9-3-07 August-October 2007 HL Online with insert by NiceTime


									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
                                                           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: ecels@paaap.org, 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 ecels@paaap.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 info_antimicrobial@epa.gov.
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
                                                         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.
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                      hbg@drnpa.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
media@adha.net, 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
info@firstcandle.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
bdunn@nfpa.org, 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; ecels@paaap.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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