VOLUME 18 page 1 August-September-October 2007 VOLUME 18 page 1 August-September-October 2007 Sign Up at www.ecels-healthychildcarepa.org for E-Mail Alerts from ECELS Two handy references should be within easy Outbreaks of Illness reach of every director of an early childhood or school age program. These have evidence-based Everyone dreads outbreaks of disease. Stopping information about how to handle outbreaks and the spread of illness to children, staff and families the types of infections that must be reported to needs prompt action. The first step is to recognize public health authorities. See Caring for Our Chil- an outbreak. Next, you need to know what to do dren, National Health and Safety Performance about it. Standards, 2nd edition, American Academy of Pe- diatrics and the American Public Health Associa- An outbreak is the occurrence of an unusual dis- tion, 2002: Standard 3.067 (also available at ease or symptom, or an illness occurring in a num- http://nrc.uchsc.edu) and the spiral-bound text ber of people which may be of public concern. Indi- called Managing Infections in Child Care and vidual cases of certain diseases, such as measles, Schools, American Academy of Pediatrics, 2005, constitute an outbreak. A food-borne outbreak oc- pages 29 and 30. curs when two or more persons experience gastro- intestinal tract disease after ingesting a common food or water. Understanding MRSA Educators must report some types of outbreaks to Many people are worried when they hear that public health authorities. Half of young children in someone has an infection caused by “MRSA.” child care typically have common colds at the same Understanding MRSA is the first step in know- time during mid-winter. This usual pattern would ing how to handle this infection. not need to be reported to public health authorities. However, three children in the same group who Staphylococcus aureus are bacteria found in have diarrhea justifies a call to local public health the nose and on the skin of nearly all healthy authorities. Public health authorities will gather in- people. When the antibiotic called methicillin formation about the diagnosis. They may suggest does not stop the growth of this type of bacte- some infection control ria, it is called methicillin-resistant Staphylo- measures. For example, coccus aureus or “MRSA.” everyone may need to do better hand and surface Although MRSA was first identified among sick hygiene. Children who people, these bacteria are present on the skin had contact with ill chil- and in the noses of healthy people in many dren may need to sepa- communities now. These bacteria spread by rate from other children. contact with hands, wounds and body fluids. New admissions may Hand washing is the most effective method to need to stop during the control the spread of MRSA. Routine hygiene outbreak. measures to control body fluids work for this germ too. When a child has open skin lesions, The public health professionals will collaborate with they should be covered. Health professionals the health providers of the ill children. They may are concerned about MRSA and other bacteria suggest whether treatment is needed for those who that are not MRSA, but that make certain were exposed to ill children. They may say when ill types of chemicals that damage the body’s children must be excluded from care. Also, their job germ-fighting cells. These bacteria can cause is to educate everyone involved with the outbreak. more frequent and more severe illness. Finally, they will continue to monitor the situation until the problem is resolved. (continued on page 2) VOLUME 18 page 2 August-September-October 2007 (continued from Understanding MRSA, page 1) To help educators write health and safety poli- MRSA are more likely than non-MRSA bacteria to cies, ECELS published Model Child Care Health make these damaging chemicals. The California Policies (MCCHP). These are policies with Childcare Health Program has a very good fact blanks for staff to fill in to adapt the policies for a sheet about MRSA as well as other free fact sheets particular site. The appendix of MCCHP has and posters, many in English and Spanish. Go to: many sample forms. Pennsylvania center-based http://www.ucsfchildcarehealth.org. programs may order a free hard copy of MCCHP from ECELS using the instructions on page 4. For the MRSA fact sheet, click on the tab You may also download the file from the ECELS “Publications and Resources,” then choose “Health website, www.ecels-healthychildcarepa.org. and Safety Notes,” and then select “Methicillin Re- sistant Staphylococcus Aureus (MRSA).” The Indiana Child Care Health Consultant Pro- gram has templates for some health and safety policies on their website in MSWord. Indiana adapted many of these policies from ECELS Risk Management - Model Child Care Health Policies. For the Indiana Reducing