Coughs and sneezes spread diseases, as the saying goes. Another saying should go that it takes good infection control procedures and best practice hygiene routines to stop the spread in childcare settings.
The national standards for under-eights daycare and childminding require the registered person, under Standard 7: Health, to promote the good health of children and take 'positive steps to prevent the spread of infection and appropriate measures when they are ill' (see box).
An infection control policy is one way to tackle this perennial problem, but do childcare practitioners who are already so burdened with bureaucracy need to undertake more paperwork?
With the help of a parent working in the local health protection team, Laura Oliver, manager of Manor Nursery near Bicester, Oxfordshire, developed an infection control policy covering a range of conditions and scenarios. She says it has more than proved its effectiveness, as staff recently prevented infectious outbreaks from spreading.
'We have had someone come in with chickenpox and someone else with diarrhoea and vomiting. In both cases we kept it to just the one child.'
Cheryl Hadland, director of the Tops Day Nurseries chain in Hampshire and Dorset, says childcare managers should not feel pressured into drawing up a new policy document as long as the issues are covered and cross-referenced within the setting's routine procedures and health policies.
'We need to avoid making managers think they are being inadequate. They need support, not more paperwork,' she says. 'They might have an infection control policy already but call it something else, or have aspects of it combined within their other policies, such as nappy changing routine and other parts covered in their health and safety policy, as we do.'
Staff at the Old School House Nursery in Stetchworth near Cambridge work to health policies which are explained to parents when their children join, says manager Lisa Weston.
'We have a guidance leaflet on infection control from the local health protection team, and if we have any concerns we contact them. If we telephone them for advice we respect confidentiality. We speak to the parents and let them know we need to telephone for advice.'
Laura Oliver says sometimes the health officials will want contact details for the child, which is why it is important to have notified the parents first. 'If a child is bitten and has broken skin and the child who bit has a cut in his mouth, there could be a spread of infection. They would want to check the child's medical history.'
She has a file of infection control fact sheets, issued by her local health protection team, which list some 44 infections and diseases. They range in severity from illnesses such as bronchiolitis and whooping cough to infections such as athlete's foot and verrucae. Each fact sheet explains how infection is spread, how that spread can be avoided and how long anyone affected should stay at home.
Laura gives parents copies of the fact sheets, if necessary, and issues them with a chart showing how long to keep their child away from nursery if they have an infection. 'If a child is on a prescribed medicine we would prefer them to be taking it for 24 hours before coming into nursery in case there is an allergic reaction, and also so there is time for the medication to start operating.
'If someone has gastro-enteritis, we ask for them to be clear of all symptoms for 48 hours before returning.'
Lisa Weston says, 'If there is anything going round we always put a notice about it on the parents' notice board. If necessary with something like chickenpox, for example, we advise parents if they are pregnant to see their GP.'
Tops settings alert parents to outbreaks, says Cheryl Hadland, 'but for something like chickenpox, we would not list the symptoms. We would assume they would know.'
'We always stress that we are not doctors,' says Lisa Weston. 'We cannot give a diagnosis, and if they have concerns they must seek medical advice.
We let them know if there is something doing the rounds so they can be vigilant.
'We always ask parents to let their doctor know that the child attends nursery and is coming into contact with other young children.'
Cheryl Hadland says policies should cover nursery routines and practice, with instructions on everything from cleaning tables before meals to washing hands before and after toileting, going outside or handling animals. They should know how to clear up after first aid situations, and be told not to kiss children on the lips.
Laura Oliver says, 'We have advice for staff beside the sinks as reminders - for example, not to wear watches so you can wash to above the wrists and not to wear rings with stones in them under which bacteria can be trapped.'
Her nursery used to employ outside cleaners, but the staff now do the cleaning themselves. 'The staff are aware of what to clean, how to clean and what with. We clean as we go along during the week. Fridays are always a quiet day and that's when all the extras get done, such as scrubbing pipes under the sinks.'
Further information
Visit the Health Protection Agency website on www.hpa.org.uk. Look up schools under the A-Z topics menu to access a list of infections and guidance about them. A spokesman for the Agency says early years settings can contact the consultant in communicable disease control at their local health protection unit, via their local primary care team, for more information.
The Wired for Health campaign is run by the Health Development Agency on behalf of the DfES and the Department for Health. It has advice and guidance for schools and nurseries, including a downloadable poster and pocket guide on infection control at www.wiredforhealth.gov.uk. The poster and guide can be found under infection in the A-Z list of topics in the resources and links section.
The Community Practitioners' and Health Visitors' Association has produced two free guides to help improve health and hygiene within homes and settings - 'Keep it clean and healthy', aimed at those carers working with under- fives and 'Looking after you and your baby', aimed at both parents and carers.
To order copies send an A4 SAE (84p for first class, 69p second class) to Pat Cole, Hartford College, 1 Longstaff Way, Hartford, Huntingdon PE29 1XT.
For further information contact Pat Cole at pat@ cole-hartford.fsnet.co.uk.
NATIONAL STANDARDS
Key issues raised in National Day Care Standard 7: Health that need to be addressed in an infection control policy:
Hygiene
7.1 The premises and equipment are clean.
7.2 The registered person ensures that staff are informed and aware of the importance of good hygiene practice in order to prevent the spread of infection. Staff are informed of and kept up to date with hygiene procedures.
7.3 Children are encouraged to learn about personal hygiene through the daily routine.
Sick children
7.12 There is a policy about the exclusion of children who are ill or infectious which is discussed with parents. This includes a procedure for contacting parents or another adult designated by the parent if a child becomes ill while in day care.
