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PS 025 368

Preventing & Managing Communicable Diseases. Training Guides

for the Head Start Learning Community.

Bowman (James) Associates, San Francisco, CA.

Administration for Children, Youth, and Families (DHHS),

Washington, DC. Head Start Bureau.

ISBN-0-16-042681-2

96

144p.; For other guides in this series, see ED 348 160, ED

398 220-222, and PS 025 367-376.

105-93-1578

U.S. Government Printing Office, Superintendent of

Documents, Mail Stop: SSOP, Washington, DC 20402-9328.

Guides Non-Classroom (055)

MF01/PC06 Plus Postage.

*Child Health; Children; Cleaning; *Communicable Diseases;

*Disease Control; Diseases; *Health Education; Health

Services; Parent Role; Parents; Physical Health; Preschool

Education; Resource Materials; *School Health Services; Sick

Child Care; Staff Development; Training Methods; Workshops

*Health Information; *Project Head Start

This training guide is intended to improve the skills of

Head Start staff and families in dealing with communicable diseases. The

guide addresses attitudes toward communicable diseases, how to reduce the

spread of disease, and how to recognize and manage illnesses more

effectively. The guide consists of six working sections. The first three are

training modules. Each module details learning opportunities, expected

outcomes, key concepts, background information, questions for discussion and

reflection, activities, points to consider, and next steps. Module 1

addresses understanding communicable diseases, and includes experience with

and understanding of communicable diseases, working with people of diverse

beliefs, and how communicable diseases spread. Module 2 addresses preventing

communicable diseases, and includes hand washing, gloving, checking on

infection control, and fresh air. Module 3 addresses recognizing and managing

communicable diseases. Topics addressed include daily health checks, managing

communicable diseases, and assessing ill children. The fourth section of the

guide addresses continuing professional development issues to help Head Start

staff develop their skills in preventing, recognizing, managing and learning

about communicable diseases. The fifth section contains resources including

books, manuals, videos, newsletters, and national organizations. The sixth

section is an appendix of fact sheets on communicable diseases ranging from

chicken pox to tuberculosis. (SD)

********************************************************************************

* Reproductions supplied by EDRS are the best that can be made *

* from the original document. * ********************************************************************************
U.S. DEPARTMENT OF EDUCATION

Office of Educational Research and Improvement EDUCATIONAL RESOURCES INFORMATION

CENTER (ERIC)

This document has been reproduced as

received from the person or organization

originating it.

Minor changes have been made to

improve reproduction quality.

Points of view or opinions stated in this

document do not necessarily represent

official OERI position or policy. HEAD START

Training Guides for the

Head Start Learning Community

Preventing & Managing

Communicable Diseases

0,1,V ICEs . 4,''' l:,.., 2$... V U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

;.-. Administration for Children and Families

iAdministration on Children, Youth and Families

'S 1. Head Start Bureau

44N,

BEST COPY AVAILABLE 2
HEAD START®

Preventing & Managing

Communicable Diseases

Training Guides for the

Head Start Learning Community

ty J U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

I eir

Administration for Children and Families

Administration on Children, Youth and Families

Head Start Bureau \
For sale by the U.S. Government Printing Office

Superintendent of Documents, Mail Stop: SSOP, Washington, DC 20402-9328

ISBN 0-16-042681-2
This national training guide was developed by James Bowman Associates, San Francisco,

California, under contract #105-93-1578 of the Head Start Bureau, Administration for

Children and Families, Department of Health and Human Services.

Photo courtesy of Fruitvale Head Start, Oakland, Ca.

1996
Contents

Preface ix

Introduction 1

Overview 1

Purpose

Audience

Head Start Program Performance Standards

Orientation to the Guide 2

Definition of Icons 3

At A Glance 4

Module 1 7

Understanding Communicable Diseases 7

Outcomes 7

Key Concepts 7

Background Information 7

Questions for Discussion/ Reflection 11

Activity 1: Who Has Had This Experience? 12

Activity 2: What Do We Think? 14

Activity 3: Working with People with Diverse Beliefs 16

Activity 4: How Communicable Diseases Spread 18

Key to Activity 4 A: Communicable Disease in Children 21

Key to Activity 4 B: How Communicable Diseases Spread 22

Activity 5: Spreading Germs 23

Next Steps: Ideas to Extend Practice 25

Handout A: Who Has Had This Experience? 27

Handout B: What Do We Think? 28

Module 2 29

Preventing Communicable Diseases 29

Outcomes 29

Key concepts 29

Background Information 29

Questions for Discussion/Reflection 36

Preventing & Managing Communicable Diseases
Contents

Activity 1: Hand Washing: Doing It Right 37

Activity 2: The Art of Gloving 40

Activity 3: Checking Up on Infection Control 43

Activity 4: Why Is Everyone Sick? 45

Key to Activity 4: Why Is Everyone Sick? 48

Activity 5: Let's Have a Picnic 49

Activity 6: Promoting Fresh Air 51

Next Steps: Ideas to Extend Practice 53

Handout C: Hand Washing 55

Handout D: Gloving 56

Handout E-1: Hand Washing Checklist 57

Handout E-2: Diapering Checklist 59

Handout E-3: Cleaning & Disinfecting Checklist 61

Handout E-4: Food Handling Checklist 63

Handout F-1: Why Is Everyone Sick? 65

Handout F-2: Why Is Everyone Sick? 66

Handout G: Air Quality 67

Module 3 69

Recognizing & Managing Communicable Diseases 69

Outcomes 69

Key Concepts 69

Background Information 69

Questions for Discussion/Reflection 76

Activity 1: The Daily Health Check 77

Key to Activity 1: Does the Child Look Sick? 79

Activity 2: Assessing the Child Who Is Twenty Questions 80

Key to Activity 2: Crystal's Story 83

Activity 3: What Would You Do? 84

Key to Activity 3: Managing Communicable Diseases:

Ten Steps to Consider 87

Activity 4: Handling an Outbreak 88

Next Steps: Ideas to Extend Practice 90

Handout H: Daily Health Check 91

Handout I: Symptom Record 92

vi Preventing & Managing Communicable Diseases
Contents

Handout J: Does the Child Look Sick? 93

Handout K: When a Child Is Too Sick to Attend 94

Handout L: What Would You Do? 95

Handout M-1: Handling an Outbreak 96

Handout M-2: Handling an Outbreak 97

Continuing Professional Development 99

Resources 101

Books & Manuals 101

Videos 105

Newsletters 106

National Organizations 107

Appendix 109

Communicable Disease Fact Sheets 109

Chicken Pox 109

Colds and Flu 110

Conjunctivitis 111

Cytomegalovirus 112

Fifth Disease 113

Giardias is 114

Hand, Foot, and Mouth Syndrome 115

Head Lice 116

Hepatitis A 117

Hepatitis B 118

Herpes 120

HIV/AIDS 121

Impetigo 122

Infectious Diarrhea 123

Measles 125

Meningitis 127

Mumps 128

Pertussis 129

Pinworms 130

Ringworm 131

Preventing & Managing Communicable Diseases vii
Contents

Roseola 132

Rubella 133

Scabies 134

Streptococcal Infections 135

Tuberculosis 136

a

viii Preventing & Managing Communicable Diseases
Preface

The spread of communicable diseases is a fact of life in Head Start.

Illnesses spread because children have close contact and naturally explore

their environment by touching and putting things in their mouths. The

demands of supervising children, wiping noses, diapering, preparing

meals, and tending to injuries make practicing good hygiene all the time

challenging for staff and parents.

When their children are sick, parents often feel caughtthey want to care

for their sick children, but they might lose their jobs if they miss too many

days of work. Children may be brought to school sick, increasing the

spread of illness and the burden on staff.

The spread of communicable diseases in Head Start has a big impact on

the health and well-being of children, families, and staff. Victor tells his

story:

"My son Ivan has been so sick since he started school in September. He's

had a constant cold and one ear infection after another. He's been on

antibiotics all winter long. They're saying that all the ear infections might

damage his hearing, so the doctor is talking about surgery to put tubes in

his ears to stop the infections. Several other children in the class are in the

same situation. I only wish there was something we could do to keep the

kids healthier."

The spread of communicable diseases can be reduced. This guide,

Preventing & Managing Communicable Diseases, helps inform Head

Start programs about steps they can take to prevent and manage

communicable diseases more effectively. Communication and

cooperation must be established among program staff, parents, and health

professionals. Programs must develop clear health policies and a plan for

teaching staff, parents, and children about communicable diseases.

The concepts and activities in this guide build on each other. For a

comprehensive approach, users should proceed from the beginning to the

end. However, the learning activities can be adapted to your own

situation. For example, you may adapt a workshop activity to coaching or

insert stories from your own program.

Training materials are effective only when they are applied to the

everyday work setting. Knowledge and skills that are developed in

training must be supported by follow-up activities. The guide contains

sections entitled "Next Steps" and "Continuing Professional

Development" to help users design long-term learning plans.

10

Preventing & Managing Communicable Diseases ix
Preface

This guide was developed with the assistance of many Head Start

programs across the country. We would like to thank the Head Start staff

and parents who discussed the challenges that they faced in dealing with

communicable diseases, shared their stories, participated in trainings, and

provided feedback on the activities. We appreciate the feedback provided

by the Head Start Bureau, Regional Offices, Technical Assistance

Support Centers (TASCs), Resource Access Projects (RAPs), and

National Training Contractors (NTCs). We especially value the detailed

review and input provided by the guide's development team of Head Start

staff and health professionals.

We hope that Preventing & Managing Communicable Diseases helps

you develop a partnership among Head Start staff, parents, health

professionals, and children to deal with communicable diseases

effectively and create a healthier Head Start.

11

Preventing & Managing Communicable Diseases
Overview

Introduction

Purpose

Audience

Performance Standards

The purpose of this guide is to improve the skills of Head Start staff and

families in dealing with communicable diseases. The guide addresses

attitudes toward communicable diseases, how to reduce the spread of

disease, and how to recognize and manage illnesses more effectively.

Since communicable diseases are the most common cause of illness, this

guide aims to help Head Start keep its children, families, and staff

healthier.

Designed for all Head Start staff and health consultants who work with

Head Start, this guide is particularly helpful for classroom teachers and

aides who are responsible for preventing the spread of disease,

recognizing when children are sick, and responding to illnesses. Activities

can be adapted to teach children and parents about communicable

diseases. The guide also gives program directors, health coordinators, and

consultants guidance as they develop health policies and monitor the

program's practices in preventing and managing communicable diseases.

Head Start staff from a wide variety of functions need to learn about

communicable diseases. Head Start Program Performance Standards

require administrators to develop health policies to prevent and manage

communicable diseases in their programs. Classroom staff and food

service personnel must follow practices to prevent, recognize, and manage

illnesses. They also need to teach children and work effectively with

parents around communicable diseases.

12

Introduction
Introduction

Orientation to the Guide

The Preventing & Managing Communicable Diseases guide has six

working sections:

Module 1: Understanding Communicable Diseases

Module 2: Preventing Communicable Diseases

Module 3: Recognizing & Managing Communicable Diseases

Continuing Professional Development

Resources

Appendix: Communicable Disease Fact Sheets

Each module provides learning opportunities for workshop sessions and

coaching. Each has the following sections:

Outcomes define what participants will learn from the module.

Key Concepts are the main ideas conveyed in the module. These

sections can be used as handouts or overheads.

Background Information elaborates on the Key Concepts. It can

be a resource for coaching or a guide for a group presentation.

Questions for Discussion/Reflection are at the end of each

Background section. They can initiate discussion in workshops or

coaching sessions or serve as prompts for staff journals.

Activities are practical exercises that reinforce the key concepts and

help participants develop their skills. Some activities refer to

Handouts for participants at the end of the module.

Points to Consider summarize the main issues that the trainer or

coach should try to elicit through the activity. They are listed at the

end of each activity.

Next Steps: Ideas to Extend Practice are additional activities to

follow-up what participants learned through the module. They

are listed at the end of each module.

13

2 Preventing & Managing Communicable Diseases
Introduction

Definition of Icons

Coaching A training strategy that fosters the development of skills

through tailored instruction, demonstrations, practice, and

feedback. The activities are written for a coach to work

____......,a closely with one to three participants.

Workshops A facilitated group training strategy that fosters the

development of skills through activities which build on

learning through group interaction. These activities are

written for up to 25 participants working in small or large

groups with one or two trainers.

Next Steps:

Ideas to Extend Practice

ri.- . Activities assigned by the trainer immediately following

the completion of the module to help participants review

key information, practice skills, and examine their progress

j toward expected outcomes of the module.

III Continuing

Professional Development

Followup activities for the program to support continued

staff development in the regular use of the skills addressed

in a particular training guide. It includes:

1) opportunities tailored to the participant to continue

building on the skills learned in the training; and

2) ways to identify new skills and knowledge needed to

expand and/or complement these skills through

opportunities in such areas as in higher education,

credentialing, or community educational programs.

F

Introduction 3
Introduction

At A Glance

Modules Activity Time Materials

Module 1:

Understanding Communicable

Diseases

Activity 1: Who Has Had

This Experience? (FV)

15-20

minutes

Handout A

Activity 2: What Do We

Think? (C)

60-90

minutes

Handout B;

Appendix:

Colds and Flu

Activity 3: Working with

People with Diverse

Beliefs (W)

45-60

minutes

Appendix:

Colds and Flu,

Infectious

Diarrhea, Head

Lice, HIV/AIDS

Activity 4: How

Communicable Diseases

Spread (W)

45-60

minutes

Keys to Activity 4

(For trainer only)

Activity 5: Spreading

Germs (C)

30-45

minutes

Keys to Activity 4

(For trainer only)

Module 2:

Preventing Communicable

Diseases

Activity 1: Hand Washing:

Doing It Right (KO

30

minutes

Handout C

Activity 2: The Art of

Gloving MO

20-30

minutes

Handout D

Activity 3: Checking Up

on Infection Control (C)

120

minutes

Handouts E 1 -E4

Activity 4: Why Is

Everyone Sick? (C)

30-45

minutes

Handouts E 1 -E4

and Fl-F2;

Appendix:

Giardiasis,

Pinworms;

Key to Activity 4

(For trainer only)

Activity 5: Let's Have

a Picnic (W)

30-45

minutes

Handout E4

Activity 6: Promoting

Fresh Air (W)

30-45

minutes

Handout G

15

4 Preventing & Managing Communicable Diseases
Introduction

Modules Activity Time Materials

Module 3:

Recognizing & Managing

Communicable Diseases

Activity 1: The Daily

Health Check (C)

60-90

minutes

Handouts H, I, & J

Activity 2: Assessing

the Child Who Is Ill:

Twenty Questions (W)

45-60

minutes

Handouts I & K;

Key to Activity 2

(For trainer only)

Activity 3: What Would

You Do? (Ff9

60-90

minutes

Handouts K & L;

Appendix: Infectious

Diarrhea, Chicken Pox,

Head Lice, Impetigo

Activity 4: Handling an

Outbreak (C)

60-90

minutes

Handouts Ml-M2 &

Appendix: Chicken

Pox, Hepatitis A

(W) = Workshop Activity

(C) = Coaching Activity

16

BEST COPY AVAILABLE

Introduction 5
Module 1

Understanding Communicable Diseases

Outcomes After completing this module, participants will be able to explain what

communicable diseases are and how they spread.

Key Concepts Communicable diseases are illnesses that spread from person to

person. They are the most common cause of illness in young

children.

Communicable diseases are caused by microscopic germs and

bugs. They are carried in "body fluids"blood, mucus, saliva,

vomit, stool, urine, and eye dischargesand on the skin and hair.

Communicable diseases are spread in different ways, depending

on the diseasefor example by touching, breathing, and eating.

People have different beliefs about communicable diseases that

are shaped by culture, education, experience, and fears. We must

build our approach to communicable diseases on sensitivity and

respect for different beliefs and practices.

Background Information A. What Are Communicable Diseases?

Communicable diseases are illnesses that spread from one person to

another. They are also called contagious or infectious diseases.

Communicable diseases are caused by germs and tiny bugs. The germs

are so small that they can only be seen with a microscope, not with the

naked eye. The germs and bugs are categorized as:

viruses (e.g., "colds," chicken pox, hepatitis A & B, HIV),

bacteria (e.g., "strep," tuberculosis), or

fungi (e.g., ringworm, thrush), and

parasites (e.g., giardia, pinworms, scabies, head lice).

Illnesses caused by bacteria, fungi and parasites always need medical

evaluation and antibiotic treatment. Many illnesses caused by viruses are

mild and go away on their own, but some need medical evaluation and

treatment.

Understanding Communicable Diseases 7

1
Module 1

NOTE: Some illnesses and health conditions are not communicable and

do not spread from one person to another. Examples of these include

asthma, allergies, seizures, cerebral palsy, and blindness.

B. How Do Communicable Diseases Spread?

Germs that cause communicable diseases are found in and on people,

animals, food, water, air, and dirt. Most of the germs are carried in human

"body fluids"blood, mucus, saliva, vomit, stool, urine, and discharges

from the eyes and skin lesions. Most communicable bugs are carried on

the skin and hair.

Germs spread when the body fluids of one person get into the body of

another person. Most communicable bugs spread by getting onto the skin

or hair.

Communicable diseases can be categorized by the way they spread:

Respiratory diseases (e.g., colds) affect the head and chest. They

are spread by:

coughing, sneezing, and breathing,

touching nasal mucus, saliva, and eye discharge.

Gastrointestinal diseases (e.g., infectious diarrhea) affect the

stomach and intestines. They are spread by:

touching stool, vomit, or contaminated surfaces,

eating food contaminated by stool,

drinking or bathing in water contaminated by stool.

Dermatologic diseases (e.g., ringworm) affect the skin and hair.

They are spread by:

touching skin or hair,

- sharing items such as clothes, hats, towels, and hairbrushes that

touch skin or hair.

Blood-borne diseases (e.g., hepatitis B) affect the entire body. They

are spread by: 18

8 Preventing & Managing Communicable Diseases
Module 1

- getting blood onto broken skin,

receiving blood transfusions,

- sharing needles used for injections, piercing, or tattoos,

- having sexual contact that shares body fluids.

The majority of illnesses spread in early childhood programs are

respiratory, gastrointestinal, and dermatologic diseases. The spread of

blood-borne diseases is extremely rare.

C. Why Are Communicable Diseases Common Among Young

Children?

Young children have frequent illnesses caused by communicable diseases.

Studies show that preschool-age children have symptoms of illness onethird to one-half of the days out of the year.

Young children are more vulnerable to illnesses because their immune

systemsthe body's natural defenses against diseaseare not yet built

up. Infants and toddlers tend to get sick more often than older children.

And when children enter a new child care setting, they tend to get sick

more in the first year. Over time, as children develop and learn, their

immune defenses also develop and learn to protect them against diseases

and keep them healthier.

For example, children get frequent colds, but the average number they

suffer per year decreases as they get older:

Infants and toddlers have 6-10 colds/year.

Preschool-age children have 3-5 colds/year.

Older children have 1-3 colds/year.

Communicable diseases spread in early childhood programs because:

There is close contact among many children and germs.

Young children explore their environment by touching people and

things and by putting their hands and objectsand germsinto

their mouths.

Most young children have not yet developed good hygiene practices.

Understanding Communicable Diseases 9

1$
Module 1

They touch their noses, mouths, bottoms, animals, dirt, food, and

toys, and often forget to wash their hands.

Surfaces and objects can carry germs. These include toys, tabletops,

floors, diapering and toileting areas, sinks, doorknobs, water

fountains, sandboxes, and water play tables.

Teachers and parents also spread germs. Studies of early childhood

programs show that the surface most likely to carry germs is the

caregiver's hands. In meeting the needs of many childrenwiping

runny noses, changing diapers, assisting with toileting, and handling

foodproper hygiene practices are sometimes neglected.

D. What Is the Impact of Communicable Diseases on Head Start?

Most of the communicable diseases that children experience, such as

colds and stomach upsets, are mild. Children are usually sick for a few

days and then get better on their own.

Some illnesses, however, are more serious and require medical evaluation

and treatment. For example, strep throat needs treatment with antibiotics.

Some frequent illnesses can lead to complications. For example, colds can

lead to frequent ear infections in some infants and toddlers, which can

lead to hearing loss. Some children with immune problems, such as HIV/

AIDS, are more susceptible to illnesses. Rarely, communicable diseases

such as meningitis, measles, and tuberculosis can be fatal.

The illnesses don't simply spread among the childrenthey also spread

to staff, parents, and other family members. Communicable diseases can

lead to significant pain and suffering, time missed from school and work,

and medical costs for families and staff.

E. How Do Beliefs and Attitudes Affect the Management of

Communicable Diseases in Head Start?

Each person has a unique set of beliefs about health and illness. These

beliefs are shaped by many factors including cultural background,

education, and personal experience. People in the Head Start

communitystaff; children, parents, and other professionalshave

diverse beliefs about communicable diseases, including:

Beliefs about the causes of illness, for example, germs, poor

hygiene, lowered resistance, weak constitution, emotions and stress,

20

10 Preventing & Managing Communicable Diseases
Module 1

eating bad food, exposure to cold air, evil eye, punishment for sins,

hot/cold imbalance, lack of harmony with nature, and fate.

Practices to maintain health and treat illness, for example,

washing hands, eating certain foods, exercise/rest, bathing/not

bathing, taking medicine, drinking teas, injections, prayer, laying on

hands, religious ceremonies, hot/cold remedies, acupuncture,

cupping, coin rubbing, massage, offerings, and family support.

Sources of health information and treatment, for example,

doctors, nurses, psychologists, chiropractors, homeopaths, family

members, elders, healers, religious leaders, pharmacists,

acupuncturists, medicine men, santeros, and curanderos.

Head Start's approach to preventing and managing communicable disease

must be built on respect for different health beliefs and practices.

Illnesses among children, staff, and parents can strain emotions and

workloads. When staff and parents react to illness with anger or shame,

illnesses may not be handled effectively, leading to more severe

symptoms and further spread. However, when staff and parents react to

illness with information and sensitivity, it leads to more effective

treatment and reduced spread.

Head Start children are also developing their own ideas about health and

illness based on the attitudes and responses of the adults around them.

When staff and parents respond to illness with blaming or fear, children

may feel afraid and isolated. When adults respond with concern and

acceptance, children develop a more comfortable and "healthier" attitude

toward illness.

Questions for Discussion/ Think about the last communicable disease that "went around" your Head

Reflection Start program. What was the impact on children, families, and staff?

How many got sick?

How much pain and suffering did they experience?

How many days of school or work were missed?

What were the costs for health care and medicine?

What might have been done to prevent or manage the illness more

effectively?

Understanding Communicable Diseases

2
Module 1

Activity 1:

Who Has Had

This Experience?

Purpose: This activity is a brief "icebreaker" to help participants

recognize the impact of communicable diseases on their daily lives.

