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Infection control advice for schools and other childcare settings

Schools and nurseries and other childcare settings, are common sites for transmission of infection as children are particularly susceptible. Some of this advice also applies to those who are homeschooled or do not have access to mainstream education.

Children have immature immune systems, close contact with other children, sometimes have no or incomplete vaccinations and have a poor understanding of hygiene practices. As such, there is a risk of infections quickly spreading. Remember, the best way to prevent and manage infectious disease is to:

  • Promote immunisation
  • Promptly exclude the unwell child or member of staff
  • Check that effective hand washing is being carried out routinely

Preventing the spread of infections

Micro-organisms such as bacteria, viruses and fungi are everywhere and commonly do not cause infection (and can even be beneficial). However, some do cause infection resulting in symptoms such as fever and sickness.
Where a case of infection is known, measures aim to reduce or eliminate the risk of spread through information and prompt exclusion of a case.

Infections are spread in many different ways but the most important of these are through:

  • Respiratory spread: Contact with cough or other secretions from an infected person, like influenza. This can happen by being near the infected person when they cough and then breathe in the organism; or by picking up the organism from an infected item, for example a used tissue or on an object in the environment, and then touching your nose or mouth.
  • Direct contact spread: By direct contact with the infecting organism, for example contact with skin during contact sports such as rugby and in gyms, like impetigo or staphylococcal infections.
  • Gastrointestinal spread: Resulting from contact with contaminated food or water (hepatitis A), contact with infected faeces or unwashed hands after using the toilet (typhoid fever).
  • Blood borne virus spread: By contact with infected blood or body fluids, for example while attending to a bleeding person or injury with a used needle (hepatitis B). Human mouths are inhabited by a wide variety of organisms, some of which can be transmitted by bites. Human bites resulting in puncture or breaking of the skin are potential sources of exposure to blood borne infections therefore it is essential that they are managed promptly.

Managing a child with an infection

Infections in children, especially young children are common due to a child's immune system being immature. Bacteria, viruses and fungi can be found anywhere and the majority of these micro-organisms will not cause an infection, but some infections are passed to others maybe through play or the lack of good hygiene habits. Many diseases can spread during the infectious period and the symptoms do not appear until later.

To reduce the transmission of infection, we need to put infection prevention and control measures into action by promoting routine use of good standards of hygiene. This can usually be achieved through:

  • Good hand washing
  • Keeping the environment clean
  • Immunisation of pupils and staff

To eliminate or reduce the risk of spread where a case of infection is known, prompt exclusion of the case is required and provide information to parents/carers.

If you are notified of a case of infectious disease in a pupil or staff member, please contact the Dudley Metropolitan Borough Council Health Protection Team by contacting Dudley Council Plus. Please also inform your Health Protection Team at Public Health England as soon as possible as not all infections require exclusion. Your local team can also give you additional advice and support as needed.

Managing children with the same infection (outbreaks)

Classification of an outbreak
An outbreak or incident may be defined as:

  • An incident in which two or more people experiencing a similar illness are linked in time or place
  • A greater than expected rate of infection compared with the usual background rate for the place and time where the outbreak has occurred. For example 2 or more cases of diarrhoea and/or vomiting which are in the same classroom, shared communal areas or taking part in the same activities. 

When to report

Please contact your local health protection team as soon as you suspect an outbreak to discuss the situation and agree if any actions are needed. It is useful to have the information listed below available before this discussion as it will help to inform the size and nature of the outbreak:

  • Total numbers affected (staff and children)
  • Symptoms
  • Date(s) when symptoms started
  • Number of classes affected

Visit Public Health England for exclusion information. 

If you suspect cases of infectious illness but are unsure if it is an outbreak, please contact the Dudley Metropolitan Borough Council Health Protection Team by calling Dudley Council Plus on 0300 555 2345. Please also inform your Health Protection Team at Public Health England as soon as possible. 
How to report
Childcare settings are asked to telephone their local Health Protection team as soon as possible to report any serious or unusual illness particularly for:

  • Escherichia coli (VTEC) (also called E.coli 0157) or Escherichia coli VTEC infection
  • Food poisoning
  • Hepatitis
  • Measles, mumps, rubella (rubella is also called German measles)
  • Meningitis
  • Scarlet fever
  • Tuberculosis
  • Typhoid
  • Whooping cough (also called pertussis)

The full list of notifiable diseases was updated in 2010. Your local Health Protection Team at Public Health England can also draft letters and provide factsheets for parents and carers to ensure the most up to date information is given.

