Health and Safety of Staff and Children

1. Health and Safety of Staff and Children 2011 Margaret Poppe RN, MSN

2. Child Care Worker’s Health Working in Child Care settings can be associated with: • Increased exposure to infectious Diseases • Muscle and Skeletal Injuries • Falls • Environmental Hazard Exposure • Stress

3. Developmental Injury Risks for Children

4. Preventing Injuries in Child Care Settings What types of injuries: • Minor (cuts, scrapes, bruises) • Severe( head injuries and broken bones, internal injuries, dental injuries) How: • Falls • Collisions • Drowning Why: • Physical ability • Hazards • Lack of supervision

5. Site Specific Safety Assessment Checklist • Every child care facility should have daily and monthly safety checklists in place that are specific to their own facilities and environments. • Create injury prevention and response policies and assure that all staff are aware. Adapted from : The National Training Institute for Child Care Health Consultants

6. Supervision • Be alert and attentive • Be aware of age-appropriate equipment • Evaluate and inspect hazards • Know and apply safe playground rules • Teach children correct use of equipment • Be consistent with adult-child ratio • Intervene for inappropriate behavior • Ensure safe clothing for children • Assign staff to a “zone” and rotate Adapted from : The National Training Institute for Child Care Health Consultants

7. What is Sudden Infant Death Syndrome (SIDS)? • SIDS is the unexpected death of seemingly healthy babies 12 months or younger. • No cause of death is determined by • Death scene investigation and autopsy. • Review of baby’s medical history. • Experts cannot predict which babies will die from SIDS. Reducing the Risk of SIDS in Child Care Speaker's Kit http://www.healthychildcare.org/sids.html Willinger M, James LS, Catz C. Defining the sudden infant death syndrome (SIDS): deliberations of an expert panel convened by the National Institute of Child Health and Human Development. Pediatr Pathol. 1991;11:677–684 Revised – 12/08

8. Critical development period SIDS Vulnerable infant External stressors Triple Risk Model Reducing the Risk of SIDS in Child Care Speaker's Kit http://www.healthychildcare.org/sids.html Revised – 12/08

9. Rebreathing Theory • Infants in certain sleep environments are more likely to trap exhaled CO2 around the face • Lie prone and near-face-down/face-down • Soft bedding • Tobacco smoke exposure • Infants rebreathe exhaled CO2 : CO2 ↑ & O2 ↓ • Infants die if they cannot arouse/ respond appropriately SIDS and Sleep-related Deaths: Current Statistics, Accomplishments & Challenges Fern R. Hauck, MD, MS, Department of Family Medicine ,University of Virginia

10. Reasons that people place babies on their tummies • They think that babies are more likely to choke or aspirate if they vomit or spit up • They are worried that babies won’t sleep as well • Parental requests Reducing the Risk of SIDS in Child Care Speaker's Kit http://www.healthychildcare.org/sids.html Revised – 12/08

11. Anatomy when sleeping on stomach Reducing the Risk of SIDS in Child Care Speaker's Kit http://www.healthychildcare.org/sids.html Revised - 0408

12. Anatomy when supine Reducing the Risk of SIDS in Child Care Speaker's Kit http://www.healthychildcare.org/sids.html Revised – 12/08

13. Tummy to Play and Back to Sleep • Supervised tummy time when babies are awake • Promotes healthy physical and brain development • Strengthens neck, arm, and shoulder muscles • Decreases risk of head flattening and balding • Encourages bonding and play between the supervising adult and the baby • Back to sleep • Reduces the risk of SIDS • Comfortable and safe Revised – 12/08

14. Tummy Time • Tummy time is for babies who are awake and being observed. • It is needed to develop strong muscles. • Have tummy time 2 to 3 times a day and increase the amount of tummy time per day as the baby gets stronger. • There are lots of ways for babies to enjoy tummy time! Reducing the Risk of SIDS in Child Care Speaker's Kit http://www.healthychildcare.org/sids.html Revised – 12/08

15. Safe Sleep Practices • Always put healthy babies to sleep on their backs for naps and at bedtime. Reducing the Risk of SIDS in Child Care Speaker's Kit http://www.healthychildcare.org/sids.html Revised – 12/08

16. Safe Sleep Practices • Avoid overheating. • Do not overdress baby. • Never cover baby’s head with a blanket. • Room temperature should be comfortable for a lightly clothed adult. Reducing the Risk of SIDS in Child Care Speaker's Kit http://www.healthychildcare.org/sids.html Revised – 12/08

17. Safe Sleep Practices • Pacifiers may be offered to babies to reduce the risk of SIDS • If breastfed, wait until breastfeeding is well established (approximately 3 - 4 weeks of age), before offering a pacifier. • If the baby refuses the pacifier, don’t force it. • If the pacifier falls out while the baby is asleep, you do not have to re-insert it. Reducing the Risk of SIDS in Child Care Speaker's Kit http://www.healthychildcare.org/sids.html Revised – 12/08

18. Safe Sleep Environment • Safe crib, firm mattress. • Avoid chairs, sofas, air mattresses, water beds, and adult beds. Reducing the Risk of SIDS in Child Care Speaker's Kit http://www.healthychildcare.org/sids.html Revised – 12/08

19. Emergencies in Child Care Facilities • General emergencies • Missing children • Disgruntled or impaired parents/guardians or their authorized representatives • Medical emergencies • Natural disasters, including hurricanes, tornados, and severe storms • Fire/smoke emergencies • Bioterrorism/war emergencies (such as bomb threats) • Nuclear or radiation emergencies • Utility disruption • Hazardous materials • Chemical leaks The National Training Institute for Child Care Health Consultants, 2009