For this activity, you will need:

One copy of Handout A: Who Has Had This Experience? for each

participant

Pens/pencils

Step 1: Explain that this exercise helps us get to know each other

through discussing some of our experiences with communicable

diseases.

Trainer's note: Participants may feel uncomfortable discussing

some communicable diseases or have concerns about

confidentiality. Encourage participants to discuss these issues

only to the extent to which they feel comfortable.

Step 2: Ask participants: What are communicable diseases? (see

Background Information)

Step 3: Distribute Handout A: Who Has Had This Experience? Give

participants a minute to review the questions on the worksheet.

Step 4: Have participants take 5-10 minutes to mingle with each other,

introduce themselves, and discuss some of their experiences

with communicable diseases. Participants should sign their

names on other participants' worksheets next to an experience

that they have had.

Step 5: After most people have completed their worksheets, have

participants return to their seats. Ask participants: a. What were some common experiences or practices?

b. What were less common experiences or practices?

c. Were there some diseases that you felt ashamed of having?

Did that affect the way you dealt with having those

diseases? How? 22

12 Preventing & Managing Communicable Diseases
Module 1

Points to Consider:

d. Were there some diseases that you felt angry about or

blamed others for spreading? Did that affect the way you

dealt with the diseases? How?

e. How can we make the management of communicable

diseases more effective in Head Start?

Communicable diseases are illnesses that spread from person to

person. They are the most common cause of illness in young

children.

All of us do many things each day to prevent and manage

communicable diseasesboth at home and at work.

Head Start staff and families have some similar and some different

experiences, information, fears, and questions about communicable

diseases. We can learn from reflecting on our own experiences,

sharing them with others, and asking questions.

Fear, anger, blame, and denial are common responses to

communicable diseases, but they make us deal poorly with our

illnesses. Acceptance and information can help us manage these

diseases more effectively.

To manage communicable diseases effectively, Head Start programs

need clear health policies, up-to-date information, and sensitive

communication among staff, parents, and children about

communicable diseases.

23

Understanding Communicable Diseases 13
Module 1

Activity 2:

What Do We

Think?

Purpose: This activity helps participants develop strategies to work with

people in the Head Start program who have diverse beliefs about

communicable diseases.

For this activity, you will need:

A copy of Handout B: What Do We Think? for each participant

A copy of the Appendix handout: Colds and Flu, for each participant

Step 1: Explain that this activity helps us examine different beliefs

about communicable diseases.

Step 2: Distribute Handout B: What Do We Think? Explain that

participants should first write down their own answers to the

questions. Then they should interview two peopleanother

Head Start staff person and a parentand write down their

responses to the same questions. Ask participants to try to select

people who are different from them in age, ethnicity, or

lifestyle.

Step 3: After the interviews are complete, bring the participants back

together to discuss their findings.

a. What were some of the similar beliefs about colds?

b. What were some of the different beliefs about colds?

c. How are the beliefs based on culture, education, and

personal experience?

Step 4: Distribute the Appendix handout: Colds and Flu. Explain that

this handout is the current information from public health

authorities that guides Head Start's practices regarding colds.

Give participants a few minutes to review it.

Step 5: Ask:

a. What differences are there between the "Colds and Flu"

handout and the other beliefs about colds?

b. Understanding that the Head Start program is made up of

people with all of these beliefs and more:

2

14 Preventing & Managing Communicable Diseases
Module 1

Points to Consider

What might be some potential conflicts in managing

colds in a Head Start program?

What are some strategies to resolve conflicts and

establish common practices for preventing and

managing communicable diseases in Head Start?

People have different beliefs about communicable diseases,

including beliefs about the causes, prevention, and treatment of

illnesses, and about different resources for information and

treatment.

Each person's beliefs are shaped by culture, education, and personal

experience.

Head Start staff must demonstrate sensitivity and respect for

different beliefs and practices.

Staff must also follow Head Start health policies guiding the

management of communicable diseases in the program. Policies

should be clear, up to date, and developed in cooperation with

public health authorities and the Health Services Advisory

Committee.

25

Understanding Communicable Diseases 15
Module 1

Activity 3:

Working with

People with

Diverse Beliefs

Purpose: This activity helps participants develop strategies to work with

diverse beliefs about communicable diseases in Head Start.

For this activity, you will need:

Four sheets of flip chart paper and a marker for each participant

A copy of each of these Appendix handouts: Colds and Flu,

Infectious Diarrhea, Head Lice, HIV/AIDS, for each participant

Preparation Note: Before the training, take out four pieces of flip

chart paper. Write one of the following sentences at the top of

each paper:

1. Colds and flu are caused by...

2. Most diarrhea is caused by...

3. Head lice keep going around the center because...

4. When caring for children with HIV/AIDS, I sometimes

worry that HIV will be spread by...

Step 1: Explain that the purpose of this exercise is to explore the wide

range of beliefs and feelings about communicable diseases.

Step 2: Post the four flip chart sheets you have prepared around the

room. Give participants markers and ask them to write as many

phrases as possible on each sheet to complete each sentence

with what they believe, what others believe, and things that

they've heard.

Step 3: After about 10 minutes, ask participants to sit down. Read each

statement and the different beliefs and feelings that were listed.

Step 4: Ask participants:

a. What is similar about all of the lists?

b. How are the beliefs based on culture, education, and

personal experience?

Step 5: Distribute the Appendix handouts to participants. Explain that

these handouts offer current information from public health

authorities that guides Head Start's policies on communicable

diseases.

Step 6: Beginning with Colds anFlu, give participants a few minutes

16 Preventing & Managing Communicable Diseases
Module 1

Points to Consider

to review the handout. Ask participants: a. Which statements from the flip chart list of causes of colds

and flu are supported most by the information on the

handout? (Circle them or write them down.)

b. Do the same for infectious diarrhea, head lice, and HIV/

AIDS.

Step 7: Ask: a. When managing colds and flu in a Head Start program, what

might be some potential conflicts...

due to diverse beliefs and feelings among staff and

parents?

due to strong feelings (e.g., anger, blaming, fear,

shame)?

b. What are some strategies to resolve conflicts and establish

common practices for managing communicable diseases in

Head Start?

People have different beliefs about the causes, prevention, and

treatment of communicable diseases and about resources for

information and treatment.

Each person's beliefs are shaped by culture, education, and personal

experience.

Anger, blaming, fear, and shame can make it difficult to prevent and

manage communicable diseases effectively.

To manage communicable diseases effectively, Head Start staff

must:a. demonstrate sensitivity and respect for diverse beliefs and

practices,

b. follow Head Start health policies.

Head Start health policies should be clear, up to date, and developed

in cooperation with public health authorities and the Health Services

Advisory Committee.

Understanding Communicable Diseases 27 17
Module 1

Activity 4:

How

Communicable

Diseases Spread

Purpose: This activity helps participants understand how communicable

diseases spread and why they spread so widely.

For this activity, you will need:

Flip chart paper

Colored markers (red, blue, brown, green)

Key to Activity 4: A: Communicable Diseases in Children; Key to

Activity 4: B: How Commmuicable Diseases Spread (for trainer only)

One index card and pen/pencil for each participant

Overhead projector and transparency

Preparation Note: Before the activity:

Copy the chart on Communicable Diseases in Children (Key

to Activity 4: A) onto an overhead transparency.

Copy the outline of the human body (Key to Activity 4: B)

onto flip chart paper.

Separate out eight of the index cards:

a. On four cards, write a small letter in the lower right

corner: "R" on one, "G" on another, "D" on another, and

"B" on another

b. On four cards, write a small letter "H" in the lower left

corner

Review Appendix: Communicable Disease Fact Sheets

Step 1: Explain to participants that this activity helps them understand

how communicable diseases spread.

Step 2: Show the overhead chart on Communicable Diseases in

Children (Key to Activity 4: A). Briefly review the four main

ways that communicable diseases are spread (respiratory,

gastrointestinal, dermatologic, and blood-borne), common

examples of the diseases, general symptoms of the diseases, and

specific ways they spread in Head Start programs.

2

18 Preventing & Managing Communicable Diseases
Module 1

Step 3: Post the flip chart paper with the outline of the human body.

Explain that, for each type of disease, the germs are carried by

and spread from specific parts of the body. Color the parts

accordingly (See Key to Activity 4: B):

Respiratory (blue): nose, mouth and lungs

Gastrointestinal (brown): mouth, stomach, intestines,

bottom

Dermatologic (green): skin, hair

Bloodborne (red): blood throughout the body

Emphasize that all of the different germs can be carried on one

part of the bodythe hands. Color the hands with all of the

colors.

Step 4: Explain to participants that they will play a game to see how

quickly communicable diseases spread.

Step 5: Distribute an index card to each participant (Make sure that the

eight index cards with letters on them are distributed). Ask

participants to stand up, mingle with each other, and do the

following:

Introduce yourselves to someone and shake hands with

them. Write your name on the other person's index card.

Then return the card to the owner.

Tell participants that they will have one minute to do this as

many times as possible. When the minute is up, have everyone

sit down together.

Step 6: Ask the person who has an "R" in the lower right corner of his

card to stand up. Explain that he has a respiratory diseasea

coldand got germs on his hands from blowing his nose.

Ask all participants who shook his hand and have his name on

their cards to stand up. Explain that they caught his cold. Ask

them all to continue to stand up.

Step 7: Ask the person who has an "G" in the lower right corner of her

card to stand up. Explain that she has a gastrointestinal

diseasediarrheaand got germs on her hands from going to

the bathroom.

Understanding Communicable Diseases 19
Module 1

Points to Consider:

Ask all participants who shook her hand and have her name on

their cards to stand up. Explain that they caught her diarrhea.

Ask them all to continue to stand up.

Step 8: Ask the person who has a "D" in the lower right corner of his

card to stand up. Explain that he has a dermatologic disease

scabiesand got germs on his hands from scratching his rash.

Ask all participants who shook his hand and have his name on

their cards to stand up. Explain that they caught his scabies. Ask

them all to continue to stand up.

Step 9: Ask the person who has a "B" in the lower right corner of her

card to stand up. Explain that she has a blood-borne disease

hepatitis Band got germs on her hands from cutting her hand

on a piece of glass.

Ask all participants who shook her hand and have her name on

their cards to stand up. Explain that they caught her hepatitis B

because they had a cut on their hand that allowed infected blood

to enter their system. Ask them all to continue to stand up.

Step 10: Have participants look around the room. Ask: What do you

observe?

Step 11: Ask for all participants who have an "H" in the lower left corner

of their cards to raise their hands. Explain that they did not catch

the disease because of good hand washingthey washed their

hands at the proper time and so did the other people. Ask them

to sit down.

Step 12: Ask: What did you observe about the spread of diseases through

this activity?

The majority of illnesses spread in early childhood programs are

respiratory, gastrointestinal, and dermatologic diseases. The spread

of bloodborne diseases is extremely rare.

When only a few individuals have communicable diseases, they can

spread widely among a group of people, for example, among

children and adults in a Head Start program. The more people have

close contact with each other, the more germs and diseases can

spread.

A few simple prevention measures, such as hand washing, can

reduce the spread of disease.

30

20 Preventing & Managing Communicable Diseases
Communicable Disease in Children

Module 1

Key to Activity 4: A

cat

Diseases Possible Poss

Symptoms* Spread By

ow

III

'1:1.,

a)

rg

"colds"

"flu"

ear infection

"step" throat

scarlet fever

conjunctivitis

roseola

pneumonia

tuberculosis (TB)

chicken pox

fifth disease ("slap cheek")

haemophilus influenza B (HIB)

measles

mumps

rubella (German measles)

pertussis (whooping cough)

runny nose

ear ache

sore throat

cough

headache

fever

rash

wiping nose with hand

and then touching

people and objects

wiping children's noses

and not washing hands

afterwards

coughing or sneezing

into air

sharing of mouthed

toys by infants

kissing children on the

mouth

poor ventilation

Irs *-1o

L.

ia.

64

rotavirus

hepatitis A

salmonella

shigella

campylobacter

giardia

pinworms

Coxsackie virus (hand, foot, and mouth)

Escherichia coli (E. Co li)

polio

amebas

stomach ache

nausea

vomiting

diarrhea

not washing hands after

toileting/diapering and

before cooking/eating

sharing of mouthed

toys by infants

not cleaning and

diapering/

toileting areas

improper refrigeration

and preparation of meat,

poultry, eggs, or milk

products

Tie

o

CO6, A cs

impetigo

herpes

ringworm

lice

scabies

rash

oozing lesions

itching

touching infected skin/

hair

sharing clothes, hats,

bedding, linen,

hairbrushes, etc. asg4

v

0° act

hepatitis B

HIV/AIDS

fatigue

weight loss

fever

contact with blood into

broken skin or eyes,

nose, or mouth

sexual contact

Understanding Communicable Diseases 21

-I L.
Module 1

How Communicable Diseases Spread Key to Activity 4: B

Respiratory (blue): nose, mouth, lungs

Gastrointestinal (brown): mouth, stomach, intestines, bottom

Dermatological (green): skin, hair

Bloodborne (red): blood throughout body (All diseases and all colors: hands)

32

22 Preventing & Managing Communicable Diseases
Module 1

Activity 5:

Spreading Germs Purpose: This activity helps participants understand how communicable

diseases spread and identify specific behaviors that spread disease in

Head Start.

For this activity, you will need:

Flip chart paper

Colored markers (red, blue, brown, green)

Key to Activity 4: A: Communicable Diseases in Children; Key to

Activity 4: B: How Commmuicable Diseases Spread (for trainer only)

Preparation Note: Before the activity:

Copy onto flip chart paper:

The chart on Communicable Diseases in Children

(Key to Activity 4: A). Don't fill in the last column,

"Spread by..."

The outline of the human body (Key to Activity 4: B)

Review Appendix: Communicable Disease Fact Sheets

Step 1: Explain to participants that this activity will help them

understand how communicable diseases are spread.

Step 2: Post the chart on Communicable Diseases in Children. Briefly

review the four main ways that communicable diseases are

spreadRespiratory, Gastrointestinal, Dermatologic, and

Bloodborne. Discuss common examples of the diseases and

general symptoms.

Step 3: Post the outline of the human body. Explain that, for each type

of disease, the germs and parasites are carried by and spread

from specific parts of the body. Color the parts accordingly (See

Key to Activity 4: B: How Communicable Diseases Spread):

Respiratory (blue): nose, mouth, and lungs

Gastrointestinal (brown): mouth, stomach, intestines,

bottom

Dermatologic (green): skin, hair

Bloodborne (red): blood throughout the body

Understanding Communicable Diseases 23

33
Module 1

Points to Consider:

Emphasize that all of the different germs can be carried on one

part of the bodythe hands. Color the hands with all of the

colors.

Step 4: Have participants list the specific ways that communicable

diseases spread in early childhood programs, keeping in mind

the parts of the body and the body fluids that carry different

types of diseases. Write these down in the last column ("Spread

By...") of the chart on Communicable Diseases in Children (See

Key to Activity 4: A: Communicable Diseases in Children).

Step 5: Ask participants:

a. Were you surprised by the way that any of the diseases was

spread? (For example, although chicken pox involves skin

lesions, it is spread by the respiratory route; and hand, foot,

and mouth syndrome is spread by the gastrointestinal route.)

b. Why might it be important to know how specific diseases

are spread?

The majority of illnesses spread in early childhood programs are

respiratory, gastrointestinal, and dermatologic diseases. The spread

of bloodborne diseases is extremely rare.

It is important to understand how diseases are spread in order to

know how to prevent their spread. For example, if there is an

outbreak of hand, foot, and mouth syndrome (Coxsackie virus),

which is spread by the gastrointestinal route, staff members should

review their universal precautions to prevent gastrointestinal

diseases (e.g., diapering, hand washing, disinfecting, and food

preparation) to see where there has been a breakdown.

24 Preventing & Managing Communicable Diseases
Module 1

Next Steps:

Ideas to

Extend Practice

Teaching Children about Germs

Set up activities to help children understand about germs and illnesses, for

example:

Explain what germs are, where you find them, and how they spread.

Remind children that we usually cannot see germs even when they

are there.

Have them draw pictures of germs and make a collage.

Grow germs on a piece of bread. Introduce germs by touching the

bread or putting mucus, saliva, or dirt on it. Moisten it with water,

seal it in a plastic baggie, and keep in a warm place. Observe germs

growing for a week.

Demonstrate a microscope.

Discussing Beliefs about Communicable Diseases

Set up a staff-parent workshop to discuss communicable diseases. Invite

health professionals and families from different cultural backgrounds.

Discuss different beliefs and emphasize the importance of respecting

diverse beliefs and practices. Discuss the lessons for children on

communicable diseases and encourage parents to reinforce the lessons at

home. Allow staff and parents to ask questions and express their concerns

about the prevention and management of communicable diseases in Head

Start.

Observing the Spread of Germs in Head Start

As a follow-up to Activities 4 and 5, have staff return to their Head Start

duties and observe behaviors that may spread germs. Staff should be

aware of their own behaviors as well as the behaviors of other staff,

parents, and children. Pay special attention to coughing/sneezing, wiping

noses, diapering, toileting, and handling food. Also note behaviors that

might prevent the spread of germs, such as, hand washing, cleaning, and

disinfecting. Discuss the observations in a staff meeting.

Understanding Communicable Diseases 25
Module 1: Understanding Communicable Diseases

Handout A: Who Has Had This Experience?

Find Someone Who . . . Sign Here

Opens windows to prevent the spread of illnesses.

Has chapped hands from washing them so much.

Teaches children to cough into their elbow or shoulder.

Carries latex gloves on the playground.

Has seen a child with chicken pox.

Has dealt with a case of giardia in child care.

Has caught conjunctivitis (pink eye) from a child.

Has a child who caught head lice in school.

Missed work this year to take care of a sick child.

Knew someone with a disease that could have been

prevented by immunization.

Got a flu shot this year.

Has discussed communicable diseases with a

health professional.

Preventing & Managing Communicable Diseases 36' 27
Module 1: Understanding Communicable Diseases

Handout B: What Do We Think?

Why do people catch colds?

My ideas:

Other staff person's ideas:

Parent's ideas:

What can we do to reduce the spread of colds?

My ideas:

Other staff person's ideas:

Parent's ideas:

When you catch a bad cold, what do you do to get better? Whom do you ask for advice?

My ideas:

Other staff person's ideas:

Parent's ideas:

37

28 Preventing & Managing Communicable Diseases
Module 2

Preventing Communicable Diseases

Outcomes After completing this module, participants will improve their practices to

reduce the spread of diseases.

Key Concepts Health screenings and immunizationsfor all children, family

members, and staffare important to prevent the spread of

diseases.

You can't tell by looking at people whether they carry a

communicable disease. To prevent the spread of diseases, we

must take the same infection control precautions at all times with

all people.

Staff, children, and parents should follow daily infection control

practices to prevent the spread of disease:

Wash hands at proper times and with the proper technique.

Use latex or vinyl gloves for contact with blood.

Clean and disinfect objects and surfaces regularly.

Prepare and handle food in a sanitary manner.

- Dispose of wastes properly.

- Provide fresh air and ventilation.

Background Information A. Health Maintenance

The best defense against communicable disease is a healthy body. Intact

skin is an excellent barrier to germs. A strong immune system fights off

most of the germs that enter the body. When we take care of our bodies

with proper nutrition, exercise, and rest, our bodies can usually take care

of us.

1111 All children and adults should have periodic health screenings. This helps

identify special health needs and makes treatment to prevent further

Preventing Communicable Diseases 38 29
Module 2

health problems possible. The health screening items most relevant to

communicable disease are:

1. Immunizations (or vaccines) protect children and adults against

serious illnesses. For the best protection, children should begin

getting immunizations at birth and receive the entire series within the

first 15 to 18 months of life. Currently, it is recommended that

children be immunized against the following diseases:

Polio

Diphtheria

Tetanus

Pertussis (whooping cough)

Haemophilus influenza B

Measles

Mumps

Rubella (German measles)

Hepatitis B

Varicella (Chicken pox)

Staff and parents should consult their health care provider about the

following immunizations: polio, measles, mumps, rubella, tetanus,

diphtheria, hepatitis B, influenza, pneumococcus, and chicken pox.

Note: Since new immunizations can become available any time,

consult your local public health authorities to learn the most current

recommendations.

2. Tuberculin (TB) Test Tuberculosis (TB) is a communicable disease

that can cause cough, pneumonia, fevers, weight loss, and even death.

Young children, seniors, and people with health problems are

especially at risk. TB spreads by coughing. The infection enters the

lungs and may cause no symptoms for years.

Young children and adults working with children should get tested

periodically for TB. The recommended test, Mantoux or PPD,

involves an injection on the forearm. After 2-3 days, the site is

checked for swelling indicating TB infection. If there is a reaction,

further evaluation including a chest x-ray is needed to determine

treatment and follow-up. When TB is identified early, it usually can

be treated successfully with antibiotics.

B. Special Health Needs

Children and adults may have special health needs related to

communicable diseases:

Some health conditions weaken the body's immunity and make the

person more susceptible to complications from communicable

diseases. Examples of such conditions include diabetes, sickle cell

anemia, asthma/lung disease, heart defects, kidney disease, HIV/

39

30 Preventing & Managing Communicable Diseases
Module 2

AIDS, cancer chemotherapy, organ transplant, and steroid

medications.

Some medical equipment and procedures make a person vulnerable to

infection. Examples include feeding tubes, tracheostomy, ventricular

(brain) shunt, urinary catheterization, and intravenous lines.

Pregnant women are at risk for certain communicable diseases that

can cause miscarriage, birth defects, or illness in the newborn.

Examples include rubella (German measles), measles, mumps,

hepatitis B, cytomegalovirus (CMV), herpes, parvovirus (fifth

disease, "slap cheek"), chicken pox, and HIV.

Some people carry "chronic" infectious diseases for many years or

for life. Examples include herpes, hepatitis B, HIV, CMV, and

salmonella.

Some children have conditions or behaviors that increase the spread

of germs. For example, mouthing behaviors in older children can

increase their chances of getting sick. Drooling, biting, and having

older children in diapers can increase the spread of germs to other

children and adults.

Head Start programs should be aware of the specific immunizations,

medications and precautions needed for children and staff with special

health needs.

C. Universal Infection Control Precautions

"Infection control" practices help reduce the spread of illnesses caused by

germs. "Universal precautions" means using the same infection control

practicessuch as hand washing, using gloves, and cleaning and

disinfectingwhen dealing with the blood or body fluids of all children

and adults, at all times.

It isn't enough to take precautions only when someone looks sick. People

can carry and spread infections when they appear sick and when they

appear healthy. Many infections (e.g., colds, flu, chicken pox, hepatitis A)

are contagious in the day or two before symptoms develop. People can

carry some infections (e.g., hepatitis B, HIV, CMV, giardia) without any

symptoms for a long time.

Universal infection control precautions are effective in preventing the

spread of illness. For example, careful hand washing has been shown to

reduce the incidence of diarrhea in early childhood programs by half.

