Infection Prevention in the Classroom Setting

1. Infection Prevention in the Classroom Setting Texas Public Health Training Center in partnership with the USA Center for Rural Public Health Preparedness Materials provided by the USA Center for Rural Public Health Preparedness at the Texas A&M Health Science Center School of Rural Public Health supported by Grant/Cooperative Agreement Number 5U90TP624250-04. Contents are solely the responsibility of the authors and do not necessarily represent the official views of CDC.

2. Welcome! Germs can spread rapidly in a classroom setting, so staying informed and active to protect yourself and students from infectious diseases is essential. Increased awareness will minimize the risk of infection, prevent disease transmission, and preserve a healthy and safe classroom environment. The Texas Public Health Training Center in partnership with the USA Center for Rural Public Health Preparedness at Texas A&M Health Science Center School of Rural Public Health designed this train-the-trainer activity for teachers and their students. It provides information, ideas, and learning activities for the classroom to help keep children healthy and prevent the spread of infection in the classroom setting.

3. What is an Infectious Disease? Infection An infection occurs when microorganisms, or germs, enter and multiply in the body. Infectious Disease An infectious disease occurs when the infection damages the body and produces signs and symptoms indicating the body is unhealthy. Infectious Agent Infectious agents are microorganisms such as bacteria, fungi, viruses, protozoa, and parasites that can cause infectious disease. www.mayoclinic.com/health/infectious-disease/ID0004

4. Infectious Disease Examples Common Cold Influenza Meningitis Chickenpox Staph / Methicillin-resistant Staphylococcus aureus (MRSA) Tuberculosis Severe Acute Respiratory Syndrome (SARS) Head lice Ringworm Salmonellosis Chlamydia Human Immunodeficiency Virus (HIV) Hepatitis A, B, and C www.go.mb.ca/health/publichealth/cdc/fs/infcontshelter.pdf

5. Influenza Seasonal Flu - Respiratory illness caused by influenza viruses - Annual outbreaks among humans - Vaccination available H1N1 (Swine) Flu - Contagious new influenza virus - Vaccine will be available H5N1 (Bird) Flu - Highly contagious, deadly infection occurs naturally among birds - Presently, no sustained human-to-human transmission - May evolve to infect and spread among human population - No vaccine Pandemic Flu - World-wide outbreak of any new strain of influenza virus - Little or no human immunity - No vaccine www.flu.gov

6. How Are Infectious Diseases Spread? Understanding how infectious diseases are spread is important for minimizing the risk of infection and preventing disease transmission. Three ways in which infectious diseases can be transmitted: Direct transmission Indirect transmission Airborne transmission www.cdc.gov/ncidod/dvrd/spb/mnpages/glossary.htm

7. Direct Transmission Direct transmission occurs when an infectious agent is transferred directly into the body such as through the eyes, nose, mouth, or through a break in the skin such as a cut on the finger. Infectious agents are spread directly in the following ways: Person-to-person through physical contact including touching, biting, hugging, or kissing Example: MRSA, Hepatitis Animal-to-person through physical contact, bites, and scratches Example: Ringworm, Rabies Infectious droplets during coughing, sneezing, talking, singing, and spitting (spread is limited to approximately three feet) Example: Cold, Influenza www.cdc.gov/ncidod/dvrd/spb/mnpages/glossary.htm

8. Indirect Transmission Infectious diseases are spread indirectly through vehicles and vectors. Vehicle-borne transmission Some infectious agents can linger on inanimate objects, such as desks, chairs, computer keyboards, doorknobs, faucets, toys, eating utensils, or clothing. Example: Touching a pencil used by a person infected with the flu and then touching the eyes, nose, or mouth before performing hand hygiene. Other vehicles include food, water, and biological products such as blood and body fluids. Example: Eating peanut butter contaminated with Salmonella, or pepperoni contaminated with E. coli. Vector-borne transmission Common vectors include insects, such as mosquitoes, ticks, and lice. Example: Becoming infected with West Nile Virus as a result of being bittenby an infected mosquito, or sharing a comb with someone who has head lice. www.cdc.gov/ncidod/dvrd/spb/mnpages/glossary.htm