Illnesses and Injuries materials, go to www.indiana.edu/~cchealth. Editor’s Note: This article is a revision, consolidation and up- Consult a Child Care Health Consultant to be date of two articles previously published in Health Link Online sure your site-specific health and safety policies in February and March 2007. See these original articles at www.ecels-healthychildcarepa.org for more detailed explana- are current with what experts recommend. If your tion of the four steps listed below. program does not already have a local health pro- fessional who routinely visits to offer health and Using tools available from ECELS will help keep safety advice, ECELS can help you find one. A children and staff safe and healthy. For programs Child Care Health Consultant can help review in Keystone STARS, these tools will help meet policies to improve practices. Minimizing the risk the Continuous Quality Improvement require- of the spread of illness among the children keeps ments under Leadership and Management. To staff healthier. Minimizing the risk of injury keeps prevent illness and injury, follow these four steps: children and staff safe too! 1. Write and use policies that define how the 2. Establish Routine Checks program avoids risky practices and hazards. Use the Health and Safety Checklist in Model 2. Establish routine checks for conditions and Child Care Health Policies, Appendix Q. This practices that are known to cause harm. checklist raises awareness as well as finds haz- ards and risky practices that people might over- 3. Use records of illness and injury to see look. For an excellent checklist focused on reduc- what needs attention. ing risk in active play areas (playgrounds and in- door gross motor play areas), go to the ECELS 4. Make and implement Action Plans for risk website, www.ecels-healthychildcarepa.org, Se- control. Include in the Action Plans when to lect the section Publications and Media, then the review routine site checks and records. Keep subsection, Print Publications. Click on Active the program improving by modifying policies Play Areas Safety Checklist (Brief). as needed. Monthly checks of the whole facility are a good If you have any questions or need advice about idea. You will find more hazards if different peo- how to implement these steps, contact ECELS by ple do different parts of the checklist and if you email: email@example.com, or call 800/243-2357 or change who does the checks from one month to 484/446-3003. another. Review your findings with your Child Care Health Consultant, then fix what you can. 1. Write and Use Policies Certified Playground Safety Inspectors (CPSI) are Every program needs written health policies. health consultants who have specialized training These polices are tools for staff and parent orien- to identify known hazards and recommend tation, and a reference for operation of the pro- changes that reduce the risk of injury during ac- gram. Sitting down to write policies from scratch tive play. Contact ECELS for instructions about is hard. You can use a set of model policies to get how to find a CPSI. started. However, you must adapt model policies (continued on page 3) to make them appropriate for your site. VOLUME 18 page 3 August-September-October 2007 (continued from Risk Management on page 2) Injury Report Details: a) name and contact information for the facility b) child’s name and birth date 3. Use Records to See c) date and time of the incident What Needs Attention d) witnesses e) location of the incident For Illnesses f) action that caused the injury g) part of the body injured Symptom Records: h) first aid given at the facility On a daily basis, facili- i) who was contacted and when ties need to document j) treatment by a health professional (if any) enrollment, attendance and symptoms for the chil- k) follow-up plan to care for the child dren in care. See Model Child Care Health Poli- l) corrective action needed to prevent recur- cies, Appendix H: Enrollment/ Attendance/ rence Symptom Record. m) any official or agency notified n) dated signature of the staff Tracking Procedure: Every day, someone should dated signature of the parent. look at the records of symptoms to detect patterns of illness promptly — in each group of children and Tracking Procedure: Every three to six in the facility overall. You may be able to stop an months, organize a staff meeting to review the epidemic if you improve sanitation and hygiene at injury reports from the previous period. Group the first sign of a sudden increase in frequency of a brainstorming is best. Include those who are af- particular type of illness or symptom. Also, some- fected by the issues and those who have the one on the staff should review the daily illness/ authority to make changes. Be sure to get input symptom records about once a month, noting dif- from someone with expertise in