infection prevention in the classroom setting

Infection Prevention in the Infection Prevention in the Classroom SettingClassroom Setting

USA Center for Rural Public Health Preparedness atUSA Center for Rural Public Health Preparedness atTexas A&M Health Science CenterTexas A&M Health Science Center

School of Rural Public HealthSchool of Rural Public Health

Welcome!Welcome!Germs can spread rapidly in a classroom setting, so staying Germs can spread rapidly in a classroom setting, so staying informed and active to protect yourself and students from informed and active to protect yourself and students from infectious diseases is essential. Increased awareness will infectious diseases is essential. Increased awareness will minimize the risk of infection, prevent disease transmission, and minimize the risk of infection, prevent disease transmission, and preserve a healthy and safe classroom environment.preserve a healthy and safe classroom environment.

The USA Center for Rural Public Health Preparedness at Texas The USA Center for Rural Public Health Preparedness at Texas A&M Health Science Center School of Rural Public Health A&M Health Science Center School of Rural Public Health designed this train-the-trainer activity for teachers and their designed this train-the-trainer activity for teachers and their students. It provides information , ideas, and learning activities for students. It provides information , ideas, and learning activities for the classroom to help keep children healthy and prevent the the classroom to help keep children healthy and prevent the spread of infection in the classroom setting.spread of infection in the classroom setting.

What is an Infectious Disease?What is an Infectious Disease?InfectionInfection– An infection occurs when microorganisms, or germs, enter An infection occurs when microorganisms, or germs, enter

and multiply in the body.and multiply in the body.

Infectious DiseaseInfectious Disease– An infectious disease occurs when the infection damages An infectious disease occurs when the infection damages

the body and produces signs and symptoms indicating the the body and produces signs and symptoms indicating the body is unhealthy. body is unhealthy.

Infectious AgentInfectious Agent– Infectious agents are microorganisms such as bacteria, Infectious agents are microorganisms such as bacteria,

fungi, viruses, protozoa, and parasites that can cause fungi, viruses, protozoa, and parasites that can cause infectious disease.infectious disease.

www.mayoclinic.com/health/infectious-disease/ID0004www.mayoclinic.com/health/infectious-disease/ID0004

Infectious Disease ExamplesInfectious Disease ExamplesCommon ColdCommon ColdInfluenzaInfluenzaMeningitisMeningitisChickenpoxChickenpoxStaph / Methicillin-resistant Staph / Methicillin-resistant Staphylococcus aureusStaphylococcus aureus (MRSA) (MRSA)TuberculosisTuberculosisSevere Acute Respiratory Syndrome (SARS)Severe Acute Respiratory Syndrome (SARS)Head liceHead liceRingwormRingwormSalmonellosis Salmonellosis ChlamydiaChlamydiaHuman Immunodeficiency Virus (HIV)Human Immunodeficiency Virus (HIV)Hepatitis A, B, and CHepatitis A, B, and C

www.go.mb.ca/health/publichealth/cdc/fs/infcontshelter.pdfwww.go.mb.ca/health/publichealth/cdc/fs/infcontshelter.pdf

How Are Infectious Diseases Spread?How Are Infectious Diseases Spread?

Understanding how infectious diseases are spread Understanding how infectious diseases are spread is important for minimizing the risk of infection and is important for minimizing the risk of infection and preventing disease transmission. preventing disease transmission.

Three ways in which infectious diseases can be Three ways in which infectious diseases can be transmitted:transmitted:

Direct transmissionDirect transmission

Indirect transmissionIndirect transmission

Airborne transmissionAirborne transmission

www.cdc.gov/ncidod/dvrd/spb/mnpages/glossary.htm

Direct TransmissionDirect TransmissionDirect transmission occurs when an infectious agent is transferred Direct transmission occurs when an infectious agent is transferred directly into the body such as through the eyes, nose, mouth, or directly into the body such as through the eyes, nose, mouth, or through a break in the skin such as a cut on the finger. Infectious through a break in the skin such as a cut on the finger. Infectious agents are spread directly in the following ways:agents are spread directly in the following ways:

Person-to-personPerson-to-person– through physical contact including touching, biting, hugging, or through physical contact including touching, biting, hugging, or

kissingkissing– Example: MRSA, HepatitisExample: MRSA, Hepatitis

Animal-to-person Animal-to-person – through physical contact, bites, and scratchesthrough physical contact, bites, and scratches– Example: Ringworm, RabiesExample: Ringworm, Rabies