9. Airborne Transmission Airborne transmission is the spread of infectious agents as aerosols that usually enter the respiratory tract. Unlike the infectious droplets, these tiny particles have the ability to remain suspended in the air for long periods of time and travel long distances. Tuberculosis, chicken pox, and the measles are examples of infectious diseases spread by airborne particles. Example: An individual becomes infected with Severe Acute Respiratory Syndrome (SARS) by inhaling infectious airborne particles while on a crowded bus. www.cdc.gov/ncidod/dvrd/spb/mnpages/glossary.htm

10. Importance of Hand Hygiene Hand hygiene, including handwashing and the use of hand sanitizer, is extremely important in preventing infectious disease transmission in a classroom environment. Many people tend to minimize the significance of hand hygiene, often forgetting or eliminating hand washing due to busy schedules, lack of available soap and water, and inconvenience, but this is the single most important practice to prevent the spread of infectious disease. It is also the best method to protect children from infection in the classroom setting. www.cdc.gov/cleanhands

11. Handwashing Three necessary components of proper handwashing include: Soap Clean water Friction www.cdc.gov/cleanhands/

12. Proper Handwashing Technique Wet hands with clean warm water. Apply soap and rub hands together to create a lather. Scrub all surfaces of the hands including the palms, back of hands, wrists, between fingers, and under fingernails. Continue washing hands for 20 seconds, about the time it takes to sing the “Happy Birthday” song twice. Rinse hands well to remove all soap. Dry hands completely with a towel or air dryer. If available, use a towel to turn off the faucet and open the door to avoid recontamination. www.cdc.gov/cleanhands/

13. Easy to Miss Areas Using proper technique is essential to sanitizing hands effectively. Inadequate handwashing causes significant areas of the hands to be missed. All areas of the fingers, hands, and wrists must be covered during hand hygiene. By imagining the rapid method generally used when washing hands, it is easy to understand which places are most frequently ignored. Insufficient handwashing often involves rubbing the palms together with soap and water and possibly a quick swipe across the back of each hand. This is clearly depicted in the following diagram of frequently missed areas during handwashing. www.foodlink.org.uk/factfile_c.asp?file=2&chapter=2

14. Frequently Missed Areas http://www.leics.gov.uk/index/social_services/general_information/partners/handwashing.htm

15. When to Wash Hands After blowing the nose, sneezing, or coughing After going to the bathroom After contact with blood or body fluids, such as saliva, nasal secretions, urine, feces, or vomit After PE or playing sports After playing outside at recess After handling garbage or waste When hands appear soiled Before preparing medicine or handling contact lenses www.cdc.gov/cleanhands/

16. When to Wash Hands (2) Before preparing, serving, or handling food Before eating lunch or snacks Frequently when sick or after contact with others who are sick Before and after touching a cut or wound Before and after touching the eyes, nose, or mouth After handling animals, animal waste, or their belongings, such as toys or a leash After changing a diaper www.cdc.gov/cleanhands/

17. Waterless Alcohol-basedHand Sanitizer When to Use Substitute when soap and water are not available. Ineffective for cleaning hands that are visibly dirty. Do not substitute when handling or preparing food. Do not overuse; traditional handwashing is best. Supervise children while they use hand sanitizer. Two necessary components Alcohol-based hand sanitizer Friction www.health.state.mn.us/handhygiene/clean.html

18. Proper Hand Sanitizer Technique Proper Technique Apply small amount of hand sanitizer to the palm. Rub hands together covering all surfaces, much like when washing hands with soap and water. Rub until hand sanitizer is absorbed completely and hands become dry. www.health.state.mn.us/handhygiene/clean.html

19. Hand Washing & Absenteeism Am J Infect Control 2002; 28: 340-6

20. “A study of 305 school children found that those who washed their hands four times a day had 24% fewer sick days due to respiratory illness and 51% fewer sick days due to upset stomach.” www.cdc.gov

21. Classroom Hand Washing Activity Ideas Practice washing hands properly with children. Have them sing the “HAPPY BIRTHDAY” song twice to demonstrate 20 seconds. Ask children to draw pictures of when it is a good idea to wash hands. Publish hand washing facts in bathroom stalls or school newsletter. For younger kids, place posters in restrooms illustrating children washing hands to encourage hand hygiene.

22. Other Learning Activities Use fluorescent hand lotion to test hand washing effectiveness and to observe how germs spread between hands, surfaces, pens, etc. Swab high-traffic surfaces and culture on agar in a Petri dish or touch fingers to the agar and then incubate to demonstrate the growth of microorganisms. Share infection prevention training with parents at parent-teacher meetings to disseminate education to the home.