safety, such as ferences in patterns between groups of children in a Child Care Health Consultant or a Certified the facility. Such differences might indicate that a Playground Safety Inspector. Look for patterns particular group needs to pay more attention to of injury. Then consider what preventive action sanitation and hygiene to prevent disease. might help. For Injuries 4. Make and Implement an Action Plan. Injury Report Form: Use a form that records the Figure out what you want to change, the re- necessary details. Make three copies. Use the sources you will need, who will be responsible copies for: 1) communication with parents, 2) docu- for needed changes, how changes will be imple- mentation in the injured person’s file for liability pro- mented, and a time frame to get the job done. tection and reference, and 3) a separate file that Assign the tasks, including checkpoints when a you can review to identify patterns of injury within responsible person will monitor progress on the each classroom, on the playground, or within your plan. entire facility. These approaches and tools will benefit you ECELS recommends the Injury Report Form in every day. Children and staff will be safer and Model Child Care Health Policies, Appendix O. If healthier. You will have fewer absences. The you use a different form, be sure the form records burden of caring for illness and injuries will be the essential details. less for everyone. Environmental Health Self-Learning Module Available from ECELS To learn more about environmental health hazards and what you can do about them in the early learning environment, use the new ECELS Environmental Health Self- Learning Module. You can access this self-learning module on-line or request hard copy from ECELS. Go to www.ecels-healthychildcarepa.org. Click on the photo and header “Child Care Provider Training,” select “Self-Learning Modules” from the drop-down menu that appears when you roll your cursor over the header on the new page. Scroll down the page on the list of self-learning mod- ules and find the Environmental Health Self-Learning Module. Read more about it and then click on it to open it there. If you need help, email ECELS firstname.lastname@example.org or call 800/243-2357 or 484/446-3003. VOLUME 18 page 4 August-September-October 2007 Watch for a Survey about Oral Health According to the Caring for Our Children Stan- dards, solutions to use for sanitizing include a Practices in Early Learning Programs correctly-made mixture of bleach and water, other industrial products that meet the federal Public health authorities are concerned about standards for sanitizers, or federally-approved high rates of early childhood dental disease. To “hospital grade” germicides. Check the label help early learning practitioners foster oral carefully. Be sure the product is non-toxic and health, ECELS offers an Oral Health Self- that the instructions on the label provided by the Learning Module. The ECELS web site and the manufacturer are easy for staff to follow. ECELS Professional Development Brochure lists this and other opportunities to learn about health The EPA has more information about these and safety. (See the brochure insert.) products. Go to http://www.epa.gov/pesticides/ factsheets/antimic.htm, call the EPA at 703-308- What are early learning practitioners doing about 0127, or e-mail email@example.com. oral health in their programs? In 2007, ECELS established an Oral Health Advisory Work Group. This group developed a survey to ask early learning practitioners about what they know and do in this important area of child health. For a spray solution of bleach sanitizer, mix 1 tablespoon of A sample of centers will receive the survey with bleach with 1 quart of water. this issue of the ECELS newsletter to return by Make the solution fresh daily. mail. The ECELS Oral Health Advisory-Work Group will review the responses and suggest Needs 2 minutes of contact. ways to include oral health activities in early learning programs. Later in 2008, the member- ship organizations of Pennsylvania early learning practitioners will send an email invi- tation to complete a revised version of the survey online. The revised survey will ask about the feasibility of the proposed oral health activities. Order Free Materials What is: Vaccine Wallet Records For Parents The Pennsylvania Immunization Card is an Eng- — a Sanitizer? lish/Spanish wallet-sized personal immunization record for children and adults. They are available — a Disinfectant? in packs of 50 cards at no cost for distribution to Pennsylvania families. Check the website of the The U. S. Environmental Protection Agency (EPA) Centers for Disease Control and Prevention regulates products labeled as sanitizers or disinfec- (www.cdc.gov/vaccines) in January for annual tants. They are mixtures of substances to keep updates to the national