Preventing Communicable Diseases 40 31
Module 2

1. Hand washing: This is the most important infection control measure.

Staff, children, and parents should wash their hands:

BEFORE

AND

AFTER

AFTER

preparing and serving food, feeding

children, and eating/drinking

taking or giving medication

doing mouth/eye care and medical

procedures

toileting, diapering, assisting a child at the

toilet, and handling soiled clothes

touching blood, skin lesions, eye discharge,

saliva, vomit, urine, stool, and mucus (including

wiping noses)

playing or working outdoors

handling animals

cleaning up

(For proper technique, see Handouts C: Hand Washing and E-1:

Hand Washing Checklist)

2. Gloves: When caregivers deal with blood and body fluids, the best

protection is intact skin and hand washing. Disposable latex or vinyl

gloves provide added protection.

The Centers for Disease Control and Prevention (CDC) and

Occupational Safety and Health Administration (OSHA) recommend

gloves for contact with blood, mucous membranes (e.g., mouth and

eyes), and discharges. Use gloves for:

Caring for bloody injuries/incidents (e.g., bloody noses),

Cleaning surfaces and handling items soiled with blood,

Changing diapers with bloody stool or oozing diaper rash,

Caring for oozing skin rashes or lesions,

Providing mouth or eye care and medical procedures,

Cleaning up large spills of other body fluids (e.g., vomit, urine,

and stool).

(For proper technique, see Handout D: Gloving)

3. Diapering and Toileting: Stool carries germs that cause

gastrointestinal illnesses. The moms in stool spread widely among

-11,- 32 Preventing & Managing Communicable Diseases
Module 2

children in diapers and those learning toileting. Adults who diaper

and assist children with toileting can also spread germs.

The keys to infection control in diapering/toileting are:

Diaper children on an elevated surface used only for diapering,

away from food preparation, and within reach of hand washing.

After diapering and toileting, both child and adult must wash

their hands.

Clean and disinfect the diapering surface after each use.

Clean and disinfect toileting areas daily and when soiled.

Discard dirty diapers in a covered step can.

Avoid having staff who change diapers prepare food.

(For proper techniques, see Handout E-2: Diapering Checklist)

4. Cleaning and Disinfecting: Germs inevitably spread to surfaces and

objects. That is why surfaces and objects must be cleaned and

disinfected on a regular schedule and after soiling with blood or body

fluids.

Cleaning: Use soap and water to wash away visible soil and

many germs.

Disinfecting or sanitizing: Use a special solution (e.g., bleach

or other approved disinfectant) to kill germs that remain on the

surface after cleaning. They can be effective only if the visible

soil, which harbors germs, is cleaned off first.

(For schedule and technique, see Handout E-3: Cleaning &

Disinfecting Checklist)

5. Disposal and Laundry: Items soiled with stool, blood, or other body

fluids must be disposed of or laundered properly to prevent the

spread of disease:

Discard disposable items (e.g., diapers, gloves, paper towels,

tissues) immediately. Trash cans should be:

within reach of diaper changing, hand washing, and food

preparation areas

Preventing Communicable Diseases 33

42
Module 2

operated by a foot pedal

tightly covered

lined with a plastic bag, emptied and disinfected daily

Seal clothes, bedding, and cloth toys soiled with stool, urine,

blood, or other body fluids in a plastic bag until laundering.

6. Food Handling: Preparing and eating food is fun and healthy. If food

is handled improperly, however, germs can spread to everyone who

eats the food. Most food-borne illness causes vomiting and diarrhea,

and such illnesses can be especially severe for infants, young

children, seniors, and people with immune problems.

The main causes of foodborne illness are using poor hygiene when

handling food (e.g., not washing hands, preparing food when ill), not

cooking meat and poultry sufficiently, and letting "perishable" foods

(e.g., meat, fish, poultry, milk, eggs, mayonnaise) sit out at room

temperature.

In every activity that involves food, staff, parents, and children must

pay careful attention to food safety:

Ensure good hygiene, especially hand washing, among food

handlers.

Refrigerate perishable foods until preparation.

Cook meat and poultry thoroughly.

Keep hot foods hot and cold foods cold when serving.

Discard uneaten food from plates, milk from bottles, and familystyle bowls of perishable food after two hours.

Clean and disinfect cutting boards, utensils, and tables.

(For details, see Handout E-4: Food Handling Checklist)

7. Air Quality: Most people believe that exposure to cold air can give

you a cold. Actually, research shows that fresh air is healthy. When

children and adults spend long periods of time together indoors

particularly in small, overheated, and poorly-ventilated spaces

diseases spread widely.

43

34 Preventing & Managing Communicable Diseases
Module 2

To disperse the germs and reduce the spread of illness:

Open windows to improve indoor ventilation.

Maximize outdoor play time.

8. Other Hygiene Issues

Kissing: It is important to show children affection without spreading

germs to them or catching their illnesses. Don't kiss children on the

mouth, give them hugs instead.

Sneezing and coughing: The old adage, "Cover your mouth when

you sneeze or cough" may prevent you from spraying saliva, mucus,

and germs into the air, but you spray germs onto your hands instead.

If you don't wash your hands immediately, then you spread germs

when you touch people and objects afterward. A healthier way to

sneeze and cough is:

Into your elbow or shoulder

Facing down and away from people

Toothbrushes: Since toothbrushes can pick up and spread germs

from our mouths, it is important to follow careful hygiene with

toothbrushing:

Have a personal, labeled toothbrush for each child.

If toothpaste is used, dispense it onto a clean surface (e.g., a

piece of paper or the edge of a paper cup) to prevent

contaminating the tube from each toothbrush.

Store toothbrushes with bristles up, not touching other brushes,

and allow to air-dry.

Replace toothbrushes when bristles are splayed and when

contaminated. They cannot be disinfected.

Water play tables and portable wading pools: Water play can be

fun and refreshing for children. However, water play tables and

wading pools can spread disease. For safer water play:

Give children individual water basins.

Have children wash their hands before and after using the water

basin.

Preventing Communicable Diseases 44 35
Module 2

Questions for Discussion/

Reflection

After each use, empty out the water and clean and disinfect the

basin.

Use sprinlders and hoses instead of wading pools.

Sandboxes: Since cats and other animals may use sandboxes as litter

boxes, they can spread germs to children. For healthier sand play:

Use only sterilized sand and replace it every two years.

Cover sandboxes when not in use.

Make sure that children wash their hands after playing in the

sand.

We've heard some infection control messages such, as "Wash your

hands," for years. We may think we know about disease prevention and

that there's nothing more we need to learn about it. However,

recommendations change (such as immunizations) and new

recommendations are made (such as using gloves). And we don't always

put the infection control methods we do know into daily practice (such as

hand washing).

What factors keep us from practicing infection control?

Not knowing the procedures

Not believing they are effective

Not having the time

Not having the necessary supplies

Having other demands that are more urgent

4 5

36 Preventing & Managing Communicable Diseases
Activity 1:

Module 2

Hand Washing:

Doing It Right

Purpose: This activity helps participants perfect their hand-washing skills.

For this activity, you will need:

Sinks, liquid and bar soap, paper and cloth towels, hand lotion, trash

can

A copy of Handout C: Hand Washing, for each participant

Step 1: Explain that this exercise looks closely at all of the steps in hand

washing to reinforce the proper technique.

Step 2: Review the recommendations for when adults and children

should wash their hands (see Background Information).

Step 3: Set up the hand-washing demonstration at an actual sink or at a

"pretend sink" with faucets.

Ask for a volunteer to help demonstrate the proper handwashing technique. Explain that she has just helped a child with

toileting. Ask her to describe what she is doing at each step.

Step 4: When the volunteer turns on the water, ask:

a. Is hot or cold water better? (AnswerWarm water is

preferred for comfort and to help dissolve grease and grime,

but cold water works, too.)

b. Is it okay for adults and children to wash hands in a

stoppered sink or a bowl? (AnswerYou must wash your

hands under running water that drains away because

standing water can spread germs.)

Step 5: When the volunteer is ready to soap her hands, ask:

a. Which is better, liquid or bar soap? (AnswerLiquid soap is

preferred because it is easier to handle, but bar soap is

okay.)

b. Is antibacterial soap necessary? (AnswerAntibacterial

soap does not add any benefit in hand washing.)

c. What parts of your hands should you scrub? (AnswerBe

Preventing Communicable Diseases 37

4 6
Module 2

sure to wash all surfaces. Germs accumulate between the

fingers, under fingernails, on jewelry, and around the

wrists.)

d. How long should you scrub your hands? (AnswerScrub

hands for at least 10 seconds.)

Step 6: When the volunteer rinses her hands, offer her the towels and

ask:

a. Which is better, a paper or cloth towel? (AnswerA

disposable paper towel is preferred since a cloth towel can

carry germs.)

Step 7: When the volunteer turns off the water, observe whether she

uses the paper towel to turn off the faucet and then throws it in

the trash. If she turns off the faucet with her bare hands, ask:

a. What could be improved in this hand-washing technique?

(AnswerThe faucet is covered with germs because you

turned it on when your hands were dirty. Don't touch the

dirty faucet with your clean hands. Leave the water running

while you dry your hands and turn off the faucet with the

paper towel. Then throw the paper towel away.)

b. What kind of trash can is best? (AnswerThe trash can

should be lined with a disposable plastic bag. Its cover

should be tight fitting and operated with a foot pedal, so you

don't have to touch the lid, which is full of germs.)

Step 8: Offer the volunteer some hand lotion and ask:

a. Why might it be helpful to use hand lotion? (AnswerIf you

wash your hands as often and thoroughly as recommended,

they may get chapped. Maintaining intact skin is important

to prevent the spread of diseases.)

Step 9: Thank the volunteer for the demonstration. Distribute Handout

C: Hand Washing, to everyone.

Step 10: Ask participants:

a. What new things did you learn about hand washing?

b. What gets in the way of your following all the

recommended steps in hand washing in Head Start?

38 Preventing & Mirfaging Communicable Diseases
Module 2

c. What would make it easier for you to follow the

recommendations for hand washing in Head Start?

d. What are some strategies for teaching children to wash their

hands properly?

Points to Consider: Hand washing is the most important practice to prevent the spread of

disease in Head Start.

The most common problem in hand washing is contaminating your

clean hands from the dirty faucets. To prevent this:

Turn off the faucets with a paper towel.

Clean and disinfect the faucets daily.

When renovating or building child care facilities, consider

installing sinks with faucets operated by elbow, knee, or foot

pedals or by electronic sensors.

There are many reasons why hand washing is not done properly in

Head Startbeing in a rush, not having accessible sinks, running out

of soap or paper towels, not knowing the proper technique, and not

understanding the importance of each step. Some strategies to

improve hand washing include:

displaying hand-washing posters throughout the center

reviewing facilities to ensure access to sinks

making sure supplies are stocked

having periodic monitoring and in-service training on handwashing techniques

Preventing Communicable Diseases 39
Module 2

Activity 2:

The Art of

Gloving

Purpose: This activity helps participants perfect their technique in using

gloves.

For this activity, you will need:

Latex or vinyl gloves for each participant and the trainer

Red paint (water-based)

Plastic bags

Diaper wipes

A copy of Handout D: Gloving, for each participant

Step 1: Explain that this exercise helps us learn the proper technique for

using gloves.

Step 2: Review the importance of using gloves and when to use them

(see Background Information).

Step 3: Tell participants to imagine that you are caring for a child who

got a bloody nose on the playground. Put on the gloves. Cover

your hands with red paint representing the blood and germs.

Step 4: Explain that the bleeding has stopped, and you are walking the

child back to the classroom. Touch the door, another child, or

your face.

Ask: What is wrong with this? (AnswerOnce the gloves

are dirty, remove them and discard them promptly. Be

careful that you don't contaminate yourself objects or other

people with the dirty gloves.)

Step 5: Say: Oh no, another child just skinned her knee! It's lucky that I

still have my gloves on.

Ask: What's wrong with this? (AnswerYou must put on a

fresh pair of gloves before each procedure. If you reuse

gloves, you spread germs from one child to another.)

Step 6: Say: There's really nothing to taking off gloves, right? Remove

the gloves incorrectly, grabbing the gloves at the wrists, and

getting paint on your hands.

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40 Preventing & Managing Communicable Diseases
Module 2

Points to Consider:

Ask: What's wrong with this? (AnswerIf you remove

gloves incorrectly, you contaminate your hands.)

Step 7: Slowly, demonstrate how to remove gloves correctly:

Grab the first glove at the palm of the handonly touch

dirty surfaces to dirty surfaces.

Grab the second glove underneath at the wristonly touch

clean surface to clean surfacesand remove by turning it

inside-out, with the dirty outer surface inward.

Dispose of the dirty gloves immediately in a plastic bag or

plastic-lined trash can.

Wash your hands afterward.

Step 8: Distribute a pair of gloves and Handout D to each participant.

Step 9: Have participants pair up to practice putting on and removing

the gloves correctly. Partners should observe and help each

other.

Step 10: After a few minutes, offer them the chance to cover their gloves

in paint and test their technique in removing the gloves. Give

them a plastic bag to dispose of the gloves and diaper wipes to

clean their hands.

Step 11: Ask: a. What did you learn from this activity?

b. How can Head Start help staff use gloves correctly?

Gloves are important to protect staff, children, and families from the

spread of disease.

Gloves provide protection only when used correctly. If you use

gloves incorrectly, you actually risk spreading more germs than if

you didn't use gloves at all.

Using gloves might seem simple, but staff members need to learn and

practice the proper technique. Don't develop carelessness or a false

sense of security when using gloves.

Preventing Communicable Diseases 41

50
Module 2

To use gloves at the proper times, we need to prepare in advance by

making gloves accessible where they may be neededthe

playground, first aid kit, diaper changing table, and with cleaning

supplies. The closer at hand gloves arein an apron pocket or a

fanny packthe more likely they are to be used.

For special medical procedures such as tube feeding or tracheostomy

care, be sure to wash your hands before putting on gloves to avoid

spreading germs to the child.

42 Preventing & Managing Communicable Diseases
Activity 3:

Module 2

Checking Up on

Infection Control

Purpose: This activity helps programs review their infection control

practices, identify problems, and make plans for improvement.

This activity is particularly helpful for the management team, classroom

teachers, aides, and food service workers. You will need:

Copies of Handouts E:1-4: checklists on Hand Washing, Diapering,

Cleaning and Disinfecting, and Food Handling, for each participant

Pens/pencils

Step 1: Explain that there are many details involved in preventing the

spread of germs. This activity helps assess infection control

practices and identify how to do them better.

Step 2: Distribute Handouts E:1-4. Have participants spend 30-40

minutes observing their program's infection control practices.

Instruct them to complete the yes/no part of the checklist but

leave the "Comments" section blank for now.

Step 3: Bring the participants back together. Have participants review

their checklists. Congratulate them for each "Yes" item. For

every "No" item, discuss:

a. Why is this practice important to prevent the spread of

germs?

b. Is this a practice that you want to improve?

c. What can get in the way of doing this correctly?

d. What do you need to make the improvement? In the

"Comments" section:

List your suggestions for improvement (e.g., revising

the policy, training other staff, posting instructions,

getting supplies).

What do you need to make the change?

Who will take responsibility for the change?

Set a timeline for making the changes.

Preventing Communicable Diseases 43

5 2
Module 2

Points to Consider: Following infection control practices routinely is crucial to

preventing the spread of communicable diseases. Programs need

complete and up-to-date infection control policies, staff training, and

proper supplies and facilities.

Programs should periodically monitor and improve their infection

control practices.

3

44 Preventing & Managing Communicable Diseases
Activity 4:

Module 2

Why Is

Everyone Sick?

Purpose: This activity helps participants identify practices that contribute

to the spread of disease and develop strategies to reduce the spread of

disease in Head Start.

This activity is particularly helpful for classroom staff, food service

workers, and home visitors. You will need:

Flip chart paper, marker

Copies of Appendix handouts: Giardiasis, Pinworms, and of E:1-4

checklists: Hand Washing, Diapering, Cleaning and Disinfecting, and

Food Handling, for each participant

A copy of Handout F1-2: Why Is Everyone Sick? for each participant

Key to Activity 4 (for trainer only)

Pens/pencils

Step 1: Tell participants to imagine that they are each the new health

coordinator for Germtown Head Start. In their orientation, the

program director says:

"Whenever anyone in our parent-infant program gets sick, it just

seems to go through the whole center. All the children get sick,

and their siblings and parents catch it, too. Staff get sick and

bring the illness home to their families. Once this year, we had

to shut down the program because we didn't have enough staff.

"Most of the illnesses that go around are mildcolds, flu,

vomiting, and diarrhea. But we've also had giardiasis and

pinworms spread through the center.

"Can you help figure out why these diseases are spreading

around and what we can do to keep everyone healthier?"

Step 2: Ask:

a. Are there any diseases mentioned that you need to know

more about in order to solve this problem?

b. What resources would you use?

Preventing Communicable Diseases 45

54
Module 2

Step 3: Explain that you called your health consultant or local

department of public health to discuss the situation, and they

sent you information. Distribute handouts from the Appendix:

Giardiasis, Pinworms; and handouts E:1-4: Hand Washing,

Diapering, Cleaning and Disinfecting, and Food Handling.

Allow a few minutes for review.

Step 4: Ask: Now that you have some background information...

What staff members would you want to talk with?

What would you want to ask them?

What would you want to observe at the program?

Step 5: Distribute Handouts F:1-2: Why is Everyone Sick? Explain that

page 1 is the report from the lead teacher, and page 2 has

pictures of what the participants observe in the program.

Step 6: Allow 10-15 minutes to review the handouts. Using the

checklists as guides:

In the report, underline practices that spread disease.

In the pictures, circle items that spread disease.

In the checklists, check "No" where there are problems with

infection control.

Step 7: Post two flip chart papers side-by-side. On the left page write

"Practices That Spread Disease" and on the right page write

"Recommendations" (see Key to Activity 4).

Ask: From your discussions with staff, observations in the

classroom, and research...

a. What are the practices that might spread disease in

Germtown Head Start? (List on the left page.)

b. For each practice that spreads disease, what changes would

you recommend to reduce the spread of disease? (List on the

right page.)

Step 8: Ask:

a. What strategies would you discuss with the director to

implement the changes needed? For example:

55

46 Preventing & Managing Communicable Diseases
Module 2

What health policies need to be made?

What staff training is needed?

What education is needed for children and parents?

What changes in the facility are needed?

b. What resources would you draw on?

Step 9: Ask:

a. How would you phase in the changes over time?

b. How would you monitor the changes and the impact on

disease in the program?

Step 10: Ask:

How can Head Start home visitors use this information when

they visit families, observe the facilities and practices in the

homes, and discuss health issues with parents?

Points to Consider: Communicable diseases spread in Head Start programs because of

hygiene practices both in the centers and in homes.

Program managers should discuss communicable diseases issues with

each other, observe staff and parents' practices, and draw on the

assistance of local health resources to identify practices that lead to

the spread of disease.

To implement effective infection control and reduce the spread of

disease, programs may need to revise their health policies, conduct

staff in-service training, provide education for children and parents,

make changes in the facility, and do close monitoring and follow up.

Preventing Communicable Diseases 47
Module 2

Why Is Everyone Sick? Key to Activity 4

Practices That Spread Disease Recommendations

Changing diapers on floor where children Change diapers on elevated changing table

play, eat, and sleep near hand washing and away from food area

Not using fresh gloves for each diaper change Use fresh gloves for each diaper change

Allowing children with diarrhea to attend Don't let children with diarrhea attend

Disposing of dirty diapers/gloves in open Dispose of dirty diapers/gloves in

trash can plastic-lined, covered step can

Staff, parents, and children not washing Have staff, parents, and children wash hands

hands after diaper changes after diapering

Leaving milk out on the counter Refrigerate milk until ready to serve

Staff who change diapers also preparing food Avoid having people who change diapers

and bottles prepare food and bottles

Not cleaning and disinfecting mouthed toys Clean/disinfect mouthed toys

Using potty chair in play area Have children use toilets in bathroom. Make

bathroom/sink accessible

Not cleaning table before and after meals Clean/disinfect tables before and after meals

Children, staff, and parents washing Have children, staff, and parents wash hands

hands/face in the communal bowl with soap/running water in sink

Children using common washcloth/towel Use disposable paper towels for washing

faces/drying hands

Saving leftover food for next meal After meals, discard milk and uneaten food

that is perishable or has been in a child's

mouth or hands

Keeping children indoors all day Open windows to increase ventilation

indoors; increase outdoor play

, 48 Preventing &

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anaging Communicable Diseases
Activity 5:

Module 2

Let's Have

a Picnic

Purpose: This activity helps participants identify proper food handling

practices to prevent the spread of disease.

This activity is particularly helpful for food service workers, classroom

staff, and parents involved in food preparation. You will need:

Five pieces of flip chart paper and five markers

Handout E-4: Food Handling Checklist (for trainer only)

Step 1: Explain that this activity involves planning a picnic. Participants

will pay special attention to safe food handling to prevent the

spread of disease.

Step 2: Say: It's a great day for a picnicsunny and warm. The menu

for the picnic is fried chicken, potato salad, melon, and milk.

Infants will drink formula and eat baby food.

Step 3: Divide participants into five groups. Assign each group a topic:

food selection, storage, preparation, serving, and cleanup.

Give each group a flip chart paper and marker. Ask the groups

to spend 5-10 minutes listing some important considerations for

their topic in planning this picnic. (For example, under

"Preparation": "Cook the chicken thoroughly, until the juices

run clear.")

Step 4: Bring the groups back together. Allow each group a few minutes

to present its list. Ask the other participants to add any points

that they feel are important.

Use Handout E-4: Food Handling Checklist as a guide to the

main points to elicit.

Step 5: Ask: a. Over the past few years in your program, have you had any

foodborne illnesses or unexplained outbreaks of vomiting

and diarrhea that might be associated with unsafe food

handling?

b. What have you observed about food safety practices in your

Head Start programpicnics, cooking projects, snacks,

lunches, potluck meals, conferences, and fundraisers?

Preventing Communicable Diseases 49

58
Module 2

Points to Consider:

c. How might these food safety principles apply to food activities at

your program?

d. How can Head Start home visitors use this information when they

visit families, observe the facilities and practices in the homes, and

discuss food safety with parents?

e. What are some strategies for teaching proper food handling to

children?

Food is a source of health and well-being; but it can also be a source

of illness when handled improperly.

Most often foodbome illness result from using poor hygiene (e.g., not

washing hands, preparing food when ill), not cooking meat and

poultry sufficiently, and letting "perishable" foods (e.g., meat, fish,

poultry, milk, eggs, mayonnaise) sit out at room temperature.

Foodborne illness spreads in Head Start programs because of hygiene

practices both in the centers and in homes.

To prevent foodbome illness, programs must ensure that food

vendors, staff, parents, and children conduct all aspects of food

handlingselection, storage, preparation, serving, and cleaningin

a safe and sanitary manner (see Background Information).

