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Draft 5th edition of Staying Healthy in early childhood education and care submission

ID: 
20
Personal Details
Organisation Name: 
TIPCU
C. Additional Information
Please identify the best term to describe the Organisation: 
Government Department - State
E. Submission
Submission methods: 
Online Submission (specific questions)
Online Submission (specific questions)
1. The 5th edition target education and care settings with children under 5 years of age. What additional considerations need to be given to make this resource applicable to education and care settings for older aged groups?: 

Behaviour of older children/adolesecents so may need to look at including issues such as sexual behavious and drug and alcohol issues.

2. Are there other resources that would be useful to accompany the 5th edition of Staying Healthy ? e.g. posters, fact sheets or on-line information. Please provide links or references.: 

Posters related to hand hygiene should be sourced from Hand Hygiene Australia website - www.hha.org.au

Fact sheets for the notifiable diseases could be referenced to the jurisdictional websites

3. Please comment on the new format , are there aspects that can be improved?: 

Handwashing/hand hygiene procedures are outlined in both section 1 and section 3. Our suggestion is that it remains in one or the other section and is rewritten in regards to how to handwash and how to perform hand rub; HHA have a number of resources that you could use in this section.

General Comments
Comments: 

Hand Hygiene

All references s to handwashing should be termed ’hand hygiene’. We suggest that hand hygiene procedures such as handwashing and using a waterless hand rub use Hand Hygiene Australia (HHA) as the resource. 

Handwashing/hand hygiene procedures are outlined in both section 1 and section 3. Our suggestion is that it remains in one or the other section and is rewritten in regards to how to handwash and how to perform hand rub; HHA have a number of resources that you could use in this section.

We suggest using the definition of hand hygiene as per HHA. A suggestion is ‘Hand Hygiene is a general term and refers to hand washing and/or the use of waterless hand rubs. Hand hygiene is one of the most important ways of preventing the spread of infection. Washing hands physically removes dirt and germs. Using a waterless hand rub reduces the amount of germs on your hands’

 

Page 9 –

‘Using soap and water is the most effective way to achieve hand hygiene’ – this statement is incorrect; should read ‘hand hygiene is the most effective…..

We are unsure if the comment re antibacterial soaps ‘do not kill viruses’ is correct or necessary. However it is good pointing out that there is no place for their routine use ion childcare.

The five-step method for washing hands - refer to HHA and WHO for this and to the use of waterless hand rubs.

1 Wet hands under running water

2 Apply soap

3 Lather and rub for at least 20 seconds

4 Rinse hands thoroughly - Add - under running water

5 Dry hands.

 

Page 40 –

There are instructions on how to wash a baby’s hands; it may be more appropriate to use the term ‘babies and infants’ whenever there is mention of ‘baby’ as a referral to infants includes a wider age range than the word ‘baby’.

Table 6 – you should include ‘after touching animals’ in this table

 

 

Chain of infection.

This is outlined in a number of different areas within the document, including the Glossary and uses a 4 step chain that is not in common use. We suggest using the Chain of Infection in line with the NHMRC Infection Control Guidelines (Figure A1.1) with three steps namely:

  • Source of infectious agent (or germ)
  • Mode(or route) of transmission
  • Susceptible host

In the 4 step chain of infection in the document, you mention that the germ spreads into the environment , the germ survives in the environment and that the germ is passed on to the next person.  This is not a component of the chain of infection for all infections as many diseases are transmitted directly person to person (chickenpox) or from the environment to host (Legionella).

The chain of infection should hold true for all infections which is why the 3 step chain is generally accepted (and is used in the NHMRC Infection Control guidelines) - for any infection to occur you need all components of the chain (germ, transmission and host) to be in place. Removing any one of these components will prevent an infection from occurring.

Page 5

Ways in which germs can spread - You need to include Direct Contact in this section - for example, head lice are transmitted this way (head to head contact). As are scabies – direct skin to skin contact. Again this could be incorporated into the ‘transmission’ section of the chain of infection.

Touching infectious body fluids or secretions – this  heading implies that simply touching body fluids is a risk when the risk is actually ingestion or injection or due to a splash or spray of body fluids

 How this occurs should be more properly put as ‘germs can enter the body by being swallowed or via damaged skin or mucous membranes. 

 

Page 6 –

How can diseases spread in education and care services?

‘If a child has a sick sibling at home, they can also bring germs from home into the education and care service.’ This statement is incorrect – a person has to be shedding microorganisms to transmit an infection to another - ie have an active infection with signs and symptoms or be asymptomatic but shedding (be incubating a disease or recovering from a disease). For example, a child may have a sibling a home with chickenpox but the child themselves cannot spread chickenpox to anyone else unless they have the illness themselves (or are incubating it).

Different germs spread in different ways -  Germs are spread via contact, droplet or the airborne routes.  It may be more appropriate to use these headings and provide examples under each rather than the way you have done as it is not clear.

Whether or not a person becomes ill in an education and care service depends on three things - These points form part of the explanation of the 3 steps of the chain of infection.  The concept of "breaking the chain" would be worthwhile exploring in this section including examples of how this can occur.

 

 

Specific comments are as follows: 

Page 1cough etiquette - are the words "proper, appropriate and effective" necessary? It would read better if it just stated ‘cough etiquette’.

