17. Infection Control Policy

15.POLICY ON INFECTION CONTROL

1. RATIONALE AND POLICY CONSIDERATIONS

The Policy on Infection Control must specify the procedures to be followed in the service to protect staff (paid and unpaid) and children attending the service from the transmission of infections.

“Children who spend time in group childcare settings such as the preschool setting generally are open to contracting a wide range of illnesses (particularly gastrointestinal and respiratory illnesses). Infants and toddlers are at particular risk of infection - they explore the environment with their mouths, have poor control of their secretions and excretions, have little immunity to common illnesses and require a lot of hands-on care from adults. In order to minimize the risk of infection, Standard Infection Control Precautions should be used routinely in all [early years] settings.”

(Management of Infectious Disease in Childcare Facilities and Other Childcare Settings (2012) Preschool and Childcare Facility Subcommittee Health Protection Surveillance Centre (HPSC))

Adults too need to be protected, as far as possible, from the spread of any infection and the service has a duty of care to all of the children and adults who use the service as well as to all members of the staff team.

“Standard precautions are basic good hygiene measures (e.g. hand washing, appropriate use of protective clothing, environmental cleaning etc.) that should be practiced by all caregivers at all times and with all children. It is not always possible to tell who has an infectious disease, infection can be spread by a person who has no signs and symptoms of illness or is incubating an infection e.g. flu, Chickenpox. For this reason, it is essential that good hygiene practices are applied routinely in all childcare settings.”

(HPSC, 2012)

The overall aims of this policy are:

· To promote and protect the health of all of the children and adults in the service and reduce the risk of infection.

· To provide guidelines to parents/guardians/carers as users of the service about the attendance of sick children and to keep the incidence of infectious disease to a minimum.

· To help differentiate between minor (can attend the service) and more significant (should not remain in the service) infections and to give guidance on the prevention and management of infectious disease

It is also important to encourage and support parents/guardians to maintain their children’s immunisation schedules.

Legislation and regulatory requirements

· Regulation 10 of the Child Care Act 1991 (Early Years Services) Regulations 2016, requires a Policy on Infection Control that specifies the procedures to be followed in the service to protect staff members (paid and unpaid) and children attending the service from the transmission of infections.

· Regulation 23: Safeguarding Health, Safety and Welfare of Child requires that the Infection Control Policy is implemented; staff know their roles and responsibilities and have received training on the policy.

· Regulation 31: Notification of Incidents requires that where there is a diagnosis of a notifiable illness [1] as defined in the Infectious Diseases Regulations 1981(SI No 390 of 1981) of any child attending the service or any staff members this must be notified to the Tusla Early Years Inspectorate.

Other relevant requirements include:

· The Safety, Health and Welfare at Work Act, 2005, Number 10 of 2005, sets out the general duties of all employers to manage the safety, health and welfare of their employees in any place of employment. [Guidelines on the Act and its requirements are available on the Health and Safety Authority’s website: www.hsa.ie]

· The Safety, Health and Welfare at Work (Biological Agents) Regulations 2013 (S.I. No. 572 of 2013) set down the minimum requirements for the protection of workers from the health risks associated with biological agents in the workplace. [biological agents include bacteria and viruses] The duties include carrying out a risk assessment and putting in place the appropriate measures to protect employees’ health and safety.

Children need:

· The service to have efficient and effective systems and procedures in place that ensure that their health and wellbeing are protected.

· Their parents/guardians to know what their responsibility is, in helping to protect them and others in the service.

Parents/guardians need:

· To be clear on what systems and procedures are in place to protect their children from infections and to deal with any incidences of infection that occur in the service.

· To know the durations and the reasons for any exclusion periods that may apply in relation to their child during any incidences of infectious diseases and they need to know what will happen should their child become ill while attending the service.

All members of the staff team need:

· To be very clear on their roles and responsibilities relating to infection control in the service.

· To know what parents/guardians must be told in relation to keeping their child away from the service during any outbreak of an infectious disease and exactly what to do in the case of a child becoming ill while at the service.