50 Preventing & Managing Communicable Diseases
Activity 6:

Module 2

Promoting

Fresh Air

Purpose: This activity helps participants develop strategies to improve

air quality in the program in order to reduce the spread of illness in Head

Start.

For this activity, you will need:

A copy of Handout G: Air Quality, for each participant

Step 1: Explain that this exercise explores policies to improve air

quality and reduce the spread of illnesses in Head Start.

Step 2: Divide participants into three groups. Instruct participants to

take on roles for the exercise:

Group 1 members are directors of programs

Group 2 members are teachers

Group 3 members are parents

Step 3: Distribute Handout G: Air Quality. Explain that public health

authorities recommend these policies to improve the air quality

and reduce the spread of diseases in early childhood programs.

The directors would like to incorporate all of these air quality

standards into the health policy for their program. Review each

point.

Step 4: Ask teachers: What are some of your concerns?

If the teachers don't raise any concerns, give a few examples:

When it's 68 degrees in the center, it feels a little cold.

When I go on my break, I feel that I need a cigarette. Why

can't I smoke at school?

I like to have the children all playing next to each other, so

they're easier to supervise.

I'm afraid to let children play outdoors because there have

been some drive-by shootings nearby.

Ask the directors to respond to the teachers' concerns.

Preventing Communicable Diseases 51

60
Module 2

Step 5: Ask the parents: What are some of your concerns?

If the parents do not raise any concerns, give a few examples:

Don't the babies catch colds if there's a draft?

I don't like my child playing outdoors so much because she

skins her knees and gets her clothes dirty.

I'm worried about the children playing outdoors when it's

hot out; they'll get sunburned and overheated.

Kids can't play outdoors when it's cold and rainy; they'll

get wet and chilled and catch pneumonia.

Ask the directors to respond to the parents' concerns.

Step 6: Ask participants ("directors," "teachers," and "parents"):

Given the concerns among staff and parents, what steps

should the program take to implement the policy on air

quality?

What strategies might be helpful for teaching children about

the importance of fresh air and addressing some of their

concerns (e.g., being too cold, wet, or sick)?

How might this process be useful for implementing other

health policy changes?

Points to Consider: Although research has shown that fresh air is healthy, many Head Start

staff, parents, and children have fears and concerns about cold air.

Fresh air is one example of a health issue that can raise concerns

among staff, parents, and children. For this, and for all health issues,

programs should maintain open communication and be sensitive to

the concerns of staff, parents, and children.

Programs can use staff-parent meetings, health workshops, and

classroom activities to provide information and address concerns.

6i.

52 Preventing & Managing Communicable Diseases
Module 2

Next Steps:

Ideas to

Extend Practice

Teaching Children to Prevent the Spread of Germs

Set up activities to teach children to prevent the spread of germs:

a. Have them rub cooking oil on their hands then sprinkle on cinnamon

to represent germs that we can't see. Practice scrubbing hands all

over with soap and water to wash away all of the "germs." Remind

them that this is how we all need to scrub our hands every time, even

when we can't see the germs.

b. Teach children to catch their coughs and sneezes in their elbows.

c. Teach them to share food without sharing germs. At snack time,

practice sharing food in different ways:

Food in individual units (e.g., carrots, crackers): Touch only the

one that you take.

Food to be divided into portions (e.g., casserole, rice, pudding):

Use a clean knife /spoon to cut and serve onto individual plates.

Liquids (e.g., milk, oatmeal, soup): Pour or ladle into individual

cups or bowls.

Promoting Immunizations for Younger Siblings

While Head Start programs ensure that enrolled children receive the

necessary immunizations, many families have younger siblings at home

who are not adequately immunized. Head Start staff can play an important

role in helping families get siblings immunized to protect the children

from serious diseases and prepare them for entry into Head Start.

Show the video, Before It's Too Late, Vaccinate (available in English and

Spanish) at a staff and/or parent meeting. Discuss the importance of

immunizations, the challenges to obtaining immunizations, and strategies

for maximizing immunization rates among families.

Ask:

a. Do you know anyone who became very sick, disabled, or died from a

disease that we can now prevent by vaccines (e.g., polio, measles,

HIB meningitis, or whooping cough)?

b. What difficulties have you faced in getting yourself or your own

children immunized?

Preventing Communicable Diseases 53

6 2
Module 2

c. How can all Head Start staff help promote immunization of children,

families, and staff? For example, what could a director, health

coordinator, teacher, health aide, family service worker, or busdriver do?

Assessing the Program's Infection Control

Using the infection control checklists (Handouts E:1-4), assess the

program's facilities and procedures in hand washing, diapering, cleaning/

disinfecting, and food handling. Also observe the handling and storage of

toothbrushes. You may get assistance from health consultants or your

local health department.

Identify the main infection control problems and develop a plan to

improve them. Determine what policies are needed. Target training to

specific issues of concern. For example, if hand-washing practices are

inadequate, show the videos ABCs of Clean and Hooray for

Handwashing. Set a timeline for the changes. Follow up six months later.

Having a Picnic

Have the picnic that you planned in Activity 6. You may use the menu

listed or develop your own menu. Plan the picnic, paying special attention

to safe food handling to prevent illnesses caused by spoiled food.

Consider food quality, storage, preparation, serving, and cleanup (see

Handout E-4: Food Handling Checklist).

Promoting Fresh Air

Review your program's policies concerning air quality (see Handout G:

Air Quality). Work with your management team, Health Services

Advisory Committee and Policy Council to draft policies to improve air

quality and reduce the spread of illnesses in your program. Organize a

staff-parent meeting, as in Activity 6, to discuss the policy. Take steps to

implement the policy. Do follow-up interviews of staff and parents six

months later to evaluate the new policy.

6 ,-3'

54 Preventing & Managing Communicable Diseases
Module 2: Preventing Communicable Diseases

Handout C: Hand Washing

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t.o ------5,

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Have the necessary supplies on hand.

Scrub hands with soap and water for at least 10

seconds.

Rinse hands well under running water. Leave the

water running.

Dry hands with a paper towel.

Turn off the faucet with the paper towel, instead

of with bare hands.

Discard the paper towel in the trash can.

Apply hand lotion if needed.

Preventing & Managing Communicable Diseases 55
Module 2: Preventing Communicable Diseases

Handout D: Gloving

Put on a clean pair of gloves.

Provide the appropriate care.

Remove each glove carefully. Grab the first glove

at the palm and strip the glove off. Touch dirty

surfaces only to dirty surfaces.

Ball up the dirty glove in the palm of the other

gloved hand.

With the clean hand, strip the glove off from

underneath at the wrist, turning the glove inside

out. Touch clean surfaces only to clean surfaces.

Discard the dirty gloves immediately in a step can.

Wash your hands.

65

56 Preventing & Managing Communicable Diseases
Module 2: Preventing Communicable Diseases

Handout E-1: Hand Washing Checklist

For any items checked NO, write your plan for change in the "Comments" column.

Do staff, children, and parents wash

hands... Yes No Comments

Before and after...

Preparing and serving food?

Eating/drinking?

Taking or giving medication?

Doing mouth/eye care and medical

procedures?

After...

Toileting, diapering, assisting a child at

the toilet and handling soiled clothes?

Touching blood, skin lesions, eye

discharge, saliva, vomit, urine, stool,

and mucus (including wiping noses)?

Playing or working outdoors?

Handling animals?

Cleaning up?

Preventing & Managing Communicable Diseases

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Module 2: Preventing Communicable Diseases

Handout E-1: Hand Washing Checklist (continued)

When handwashing do you... Yes No Comments

Have the following facilities and

supplies

Sink with running water within reach of

diapering, toileting, and food

preparation?

Soap (preferably liquid)?

Disposable paper towels?

Trash can?

Handwashing posters?

Use the following procedures

Lather with soap and water?

Scrub all surfaces with hands for at

least 10 seconds?

Rinse off under running water?

Turn off faucet with paper towel?

Discard paper towel in trash?

in rl

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Preventing & Managing Communicable Diseases
Module 2: Preventing Communicable Diseases

Handout E-2: Diapering Checklist

When changing diapers, do you... Yes N o Comments

Use a diaper-changing surface that is...

Elevated and sturdy?

Waterproof (e.g., formica, metal or plastic diaper

pad)?

Guarded by a railing? (Don't use a strap)

Within reach of a hand-washing sink?

Away from the food preparation and serving area?

Not used for any other purpose?

Have the following supplies on hand:

Disposable, non-porous paper to cover the surface?

Clean, disposable diapers and/or cloth diapers and

waterproof diaper covers?

Disposable diaper wipes?

Disposable latex or vinyl gloves?

Plastic bags?

Covered, foot-pedal-operated trash can with

disposable plastic liner?

Soap and water solution?

Disinfectant solution?

Disposable paper towels?

r-)

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Module 2: Preventing Communicable Diseases

Handout E-2: Diapering Checklist (continued)

When changing diapers, do you... Yes N o Comments

Use the following procedures:

Have a routine for when to check and change

diapers?

Cover the diapering surface with disposable,

non-porous paper?

Always keep at least one hand on the child?

Wear disposable gloves if blood in the stools or

oozing rash are present?

Seal soiled clothes in a plastic bag to send home?

Wipe from front to back and use a clean wipe for

each pass?

Discard disposable diapers, diaper wipes, gloves,

and paper in a covered, foot-pedal-operated trash

can?

Change both the dirty cloth diaper and diaper

cover together?

Wipe your hands with a disposable diaper wipe

before putting a clean diaper on the child?

Wash the child's hands with soap and running

water afterward?

Clean visible soil off the diapering surface with

paper towel, soap, and water?

Spray the diapering surface with disinfectant, wipe

with a paper towel, and air-dry?

Wash your hands with soap and running water

afterwards? 6

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Module 2: Preventing Communicable Diseases

Handout E-3: Cleaning & Disinfecting Checklist

Do you clean and disinfect... Yes No Comments

After each use or occurrence...

Diapering surface?

Kitchen counter?

Utensils, dishes, cups, bottles, nipples?

Dining table, high chair, feeding table?

Mouthed toys?

Spills of food or drink?

Surfaces, bedding and clothes soiled with stool,

urine, blood, or other body fluid?

Daily...

Diapering surface?

Toilets and bathrood area?

Sinks and faucets?

Drinking fountains?

Kitchen counter?

Telephone receiver?

Floors (carpet vacummed)?

Trash cans?

Frequently-handled toys and play tables?

Door knobs?

Weekly...

Low shelves?

Cribs, mattresses, and bedding?

Cloth toys?

Refrigerator?

Monthly...

Carpets?

Walls?

All shelves?

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Module 2: Preventing Communicable Diseases

Handout E-3: Cleaning & Disinfecting Checklist (continued)

Do you clean and disinfect... Yes N o Comments

With the following supplies:

Bleach solution or other approved

disinfectant?

Opaque spray bottle?

Disposable paper towels?

By the following procedures:

If you use bleach, do you:

-Make a fresh solution every day?

-Mix

1 tablespoon bleach in 1 quart water?

or

1/4 cup bleach in 1 gallon water?

Wash surfaces by:

-Cleaning off visible soil with soap and

water?

-Spraying on disinfectant, wiping with

paper towel, and air-drying?

Wash plastic toys in

-Dishwater with detergent?

or

-Basin of soap/water; then rinse in

disnfectant and air-dry?

Wash cloth toys in laundry with

detergent? 71

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Module 2: Preventing Communicable Diseases

Handout E-4: Food Handling Checklist

Do you... Yes No Comments

Select food that is...

Fresh and unspoiled?

From government-inspected meat and food

suppliers?

Pasteurized milk products?

Not from bulging, damaged, or home cans?

Store food by...

Keeping refrigerators under 40° F; freezers under

0° F?

Refrigerating or freezing perishable food?

Cooking meat, fish, and poultry within two days?

Sealing non-perishable food in containers?

Prepare food by...

Using a separate area from diapering, toileting,

play, and animals?

Using staff members who have no illness or open

skin lesions?

Using staff members who do not change diapers?

Washing hands first?

Using clean and disinfected counters, cutting

boards, and utensils?

Defrosting food in refrigerator, microwave, or by

cooking (not at room temperature)?

Washing fruits and vegetables prior to use?

Cooking meat/poultry throroughly until juices run

clear?

Washing hands, cutting boards, and utensils after

handling raw meat/poultry?

Preventing & Managing Communicable Diseases

BESTOOMAUBLE

72 63
Module 2: Preventing Communicable Diseases

Handout E-4: Food Handling Checklist (continued)

Do you... Yes No Comments

erve and eat foods , After washing hands?

Keeping hot foods hot, cold foods cold?

On clean and disinfected tables?

On clean or disposable plates, cups/bottles, and

utensils?

For infants...

Using individual, labeled bottles?

Using clean, disinfected bottles/nipples?

Warming bottles under running water, in pan on

stove, or crockpot (not microwave)?

Shaking/mixing well and testing temperature?

Never giving honey?

Serving baby food in bowl/cup (not jar)?

Clean up .by

Discarding uneaten food from plates,

bottles/cups, and perishables in family-style

bowls (after two hours)?

Refrigerating leftovers immediately?

Discarding disposable plates and utensils?

Washing dishware in dishwasher or hot

water/detergent then disinfecting?

Cleaning and disinfecting counters, cutting

boards, and tables? °, el

64

BEST COPY AVAILABLE

Preventing & Managing Communicable Diseases
Module 2: Preventing Communicable Diseases

Handout F-1: Why is Everyone Sick?

Lead Teacher's Report

Here's an overview of our day at the center:

When the children arrive in the morning, many have dirty diapers, so we change them all first. We lay

them all down on the carpet and then put on our gloves. We change all of the babies' diapers and then

take off the gloves and throw the diapers and gloves in the trash. When the children have diarrhea, we

seal the diaper in a plastic bag. The bathroom sink is way down the hall, but luckily we don't need to

wash our hands, since we wear gloves.

Then we give the children their bottles and snacks. The teachers and parents prepare the food in our

kitchen area in the room.

110 After snack, we bring out the toys and let the children play on the carpet area or at play tables for most

of the morning. Then we put the toys back into their cabinets.

Before lunch, we change diapers again. The toddlers also use the potty. The children wash their hands in

a bowl of soapy water that we pass around. We also dip a washcloth in the soapy water to wash off their

faces. Staff and parents wash their hands with the children. We pass around a towel to dry our hands.

The children eat seated in the adults' laps on the carpet or in chairs at the play tables. We save the leftover food for the afternoon snack.

After lunch, we all brush our teeth at the sink. The children take naps on mats on the carpet. The afternoon is similar to the morning: free play and then snack time. We keep the children indoors most days,

because we don't want the babies to catch colds outdoors.

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Preventing & Managing Communicable Diseases 65
Module 2: Preventing Communicable Diseases

Handout F-2: Why is Everyone Sick?

66 Preventing & Managing Communicable Diseases
Module 2: Preventing Communicable Diseases

Handout G: Air Quality

Fresh air disperses germs and reduces the spread of illness.

Maintain good ventilation of indoor space

Keep air temperature between 65 and 72 degrees F.

Open windows to circulate fresh air.

Clean air conditioners and humidifiers regularly.

Spread out toys and equipment.

Alternate cribs/cots head-to-toe, three feet apart.

Do not allow smoking.

Maximize outdoor play

In hot and sunny weather:

Play in the shade.

Wear hats, visors, sunglasses, and sunblock cream.

Drink liquids frequently.

Use sprinklers and hoses for water play.

In cold and wet weather:

Dress in warm, waterproof clothes.

Play in areas shielded from wind and rain.

Play outdoors for briefer periods.

Have an extra supply of dry clothes.

Preventing & Managing Communicable Diseases G 67
Module 3

Recognizing & Managing Communicable Diseases

Outcomes After completing this module, participants will be able to:

Recognize the signs and symptoms of illness in young children,

Respond appropriately to ill children,

Communicate effectively with parents and health care providers

about illness.

Key Concepts Recognizing and managing communicable diseases involves a partnership among staff, families, and health professionals.

Background Information

Head Start staff's role is to:

Work with health professionals to develop health policies, staff

training, and information for parents.

Observe children for signs of illness.

Care for ill children until they can be sent home.

Document signs and symptoms, as well as actions taken.

Minimize the spread of illness to other children and staff.

Discuss with parents their ill child's condition, whether he is too

sick to attend, the need for medical evaluation and treatment, and

when to return.

Head Start staff's role is not to diagnose or prescribe treatment for

illnessthat's the health care provider's role; and not to provide

total care for sick childrenthat's the parents' role.

Head Start staff members are on the "front line" caring for children. You

may recognize and respond to the first signs of illness in children. Dealing

effectively with illness in children requires a partnership among staff,

parents, children, and health care providers.

7 Recognizing & Managing Communicable Diseases 69
Module 3

A. The Daily Health Check

The daily health check is a quick assessment of each child's health. It

takes less than a minute. You gather information from what the parent and

child tell you, and what you observe. You use all of your senseslisten,

look, feel, and smell.

Do the health check each day:

When the child arrives at the program

Throughout the day

(See Handout H: Daily Health Check)

When you do the health check every day, you learn what is normal for

each child, and you recognize unusual signs or symptoms indicating that

the child might be ill.

When ybu recognize the early signs of illness, you can make the child

more comfortable and alert the parents that the child might need medical

evaluation and treatment. For example, you might observe that a child

complains of sore throat and has a red body rash and fever. Documenting

your observations, calling the parents to take the child home, and advising

them to take the child to the doctor can lead to prompt diagnosis of strep

throat and treatment for the child. This can prevent more severe illness for

the child and the spread of the illness to others.

B. Assessing the Ill Child

1. Interpreting the Health Check

The health check tells you when a child might not be feeling "his normal

self." These signs might indicate illness, fatigue, hunger, injury, or

stress. Your assessment of the ill child involves careful observation,

understanding of childhood illness, and familiarity with the child.

Different children have different ways of showing you that they

might be sick. For example, one child's "stomachache" might mean

that she needs to have a bowel movement, but for another child that

she's anxious or upset, and for another child that he's sick with the

"stomach flu" and ready to vomit.

Children can also show different signs at different ages:

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70 Preventing & Managing Communicable Diseases
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It can be difficult to tell when infants are sick. You need to be

alert to small signs such as fussiness, poor appetite, listlessness,

or feeling warm.

When toddlers and young preschoolers are sick, they often have

a general complaint, "I don't feel good." You need to ask them

to tell you or show you where it hurts.

2. Checking for Fever

When a child complains of not feeling well and looks and acts sick,

you may take the child's temperature to tell whether he has a fever.

Fever is when the body's temperature rises higher than normal. Body

temperature can rise in response to an illness, immunization, exercise, overdressing, or hot weather.

Fever is not an illness in itselfit is a possible sign of illness. Consider fever along with all of the other signs and symptoms (i.e., how

sick the child looks and acts) to determine how sick the child is.

C. Caring for the Ill Child

When a child is sick, staff must decide whether the child is too sick to

stay in the program. Although it is not the role of the program to care for

ill children, staff need to provide care until the parents arrive. You need to

rely on clear health policies and your own judgment and experience.

1. When a Child Is Too Sick to Attend

A child is too sick to attend the program if (any of the following):

The child is too sick to participate comfortably in the program's

activities.

The staff cannot adequately care for the needs of the sick child

without compromising the care of other children.

The child might have a specified communicable disease that

could spread to other children and staff.

(See Handout K: When a Child Is Too Sick to Attend)

2. Developing a Care Plan

When children are sick, they have greater emotional and physical needs.

Recognizing & Managing Communicable Diseases 71

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Module 3

The basic care plan should follow the "4 C's":

Comfort the child

Care for the child's symptoms

Complete the Symptom Record

Call the parents

Comfort

Ill children may feel irritable, sad, lonely, frightened, angry, and bored.

They often regress to a less mature level of behavior. Nurturing by a

trusted caregiver in a familiar setting can reduce the stress of an illness:

Touch and sing to the child.

Frequently ask how she is feeling and acknowledge her feelings with

understanding and concern.

Let her know who will pick her up and when.

Encourage the other children to draw a get-well picture, make her a

snack, or choose a toy for her to play with.

Care

Isolation or "Get-Well" Area: The isolation or get-well area is a place

to care for the sick child, slightly away from the main area of activity. The

purpose is to isolate the germs so they don't spread to other children. Do

not isolate the child. Maintain constant supervision of the sick child to

observe her symptoms, care for her needs, and make her feel included.

Rest and Activities: When a child is sick, especially with a fever, he has

a greater need for rest because his body is working to fight off the illness.

Provide opportunity for quiet play, rest, and sleep.

Nutrition and Fluids: When a child has a fever, vomiting, or diarrhea, he

has a greater need for nutrition and fluids to replace what is being lost.

However, many children lose their appetite when they are sick. Frequently offer small amounts of liquids (e.g., water, juice, broth, gelatin)

and light snacks (e.g., crackers, toast, noodles, tortillas, rice, bananas,

applesauce).

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72 Preventing & Managing Communicable Diseases
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Care for Fevers: When fever accompanies an illness, it actually helps the

body fight off the disease. A fever is usually not harmful and does not

need to be treated. To make the child feel more comfortable you may:

Undress the child to the point of comfort (i.e., light clothes and a

sheet or blanket). Do not bundle the child to "sweat out" the fever.

Frequently offer clear liquids to drink.

Place a cool compress on the child's forehead.

Medications: Medications may be prescribed to treat an illness or relieve

symptoms. But medications can also be dangerous if they are given when

not needed, or if they are given in the wrong way, wrong amount, or at the

wrong time. They can be dangerous even when given properly, for example,, if the child has an allergic reaction.

Give medicines only in accordance with state licensing regulations and

when prescribed by the child's health provider. Staff members should be

trained in procedures to administer medications and document each time

they give medicine to a child.

Emergency Care: Although severe illness is rare among children, staff

must recognize and get immediate medical care (emergency medical system, 911) for the following:

Signs that the brain may not be functioning wellsuch as, listlessness, confusion, seizures, severe irritability, severe headache, unconsciousness.

Breathing problemssuch as, rapid breathing, persistent coughing,

wheezing, sucking-in around the ribs, choking, bluish/grayish lips or

nails.

Severe loss of body fluids and circulation problems due to large blood

loss, persistent vomiting or diarrhea, or dehydrationsignaled by

pale/ashen color, cold hands and feet.

Severe painsuch as, headache, abdominal pain, chest pain.

NOTE: Have emergency contact information and consent for emergency

treatment signed by the parents on file for each child. Make sure the information is current.

Recognizing & Managing Communicable Diseases 73
Module 3

Completing the Symptom Record

It is important to document the child's illness in order to share information with the parents. This helps parents know how their child is feeling

and how they should care for him. If they take the child to the doctor, it

will aid in the diagnosis and treatment.

