1. Chapter 5 The Infectious Process and Environmental Control
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2. What Makes an Illness Communicable?
Three components are required for an illness to be communicable:
Pathogen
Susceptible host or individual
Method of transmission
   A communicable  illness is an infection that can be transmitted or spread from one person or animal to another. Three factors, all of which must be present at approximately the same time, are required for this process to occur (Figure 5–1).
a pathogen
a susceptible host
a method of transmission
First, a pathogen  or disease-causing agent, such as a bacteria, virus, or parasite, must be present and available for transmission. These invisible germs are specific for each illness and are most commonly located in discharges from the respiratory (nose, throat, lungs) and intestinal tract of infected persons. They can also be found in the blood, urine, and discharges from the eyes and skin. Most pathogens require a living host for their survival, with the exception of the organism that causes tetanus; it is able to survive in soil and dust for several years.
Second, there must be a susceptible host  or person who can become infected with the pathogen. The communicable illnesses that children most commonly experience usually enter their new host through either a break in the skin, the respiratory tract , or digestive tract. The route of entry depends on the specific illness or disease involved.
Not every child who is exposed to a particular virus or bacteria will become infected. Conditions must be favorable to allow an infectious organism to successfully avoid the body's defense systems, multiply, and establish itself. Children who are well rested, adequately nourished, immunized , and healthy are generally less susceptible to infectious organisms. Some children will have immunity as a result of having experienced a prior case of the same illness. However, the length of this protection varies with the illness and can range from several days to a lifetime. For example, a child who has had chickenpox will have permanent immunity to the
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3. What Makes an Illness Communicable?
Pathogen
Method of
Transmission
Susceptible
Host   
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4. How are Illnesses Transmitted?
Pathogens or organisms (e.g., viruses, parasites, bacteria, fungi) can be transmitted in several ways:
Airborne
Fecal-oral
Direct contact
Indirect contact
Give an example of an illness that is transmitted by each of these methods.
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5. Stages of an Infectious Illness
Describe what typically occurs during each of these stages:
Incubation
Prodromal
Acute
Convalescence
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6. Controlling Infectious Illness…..
Understanding the communicable process provides the most effective means for limiting the spread of infectious illnesses.
Teachers have an ethical and professional responsibility to protect the wellness of all children in a group setting.
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7. Infection Control Measures
Ongoing teacher observations provide early clues about a child’s changing state of health.
Policies should be in place and address a variety of protective measures such as exclusion guidelines, cleaning procedures, diapering procedures, food preparation, hand washing, and sanitation.
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8. Exclusion Guidelines 10A NCAC 09
Exclusion Guidelines 10A NCAC INFECTIOUS AND CONTAGIOUS DISEASES
(a) Centers may provide care for a mildly ill child who has a Fahrenheit temperature of less than 100 degrees axillary, 101 degrees orally, or 102 degrees rectally and who remains capable of participating in routine group activities; provided the child does not:
(1) have the sudden onset of diarrhea characterized by an increased number of bowel movements compared to the child's normal pattern and with increased stool water; or
(2) have two or more episodes of vomiting within a 12 hour period; or
(3) have a red eye with white or yellow eye discharge until 24 hours after treatment; or
(4) have scabies or lice; or
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9. Exclusion Guidelines 10A NCAC 09
Exclusion Guidelines 10A NCAC INFECTIOUS AND CONTAGIOUS DISEASES
(5) have known chicken pox or a rash suggestive of chicken pox; or
(6) have tuberculosis, until a health professional states that the child is not infectious; or
(7) have strep throat, until 24 hours after treatment has started; or
(8) have pertussis, until five days after appropriate antibiotic treatment; or
(9) have hepatitis A virus infection, until one week after onset of illness or jaundice; or
(10) have impetigo, until 24 hours after treatment; or
(11) have a physician's or other health professional's written order that the child be separated from other children.
Exlcusion should apply to staff as well
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10. Infection Control Measures (continued)
Immunizations should be current and required for children and teachers.
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11. Immunizations
All children in North Carolina must be vaccinated against certain diseases.
Immunization records are checked when a child enters a child care center.
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12. Required vs. Recommended in North Carolina
All children in North Carolina are
required to be vaccinated against:
Diphtheria
Hepatitis B
Hib Disease
Measles
Meningococcal
Mumps
Pertussis (whooping cough)
Pneumococcal
Polio
Rubella
Tetanus
Varicella (chickenpox)
The CDC also recommends
Children be vaccinated against
the following diseases, although
Immunization against these
diseases is not required for
children in North Carolina:
Hepatitis A
Influenza
Rotavirus
Human Papillomavirus

13. Children Need These Shots:
By this age:
Children Need These Shots:
3 months
1 DTaP
1 Polio
1 Hib
1 Hep B
1 PCV***
5 months
2 DTaP
2 Polio
2 Hib
2 Hep B
2 PCV***
7 months
3 DTaP
2-3 Hib
3 PCV***
12-16 months
3-4 Hib
1 MMR
1 Var+
4 PCV***
19 months
4 DTaP
3 Polio
3 Hep B
4 years or older (in daycare only)
4 years and older (and in kindergarten)
5 DTaP
4 Polio
2 MMR*
2 Var+

14. Child Care Operator's Responsibility
The child care facility maintains on file immunization records for all children attending the child care facility, which contains the information required for a certificate of immunization.