Management needs:

· This policy to help with ensuring that their legislative and regulatory responsibilities relating to infection control in the service are met and that all relevant best practice guidelines are implemented in the service.

· To ensure that everyone in the staff team and all parents/guardians are clear on their roles and responsibilities in relation to protecting everyone in the service as well as the reasons for, and the required duration of, exclusion periods for any diagnosed cases of infectious illness.

National Quality Frameworks

Tusla: Quality and Regulatory Framework

Síolta: The National Quality Framework for Early Childhood Education

See information on best practices for minimising the spread of infectious diseases in Management of Infectious Disease in Childcare Facilities and Other Childcare Settings (2012) Preschool and Childcare Facility Subcommittee Health Protection Surveillance Centre (HPSC)

2. DEFINITIONS/GLOSSARY

INFECTIOUS DISEASE	An illness in which the symptoms and signs of illness are caused by germs. These germs can be any of a number of different types - bacteria, viruses, fungi, protozoa and parasites. For example, strep throat is caused by a bacteria called ‘group A streptococcus’ and impetigo, a common bacterial skin infection in children, can be caused by this or other bacteria, whereas measles, mumps and chickenpox are all caused by viruses.
CONTAGIOUS DISEASE	Any illness caused by germs is an infectious illness, but that which can pass from one person to another is contagious. Not all infectious diseases are contagious. Ear infections are caused by germs, but are not passed from child to child. Thus, although an ear infection is an infectious disease it is not a contagious disease. On the other hand, chickenpox rapidly spreads from person to person and is an example of a highly contagious infectious disease.
STANDARD PRECAUTIONS	Basic good hygiene measures (e.g. hand washing, appropriate use of protective clothing, environmental cleaning etc.) that should be practiced by all caregivers at all times and with all children. It is not always possible to tell who has an infectious disease, infection can be spread by a person who has no signs and symptoms of illness or is incubating an infection e.g. flu, Chickenpox. For this reason, it is essential that good hygiene practices are applied routinely in all early years settings. (HPSC, 2012)
CLEANING	The removal of food residues, dirt and grease using a detergent.
DISINFECTION	A process that reduces the numbers of bacteria to a safe level.
DISINFECTANT	A chemical that will reduce the number of germs to a level at which they are not harmful.
DETERGENT	An artificial cleansing agent capable of breaking down oils and fats.
SANITIZERS	A combined detergent and disinfectant.

3. POLICY STATEMENT

The aim of this policy is to ensure an environment is provided in which children and adults are kept safe and staff members may safely carry out their roles.

This policy must be read in conjunction with Management of Infectious Disease in Childcare Facilities and Other Childcare Settings (2012) from the Preschool and Childcare Facility Subcommittee at the Health Protection Surveillance Centre (HPSC), which guides practice in infection control in this early years service.

There are three basic principles of infection prevention outlined in the HPSC guidance:

1. Handwashing is the single most effective way of preventing the spread of infection and should be used at every opportunity

2. Immunisation. All children and staff should be appropriately immunised

3. Exclusion. Any unwell staff member or child should be excluded (see Illness and Exclusion Policy; see Appendix B)

The HPSC guide outlines the most effective ways to prevent infection and can be summarised as follows:

· To protect staff and children from the spread of infections, [early years] staff need to understand how diseases are spread and which measures interrupt their spread.

· The spread of germs can be greatly reduced if standard precautions (see below) are used consistently and regularly.

· It is vital that staff receive training in the use of Standard Precautions. This is particularly important because some diseases are contagious before symptoms appear and because the disease status of a child may not be known.

· The single most important way to prevent the spread of germs is by hand washing.

· Maintaining a good standard of environmental hygiene, coupled with appropriate cleaning of toys, personal care items, utensils and bed linen as well as appropriate disposal of items soiled with body fluids are other important precautions.

Standard precautions are applied when anyone has contact with:

· Blood

· All body fluids, secretions (nasal secretions) and excretions (urine, faeces, vomit) except sweat, regardless of whether or not they contain visible blood

· Non-intact skin (broken skin, sores)

· Mucous membranes (eyes and mouth).

