Guidance on infection control

A useful Guidance on infection control in schools and other childcare settings

About Public Health England

Public Health England exists to protect and improve the nation’s health and wellbeing, and reduce health inequalities. It does this through advocacy, partnerships, world-class science, knowledge and intelligence, and the delivery of specialist public health services. PHE is an operationally autonomous executive agency of the Department of Health.

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Prepared by: Mamoona Tahir. Information produced with the assistance of the Royal College of Paediatrics and Child Health.

For queries relating to this document, please contact [email protected]

© Crown copyright 2014 You may re-use this information (excluding logos) free of charge in any format or medium, under the terms of the Open Government Licence v2.0. To view this licence, visit OGL or email [email protected]. Where we have identified any third party copyright information you will need to obtain permission from the copyright holders concerned.

Published September 2014 (version 2) PHE publications gateway number: 2014006

This document is available in other formats on request. Please email [email protected]

Contents

About Public Health England 2

1. Introduction 4
2. Rashes and skin infections 5
3. Diarrhoea and vomiting illness 6
4. Respiratory infections 7
5. Other infections 7
6. Good hygiene practice 9

Handwashing 9

Coughing and sneezing 9

Personal protective equipment (PPE) 9

Cleaning of the environment 9

Cleaning of blood and body fluid spillages 9

Laundry 10

Clinical waste 10

Sharps disposal 10

Sharps injuries and bites 10

Animals 10

Animals in school (permanent or visiting) 10

Visits to farms 11

Vulnerable children 11

Female staff – pregnancy 11

7. Immunisations 12

Immunisation schedule 12

Appendix 1. PHE centre contact details 13

Introduction

The document provides guidance for schools and other childcare settings, such as nurseries, on infection control issues.

It is an updated version of guidance that was produced in 2010.

Prevent the spread of infections by ensuring:

• routine immunisation
• high standards of personal hygiene and practice, particularly handwashing
• maintaining a clean environment

For further information and advice visit www.gov.uk/phe or contact your local health PHE centre. See Appendix 1 for contact details.

Rashes and skin infections

Children with rashes should be considered infectious and assessed by their doctor.

Infection or complaint

5 Recommended period to be kept away from school, nursery or childminders

Comments

Athlete’s foot None Athlete’s foot is not a serious condition.

Treatment is recommended Chickenpox Until all vesicles have crusted over

See: Vulnerable Children and Female Staff – Pregnancy Cold sores, (Herpes simplex)

None Avoid kissing and contact with the sores. Cold sores are generally mild and self-limiting German measles (rubella)*

Four days from onset of rash (as per “Green Book”)

Preventable by immunisation (MMR x2 doses). See: Female Staff – Pregnancy

Hand, foot and mouth

None Contact your local HPT if a large number of children are affected. Exclusion may be considered in some circumstances Impetigo Until lesions are crusted and healed, or 48 hours after starting antibiotic treatment

Antibiotic treatment speeds healing and reduces the infectious period

Measles* Four days from onset of rash

Preventable by vaccination (MMR x2). See: Vulnerable Children and Female Staff – Pregnancy Molluscum contagiosum

None A self-limiting condition

Ringworm Exclusion not usually required

Treatment is required

Roseola (infantum) None None

Scabies Child can return after first treatment

Household and close contacts require treatment Scarlet fever* Child can return 24 hours after starting appropriate antibiotic treatment

Antibiotic treatment is recommended for the affected child

Slapped cheek/fifth disease. Parvovirus B19

6 None (once rash has developed)

See: Vulnerable Children and Female Staff – Pregnancy

Shingles Exclude only if rash is weeping and cannot be covered

Can cause chickenpox in those who are not immune, ie have not had chickenpox. It is spread by very close contact and touch. If further information is required, contact your local PHE centre. See: Vulnerable Children and Female Staff – Pregnancy Warts and verrucae None Verrucae should be covered in swimming pools, gymnasiums and changing rooms

3. Diarrhoea and vomiting illness

Infection or complaint

Recommended period to be kept away from school, nursery or childminders

Comments

Diarrhoea and/or vomiting

48 hours from last episode of diarrhoea or vomiting E. coli O157 VTEC Typhoid* [and paratyphoid*] (enteric fever) Shigella (dysentery)

Should be excluded for 48 hours from the last episode of diarrhoea. Further exclusion may be required for some children until they are no longer excreting

Further exclusion is required for children aged five years or younger and those who have difficulty in adhering to hygiene practices. Children in these categories should be excluded until there is evidence of microbiological clearance. This guidance may also apply to some contacts who may also require microbiological clearance. Please consult your local PHE centre for further advice Cryptosporidiosis Exclude for 48 hours from the last episode of diarrhoea

Exclusion from swimming is advisable for two weeks after the diarrhoea has settled

4. Respiratory infections

Infection or complaint

7 Recommended period to be kept away from school, nursery or childminders

Comments

Flu (influenza) Until recovered See: Vulnerable Children

Tuberculosis* Always consult your local PHE centre

Requires prolonged close contact for spread

Whooping cough* (pertussis)

Five days from starting antibiotic treatment, or 21 days from onset of illness if no antibiotic treatment

Preventable by vaccination. After treatment, non-infectious coughing may continue for many weeks. Your local PHE centre will organise any contact tracing necessary

5. Other infections

Infection or complaint

Recommended period to be kept away from school, nursery or child minders

Comments

Conjunctivitis None If an outbreak/cluster occurs, consult your

local PHE centre Diphtheria * Exclusion is essential.

