Managing infectious diseases in child care and schools : a quick reference guide

266 Pages·2013·11.157 MB·English

by  Aronson, Susan S., Shope, Timothy R.

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a A m e r i c A n A c A d e m y o f P e d i A t r i c s
A M e R I C A n A C A D e M y o f P e D I A T R I C S n
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Managing Infectious Diseases in
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A Quick Reference Guide, 3rd Edition s

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Edited by Susan S. Aronson, MD, FAAP, and Timothy R. Shope, MD, MPH, FAAP e Diseases in Child Care
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Completely revised and updated, the new 3rd edition of this s

award-winning quick reference guide provides the information new In 3RD eDITIon in
you need to know—fast—about the prevention and management — Completely reviewed and updated through- C
of infectious diseases in child care and school settings. out to reflect the latest guidance and recom- h and Schools
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Presented in an easy-to-use format, this must-have mendations, including alignment with new ld
guide  provides editions of C
— Caring for Our Children: National Health a
— Content from the premier American Academy of Pediatrics r
and Safety Performance Standards: Guide- e
sources of information on infectious diseases and child
care settings, Red Book® and Caring for Our Children lines for Early Care and Education Programs, an A Quick Reference Guide, 3rd Edition
— Quick Reference Sheets on more than 50 common infectious 3rd Edition d
diseases and symptoms that occur in children in group settings — Red Book®: 2012 Report of the Committee on S
— Easy-to-read explanations on how infectious diseases spread Infectious Diseases, 29th Edition ch
— Strategies for limiting the spread of infection — New infectious disease Quick Reference o
— When exclusion is and is not indicated Sheets ol
— Guidance about which situations require immediate help s
— Bedbugs
— Immunization information
— Cryptosporidiosis A
— Ready-to-use sample letters and forms for parents or referrals — New diapering “how-to” poster Q
— And much more!
— New forms and resources added to u
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About the editors Chapter 11 k
susAn s. Aronson, md, fAAP, works at the — New Web links to professional development Re
Pennsylvania Chapter of the American Academy materials fe
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of Pediatrics as a pediatric advisor for the Early e
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Childhood Education Linkage System–Healthy c
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Child Care Pennsylvania. In 2011, she retired from her appointment as clinical professor of pediatrics at G
the University of Pennsylvania in Philadelphia. A nationally recognized expert on health and safety issues u
in early education and child care settings, Dr Aronson is an advisor to the Executive Committee of the id
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American Academy of Pediatrics Section on Early Education and Child Care. She is the author/editor of , 3
Healthy Young Children, 5th Edition (2012). She is known to many educators from 2 decades of reading her column (“Ask r
Dr. Sue Your Health and Safety Questions”) in www.ChildCareExchange.com Exchange magazine. d E
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timothy r. shoPe, md, mPh, fAAP, is an associate professor of pediatrics at the Children’s Hospital of i
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Pittsburgh of University of Pittsburgh Medical Center. Dr Shope is a member of the American Academy io
of Pediatrics Section on Early Education and Child Care and regularly speaks and writes about exclusion n
and return-to-care criteria for mildly ill children in child care and schools. He retired after 21 years of
service in the Navy in 2011.
editors
Susan S. Aronson, , Timothy R. Shope, , ,
Available in print and ebook formats! Print as many Quick reference sheets as you need with the ebook version. md faap md mph faap
for other pediatric resources, visit the American Academy of Pediatrics online
bookstore at www.aap.org/bookstore.
AAP
A m e r i c A n A c A d e m y o f P e d i A t r i c s
Managing Infectious
Diseases in Child Care
and Schools
A Quick Reference Guide, 3rd Edition
Editors
Susan S. Aronson, md, faap
Timothy R. Shope, md, mph, faap
American Academy of Pediatrics
141 Northwest Point Blvd
Elk Grove Village, IL 60007-1019
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AAP Department of Marketing and Publications Staff
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Director, Department of Marketing and Publications
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Editorial Assistant
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Library of Congress Control Number: 2013931766
ISBN: 978-1-58110-765-4
eISBN: 978-1-58110-809-5
MA0662
The recommendations in this publication do not indicate an exclusive course of treatment or serve as a standard of medical care.
Variations, taking into account individual circumstances, may be appropriate.
Copyright © 2013 American Academy of Pediatrics. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or
transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without prior permission from the publisher.
No permission is necessary to make single copies of Quick Reference Sheets for noncommercial, educational purposes.
Printed in the United States of America.