The key elements of standard precautions taken in the service include:

· Hand washing and skin care

· Use of protective clothing, e.g. gloves and plastic apron

· Management of spillages, i.e. blood or other body fluids

· Management of cuts, bites and needle-stick injuries

· Coughing and sneezing etiquette

· Environmental hygiene

· Safe handling of laundry

· Safe handling and disposal of waste including sharps

· Food hygiene.

Exclusion of children on the basis of infectious diseases

Children are excluded only if they are actually ill,

present a danger or a risk to others (children or adults)

or are unable to benefit from the service’s normal activities.

There are some particular illnesses/symptoms, where exclusion is necessary.

In order to ensure the safety and health of all our children and staff those who have any of the following conditions will be excluded from the service:

· Acute symptoms of food poisoning/gastro-enteritis.

· Temperature 38 degrees or over

· A deep persistent coughing

· Severe congestion

· Eye discharge

· Difficulty breathing or untreated wheezing

· An unexplained rash or skin disorder

· Vomiting

· Diarrhoea²

· Strep throat

· Lice or nits - see Head Lice Policy and Procedure

· Contagious condition

· A child who is on an antibiotic for less than 24 hours

· A child that complains of a stiff neck and headache with one or more of the above symptoms

If any of above symptoms are evident, parents are asked to keep their child away from the service, and staff members are required to stay away, until they have seen their GP.

Specific exclusion periods are necessary, and are applied, for particular diagnosed illnesses as outlined in Appendix B.

· Any ill child in the service who becomes ill with fever, headache and vomiting will be sent home as soon as their parents or guardians can be contacted. Parents will immediately be made aware of the staff’s concerns for the child’s well-being.

· In this situation, if there is any significant delay in contacting the child’s parents/guardians the child will be brought directly to the local hospital Emergency Department.

· A child with fever, headache and vomiting must not be allowed to wait indefinitely in the service.

· Parents/guardians are included in the team approach to infection control. A co-operative approach between parents and the service will help to ensure a healthy environment for the children.

· Parents/guardians who feel their child is too ill or unwell to participate in indoor or outdoor activity, are advised to keep them home to ensure a complete recovery.

· Keeping immunisation records for all children attending the service is a legal requirement. Prior to enrolment parents/guardians are asked for a copy of their child’s immunisation passport or record card. Parents/guardians are encouraged to ensure that their child is fully up to date with their immunisations and are required to inform the service if their child has not received any of the standard vaccinations. If the child is not fully vaccinated, parents need to provide the letter and declare their full responsibility of health and safety of own child. Also, the child might be refused the place or be excluded for some days, if the risk for other children will be identified by the service.

· Parents/guardians must inform the service of any known infectious illness in their child. This is of particular importance if the illness might affect others in the service, for example, if a child develops chickenpox or measles or other such contagious illnesses.

· Parents/guardians are informed by text if there are any outbreaks of contagious infection in the service.

· Parents/guardians of children with any chronic (persistent or long-term) infectious conditions will be encouraged to share this information with the service.

· All female staff members need to know if they are immune to Rubella.

· (A simple blood test can tell if someone is susceptible to infection.)

· All parents/guardians/carers and staff members will be notified of any known incidence of Rubella in the service.

4. Procedures & Practices

Prevention of Spread of Infection:

1. Handwashing

· Posters of correct hand washing procedures are available at wash hand basins for adults and children. (See Appendix A.)

· Warm running water is available for hand washing at a temperature no greater than 43°C at children’s wash hand basins.

· A cleaning agent such as soap is used when hand washing.

· Hand drying facilities are available - disposable paper towels are used

· Children’s hand washing and hand drying is supervised at all times.

· Hands are washed and dried after using the toilet, after handling animals, after sneezing, blowing nose, coughing, or touching a cut or sore and before eating or handling food.

2. Respiratory hygiene (coughing and sneezing)

· All adults and children cover their mouths and nose with a tissue or if no tissue, they use their sleeve, when coughing or sneezing (See Appendix C.)

