Daily Health Observation Training for Child Care Providers

1
Daily Health Observation Training for Child Care
Providers

• Division of Child and Adolescent Health
• Virginia Department of Health

2
Learning Objectives

• Participants will be able to
• learn how infectious illnesses are spread
• perform a Daily Health Assessment on children.
• use proper handwashing and gloving techniques
  to prevent the transmission of infectious
  diseases
• understand DSS Licensing Standards that address
  health observation and prevention of illness
• identify signs and symptoms of common contagious
  diseases in children to prevent the spread of
  disease.

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Learning Objectives (continued)

• Understand current immunization requirements
  Instruct child care staff on how to document
  activities
• Understand OSHA requirements for health and
  safety practices for child care staff

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Ways Diseases/Illnesses Spread(California Child
Care Health Program)

• Source of germs must be present
• Route or (ways) of transmission along which germs
  can be carried must be present, e.g., direct
  contact, respiratory, fecal-oral, contact with
  blood
• A host or vulnerable person who is not immune to
  the germ must be present and come in contact with
  the germs

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Ways to Keep Children and Yourself Healthy
(California Child Care Health Program)

• Attack the source of the infection or first
  link by identification, treatment and, if
  necessary, isolation of the sick person
• Attack the route of transmission or the second
  link by personal and general hygiene, healthy
  practices, e.g., disinfecting toys, etc.

• Protect the vulnerable person or the third
  link through immunization, balanced nutrition,
  and health practices such as proper hand washing,
  etc.

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Daily Health Assessment

• Do upon arrival
• Look
• Listen
• Feel
• Smell
• Goal is to assess, not diagnose an illness.
  The key to detecting an illness in a child is a
  change in the childs behavior

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Should She Stay or Should She Go?

• What signs and symptoms may tell you a child is
  not well enough to participate that day?
• flip chart

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• Skin
• Is the face flushed or is the child perspiring?
• Is the skin jaundiced or discolored?
• Are there bruises, sores or a rash present?
• Is the child scratching?

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Fever

• be consistent in where /how you take the childs
  temperature
• Axillary temps are best in child care. Do not
  take temperature rectally.
• If child is overdressed retake temperature
• Look for other signs of illness
• Exclude Temp.over 101

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Head

• Scratching his head
• Has child vomited?
• Squinting at objects?
• Is the child drowsy or have a poor appetite?
• Headache after school?
• Other complaints?

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Rashes

• is the child on medication?
• change in soap or food?
• playing outside in grass or woods?
• Exclude for fever over 101 or if you suspect
  scabies/lice or other communicable illness

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Eyes

• Is the eyelid swollen?
• Bruises around the eye
• Is there a thick discharge from the eyes?
• Is the child rubbing her eyes?
• Can you see a foreign object in the eye?
• Exclude if you suspect Conjunctivitis-eyeball is
  pink/red and thick drainage. 24 hrs. of
  antibiotic and no thick drainage

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Nose

• Is there a discharge from the nose?
• What color?
• Can the child breathe through the nose?
• Having a cold is not a reason for exclusion
• Exclude Fever and child is noticeably
  uncomfortable/cranky

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Ears

• Discharge from ear
• Is the child pulling at the ear?
• High temperature?
• Complaints of dizziness
• Walking unsteadily
• some ear infections are viral
• Exclude Fever

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Throat

• Does child have trouble swallowing?
• Are there spots or sores in the mouth?
• Does child have a cough or runny nose?
• Does child have a rash?
• Is the temperature over 101 degrees?
• Cavities can cause sore throat
• Exclude Strep throat-24 hrs. of antibiotic

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Cough

• What does the cough sound like? hacking-sinus cro
  upy-cold wheezing-asthma
• Is the cough productive?
• Exclude Pertussis, breathing so hard cant play,
  cry, drink

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Stomachaches

• Check for other complaints
• Change in appetite?
• Has child vomited?
• Is child constipated?
• Does child have loose stools/diarrhea?
• Does child want to lie down?
• Persisting after school hours?
• Exclude Recurrent vomiting or diarrhea

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Hygienic Practices

• Hand washing is the first fine of defense against
  infectious disease
• Wash hands and lather, rubbing front and back for
  10- 20 seconds with soap
• Rinse under running water from wrists to
  fingertips
• Dry with paper towel and turn faucet off with
  paper towel

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When to wash

• upon arrival
• before preparing, handling, or serving food
• before and after eating
• after coming in from play, handling pets
• after toileting (self or child)
• after diaper changing or cleaning up a mess
• after handling used tissues or body fluids,
• after using water/sand table

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Glo Germ Activity

• Centers for Disease Control Prevention
  (CDC) estimates that
• 75 of infection could be prevented in child
  care if proper hand washing techniques were
  followed.

www.glogerm.com
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Sanitizing Surfaces

• 1/4 cup bleach to gallon water (1 tbsp per quart)
• prepare daily
• spray on and allow to air dry
• clean heavily soiled areas with detergent and
  water first

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Diapering

• Gather supplies
• Lay child on diapering surface and remove diaper
• dispose of diaper in lined, covered step can
• clean bottom with moist, disposable wipe and
  discard
• wipe your hand with new wipe and discard

