UPDATES ON INFECTION CONTROL INSPECTIONS IN CHILD CARE CENTRES - - PowerPoint PPT Presentation

UPDATES ON INFECTION CONTROL INSPECTIONS IN CHILD CARE CENTRES

Public Health Services

October 12, 2016

Infectious Diseases Program

Kelly-Anne Colling Julie Gordon

2 Public Health Services

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
• f 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.”

3 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”

4 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

5 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

6 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

7 Public Health Services

Infectious Disease s Program

8 Public Health Services

Infectious Diseases Program

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

9 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

10 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)

11 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 Diarrhea - Shigella Until a negative stool specimen is collected at least 24 hours after symptoms resolve Diarrhea – Giardia Until symptom free for 24 hours Diarrhea - Norovirus Until 48 hours after last diarrhea bowel movement Diarrhea – Salmonella and Campylobacter Until 24 hours after last diarrhea bowel movement 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 Pertussis (whooping cough) Until 5 days after antibiotics are started, or until 3 weeks if not treated with antibiotics Pinkeye with discharge Until 1 full day of antibiotic treatment (if bacterial) or until doctor 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 Vomiting Until the vomiting stops, or it is determined that the vomiting is caused by a non-infectious condition

12 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
• ur 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

13 Public Health Services

Infectious Diseases Program

What to do in the event of an

• utbreak?
• 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

14 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

• r 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.

15 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

16 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, counters, faucet handles, etc.) Daily

17 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

18 Public Health Services

Infectious Diseases Program

Clean-up of Body Fluids

• Remove children from the area and begin clean-up

immediately

• Wear disposable gloves and any other personal protective

equipment as required

• Body fluids can be soaked up using disposable paper towels

and discarded in a leak proof plastic bag which is tied up and placed the garbage receptacle

• Thoroughly clean the surface with a detergent and rinse with

water

• After area is cleaned, apply disinfectant (1:10 bleach and water

mixture) or other disinfectant following the manufacturer’s instructions

19 Public Health Services

Infectious Diseases Program

Clean-up of Body Fluids Continued

• Remove gloves and personal protective equipment. Place in a leak-

proof bag, then place in the garbage.

• Wash hands with soap and water.
• Vomit or blood that contaminates a sensory play table requires

immediate closure to drain/empty, wash, rinse and high level

• disinfect. All the toys or articles that were in the sensory bin require

cleaning and disinfecting as well.

20 Public Health Services

Infectious Diseases Program

Food Safety

• Food handlers must adhere to the

requirements of the Ontario Food Premises Regulation R.R.O. 1990, Reg. 562

• Cold hazardous foods are to be maintained at

40 C or less

• Hot hazardous foods are to be maintained at

600 C or higher (after final cooking temperatures have been reached)

• Frozen foods must be maintained at -180 C or

less

21 Public Health Services

Infectious Diseases Program

Food Safety Continued

• Medium and high-risk daycares must have a certified food handler
• n-site, supervising the preparation of food
• Ill food handlers cannot work until they are well
• Food prepared at home cannot be served at the child care centre. All

food brought in to the child care centre must come from an inspected food premises

• An integrated pest management program should be in place to

prevent infestations of mice, rats, cockroaches etc.

22 Public Health Services

Infectious Diseases Program

Dishwashers

• Dishwashers are to be maintained on a regular basis.