Documentation is also important for the program's records. The records

can be reviewed by a health consultant for improving the prevention and

management of illnesses in the program. The records will also be available to the licensing agency, public health authority, or insurer in case of

severe illnesses or complications.

Carefully document:

The signs and symptoms of illness that you observe.

How you responded to the symptoms.

(See Handout I: Symptom Record)

Calling Parents

Staff and parents depend on each other for sharing concern and responsibility for the child and respecting each other's feelings and beliefs. Since

a child's illness can add stress to the relationship between caregivers and

parents, sensitive communication around illness is crucial.

Prepare in advance by developing clear, up-to-date health policies. Give

parents a copy of the policies and discuss them during enrollment/orientation and parent-teacher meetings. Explain that, although the program

takes many measures to reduce the spread of disease, it is inevitable that

children get sick. Clarify the policy on when a child is too sick to attend

and help parents plan who will care for the child when she is sick.

When a child is sick, always report the symptoms to the parents, either

immediately or at the end of the day, depending upon the severity of the

symptoms.

Express your concern about the child's health and comfort. For

example, "I'm concerned that Emma hasn't wanted to eat or play and

just doesn't seem herself."

Describe the child's symptoms and what you did. For example,

"Joey vomited up his formula twice. He's been pulling at his left ear

and has a fever of 101 under the arm. I cleaned him up, and he's

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74 Preventing & Managing Communicable Diseases
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asleep now." Do not be vague, for example, "Joey feels hot." Do not

diagnose the illness, for example, "Joey has an ear infection so you

need to pick him up and get him antibiotics."

Try to be sensitive to the parents' situation. If the child needs to be

sent home, tell the parents that you understand it might be difficult for

them to make last-minute arrangements. Ask who will be able to pick

up the child and when they will come. Try to be flexibleunless it is

a medical emergency, immediate pick-up is not usually necessary.

Reassure them that you will keep the child comfortable until they

arrive.

Discuss the possible need for medical evaluation and treatment.

When in doubt, suggest that the health provider check it out. Depending upon how sick the child looks and acts, you might state, "It's

probably nothing serious, but if she's not getting better you might

want to have her checked by her health provider," or "She looks

pretty sick, and I really think that you should take her to the doctor

right away."

Ask the parents to give you the health care provider's diagnosis

and treatment recommendations. Emphasize that you are concerned about the child. Also, you may need to notify other parents

and the health department of exposure to a communicable disease.

Tell the parents when the child can return (e.g., when the symptoms

resolve or 24 hours after starting antibiotics).

NOTE: When giving information to other parents or posting exposure

notices, maintain confidentialitydo not report the name of the child.

D. Communicating with Health Providers

Periodically, health concerns arise that are beyond the knowledge of Head

Start teachers, directors and health coordinators. Programs need to develop relationships with health professionals who can provide assistance.

Keys to effective communication include:

Address questions to the appropriate health provider. For example, when your concerns address the health of a specific child,

consult the child's health care provider (with the parents' permission). When the concerns are group health issues (e.g., health policies

or infection control practices), contact your program's health consultant or the public health department.

State your concern briefly and clearly. Have all of the necessary

facts (e.g., the Symptom Record) on hand.

Recognizing & Managing Communicable Diseases 75

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Module 3

Questions for Discussion/

Reflection:

Listen carefully and document the advice. If you don't understand

something, clarify it immediately. If the advice is complicated, request written information. Summarize to confirm your understanding.

When a child becomes ill, it can be very stressful for the child, parent,

and Head Start staff. Dealing effectively with illness requires cooperation

among staff, families, and health professionals.

What is the greatest challenge for you in dealing with communicable

diseases in the program?

What has your program done to encourage cooperation among staff,

parents, and health professionals regarding communicable diseases?

What could your program do to manage illnesses more effectively?

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76 Preventing & Managing Communicable Diseases
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Activity 1: The

Daily

Health Check

Purpose: This activity helps participants develop their skill observing

children for signs of health and illness.

This activity is particularly helpful for teachers and aides. You will need:

A copy of Handout H: Daily Health Check, for each participant

Handout I: Symptom Record

Handout J: Does the Child Look Sick?blank chart

Key to Activity 1: Does the Child Look Sick? (for trainer only)

Step 1: Review the importance of the Daily Health Check (see Background Information) and how to do itHandout H: Daily

Health Check.

Step 2: Schedule 30 minutes for the coaching group to greet children

and parents as they enter a classroom in the morning. Do the

Daily Health Check with each familytalking with the child

and parent and observing the child.

Step 3: Identify one child with the most signs of being sick. Using

Handout I: Symptom Record, fill in the child's symptoms that

you observe. Make a list of the additional information you

would like to have. Make a list of additional information you

would like to have. Whom do you need to get that information

from? The child? Parent? Teacher?

Step 4: Have the group members sit down together and discuss the

Daily Health Check. Ask:

a. Approximately how long did it take to do the Daily Health

Check for each child?

b. What felt most comfortable for you?

c. What was most difficult for you?

Step 5: Using Handout J: Does the Child Look Sick?, fill in all the signs

they observed of children "Looking Healthy" and the signs of

possibly "Looking Sick." Try to note signs from every category

(See Key to Activity 1).

Step 6: Ask: What signs and symptoms do you think are most helpful in

determining how sick a child is?

Recognizing & Managing Communicable Diseases 77 85
Module 3

Points to Consider:

Step 7: When the Symptom Record is complete, use it to help answer

the following questions about the child you are observing. Ask:

a. Do you think that this child is too sick to stay in the program

for the rest of the day?

If yes, why do you think that?

If no, what additional signs or symptoms would you watch

for to indicate that the child is too sick to stay in the program?

b. What would you say to the parents?

c. Under what circumstances might you want to call a health

professional? What would you say?

d. How would you care for the child until she is picked up?

e. Why is it helpful to document the child's symptoms and your

actions in a Symptom Record?

The daily health check involves observing and talking with the parent

and child. It should be done every day as children enter the program,

and throughout the day.

One of the best signs of whether a child is ill is how she looks and

acts, especially comfort, activity level, and appetite.

A child is too sick to attend the program if he is too sick to participate

in activities, staff cannot care for his needs, or he might have a specified communicable disease.

When a child is ill, communication with parents must be clear, informative, and sensitive to the parents' concerns (see Background Information).

Consult a health professional about signs of severe illness, questions

about diagnoses and treatment, and to report communicable diseases.

A Symptom Record documents observations and actions to inform

parents and health care providers. It may also be reviewed by management, consultants, licensing, courts, or insurers.

78 Preventing & Managing Communicable Diseases
Module 3

Does the Child Look Sick? Key to Activity 1

One of the best signs of whether a child is seriously ill is how she looks and acts. Check the child for

signs of health and illness.

Looking Healthy Looking Sick

General

Appearance

Comfortable

Cheerful, responsive

Active, playing

Behavior appropriate for

child and time of day

Good appetite

Excessive crying, dinginess,

fusiness

Doubled over in pain, unable to

move

Listless, lethargic, unresponsive

No appetite

Vomiting, diarrhea

Breathing Breathing slowly

Relaxed

Quiet

Breathing fast

Difficulty breathing

Sucking in around ribs

Flaring nostrils

Persistent cough

Wheezing

Skin Normal skin color and texture

for child

Normal skin temperature

No rashes, sores, swelling, or

bruising

No scratching at skin or scalp

Pale, grayish, flushed, yellowish

Hot or cold and clammy skin

Skin rash, sores, swelling, or bruising

Scratching at skin or scalp

Skin doesn't spring back when

pinched

Eyes, Nose,

Ears, and

Mouth

Eyes bright and clear

Nose clear

Eyes clear

Mouth without sores,

swallowing comfortable

Eyes swollen, red, crusty, goopy,

watery, yellowish, or sunken

Nose congested or runny

Ears draining pus or blood

Pulling at ears

Mouth or lips with sores, excessive

drooling, difficulty swallowing

Odors No odor or normal odor for

child

Breath smells foul or fruity

Stool smells foul

From: Keeping Kids Healthy, Sacramento, CA: California Dept. of Education, 1994

Recognizing & Managing Communicable Diseases 87 79
Module 3

Activity 2: Assessing

the Child Who

Is III: Twenty

Questions

Purpose: This activity helps participants develop skill in assessing an ill

child and communicating with parents about the child's illness.

For this activity, you will need:

Key to Activity 2: Crystal's Story (for trainer only)

A copy of Handout I: Symptom Record, for each participant

A copy of Handout K: When a Child Is Too Sick to Attend, for each

participant

Flip chart paper and markers

Step 1: Explain that this exercise helps assess how sick a child is.

Step 2: Instruct participants to imagine they are a classroom teacher.

Read aloud Crystal's StoryPart 1.

Step 3: Tell participants that they need to determine how sick Crystal is

and how to care for her. They will play a game of Twenty Questions to find out the information. Their questions should search

for:

Information about the child's symptoms and behavior. You

must specify who would you ask and what you would ask

them, for example, "I want to ask Crystal, 'What's bothering

youyour stomach, your head, your throat...?"

Observations of the child, for example, "I want to observe

Crystal's skin."

Step 4: Distribute Handout I: Symptom Record. Instruct participants to

fill in the information and observations they make.

Step 5: As the participants ask for information and observations, the

trainer will reveal pieces of information based on Crystal's

StoryPart 2. Participants should fill in Crystal's Symptom

Record.

Step 6: After participants have asked 20 questions, explain that this is

all the information that they could obtain in the midst of their

busy day caring for Crystal and all of her classmates.

Step 7: Distribute Handout K: When a Child Is Too Sick to Attend.

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80 Preventing & Managing Communicable Diseases
Module 3

Points to Consider:

Explain that this is the current health policy that your program

has adopted to determine when a child is too sick to attend.

Step 8: Ask participants:

a. Do you think Crystal is too sick to stay in the program for the

rest of the day? What questions were most helpful in determining that?

b. When do you want to call her parents? What would you say?

c. Under what circumstances might you want to call a health

professional? What would you say?

d. How would you care for Crystal until she is picked up?

e. What would you do to minimize the spread of Crystal's illness to other children and staff?

f. Why is it helpful to document the child's symptoms and your

actions in a Symptom Record?

When a child complains, "I feel sick," you need to ask questions and

observe the child (e.g., degree of comfort, activity level, appetite,

breathing, skin) to determine how sick she is.

A child is too sick to attend the program if he is too sick to participate

in activities, staff cannot care for his needs, or he might have a specified communicable disease.

Call Crystal's parents and discuss:

- Your concern about Crystal.

The signs and symptoms you observed and what you did.

That she needs to be picked up; who will come and when? Be

understanding of the parents' situation.

How you'll take care of her until they arrive.

Your suggestion that she see the doctor and your request that

they tell you the diagnosis and recommended treatment.

When Crystal can return to school.

Recognizing & Managing Communicable Diseases 81

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Module 3

Consult a health professional about signs of severe illness, questions

about diagnoses and treatment, and to report communicable diseases.

As you care for Crystal until she's picked up: comfort her, make a

place for her to rest, and offer her small amounts of clear liquids to

drink.

To minimize the spread of Crystal's illness:

Make sure that Crystal washes her hands well, especially after

using the toilet.

Make sure that staff members wash their hands well after caring

for Crystal and before preparing and serving food.

Don't share food or drinks.

A Symptom Record documents observations and actions to inform

parents and health care providers and may be reviewed by management, consultants, licensing, courts, or insurers.

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82 Preventing & Managing Communicable Diseases
Module 3

Crystal's Story Key to Activity 2

PART 1

Crystal is a three-and-a-half year old who is usually very active and cheerful. She is quieter than usual when she

arrives at school. When it's time for snack, she complains, "I don't feel good."

PART 2

A. Information from:

Parents:

Crystal complained of a stomach ache last night.

Crystal didn't eat much breakfast this morning.

Crystal's brother is home sick with fever, vomiting, and diarrhea.

Teachers:

Crystal was clingy and whiny this morning.

Crystal just wanted to play quietly this morning.

Crystal:

My tummy hurts.

My head hurts.

I have diarrhea.

I feel like I'm going to throw up.

B. Observations of Crystal:

General appearancesad, uncomfortable, no appetite, low activity level

Breathingnormal

Skinpale, cold, and clammy

Eyes/nose/ears/moutheyes glassy

Odorsbreath smells fruity, stool smells foul

Temperature-101 degrees F. axilliary

Recognizing & Managing Communicable Diseases 83
Module 3

Activity 3: What

Would You Do? Purpose: This activity helps staff members develop their skills in responding to communicable diseases in their program.

For this activity, you will need:

Flip chart paper and markers (at least five)

Five copies of Handout K: When a Child Is Too Sick to Attend

Handout L: What Would You Do?

Appendix: Communicable Disease Fact Sheets: Infectious Diarrhea,

Chicken Pox, Head Lice, Impetigo

Step 1: Explain that this activity allows participants to plan how to manage communicable diseases in the classroom.

Step 2: Divide participants into five groups. Distribute to each group

one story from Handout L: What Would You Do? and flip chart

paper and a marker.

Step 3: Instruct each group to read its story of a child with a communicable disease in Head Start.

Step 4: Ask each group:

a. Do you need any more information about a specific disease?

b. What do you need?

c. What resources would you use?

Step 5: Tell participants that they went to their health resource library or

spoke with their health consultant or local health department and

got written material on communicable diseases. Distribute

Handout K: When a Child Is Too Sick to Attend, to every group,

and the Fact Sheets to the groups as follows:

Story #1: Infectious Diarrhea

Story #2: Chicken Pox

Story #3: (No diagnosis yet)

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84 Preventing & Managing Communicable Diseases
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Story #4: Head Lice

Story #5: Impetigo

Step 6: Ask: What are the strengths and weaknesses of using fact sheets

for managing communicable diseases in Head Start?

Step 7: Instruct each group to take approximately 15 minutes to review

the story and the fact sheet and list on the flip chart paper what

the program should do to manage the communicable disease.

Step 8: Bring the groups back together. Ask each small group to report

back to the large group. Read the story aloud, post the plan, and

explain how you assessed and managed the situation.

Step 9: Explain that, although each story is different, there are some

common steps to consider in managing a communicable disease.

Ask participants to scan the plans for all of the stories and look

for the common themes.

On flip chart paper, write the title: "Managing Communicable

Diseases: Ten Steps to Consider." Underneath it, list four categories: "The Ill Child," "Parent," "Health Professionals," and

"The Program" (staff and other children and families).

Have participants list the ten general steps to managing diseases

(see Key to Activity 3: Managing Communicable Diseases).

Step 10: Ask participants:

a. Why is a partnership among staff, families, and health professionals needed to manage communicable diseases effectively

in Head Start?

b. What are some of the challenges in working with families and

health professionals in dealing with communicable diseases?

c. What strategies have been helpful in working with families

and health professionals around illness?

d. How could your program respond more effectively to diseases?

9 3

Recognizing & Managing Communicable Diseases 85
Module 3

Points to Consider: Head Start programs need to use reliable health resourcescurrent

written materials and health professionalsto develop health policies

on preventing, recognizing, and managing communicable diseases.

When children are ill, staff should be careful not to diagnose or prescribe the treatment for an illnessthat is the role of the health care

provider. When a health professional has made the diagnosis, fact

sheets can help inform staff and parents about what the disease is and

how to manage it.

Often, when children are ill, staff do not know the diagnosis (e.g.,

Story #3), or they may make an incorrect diagnosis (e.g., Story #5).

Pending further information from the health care provider, management decisions should be based on the child's symptoms.

For every illness, programs should consider each step in Managing

Communicable Diseases (Key to Activity 3). For each step, ask: "Is

this necessary?" "What should I do?"

When responding to communicable diseases, communication between

staff and parents must be clear, informative, and sensitive to each

others' concerns (see Background Information).

86 Preventing & Managing Communicable Diseases
Module 3

Managing Communicable Diseases:

Ten Steps to Consider Key to Activity 3

In Relation to.. . The Ill Child:

1. Observe the child.

2. Assess the child: Is she too sick to attend? What care does she need?

3. Care for the child.

4. Document the symptoms and actions taken.

The Parent:

5. Call the parent: Explain your observations and actions, assessment of how sick

the child is, the need for her to go home, the need for medical evaluation and

treatment, and when to return to the program.

Health Professionals:

6. Call the program's health consultant or the child's health care provider (with parents' permission) with questions.

7. Call emergency medical services for severe illness.

8. Call the health department for reportable diseases.

The ProgramStaff and Other Children and Families:

9. Follow infection control measures to prevent the spread of disease.

10. Notify parents and staff about exposure to certain communicable diseases. Monitor other children and staff for illness.

Recognizing & Managing Communicable Diseases 95 87
Module 3

Activity 4:

Handling

an Outbreak

Purpose: This activity helps participants respond effectively to outbreaks

of communicable diseases.

This activity is particularly helpful for directors, health coordinators, and

head teachers. You will need:

A copy of Handout M1-2: Handling an Outbreak, for each participant

A copy of the Appendix: Communicable Disease Fact Sheets

Chicken Pox and Hepatitis A, for each participant

Trainer's note: If another communicable disease (e.g., ringworm or

measles) has been an issue for the program, you may rewrite Handout M

and substitute the corresponding Appendix fact sheets for those above.

Step 1: Have participants imagine they are program directors or health

coordinators. They are notified of an outbreak of a communicable disease in their program and will coordinate the response

to the outbreak.

Step 2: Distribute Handout M1-2: Handling an Outbreak, and the Appendix: Communicable Disease Fact Sheets for chicken pox and

hepatitis A. Allow participants a few minutes to review Outbreak #1 and the chicken pox fact sheet.

Step 3: Using the fact sheet as a guide, work through the responses to

the questions on handling the outbreak.

Step 4: Repeat Steps 2 and 3 for Outbreak #2: Hepatitis A.

Step 5: Discuss:

a. Why is a partnership among staff, families, and health professionals needed to manage communicable diseases effectively

in Head Start?

b. What are some of the challenges in working with families and

health professionals in dealing with communicable diseases?

c. What strategies have been helpful in working with families

and health professionals regarding illness?

d. How could your program respond more effectively to diseases?

88 Preventing & Managing Communicable Diseases
Module 3

Points to Consider: Head Start programs need to use reliable health resourcescurrent

written materials and health professionalsto develop health policies

on preventing, recognizing, and managing communicable diseases.

Both parents and staff need to be informed about the program's health

policies.

When children are ill and a health care provider has made the diagnosis, fact sheets can help inform staff and parents about what the disease is and how to manage it.

During outbreaks of communicable diseases, communication between

staff and parents must be clear, informative, and sensitive to each

others' concerns.

Every program should have an ongoing relationship with the local

health department and/or a health consultant (e.g., Health Services

Advisory Committee member) to call in case of questions about communicable diseases.

9?

Recognizing & Managing Communicable Diseases 89
Module 3

Next Steps:

Ideas to Extend

Practice

4.".4010:114'..41....1

Establishing a Relationship with a Health Consultant

Every program should develop a relationship with a Health Service Advisory Committee member or a health consultant, such as a physician or

nurse. Your health consultant can help you develop the health policies

and update them annually, since health recommendations may change.

The health consultant can also help with training for staff and workshops

for parents. Your consultant might visit your program periodically to observe infection control practices, review your illness records, and identify

health practices that need improvement. Your health consultant can also

assist in accessing local resources and address any health questions that

might arise.

Reviewing and Revising Your Health Policy

Review your program's health policy to determine whether it covers all

aspects of preventing, recognizing, and managing communicable diseases.

For example: Do the infection control policies address hand washing,

gloves, diapering/toileting, cleaning and disinfecting, disposal of wastes,

and food handling? Do staff conduct daily health checks and complete

symptom records for ill children? Do you have a policy on when a child is

too sick to attend? Do you have exposure notices on communicable diseases? Do you have a Blood-Borne Pathogens Exposure Plan?

Work with a health consultant and your Health Services Advisory Committee to make sure your health policy is complete and up-to-date. Review

the health policy annually.

Training Staff on the Health Policy

Make sure that all staff receive a written copy of and training on the

health policy. Staff need to be informed about what the policy is and why

it is important. Invite your health consultant and Health Services Advisory Committee members to address any questions about the policy. Update the training annually.

Informing Parents about the Health Policy

At orientation, give parents a brief summary of the program's health

policy. Review the key points, such as when they should keep their child

home for illness. When illnesses arise, use the fact sheets as exposure

notices. Make sure that written material is translated into the families'

languages. Offer a parent-staff workshop during the year to address any

concerns about the health policy and the management of illness in the

program. Invite your health consultant and Health Services Advisory

Committee members to address any questions.

9 C,

90 Preventing & Managing Communicable Diseases
Module 3: Recognizing & Managing Communicable Diseases

Handout H: Daily Health Check

Do the daily health check when you greet each child and parent as they arrive. It usually takes less than a

minute. Also observe the child throughout the day.

LISTEN: Greet the child and parent. Ask the child, "How are you today?" Ask the parent, "How are you doing? How's (name of child)?" "Was there anything different last night?" "How did he sleep?" "How

was her appetite this morning?"

Listen to what the child and parent tell you about how the child is feeling.

If the child can talk, is he complaining of anything? Is he hoarse or wheezing?

LOOK: Get down to the child's level to see her clearly. Observe signs of health or illness.

General appearance (e.g., comfort, mood, behavior, and activity level)

Is the child's behavior unusual for this time of day?

Is the child clinging to the parent, acting cranky, crying, or fussing?

Does she appear listless, in pain, or have difficulty moving?

Breathing

Is the child coughing, breathing fast, or having difficulty breathing?

Skin

Does the child look pale or flushed?

Do you see a rash, sores, swelling, or bruising?

Is the child scratching her skin or scalp?

Eyes, Nose, Ears, Mouth

Do the child's eyes look red, crusty, goopy, or watery?

Is there a runny nose?

Is he pulling at his ears?

Are there mouth sores, excessive drooling, or difficulty swallowing?

FEEL: Gently run the back of your hand over the child's cheek, forehead, or neck.

Does the child feel unusually warm or cold and clammy?

Does the skin feel bumpy?

SMELL: Be aware of unusual odors.

Does the child's breath smell foul or fruity?

Is there an unusual or foul smell to the child's stools?

From: Keeping Kids Healthy. Sacramento, CA: California Dept. of Education, 1994.

Recognizing & Managing Communicable Diseases 91

99
Module 3: Recognizing & Managing Communicable Diseases

Handout I: Symptom Record

Child's name: Date:

MAIN SYMPTOM

When it began How long it has lasted

How much How often

Staying constant, getting better or worse? v

0v; tr.;

OTHER SYMPTOMS: Complaints eC eAcr' ,- General appearance (e.g., comfort, mood, behavior, activity level, appetite) a

eh

, . e

a Ecla .0

CIRCLE THE SYMPTOMS: t qc ..Q 4 G.)

