- Provide management practices that ensure a healthy environment.
- Describe, apply, and communicate about your program’s exclusion and readmission policies.
- Identify and share resources related to health maintenance and common childhood illnesses.
All staff members who work with children are required to complete training in to learn how to help prevent the spread of infectious disease. Often, a nurse or health care professional provides this training. You can help support staff members' learning. Make sure you are familiar with the resources related to infectious disease provided in this Healthy Environments course.
You will also need to teach staff members how to model healthy habits related to infectious disease. For example, make sure staff members know how to cover their coughs and proper glove-wearing procedures. Provide ongoing training around standard and universal precautions (see Lesson Two): glove-wearing, cleaning and disinfecting procedures, etc.
You will also need to make sure staff know how to perform and document daily health checks. This includes recognizing when a child experiences illness or a health concern. Make sure new staff members know your program's exclusion policy. You may be called to help a staff member make a decision about whether a child is ill and needs to be sent home (see the When Should A Child Be Sent Home resource in the Learn Activities section below). You must also be familiar with the signs and symptoms of common infectious diseases (see the Signs and Symptoms Chart, also in the Learn Activities section below) and your program's policies. You may also be responsible for communicating with families when certain infectious diseases occur in your program. Be prepared to make sure staff members follow exclusion and readmission policies themselves: sick staff members can spread illnesses, too.
Model practices that prevent the spread of infectious diseases. Follow the Centers for Disease Control and Prevention's guidelines for covering your cough and handwashing (Lesson Two). You can also model talking to children about healthy habits. For example, if a child sneezes while you are in a classroom, remind them child to go wash their hands. You can also help staff members remember to wash their own hands and the child's hands after wiping a child's nose. It's OK to kindly remind staff members, trainers, and coaches to take steps to prevent the spread of disease, too. This helps promote a culture of healthy habits in your program.
You might be called when a staff member suspects a child is ill. Be prepared to conduct a health check and look for signs of illness (see the Explore Activity resources below for more information on performing daily health checks). Follow your program's procedures for exclusion and readmission. In the event of an emergency or illness, model proper sanitation procedures in the presence of body fluids like blood, vomit, urine, or feces. Remain calm in these situations and help staff use their training. You might also need to supervise children while staff members respond to the emergency.
Infectious Disease Prevention
The transmission of disease can be greatly reduced by using the following precautions:
- Cover sneezes and coughs properly
- Proper handwashing
- Proper diapering procedures
- Thorough sanitation techniques
- Precautions against contact with bodily fluids
Signs of Illness
To prevent the spread of infectious disease in your program, it is important that staff monitor all children and youth daily. This monitoring should be done by completing health checks for each child as they enter the program and also throughout the day. As the program manager, it is your responsibility to ensure your staff know what signs of illness to look for in children. Staff should look for the following:
- Changes in behavior, such as drowsiness or sluggishness
- Changes in appearance from the previous day
- Skin rashes, itchy skin and scalp
- Rise in body temperature
- Complaints of pain, not feeling well
- Drainage from eyes
- Vomiting, diarrhea
- Severe coughing
- Difficult or rapid breathing
- Sore throat, difficulty swallowing
- Yellowish skin or eyes
- Unusually dark urine or grey, white stool
- Stiff neck with elevated temperature
If a child demonstrates signs of illness, you will be required to take the proper actions to support and protect the child and your program.
Policies for Caring for Ill Children
Unless your program includes a provision for the care of sick children and youth, children who show signs of illness need to be isolated from the other children until they are picked up.
Children and youth must be supervised at all times, so you may elect to have sick children and youth removed to an office and placed on a cot or crib until their family arrives. You must ensure that your staff understands what your program's policies are when it comes to caring for ill children and youth. Staff should take care to wash hands and wash any soiled bedding and used cots or cribs after use by an ill child.
