thefresh mat for the afternoon. If faeces or urine spill onto the change surface, clean the surface with detergent andwarm water and leave it to dry. After each nappy change and at the end of each day, wash the surface well withdetergent and warm water, rubbing with paper towel or a cloth as you wash. Put thepaper towel in the bin, or put the cloth aside for washing after each nappy change—there will be many germs on this cloth, and it cannot be used again until it has beenwashed. Leave the change surface to dry. See Section 3.3 for information on how toclean the nappy change table if the child had diarrhoea.This is the best method to keep the nappy change table cleana:11. Wash your hands and the child’s hands10. Take the child away from thechange table9. Dress the child8. Place a clean nappy on the child7. Remove your gloves and put them inthe bin6. Remove the paper and put it in ahands-free lidded bin5. Clean the child’s bottom2. Place paper on thechange table3. Put disposablegloves on both hands4. Remove the child’s nappy and put anydisposable nappy in a hands-free liddedbin. Place any soiled clothes (including anycloth nappy) in a plastic bagCHANGING1. Wash your handsPREPARATION If the infant cannot stand at a hand basin, wash their hands with pre-moistened disposable wipes,then dry thoroughly. If the infant cannot stand at a hand basin, wash their hands with pre-moistened disposable wipes; makesure their hands are rinsed with water to remove any soap, then dry thoroughly.PREPARATIONInfants need their hands washed as often and as thoroughly as older children: If the infant can stand at a small hand basin, wash their hands the same way you wash your own hands. If the infant can stand at a small hand basin, wash their hands the same way you wash your own hands.5th Edition updated version June 201341Infants need their hands washed as often and as thoroughly as older children:Page 5th Edition versionThe June 2013 update of Staying Healthy 5th Edition includes fact sheets on croup and warts, which were omitted in the first edition. NHMRC has also taken this opportunity tomake minor amendments to the publication, which are underlined below.Staying Healthy 5th Edition – updated June 2013
ContentsINTRODUCTION1Alignment with the National Quality StandardsScope of this editionBest-practice advice112PART 1 Concepts in infection control31.1 What causes infections?51.2 How do infections spread?61.2.1 The chain of infection61.2.2 Ways in which germs can spread71.2.3 How can diseases spread in education and care services?81.3 Main ways to prevent infection101.3.1 Effective hand hygiene10Soap and waterAlcohol-based hand rubsAntibacterial soapHand dryingHand care11111212121.3.2 Exclusion of ill children, educators and other staff13The exclusion procedureInvolving parentsRecommended minimum exclusion periods1314151.3.3 Immunisation191.3.4 Additional strategies24Appropriate use of glovesCough and sneeze etiquetteEffective environmental cleaningPART 2 Monitoring illness in children242526292.1 Watching for and recording symptoms in children312.1.1 What to do if a child seems unwell312.1.2 What to do if a child has a fever32Reducing the fever322.1.3 Keeping records342.1.4 Managing symptoms after immunisation34Managing injection site discomfortManaging fever after immunisation3434CONTENTSStaying Healthy 5th Editionv
PART 3 Procedures3.1 Personal hygiene3.1.1 Hand hygieneWhen to perform hand hygieneHow to wash hands with soap and waterHow to clean hands with alcohol-based hand rub3.1.2 Using glovesDisposable gloves3.2 Hygienic nappy changing and toileting3.2.1 Nappy changingPlacing paper on the change tableWearing disposable glovesCleaning the childCleaning the change table3.2.2 Toilet training3.3 Safely dealing with spills3.3.1 BloodLooking after the childDressing the woundChecking for contact with bloodCleaning the blood spill41414142434343454546464646474848484949493.3.2 Faeces, vomit and urine513.3.3 Nasal discharge513.4 Cleaning the education and care service523.4.1 Cleaning equipment523.4.2 When to clean523.4.3 Special considerations for cleaning54Bathrooms and toiletsNappy change nsCarpets, mats and curtains3.5 Food safety54545454555555555555563.5.1 Basics for meals and snacks573.5.2 Preparing food57Heating and cooling foodSeparating raw and cooked foods3.5.3 Preparing, storing and heating bottlesPreparing bottlesStoring bottlesHeating bottles3.5.4 Children’s cooking classesvi39CONTENTSNational Health and Medical Research Council57585858585959
3.6 Other considerations to prevent the spread of infectious diseases603.6.1 Sandpits603.6.2 Celebration cakes and blowing out candles603.6.3 Play dough603.6.4 Animals61616161Bat bites and scratchesFish and marine animalsFleasPART 4 Issues for employers, educators and other staff634.1 Work health and safety654.2 Immunisation664.2.1 Recommended vaccinations for educators and other staff674.3 Infectious diseases during pregnancy694.3.1 Cytomegalovirus (CMV)694.3.2 Hand, foot and mouth disease694.3.3 Human parvovirus B19 (erythema infectiosum, fifth disease)694.3.4 Listeriosis704.3.5 Rubella (German measles)704.3.6 Toxoplasmosis704.3.7 Varicella (chickenpox)704.4 The role of public health units71PART 5 Fact sheetsPART 6 Glossary and resources731736.1 Glossary1756.2 Useful contacts1786.2.1 Public health units1786.2.2 Work health and safety authorities1786.2.3 Food safety authorities1796.3 Useful websites1806.4 Forms181Record of illness at the education and care serviceReport form for parent or doctorMedication permission formStaff immunisation record181182183184CONTENTSStaying Healthy 5th Editionvii