9-317/0613 1 2 3 4 5 6 7 8 9 10
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RevieweRs/ContRibutoRs • • • III
Reviewers/Contributors
Editors
Susan S. Aronson, MD, FAAP
Timothy R. Shope, MD, MPH, FAAP
Technical Reviewers
Abbey Alkon, RN, PhD
Nancy Alleman, RN, CPNP
Sandra Cianciolo, RN, BSN, MPH
Margaret C. Fisher, MD, FAAP
Danette S. Glassy, MD, FAAP
Barbara U. Hamilton, MA
Andrew Hashikawa, MD, FAAP
Harry L. Keyserling, MD, FAAP
Sandy McDonnell, MSN, RN, CRNP, PNP-BC
Linda Satkowiak, ND, RN, CNS, NCSN
Kam Sripada, EdM
Howard L. Taras, MD, FAAP
American Academy of Pediatrics Disaster Preparedness Advisory Council
Additional Reviewers
Rebecca L. Slayton, DDS, PhD
AAP Board of Directors Reviewer
Sara H. Goza, MD, FAAP
American Academy of Pediatrics
Errol R. Alden, MD, FAAP
Executive Director/CEO
Roger F. Suchyta, MD, FAAP
Associate Executive Director
Maureen DeRosa, MPA
Director, Department of Marketing and Publications
Mark Grimes
Director, Division of Product Development
Jeff Mahony
Manager, Digital Strategy and Product Development
Fan Tait, MD, FAAP
Associate Executive Director/Director, Department of Child Health and Wellness
Jeanne M. VanOrsdal, MEd
Manager, Early Education and Child Care Initiatives
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table of Contents • • • V
Table of Contents
Foreword ................................................................................................................................................................IX
About This Book ....................................................................................................................................................X
What Is New in This Edition? ...............................................................................................................................XI
Chapter 1 Introduction: Keeping Healthy ............................................................................................................1
Strengthening Resistance to Infections ...................................................................................................................................3
Structuring and Managing the Environment ........................................................................................................................3
Reducing the Numbers of Harmful Germs ............................................................................................................................4
Exclusion When Necessary of Children and Adults Who Are Ill ......................................................................................4
The Role of the Child Care Health Consultant and School Health Personnel ............................................................5
Planning and Policies ...................................................................................................................................................................6
What Families Can Do to Reduce Illness From Infection in Child Care and Schools ...............................................7
What Staff Members Can Do to Reduce Illness From Infection in Child Care and Schools ................................11
What Health Professionals Can Do to Reduce Illness From Infection in Child Care and Schools .....................15
Chapter 2 How Infection Spreads .....................................................................................................................17
Infection Spread by Contact With People or Objects ......................................................................................................19
Infection Spread by the Fecal-Oral Route ..........................................................................................................................19
Infection Spread by the Respiratory Route ........................................................................................................................19
Infection Spread Through Blood, Urine, and Saliva .......................................................................................................19
Chapter 3 Infection Control Measures ...............................................................................................................21
Administration and Consultation ........................................................................................................................................23
Sanitation, Disinfection, and Maintenance .......................................................................................................................25
Hand Hygiene .............................................................................................................................................................................31
Changing Diapers, Soiled Disposable Training Pants, and Soiled Underwear .........................................................35
Chapter 4 Health of Teachers/Caregivers and Other Staff Members ...............................................................39
Introduction ...............................................................................................................................................................................41
Regular Health Checkups: Health Appraisals ...................................................................................................................41
Health Limitations of Staff Members ...................................................................................................................................43
Learn About and Practice Minimizing Risk of Illness and Injury ................................................................................45
Evaluating Performance Using Health Policies and Procedures ..................................................................................47
Chapter 5 Recognizing the Ill Child: Inclusion/Exclusion Criteria ...................................................................49
Daily Health Check ...................................................................................................................................................................51
When to Call Emergency Medical Services (and Also Notify Parents/Legal Guardians) ........................................51
Situations That Require Urgent Medical Attention ........................................................................................................52
Conditions That Do Not Require Exclusion to Control Spread of Disease to Others ..........................................52
Conditions Requiring Temporary Exclusion .....................................................................................................................55
Procedures for a Child Who Requires Exclusion ..............................................................................................................56
Reportable/Notifiable Conditions ........................................................................................................................................56
Preparing for Managing Illness .............................................................................................................................................56
Chapter 6 Signs and Symptoms Chart ...............................................................................................................57
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VI • • • table of Contents
Chapter 7 Quick Reference Sheets ...................................................................................................................67
Bedbugs .........................................................................................................................................................................................69
Bites (Human and Animal) ......................................................................................................................................................71
Boil/Abscess/Cellulitis ..............................................................................................................................................................73
Campylobacter ...............................................................................................................................................................................75
Chickenpox (Varicella-Zoster Infections) ............................................................................................................................77
Cryptosporidiosis .......................................................................................................................................................................79
Cytomegalovirus (CMV) Infection .........................................................................................................................................81
Dental Caries (Early Childhood Caries or Cavities) ..........................................................................................................83
Diarrhea ........................................................................................................................................................................................85
Diarrhea Caused by Specific Types of E coli (Escherichia coli) ...........................................................................................87
Ear Infection ................................................................................................................................................................................89
