Paediatric Infection ControlPaediatric Infection ControlJodie BurrJodie Burr

Infection Control CoordinatorInfection Control CoordinatorWomen’s and Children’s HospitalWomen’s and Children’s Hospital

IC Issues specific to IC Issues specific to childrenchildren

Communicable diseases affect a Communicable diseases affect a higher % of children than adultshigher % of children than adults

Developmental immunity (increased Developmental immunity (increased susceptibility) - acquire – spreadsusceptibility) - acquire – spread

IC Issues specific to IC Issues specific to childrenchildren

Child care staff are at a greater Child care staff are at a greater risk for exposure to risk for exposure to communicable diseases - communicable diseases - immune statusimmune status

Type and amount of physical contact Type and amount of physical contact (eg feeding, diapering)(eg feeding, diapering)

IC IC IssuesIssues specific to specific to childrenchildren

May lack the mental / physical May lack the mental / physical ability to adhere to IC principlesability to adhere to IC principles

lack of hygienelack of hygieneunable to understand / comply with IC unable to understand / comply with IC

principlesprinciples

IC Issues specific to IC Issues specific to childrenchildren

More likely to have contact with More likely to have contact with contaminated environmental contaminated environmental surfaces and objectssurfaces and objects

IC Issues specific to IC Issues specific to childrenchildren

Parents and siblingsParents and siblingsmay have the same infectious agentmay have the same infectious agenteducation about transmission and IC education about transmission and IC

principlesprinciples

Spread of InfectionSpread of InfectionSources of infectionsSources of infections

The host’s own (endogenous) floraThe host’s own (endogenous) flora The hand’s of child care workersThe hand’s of child care workers Inanimate objects (fomites)Inanimate objects (fomites)

After being exposed to an After being exposed to an infectious agent:infectious agent: Some people already have immunity Some people already have immunity

and therefore don’t develop an infectionand therefore don’t develop an infection Some people become asymptomatic Some people become asymptomatic

carrierscarriers Other people develop clinical disease (ie Other people develop clinical disease (ie

infection)infection)

Spread of InfectionSpread of InfectionThe Susceptible HostThe Susceptible Host

Varies with ageVaries with age Underlying medical conditionsUnderlying medical conditions Nutritional statusNutritional status Drug therapyDrug therapy

TraumaTrauma Surgical proceduresSurgical procedures Invasive or indwelling devicesInvasive or indwelling devices Therapeutic and diagnostic proceduresTherapeutic and diagnostic procedures

Spread of InfectionSpread of Infection

3 main routes of transmission3 main routes of transmission ContactContact

Direct / IndirectDirect / IndirectMost frequent means of transmissionMost frequent means of transmission

DropletDropletGenerated during coughing, Generated during coughing,

sneezing, talkingsneezing, talking AirborneAirborne

Generated by coughing, sneezing, OR Generated by coughing, sneezing, OR by, OR by air currentsby, OR by air currents

StandardStandard PrecautionsPrecautions

Apply to:Apply to:BloodBloodNon-intact skinNon-intact skinMucus membranesMucus membranesAll body fluids (including sweat)All body fluids (including sweat)

Regardless of whether there is Regardless of whether there is visible blood or body fluidsvisible blood or body fluids

Standard PrecautionsStandard PrecautionsHand WashingHand Washing

The single most effective The single most effective method in the prevention method in the prevention of disease transmission is of disease transmission is to wash your hands wellto wash your hands well

Hand WashingHand WashingHow to wash your handsHow to wash your hands

Use soap and running waterUse soap and running waterRub hands together (count to 10)Rub hands together (count to 10)

Wash all over, including:Wash all over, including:Backs of handsBacks of handsWristsWristsFingers, nails and thumbsFingers, nails and thumbs

Rinse hands well (count to 10)Rinse hands well (count to 10)Dry hands thoroughlyDry hands thoroughly

Areas most frequently Areas most frequently missedmissed

When to wash handsWhen to wash hands

When you arrive at the centreWhen you arrive at the centre Before handling foodBefore handling food Before eatingBefore eating After changing nappiesAfter changing nappies \after going to the toilet\after going to the toilet After cleaning up, coming onto contact After cleaning up, coming onto contact

with faeces or vomit or other body fluidswith faeces or vomit or other body fluids After wiping noses (either your own or a After wiping noses (either your own or a

childs)childs)

Specific childcare issuesSpecific childcare issuesNappy change area:Nappy change area:

Have a specific area for nappy changingHave a specific area for nappy changingClean nappy change area after each Clean nappy change area after each

nappy changenappy changeWear glovesWear glovesWash hands afterwardsWash hands afterwards

LinenLinenUse hot water and detergentUse hot water and detergentWear gloves if linen soiledWear gloves if linen soiledEnsure clean linen is stored away from Ensure clean linen is stored away from

soiled linensoiled linen

Specific childcare Specific childcare issuesissues

ToysToys All shared toys should be able to be All shared toys should be able to be

washedwashed SandpitsSandpits

Keep well maintained and cleanKeep well maintained and clean Ensure good drainage, rake often , coverEnsure good drainage, rake often , cover Dispose of any soiling (blood, faeces, etc)Dispose of any soiling (blood, faeces, etc)