C,...) to

Breathing: coughing wheezing breathing fast difficulty breathing other 0 0

>4° Skin: pale flushed rash sores swelling bruises itchiness other r.°'' "8 g c c o a> ..it

Vomiting: (# times) Diarrhea (# times) Urine 0. ed

.., c.) T wEl 4

Eyes: pink/red watery discharge crusty swollen other 10' cp

... 1 "E

0.4 '

Nose: congested runny other 44. 4.e'

o

Ears: pulling at ears discharge other l'

,... u g

..,c c!: Mouth: sores drooling difficulty swallowing other c

..c 5 1 , 0

Odors: (e.g., breath, stool) 0

.t z

Temperature: (axillary, oral, rectal, other ) .,.,ca .,^ i

$..t1 o tv

WHAT HAS BEEN DONE: Comfort Rest 0. rt, CI CZ Liquids (name, amount, time) Food (name, amount, time) 4, -I

as Medications (name, amount, time) C..) ., 1

...vt Emergency measures C.)

..... b0 i

Who was called and when (e.g., parent/guardian, emergency contact person, health consultant, child's health provider, c..): emergency medical services) i r

6

M

c.) 4+ Signature o..) e) n I as

'4

92 Preventing & Managing Communicable Diseases
Module 3: Recognizing & Managing Communicable Diseases

Handout J: Does the Child Look Sick?

One of the best signs of whether a child is seriously ill is how she looks and acts. Check the child for

signs of health and illness.

Looking Healthy Looking Sick

General

Appearance

Breathing

Skin

Eyes, Nose,

Ears, and

Mouth

Odors

From: Keeping Kids Healthy. Sacramento, CA: California Dept. of Education, 1994.

Recognizing & Managing Communicable Diseases 101 93
Module 3: Recognizing & Managing Communicable Diseases

Handout K: When a Child Is Too Sick to Attend

Most children with mild illnesses can safely attend child care. But, a child may be too sick to attend if:

The child does not feel well enough to participate comfortably in the program's activities.

The staff cannot adequately care for the sick child without compromising the care of the other

children.

The child has any of the following symptoms unless a health provider determines that the

child is well enough to attend and that the illness is not contagious:

Fever (above 100° F. axillary or above 101° F. orally) accompanied by behavior change

and other signs or symptoms of illness (i.e., the child looks and acts sick)

Signs or symptoms of possibly severe illness (e.g., persistent crying, extreme irritability,

uncontrolled coughing, difficulty breathing, wheezing, lethargy)

Diarrhea: Changes from the child's usual stool patternincreased frequency of stools,

looser/watery stools, stool runs out of the diaper, or child can't get to the bathroom in time.

Vomiting more than once in the previous 24 hours

Mouth sores with drooling

Rash with a fever or behavior change

The child has any of the following diagnoses from a health provider (until treated and/or no

longer contagious):

Infectious conjunctivitis/pink-eye (with eye discharge)until 24 hours after treatment started

Scabies, head lice, or other infestationuntil 24 hours after treatment and free of nits

Impetigountil 24 hours after treatment started

Strep throat, scarlet fever, or other strep infectionuntil 24 hours after treatment started

and the child is free of fever

Pertussisuntil five days after treatment started

Tuberculosis (TB)until a health care provider determines that the disease is not contagious

Chicken poxuntil six days after start of rash or all sores have crusted over

Mumpsuntil nine days after start of symptoms (swelling of "cheeks")

Hepatitis Auntil seven days after start of symptoms (e.g., jaundice)

Measlesuntil six days after start of rash

Rubella (German measles)until six days after start of rash

Oral herpes (if child is drooling or lesions cannot be covered)until lesions heal

Shingles (if lesions cannot be covered)until lesions are dry

102

Adapted from: Caring for Our Children, American Academy of Pediatrics and American Public Health Association, 1992.

94 Preventing & Managing Communicable Diseases
Module 3: Recognizing & Managing Communicable Diseases

Handout L: What Would You Do?

Story #1:

Miriam, a three-year-old child, is dropped off by her father who is hurrying off to work. Within

an hour, the staff notices that Miriam does not quite seem herself; she appears a little flushed and

quiet, is not playing vigorously, and is tearful at the slightest provocation. Although Miriam is

fully toilet trained, she soils her pants with a watery stool.

Story #2:

Sam is a two-year-old child in your care. You are changing his diaper when you notice about a

dozen red, blistering spots on his abdomen. He also feels warm. You think it is chicken pox because Sam's sister had chicken pox two weeks ago.

Story #3:

Charles, a four-month-old baby, does not quite seem himself; he only drank one ounce of his

bottle, napped for three hours, and awoke from his nap crying inconsolably and arching backwards. He looks flushed. When you pick him up, he starts having a seizure.

Story #4:

Gillian is a five-year-old who caught head lice when it went around the center. All of the parents

received a note about getting treatment for lice. When Gillian came back to school, her teacher

noticed some nits in her hair. Gillian's mom was told that she needed to repeat the treatment.

When Gillian came back again, the teacher still noticed nits.

Story #5:

James is four years old and has a pink lesion near his mouth. It looks to you like impetigo;

you've seen a couple of other kids with something like that. You tell James' dad that he needs to

take James to the doctor to get treatment for his impetigo, and he can't come back to school until

24 hours after he's been on antibiotics. James' dad calls you to say that he took James to the doctor, and she didn't think it was impetigo.

Recognizing & Managing Communicable Diseases 103 95
Module 3: Recognizing & Managing Communicable Diseases

Handout M-1: Handling an Outbreak

Outbreak #1: Many children in your center are sick with Chicken Pox. Some of the children and adults who

haven't gotten sick yet have never had chicken pox. A child with AIDS and a pregnant teacher

are in the center.

What health consultation might be helpful?

Who should be sent home?

What should they be told regarding:

The need for medical evaluation and treatment?

When they can return?

What notification is needed:

To staff and parents?

To the health department?

What steps should be taken to reduce the spread of disease?

Are any special precautions needed? 1O

96 Preventing & Managing Communicable Diseases
Module 3: Recognizing & Managing Communicable Diseases

Handout M-2: Handling an Outbreak

Outbreak #2: Two staff people and three parents in your infant-toddler center have become ill and jaundiced.

They have been diagnosed with Hepatitis A.

What health consultation might be helpful?

Who should be sent home?

What should they be told regarding:

The need for medical evaluation and treatment?

When they can return?

What notification is needed:

To staff and parents?

To the health department?

What steps should be taken to reduce the spread of disease?

Are any special precautions needed?

Recognizing & Managing Communicable Diseases 97
Continuing Professional Development

This guide helps Head Start staff develop their skills in preventing, recognizing, and managing communicable diseases. To continue to learn about

communicable diseases:

Review the program's policies and practices in preventing and managing

communicable diseases. Every year, work with the Health Services Advisory Committee or a health consultant to review the health policies and

ensure that they are up to date. Assess the facilities for hand washing,

diapering, toileting, and food preparation to ensure that proper supplies

are available for infection control. Observe staff, children, and parents

doing hand washing, diapering, toileting, cleaning, and food preparation.

Identify practices that need improvement and address these in a workshop.

Develop an educational program on communicable diseases for new

Head Start staff. The program should include:

General information about communicable diseases,

Current Head Start health policies,

Activities and handouts to develop skill in infection control practices, such as hand washing, gloving, diapering, cleaning and disinfecting, and food handling,

Monitoring of infection control practices by an experienced staff

person.

Periodically reserve time during staff meetings to discuss challenges in

dealing with communicable diseases. For example, has communication

with parents regarding illnesses been difficult? Have head lice or ringworm been persistent problems in the program? Develop strategies to

address the challenges.

Reassess your personal knowledge and skills in managing communicable

diseases. Have staff members each identify one aspect of communicable

diseases that they would like to learn more about. For example, a teacher

might want to develop her skill in discussing a child's illness with the

parent; or a food service worker might like to develop ideas for less perishable lunches and snacks. Develop a personal action plan for improvement.

Investigate other Head Start programs that are managing communicable

diseases effectively. At meetings (e.g., local and regional health coordinators meetings, Head Start Association conferences, health conferences),

discuss strategies for preventing and managing communicable diseases.

Share sample health policies, exposure notices, and ideas for teaching

Continuing Professional Development 99 1 3
Continuing Professional Development

children about germs. Visit other programs and bring back information

and techniques.

Subscribe to health publications to stay informed about current recommendations. Keep a library with books, journals, and videos on communicable diseases. Circulate articles from child care health newsletters that

address issues that are important to the program.

Maintain connections with local health professionals. Invite local health

care providers, such as pediatricians or public health nurses, to parentstaff meetings to answer questions about communicable diseases. Address

common illnesses, such as ear infections, and emerging illnesses, such as

HIV/AIDS, hepatitis B, and tuberculosis.

Encourage staff to attend classes and conferences on communicable diseases. Courses may be available through the local community college,

child care resource and referral agency, hospitals, and other health training agencies. Allow staff to attend local, regional, and national conferences on health sponsored by Head Start and child care and public health

associations.

Advocate for improved management of communicable diseases in the

community. What diseases is your program facing: intestinal parasites,

measles, tuberculosis, HIV/AIDS? Join with other community groups

advocating for public health improvements, such as sewer systems, water

supply, housing, immunizations, and treatment of diseases.

100 Preventing & Managing Communicable Diseases
Resources

Books & Manuals: American Academy of Pediatrics. In: Peter, G., ed. 1994 Red Book: Report of the Committee on Infectious Diseases. 23rd ed. Elk Grove

Village, IL: American Academy of Pediatrics, 1994. 687 pp.

This book is a detailed summary of communicable diseases in children. It represents the recommendations of children's health

authorities including the American Academy of Pediatrics (AAP) and

The Centers for Disease Control (CDC). It contains a detailed description of each communicable diseaseclinical manifestations,

epidemiology, diagnostic tests, treatment, control measures. It also

has a chapter on Children in Out-of-Home Care.

Contact: American Academy of Pediatrics, P.O. Box 927, 141 Northwest Point Blvd., Elk Grove Village, IL 60009-0927. Telephone:

(800) 433-9016. $64.95 each (Quantity prices on request).

American Academy of Pediatrics, Pennsylvania Chapter. Preparing for

Illness: A Joint Responsibility for Parents and Caregivers. Bryn

Mawr, PA: Pennsylvania Chapter, American Academy of Pediatrics,

1993. 42 pp.

This brochure presents recommendations for preventing and managing illnesses in early childhood programs. It contains information on

keeping children healthy, recognizing the ill child, inclusion/exclusion from child care, and conditions requiring immediate medical

evaluation. It also has a chart on illnesses, organized by symptoms or

diagnosis, which lists what you see, possible causes, when to exclude

the child and/or seek medical advice, and when to readmit the child to

the program.

Contact: National Association for the Education of Young Children,

1509 16th Street, NW, Washington, DC 20036-1476. Telephone:

(800) 424-2460. $2.00, includes shipping/handling; discounts for bulk

orders.

American Public Health Association and American Academy of Pediatrics. Caring for Our Children: National Health and Safety

Performance StandardsGuidelines for Out-of-Home Child Care

Programs. Washington, DC: American Public Health Association,

1992. 410 pp.

This is a comprehensive set of health and safety guidelines for out-ofhome child care programs. It represents the current recommendations

of children's health authorities, including the American Academy of

Pediatrics (AAP) and American Public Health Association (APHA)

and child care associations. It covers staff health and training, child

development, nutrition, facilities, and children with special needs. It

Resources 101

103
Resources

has a chapter on health promotion that includes detailed information

on preventing communicable diseases; and a chapter on infectious

diseases that addresses managing illnesses. Each recommendation

includes an explanation of why the standard is important.

Contact: American Public Health Association, 1015 15th Street, NW,

Washington, DC 20005. Telephone: (202) 789-5665. $35.00 members

($50.00 non-members), plus $7.00 for shipping/handling.

American Red Cross. American Red Cross Child Care Course. Washington, DC: American Red Cross. Multiple volumes.

This is an easy-to-use curriculum on childhood illnesses and injuries.

The section on illnesses addresses preventing infectious diseases and

caring for ill children. It includes charts, pictures, handouts, forms,

and exercises for teaching child care staff and children about communicable diseases.

Contact: Contact your local chapter of the American Red Cross or

the national office of the American Red Cross, 1709 New York Avenue, Suite 208, Washington, DC 20006. Telephone: (202) 728-6523.

Cost is determined by your local American Red Cross Chapter.

Aronson, S., and H. Smith. Model Child Care Health Policies. Bryn

Mawr, PA: Pennsylvania Chapter, American Academy of Pediatrics,

1993. 90 pp.

This manual provides a sample health policy for early childhood programs. It addresses admissions, supervision, discipline, health plan,

emergencies, safety, and staff health. It includes several sections on

communicable diseasessanitation and hygiene, food handling, care

of ill children, and medications. It contains handouts such as a symptom record, medication log, and a health and safety checklist. It also

has a chart on illnesses, organized by symptoms or diagnosis, which

lists what you see, possible causes, when to exclude the child and/or

seek medical advice, and when to readmit the child to the program.

The model policies are available on diskette to help programs develop

their own health policies.

Contact: National Association for the Education of Young Children,

1509 16th Street, NW, Washington, DC 20036-1426. Telephone:

(800) 424-2460 or (201) 232-8777. $5.00. Order No. 716.

California Department of Education and The Center for Health Training.

Keeping Kids Healthy: Preventing and Managing Communicable

Disease in Child Care. Sacramento, CA: California Department of

Education, 1994. Manual 94 pp; video 29 minutes.

1O3

102 Preventing & Managing Communicable Diseases
Resources

This manual addresses preventing, recognizing and managing communicable disease in child care. It contains handouts on infection

control, daily health check, symptom record, medications, when a

child is too sick to attend, emergencies, and exposure notices for each

communicable disease. It also presents suggestions on effective communication between early childhood professionals, parents and health

care providers about health and illness. A companion video is also

available.

Contact: Bureau of Publications, Sales Unit, California Department

of Education, PO Box 271, Sacramento, CA 95812-0271. Telephone:

(916) 445-1260. Anticipated cost: manual $8-9, video $16-17.

Kendrick, A.S., R. Kaufmann, and K.P. Messenger, eds. Healthy Young

Children: A Manual for Programs. Washington, DC: National Association for the Education of Young Children, 1995. 297 pp.

This is a comprehensive book on health in early childhood programs.

It addresses health promotion, healthful environments, safety and first

aid, preventive health care, nutrition, children with special needs, and

child abuse and neglect. It has several chapters on preventing and

managing infectious diseases that contain current recommendations

from public health authorities. These include practical charts, checklists, and exposure notices for parents.

Contact: National Association for the Education of Young Children.

1509 16th Street, NW, Washington, DC 20036-1426. Telephone:

(800) 424-2460 or (202) 232-8777; fax (202) 328-1846. $15.00, no

shipping/handling for regular mail orders under $20.00.

National Pediatric HIV Resource Center. Getting a Head Start on HIV: A

Resource Manual for Enhancing Services to HIV-Affected Children in

Head Start. Newark, NJ: National Pediatric HIV Resource Center, in

cooperation with Region II Head Start Resource Center, 1992. 56 pp.

This is a manual on caring for HIV-affected children in Head Start. It

describes the impact of HIV infection on a child's physical health,

growth, development, and mental health; special health care concerns;

and legal issues. The manual includes activities for children and practical strategies for working with HIV-affected families. It also

includes sample policies and staff training on HIV/AIDS.

Contact: National Maternal and Child Health Clearinghouse

(NMCHC), 2070 Chain Bridge Rd., Suite 450, Vienna, VA 22182-

2536. Telephone: (703) 821-8955; fax (703) 821-2098. Available at

no charge. NMCHC invoice code F097.

Resources 110 103
Resources

Seattle-King County Department of Public Health. Child Care Health

Handbook 3rd ed. Seattle, WA: Seattle-King County Department of

Public Health, 1990. 184 pp. $10.00.

This is a comprehensive manual on health and safety in child care. It

covers growth and development, health screening, nutrition, dental

health, behavior, injuries, child abuse and neglect, and staff health. It

has several chapters that address preventing and managing illnesses.

These include charts outlining recommended responses to illness,

organized by symptoms and diagnosis.

Caregiver-Parent Health Connection; Communicable Disease Prevention. Seattle, WA: Seattle-King County Department of Public

Health, 1994. $15.00 plus postage/handling.

This is a practical manual for preventing and managing communicable diseases in child care. It includes general information for

caregivers and parents, sample fact sheets and parent letters on communicable diseases, and self-assessment checklists for caregivers.

Contact: Child Care Health Program, Seattle-King County Department of Public Health, 110 Prefontaine Place South, Suite 500,

Seattle, WA 98104. Telephone: (206) 296-4613.

U.S. Department of Labor, Occupational Safety and Health Administration. Occupational Exposure to Bloodborne Pathogens. Federal

Register, Vol. 56, No. 235, December 6, 1991.

This document represents the Occupational Safety and Health Administration (OSHA) legal regulations on bloodborne pathogens in

workplaces in the United States. It defines "bloodborne pathogens"

and "exposures," and covers the requirements for developing an exposure control plan, universal infection control measures, hepatitis B

vaccine, reporting and following-up exposures, and staff training.

Contact: OSHA, 200 Constitution Ave., NW, Washington, DC

20210. Telephone: (202) 219-4667.

Videos American Academy of Pediatrics. Before It's Too Late, Vaccinate. Elk

Grove Village, IL: American Academy of Pediatrics, revised 1994.

This is a 17-minute video on the importance of immunizations for

children. It addresses what immunizations are, the diseases they protect against, and the recommended schedule for immunizations in

early childhood. The video is raiilable in English and in Spanish.

11_ 104 Preventing & Managing Communicable Diseases
Resources

Contact: American Academy of Pediatrics, P.O. Box 927, 141 Northwest Point Blvd., Elk Grove Village, IL 60009-0927. Telephone:

(800) 433-9016.

American Academy of Pediatrics and National Association for Education

of Young Children. Caring for Our Children. Elk Grove Village, IL:

American Academy of Pediatrics, 1995. $75.00, plus $8.75 shipping/

handling.

This is a series of six 30-minute videos on health and safety in out-ofhome child care settings. The videos are based on the book, Caring

for Our Children: National Health and Safety Performance Standards, developed by the American Academy of Pediatrics and

American Public Health Association. The videos cover staff health,

basic caregiving, preparing for emergencies, setting up safe child

care, maintaining safe child care, and dealing with illness.

Contact: American Academy of Pediatrics, P.O. Box 927, 141 Northwest Point Blvd., Elk Grove Village, IL 60009-0927. Telephone:

(800) 433-9016. or National Association for Education of Young

children, 1509 16th Street, NW, Washington, DC 20036-1426. Telephone: (800) 424-2460 or (202) 232-8777; fax (202) 328-1846.

California Department of Education and The Center for Health Training.

Keeping Kids Healthy: Preventing and Managing Communicable

Disease in Child Care. Sacramento, CA: California Department of

Education, 1994.

This is a 29-minute video on preventing, recognizing and managing

communicable disease in child care. It explains how communicable

diseases spread in child care, and demonstrates measures to prevent

the spread of disease. It shows a daily health check and possible signs

and symptoms of common childhood diseases. It also has suggestions

on effective communication between early childhood professionals

and parents about health and illness.

Contact: Bureau of Publications, Sales Unit, California Department

of Education, PO Box 271, Sacramento, CA 95812-0271. Telephone:

(916) 445-1260. Anticipated cost: $17.

U.S. Department of Health and Human Services. The ABC's of Clean;

Hooray for Handwashingpamphlet & video. New York, NY: The

Soap and Detergent Association.

This is a 16-minute video that explains how illnesses spread among

children in group care.. It demonstrates simple measures for adults

and children to reduce the spread of disease. The educational packResources 112 105
Resources

age also includes an audio tape with songs promoting hand washing

and hygiene, teachers' guide, posters, and handouts for parents.

Contact: The Soap and Detergent Association, 475 Park Avenue South,

New York, NY 10016. Telephone: (212) 725-1262. Cost: None.

Newsletters American Academy of Pediatrics, Pennsylvania Chapter, ECELS. Early

Childhood Health Link.

Contact: Healthy Child Care Pennsylvania (ECELS), PA AAP,

Building 2, Suite 307, Rosemont Business Campus, 919 Conestoga

Rd., Rosemont, PA 19010. Telephone: (610) 520-9125. Web: http://

www.delcom.com/paaap/ped.html.

National Center for Education in Maternal and Child Health (NCEMCH).

MCH Program Interchange. U.S. Dept. of Health and Human Services.

Contact: NCEMCH, Maternal and Child Health Bureau, 2000 15th

St., North. Arlington, VA 22201. Telephone: (703) 524-7802.

San Diego State University. Child Care Health Connections, 1995.

Contact: San Diego State University, Child Care Health Connections,

6505 Alvarado Road, #108, San Diego, CA 92120. Telephone: (619)

594-4373. Yearly cost: $15.

National Organizations American Academy of Pediatrics:

Contact: 141 Northwest Point Blvd., Elk Grove Village, IL 60009-

0927. (708) 228-5005

American Public Health Association:

Contact: 1015 15th St., NW, Washington, DC 20005. (202) 789-5600

Centers for Disease Control:

Contact: Center for Health Promotion & Education, Centers for Disease Control, 1600 Clifton Rd., NE, Atlanta, GA 30329. (404)

639-3311 1 S

106 Preventing & Managing Communicable Diseases
Resources

National Association for the Education of Young Children:

Contact: 1509 16th Street, NW, Washington, DC 20036-1426. (800)

424-2460 or (202) 232-8777

National Maternal and Child Health Clearinghouse:

Contact: 2070 Chain Bridge Rd., Suite 450, Vienna, VA 22182-2536.

(703) 821-8955

Resources 107
0 Chicken Pox

Appendix: Communicable Disease Fact Sheets

What is chicken pox? It is a common illness that usually lasts five to seven days with:

Mild fever

Itchy skin rash, which: - starts as small red spots that blister and scab over

- can be anywhere on the body and scalp

Although chicken pox is usually a mild illness, it can be dangerous for:

Pregnant women because it can cause birth defects or severe illness in the baby.

Newborns, teens, adults, and people with immune problems (e.g., HIV/AIDS, chemotherapy, organ transplant, steroid medications).

How does chicken pox spread? It is very contagious and spreads by:

Being in a room together, coughing, and sneezing

Sharing food, eating utensils, mouthed toys, and tissues

Touching the nose, mouth, and the rash

Once you have had chicken pox or have gotten the vaccine, you usually won't catch it again.

When is chicken pox contagious?

From two days before until five days after the rash appears.

After exposure, it usually takes 11 to 14 (up to 21) days to get sick.

How do I know if my child has chicken pox? By how the rash looks. Doctors usually advise not to bring the

child to their offices because the illness could spread to others.

What should I do if my child has chicken pox?

Treatment: Follow your doctor's recommendations:

Baking soda/oatmeal baths, calamine lotion and antihistamines for itchiness.

Giving acetaminophen for fever. Never give aspirinit can cause a fatal condition called Reye's

Syndrome.