Fever ...............................................................................................................................................................................................91
Fifth Disease (Human Parvovirus B19) ................................................................................................................................93
Giardiasis ......................................................................................................................................................................................95
Haemophilus influenzae Type b (Hib) .......................................................................................................................................97
Hand-Foot-and-Mouth Disease..............................................................................................................................................99
Hepatitis A Infection ...............................................................................................................................................................101
Hepatitis B Infection ...............................................................................................................................................................103
Herpes Simplex Virus ..............................................................................................................................................................105
HIV/AIDS ...................................................................................................................................................................................107
Impetigo ......................................................................................................................................................................................109
Influenza .....................................................................................................................................................................................111
Lice (Pediculosis Capitis) ........................................................................................................................................................113
Lyme Disease (and Other Tick-borne Diseases) ...............................................................................................................115
Measles ........................................................................................................................................................................................117
Meningitis ..................................................................................................................................................................................119
Molluscum Contagiosum ......................................................................................................................................................121
Mononucleosis ..........................................................................................................................................................................123
Mosquito-borne Diseases .......................................................................................................................................................125
Mouth Sores ..............................................................................................................................................................................127
MRSA (Methicillin-resistant Staphylococcus aureus) ..........................................................................................................129
Mumps ........................................................................................................................................................................................131
Pinkeye (Conjunctivitis) .........................................................................................................................................................133
Pinworms ....................................................................................................................................................................................135
Pneumonia .................................................................................................................................................................................137
Respiratory Syncytial Virus (RSV) ........................................................................................................................................139
Ringworm ...................................................................................................................................................................................141
Roseola (Human Herpesvirus 6) ..........................................................................................................................................143
Rotavirus .....................................................................................................................................................................................145
Rubella (German Measles) .....................................................................................................................................................147
Salmonella ....................................................................................................................................................................................149
Scabies .........................................................................................................................................................................................151
Shigella ..........................................................................................................................................................................................153
Shingles (Herpes Zoster) ........................................................................................................................................................155
Strep Throat (Streptococcal Pharyngitis) and Scarlet Fever .........................................................................................157
Sty .................................................................................................................................................................................................159
Thrush (Candidiasis) ...............................................................................................................................................................161
Tuberculosis (TB) .....................................................................................................................................................................163
Upper Respiratory Infection (Common Cold) .................................................................................................................165
Urinary Tract Infection ...........................................................................................................................................................167
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table of Contents • • • VII
Vomiting .....................................................................................................................................................................................169
Warts (Human Papillomavirus) ............................................................................................................................................171
Whooping Cough (Pertussis) ................................................................................................................................................173
Yeast Diaper Rash (Candidiasis) ..........................................................................................................................................175
Chapter 8 Role of the Health Consultant in Child Care and Schools ...............................................................177
Why Does an Early Care and Education Program, a Before- and After-School Child Care Program,
or a School Need a Health Consultant? ...................................................................................................................179
What Are the Qualifications of a Health Consultant? ..................................................................................................179
What Does a Health Consultant Do? ................................................................................................................................180
Where Can a Child Care Program or School Find a Health Consultant? ................................................................181
Chapter 9 Immunization Schedule and Information ........................................................................................183
Preventing Diseases With Routine Childhood Immunizations .................................................................................185
Unimmunized/Under-immunized Children ...................................................................................................................185
Teacher/Caregiver Immunizations .....................................................................................................................................185
Chapter 10 Infectious Disease Outbreaks, Epidemics, and Bioterrorism/
Environmental Health Emergencies ................................................................................................187
Why Children Are Especially Vulnerable ...........................................................................................................................189