When a child transfers to another child care facility, the facility where the child previously attended must, upon request, send a copy of the child’s immunization record, at no charge, to the child care facility or school to which the child has transferred.
The child care operator must complete and submit annually to the N.C. Immunization Branch the Annual Child Care Immunization Report.
This report is due to the N.C. Immunization Branch on December 1st of each year.
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15. Infection Control Measures (continued)
Environmental measures must be implemented and include:
Universal infection control precautions for handling body fluids (e.g. blood, feces, vomited matter) and disinfection (Table 5-2)
Using proper hand washing technique and washing at appropriate times (Tables 5-3)
Click on link and watch the CDC’s “Hands Together” video on hand washing:
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16. Environmental measures (continued)
Cleaning and disinfecting eating and food preparation areas, bathrooms, diapering areas, toys, and equipment (Table 5-4).
Arranging rooms to minimize extended periods of close contact.
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17. Environmental measures (continued)
Maintaining comfortable room temperatures; opening doors and windows for fresh air.
Taking special precautions with sandboxes, pools, and water tables.
Teaching children, teachers, and families about infectious illness and effective control measures.
Informing families of exposure
Sample exposure letter
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18. Administering Medication
When parents request that medicine be given to their child, you will need to make sure you have all the documentation and materials required to legally and safely give the medication.
If medication is brought into the center for a child riding a van or bus, the medication must be transferred between responsible adults.
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19. Permission to Administer Medication:
Check to see if parents have completely filled out the required information on the Permission to Administer Medication form.
Parents must provide written permission for prescribed medication and for over-the-counter medication.
This meets the requirement for written permission from the parent to give the child a medication.
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20. Permission to Administer Medication:
The written permission slip must include:
Name of the child
Any special instructions, like give with food or milk
Name of the medication
Dosage
Any possible reactions to watch for
Dates to be given
Times to be given
Parent’s signature
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21. For prescribed medications:
Check to see that the medication is in its original container.
Be sure the container is properly labeled with the:
• Name of the child who will be given the medication
• Name of the medication or prescription number
• Directions for giving the medication: dose, time, number of days, and the route. (Route refers to the way the medication is given: for instance, by mouth, by eye drops or eardrops, or applied topically to the skin.)
• Name of the prescribing physician or other health professional
• Date the prescription was filled
• Date the medication expires
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22. For over-the-counter medications:
Cough syrup, decongestants, and acetaminophen
are examples of over-the-counter medicines.
Check to see that the medication is in its original container, has the child’s name written on it and that the directions are visible and understandable.
Caregivers can only give the recommended dosage included in the instructions found on the packaging, unless the medication is accompanied by written instructions signed by a physician.
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23. Administering Medication
Before giving medication:
• Wash your hands before giving or applying medication to each child.
• Check that the parent has signed and provided all the required information on the Permission to Administer Medication form.
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24. Administering Medication
Take the medication out of the locked storage area or container.
Relock.
Prepare the dose.
Avoid touching the medication with your hands.
Use an appropriately labeled medicine dropper, cup, or spoon
for accurate measuring of liquid medications.
Do not use tableware such as spoons for measuring, as they are not accurate.
Double check the time, the amount of the dose and the route
of administration on the container label and on the permission
slip.
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25. Remember:
• Never give a medication you do not have written permission from the parent to give. • Never give a medication that has expired. • Never give a medication someone else prepares. • Never give medication by a route you are not comfortable with or for which have not received enough training.
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26. Administer medication:
Give the exact dose to the child, by the route specified.
Follow any special instructions, such as giving the medication with food or on an “empty stomach”.
Wash your hands.
Return the medication to the locked storage area or container.
Relock.
Document that you have given the medication by completing the required information on the “Permission to Administer Medication” form (date, time, dose, route, signature).
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27. After medication is given:
If an error is made administering the medication, be sure to document what was given and inform the parents and director of the error.
Additional documentation may be needed.
Observe the child’s response to the medication and report any side effects or reactions to the parent, the child care health consultant or physician if necessary.
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28. After medication is given:
If an allergic reaction occurs, the parent should be notified immediately.
If a life threatening reaction occurs, dial 911 immediately and:
Follow the emergency action plan for your facility.
If the child has special health needs, follow the instructions on the child’s individual health plan.
Complete the required incident report.
Keep a copy in the child’s folder, send a copy to DCD, and give the parents a copy.
Record the incident in the incident log.
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29. Return unused medication to the parents after the last authorized dose has been given to the child.
Return expired medications to parents or dispose of them if the parents do not want the expired medications
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30. Caring for Mildly Ill Children
Factors to consider
Is the illness highly contagious?
Will other children be placed at risk?
Does the child feel well enough to participate?
Does the child’s illness place them at greater risk of catching something else?
Can teachers meet the child’s needs as well as those of the other children in attendance?
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