If a health care professional determines that a child is ill with a contagious disease, then families of all the children and staff members who were exposed should be notified. This can be done at the end of the day during pick-up time by a note or memo. The ill child's confidentiality should be maintained and only information regarding the disease, not the ill child's name, should be shared. Check your program's policies for the distribution of notes to families.
Your programs should notify the staff and families of children who have come into contact with a child who is ill with one of the following conditions:
- Pertussis (whooping cough)
- Invasive infections such as strep
- Skin infections or infestations (head lice, scabies, and ringworm)
- Infections of the gastrointestinal tract (often with diarrhea) and hepatitis A virus (HAV)
- Haemophilus influenzae type B (Hib)
- Fifth disease (parvovirus B19)
Families and staff should also be notified if two or more unrelated persons affiliated with the facility are infected with a vaccine-preventable or infectious disease.
If one of these diseases or conditions is suspected in your classroom, your program will need to notify all families and staff who have come in contact with the child or children. This notification should include (Caring for our Children, 2015):
- The names, both the common and the medical name, of the diagnosed disease to which the child was exposed, whether there is one case or an outbreak, and the nature of the exposure (such as a child or staff member in a shared room or facility)
- Signs and symptoms of the disease for which the parent/guardian should observe
- Mode of transmission of the disease
- Period of communicability and how long to watch for signs and symptoms of the disease
- Disease-prevention measures recommended by the health department (if appropriate)
- Control measures implemented at the facility
- Pictures of skin lesions or skin condition may be helpful to parents or guardians (e.g., chicken pox, spots on tonsils, etc.)
In some cases, you may need to contact medical professionals or public health officials. There are certain illnesses that are considered "reportable illnesses." Your program will need to follow health guidelines to notify families and staff about the occurrence of these types of illness. A list of reportable illnesses is updated annually by the Centers for Disease Control and Prevention (CDC) and is available at https://wwwn.cdc.gov/nndss/conditions/notifiable/2018/.
Exclusion and Readmission
As a program manager, it is critical that you apply your exclusion and readmission policy consistently. Infectious disease guidelines from your program's Public Health and Program Medical Advisor may require that children be excluded from your program for 24 to 48 hours. You need to be well versed in the requirements for your local area. Some outbreaks require notification to the health department or your local medical authority. Some illnesses may require a physician's note for re-entry to your program. Your policy should reflect these exclusion parameters.
Diseases that spread within your program should be tracked and reported to your local medical authority as appropriate. If a pattern of outbreaks emerge from the tracked information, you will need to work with your staff to implement new training or provide additional supports to prevent future outbreaks.
Families must be reminded of your policies when they pick up an ill child or if they call the program to report an absence. Your program's exclusion and readmission policies should be covered in your family orientation process as well as included in your family and staff handbooks.
Many people within your program are responsible for various functions that help ensure the program is free of infectious disease. As a manager, you must be diligent to make sure staff follow and support your program's illness-related policies.
Requiring immunizations is an important strategy to prevent infectious disease. Most programs require that children and youth are current on their immunizations upon enrollment, or within a certain number of days after enrollment, and require that immunizations are kept up-to-date. You and your staff need to be clear on your program's policies regarding immunization updates. Because families need time to make doctor appointments and turn in forms, you should provide forms at least 60 days before they are required and provide some regular reminders to families until forms are returned. Be sure to keep the phone numbers of health-care providers and immunization clinics on file for families.
Some families have religious or cultural objections to having their children or youth immunized. In the event of an outbreak of an infectious disease that is preventable by vaccine, your program may require that all children who are not vaccinated against the disease be denied care. As the manager, it is your responsibility to know how to identify those children who are not immunized and to enforce the denial of care. It is essential that you and your staff do all you can to control the spread of disease and to protect children who have not yet developed an immunity to a certain disease. Check for any allowances for these families based on your policies.
It is important to keep copies of the most current immunization records and check them against the schedule on the Centers for Disease Control and Prevention website at http://www.cdc.gov/vaccines/schedules/index.html. In addition to children and youth, you need to ensure that staff are up-to-date on required immunizations. Just as you do for families, remind staff at least 60 days before they may need immunization updates.