Planning ......................................................................................................................................................................................189
Types of Infectious Disease Emergencies ...........................................................................................................................189
Symptom Records ...................................................................................................................................................................190
Parent Notification ..................................................................................................................................................................190
Tracking Procedure ..................................................................................................................................................................191
Corrective Action ......................................................................................................................................................................191
Chapter 11 Sample Letters, Forms, and Relevant Resources............................................................................193
Routine Schedule for Cleaning, Sanitizing, and Disinfecting .....................................................................................197
Selecting an Appropriate Sanitizer or Disinfectant ........................................................................................................199
Recommended Immunization Schedule for Persons Aged 0 Through 18 Years—2013 ........................................206
Catch-up Immunization Schedule for Persons Aged 4 mo Through 18 Years Who Start Late or
Who Are More Than 1 Month Behind—United States, 2013 ..............................................................................210
Recommended Adult Immunization Schedule—United States, 2013 ........................................................................213
Sample Health Information Consent Form ......................................................................................................................215
Cleaning Up Body Fluids .......................................................................................................................................................216
Diapering ....................................................................................................................................................................................217
Situations that Require Medical Attention Right Away ................................................................................................220
Enrollment/Attendance/Symptom Record ......................................................................................................................221
Parent/Legal Guardian Alert Letter ....................................................................................................................................222
Symptoms or Suspected Illness—Sample A ......................................................................................................................223
Symptoms or Suspected Illness—Sample B ......................................................................................................................224
Medication Administration Packet .....................................................................................................................................225
Return to Group Care Form ................................................................................................................................................230
Gloving ........................................................................................................................................................................................231
Child Care Staff Health Assessment ...................................................................................................................................232
Sample Food Service Cleaning Schedule ...........................................................................................................................233
Glossary .............................................................................................................................................................235
Index ..................................................................................................................................................................243
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ffooRReewwooRRdd •• •• •• IIXX
Foreword
In the United States, more than two-thirds of children younger than 6 years, and almost all children older than
6 years, spend significant time in child care and school settings outside of the home. Exposure to groups of
children increases the risk of infectious diseases. This fact has important personal, public health, economic, and
social consequences. The intent of this book is to provide an easy-to-use reference for those who are responsible
for the prevention and management of infectious diseases in child care and school settings—teachers/ caregivers,
pediatric practitioners, public health professionals, and parents. This is the third edition of this book. New
topics were added at the request of enthusiastic users. Review of scientific evidence since the previous editions
led to a few changes as well.
In this book, educators in group care settings and schools are interchangeably called teachers/caregivers and
educators. Teachers/caregivers will find that this book offers easy-to-read explanations for how infectious diseases
spread, how to prepare for inevitable illness, and how to incorporate measures that limit any excess burden of ill-
ness associated with group activities. The Signs and Symptoms Chart (Chapter 6) will help nonmedical professionals
become aware of what might cause various signs and symptoms. The set of fact sheets (Chapter 7, “Quick Reference
Sheets”) describes specific types of infectious diseases in common terms, with guidance about how they spread and
what needs to be done by teachers/caregivers, children, and families when someone in the group has a disease. By
using this book as a handy reference, teachers/caregivers can feel more confident in making decisions about inclu-
sion and exclusion of ill children and in seeking advice from medical and public health professionals when necessary
to reduce the burden of infectious diseases on other children and staff members.
Pediatricians and other health professionals will find this book helpful as a reference that facilitates communication
with teachers/caregivers. Pediatric health professionals are the primary source of information for teachers/ caregivers
about the management of infectious diseases for individual children and the implications of these infections for
groups of children and the adults who care for them. Pediatric health professionals can use the content of the book
to identify exclusion and inclusion recommendations, supplement their communications with educators about
infectious diseases of patients, and augment their instructions for the care of the child for parents and teachers/
caregivers involved in the child’s care. They also can use the content of the book to identify the need for linking
teachers/caregivers with public health authorities when necessary.
Parents will benefit from the content of this book because it will provide a common means for communication
among family members, pediatric health professionals, and teachers/caregivers that is based on the best available
evidence and expert opinion about best practices. Additionally, parents and teachers/caregivers will benefit from
the Quick Reference Sheets. These may be copied. For example, a health professional can give a copy to parents to
share with teachers/caregivers, or teachers/caregivers can send copies home to parents. Use these sheets to describe
a condition or infection affecting their child or the group of children to which their child is exposed.
This book also addresses the controversial subject of exclusion and return-to-care criteria. Controversy exists
because often, teachers/caregivers, pediatric practitioners, public health professionals, and parents disagree about
which conditions require exclusion. For example, children with runny noses may be excluded unnecessarily, but
others with diarrhea that is associated with loss of bowel control that causes a child to have an accident may be
allowed to stay, when their loss of bowel control may pose a greater infection risk. Adding to the confusion, each
state health department and licensing agency has unique rules or exclusion criteria for determining which symp-
toms, diseases, and conditions require exclusion from child care or school.
The recommendations in this book are based on the best available medical information as determined by the
American Academy of Pediatrics. Some of the exclusion criteria in this book are more detailed than existing guide-
lines and can be followed without conflict with existing rules or regulations. Others will conflict because they
are  evidence-based and the evidence does not support practices that have become embedded in existing rules or
regulations developed without the benefit of current evidence. It is our hope that policy makers incorporate the
exclusion and return-to-care recommendations in this book as they move toward revising their state requirements
and regulations.
— Susan S. Aronson, MD, FAAP
Timothy R. Shope, MD, MPH, FAAP
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