Infectious dropletsInfectious droplets– during coughing, sneezing, talking, singing, and spittingduring coughing, sneezing, talking, singing, and spitting

(spread is limited to approximately three feet)(spread is limited to approximately three feet)– Example: Cold, InfluenzaExample: Cold, Influenza

www.cdc.gov/ncidod/dvrd/spb/mnpages/glossary.htmwww.cdc.gov/ncidod/dvrd/spb/mnpages/glossary.htm

Indirect TransmissionIndirect TransmissionInfectious diseases are spread indirectly through vehicles and Infectious diseases are spread indirectly through vehicles and vectors.vectors.

Vehicle-borne transmissionVehicle-borne transmission– Some infectious agents can linger on inanimate objects, such as desks, chairs, Some infectious agents can linger on inanimate objects, such as desks, chairs,

computer keyboards, doorknobs, faucets, toys, eating utensils, or clothing. computer keyboards, doorknobs, faucets, toys, eating utensils, or clothing. – Example: Touching a pencil used by a person infected with the flu and then Example: Touching a pencil used by a person infected with the flu and then

touching the eyes, nose, or mouth before performing hand hygiene. touching the eyes, nose, or mouth before performing hand hygiene. – Other vehicles include food, water, and biological products such as blood and Other vehicles include food, water, and biological products such as blood and

body fluids.body fluids.– Example: Eating peanut butter contaminated with Salmonella, or pepperoni Example: Eating peanut butter contaminated with Salmonella, or pepperoni

contaminated with E. coli. contaminated with E. coli.

Vector-borne transmissionVector-borne transmission– Common vectors include insects, such as mosquitoes, ticks, and lice. Common vectors include insects, such as mosquitoes, ticks, and lice. – Example: Becoming infected with West Nile Virus as a result of being bittenExample: Becoming infected with West Nile Virus as a result of being bitten

by an infected mosquito, or sharing a comb with someone by an infected mosquito, or sharing a comb with someone who has head lice.who has head lice.


Airborne TransmissionAirborne TransmissionAirborne transmission is the spread of infectious Airborne transmission is the spread of infectious agents as aerosols that usually enter the respiratory agents as aerosols that usually enter the respiratory tract. Unlike the infectious droplets, these tiny tract. Unlike the infectious droplets, these tiny particles have the ability to remain suspended in the particles have the ability to remain suspended in the air for long periods of time and travel long distances. air for long periods of time and travel long distances.

Tuberculosis, chicken pox, and the measles are examples Tuberculosis, chicken pox, and the measles are examples of infectious diseases spread by airborne particles.of infectious diseases spread by airborne particles.

Example: An individual becomes infected with Severe Acute Example: An individual becomes infected with Severe Acute Respiratory Syndrome (SARS) by inhaling infectious Respiratory Syndrome (SARS) by inhaling infectious airborne particles while on a crowded bus.airborne particles while on a crowded bus.


Importance of Hand HygieneImportance of Hand HygieneHand hygiene, including handwashing and the use of hand Hand hygiene, including handwashing and the use of hand sanitizer, is extremely important in preventing infectious sanitizer, is extremely important in preventing infectious disease transmission in a classroom environment. disease transmission in a classroom environment.

Many people tend to minimize the significance of hand Many people tend to minimize the significance of hand hygiene, often forgetting or eliminating hand washing due to hygiene, often forgetting or eliminating hand washing due to busy schedules, lack of available soap and water, and busy schedules, lack of available soap and water, and inconvenience, but this is the single most important practice inconvenience, but this is the single most important practice to prevent the spread of infectious disease. It is also the best to prevent the spread of infectious disease. It is also the best method to protect children from infection in the classroom method to protect children from infection in the classroom setting. setting.

www.cdc.gov/cleanhandswww.cdc.gov/cleanhands

HandwashingHandwashing

Three necessary components of proper Three necessary components of proper handwashing include:handwashing include:

