Promote Hygiene & Safety Practices & Promote Appropriate Practices To Respond To Illnesses

Introduction
In this section, you will look at:
health and hygiene requirements within childrens services environments reporting requirements to parents and health authorities

development of polices and procedures

monitoring policy compliance

Infection Control
children under two have a higher risk of illness when they attend child care
this risk decreases in children over two upper respiratory infections are the most common infection

infectious diarrhoea is the second most common illness

the amount of cases of both of these infections can be reduced with good infection control routines

The benefits of good infection control practices are:

modelling of appropriate behaviours for children

fewer children become ill

fewer staff members become ill

fewer phone calls to parents to tell them their child is ill less financial problem for parents, as they do not need to take time off from work

less administration work in replacing staff who are sick.

To be able to analyse work practices and their effectiveness, you need to understand how infectious diseases are spread. The word spread means to move out over a larger area. This is what germs do. They leave the host (the person who is sick), live in the environment, move on to the next host, multiply and make that person sick. Germs are microscopic, which means that we cannot see them with our naked eye. Germs can be viruses, bacteria, fungi or protozoa. They can survive on objects, such as toys and taps, for varying amounts of time, depending on the germ itself.

Infections spread in the following ways: Airborne droplets: when we sneeze or cough, droplets are expelled into the air or settle onto objects, such as toys. These droplets are then inhaled by the next person or transferred from surface to surface, and hand to mouth. Hands infected with nasal and throat discharges after wiping a nose or covering a cough. The germs go from hand to surface, to next persons hand and mouth. Hands and surfaces infected with faeces can pass germs onto the next person. Bodily secretions, such as urine and blood, can spread infection. Mumps and cytomegalovirus can be spread in urine and hepatitis B and HIV are transmitted by blood contact. Germs enter the next recipient via the mouth, intestinal tract, nose, lungs, mucosa of eyes, genitals, skin lesions and dermatitis.

How the next person is affected by the germ depends on that persons immunity to the infection and the type of germ. Infection control is as simple as blocking the transfer stage. That means making sure that surfaces and toys that children touch are clean, that hands are washed frequently and that any discharge from the body is cleaned away safely. Wounds should be covered.

Effective hand washing is, by far, the easiest and most effective way to lessen the transfer of germs and control the spread of infections.

Immunisation is the other way to block the transfer of germs and infectious diseases, as the body builds up an immunity to that particular infection and, therefore, does not develop the symptoms or develops a lesser type of infection. Immunisation is an important preventative measure for both children and staff.

Managing An Unwell Child

Through careful observation and understanding of each individual child, you will know when a child is not behaving in a normal way for him/her. You suspect that the child is unwell. What should you do? keep the child away from the other children, if possible
check the childs temperature, preferably with a digital thermometer (under the arm for 3 minutes and remembering that this temperature will be less than one taken in the mouth)

help the child to cover coughs and wipe away nasal secretions, remembering to wash hands frequently try to ascertain the symptoms

record the date and time, the symptoms, the childs temperature and any actions taken on the appropriate form developed for your service if the child has a temperature above 38 degrees Celsius, remove excess clothing and sponge or bath the child in lukewarm water encourage the child to drink water

inform the parents/guardians and suggest medical attention. Give the parents a copy of the form you have used to record the symptoms, temperature readings, times and actions taken. Place the original copy in the childs file.

 The Service Manager should keep records of illnesses and infectious diseases, so that patterns can be tracked, spread of infection can be prevented and success of control measures can be seen. Records for both children and staff are required.
Children and staff with infectious conditions may need to be excluded from the service for a specified time.

Medications
Your Service should have a Policy and Procedure for administering medications. This Policy should consider the following points: parents given information about administration of medications on enrolment parents signing an enrolment clause that states they understand and will abide by the medication policy of the service

staff understanding the serious nature of giving medications that parents request parent/guardian to make a written request that medication be given, usually on a set form that the service has devised the request should state the childs name, the date, the time for the medication to be administered, the name of the medication, the dose to be given, the way the medication is to be given (orally, nebuliser) and a parent/guardian name and signature

medications should be in the original container with the childs name on the label, the medication and dose clearly stated and the medication within its use by date the medication may be accompanied by a Doctors letter that gives clear instructions for the dose and time

the service will need to consider alternative and over-the-counter medications and what policy they will adopt for administration medications with another persons name on them or medications that are out of date cannot be given medications must be handed to a staff member
medications must be safely stored in a locked container, out of reach of children, and may need to be stored in a fridge

two staff members (preferably senior staff) must check the request, the medication, the dose and the child it is given to. Both staff members must sign the request form and note the time the medication was given it is advisable for the parent/guardian to sign the form at the end of the day, to note that they have checked that the medication was given the request form should be securely filed in the childs notes.