23. Hand Washing Song ABCDEFG Wash your hands to stay healthy. Palms and backs and fingers, too. Under nails germs hide from you. Before you eat and after play, Wash your hands throughout the day.

24. Fun Online Resources The following are additional informative internet links providing more resources to teach children about infection prevention, including online games that students can explore in the classroom or at home. • INFECTION DETECTION PROTECTION Fun interactive online activities provided by the American Museum of Natural History • FIGHT BAC! Animated bacteria fighting games • CLEAN HANDS COALITION List of handwashing resources for children and adults • THE SCRUB CLUB Animated website with activities, games, music, and tips for teaching kids. Some materials also available in Spanish • LATHER UP FOR GOOD HEALTH! Internet, Classroom, and Home Activities by SOFTSOAP

25. Additional Activities & Materials Please take a moment to explore the following online resources for helpful teaching materials about infection prevention. Some of the links include a video, suggestions for infection prevention related lesson plans, a classroom experiment, printable classroom activity sheets, and other fun learning activities for children. • VIDEO: 10 QUICK & QUIET STEPS TO HAND WASHING SUCCESS A creative and fun instructional video developed by a school nurse and students. The Real One player is needed to view the video. To install Real One Player click • HANDWASHING PROJECT IDEASMultidisciplinary activities for teachers and students to promote handwashing • HAND HYGIENE EXPERIMENTClassroom science experiment to demonstrate persistence of bacteria and proper handwashingtechnique • TEACHING HAND HYGIENE Materials, curricula, and ideas for teaching hand washing to all ages • INFECTION PREVENTION WORD GAMESPrintable infection prevention word games

26. Clean Classroom Environment Maintaining a clean classroom environment reduces the presence of germs and the spread of infectious diseases, and therefore, protects the health of students, teachers, school staff, and parents.

27. General Infection Prevention • Encourage children, teachers, and all school personnel to wash hands frequently using soap and water for 15-20 seconds and to assist children as needed. • Substitute alcohol-based hand sanitizer when clean water and soap are unavailable. • Promote appropriate respiratory etiquette: Cover coughs and sneezes with tissue. Throw away tissues immediately and use hand hygiene. If a tissue is not available, sneeze or cough into the elbow or upper sleeve. Following general infection prevention measures and maintaining personal hygiene reduces the spread of infectious diseases in a school setting.

28. General Infection Prevention (2) Teach children to properly dispose of used tissues. Provide tissues and trash receptacles in classrooms and on school buses. Advise parents to keep sick children home from school. Remain at home when ill and encourage others to do the same. Avoid close contact (less than 3 feet of space) with those who are sick. Maintain and promote good personal hygiene; bathe and wash hands regularly. Discourage touching the eyes, nose, and mouth. Maintain a clean classroom environment. Ensure commonly used areas such as door handles, eating surfaces, and desks are clean and disinfected.

29. General Infection Prevention (3) Keep open wounds clean and covered with a bandage until healed. Avoid contact with other people’s wounds and bandages. Discourage sharing eating utensils, glassware, or personal items such as toothbrushes, combs, razors, towels, clothing or other items that come into contact with bare skin. Clean shared sports equipment with antiseptic before each use or use a cloth or a towel as a barrier between the skin and the equipment. Avoid skin-to-skin contact with anyone who has a Staph infection. Encourage a healthy lifestyle that includes a nutritious diet and adequate sleep.

30. Additional Considerations The incorporation of animals into the classroom environment can provide many beneficial learning experiences for children. It is important to keep in mind the risks of Zoonotic Diseases, or those that are transmissible from animals to humans. The following considerations are important when dealing with animals in a classroom: Always wash hands very thoroughly after touching animals or their belongings Ensure animals have current vaccinations and receive annual veterinary exams Bathe animals regularly Avoid contact with animal waste or food Only handle a new animal with permission and supervision Teach children the proper way to handle the animal

31. This concludes the train-the-trainer activity, Infection Prevention in the Classroom Setting. We hope you have enjoyed this presentation and will utilize and share this information with your schools to help keep children healthy and prevent the spread of infection in the classroom setting. The End

32. Questions? Please direct any questions to the following: Sherry Falgout, MPH Manager, Public Health Practice Programs Office of Special Programs Texas A&M Health Science Center School of Rural Public Health (979) 845-2387 slfalgout@srph.tamhsc.edu