Confidentiality
It is important to note that health protection teams are bound to manage personal case details in strict confidence. Therefore, information given to schools from the team for distribution during an outbreak will never name cases or give out any personal details. Organisations where cases are identified are also bound to manage personal case details in strict confidence. For more advice and information read the available guidance from Public Health England.

Immunisations

After clean water, vaccination is the most effective public health intervention in the world for saving lives and promoting good health. Vaccines protect us, our children and loved ones from serious and potentially fatal diseases. Visit the immunisations page for more information. 

Staff health

Staff immunisation
All staff should undergo a full occupational health check before starting employment; this includes ensuring they are up to date with immunisations, including Measles, Mumps, Rubella (MMR).

Exclusion
Staff employed in schools, nurseries and other childcare settings should have the same rules regarding exclusion applied to them as are applied to the children. They may return to work when they are no longer infectious, provided they feel well enough to do so.

Pregnant staff
It should be noted that the greatest risk to pregnant women from such infections comes from their own household rather than the workplace. However, if a pregnant woman develops a rash, or is in direct contact with someone with a rash who is potentially infectious, she should consult her doctor or midwife.

Chickenpox
Chickenpox can affect the pregnancy if a woman has not already had the infection. The GP and midwife should be informed promptly. A blood test may be arranged to check immunity if it isn’t already known. Shingles is caused by the same virus as chickenpox therefore anyone who has not had chickenpox is potentially vulnerable to the infection if they have close contact with a case of shingles.

Measles
Measles during pregnancy can result in early delivery or even loss of the baby. If a pregnant woman is exposed, the midwife should be informed immediately. All female staff under the age of 25 years, working with young children, should have evidence of 2 doses of MMR vaccine or a positive history of measles.

Rubella (German measles)
If a pregnant woman comes into contact with German measles she should inform her GP and midwife immediately. The infection may affect the developing baby if the woman is not immune and is exposed in early pregnancy.
All female staff under the age of 25 years, working with young children, should have evidence of 2 doses of MMR vaccine or a positive history of Rubella.

Slapped cheek disease (Parvovirus B19)
Slapped cheek disease (Parvovirus B19) can occasionally affect an unborn child if exposed early in pregnancy. The pregnant woman should inform their midwife promptly.

Food handling staff
Food handlers and catering staff may present a particular risk to the health of their pupils and staff if they become infected (or have close contact) with diseases that can be transmitted to others via the medium of food or drink. These diseases commonly affect the gastrointestinal system (stomach and bowel) and usually cause diarrhoea or vomiting, or both.
Food handling staff suffering from such diseases must be excluded from all food handling activity in the school or nursery setting until advised by the local Environmental Health Officer that they are clear to return to work. There are legal powers for the formal exclusion of such cases but usually voluntary exclusion will suffice with ‘off work’ certificates from the GP, as necessary.

For more advice and information read the available guidance from Public Health England.

Children at particular risk from infection

Some children have impaired immune defense mechanisms in their bodies (known as immuno-compromised) and hence will be more likely to acquire infections. Also, the consequence of infection in the immuno-compromised is likely to be significantly more serious than in those with a properly functioning immune system (known as immuno-competent).
Impaired immunity can be caused by certain treatments such as those for leukaemia or other cancers, like cytotoxic therapy and radiotherapy. Other treatments such as high doses of steroids, enteral feeding and others, may also have a similar effect. Children and carers will have been fully informed by their doctor.

There are also some rare diseases, which can reduce the ability of a person to fight off infection. Usually nurseries and schools are aware of such vulnerable children through information given by their parents or guardians. If a vulnerable child is thought to have been exposed to a communicable disease, chickenpox or measles in the school setting, parents or guardians of that child should be informed promptly so that they can seek further medical advice from their GP or specialist, as appropriate.

It is important that these children are also made known to the school nurse on entry to the school. For more advice and information read the available guidance from Public Health England.