– SoapSoap

– Clean waterClean water

– FrictionFriction

www.cdc.gov/cleanhands/www.cdc.gov/cleanhands/

Proper Handwashing TechniqueProper Handwashing Technique

1.1. Wet hands with clean warm water.Wet hands with clean warm water.2.2. Apply soap and rub hands together to create a lather.Apply soap and rub hands together to create a lather.3.3. Scrub all surfaces of the hands including the palms, back of Scrub all surfaces of the hands including the palms, back of

hands, wrists, between fingers, and under fingernails.hands, wrists, between fingers, and under fingernails.4.4. Continue washing hands for 20 seconds, about the time it Continue washing hands for 20 seconds, about the time it

takes to sing the “Happy Birthday” song twice.takes to sing the “Happy Birthday” song twice.5.5. Rinse hands well to remove all soap.Rinse hands well to remove all soap.6.6. Dry hands completely with a towel or air dryer.Dry hands completely with a towel or air dryer.7.7. If available, use a towel to turn off the faucet and open the If available, use a towel to turn off the faucet and open the

door to avoid recontamination. door to avoid recontamination.


Easy to Miss AreasEasy to Miss AreasUsing proper technique is essential to sanitizing hands Using proper technique is essential to sanitizing hands effectively. Inadequate handwashing causes significant effectively. Inadequate handwashing causes significant areas of the hands to be missed. All areas of the fingers, areas of the hands to be missed. All areas of the fingers, hands, and wrists must be covered during hand hygiene.hands, and wrists must be covered during hand hygiene.

By imagining the rapid method generally used when washing By imagining the rapid method generally used when washing hands, it is easy to understand which places are most hands, it is easy to understand which places are most frequently ignored. Insufficient handwashing often involves frequently ignored. Insufficient handwashing often involves rubbing the palms together with soap and water and possibly rubbing the palms together with soap and water and possibly a quick swipe across the back of each hand. This is clearly a quick swipe across the back of each hand. This is clearly depicted in the following diagram of frequently missed areas depicted in the following diagram of frequently missed areas during handwashing.during handwashing.

www.foodlink.org.uk/factfile_c.asp?file=2&chapter=2 / /

Frequently Missed AreasFrequently Missed Areas

www.foodlink.org.uk/factfile_c.asp?file=2&chapter=2 / /

When to Wash HandsWhen to Wash HandsAfter blowing the nose, sneezing, or coughingAfter blowing the nose, sneezing, or coughingAfter going to the bathroomAfter going to the bathroomAfter contact with blood or body fluids, such as saliva, nasal After contact with blood or body fluids, such as saliva, nasal secretions, urine, feces, or vomitsecretions, urine, feces, or vomitAfter PE or playing sportsAfter PE or playing sportsAfter playing outside at recessAfter playing outside at recessAfter handling garbage or wasteAfter handling garbage or wasteWhen hands appear soiledWhen hands appear soiledBefore preparing medicine or handling contact lensesBefore preparing medicine or handling contact lenses


When to Wash Hands (2)When to Wash Hands (2)Before preparing, serving, or handling foodBefore preparing, serving, or handling foodBefore eating lunch or snacksBefore eating lunch or snacksFrequently when sick or after contact with others who are Frequently when sick or after contact with others who are sicksickBefore and after touching a cut or woundBefore and after touching a cut or woundBefore and after touching the eyes, nose, or mouthBefore and after touching the eyes, nose, or mouthAfter handling animals, animal waste, or their belongings, After handling animals, animal waste, or their belongings, such as toys or a leashsuch as toys or a leashAfter changing a diaperAfter changing a diaper


Waterless Alcohol-basedWaterless Alcohol-basedHand SanitizerHand Sanitizer

When to UseWhen to Use– Substitute when soap and water are not available.Substitute when soap and water are not available.– Ineffective for cleaning hands that are visibly dirty.Ineffective for cleaning hands that are visibly dirty.– Do not substitute when handling or preparing food.Do not substitute when handling or preparing food.– Do not overuse; traditional handwashing is best.Do not overuse; traditional handwashing is best.– Supervise children while they use hand sanitizer.Supervise children while they use hand sanitizer.