· As required, we will notify the Tusla Early Years Inspectorate when the department of Public Health has confirmed to us that there is a diagnosis of a child attending the service, an employee, unpaid worker, contractor or other person working in the service as suffering from an infectious disease within the meaning of The Infectious Diseases Regulations 1981 (SI No 390 of 1981) and amendments. www.hpsc.ie/NotifiableDiseases/ListofNotifiableDiseases/

We will contact the local Department of Public Health:

· If we have a concern about a communicable disease or infection, or if we need advice on infection control.

· If we are concerned that the number of children who have developed similar symptoms is higher than normal / if we think that we may have an outbreak of infectious disease in the service.

· If we are not sure whether to exclude a child or member of staff.

· Before sending letters to parents/guardians about an infectious disease.

3. Cleaning the environment

· A cleaning programme is in place (Appendix D)

· Detergents and disinfectants are used correctly

· Detergents and disinfectants are used according to the manufacturers’ instructions.

4. Personal protective clothing

· Protective clothing is used when required (gloves and aprons).

5. Blood and body fluid spillages

· Standard Precautions as outlined in Management of Infectious Disease in Childcare Facilities and Other Childcare Settings (2012) are used when any member of staff has contact with:

· Blood

· All body fluids, secretions (nasal secretions) and excretions (urine, faeces, vomit) except sweat, regardless of whether or not they contain visible blood

· Non-intact skin (broken skin, sores)

· Mucous membranes (eyes and mouth)

· Spillages of blood, faeces, urine and vomit are cleaned immediately using disposable cloths and disposed of in closed bin. Mops are never used for cleaning blood, urine, vomit or faeces.

· Extreme care must be taken in cleaning up bodily fluids using Standard Precautions.

· It should be assumed that blood is infectious, regardless of its source.

· The procedure used for dealing with blood and body fluid spillages is as outlined in Management of Infectious Disease in Childcare Facilities and Other Childcare Settings (2012) on Page 13. This procedure is attached as an appendix E to this policy and printed and displayed close to the cleaning sink.

· First Aid should not be withheld if gloves are not available. While due care and caution is important in handling potentially infectious fluids, fear of infection should never prevent First Aid being given.

· Avoid direct contact with blood or bloody fluids. Should blood come in contact with skin the likelihood of transmission of infection through intact skin is very remote. DO NOT PANIC. Wash the area with soap and water. If blood splashes into the eye or mouth, rinse with water.

6. Laundry

· Soiled linen is washed separately at the hottest wash the fabric will tolerate. Gloves and aprons are used when handling soiled linen. Soiled linen is placed in the plastic bag sealed and store in the laundry box.

· Children’s soiled clothing is placed in a plastic bag sealed and sent home with parents/guardians.

7. Waste

· Waste is recycled in accordance with local authority policy where possible.

· Nappies are stored in a leak proof airtight container which is easy to clean.

· Foot operated pedal bins are used to dispose of gloves, aprons and soiled dressings.

· External bins are stored away from children’s access.

8. Animals, pets including poultry and fish

· Hand washing and drying procedures are adhered to before and after handling animals, pets, poultry and fish.

· All animals, pets, poultry and fish are managed in accordance with required and appropriate instructions for their care.

· Children are not allowed unsupervised access to animals, pets, poultry and fish.

· Animal, pet, poultry vaccination and health care are in accordance with veterinary advice.

[For guidance to develop specific procedures relating to Pets and Farm/Zoo Visits see Management of Infectious Disease in Childcare Facilities and Other Childcare Settings (2012) pages 30-32.]

9. Sterilising babies’ bottles

Sterilisation procedures (infants’ feeding equipment and soothers) are carried out at home.

10. Perishable food

· All perishable food is kept in a refrigerator at temperatures of 0°– 5°C.

· Perishable food is not left at room temperature for more than two hours.

· Perishable food left at room temperature for two hours or longer is discarded.