Always consult with your local HPT

Family contacts must be excluded until cleared to return by your local PHE centre. Preventable by vaccination. Your local PHE centre will organise any contact tracing necessary Glandular fever None

Head lice None Treatment is recommended only in cases

where live lice have been seen Hepatitis A* Exclude until seven days after onset of jaundice (or seven days after symptom onset if no jaundice)

In an outbreak of hepatitis A, your local PHE centre will advise on control measures

Hepatitis B*, C*, HIV/AIDS

8 None Hepatitis B and C and HIV are bloodborne viruses that are not infectious through casual contact. For cleaning of body fluid spills see: Good Hygiene Practice Meningococcal meningitis*/ septicaemia*

Until recovered Meningitis C is preventable by vaccination

There is no reason to exclude siblings or other close contacts of a case. In case of an outbreak, it may be necessary to provide antibiotics with or without meningococcal vaccination to close school contacts. Your local PHE centre will advise on any action is needed Meningitis* due to other bacteria

Until recovered Hib and pneumococcal meningitis are preventable by vaccination. There is no reason to exclude siblings or other close contacts of a case. Your local PHE centre will give advice on any action needed Meningitis viral* None Milder illness. There is no reason to exclude siblings and other close contacts of a case. Contact tracing is not required MRSA None Good hygiene, in particular handwashing and environmental cleaning, are important to minimise any danger of spread. If further information is required, contact your local PHE centre Mumps* Exclude child for five days after onset of swelling

Preventable by vaccination (MMR x2 doses)

Threadworms None Treatment is recommended for the child and household contacts Tonsillitis None There are many causes, but most cases are due to viruses and do not need an antibiotic

* denotes a notifiable disease. It is a statutory requirement that doctors report a notifiable disease to the proper officer of the local authority (usually a consultant in communicable disease control). In addition, organisations may be required via locally agreed arrangements to inform their local PHE centre. Regulating bodies (for example, Office for Standards in Education (OFSTED)/Commission for Social Care Inspection (CSCI)) may wish to be informed – please refer to local policy.

Outbreaks: if an outbreak of infectious disease is suspected, please contact your local PHE centre.

6. Good hygiene practice

Handwashing

Handwashing is one of the most important ways of controlling the spread of infections, especially those that cause diarrhoea and vomiting, and respiratory disease. The recommended method is the use of liquid soap, warm water and paper towels. Always wash hands after using the toilet, before eating or handling food, and after handling animals. Cover all cuts and abrasions with waterproof dressings.

Coughing and sneezing

Coughing and sneezing easily spread infections. Children and adults should be encouraged to cover their mouth and nose with a tissue. Wash hands after using or disposing of tissues. Spitting should be discouraged.

Personal protective equipment (PPE)

Disposable non-powdered vinyl or latex-free CE-marked gloves and disposable plastic aprons must be worn where there is a risk of splashing or contamination with blood/body fluids (for example, nappy or pad changing). Goggles should also be available for use if there is a risk of splashing to the face. Correct PPE should be used when handling cleaning chemicals.

Cleaning of the environment

Cleaning of the environment, including toys and equipment, should be frequent, thorough and follow national guidance. For example, use colour-coded equipment, COSHH and correct decontamination of cleaning equipment. Monitor cleaning contracts and ensure cleaners are appropriately trained with access to PPE.

Cleaning of blood and body fluid spillages

All spillages of blood, faeces, saliva, vomit, nasal and eye discharges should be cleaned up immediately (always wear PPE). When spillages occur, clean using a product that combines both a detergent and a disinfectant. Use as per manufacturer’s instructions and ensure it is effective against bacteria and viruses and suitable for use on the affected surface. Never use mops for cleaning up blood and body fluid spillages – use disposable paper towels and discard clinical waste as described below. A spillage kit should be available for blood spills.

 

Laundry

Laundry should be dealt with in a separate dedicated facility. Soiled linen should be washed separately at the hottest wash the fabric will tolerate. Wear PPE when handling soiled linen. Children’s soiled clothing should be bagged to go home, never rinsed by hand.

Clinical waste

Always segregate domestic and clinical waste, in accordance with local policy. Used nappies/pads, gloves, aprons and soiled dressings should be stored in correct clinical waste bags in foot-operated bins. All clinical waste must be removed by a registered waste contractor. All clinical waste bags should be less than two-thirds full and stored in a dedicated, secure area while awaiting collection.

Sharps disposal

Sharps should be discarded straight into a sharps bin conforming to BS 7320 and UN 3291 standards. Sharps bins must be kept off the floor (preferably wall-mounted) and out of reach of children.

Sharps injuries and bites

If skin is broken, encourage the wound to bleed/ wash thoroughly using soap and water. Contact GP or occupational health or go to A&E immediately. Ensure local policy is in place for staff to follow. Contact your local HPT for advice, if unsure.

Animals

Animals may carry infections, so hands must be washed after handling any animals. Health and Safety Executive (HSE) guidelines for protecting the health and safety of children should be followed.

Animals in school (permanent or visiting)

Ensure animals’ living quarters are kept clean and away from food areas. Waste should be disposed of regularly, and litter boxes not accessible to children. Children should not play with animals unsupervised. Veterinary advice should be sought on animal welfare and animal health issues and the suitability of the animal as a pet. Reptiles are not suitable as pets in schools and nurseries, as all species carry salmonella.