Preventing and containing outbreaks

What can schools do to prevent infections spreading? Fiona Riley, chair of the Institution of Occupational Safety and Health’s Education Group and health & safety manager at a large independent day school, examines the controls that can be put in place

The importance of good hygiene in schools cannot be overestimated. A raft of measures can be used to prevent infections, ranging from good hand hygiene to strict controls around the keeping of pets in the building. While most school settings will have considered the need for protocols for dealing with the cleaning of blood and body fluid spillages, clinical waste, laundry and the use of personal protective equipment, consideration should also be made on the impact to those more vulnerable to the risk of infection. Some medical conditions make children vulnerable to infections that would not normally be serious by reducing immunity. These conditions may include children who are suffering from cancer and those who are taking steroids. Such individuals are particularly vulnerable to chickenpox and measles. During pregnancy, German measles (rubella) and slapped cheek disease (Parvovirus B19) can occasionally affect an unborn child. Additionally chickenpox can affect the pregnancy if a woman has not already had the infection. It is important to remember that not all pupils may have current vaccinations.

Setting protocols

When setting protocols to deal with blood and body fluid spillages and clinical waste, the key areas that the policy needs to include and help employees to understand are the types of blood‑borne viruses that exist; the types of work where exposure to a blood‑borne virus may occur; and how blood-borne viruses can spread. Other areas that need to be included are the legal duties of the school (as the employer) and employees; the action to be taken after possible infection with a blood‑borne virus; and the special considerations to be taken by employees who are trained first aiders. In addition to the above protocols, prevention and control measures are the most effective way of managing the risk. This includes ensuring the prohibition of eating and drinking in working areas where there is a risk of contamination and the prevention (where possible) of open wounds, cuts and abrasions, especially in the presence of blood and body fluids. The use of, or exposure to, sharp objects such as needles, glass and metal should be avoided. If use or exposure is unavoidable, care will be taken when handling and disposing of these objects. Devices which incorporate safety features such as safer needle devices and blunt-ended scissors should be used. Waterproof dressings and suitable gloves where employees have breaks in skin that may be exposed to a blood‑borne virus, should be used. Visors or goggles or safety spectacles and a mask should be worn where splashing may occur, as should water-resistant protective clothing. Compliance with good basic hygiene practices, such as hand washing is essential, as is the use of disinfectant where contamination of surfaces may occur.

Good waste management is key

Employees who come into contact with contaminated materials and those who are required to dispose of the materials will be required to cover any cuts or grazes they have with a waterproof plaster or dressing prior to the handling and removal of the materials. They must also wear protective disposable gloves and an apron if contaminated materials need to be handled, as well as dispose of contaminated materials in specially-adapted containers. The school will provide suitable containers appropriate to the contaminates that are to be removed. Those involved must also place all contaminates, including personal protective equipment (which may also be contaminated), into two bags (double bag) and place in a yellow plastic refuse bag.

Keeping the area clear

One of the most effective tools for preventing the spread of infection is to ensure that both pupils and staff remain away from the setting for the recommended periods (usually 48 hours) following an infection. By returning too soon following an illness, the rate of further outbreaks can climb considerably and this regularly results in further absence among fellow pupils and staff. This can be particularly problematic in the early years sector, where parents often do not have alternative childcare arrangements and are keen to return their child to the setting at the earliest opportunity. Be mindful of when the likelihood of infections occur in the academic year and introducing targeted reminders to all pupils and staff can impact on the likelihood of outbreaks of common issues such as norovirus and seasonal influenza. For example, posters in toilet areas reminding of the importance of good hand hygiene and ensuring that consumables are always fully stocked is a good start, as is an increased frequency in housekeeping attendance. At our school, one area we saw considerable benefit in was the positioning of hand sanitisers in communal areas. For example we ensure that all pupils have clean hands before entering the dining hall. Meanwhile the cleanliness of water fountains and water machines, including drip trays, is paramount as these are high-traffic areas. Regular infection control audits can help to ensure housekeeping standards are being met, while regular disinfection of items in communal areas such as play equipment, toys and sand pits can also assist.

Off-site visits and pets

Infection control doesn’t just need to be considered in and around the school premises. What about when children go off site? When undertaking external visits it is important to clean your group’s shoes, pushchairs and so on after farm or countryside visits, to avoid contaminating cars, toys, nursery floors or other surfaces. Outdoor shoes should be changed in environments where children are crawling. Laundry is a key area for hygiene control. With the increased use of wash cycles at lower temperatures this may not be enough to actually kill bacteria. It is important that you do not handle soiled clothing by hand. Place it directly into a named plastic bag or container and seal to prevent further handling, prior to the child’s parent or guardian collecting. The parent or guardian should be advised that the clothing is dirty and should be washed at the highest possible temperature for the fabric. There are of course other potential infection threats, such as supervising children when exposed to pets. Pets must be clean and healthy. Exotic (non-domestic and unusual) animals, such as reptiles should not be kept as nursery pets due to the high risk of salmonella, which they carry. Rodents are also not recommended (if in a childminding setting, they should be excluded from the area children are cared for). Pet living quarters must be kept clean and away from food areas. Activities such as farm visits, or bringing animals into childcare settings, or having pets can expose children to a range of potentially harmful germs including E. coli O157. All animal droppings should be considered infectious.