Preventing the Spread of Infectious Diseases in Childcare settings
This issue is the second of 3 issues in Infection Control Guidance for Childcare settings which
cover the three basic principles underpining all infectious disease prevention
Issue 1: Handwashing. This will cover the importance of hand washing for staff and children in
preventing the transmission of Infectious Diseases in childcare settings.
Issue 2: Immunisation. This will cover the importance of ensuring that children and staff within
a childcare setting are appropriately immunised
Issue 3: Exclusion. This will cover exclusion of ill children and staff from childcare settings to
reduce the risk of transmission of Infectious diseases
The Guidelines ‘Management of Infectious Disease in Childcare Facilities and Other Childcare
Settings’ can be accessed at http://www.hpsc.ie/hpsc/A-Z/LifeStages/Childcare/
Issue 2: Immunisations in Childcare Facilities
Preventing an illness is preferable to treating it once it has developed. There are now many safe
and effective vaccines against many serious illnesses. Some are given routinely to all the
population, others only to individuals thought to be at high risk of certain infections. All children
attending a childcare facility should be appropriately immunised. The principle of immunisation
is simple; it gives the body a memory of infection without the risk of natural infection.
Immunisation protects the individual child from infection and also protects those around the child
who are too young to be immunised or who cannot be immunised for other medicals reasons (eg,
those undergoing chemotherapy).
Keeping immunisation records
o
Childcare facilities have a legal requirement to establish and maintain immunisation
records on all children attending. A sample template for record keeping is available in the
resource section of the document- ‘Management of Infectious Disease in Childcare
Facilities and Other Childcare Settings’.
o
The immunisation record should continue to be updated in the childcare setting as the
child receives his/her immunizations. Staff within a childcare facility should encourage
parents to ensure that their children are up to date with their immunizations.
o
As a manager/staff member of a childcare facility you can encourage parents to read the
booklet; “Your child’s immunization: A guide for parents”. Many misconceptions in
relation to immunization are discussed in the booklet. It is available at
http://www.healthpromotion.ie/publication/fullListing?category=Immunisation.
Alternatively they may have received a copy from their general practitioner. If parents
have questions following their reading of the guide, encourage them to discuss their
concerns with the child’s General Practitioner.
o
As a manager you need to check the immunisation status of children attending your
facility on a regular basis. Parents of children who are not appropriately immunized
should be informed of the risk to their children and other children and their reason for
objection to immunisation should be recorded on the child’s immunisation record in the
childcare facility.
o
For medical reasons it may be necessary to withhold one or more immunisations from a
child. This will usually be on a temporary basis and is normally quite rare.
o
In 2008 there was a major change to the childhood immunisation schedule for children
born after 1st July 2008. The main changes were the introduction of two additional
vaccines, pneumococcal vaccine and hepatitis B vaccine. A copy of the immunisation
schedule is available in Chapter 4 of ‘Management of Infectious Disease in Childcare
Facilities and Other Childcare Settings’.
Vaccine and non-vaccine preventable Infectious Diseases relevant to
Childcare Staff
Measles, Mumps and Rubella
It is recommended that staff working with children have documented evidence of receiving two
doses of the MMR vaccine or have knowledge from their parents that they had these illnesses as
children and therefore have developed natural immunity to measles, mumps and rubella.
Measles Mumps and Rubella vaccination status may be established by contacting your GP or
your local child health office (see below).
Carlow/Kilkenny child health office
South Tipperary child health office
Wexford child health office
Waterford child health office
056- 7784670 or
052- 6177246
053- 9185749
051 - 842908
056- 7784771
Measles
o
o
o
All staff working with children should have evidence of immunity to measles.
Infection with measles during pregnancy can result in early delivery or even loss of the
baby.
If a non-immune pregnant woman is exposed to measles, her GP or antenatal care
provider should be informed immediately to ensure appropriate management.
Mumps
All staff working with children should have evidence of immunity to mumps
Rubella (German measles)
o
o
o
All staff working with children should have evidence of immunity to rubella.
Rubella may have devastating consequences on the developing baby if a non-immune
mother is exposed in early pregnancy.
If a pregnant woman comes in contact with rubella and is unaware of her immune status,
she should contact her GP or antenatal care provider immediately to ensure appropriate
investigation.
Hepatitis B
o
o
o
o
There is no indication for childcare staff to be immunised against hepatitis B since good
implementation of standard precautions should provide adequate protection against blood
and body fluid exposure.
The use of Standard precautions should be part of the usual work practice of all childcare
staff. For information on Standard Precautions, see Chapter 3 – ‘Management of
Infectious Disease in Childcare Facilities and Other Childcare Settings’.
Now that hepatitis B vaccine has been included in the routine childhood immunisation
schedule, immunised infants and young children should not pose a risk in the future
There is no need for staff with chronic hepatitis B infection to be excluded from working
in a childcare setting
Chicken Pox
It is also beneficial as a female member of staff to know if you have had chicken pox as a child.
All female staff of childbearing age should discuss testing for chickenpox immunity with their GP
(or occupational health provider). Those with negative serology should be offered immunisation.
All other non-immune staff should also be offered immunisation.
Influenza
Influenza has a tendency to spread readily through childcare settings and childcare workers are
likely to have a risk of infection similar to healthcare workers in paediatric settings. As a result
childcare workers who are in recognized risk groups for influenza should ensure that they are
fully immunized against influenza.
Risk groups:
o those with a long-term medical condition such as diabetes, heart or lung disease
o people whose immune system is impaired due to disease or treatment
o persons with a body mass index (BMI) over 40
o pregnant women. (can be given at any stage of pregnancy)
Slapped Cheek Disease (Parvovirus B19)
o
o
o
o
Simple hygiene measures including scrupulous handwashing provide the most effective
method of prevention and control of this viral disease. .
Parvovirus B19 can occasionally affect an unborn child.
A women exposed early in pregnancy (before 20 weeks) should inform her GP or
antenatal care provider to ensure appropriate investigation and follow-up.
There is no vaccine available
Summary
Pregnant staff
It is important that staff who are pregnant or planning a pregnancy should ensure that they are
appropriately immunised and compliant with infection control precautions
Temporary Staff
Rapid turnover of part time staff may present a challenge to managers / proprietors who are keen
to maintain high hygiene standards and every effort should be made to ensure that all new staff
undergo induction training including training in infection prevention and control. It is important
to remember that temporary staff is afforded the same legal protection in the workplace as are
permanent staff.
Disclaimer
New employees who do not wish to receive vaccines as part of their occupational health
requirements should be asked by their employer to sign a disclaimer indicating that they have
been fully informed of the risks inherent in this choice of action. Whilst they may choose to incur
such risk themselves, they must be made fully aware of their particular responsibility to minimize
risk to others (e.g. children in their care and colleagues) and to report exposures to relevant
infections should they arise. Work exclusion on a temporary basis may then be necessary.
*Compliance with infection control requirements should be considered an essential
contractual pre-requisite for all employees*.