The key role nurseries can play in protecting children from infections and illness has been underlined by the publication of a study showing that the UK is one of the five worst countries in Europe for measles.
Measles cases are running at a 13-year high in England and Wales, with the Health Protection Agency reporting 1,049 cases between January and October 2008, more than the whole of the previous year. The increase has been linked to the poor take-up of the MMR vaccine.
The Europe-wide research project, published in The Lancet, shows that the worst places for measles are the UK, Romania, Germany, Italy and Switzerland. According to guidance issued by the NHS Choices website, one in 15 children who contracts measles will develop serious complications such as pneumonia, fits, and in rare cases, encephalitis and brain damage. Such complications can lead to death if they are severe.
But what can nursery managers do to try to protect children?
'When children enter the setting, we ask all parents to inform us of what inoculation their children have received,' says Symone Pearce, manager of the Cedar House day nursery at London's Maudsley Hospital. 'If we note that children have not received the MMR or not the measles inoculation, if they have received them separately, we will talk to the parents, asking if there was a medical reason for this and explaining the implications of a measles epidemic. We can only advise parents to inoculate their child.
'If we have even a suspected case of measles we will place a notice on the main door warning that we have an unconfirmed case within the nursery and advise immuno-suppressed people not to enter the building. We are in close contact with our infection control department who always offer support and advice to us. We also liaise with Southwark's health protection team, who will also offer support and advice and in turn liaise with the GP of the child who has suspected measles.'
Measles, which is most common among children aged between one and four, is a highly infectious viral illness and spreads through the air via droplets of saliva. You can catch it through direct contact with an infected person, or when they cough or sneeze.
The illness causes a range of symptoms, including distinctive red-brown spots, fever and coughing, which appear nine to 11 days after the infection begins, and lasts up to 14 days. The condition is most infectious after the first symptoms have appeared and before the rash has developed.
Posters and booklets
To limit the risk of sick children coming to nursery and infecting others, all parents joining any of the four HRH Nurseries in Cambridgeshire are given a booklet called 'What to do if your child is ill' when they make their initial visit to a setting.
'When they look around the nursery, the manager will give them the booklet and go through it with them,' says HRH proprietor Glen Perrott. 'It says that an average day at nursery can be hectic, noisy and stimulating and it is not the place for a poorly child.
'If you suspect that your child may be sickening for something, has been awake most of the night coughing, has an unexplained rash, has spiked a temperature or has sickness and diarrhoea, please do not bring him or her into nursery.'
She adds, 'It is not fair to put other children at risk, particularly young babies who have yet to fully develop their immune system.'
At Emma's Day Nursery in Bournemouth, manager Emma Henwood says, 'We have a poster giving the guidelines on infection control issued by our local health protection unit, which gives details such as how long a child should be kept away from nursery. It is in our foyer and the parents and staff are all aware of it. That is backed up by our own health and safety policies, which are more specific and personal.
'If there were measles, we would look at the specific guidelines because it is a notifiable disease and we would inform our local health protection unit. There are implications for vulnerable children and staff members who are pregnant.'
The NHS Choices website warns that the saliva droplets through which measles is spread can survive and remain contagious on surfaces for a few hours, which highlights the importance of maintaining rigorous infection control policies and procedures in early years settings.
'All staff understand that good hand hygiene is essential to limiting the spread of infection,' says Mrs Pearce at Cedar House. 'We encourage all staff to wear a portable alcohol hand gel at all times and to use it after wiping a child's nose, for example if they cannot get to a sink to wash their hands straight away. The children see the adults washing their hands and this is reflected in the children, who learn from a young age the importance of handwashing - it becomes second nature to them. Children are encouraged to sneeze and cough into a tissue, as the tissue can be binned or flushed away, taking the germs with it. They are also encouraged to wash their hands afterwards.
'Staff always wear gloves and an apron when dealing with bodily fluids and at nappy changing times, surfaces are cleaned with antibacterial spray, and baby toys are washed regularly.'
'We are fastidious,' says Ms Henwood. 'We use anti-bacterial sprays and wipes. We have never really had a bug going through the nursery in the six and a half years since we opened.'
Staff illnesses
This time of year sees a crop of seasonal bugs that can wreak havoc in an early years setting such as winter vomiting, coughs and the common cold.
Parents at HRH nurseries are advised that if their child becomes poorly at nursery, they are expected to collect them within 30 minutes. 'We say that if they live or work a long way from the nursery then they will need to arrange emergency cover,' says Mrs Perrott.
'We also ask parents to tell us their occupations. One of our nurseries is on the site of Hinchingbrooke Hospital. We need to know if someone works in the special baby unit so we can warn them if there is a bug going round the nursery.'
How do nurseries cope if their staff become ill? 'The staff know to stay away from work until they are clear,' says Ms Henwood. 'We are a small team, but as manager I am usually supernumary. We have part-time members of staff so I can call on them if someone is sick or we have three agencies locally with 24 help- lines. Sometimes it has not been easy but we have always managed to organise cover.'
FURTHER INFORMATION
National Health Service: www.nhs.uk
Health Protection Agency: www.hpa.org.uk
- See 'Let's talk about child sickness', p22-23