vaccine schedule. In bacteria, viruses or fungi from growing on inani- 2007, new recommendations include a second mate objects and surfaces. The products may be dose of varicella vaccine and that all 11-18 year sprays, liquids, powders or gases. The EPA regis- old children should get meningitis vaccine. ters thousands of such products. Vaccine Video To Show to Parents and Staff Germicides and antiseptics are different from sani- “Vaccines and Your Baby” is a 28-minute video tizers and disinfectants. They are considered drugs that explains the basics of vaccines. You can because they are used in or on living humans or show this video to parents and staff. Pennsyl- animals. The Federal Food and Drug Administra- vania early learning practitioners may order a tion regulates drugs. free VHS copy of this video from ECELS. Disinfectants differ from sanitizers. Disinfectants To order these and other materials from ECELS, destroy or irreversibly inactivate fungi and bacteria, go to www.ecels-healthychildcarepa.org, click but not necessarily their spores. Sanitizers reduce, any section heading, then in the left frame, click but not necessarily eliminate microorganisms to “Request Materials” and complete the form. To levels considered safe by public health codes or order by phone, call ECELS at 800-243-2357. regulations. VOLUME 18 page 5 August-September-October 2007 National Health Organization Web- Mild head injuries can lead to academic and/or sites — National Health Calendar for behavioral changes. The American Academy of Activity Ideas and Free Materials Pediatrics has a publication for parents about head injuries. Head Injury – Determining the De- The U.S. Department of Health and Human Ser- gree of Injury and Minor Head Injuries in Children. vices has a website that links users to sources of It can be ordered at www.aap.org. reliable health information at www.healthfinder.gov. One link on the site is to a list of National Health Observances that you can use to plan activities for In Pennsylvania, you or families can contact the your program. Health observances are days, following for assistance once a child is diagnosed weeks or months focused on special health con- with a head injury: cerns. See below for some examples of upcoming Brain Injury Helpline: toll free 1-866-412-4755 activities for October 2007 that are appropriate for TTY: 877-232-7640, early learning and school age practitioners. www.helpinpa.state.pa.us October Brain Injury Association of Pennsylvania: toll free 1-866-635-7097,www.biapa.org 1 - 31 Disability Rights Network of Pennsylvania: National Dental Hygiene Month 800-692-7443,TDD 877-375-7139, drnpa- American Dental Hygienists' Association firstname.lastname@example.org 444 North Michigan Avenue, Suite 3400 Chicago, IL 60611-3980 PA Department of Health – Head Injury Pro- (800) 243-ADHA (2342),(312) 440-8900 gram, www.health.state.pa.us (312) 467-1806 Fax email@example.com, www.adha.org For materials, contact: Communications Division 1 - 31 Sudden Infant Death Syndrome Awareness Be a Champion Month for Flu Vaccine! First Candle/SIDS Alliance 1314 Bedford Avenue, Suite 210 Influenza vaccine is Baltimore, MD 21208 the single best way (800) 221-7437,(410) 653-8226, to protect children (410) 653-8709 Fax and their caregivers firstname.lastname@example.org, www.firstcandle.org in group care from a Materials available, Contact: Laura Reno severe winter illness. All healthy children 7 - 13 aged 6 to 59 months, and the household contacts Fire Prevention Week and out-of-home caregivers of children from birth National Fire Protection Association to 5 years of age should be vaccinated against 1 Batterymarch Park influenza annually. Individuals of any age with Quincy, MA 02169-7471 increased risk of complications from influenza (800) 344-3555 orders only, (617) 984-7285 should get vaccine too. (617) 770-0200 Fax email@example.com, www.firepreventionweek.org Two types of vaccines are available, a flu shot Materials available,Contact: Barbara Dunn and a nasal-spray flu vaccine. The nasal-spray flu vaccine can be used by children 5-17 years of Concussions, Mild Head Injury and age and adults. Children younger than 5 years of Traumatic Brain Injury: age must receive the flu shot. They need two doses of the shot if it is the first time they are re- What’s important to know…? ceiving influenza vaccine. For more information about influenza, including links to fact sheets in Yearly, 25,975 Pennsylvania children have brain many languages go to http://www.cdc.gov/flu/. injuries (www.biapa.org). Mild traumatic brain injury is often missed, with symptoms not always immedi- See how many children and adults involved with ately apparent. Loss of consciousness does not your early learning program you can get pro- have to occur. A child may simply appear dazed or tected with vaccine this year. Plan a