Paediatric Infection Control Jodie Burr Infection Control Coordinator Women’s and Children’s Hospital

IC Issues specific to children Communicable diseases affect a higher % of children than adults Developmental immunity (increased susceptibility) - acquire – spread

IC Issues specific to children Child care staff are at a greater risk for exposure to communicable diseases - immune status Type and amount of physical contact (eg feeding, diapering)

IC Issues specific to children May lack the mental / physical ability to adhere to IC principles lack of hygiene unable to understand / comply with IC principles

IC Issues specific to children More likely to have contact with contaminated environmental surfaces and objects

IC Issues specific to children Parents and siblings may have the same infectious agent education about transmission and IC principles

Spread of Infection Sources of infections The host’s own (endogenous) flora The hand’s of child care workers Inanimate objects (fomites) After being exposed to an infectious agent: Some people already have immunity and therefore don’t develop an infection Some people become asymptomatic carriers Other people develop clinical disease (ie infection)

Spread of Infection The Susceptible Host Varies with age Underlying medical conditions Nutritional status Drug therapy Trauma Surgical procedures Invasive or indwelling devices Therapeutic and diagnostic procedures

Spread of Infection 3 main routes of transmission Contact Direct / Indirect Most frequent means of transmission Droplet Generated during coughing, sneezing, talking Airborne Generated by coughing, sneezing, OR by, OR by air currents

Standard Precautions Apply to: Blood Non-intact skin Mucus membranes All body fluids (including sweat) Regardless of whether there is visible blood or body fluids

Standard Precautions Hand Washing The single most effective method in the prevention of disease transmission is to wash your hands well

Hand Washing How to wash your hands Use soap and running water Rub hands together (count to 10) Wash all over, including: Backs of hands Wrists Fingers, nails and thumbs Rinse hands well (count to 10) Dry hands thoroughly

Areas most frequently missed

When to wash hands When you arrive at the centre Before handling food Before eating After changing nappies \after going to the toilet After cleaning up, coming onto contact with faeces or vomit or other body fluids After wiping noses (either your own or a childs)

Specific childcare issues Nappy change area: Have a specific area for nappy changing Clean nappy change area after each nappy change Wear gloves Wash hands afterwards Linen Use hot water and detergent Wear gloves if linen soiled Ensure clean linen is stored away from soiled linen

Specific childcare issues Toys All shared toys should be able to be washed Sandpits Keep well maintained and clean Ensure good drainage, rake often , cover Dispose of any soiling (blood, faeces, etc) Blood / body fluid spills Wear gloves Detergent & water +/- bleach Dispose of soiled articles or place in waterproof bag for parents to take home

Food Ensure that tables and area are clean Wash your own and the children’s hands Do not share food, plates, eating utensils Serve food rather than use a communal dish Use a separate spoon for each baby fed

Handling food Wash hands Keep raw food separate from cooked foods Use different utensils for raw and cooked foods Keep food hot or cold (do not keep food warm for a period of time) Reheat food and bottles only once Throw out left overs

Be aware of symptoms suggesting infection Infectious diseases Be aware of symptoms suggesting infection Severe, persistent, prolonged coughing Conjunctivitis Unusual spots or rashes Crusty or discharging skin lesions Frequent scratching Unusually coloured / smelly faeces or urine Sore throat / difficulty in swallowing Vomiting. Headache, stiff neck Loss of appetite Diarrhoea

Infectious diseases Have a written policy regarding what to do if a child is unwell, may include: Notify director and parents Separate ill child Take the child’s temperature Encourage parents to inform staff if a family member is ill

Infectious diseases and staff Most infectious diseases can be prevented by good hand washing Ensure immunization status is up to date Pregnant staff should be aware that some diseases may have an impact on their pregnancy Infected child care workers may be excluded from working

Meningococcal Disease Bacterial infection caused by Neisseria meningitidis Transmitted by contact or droplet Non infectious after 24 hours of appropriate antibiotic therapy Significant contacts traced and may be given prophylaxis

Meningococcal Disease

Measles Complications more common and severe in chronically ill and very young children Transmitted by droplet and contact with respiratory secretions Infectious for 4 days before and after rash Vaccination available Notifiable disease

Measles

Rubella In early pregnancy risk of teratogenic damage to fetus Infectious for 7 days before and 7 - 15 days after onset of rash Infants with congenital rubella may shed virus for several months or years Transmitted by droplet route Vaccination available Notifiable disease

Rubella

Varicella Zoster Virus Chicken Pox Highly contagious Most cases in children, over 90% of adult population is immune Transmitted by droplet and contact Infectious 2 days prior and 4 - 6 days after rash Now a notifiable disease Vaccination now available

Varicella or Chicken-pox

Parvovirus B19 Usually a mild rash disease Also called Fifth Disease or “Slapped - Cheek” Infectious prior to the rash Transmitted by droplet route

Parvovirus B19

Hand, foot and mouth disease Incubation period: 3 – 5 days Infectious period Whilst fluid in blisters Transmission: Contact with blister fluid / faeces Control: Exclude until blisters have dried Good hand washing

Hand, foot and mouth disease