Page 4  example of transmission using giardia - Would it be better not to name a particular cause as this is sometimes/often not known.

Page 15 – table of exclusions - Not sure that diphtheria is relevant as there has only been one case (in a non immunised woman) in >30 years in Australia

Page 19 – immunisation. The statement ‘This is because the effectiveness of naturopathic or homeopathic vaccinations has not been scientifically proven’. It should be made clear that these ‘vaccinations’ do not work and do not offer any protection against vaccine preventable diseases.

Page 20 – NIP schedule – may be worth putting a note in here to suggest referring to the Immunisation Australia website for updates on the NIPS.

 

Page 23 – the use of gloves. the statement ‘you can remove the dirty gloves and dress the child with your clean hands, without needing to wash your hands in between’ (in the section titled ‘Washing your hands before wearing gloves’) contradicts the statement ‘Wearing gloves does not replace the need to wash your hands, and you should ensure you wash your hands before putting gloves on and after taking them off’

The 2 sections ‘Washing hands before wearing gloves’ and ‘Washing hands after wearing gloves’ contradict each other in regard to the statement  ‘When changing a nappy, it is important to wash your hands before you put on gloves, so that when you have finished changing the child, you can remove the dirty gloves and dress the child with your clean hands, without needing to wash your hands in between’ which contradicts the statements in the section titled ‘Washing hands after wearing gloves’.

Could we suggest that these statements are rewritten to read as follows?

Cleaning hands before wearing gloves

Wash your hands or use a waterless hand rub before putting on gloves so that you remove as many germs as possible from your hands.

Cleaning hands after wearing gloves

It is important to wash your hands or use a waterless hand rub after wearing gloves, because any germs on your hands may have multiplied significantly while you were wearing the gloves. There may also be microscopic tears or holes in the gloves that can allow germs to contaminate your skin. When taking off the gloves, you may contaminate your hands with the dirty gloves; therefore, it is essential that you wash your hands or use a waterless hand rub after removing your gloves.

Page 24 - Effective environmental cleaning

We would suggest this section has the advice not to use spray bottles and why, in one paragraph. Detergent wipes could also be mentioned as an alternative to making up a detergent and water solution.

The statement ‘Detergents help to loosen the germs so that they can be rinsed away with clean water’ is not strictly true as detergents are used to break the surface tension of water and the detergent and water solution  is used to wash away dirt and debris that may contain germs.

Page 25 - Disinfectants

The comment ‘disinfectants (also known as sanitisers) are usually only necessary if a surface cannot be properly cleaned with detergent and water’ is incorrect and contradicts the correct comment you make that ‘Disinfectants (sanitisers) cannot kill germs if the surface is not clean. It is more important to make sure that all surfaces have been cleaned with detergent and warm water than to use a disinfectant ‘ .

In the section regarding disinfectants, you could also add in a sentence stating that disinfectants may be used during an outbreak (ie gastroentertis)

 

Page 31 – Reducing the fever.

You should reference the section titled ‘Medications to reduce fever include the following’   and should also reference any sections that mention administration of medications such as paracetamol or ibuprofen.

 

Page 33 – managing fever after immunisation

You should reference this section (a good reference can be found in the Immunisation Guidelines).

 

Page  43

We are not sure of the merits of 1) washing the change mat in the middle of the day if it is washed over between each nappy change and 2) the necessity of drying the mat in the sun.

 

Pages 49

Re the sentence ‘If you know that the spill came from a person with an infectious disease…’  you should include the words ‘known or suspected of having an infectious disease’ as it may not always be know if the illness has an infectious cause or not.

 

Page 51 –

There is a contradiction in the paragraph ‘Disinfectants are only necessary if a surface cannot be properly cleaned with detergent and water, or if a surface is known to be contaminated with potentially infectious material. Remember that disinfectants cannot kill germs if the surface is not clean, so you should always clean first, then disinfect.’ The second highlighted statement is correct (you should always clean first and then disinfect).

The diagram (Figure 3) outlining when to decide whether to use disinfectant or not – the comment in the last box should read ‘Use detergent and water followed by disinfectant’ as bleach is a disinfectant and is the disinfectant advocated in the section on disinfection; it can be used for small and large spills.  Suggestions to use ‘disinfectant’ for small spills and ‘bleach’ for large spills is confusing.

 

Page 52

Clothing – there are no infection control guidelines that suggest staff clothing should be 1) washed daily and 2) washed in hot water.  It may be better to suggest clothing is washed in detergent and water if it gets soiled while at work.

Linen – need to include ‘and detergent’ in the washing instructions.

 

Page 69 – Notifiable diseases – this list should be referenced to ensure it is in line with the CDNA list of notifiable diseases (http://www.health.gov.au/casedefinitions#dislist) and in line with what the various jurisdictions consider to be notifiable diseases that must be notified to the States and Territories Public Health Units. The table you have is incomplete (does not include chicken pox for example) and includes illnesses that may not be considered to be ‘notifiable’ in all jurisdictions such as ‘diarrhoea’ (if there are more than two cases)’ or Norovirus.

 

 

 

 

 

Page reviewed: 3 September, 2013