As a program manager, you must also consider how you will address issues of non-compliance in this area. How will you respond if a family or a staff member does not return the necessary documentation to update their child's, or for staff, their own, immunization record? Remember to address such issues respectfully, while keeping in mind that you must ensure the health and safety of all children, families and staff within your program. You will likely need to deny care or employment until the necessary documentation is returned.
Supervise & Support
Implement a Health-Related Tracking System
Review your policies on immunizations for children and staff, and stay up-to-date on state requirements as well. As the program manager, you must ensure a proper immunization tracking system is maintained. Additionally, it is important as you monitor your program and address concerns that you keep a reliable tracking system to ensure changes and improvements are conducted and that follow through is complete. Regardless of the system you chose to use, be sure it is one that works for your program.
The Program Administration Scale is an assessment tool created by McCormick Center for Early Childhood Leadership and is one way of assessing the administration of child care programs. It sets the establishment of "systems" as an indicator of a high-quality program. As you have learned in previous lessons, systems help you in the tracking and implementation of policies and procedures; which ultimately keeps everyone safe and healthy.
One system for tracking immunization records is a tickler system, which identifies the immunizations that need to be updated. Such a system helps alert you, or other staff members on your team, to future deadlines, preventing files or updated paperwork from being neglected. Files could be color-coded by month or information could be put into a spreadsheet and organized by date. Another tickler system might involve ordering the information in an index card file or entering it into a calendar program.
Management Practices that Support the Prevention of Infectious Disease
The chart below summarizes your key responsibilities when it comes to managing infectious disease.
I should always…
Make certain that staff are trained on our policies for managing infectious disease
Monitor the sanitary conditions throughout the program daily and address concerns immediately
Implement our exclusion and readmission policy consistently
Communicate verbally and in writing (family and staff handbooks) our policies for managing illness
It is essential to have a system in place to record daily health check information. Take some time to review the information and guides attached below and consider how your program currently conducts and documents daily health checks. lf your program does not currently use a standard system, consider using the Enrollment / Attendance / Symptom Record, from the American Academy of Pediatrics, as a sample. How could you update this form to work in your program? How could daily health checks or documentation of daily health checks be included in other systems within your program to ensure they are appropriately completed and help support staff efficiency?
You will also a find A Daily Health Check poster from the North Carolina Child Care Health and Safety Resource Center and a Daily Health Check Guide. Make these resources available for staff.
A Daily Health Check
What system do you use to ensure that children’s immunization records are up-to-date? How effective is it? Use the Immunization Record Audit Activity to randomly review 20 percent of your program's child and youth files. Are the immunization records current for each of the files reviewed? If they are not, decide and list what actions need to be taken to bring them up-to-date.
American Academy of Pediatrics, American Public Health Association, National Resource Center for Health and Safety in Child Care and Early Education. (2015). Caring for Our Children: National health and safety performance standards; Guidelines for early care and education programs. (3rd ed.). Elk Grove Village, IL: American Academy of Pediatrics; Washington, DC: American Public Health Association. Retrieved from http://nrckids.org
Harms, T., D. Cryer and R.M. Clifford. (2006). Infant/Toddler Environment Rating Scale, revised edition. New York Teachers College Press.
Harms, T., D. Cryer and R.M. Clifford. (2005). Early Childhood Environment Rating Scale, revised edition. New York Teachers College Press.
Harms, T., D. Jacobs and Romano. (1995). School Age Environment Rating Scale, New York Teachers College Press.
Health and Safety in Family Child Care Homes. (2010). Ohio Department of Job and Family Services.
Talan, T.N. and P. Jorde Bloom. (2011). Program Administration Scale: Measuring early childhood leadership and management, 2nd ed. New York: Teachers College Press. Retrieved from: http://mccormickcenter.nl.edu/program-administration-scale-pas-2nd-ed/