campaign. confused. Concussion is a mild traumatic brain in- Start in late October. Follow-up in November and jury. See the insert in this newsletter for what to December. look for when a child has a head injury. VOLUME 18 page 6 August-September-October 2007 Special FALL 2007 Hard-Copy Issue of CHIP Now Covers ALL Health Link Online Uninsured Children! This is a special issue of Health Link Online. The Pennsylvania’s Children’s Pennsylvania Department of Health gave ECELS Health Insurance Program funding to mail this newsletter in hard copy. The (CHIP) now covers all un- November-December 2007 and subsequent issues insured children and teens (up to age 19), regard- of Health Link Online will be on-line-only publica- less of family income. All families need to do is tions again. The Pennsylvania Department of apply! CHIP is comprehensive health insurance Health has funded one more hard-copy issue of the that includes doctor visits, dental care, eye care, newsletter that will be mailed in 2008. prescriptions, immunizations, hospital stays and much more. You will find all back issues of ECELS newsletters on the ECELS website. To receive an e-mail notice For many families, CHIP is free, with no co-pays when ECELS posts a new Health Link Online on or monthly premiums. Families with higher in- the website, be sure to sign up at www.ecels- comes have low monthly premiums and co-pays healthychildcarepa.org for E-Mail Alerts from for some services. To qualify for CHIP, children ECELS. When you sign up, you will receive a con- must be Pennsylvania residents under the age of firming e-mail to which you must respond to join 19. They must not be eligible for Medical Assis- the list. This step is a safeguard to be sure that tance or other health insurance. Also, they must only those who want to receive the E-Mail Alerts meet citizenship requirements. from ECELS are on the list. All new applicants whose family annual income falls above the free CHIP income range and into the low-cost and at-cost CHIP ranges must also Reducing the Risk of SIDS show that their children have been uninsured for six months. There are three exceptions to this re- ECELS participated in a project with the (national) quirement for a six month uninsured period: chil- American Academy of Pediatrics (AAP) to reduce dren under the age of 2, children who have lost the risk of SIDS in child care. The AAP conducted health insurance because a parent lost their job the study in four states - CA, MT, LA, and PA. Pre- and children who are moving from another public liminary analysis of the data from this project show insurance program. more child care programs need safe sleep policies and need to place infants to sleep safely. Also, the Encourage families whose children need health results indicate that some parents are not aware of insurance to apply right away. It’s easy to do. Go safe sleep practices. ECELS offers AAP instruc- to the CHIP Web site (www.chipcoverspakids. tional materials in a workshop as well as a self- com) or call the CHIP Helpline at 1-800-986- learning module on Reducing the Risk of SIDS in KIDS. Child Care. Pennsylvania early learning practitio- ners can request these learning opportunities from Reach out to uninsured families. If you would like ECELS. to display CHIP information in your facility, would like more information, or would like someone to Published 8/31/07 at www.ecels-healthychildcarepa.org. come to speak to your organization about CHIP, Editor: Susan S. Aronson, MD, FAAP. Contact ECELS please go to www.chipcoverspakids.com or call at: 484-446-3003 or 800-24-ECELS; firstname.lastname@example.org; 1-800-986-KIDS. To order brochures and posters PA AAP, Rose Tree Corporate Center, Bldg II, Suite on the website, click on “CHIP Resources,” then 3007,1400 N. Providence Road, Media, PA 19063. “Promotional Materials.” In This Issue: Order Free Materials Outbreaks of Illness National Health Organization Websites and Understanding MRSA National Health Calendar Risk Management— Illness and Injuries Concussions, Mild Head Injury and Traumatic Brain Injury Environmental Health Self-Learning Module Survey about Oral Health Practices in Early Be a Champion for Flu Vaccine Learning Programs Reducing the Risk of SIDS 2 Hard-Copy Inserts: ECELS Professional Development Brochure and When Your Child’s Head Has Been Hurt (1000 centers will receive a 3rd insert of a questionnaire on Oral Health) VOLUME 18 page 7 August-September-October 2007 Safety Sheet Injury Prevention VOLUME 18 page 8 August-September-October 2007 The TBI Technical Assistance Center granted permission on September 1, 2007 to the PA Chapter of the American Academy of Pediatrics to reproduce and to publish this document online. Note correction of TBI Technical Assistance Center phone number above right to (301) 656-3500.
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