Appendix 1 Process report185Appendix 2 Key documents and references189TablesTable 1.1Recommended minimum exclusion periods17Table 1.2National Immunisation Program Schedule21Table 1.3Vaccine-preventable diseases23Table 2.1Sample record of illness in the education and care service34Table 2.2Comparison of effects of diseases and side effects of vaccines35Table 3.1When to perform hand hygiene42Table 3.2When to wear gloves43Table 3.3Nappy changing procedure45Table 3.4Recommended methods for cleaning blood spills49Table 3.5When to clean different surfacesTable 5.1Quick-check dilution table53100FiguresFigure 1.1 The chain of infectionviii6Figure 1.2 The role of hands in the spread of infection11Figure 3.1 Decision tree: when to use disinfectant53CONTENTSNational Health and Medical Research Council
IntroductionInfections are common in children and often lead to illness. At home, children are reasonably well protectedfrom infectious diseases because they do not come into contact with as many people as children whoattend education and care services. The adults they meet are usually immune to many childhood illnessesbecause they had them as children, or have been vaccinated against them.Many children first enter education and care services at a time when their immune systems are still developing.They may not have been exposed to many common germs that cause infections—bacteria, viruses, fungi,protozoa—and they may be too young to be vaccinated against some diseases. The way that children interact ineducation and care services means that diseases can quickly spread in a variety of ways. Children (particularlyyounger children) will have close physical contact with other children and carers through regular daily activitiesand play; they often put objects in their mouths; and they may not always cover their coughs or sneezes.Staying healthy-Preventing infectious diseases in early childhood education and care services is a bestpractice tool that provides simple and effective ways for educators and other staff to help limit the spreadof illness and infectious diseases in education and care settings.Alignment with the National Quality StandardsThe Australian Children’s Education and Care Quality Authority (ACECQA) is the national body guiding theimplementation of the National Quality Framework in the education and care sector in Australia.Under the National Regulations and the National Quality Standards, providers and educators are required toimplement and encourage effective hygiene practices. Following best practice in maintaining high standardsof hygiene minimises the spread of infectious diseases and promotes good health. It is important to leadby example to ensure that educators and other staff, children, visitors and families all remember to practiseeffective infection prevention and control.The National Quality Framework for Early Childhood Education and Care was developed to improve andstandardise the quality of education and care in Australia. Quality Area 2: ‘Children’s Health and Safety’includes standards relating to hygiene and infection control in education and care services, and QualityArea 7: ‘Leadership and Service Management’ refers to the policies and procedures that services shouldhave in place.1 The framework came into effect on 1 January 2012, and these quality areas have beenconsidered in this edition of Staying healthy.Staying healthy is a best-practice tool that allows education and care services to interpret and adapt adviceto meet the regulatory requirements according to the children in their care and their education and careservice environment.Scope of this editionThe advice in the 5th edition of Staying healthy is drawn from established guidelines that are regularlyupdated using the principles of evidence-based medicine (including the Australian guidelines for theprevention and control of infection in healthcare, 2010). It also updates and builds on advice in previouseditions of Staying healthy. It is designed to be used by anyone caring for children—the term ‘educationand care service’ includes day care, long day care, family day care, preschool and out-of-school-hours care.1The Guide to the National Quality Standard is available at the%20National%20Quality%20Standard%20FINAL.pdf (viewed 28 March 2012).INTRODUCTIONStaying Healthy 5th Edition1