If your child or anyone at home has immune problems or is pregnant and has never had chicken pox, call

your doctor immediately.

Keep your child home: until six days after the start of the rash or when all the lesions are scabbed over.

Notify your Head Start program immediately.

To limit the spread:

Get the new chicken pox vaccine for children over 12 months and adults who never had the disease.

Don't expose newborns, pregnant women, or people with immune problems.

Wipe noses with clean tissues, throw them away, and wash your hands.

Cough and sneeze into your elbow and away from people.

Don't share food, pacifiers, bottles, or toothbrushes. Wash eating utensils, drinking cups, and mouthed

toys well between uses.

Don't kiss children on the mouth.

Open windows indoors and maximize outdoor play.

Appendix 109

115
Appendix.: Communicable Disease Fact Sheets

Colds and Flu

What are "colds" and "flu"? They are common infections of the head and chest caused by viruses. Colds cause

mild illness for five to seven days with:

Stuffy and runny nose (clear or greenish mucus)

Headache and sore throat

Sneezing and coughing

The flu makes you a little sicker for a little longer with:

Fever and chills

Muscle aches and fatigue

How do colds and flu spread? They are very contagious. They spread when people:

Touch infected mucus from the nose or saliva

Cough and sneeze

Kiss on the lips

Share food, eating utensils, and mouthed toys

Are together in crowded, poorly-ventilated, and overheated rooms

When are colds and flu contagious?

From one to two days before the symptoms start and the first few days of the illness.

It usually takes several days after exposure to colds or flu to become ill.

How do I know if my child has a cold or the flu? By the typical symptoms.

What should I do if my child has a cold or the flu?

Treatment: Follow your doctor's recommendations:

Help your child recover by providing:

- rest, food, and plenty of liquids to drink. - a cool mist vaporizer.

For fever, the doctor might recommend acetaminophen. Never give aspirinit can cause a fatal

condition called Reye's Syndrome.

You do not need to:

Give antihistamine or decongestant medications.

Bundle children up or keep them indoors.

Should my child stay home? Children with colds or flu can attend school as long as they feel well enough to

participate.

To limit the spread:

Wipe noses with clean tissues, throw them away, and wash your hands.

Cough and sneeze into your elbow and away from people.

Don't share food, pacifiers, bottles, or toothbrushes. Wash eating utensils, drinking cups, and

mouthed toys well between uses.

Don't kiss children on the mouth. 1 Open windows indoors and maximize outdoor play.

110 Preventing & Managing Communicable Diseases
Appendix: Communicable Disease Fact Sheets

Conjunctivitis (Pink Eye)

What is conjunctivitis? It is a common eye infection or irritation. It can be caused by germs ("infectious

conjunctivitis") and often occurs with a cold or ear infection. It can also be caused by allergies (e.g., pollen),

chemicals, or irritants (e.g., smoke, make-up, dust). It involves one or both eyes and usually lasts three to five

days with:

Red eyes

Clear, white, yellow, or green drainage from the eyes

Crusty eyelashes when the child wakes up

Itchy, sore or burning eyes

Sensitivity to light

How does conjunctivitis spread? Conjunctivitis is contagious only when it is caused by germs ("infectious

conjunctivitis"), not by allergies, chemicals, or irritants. It spreads when people:

Touch infected drainage from the eye, mucus from the nose, or saliva

Share tissues, towels, and make-up

Cough and sneeze

When is conjunctivitis contagious?

From one to two days before the symptoms appear until:

- 24 hours after antibiotic treatment is started (for bacterial conjunctivitis)

- the end of drainage from the eyes (for viral conjunctivitis)

After exposure to conjunctivitis, it usually takes two to three days to develop the infection.

How do I know if my child has conjunctivitis? If you see the symptoms, take your child to the doctor.

Conjunctivitis is diagnosed by the signs and symptoms.

What should I do if my child has conjunctivitis?

Treatment: Follow your doctor's recommendations for antibiotic eye drops or ointment. Be sure to use it in

both eyes.

Keep your child home: until 24 hours after the start of antibiotic treatment, and until there is no discharge

from the eyes.

To limit the spread:

Encourage your child not to rub his eyes.

Have children wash their hands after touching their eyes and nose.

Wash your hands after touching the child's eyes, applying eye medication, or blowing noses.

Throw out tissues after use. Don't share tissues or towels.

ii?

Appendix 111
Appendix: Communicable Disease Fact Sheets

Cytomegalovirus (CMV)

What is cytomegalovirus (CMV)? It is a very common infection in young children. It usually has:

No symptoms at all

-ORFever, sore throat, swollen glands, tiredness for less than a week

Although CMV is usually mild, it can be dangerous for:

Pregnant womenIt can cause birth defects in the baby.

People with immune problems (e.g., HIV/AIDS, cancer chemotherapy, organ transplants)It can cause

pneumonia and blindness.

How does CMV spread? CMV is mainly spread by:

Touching urine when changing diapers

Sharing food, eating utensils, and mouthed toys

Kissing on the lips

When is CMV contagious? Some people with CMV are contagious for a very short time; others can spread the

virus for months to years.

How do I know if my child has CMV? Most people with CMV never know it because they don't have any

symptoms. Rarely, special blood or urine tests might be done to check for CMV infection.

What should I do if my child has CMV?

Treatment: Follow your doctor's recommendations. Usually, no special treatment is needed.

If your child or anyone at home has immune problems or is pregnant, call your doctor to discuss CMV.

Should my child stay home? A child with CMV does not need to stay home.

To limit the spread:

Wash hands after diapering, toileting, or contact with saliva and blood.

Don't share food, pacifiers, bottles, or toothbrushes.

Wash eating utensils and drinking cups between uses.

Clean and disinfect mouthed toys and dining tables after each use.

Don't kiss children on the mouth.

112 Preventing & Managing Communicable Diseases
Appendix: Communicable Disease Fact Sheets

Fifth Disease ("Slap Cheek")

What is fifth disease? It is typically a mild illness that is caused by a virus called parvovirus. It can last from one

to three weeks with:

Runny nose or mild fever

Blotchy red rash, which:

starts on the cheeks (like "slapped cheeks") and can be all over body

may be itchy

may come and go, especially after exercise or sun exposure

Although fifth disease is usually mild, it can be dangerous for:

Pregnant women because it can cause miscarriage or stillbirth.

People with sickle cell anemia and immune problems (e.g., HIV/AIDS, cancer chemotherapy, organ

transplant, taking steroid medication).

How does fifth disease spread? It spreads by:

Being in a room together, coughing, and sneezing

Touching mucus from the nose or saliva

Kissing on the lips

Sharing food, eating utensils, and mouthed toys

When is fifth disease contagious?

One to two weeks before the rash appears. After the rash, it is usually not contagious.

After exposure, it typically takes two to three weeks to get sick.

How do I know if my child has fifth disease? A doctor can tell by the signs and symptoms.

What should I do if my child has fifth disease?

Treatment: Follow your doctor's recommendations:

Help your child recover by encouraging rest, food, and plenty of liquids to drink.

If your child or anyone at home has a blood disorder, immune problems, or is pregnant, contact your doctor

immediately.

Should my child stay home? Children with fifth disease do not need to stay home as long as they feel well

enough to participate. Notify your program.

To limit the spread:

Wipe noses with clean tissues, throw them away, and wash your hands.

Cough and sneeze into your elbow and away from people.

Don't share food, pacifiers, bottles, or toothbrushes. Wash eating utensils, drinking cups, and

mouthed toys well between uses.

Don't kiss children on the mouth.

Open windows indoors and maximize outdoor play.

Appendix 113
Appendix Communicable Disease Fact Sheets

Giardiasis

What is giardiasis? It is an intestinal infection caused by a parasite, Giardia lamblia. It can last for weeks or

months with:

No symptoms at all -ORPersistent diarrhea (with mucus and foul smell)

Gas, bloating, abdominal pain, nausea

Weight loss

How does giardiasis spread? It spreads by:

Touching stool when diapering and toileting

Not washing hands before handling food

Not cleaning/disinfecting toys and diapering, toileting, and hand-washing areas

Playing in wading pools and water-play tables

Drinking contaminated water in areas with inadequate sewage treatment or from lakes, rivers, and pools

When is giardiasis contagious?

As long as the parasite is present in the stool, whether or not the person has symptoms. It spreads more

easily when the person has diarrhea.

After exposure to giardiasis, it usually takes one to two weeks to develop the illness.

How do I know if my child has giardiasis? If anyone in the family has the symptoms, see your doctor. Giardiasis is diagnosed by tests of the stool, usually three samples.

What should I do if my child has giardiasis?

Treatment: Follow your doctor's recommendations:

If the child has symptoms, a medication might be prescribed.

If the child has no symptoms, it is usually not treated. Often, the infection resolves on its own within

four to six weeks.

If other family members have symptoms, see your doctor.

Keep your child home: if she has diarrhea. He can return to the program after treatment and when the diarrhea is resolved. Notify your Head Start program.

To limit the spread:

Wash hands after diapering and toileting and before handling food.

Clean and disinfect diapering areas, mouthed toys, and dining tables after each use; clean and disinfect toileting areas and hand-washing sinks daily.

Use sprinklers instead of wading pools. Use individual water-play basins instead of water-play

tables.

Do not drink water from lakes, rivers, or pools. 12.9

114 Preventing & Managing Communicable Diseases
Appendix: Communicable Disease Fact Sheets

Hand, Foot, and Mouth Syndrome (Coxsackie Virus)

What is hand, foot, and mouth syndrome? It is a common childhood illness caused by the Coxsackie virus. It

is usually a mild illness that lasts for one to three weeks with:

Sores in the mouth, sore throat

Blisters on the hands and feet

Mild fever

How does hand, foot, and mouth syndrome spread? It spreads by:

Touching stool when diapering and toileting

Not washing hands before handling food

Not cleaning/disinfecting toys and diapering, toileting, and hand-washing areas

Playing in wading pools and water-play tables

When is hand, foot, and mouth syndrome contagious?

Mostly in the first week during the mouth sores. By the time the hand and foot rash appears, it is less

contagious.

After exposure, it takes three to six days to get sick.

How do I know if my child has hand, foot, and mouth syndrome? A doctor can diagnose it by the symptoms.

What should I do if my child has hand, foot, and mouth syndrome?

Treatment: Follow your doctor's recommendations:

Help your child recover by encouraging rest, food, and plenty of liquids to drink.

Should my child stay home? Children can attend school as long as they feel well enough to participate.

Notify your Head Start program.

To limit the spread:

Wash hands after diapering and toileting and before handling food.

Clean and disinfect diapering areas, mouthed toys, and dining tables after each use; clean and disinfect toileting areas and hand-washing sinks daily.

Use sprinklers instead of wading pools. Use individual water-play basins instead ofwater-play

tables.

Don't kiss children on the mouth.

12

Appendix 115
Appendix: Communicable Disease Fact Sheets

Head Lice

What are head lice? They are tiny bugs that live on the scalp and hair. You may see:

Small grayish eggs ("nits") about the size of a sesame seed

- attached firmly to the base of hairs

often behind the ears and neck

Tiny bugs ("lice") crawling in hair, bite marks on scalp

Scratching at scalp

How do head lice spread? They are very contagious. They spread by:

Touching hair

Sharing combs/brushes, hats, clothes, stuffed animals, towels, pillows, bedding, furniture, and carpets

When are head lice contagious?

As long as the bugs or nits are alive. Nits hatch in seven to 10 days, and lice can live on the scalp for 20-

30 days.

When lice and nits are off the body (e.g., on clothes), they die within seven days.

How do I know if my child has head lice? By seeing the nits or lice in the hair.

What should I do if my child has head lice?

Treatment: Consult your doctor for the appropriate treatment; some are dangerous for infants and women

who are pregnant or nursing.

Shampoo hair with special shampoo that kills lice and nits. Follow the instructions carefully.

Remove all nits with a fine-tooth comb and by hand.

Sometimes a second treatment is needed one or two weeks later to kill the lice that hatched from

surviving nits.

Keep your child home until: after treatment is completed, and he or she is free ofnits. Notify your Head

Start program.

To limit the spread:

Every day, for two weeks, check everyone at home and at school for lice and nits. Treat if necessary.

Don't share combs and brushes. Wash them in the anti-lice shampoo; boil in water for 10 minutes;

OR soak in bleach solution for one hour.

Don't share hats and jackets. Keep personal clothes and bedding separate in individual cubbies for

each child.

Launder clothes, linen, bedding, stuffed animals, and small carpets in with detergent and hot water.

Dry in hot dryer or press with hot iron. For non-washable items, dry-clean or seal in plastic bag for

10 to 14 days.

Vacuum carpets, upholstered furniture, and car seats.

116 Preventing & Managing Communicable Diseases
Hepatitis A

Appendix: Communicable Disease Fact Sheets

What is hepatitis A? It is an infection of the liver caused by a virus. It can last from one week to several months

with:

No symptoms at all, especially in young children -ORJaundice or yellowing of the skin and whites of the eyes

Abdominal pain, nausea, loss of appetite

Dark urine and pale-colored stools

Low-grade fever, fatigue

How does hepatitis A spread? It spreads by:

Touching stool when diapering and toileting

Not washing hands before handling food

Not cleaning and disinfecting toys and diapering, toileting and hand-washing areas

Playing in wading pools and water-play tables

Drinking contaminated water and eating shellfish in areas with inadequate sewage treatment

When is hepatitis A contagious?

From two weeks before until one week after the start of jaundice.

After exposure to hepatitis A, it can take two to eight weeks (typically four weeks) to get sick.

How do I know if my child has hepatitis A? If anyone in the family has symptoms, see your doctor immediately. Hepatitis A is diagnosed by special blood tests.

What should I do if my child has hepatitis A?

Treatment: Follow your doctor's recommendations:

Help your child recover by encouraging rest, food, and plenty of liquids to drink.

If children or adults at home or school were exposed to hepatitis A within the previous two weeks and

haven't gotten sick yet, they can get a special injection to prevent them from getting sick or make their illness milder.

Keep your child home: until one week after the start of jaundice and until the child feels well enough to

participate in activities. Notes your Head Start program immediately.

To limit the spread:

Report the illness to the local health department.

Ask your doctor about getting hepatitis A vaccine.

Wash hands after diapering and toileting and before handling food.

Clean and disinfect diapering areas, mouthed toys, and dining tables after each use; clean and disinfect toileting areas and hand-washing sinks daily.

Use sprinklers instead of wading pools. Use individual water-play basins instead of water-play

tables.

C) Appendix 117
Appendix: Communicable Disease Fact Sheets

Hepatitis B

What is hepatitis B? It is an infection of the liver caused by a virus. It causes:

No symptoms at all -ORJaundice or yellowing of the skin and whites of the eyes

Abdominal pain, nausea, loss of appetite

Dark urine, and pale-colored stools

Low-grade fever, fatigue

Most people recover completely within weeks to several months. But approximately 1% develop severe and fatal

complications, and 10% percent become "chronic carriers" of hepatitis B infectionwith or without symptoms

for life.

How does hepatitis B spread? It spreads by blood, sexual fluids (semen and vaginal secretions), or saliva getting into another person's body by:

Splashes of blood onto broken skin, eyes or mouth

Sharing razors and toothbrushes

Biting (rarely)

Sexual intercourse

Pregnancy, childbirth and breast feeding

Blood transfusions and sharing injection equipment

When is hepatitis B contagious?

From approximately one month before until one month after the start of jaundice.

"Chronic carriers," with or without symptoms, are usually contagious for life.

After exposure, it can take six weeks to six months to develop the illness.

How do I know if my child has hepatitis B? If you see symptoms, see your doctor immediately. Hepatitis B is

diagnosed by special blood tests.

What should I do if my child has hepatitis B?

Treatment: Follow your doctor's recommendations:

Help your child recover by encouraging rest, nutrition, and plenty offluids to drink.

For severe symptoms, hospitalization and special treatments are needed.

If children or adults at home or school were exposed to hepatitis B within the previous three days, they can

get a special injection and vaccine to prevent illness.

Keep your child home: until one month after the start of jaundice and until he or she feels well enough to

participate. "Chronic carriers" can attend as long as they don't have uncontrolled biting or oozing skin lesions that can't be covered. Notify your Head Start program.

To limit the spread:

Immunize your children against hepatitis B, starting in infancy.

For adults at risk, consider getting immunized against hepatitis B.

12

118 Preventing & Managing Communicable Diseases
Hepatitis B (continued)

Appendix: Communicable Disease Fact Sheets

Follow universal blood and body fluid precautions:

Try to avoid direct contact with blood.

Wear disposable latex or vinyl gloves for dealing with bloody injuries, bloody diarrhea, oozing

skin rashes, and mouth or eye procedures.

Clean and disinfect spills of blood.

Seal blood-stained items in a plastic bag for disposal or laundering.

Wash hands after removing gloves; wash skin after contact with blood.

Don't share food, pacifiers, teething rings, bottles, toothbrushes.

Clean and disinfect eating utensils, cups, mouthed toys, and dining tables after each use.

Don't share injection equipment. If equipment is reused, disinfect it.

Use condoms during sexual contact.

Prevent sexual abuse.

12

Appendix 119
Appendix: Communicable Disease Fact Sheets

Herpes

What is herpes? It is a common infection, in children and adults, caused by a virus. Symptoms include:

Painful sores in mouth/gums and on lips ("cold sores," "fever blisters")

Fever and headache -ORPainful sores on genitals

Symptoms resolve within a week, but can recur with illness, sun exposure, or stress.

Although herpes is usually mild, it can be dangerous for:

Pregnant womenGenital sores at delivery can cause severe illness in the baby.

People with immune problems (e.g., HIV/AIDS, cancer chemotherapy, organ transplant,

medication).

How does herpes spread? Oral (mouth) herpes spreads by:

Touching the mouth sores or saliva

Kissing on the lips

Sharing food, bottles, pacifiers, eating utensils, mouthed toys, and toothbrushes

Genital herpes spreads by sexual contact or sexual abuse.

When is herpes contagious?

Several days before the start of symptoms until the sores are healed.

After exposure, it can take two to eight weeks to develop symptoms.

How do I know if my child has herpes? If you see the symptoms, see your doctor.

Herpes is diagnosed by the typical symptoms. Sometimes swabs and cultures are done.

What should I do if my child has herpes?

Treatment: Follow your doctor's recommendations:

Help your child recover by encouraging rest, nutrition, and plenty of fluids to drink.

For severe or frequent outbreaks, medication might be prescribed.

taking steroid

If your child has immune problems or severe illness, see your doctor immediately. Special medication can

help prevent and treat the illness.

Keep your child home: until the mouth sores are healed or can be covered.

To limit the spread:

Cover lip sores with a bandage. Wash hands well after touching them.

Don't expose newborns, people with immune problems, and pregnant women.

Don't kiss children on the mouth.

Don't share food, pacifiers, bottles, or toothbrushes. Clean and disinfect eating utensils, cups,

mouthed toys, and dining tables after each use.

Children with genital lesions should be examined and tested by an experienced physician. If herpes

or another sexually-transmitted disease is diagnosed, the child should be evaluated for sexual abuse

and Children's Protective Services should be notified.12D

120 Preventing & Managing Communicable Diseases
Appendix: Communicable Disease Fact Sheets

HIV/AIDS (Human Immunodeficiency Virus/Acquired Immunodeficiency

Syndrome)

What is HIV/ADDS? It is an infection caused by a virus. Over time, it damages the body's immune system and

other organs and can lead to severe, life-threatening illnesses. Symptoms include:

No symptoms at all for years

Failure to thrive, weight loss, fevers, fatigue

Frequent infections (e.g., thrush, diaper rash, ear infections, pneumonia)

Developmental delay and neurologic problems

How does HIV/AIDS spread? It spreads by blood, sexual fluids (semen and vaginal secretions), or saliva getting into another person's body by:

Splashes of blood onto broken skin, eyes or mouth

Sharing toothbrushes and razors

Sexual intercourse

Pregnancy, childbirth, and breast feeding

Blood transfusions and sharing injection equipment

HIV has not spread by children playing together in early childhood programs.

When is HIV /AIDS contagious?

Beginning after infection, with or without symptoms, and continuing for life.

How do I know if my child has HIV/AIDS? If you think your child is at risk or you see symptoms, see your

doctor. HIV infection is diagnosed by special blood tests.

What should I do if my child has HIV /AIDS?

Treatment: Follow your doctor's recommendations:

There are many medications to treat HIV and the other illnesses. Medication can prevent spread of

HIV from mother to baby and improve health and survival.

Should my child stay home? Children with HIV/AIDS can attend school as long as they feel well enough to

participate. Keep them home if they are too sick to participate, have oozing skin lesions that can't be covered,

or other contagious conditions (e.g., active tuberculosis). To protect the child with HIV/AIDS from other

diseases, get prompt notification of disease outbreaks such as chicken pox, measles, salmonella, and

cryptospiridium, keep the child home, and consult your doctor immediately about possible treatment.

To limit the spread:

Follow universal blood and body fluid precautions: Try to avoid direct contact with blood. Wear

disposable latex or vinyl gloves for dealing with bloody injuries, bloody diarrhea, oozing skin rashes,

and mouth or eye procedures. Clean and disinfect spills of blood. Seal blood-stained items in a plastic bag for disposal or laundering. Wash hands after removing gloves; wash skin after contact with

blood.

Don't share toothbrushes.

Don't share injection equipment. If equipment is reused, disinfect it.

Prevent sexual abuse.

Between adults, use condoms during sexual contact.

.... Appendix 121
Appendix: Communicable Disease Fact Sheets

Impetigo

What is impetigo? It is a mild skin infection caused by bacteria. It is common in children around the nose and

mouth after a cold, in the diaper area, and on cuts and insect bites. It usually lasts one to three weeks with:

Reddish sores that become oozing and crusty

May be itchy

How does impetigo spread? It spreads by:

Touching or scratching the sores on the skin

Sharing towels, clothes, and bedding

When is impetigo contagious?

As long as the sores are oozing and moist and until 24 hours after antibiotic treatment is started.

After exposure, it takes four to 10 days to develop the infection.

How do I know if my child has impetigo? If you see the rash, take the child to the doctor. Impetigo is diagnosed by how the rash looks.

What should I do if my child has impetigo?

Treatment: The doctor may prescribe:

Washing sores with soap and water.

Antibiotic medication to take by mouth and/or ointment for the sores.

Keep your child home: until 24 hours after the start of antibiotic treatment. Notify your Head Start program.

To limit the spread:

Keep the lesions clean and dry.

Wash hands after touching the lesions.

Do not share clothes, towels, or bedding. Separate personal clothes and bedding in individual cubbies

for each child.