11. Other precautions

· Cots, sleeping mats and beds are at least 50cm apart.

· Toys and other play materials are not allowed into the toilet area.

· Individual combs, hairbrushes, toothbrushes, personal clothing, bedding and towels are labelled and not shared.

· At least once a day, even in winter, the children’s playrooms and staff-rooms are aired and the windows opened.

· A box of tissues is always readily available to all children and adults.

13.Nappy Changing and Toileting

(See nappy Changing and Toileting Policy)

14.Immunisation

· On enrolment, parents/guardians are asked for their child’s immunisation record. Full information on the schedule of immunisation is available at:

· National Primary Childhood Immunisation Schedule

· www.hse.ie/eng/health/immunisation/pubinfo/pcischedule/immschedule/

· Health Service Executive: Immunisation Guidelines for Ireland

· www.hse.ie/eng/health/immunisation/hcpinfo/guidelines]

· Parents/guardians of children who are not immunised are made aware of the dangers of infectious diseases. Parents are encouraged to keep to up to date with current vaccination requirements and to ensure that the service is kept informed and the child’s record updated when required.

· Parents/guardians are not required to have their children immunised to gain admission to the service but where a child’s immunisation record is not up-to-date parents/guardians are encouraged to have their child vaccinated.

· If a child is not immunised, parents/guardians must be advised that their children will be excluded from the service during outbreaks of some vaccine preventable diseases such as Measles, Whooping Cough etc., even if their child is well. This is to protect their non-immunised child.

15.Illness

When a child is unwell, parents/guardians are asked to keep them at home if they are unable to participate in all of the activities of the day and/or if there may be a risk of passing the illness to another child or adult in the service.

This is necessary under the exclusion procedure above if the child has any of the following symptoms:

· Diarrhoea and vomiting

· A temperature of 101°F / 38°C or above

· Eye discharge

· Rash or skin disorder

· Strep throat

· An earache or a bad cough. See more details on page 6-7 of this policy.

· If a child is ill or becomes ill in the service, we will expect the parent/guardian or a nominated carer to come for their child within 30 minutes.

· We will do our best to keep a sick child separate from well children. The availability of a quiet space – removed from the playroom/classroom where possible – where a child who becomes acutely ill during service hours can go and lie down or rest is essential. This is an obvious comfort to the child, but also importantly, it allows supervision of the child while awaiting the arrival of their parents/guardians and removes any acutely ill child from close contact with other children thus decreasing the risk of spread of infection.

· If all attempts at contacting a parent/guardian/carer or authorised person are unsuccessful, the next action may have to be to transfer the child to hospital by ambulance.

· Any child ill with fever, headache and vomiting must be sent home as soon as their parents/guardians can be contacted. Parents will be advised to contact their doctor immediately.

· If there is any significant delay in contacting parents/guardians of the child with fever, headache and vomiting, CALL AN AMBULANCE and then continue to try to contact the child’s parents/guardians. A child with fever, headache and vomiting must not be allowed to wait indefinitely in the service.

· In addition to these symptoms, children with meningococcal infection often develop a rash that starts as red spots but will progress to purple freckles and blotches, and even bruising (see Appendix I ). If this occurs CALL AN AMBULANCE, GET MEDICAL ATTENTION first and then contact the parents/guardians.

Exclusion periods for infectious illnesses: Appendix B.

Ill children and staff should only return when they have recovered. See exclusion notes for the different diseases outlined in Chapter 9 of Management of Infectious Disease in Childcare Facilities and Other Childcare Settings (2012) page 33.

Procedure for notifying infectious diseases

When the service is informed by the Department of Public Health of a diagnosis of a child attending the service or an employee, unpaid worker, contractor or other person working in the service, as suffering from an infectious disease within the meaning of the Infectious Disease Regulations 1981(SI No 390 of 1981) and amendments – See: www.hpsc.ie/NotifiableDiseases/ListofNotifiableDiseases/ – this will be notified to Tusla Early Years Inspectorate by [the owner/manager] using the Child Care Act (Early Years Services) Regulations 2016 Part VIII, Article 31, Notification of Incident Form available attached to this policy, Appendix G

Outbreak of an infectious disease

A contingency plan must be in place in the event of an outbreak of an infectious disease. Areas of responsibility must be clearly defined and clear channels of communication must be established between all staff members involved. You will need to agree these in your own service and include them under this policy.