Two necessary componentsTwo necessary components– Alcohol-based hand sanitizerAlcohol-based hand sanitizer– FrictionFriction

www.health.state.mn.us/handhygiene/clean.html www.health.state.mn.us/handhygiene/clean.html

Waterless Alcohol-based Waterless Alcohol-based Hand Sanitizer ContinuedHand Sanitizer ContinuedProper TechniqueProper Technique– Apply small amount of hand sanitizer to the palm.Apply small amount of hand sanitizer to the palm.– Rub hands together covering all surfaces, much like when Rub hands together covering all surfaces, much like when

washing hands with soap and water. washing hands with soap and water. – Rub until hand sanitizer is absorbed completely and hands Rub until hand sanitizer is absorbed completely and hands

become dry.become dry.

www.health.state.mn.us/handhygiene/clean.html www.health.state.mn.us/handhygiene/clean.html

Handwashing ComplianceHandwashing Compliance

Am J Infect Control 1997; 25: 424-5

Comparison of handwashing compliance Comparison of handwashing compliance between middle school students and high school between middle school students and high school students and male and female students.students and male and female students.

Classroom Handwashing Classroom Handwashing Activity IdeasActivity Ideas

Practice washing hands properly with students. Have them Practice washing hands properly with students. Have them identify or write a song, poem, or saying that they can use identify or write a song, poem, or saying that they can use when washing hands that lasts 20 seconds.when washing hands that lasts 20 seconds.

Have a contest for students to create posters and fliers with Have a contest for students to create posters and fliers with handwashing facts that can be posted bathroom stalls or handwashing facts that can be posted bathroom stalls or published in the school newspaper or newsletter. published in the school newspaper or newsletter.

Other Learning ActivitiesOther Learning Activities

Use fluorescent hand lotion to test hand washing Use fluorescent hand lotion to test hand washing effectiveness and to observe how germs spread effectiveness and to observe how germs spread between hands, surfaces, pens, etc.between hands, surfaces, pens, etc.

Swab high-traffic surfaces and culture on agar in a Swab high-traffic surfaces and culture on agar in a Petri dish or touch fingers to the agar and then Petri dish or touch fingers to the agar and then incubate to demonstrate the growth of incubate to demonstrate the growth of microorganisms.microorganisms.

Share infection prevention training with parents at Share infection prevention training with parents at parent-teacher meetings to disseminate education to parent-teacher meetings to disseminate education to the home.the home.

Additional Activities & MaterialAdditional Activities & MaterialPlease take a moment to explore the following online resources for Please take a moment to explore the following online resources for helpful teaching materials about infection prevention. Some of the helpful teaching materials about infection prevention. Some of the links include suggestions for infection prevention related lesson plans, links include suggestions for infection prevention related lesson plans, a classroom experiment, printable classroom activity sheets, and other a classroom experiment, printable classroom activity sheets, and other fun learning activities for students.fun learning activities for students.

HANDWASHING PROJECT IDEASHANDWASHING PROJECT IDEASMultidisciplinary activities for teachers and students to promote handwashingMultidisciplinary activities for teachers and students to promote handwashing

HAND HYGIENE EXPERIMENTHAND HYGIENE EXPERIMENTClassroom science experiment to demonstrate persistence of bacteria and Classroom science experiment to demonstrate persistence of bacteria and proper handwashing techniqueproper handwashing technique

Clean Classroom EnvironmentClean Classroom Environment

Maintaining a clean classroom environment reduces Maintaining a clean classroom environment reduces the presence of germs and the spread of infectious the presence of germs and the spread of infectious diseases, and therefore, protects the health of diseases, and therefore, protects the health of students, teachers, school staff, and parents.students, teachers, school staff, and parents.

Encourage children, teachers, and all school personnel to wash Encourage children, teachers, and all school personnel to wash hands frequently using soap and water for 15-20 seconds and hands frequently using soap and water for 15-20 seconds and to assist children as needed.to assist children as needed.

Substitute alcohol-based hand sanitizer when clean water and Substitute alcohol-based hand sanitizer when clean water and soap are unavailable.soap are unavailable.

Promote appropriate respiratory etiquette: Cover coughs and Promote appropriate respiratory etiquette: Cover coughs and sneezes with tissue. Throw away tissues immediately and use sneezes with tissue. Throw away tissues immediately and use hand hygiene. If a tissue is not available, sneeze or cough into hand hygiene. If a tissue is not available, sneeze or cough into the elbow or upper sleeve.the elbow or upper sleeve.

General Infection PreventionGeneral Infection PreventionFollowing general infection prevention measures and Following general infection prevention measures and maintaining personal hygiene reduces the spread of maintaining personal hygiene reduces the spread of infectious diseases in a school setting.infectious diseases in a school setting.