Special planning will need to be undertaken to meet the needs of asthmatics or children who have severe allergic reactions. On enrolment, staff and parent/guardian need to complete an Emergency Medication Plan of Action. The form used by the service should include the following information:

the name and date of birth of the child the doctors name and contact details the emergency that may arise signs, symptoms, precautions any emergency medication that should be given name of medication, dose, repeat doses other instructions, such as calling an ambulance straight away emergency contacts.

These instructions should be accompanied with a Doctors letter that confirms the medication and doses. All staff who interact with that child should fully understand the action plan, in case of an emergency for that child. Action Plans should be updated when medication needs change and routinely, at least annually.

If special apparatus is needed to administer the medication, parent/guardian needs to instruct staff in its use (eg. pen, nebuliser, spacer) One way to assist with decreasing a high temperature is to administer a dose of paracetamol (eg. Panadol), according to manufacturers instructions.

Check whether your service has a Policy about administering a single dose of paracetamol in cases where a child has a high temperature. Check the procedure. Many services will give a single dose (following manufacturers recommended dosage for the age group) of paracetamol if a child has a temperature over 38 degrees Celsius. Part of their enrolment process will include parent/guardian signing permission for this single dose to be given. The Service should try to contact the parent/guardian prior to giving the dose, just to verbally confirm that this is the parents wish. The times, calls and discussion must be documented. Parent/guardian should then collect the child and seek medical attention as soon as possible, to find the cause of the raised temperature. Parent/guardian should give feedback to the service, so that the Service Manager can monitor the illness and inform other families, if the cause is an infectious disease.

Safe Food Handling

Have you ever suffered from food poisoning? The associated symptoms of stomach cramps, vomiting and diarrhoea are not pleasant and can prove fatal in some extreme cases (depending on the organism involved). The Australian and New Zealand Food Safety Authority (ANZFSA) has agreed on Food Safety Legislation. These guidelines must be followed by any business, enterprise or activity that involves the preparation of food for a fee. A childrens service which prepares meals for children in their care, as part of the fee for service, is classified as a food business. They are not classified as a food business where parents supply the food.

You should check which authority is responsible for carrying out checks on childrens services in your state or territory.
Regardless of whether your service provides food or it is supplied by parents, you need to follow food handling guidelines and ensure that food is stored, cooked and served correctly.

Storage considerations: Services need to provide refrigerated space for childrens food that is brought from home. This is best provided within the play spaces for each room. Sufficient dry storage, refrigeration and freezer space must be provided in services that provide meals for children

Dry supplies (pasta, flour, cans) must be kept off the floor in vermin-proof containers
Older stock should be kept at the front and newer stock added at the back of the shelf. This is called stock rotation. Staff must check the use by dates and best before dates, and discard any stock past these dates.

Fridges (0 to 5 degrees Celsius) and freezers (under 0 degrees Celsius) must have their temperatures recorded each day, preferably twice per day. Fridges and freezers outside their safe temperature zones must have corrective action taken (turn the temperature down, call for maintenance). Raw meats must be stored at the bottom of the fridge, so juices will not contaminate other foods. Store cooked foods on higher shelves.

Cooking considerations: check use by dates prior to using ingredients prepare uncooked meats, cooked meats, vegetables using different boards, utensils and locations in the kitchen (you can purchase different-coloured chopping boards which enables colour coding for different purposes) follow standard recipes, so that you know which ingredients have been used in each preparation cook for required length of time check that cooked temperatures are 75 degrees Celsius or higher

maintain temperatures of hot food above 65 degrees Celsius maintain temperatures of cold food below 5 degrees Celsius leave food to cool for no more than 2 hours before refrigerating.

Food hygiene and serving considerations:

wash your hands frequently

wash childrens hands before they eat

handle ready to eat food with gloves on, or using utensils (serving spoons, tongs)
give each child an individual plate, bowl, eating utensils, cup ensure children do not share food

cooks should limit the jewellery they wear, tie their hair back and wear an apron (clean each day).