See Management of Infectious Disease in Childcare Facilities and Other Childcare Settings (2012) for guidance.

When to contact the local Department of Public Health:

· If there is a concern about a communicable disease or infection, or advice is needed on controlling them.

· If there is a concern that the number of children who have developed similar symptoms is higher than normal.

· If there is an outbreak of infectious disease in the service.

· To check whether to exclude a child or member of staff

· Before sending letters to parents/guardians about an infectious disease.

Although the child’s doctor is legally responsible for reporting serious illness, you should phone your local Department of Public Health if you become aware that a child or member of staff has a serious or unusual illness, (for example meningitis), or if a number of children or staff have the same symptoms suggesting an outbreak.

5. Communication Plan [For staff & families]

All parents/guardians are to be informed of the policy and procedures regarding Infection Control on enrollment and made aware that it is applied equally to all children, aimed at maintaining a healthy environment for all children and adults.

Staff members will check with parents/guardians that they have read and understood the policy and provide any assistance needed.

A summary of this policy will be included in the parent handbook. This policy will also be reviewed with staff at induction and annual staff training.

Handouts on infection may be given to parents/guardians/carers as a guide.

A copy of all policies will be available during all hours of operation to all staff and to parents/guardians in the Policy Folder located on Play Together Creche’s website at www.playtogethergalway.com

Policies are shared with all parents/guardians via email.

Parents/guardians may receive a copy of the full policy at any time upon request. Parents/guardians and staff will receive notification of any updates through Play together Creche’s official communication panel.

6. Related Policies, Procedures and Forms:

· Policy on Administration of Medication

· Risk Management Policy

· Health and Safety Policy

· Nappy Changing and Toileting Policy

· First Aid Policy

· Confidentiality Policy

· Illness and Exclusions Policy

· Records and Record Keeping Policy

· Hand washing Procedures (Appendix A)

· Exclusion periods for infectious Illnesses (Appendix B)

· Respiratory Hygiene (Coughing and sneezing) (Appendix C)

· Blood and Body Fluid Spillages Procedures (Appendix E)

· Tusla Notification of Incidents Form Appendix G

· List of Notifiable Illnesses Appendix H

7. References/Supporting Documents/Related Legislation

· Child Care Act 1991 (Early Years Services) Regulations 2016

· Tusla: Quality and Regulatory Framework

· Management of Infectious Disease in Childcare Facilities and Other Childcare Settings (2012) and Appendices

· Guidance on Infection Control in Schools and other Childcare Settings (2016) Public Health England produced with the assistance of the Royal College of Paediatrics and Child Health.

· Infection Prevention and Control in Childcare Settings (Day Care and Childminding Settings) October 2016 Health Protection Scotland NHS National Services Scotland

· A Guide to The Safety, Health and Welfare at Work Act, 2005 Health and Safety Authority

· A Guide to Risk Assessments and Safety Statements (updated 2016) Health and Safety Authority

8. Who Must Observe This Policy

This policy must be observed by all managers and all staff members.

Due to COVID-19 pandemic see our updated Policy on Infection control (Re-Opening COVID-19 Rosan Glas)

10. Contact Information

If you need more information about this policy, contact:

Name

Iwona Sawicka

Phone number or email

0833187143

091/458167 or 091/458999

11. Policy Created

Date this policy was created

March 2016

12. Signatures

	Name and position	Signature
Approved by	Iwona Sawicka

13. Review Date

Reviewed	March 2017	Iwona Sawicka
Reviewed	March 2018	Iwona Sawicka
Reviewed	March 2019	Iwona Sawicka
Reviewed and updated Reviewed	March 2020 March 2021	Iwona Sawicka Iwona Sawicka