These units can be used to disinfect toys as well as food service articles

• Domestic dishwashers can be used no more than

twice per day and a chlorinated detergent must be used with these units

• Public Health Services is now phasing out domestic

dishwashers in child care centres. Child care centres with domestic dishwashers will be required to upgrade to a commercial dishwasher as per the Food Premises Regulation, if the current dishwasher breaks or kitchen renovations occur. All new child care centres are required to comply with the Ontario Food Premises Regulation

23 Public Health Services

Infectious Diseases Program

Animals in Child Care Settings

• Up to date anti-rabies vaccination are required for all dogs and cats, living in or visiting

a child care centre

• The kitchen is to remain free from live birds and animals at all times
• Hands must be washed thoroughly after handling pets, its food or belongings
• All animals that come to the centre must be healthy and have appropriate clearances

from a veterinarian

• Do not allow children to kiss animals or put their face too close to a pet
• Supervise children while they are handling pets
• Enclosures must be kept in clean and sanitary condition

24 Public Health Services

Infectious Diseases Program

Animals in Child Care Settings

• Never allow children to touch unknown dogs, cats or wild animals
• Animal bites and scratches
• Wash wound immediately with soap and warm water
• Rinse wound with clean water
• Record the event and advise parent/guardian to seek medical

attention

• Inform the parent that you will report the incident to Public

Health Services

• Collect the following information:
• Pet owner’s name, address and phone number
• Description of the animal (breed, colour, size)
• Description of the event prior to biting
• Report this information to PHS at 905-546-2489, including

the name of the victim and phone number of the parent/guardian

25 Public Health Services

Infectious Diseases Program

Animals in Child Care Settings

• Animals not recommended in child care centres:
• Stray animals
• Ill animals
• Animals less than 1 yr of age
• Animals fed raw food within 90 days
• Animals from shelters
• Pregnant or birthing animals
• Dangerous animals and predatory birds
• Venomous or toxin producing animals
• Aggressive animals
• Exotic or wild animals
• Rabies reservoir species (bats, raccoons and

skunks)

26 Public Health Services

Infectious Diseases Program

Animals in Child Care Settings

• Animals not recommended for

children < 5 years old:

• Exotic animals and non-human

primates

• Reptiles
• Amphibians
• Live poultry (chicks and ducks)
• Ferrets
• Farm animals (e.g. goats, sheep

and pigs)

27 Public Health Services

Infectious Diseases Program

Refer to this document for:

• Management of

animal food and treats

• Guidelines for

visiting animals

• Guidelines for

resident animals

28 Public Health Services

Infectious Diseases Program

TB Screening in Child Care Settings

Tuberculosis (TB) is a disease spread through the air by activities like coughing and singing. Although it can affect many different parts of the body, TB most

• ften affects the lungs. TB can also live in the body for many years without

causing any symptoms (latent TB infection). People with latent TB infection can receive medication so that they will not develop active TB disease, which can be spread to others. Children can catch TB easily from adults, although children seldom spread it to

• thers. To protect young children from TB infection, the City of Hamilton Public

Health Services recommends Tuberculosis (TB) screening for all staff, students, and volunteers working in a daycare setting. TB screening identifies individuals infected with TB. People infected with TB may receive free treatment to prevent

• r cure TB. The TB skin test (TST) is one way to check if a person has TB infection.

For all recommendations, a TST or medical assessment should be performed during the 6 months before hire/placement or within 2 weeks of hire/placement as long as the person has no symptoms of active TB disease

29 Public Health Services

Infectious Diseases Program

Recommendations for Staff, Volunteers and Students Completing Placement (e.g. ECE students)

• A single TB skin test (TST), regardless of BCG status, is recommended for

individuals who have never received a TB skin test before or don’t know their TST status.

• A single TST is recommended for individuals who have had a previously

documented negative TB skin test (< 10 mm for healthy individuals).

• A TST is not needed for individuals with a documented positive TST or a

history of TB infection or disease. These individuals require an assessment by a physician or nurse practitioner to rule out active disease.

• Individuals who have had a severe blistering TST reaction in the past, or have

extensive burns or eczema present over the TST testing sites, SHOULD NOT receive a TST. These people require an assessment by a physician or nurse practitioner to rule out active disease.