20. Grab and Go Kit • List of emergency phone numbers, including parent contact information • A charged cell phone or calling card or “walkie talkies” • Water • Non-perishable food, manual can opener • First aid kit • Blankets • Radio, flashlights, extra batteries • Handwashing solution that does not require running water • Extra clothing/shoes • Diapers, baby food and formula • Prescription medicines for children and staff • Other items as needed for safety and comfort • Child records and attendance sheets The National Training Institute for Child Care Health Consultants, 2009

21. Musculoskeletal Injuries and Falls Risk Factors • Heavy lifting and carrying • Sitting on the floor or in child sized chairs with little back support • Kneeling and squatting • Reaching

22. Use “Good Body Mechanics”to Prevent Injury • Use adult size furniture • When rising from child size furniture ( use squat position, back straight, pelvis level, thighs tight • Set up storage so you can reach from normal standing • To get to child level squat or kneel keep spine straight

23. Lifting Children • Feet apart , one foot along side of child one slightly back. • Squat, bend at knees . Tighten stomach keep back straight • Use leg strength • Avoid twisting • Putting child down same process, back straight

24. Other Ways to Prevent Injury • Wear supportive non skid footwear • Regular exercise & stretching • Maintain proper body weight • Floor sitting use the wall for support • Use or request carts for moving heavy objects

25. OSHA Hazard Communication Standard 1910.1200 Requiresthat all employees be informed of the identities and hazards of the chemicals they are exposed to when working • Warning labels should be visible on containers • Products including sanitizing agents should have an MSDS (Material Safety Data Sheets) • Training on proper handling, storage, usage should be provided for staff

26. Environmental Safety for Staff and Children • Avoid use of high solvent cleaners especially carpets • Store cleaning products in their original containers • Pest management should choose the lowest number Health Hazard Rating (0-4) • Only certified professionals should be employed for pest management or mold or mildew treatment

27. Environmental Safety • Art Materials : ASTM-D-4236 or ACMI • Staff should avoid personal use of adult art supplies such as rubber cement and aerosols or turpentine based materials

28. Infectious Disease Concerns ?

29. Why do Young Children Spread Illnesses so Easily ? • Immature immune system & frequent illness • Children need a lot of intimate hands on care • Hand to mouth activity • Children are in close contact • Great number of unrelated children • Age group mixing • Children and staff bring mild illness to school

30. Chain of Infection Route of Transmission Source of Germs Host Attack the source of infection or the “first link” by identification, treatment and, if necessary, isolation of the sick person Attack the route of transmission or the “second link” by personal and general hygiene: Handwashing Protect the vulnerable person or the “third link” through immunization, balanced nutrition, and healthy practices. California Child Care Health Project

31. Modes of Transmission • Droplets • Fecal Oral Route • Skin • Blood or Body Fluids

32. Droplets

33. Stool or Fecal/Oral transmission

34. Skin Contact

35. Blood or Other Body Fluids

36. Group Activity

37. Break the Chain by Enforcing Exclusion Guidelines • http://www.healthychildcare.org/PDF/InfDiseases/Videos/Module3Video2.wmv

38. Break the Chain by Enforcing Exclusion Guidelines Key Points • The ill child is unable to take part comfortably in regular activities • The ill child needs care that significantly interferes with provider’s ability to provide appropriate care for other children • The child has signs or symptoms of a possible serious condition • Signs or symptoms that indicate a contagious illness or condition or has a diagnosed contagious illness Caring for Our Children http://nrckids.org/SPINOFF/IE/IncExc.pdf

39. Exclusion Cont. • Diarrhea that can’t be explained by diet change, is watery , and can’t be contained in the diaper or managed by regular toileting • 2 or more episodes of vomiting in 24 hours • Others See VT licensing regulations

40. VT Exclusion Guidelines • Axillary (armpit) temperature of 100°F or greater and behavior change • Rectal (anus) temperature of 102°F or greater and behavior change • Under 2 months old with temperature 100.4°F or higher rectal contact parent or EMS if not reachable http://dcf.vermont.gov/sites/dcf/files/pdf/cdd/care/ECP_Appendix_B.pdf

41. Break the Chain : Morning Health Check and Exclusion

42. Break the Chain : Immunizations

43. Concept of Herd Immunity If enough of the “herd “ is immunized the whole “herd” is protected . ( 95%) Goal : Aim to get as many children and staff immunized as possible to protect the whole group.

44. Break the Chain :Hand Washing and Sanitizing Handwashing Activity

45. Policy Considerations • What should be Done • Why • Who is responsible • When will it be done • How will it be done • How will it be communicated and enforced

46. What Should a Policy Include? • Title • Belief Statement • Intent Statement • Background • Procedure/Practice • Application © The National Training Institute for Child Care Health Consultants, UNC-CH, 2007

47. What Should a Policy Include? 7. Communication 8. References • Review • Effective Date • Review Date © The National Training Institute for Child Care Health Consultants, UNC-CH, 2007

48. Policy Activity

49. Sanitizing Surfaces Breaks the Chain • 1/4 cup household bleach to one gallon of cool water • One tablespoon household bleach to one quart cool water • Spray don’t dip • Contact time 2 minutes • Mix ever day • Safety issues

50. Safe Diapering Breaks the Chain