122 Preventing & Managing Communicable Diseases
Appendix: Communicable Disease Fact Sheets

Infectious Diarrhea (including Enterovirus, Rotavirus, Norwalkvirus,

Campylobacter, Salmonella, Shigella, E. Coli, Cholera, Giardia, Ameba)

What is infectious diarrhea? It is an intestinal infection caused by viruses, bacteria, or parasites. It is the most

common cause of diarrhea. Symptoms include:

Stools that are loose, watery, frequent, foul-smelling, mucusy, bloody

Stomach cramps, nausea, and vomiting

Fever, headache, and fatigue

Although infectious diarrhea is usually mild, it can be dangerous for:

Infants and toddlersthey can get dehydrated.

Seniors and people with immune problems (e.g., HIV/AIDS, cancer chemotherapy, organ transplant,

taking steroid medication)

How does infectious diarrhea spread? It spreads by:

Touching stool when diapering and toileting

Not washing hands before handling food

Not cleaning/disinfecting toys and diapering, toileting and hand-washing areas

Playing in wading pools and water-play tables

Drinking contaminated water and eating shellfish in areas with inadequate sewage treatment

Eating under-cooked poultry, beef, and eggs

When is infectious diarrhea contagious? Depending on the type of infection:

Usually in the one or two days before the start of symptoms until the diarrhea ends and/or treatment is

completed.

After exposure, it can take one day to weeks to get sick.

How do I know if my child has infectious diarrhea? If your child has severe symptoms, bloody stool, signs of

dehydration, or doesn't get better within two to three days, see your doctor. Infectious diarrhea is diagnosed by

the symptoms and tests of stool.

What should I do if my child has infectious diarrhea?

Treatment: Follow your doctor's recommendations:

Help your child recover by offering:

- plenty of clear liquids to drink (e.g., broth, rice water, gelatin)

- bland food (e.g., bananas, rice, applesauce, toast, crackers, noodles, tortillas)avoid milk products. - breastmilk for breastfed babies

For severe symptoms or infection from bacteria or parasites, antibiotic medication and sometimes

hospitalization and rehydration are needed.

Keep your child home: until the diarrhea is resolved. If it's a bacterial or parasite infection, the child must

have received the appropriate treatment. Notify your Head Start program immediately.

To limit the spread:

Report outbreaks to the local health department.

Wash hands after diapering and toileting and before cooking and eating.

Appendix 9

123
Appendix: Communicable Disease Fact Sheets

Infectious Diarrhea (continued)

Clean and disinfect diapering areas, mouthed toys, and dining tables after each use; clean and disinfect

toileting areas and hand-washing sinks daily.

Use sprinklers instead of wading pools. Use individual water-play basins instead of water-play tables.

Do not drink from lakes, rivers, or pools.

For perishable foods (poultry, meat, fish, eggs, and milk products):

- Cook thoroughly until juices run clear.

Serve immediately or refrigerateDon't let stand at room temperature.

1 3

124 Preventing & Managing Communicable Diseases
Measles

Appendix: Communicable Disease Fact Sheets

What is measles? It is a serious illness that is caused by a virus. It is rare today because most children are immunized against it. It usually lasts one to two weeks with:

Fever and fatigue

Red and watery eyes, runny nose, and cough

Blotchy red rash over entire body

Although most children recover from measles, it can cause pneumonia, inflammation

particularly dangerous for:

Pregnant womenIt can cause miscarriage or premature delivery.

People with immune problems (e.g., HIV/AIDS, cancer chemotherapy, organ

medication).

How does measles spread? It is very contagious and spreads by:

Being in a room together, coughing, and sneezing

Touching mucus from the nose or saliva

Kissing on the lips

Sharing food, eating utensils, and mouthed toys

People who have had measles or were immunized usually can't catch it again.

When is measles contagious?

From five days before until four days after the start of the rash.

After exposure, it can take one to two weeks for the person to get sick.

of the brain, and death. It is

transplant, taking steroid

How do I know if my child has measles? If you see the symptoms, see your doctor immediately. Measles is

diagnosed by the symptoms and a special blood test.

What should I do if my child has measles?

Treatment: Follow your doctor's recommendations:

Help the child recover by encouraging rest, nutrition, and plenty of fluids to drink.

Children with severe illness might need medication and hospitalization.

Infants, unvaccinated children and adults, people with immune problems, and pregnant women exposed to

measles within the previous three to six days can get a vaccine or special injection to help prevent them getting sick

Keep the child home: until six days after the rash appears and until he or she feels well enough to participate. Notify your Head Start program immediately.

To limit the spread:

Immunize your children against measles at 12 to 15 months of age and again at four to six or 11-12

years.

Report cases of measles to the local health department.

Don't expose infants, children who have not been immunized, or pregnant women.

Wipe noses with clean tissues, throw them away, and wash your hands.

Appendix 125

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Measles (continued)

Cough and sneeze into your elbow and away from people.

Don't share food, pacifiers, bottles, or toothbrushes. Wash eating utensils, drinking cups, and

mouthed toys well between uses.

Don't kiss children on the mouth.

Open windows indoors and maximize outdoor play.

126 Preventing & Managing Communicable Diseases
Appendix: Communicable Disease Fact Sheets

Meningitis

What is meningitis? It is a relatively rare infection of the covering of the brain and spinal cord. It can be caused

by viruses, bacteria, parasites, or fungi. It can last for one to two weeks and the symptoms can be severe

Fever and listlessness or extreme irritability

Headache, stiff neck, seizures

Vomiting

Although most children recover, it can cause deafness, learning disabilities, and death.

How does meningitis spread? Most meningitis spreads by:

Being in a room together, coughing, and sneezing

Touching mucus from the nose or saliva

Kissing on the lips

Sharing food, eating utensils, and mouthed toys

Children immunized against a common type of meningitis, hemophilus influenza B (HIB), are protected from that

form of meningitis.

When is meningitis contagious? Depending on the type of meningitis:

From one to two weeks before the start of symptoms throughout the illness. Bacterial meningitis is not

contagious after 24 to 48 hours of antibiotic treatment.

After exposure, it can take a few days to weeks to get sick.

How do I know if my child has meningitis? If you see the symptoms, see the doctor immediately. Meningitis is

diagnosed by an exam, spinal tap, and lab tests.

What should I do if my child has meningitis?

Treatment: Follow your doctor's recommendations:

Help the child recover by encouraging rest, nutrition, and plenty of fluids to drink.

Children with severe illness or infection with bacteria, parasites, or fungus may need hospitalization

and intravenous antibiotic medication.

If children or adults at home or school were recently exposed to HIB or meningococcal meningitis, special

antibiotics can help prevent the illness.

Keep the child home:until symptoms resolve and until he or she feels well enough to participate and the

health provider says it is not contagious. Notify your Head Start program immediately.

To limit the spread:

Immunize your infants against RIB at two, four, six and 12 to 15 months of age.

Report cases of meningitis to the local health department.

Wipe noses with clean tissues, throw them away, and wash your hands.

Cough and sneeze into your elbow and away from people.

Don't share food, pacifiers, bottles, or toothbrushes. Wash eating utensils, drinking cups, and

mouthed toys well between uses.

Don't kiss children on the mouth.

Open windows indoors and maximize outdoor play.

Appendix 127

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Appendix: Communicable Disease Fact Sheets

Mumps

What is mumps? It is an illness caused by a virus. It is rare today because most children are immunized against

it. It can last one or two weeks with:

Swollen painful glands under the jaw or cheeks

Fever and headache

Although most children recover, it can cause inflammation of the brain and spinal cord (meningitis) and hearing

loss. It can be dangerous for:

Pregnant women because it can cause miscarriage.

Teen and adult men because it can cause sterility.

How does mumps spread? It spreads by:

Being in a room together, coughing, and sneezing

Touching mucus from the nose or saliva

Kissing on the lips

Sharing food, eating utensils, and mouthed toys

People who have had mumps or were immunized cannot catch it again.

When is mumps contagious?

From seven days before until nine days after the start of swelling of the glands.

After exposure, it takes two to three weeks to get sick.

How do I know if my child has mumps? If you see the symptoms, see your doctor immediately. Mumps is diagnosed by the typical symptoms and a special blood test.

What should I do if my child has mumps?

Treatment: Follow your doctor's recommendations:

Help the child recover by encouraging rest, nutrition, and plenty of fluids to drink.

Keep the child home: until nine days after the start of swelling of the glands. Notify your Head Start program immediately.

To limit the spread:

Immunize children against mumps at 12 to 15 months of age.

Report cases of mumps to the local health department.

Don't expose infants, children who have not been immunized, or pregnant women.

Wipe noses with clean tissues, throw them away, and wash your hands.

Cough and sneeze into your elbow and away from people.

Don't share food, pacifiers, bottles, or toothbrushes. Wash eating utensils, drinking cups, and

mouthed toys well between uses.

Don't kiss children on the mouth.

Open windows indoors and maximize outdoor play. 1 3 tY

128 Preventing & Managing Communicable Diseases
Appendix: Communicable Disease Fact Sheets

Pertussis (Whooping Cough)

What is pertussis? It is a serious respiratory infection, especially in infants. It is rare today because most children are immunized against it. It can last for six to 10 weeks with:

Runny nose

Persistent coughing fits

- followed by a gasp ("whoop") to breathe

may lead to vomiting

Pertussis can also cause pneumonia, seizures, brain damage, respiratory failure, and death.

How is pertussis spread? It spreads by:

Being in a room together, coughing, and sneezing

Touching mucus from the nose or saliva

Kissing on the lips

Sharing food, eating utensils, and mouthed toys

When is pertussis contagious?

Mostly during the runny nose phase but remains contagious for up to three weeks. No longer contagious

after five days of effective antibiotic treatment.

After exposure, it can take one to three weeks to get sick.

Children who completed pertussis immunizations usually don't catch it.

How do I know if my child has pertussis? If your child has the symptoms, see your doctor immediately.

Pertussis is diagnosed by the symptoms and cultures of the nose and throat.

What should I do if my child has pertussis?

Treatment: Follow the treatment prescribed by your doctor:

Antibiotic medication.

For infants with severe illness, hospitalization, oxygen, special feeding, and close monitoring of

breathing are necessary.

Children at home or school who were recently exposed to pertussis can get antibiotic medication and immunization boosters to help prevent the illness.

Keep your child home: until five days after the start of antibiotic treatment and until he or she feels well

enough to participate. Notify your Head Start program immediately.

To limit the spread:

Immunize children against pertussis at two, four, six, and 12 to 15 months, and four to six years.

Report cases of pertussis to the local health department.

Don't expose infants and children who have not been immunized.

Wipe noses with clean tissues, throw them away, and wash your hands.

Cough and sneeze into your elbow and away from people.

Don't share food, pacifiers, bottles, or toothbrushes. Wash eating utensils, drinking cups, and

mouthed toys well between uses.

Don't kiss children on the mouth.

Open windows indoors and maximize outdoor play.

Appendix 135 129
Appendix: Communicable Disease Fact Sheets

Pinworms

What are pinworms? They are tiny worms that commonly infect children's intestines. The worm crawls out of

the child's anus at night and lays microscopic eggs around the opening. Symptoms include:

No symptoms at all -ORScratching around anal area or vulva (in girls), especially at night

A white, thread-like worm, about 1/2" long

- seen at night, around the child's anus, or

found in the stools

How are pinworms spread? They spread by:

Children scratching their bottoms

Touching stool during diapering and toileting

Not washing hands before handling food

Not cleaning/disinfecting toys, diapering, toileting, and hand-washing areas

Playing in wading pools and water-play tables

Sharing contaminated clothes, towels, and bedding

When are pinworms contagious?

As long as the worms are present. Not contagious after treatment.

After exposure, it can take three weeks to three months to develop symptoms.

How do I know if my child has pinworms? If you see the symptoms, see your doctor. Pinworms can be diagnosed by observing worms or using clear tape to pick up the eggs around the anus in the morning and sending it

to the lab.

What should I do if my child has pinworms?

Treatment: The doctor will prescribe oral antiparasitic medication.

Should my child stay home? Your child can return to school after treatment is started. Notify your Head

Start program.

To limit the spread:

Check other children at home and at school. Get treatment if needed.

Launder clothes, towels, and bedding. Clean/disinfect cribs and mats.

Wash hands after diapering and toileting and before handling food.

Clean and disinfect diapering areas, mouthed toys, and dining tables after each use; clean and disinfect toileting areas and hand-washing sinks daily.

Use sprinklers instead of wading pools. Use individual water-play basins instead of water-play

tables. 13

130 Preventing & Managing Communicable Diseases
Appendix: Communicable Disease Fact Sheets

Ringworm (Tinea)

What is ringworm? It is a common fungus infection of the skin, scalp, nails, and feet. Symptoms include:

Skin lesions

- ring-shaped, raised, and scaly around the border

- may be pinkish or light-colored

may be itchy

Scalp lesions: pink, swollen patches that can lead to hair loss

Nails: discolored (white, yellow, or black), thickened, and cracking

Feet ("athlete's foot"): cracking of skin between toes

How does ringworm spread? It spreads by:

Touching or scratching the sores on the skin or scalp

Sharing combs, brushes, hats, towels, clothes, and bedding

Hugging cats and dogs

Walking barefoot in showers and pools

When is ringworm contagious?

As long as the rash or lesions are present. Not contagious after treatment.

After exposure, it can take four days to two weeks to develop symptoms.

How do I know if my child has ringworm? If you see the symptoms, see your doctor. Ringworm is diagnosed

by the symptoms, exam with a special light, cultures, microscopic exam of skin/scalp scrapings.

What should I do if my child has ringworm?

Treatment: Follow the treatment prescribed by your doctor:

For skin and feet infections: antifungal cream, powder, or lotion.

For infections of the scalp and nails: oral medication for at least one to two months.

For feet infections: keep clean and dry.

Should my child stay home? The child can return to school after treatment is started. Notify your Head Start

program.

To limit the spread:

Check other children, adults, and pets at home and at school. Get medical/veterinary evaluation and

treatment if needed.

For ringworm of the scalp, clean and disinfect combs and brushes.

For fungal infection of the feet, clean and disinfect showers and baths.

Keep lesions covered if possible.

Wash hands after contact with the lesions.

Do not share combs, brushes, clothes, towels, or bedding. Separate personal clothes and bedding in

individual cubbies for each child.

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Roseola

What is roseola? It is a very common illness, especially in children less than two years of age. Roseola is caused

by a virus. It usually lasts for a week with:

High fever, often up to 104 degrees F., for three to five days

Then a skin rash of pink patches over the entire body for several days

How does roseola spread? It's not clear how roseola spreads. It may spread by contact with saliva or mucus

from the nose.

When is roseola contagious?

Probably several days before the symptoms until the end of the fever.

After exposure, it can take five to 15 days to develop the illness.

How do I know if my child has roseola? If the child has symptoms, see your doctor. Roseola is diagnosed by

the typical symptoms.

What should I do if my child has roseola?

Treatment: Follow your doctor's recommendations:

Help the child recover by encouraging rest, nutrition, and plenty of fluids to drink.

If the baby is uncomfortable with the fever:

dress the baby lightly

give lukewarm baths

the doctor might recommend acetaminophen

Should my child stay home? Children can attend when they feel well enough to participate. Notify your

Head Start program.

To limit the spread:

Wipe noses with clean tissues, throw them away, and wash your hands.

Cough and sneeze into your elbow and away from people.

Don't share food, pacifiers, bottles, or toothbrushes. Wash eating utensils, drinking cups, and

mouthed toys well between uses.

Don't kiss children on the mouth.

132 Preventing & Managing Communicable Diseases
Appendix: Communicable Disease Fact Sheets

Rubella (German Measles)

What is rubella? It is an illness caused by a virus. It is rare today because most children get immunized against

it. The illness lasts for about a week with:

Red body rash

Fever

Swollen lymph nodes ("glands") at the back of the neck

Although rubella is usually a mild illness, it can be dangerous for pregnant women because it can cause miscarriage, stillbirth, or severe birth defects in the baby.

How does rubella spread? It spreads by:

Being in a room together, coughing, and sneezing

Touching mucus from the nose or saliva

Kissing on the lips

Sharing food, eating utensils, and mouthed toys

People who have had rubella before or were immunized usually can't catch it again.

When is rubella contagious?

From several days before until five days after the start of the rash.

After exposure to rubella, it takes two to three weeks to get sick.

How do I know if my child has rubella? If you see the symptoms, take your child to the doctor. Rubella is diagnosed by the symptoms and a special blood test.

What should I do if my child has rubella?

Treatment: Follow your doctor's recommendations:

Help the child recover by encouraging rest, nutrition, and plenty of fluids to drink.

If anyone at home is pregnant, contact your doctor.

Keep your child home: until six days after the rash appears and he or she feels well enough to participate in

activities. Notify your Head Start program immediately.

To limit the spread:

Immunize your children against rubella at 12 to 15 months of age and again at four to six or 11 to 12

years.

If you're planning pregnancy, see your doctor to get a blood test to see if you need the rubella vaccine to protect you and your baby.

Report cases of rubella to the local health department.

Don't expose infants, children who have not been immunized, or pregnant women.

Wipe noses with clean tissues, throw them away, and wash your hands.

Cough and sneeze into your elbow and away from people.

Don't share food, pacifiers, bottles, or toothbrushes. Wash eating utensils, drinking cups, and

mouthed toys well between uses.

Don't kiss children on the mouth.

Open windows indoors and maximize outdoor play.

Appendix 130 133
Appendix: Communicable Disease Fact Sheets

Scabies

What is scabies? It is a skin infection caused by a microscopic bug called a mite. The mite lives on the surface

and burrows down into the skin causing:

Skin rash, which:

starts as red bumps and white thread-like lines

appears between fingers, around wrists, elbows, underarms, nipples, abdomen, waist, buttocks, penis,

feet. In infantshead, neck, palms, and soles

itches intensely, especially at night

is often covered with scratch marks and bruises

How do scabies spread? They spread by:

Touching or scratching the sores on the skin

Sharing towels, clothes, bedding, and furniture

When are scabies contagious?

From weeks before the symptoms until treatment is completed.

When the mites are off the body (e.g., on clothes, furniture), they die within four days.

After exposure, it can take four to six weeks to develop symptoms. For people who have been previously

exposed to scabies, symptoms can start within one to four days.

How do I know if my child has scabies? If your child has the symptoms, see your doctor. Scabies are diagnosed

by the signs and symptoms. Sometimes, a skin scraping may be examined under the microscope.

What should I do if my child has scabies?

Treatment: Follow the treatment prescribed by your doctor. Some scabies medications are dangerous for

infants and women who are pregnant or nursing.

Apply the medicated body lotion, leave on, and rinse off according to instructions.

Repeat treatment after seven to 10 days to kill newly-hatched mites.

Calamine lotion or antihistamine medications might reduce itching.

Keep your child home until: after treatment is completed. Notify your Head Start program.

To limit the spread:

Check everyone at home and at school for signs of scabies. Refer for medical evaluation and treatment if necessary.

Don't share hats and jackets. Keep personal clothes and bedding separate in individual cubbies for

each child.

Launder clothes, linen, bedding, stuffed animals, and small carpets in a machine with detergent and

hot water. Dry in a hot dryer or press with a hot iron. For non-washable items (e.g., hats, pillows),

dry-clean or seal in a plastic bag for four to seven days.

Vacuum carpets, upholstered furniture, and car seats.

140

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Appendix: Communicable Disease Fact Sheets

Streptococcal Infections ("Strep" Throat, Scarlet Fever)

What are streptococcal infections? Strep is a very common bacterial infection in children. It can cause strep

throat and scarlet fever. Symptoms include:

Sore and red throat, red tongue

Bright red skin rash, which:

is on the cheeks, neck, chest, back, and skin folds

may feel rough, like sandpaper

Fever, headache, and swollen lymph nodes ("glands") in the neck

Although strep infection is usually mild, it can cause severe illness including pneumonia, meningitis, rheumatic

fever (heart), bone/joint infections, and kidney disease.

How does strep spread? It spreads by:

Being in a room together, coughing, and sneezing

Touching mucus from the nose or saliva

Kissing on the lips

Sharing food, eating utensils, and mouthed toys

When is strep contagious?

From the day before the start of symptoms and during the period of illness, until 24 hours after the start

of effective antibiotic treatment.

After exposure, it takes two to five days to develop symptoms.

How do I know if my child has strep? If your child has the symptoms, see your doctor immediately. Strep

throat is diagnosed by an exam and swab of the throat for a quick lab test or culture. Scarlet fever is diagnosed by

the typical symptoms.

What should I do if my child has strep?

Treatment: Follow the treatment prescribed by your doctor:

Take the antibiotic medication for the whole course.

For sore throat, try cool drinks, popsicles, teas, salt water gargles.

The doctor might recommend acetaminophen for fever.

When symptoms of strep infection are severe, further medical tests, hospitalization, and intravenous treatment may be necessary.

Keep your child home: until 24 hours after the start of antibiotic treatment and until the fever is gone and

the child feels well enough to participate. Notify your Head Start program.

To limit the spread:

Wipe noses with clean tissues, throw them away, and wash your hands.

Cough and sneeze into your elbow and away from people.

Don't share food, pacifiers, bottles, or toothbrushes. Wash eating utensils, drinking cups, and

mouthed toys well between uses.

Don't kiss children on the mouth.

Open windows indoors and maximize outdoor play.

1 4 Appendix 135
Appendix: Communicable Disease Fact Sheets

Tuberculosis

What is tuberculosis? Tuberculosis (TB) is a serious respiratory infection that is caused by a bacteria. The infection enters the lungs and causes:

No symptoms at all -ORPersistent cough, pneumonia

Fevers, weight loss, and fatigue

And (rarely) infection of brain, heart, kidney, bones

Tuberculosis is particularly dangerous for:

Young children and the elderly

People with health problems and weakened immunity (e.g., HIV/AIDS, cancer chemotherapy, organ

transplant, steroid medications).

How does tuberculosis spread? It spreads by:

Being in a room together

Coughing and sneezing

When is tuberculosis contagious?

When the disease is "active" and the person is sick and coughing. Adults with TB are more contagious

than children. The disease is contagious until after two to four weeks of taking TB medications, and tests

confirm that it's no longer contagious.

After exposure, a person may develop a positive TB skin test (infection) within two to 10 weeks. Although most people with TB never develop symptoms, they may develop symptoms from one month to

many years later.

How do I know if my child has tuberculosis? If your child has been exposed or has symptoms, see your doctor.

TB infection is diagnosed by a skin test on the forearm. If there is a reaction ("positive TB test") after two to three

days, a chest X-ray and cultures are done to diagnose active TB infection and what treatment and follow-up are

needed.

What should I do if my child has tuberculosis?

Treatment: Follow the treatment prescribed by your doctor:

Oral antibiotic medications for six to 12 months.

Close medical follow-up including X-rays and cultures.

Keep the child home: until the doctor and/or health department determine that he is not contagious. This may

be up to two to four weeks. Notify your Head Start program immediately.

To limit the spread:

Test all children and caregivers for TB periodically.

Report the illness to the local health department.

Cough and sneeze into your elbow and away from people.

Open windows indoors and maximize outdoor play. 1

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