30 Public Health Services

Infectious Diseases Program

Requirements for Staff and Volunteers Continued

• Individuals with a positive TB skin test should know and monitor

for the symptoms of active TB disease (cough, fever, night sweats, decreased appetite, and weight loss). If symptoms develop they should see a health care provider right away. They should not work until the symptoms are assessed by a physician or a nurse practitioner. Yearly TB skin tests are not recommended. An annual CXR is not recommended for those with a positive TST.

31 Public Health Services

Infectious Diseases Program

New Children Attending Daycare

• TB screening is not routinely recommended for children

attending a daycare setting. For questions regarding TB screening in all settings, please call the Infectious Disease and TB Control Program at 905-546-2063, Monday through Friday, 9 a.m. to 4 p.m.

VACCINE PROGRAM

Public Health Services

October 12, 2017

Vaccine Program

Bridget Woudstra

33 Public Health Services

Vaccine Program

Child Care Provider Vaccine Requirements

In Hamilton, the medical officer of health recommends persons be vaccinated according to the current Publicly Funded Immunization Schedules for Ontario The employee or provider is considered vaccinated where he or she has started and will complete a vaccine series according to the Publicly Funded Immunization Schedules for Ontario. Note: Persons who are pregnant or may become pregnant, breastfeeding, with chronic disease or immunocompromised should consult with their physician prior to vaccination.

34 Public Health Services

Vaccine Program

Publicly Funded Immunization Schedule for Ontario

All Child Care Providers need to be vaccinated with (at a minimum):

• Diphtheria – complete series
• Pertussis – complete series
• Polio – complete series
• Measles (if born in 1970 or later) – one dose
• Mumps (if born in 1970 or later) – one dose
• Rubella (if born in 1970 or later) – one dose
• Varicella (if born in 2000 or later) – two doses

35 Public Health Services

Vaccine Program

Child Care Attendee Requirements

Vaccination Requirements: Students attending Child Care Centres should be vaccinated according to the Publicly Funded Schedule for Ontario. Dose amounts will depend on the age of the student.

• Tetanus
• Diphtheria
• Pertussis
• Polio
• Meningococcal Disease
• Varicella
• Measles
• Mumps
• Rubella

36 Public Health Services

Vaccine Program

Child Care Attendee Requirements

Exemption Forms Medical Exemption:

• If a student is unable to receive vaccinations due to a medical reason, the

student’s parent/guardian and family physician will fill out a medical exemption form. Statement of Conscientious or Religious Belief:

• If a student cannot receive vaccinations due to a philosophical belief, the

parent/guardian will have a statement of Conscientious or Religious Belief filled out and notarized.

• All immunization records and exemption forms need to be sent to Hamilton

Public Health, and a copy needs to remain with the child’s record at the Child Care Centre.

37 Public Health Services

Vaccine Program

Reporting Vaccines to Public Health

There are 3 forms Hamilton Public Health requires from a Child Care Centre:

• Vaccine History for Licensed Child Care Centre
• Child Care Enrolment Form
• Daycare/Nursery Monthly Admission/Withdrawal Form

38 Public Health Services

Vaccine Program

Reporting Vaccines to Public Health

Vaccine History for Licensed Child Care Centre This record should be filled out by the parent/guardian Try to ensure the information on the form is as complete as possible Keep the yellow carbon copy with the child’s records and send the white copy to Hamilton Public Health We want to thank all our providers who help parents/guardians who may not be able to write or understand English or French. Thank you!

39 Public Health Services

Vaccine Program

Reporting Vaccines to Public Health

Child Care Centre Enrolment Form

Please Fill out the Child Care Centre Enrolment Form every year. Try to get the form to us nearest the beginning of the school year (September/October)

40 Public Health Services

Vaccine Program

Reporting Vaccines to Public Health

Daycare/Nursery Monthly Admission/Withdrawal Form Please send Hamilton Public Health this form monthly If there are no new admissions or withdrawals, send the form with both boxes ticked.

QUESTIONS?

Public Health Services

Infectious Diseases Program

THANK YOU

Public Health Services

Infectious Diseases Program