Blood / body fluid spillsBlood / body fluid spills Wear glovesWear gloves Detergent & water +/- bleachDetergent & water +/- bleach Dispose of soiled articles or place in Dispose of soiled articles or place in

waterproof bag for parents to take homewaterproof bag for parents to take home

FoodFood Ensure that tables and area are Ensure that tables and area are

cleanclean Wash your own and the children’s Wash your own and the children’s

handshands Do not share food, plates, eating Do not share food, plates, eating

utensilsutensils Serve food rather than use a Serve food rather than use a

communal dishcommunal dish Use a separate spoon for each baby Use a separate spoon for each baby

fedfed

Handling foodHandling food

Wash handsWash hands Keep raw food separate from cooked Keep raw food separate from cooked

foodsfoods Use different utensils for raw and Use different utensils for raw and

cooked foodscooked foods Keep food hot or cold (do not keep Keep food hot or cold (do not keep

food warm for a period of time)food warm for a period of time) Reheat food and bottles only onceReheat food and bottles only once Throw out left oversThrow out left overs

Infectious diseasesInfectious diseasesBe aware of symptoms Be aware of symptoms

suggesting infectionsuggesting infection Severe, persistent, prolonged coughingSevere, persistent, prolonged coughing ConjunctivitisConjunctivitis Unusual spots or rashesUnusual spots or rashes Crusty or discharging skin lesionsCrusty or discharging skin lesions Frequent scratchingFrequent scratching Unusually coloured / smelly faeces or Unusually coloured / smelly faeces or

urineurine Sore throat / difficulty in swallowingSore throat / difficulty in swallowing Vomiting. Headache, stiff neckVomiting. Headache, stiff neck Loss of appetiteLoss of appetite DiarrhoeaDiarrhoea

Infectious diseasesInfectious diseases

Have a written policy regarding Have a written policy regarding what to do if a child is unwell, what to do if a child is unwell, may include:may include:Notify director and parentsNotify director and parentsSeparate ill childSeparate ill childTake the child’s temperatureTake the child’s temperatureEncourage parents to inform staff Encourage parents to inform staff

if a family member is illif a family member is ill

Infectious diseases and Infectious diseases and staffstaff

Most infectious diseases can be Most infectious diseases can be prevented by good hand washingprevented by good hand washing

Ensure immunization status is up Ensure immunization status is up to dateto date

Pregnant staff should be aware Pregnant staff should be aware that some diseases may have an that some diseases may have an impact on their pregnancyimpact on their pregnancy

Infected child care workers may Infected child care workers may be excluded from workingbe excluded from working

Meningococcal DiseaseMeningococcal Disease

Bacterial infection caused by Bacterial infection caused by Neisseria meningitidisNeisseria meningitidis

Transmitted by contact or dropletTransmitted by contact or droplet Non infectious after 24 hours of Non infectious after 24 hours of

appropriate antibiotic therapyappropriate antibiotic therapy Significant contacts traced and may Significant contacts traced and may

be given prophylaxisbe given prophylaxis

Meningococcal DiseaseMeningococcal Disease

MeaslesMeaslesComplications more common and Complications more common and

severe in chronically ill and very severe in chronically ill and very young childrenyoung children

Transmitted by droplet and contact Transmitted by droplet and contact with respiratory secretionswith respiratory secretions

Infectious for 4 days before and Infectious for 4 days before and after rashafter rash

Vaccination availableVaccination availableNotifiable diseaseNotifiable disease

MeaslesMeasles

RubellaRubella In early pregnancy risk of teratogenic In early pregnancy risk of teratogenic

damage to fetusdamage to fetus Infectious for 7 days before and 7 - 15 Infectious for 7 days before and 7 - 15

days after onset of rashdays after onset of rash Infants with congenital rubella may Infants with congenital rubella may

shed virus for several months or yearsshed virus for several months or years Transmitted by droplet routeTransmitted by droplet route Vaccination availableVaccination available Notifiable diseaseNotifiable disease

RubellaRubella

Varicella Zoster VirusVaricella Zoster VirusChicken PoxChicken Pox

Highly contagiousHighly contagious Most cases in children, over 90% of Most cases in children, over 90% of

adult population is immuneadult population is immune Transmitted by droplet and contactTransmitted by droplet and contact Infectious 2 days prior and 4 - 6 days Infectious 2 days prior and 4 - 6 days

after rashafter rash Now a notifiable diseaseNow a notifiable disease Vaccination now availableVaccination now available

Varicella or Chicken-poxVaricella or Chicken-pox

Parvovirus B19Parvovirus B19

Usually a mild rash diseaseUsually a mild rash disease Also called Fifth Disease or Also called Fifth Disease or

“Slapped - Cheek”“Slapped - Cheek” Infectious prior to the rashInfectious prior to the rash Transmitted by droplet routeTransmitted by droplet route

Parvovirus B19Parvovirus B19

Hand, foot and mouth Hand, foot and mouth diseasedisease

Incubation period:Incubation period: 3 – 5 days3 – 5 days

Infectious periodInfectious period Whilst fluid in blistersWhilst fluid in blisters

Transmission:Transmission: Contact with blister fluid / faecesContact with blister fluid / faeces

Control:Control: Exclude until blisters have driedExclude until blisters have dried Good hand washingGood hand washing

Hand, foot and mouth Hand, foot and mouth diseasedisease