The scope of Staying healthy is to provide advice on infectious diseases in children up to school age, from apublic health perspective. It is not intended as a guide to managing individual children who are ill; rather, itis intended for use in controlling and managing the spread of infections that can also affect healthy children.Although guidance on children with particular medical conditions such as diabetes, asthma or severeallergies is needed in the education and care industry, it is beyond the scope of this document.The key principles of infection prevention and control are applicable across age groups and include thedisability sector. However, it is recognised that the risks and issues vary depending on the age anddevelopmental capacity of the children. These variations in risks and issues are not considered in thisedition of Staying healthy.Education and care services are all different, and there is often more than one effective way to perform aprocedure. This document therefore includes detail on the rationale behind the procedures—with a clearunderstanding of why each step is important, educators and other staff can solve problems as they arise.This edition also includes scenarios based on real-life situations that illustrate the key messages andappropriate actions to take.Best-practice adviceThe guidance and procedures in Staying healthy represent best practice. Education and care services arestrongly encouraged to adopt these practices. However, some services may choose to develop policiesthat do not follow all of the advice in Staying healthy. For example, some services may have a philosophyof environmental sustainability, and a consequent greater emphasis on considering the resources they use.They may have policies and procedures in place to minimise waste or the use of chemicals. Education andcare services that choose not to use the best-practice advice in this document should ensure that theirpolicies and procedures minimise the spread of infection.It is not possible to prevent all infections in education and care services. However, by using the strategiesoutlined here, you can prevent many infectious diseases and control their spread.2INTRODUCTIONNational Health and Medical Research Council
PART 1Concepts in infection controlSummaryPart 1 describes the basics of infectious diseases—what causes them,how they spread and how to prevent them. A key concept is the chainof infection, which explains how germs can spread in education andcare services. To stop infections spreading, you can break the chain ofinfection at any point through: effective hand hygiene exclusion of ill children, educators and other staff immunisation cough and sneeze etiquette appropriate use of gloves effective environmental cleaning.Evidence baseThe information in Part 1 is based on: Communicable Diseases Network Australia 2008–11,Series of national guidelines, CDNA, Canberra National Health and Medical Research Council 2005,Staying healthy in child care: preventing infectious diseasesin child care, 4th edn, NHMRC, Canberra National Health and Medical Research Council 2008,The Australian immunisation handbook, 9th edn, NHMRC, Canberra National Health and Medical Research Council 2010,Australian guidelines for the prevention and control of infection inhealthcare, NHMRC, Canberra SA Health—Communicable Disease Control Branch 2009,You’ve got what?, 4th edn, SA Health, Adelaide other sources as specified in the text.INTRODUCTIONStaying Healthy 5th Edition
INTRODUCTIONNational Health and Medical Research Council
Part 1Concepts in infection control1.1 What causes infections?Microscopic living things (known as germs) are all around us. Some of these germs can cause disease inpeople, other animals or plants. There are four major types of germs: bacteria, viruses, fungi and protozoa.BacteriaBacteria are found almost everywhere, including in and on the human body. Most bacteria live in closecontact with us and our environment without causing any harm. Some are even good for us—good bacterialive in our intestines and help us use the nutrients in the food we eat and ma
early childhood education and care services (updated June 2013) 5th Edition SHIC FRONT COVER_v03.indd 1 5/06/13 9:01 AM. Staying Healthy Preventing infectious diseases in early childhood education and care services FIFTH EDITION 2012 (Updated June 2013) Staying Healthy 5th Edition
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Educator Guide EAT FOR HEALTH www.nhmrc.gov.au www.eatforhealth.gov.au GPO Box 1421, Canberra ACT 2601 16 Marcus Clarke Street, Canberra City ACT T. 13 000 NHMRC (13 000 64672) or 61 2 6217 9000 F. 61 2 6217 9100 E. nhmrc@nhmrc.gov.au
List of Human Research Ethics Committees registered with NHMRC. The table below lists the Human Research Ethics Committees (‘HREC’) registered with NHMRC.
NHMRC GUIDELINES FOR THE SCREENING, PROGNOSIS, DIAGNOSIS, MANAGEMENT AND PREVENTION OF GLAUCOMA Table of contents List of Tables Table 2.1 NHMRC Body of Evidence matrix (2009) 29 Table 2.2 Exemplar Body of Evidence matrix 30 Table 6.1 Risk factors from patient history 49 Table 6.2 Risk factors from ocular examination 56
EVIDENCE EVALUATION REPORT NHMRC CLINICAL TRIALS CENTRE . Irving, A., Agresta, B., Ko, H., Stoklosa, A. 2016, Health Effects of Water Fluoridation: Evidence Evaluation Report, report to the National Health and Medical Research Council, Canberra. The NHMRC Clinical Trials Centre (CTC) is a not-for-profit, academic research organisation that .
Staying Healthy for Beginners: an English Learner's Guide to Health Care and Healthy Living, which is available on FLC's website. Used together, the teacher and student guides seek to enhance students' understanding of health information, while at the same time improving their English language and literacy skills. Staying Healthy for .
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