General Infection Prevention (2)General Infection Prevention (2)Teach children to properly dispose of used tissues. Teach children to properly dispose of used tissues. Provide tissues and trash receptacles in classrooms and on Provide tissues and trash receptacles in classrooms and on school buses.school buses.Advise parents to keep sick children home from school.Advise parents to keep sick children home from school.Remain at home when ill and encourage others to do the Remain at home when ill and encourage others to do the same.same.Avoid close contact (less than 3 feet of space) with those Avoid close contact (less than 3 feet of space) with those who are sick.who are sick.Maintain and promote good personal hygiene; bathe and Maintain and promote good personal hygiene; bathe and wash hands regularly.wash hands regularly.Discourage touching the eyes, nose, and mouth.Discourage touching the eyes, nose, and mouth.Maintain a clean classroom environment.Maintain a clean classroom environment.Ensure commonly used areas such as door handles, eating Ensure commonly used areas such as door handles, eating surfaces, and desks are clean and disinfected. surfaces, and desks are clean and disinfected.

General Infection Prevention (3)General Infection Prevention (3)

Keep open wounds clean and covered with a bandage until Keep open wounds clean and covered with a bandage until healed.healed.Avoid contact with other people’s wounds and bandages.Avoid contact with other people’s wounds and bandages.Discourage sharing eating utensils, glassware, or personal Discourage sharing eating utensils, glassware, or personal items such as toothbrushes, combs, razors, towels, clothing items such as toothbrushes, combs, razors, towels, clothing or other items that come into contact with bare skin. or other items that come into contact with bare skin. Clean shared sports equipment with antiseptic before each Clean shared sports equipment with antiseptic before each use or use a cloth or a towel as a barrier between the skin use or use a cloth or a towel as a barrier between the skin and the equipment.and the equipment.Avoid skin-to-skin contact with anyone who has a Staph Avoid skin-to-skin contact with anyone who has a Staph infection.infection.Encourage a healthy lifestyle that includes a nutritious diet Encourage a healthy lifestyle that includes a nutritious diet and adequate sleep.and adequate sleep.

Additional ConsiderationsAdditional ConsiderationsThe incorporation of animals into the classroom environment can The incorporation of animals into the classroom environment can provide many beneficial learning experiences for children. It is provide many beneficial learning experiences for children. It is important to keep in mind the risks of Zoonotic Diseases, or important to keep in mind the risks of Zoonotic Diseases, or those that are transmissible from animals to humans.those that are transmissible from animals to humans.

The following considerations are important when dealing withThe following considerations are important when dealing with animals in a classroom:animals in a classroom:

– Always wash hands very thoroughly after touching animals or their Always wash hands very thoroughly after touching animals or their belongingsbelongings

– Ensure animals have current vaccinations and receive annual veterinary Ensure animals have current vaccinations and receive annual veterinary examsexams

– Bathe animals regularlyBathe animals regularly– Avoid contact with animal waste or food Avoid contact with animal waste or food – Only handle a new animal with permission and supervisionOnly handle a new animal with permission and supervision– Teach children the proper way to handle the animalTeach children the proper way to handle the animal

This concludes the train-the-trainer activity, “Infection Prevention This concludes the train-the-trainer activity, “Infection Prevention in the Classroom Setting.” We hope you have enjoyed this in the Classroom Setting.” We hope you have enjoyed this presentation and will utilize and share this information with your presentation and will utilize and share this information with your schools to help keep children healthy and prevent the spread of schools to help keep children healthy and prevent the spread of infection in the classroom setting.infection in the classroom setting.

The EndThe End

Contact InformationContact InformationUSA Center for Rural Public Health PreparednessUSA Center for Rural Public Health PreparednessTexas A&M Health Science CenterTexas A&M Health Science CenterSchool of Rural Public HealthSchool of Rural Public Health1266 TAMU 1266 TAMU College Station, Texas 77843-1266College Station, Texas 77843-1266Phone: (979) 845-2387Phone: (979) 845-2387E-mail: E-mail: [email protected] [email protected]

The CDC-funded Centers for Public Health Preparedness are a The CDC-funded Centers for Public Health Preparedness are a national network of academic institutions working in collaboration national network of academic institutions working in collaboration with state and local public health departments and other community with state and local public health departments and other community partners to provide life-long learning opportunities to the public partners to provide life-long learning opportunities to the public health workforce in order to handle the next public health crisis.health workforce in order to handle the next public health crisis.

infection prevention in the classroom setting

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