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Diapering

• diaper child or dress him
• wash childs hands
• remove paper liner, wash area with solution
• wash your hands

DONT USE POWDER LIKE
DARREN DID!
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First Aid Requirements

• One staff member must be trained in first aid,
  CPR and rescue breathing and either on premises
  or field trips (available to children)
• Current certification by American Red Cross,
  American Health Association, National Safety
  Council or other program approved by VDSS
• First aid kit shall be accessible to adults (not
  to children) and brought on field trips
• Kit shall contain designated supplies, including
  a cooling agent and activated charcoal (may
  special order)

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Sleep Requirements

• Occupied mats need to be at least 2 and 1/2 feet
  from heat source and 12 inches between occupied
  beds
• No stacked or double decker cots. Stack only
  when not in use.
• Designate specific cot/crib for each child
• No pillows or comforters
• Place infants on back
• Checked on every 15-20 minutes

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Gloving

• Put glove on clean hand
• Remove by grasping outside at wrist, pull inside
  out with ungloved hand grasp on inside at the
  wrist and pull inside out over hand

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Cleaning and sanitizing blood/body fluid spills

• 1. Gather all needed equipment gloves, paper
  towels, plastic bags, cleaning solution and
  sanitizing solution
• 2. Put on disposable gloves
• 3. Use generous amount of paper towels to soak up
  the liquid part of the fluid.
• 4. Place the paper towels and gloves in a
  separate plastic bag, close and tie the bag
• 5. Place closed and tied bag in regular lined
  trash can.

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Cleaning and Sanitizing procedures (continued)

• 6. WASH YOUR HANDS
• 7. Put on clean disposable gloves
• 8. Wash area with soap and water or other
  cleaning agent and rinse with water
• NON POROUS SURFACES spray with 101 bleach
  solution until glistening wet. Allow it to sit
  for 2 minutes before wiping dry, or let air dry.

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Cleaning Sanitizing procedures (continued)

• POROUS SURFACES Use paper towels to soak up the
  liquid. Carpets and rugs can be cleaned with
  standard carpet cleaning chemicals.
• Either discard or launder other fabrics through
  the machine alone with laundry detergent, then
  again using the 101 bleach solution to soak the
  fabric and laundry equipment for at least 2
  minutes

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Soiled Clothing

• Place childs or staffs soiled clothing in
  plastic bag and labeled to be washed using proper
  laundering technique.
• Childs clothing should be sent home with
  parents.

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Be Aware..

• The use of commercially pre-saturated bleach
  wipes to sanitize surfaces is not recommended.
• These wipes have not been tested for
  effectiveness in sanitizing diaper changing
  surfaces found in child care
• The contamination of the wipe during use may not
  be sufficiently controlled by the bleach solution
  in the wipe

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Whats Your Plan?

• An Exposure Control Plan will help you develop a
  plan to reduce exposure to germs in blood and
  other body fluids
• OSHA requires employers to develop and implement
  plans and policies to protect employees from
  exposure to potentially infectious body fluids.
• Download a model ECP at www.OSHA.gov under
  bloodborne pathogen standard Standard 29 CFR
  1910.1030 or visit www.paaap.org/ECELS for an ECP
  adapted for child care

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What should your ECP include?

• Who is responsible for the overall implementation
  of the ECP?
• What employees have occupational exposure (at
  least all who give direct care)
• Methods of implementation and control (policies
  and procedures) including housekeeping, first
  aid, sharps care, laundry, etc.
• Hepatitis B provision
• Post exposure evaluation and follow up
• Record keeping

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What else should your ECP include?

• Bloodborne Pathogen exposure control training log
  (all staff should receive training)
• Exposure Incident Report form
• Post Exposure Evaluation by health provider form
• Post Exposure Referral to health provider form
• Hepatitis B Vaccine Declination (Mandatory)
• Sharps Injury Log

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How You Can Prevent the Spread of Disease

• Perform the Daily Health Check
• Proper hand washing
• Proper diapering technique and disposal
• Proper disinfection of areas, including toys,
  cribs and surfaces

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Continued........

• Separation of age groups
• Separate nap areas by 3 feet
• Proper storage and care of clothes and bedding
• Adequate ventilation and daily trips outdoors
• Exclude children with signs/symptoms of
  potentially dangerous illness
• No sharing of food, plates, utensils or drinks
• Insist on up-to-date immunizations

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Immunizations

• Are the immunizations up to date?
• Children born after January 1997 need Varicella
  vaccine
• Children born after January 1994 need Hepatitis B
  vaccine
• Current requirements that are mandatory include
  DTaP, IPV, MMR, Hib, HepB, Varicella and
  Pneumococcal conjugate

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What About You?

• Have you had your Hepatitis B vaccine?
• When was your last tetanus- diphtheria vaccine?
• Have you had chickenpox?
• Do you get a yearly flu shot?

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Lets Practice.Can you identify these? Would
you exclude?
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What illness does this person have?
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QUESTIONS?
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Acknowledgements

• Claire Wood, RN, BSN
• Healthy Child Care Virginia, VDH
• Carolyn Sanford, RN, BSN
• Chesapeake Health Department, VDH
• Bethany Geldmaker, PhD
• Virginia Department of Health