Hazardous Materials
You must give consideration to the following:
all potentially dangerous products and objects are inaccessible to children at all times all cleaning products and chemicals are properly labelled (available from manufacturer)

all medications are stored in locked cabinets

all chemicals and cleaning products are stored in locked cabinets that are labelled to show adults what is stored there, for example dangerous products stored here

Material Safety Data Sheets (MSDSs) are available in the centre for all dangerous chemicals, garden products and cleaning products. These outline the safety precautions and first aid requirements of each product and are available from the manufacturer. soiled nappy and clothing containers are covered and inaccessible to children

all staff and volunteers are given information about safe storage of dangerous products and objects
playgrounds are checked to ensure that no dangerous or poisonous plants are growing

playgrounds and buildings are checked systematically and regularly for spiders, dangerous insects, syringes, broken glass and any other dangerous item (daily checklist) staff have action plans for responding to inhalation of fumes, skin burns or swallowing caused from dangerous products emergency numbers are beside all phone points, including the poisons information hotline staff talk to children about their safety in relation to dangerous products, objects and vermin the service has information available for families from local authorities about dangerous products and home safety

the service monitors staff compliance with the policies and procedures and asks families and staff to have input into annual reviews the centre has a toxic chemical policy that looks at minimising the use of chemicals within the service without affecting the hygiene level.

Immunisation & Exclusion

Both staff and children should be up to date with their immunisation schedule. Your service must keep up-to-date records of immunisation status, so that these are easily accessible if a service needs to contact parents or consider exclusion of non-immunised children (measles, whooping cough).

There are a number of infectious diseases that should be reported to the local Health Authority by childrens services staff. These include: Diphtheria Haemophilus influenzae type b Hepatitis A, B, C, D, E and others HIV infections Influenza Measles Meningococcal infection Mumps Pertussis (whooping cough) Poliomyelitis Rubella Salmonella Tetanus

Keeping Parents Informed

Service staff must keep families informed by: having Polices and Procedures readily available for parents to read and review providing information on health and safety issues providing information in different languages giving a comprehensive Information Booklet on enrolment

phoning parents to inform them of childrens illness or health issues

talking one to one about important issues ensuring information is shared about a childs care and health needs.

Staff Training
Staff training is crucial to effective management of health and safety issues. Basic OHS responsibilities and expectations should be covered in a formal orientation session for new staff and reviewed, at least annually, with all other staff. Your service may also have a system to observe staff completing hygiene practices correctly (hand washing, nappy changing) as part of their annual performance appraisal.

Monitoring Policy Compliance

Your service could use the following methods: checklists to ensure all steps of a process are completed (cleaning schedules, playground checks) annual appraisal of a process by observing the staff member complete the process and giving feedback on areas that need improving (hand washing, nappy changing) pop quizzes at staff meetings questionnaires to test knowledge.

Whatever methods are used, ensure that you keep the documentation to prove your compliance.
If any problem does arise in your service, this documentation can be used to prove that you have taken all appropriate steps to ensure that staff have the correct knowledge to provide a safe and healthy environment.

Summary
You have learnt that you must keep up to date with current trends and legislation, in relation to all health issues.
Services must have policies and procedures that are reviewed and updated annually to cover areas such as medications, infection control, hazardous materials, food hygiene, infectious diseases, sick children and immunisations. Not following contemporary practices can have a social, medical and economic cost for families, children, staff and proprietors.

The single most effective tool to control the spread of infection is effective HANDWASHING. Children and staff must be taught to wash hands frequently and correctly throughout the day. Bathrooms should have reminders and signs explaining how to wash hands effectively. They should also contain instructions for nappy changing, toilet training and toileting of children. Services should encourage immunisation of staff and children and follow standard exclusion times for infectious diseases. Medications should only be given when all prescribed criteria are present. Families must take responsibility for supplying medication and instructions according to the criteria. Two staff must check, administer and sign for medications that are given.

The Australian and New Zealand Food Safety Authority (ANZFSA) have set new standards for Food Safety that must be followed. Consideration must be given to the correct storage, preparation, cooking and serving of food. Hazardous substances are to be stored safely in lockable cabinets and correctly labelled. Staff and parents work together to review the polices and procedures; staff attend regular training; parents are informed of any changes, and service managers monitor staff compliance with the health and safety procedures.