Infection Prevention and Control Manual For Schools and Childcare Facilities

Infection Prevention and Control
In
Schools and Childcare Facilities
Compiled and Edited

By
Rose Azuike
August 2016
Infection Prevention and Control in Schools and Childcare Facilities 1
INTRODUCTION
Children, by virtue of their young developing bodies are more
susceptible to infections. In schools and childcare centres, children
come in close physical contact with adults (like teachers and nannies)
and other children who like them are also susceptible to infections.
Unhygienic practices as well as limited health knowledge and skills
of staff and children in these facilities can lead to increased frequency
in the occurrence and spread of infectious diseases. These diseases
in certain circumstances can have grave consequences on the
wellbeing, learning and development of children. They can also
impact negatively on the day to day management and reputation of
these facilities. Acquiring basic knowledge and skills in the prevention
and control of infections can help teachers and other caregivers
effectively prevent and control the spread of infections in the
learning environment.
This material provides basic information that teachers and caregivers

can apply to prevent and control the spread of infection in the
schools and childcare facilities. Topics covered include overview of
infections, infection prevention and control strategies, hygiene and
sanitation practices, boosting body immunity and, detection and
management of sick persons.
Infection Prevention and Control in Schools and Childcare Facilities i
TABLE OF CONTENTS
UNDERSTANDING INFECTIONS....1
What is infection? ............................................................. 3
Causes of infections ...4
Signs and symptoms of infections 8
Infection Process ..9
Factors that can contribute to the occurrence and spread of

infections in childcare centres and schools 19
INFECTION PREVENTION AND CONTROL STRATEGIES.....25
How to prevent and control infections .27
Strategies for Infection Prevention and Control in Childcare

and Schools .27
Ensuring Effective Infection Prevention and Control in

Childcare and Schools ....................................................41
HYGIENE AND SANITATION PRACTICES45
Hand Hygiene ....47
General Cleaning and Disinfection 53
Diaper Hygiene ..59

Table of Contents ii
Toilet Hygiene .63
Washing and Disinfection of Clothing and Bedding ...66
Washing and Disinfection of Toys ..68
Cleaning Spills ....69
Food Hygiene .....70
Waste Management ..75
HEALTH PROMOTION: BOOSTNG BODY DEFENCES...77
Immunization ..79
Health Education .82
Nutrition Services ..85
Physical Activity ....86
DETECTION AND MANAGEMENT OF THE SICK....88
Daily Health Checks .90
First Aid 92
Exclusion ....93
BIBLIOGRAPHY.96
UNIT ONE
UNDERSTANDING
INFECTIONS
Unit 1: Understanding Infections 2
Understanding infections is essential for preventing and controlling

them. This unit explains what infections are, their causes,
characteristics, how they are spread and factors that contribute to
the spread of infections in schools and childcare facilities.
Topics addressed in this unit include:
What is infection? ....................................................................................................... 3
Causes of infections .................................................................................................. 4
Signs and symptoms of infections ..................................................................... 8
Infection Process ......................................................................................................... 9
Factors that can contribute to the occurrence and spread of

infections in childcare centres and schools ................................................ 19
WHAT IS INFECTION?
Infection is the process by which organisms not normally present in
the body, enter the body, multiplies and causes harm (like an illness).
Sometimes organisms that are normally present in a particular part
of the body can enter another part of the body and cause harm.
The presence of organisms in the body triggers some reactions

(immune response) aimed at fighting off the organisms and
protecting the body from disease. In some cases the body is
successful and does not develop disease. In other cases the body is
unsuccessful and develops disease. This disease manifest as signs
and symptoms. In a few cases however, the body shows no
symptoms despite being unable to fight off the organisms.
Common terms related to infection:

Contamination With respect to the human body, contamination is
the presence of unwanted organisms, materials, chemicals and other
substances on or in the body.
Infectious diseases These are illnesses resulting from an infection.

They occur when microorganisms successfully multiply in the body,
overpower the immune system and cause damage.
Colonization This is when microorganisms are found living on a

particular part of the body without causing an infection.
Infestation This is the invasion of the body, either the surface or

internal structures, by parasites and pests.
Communicable/transmissible This refers to an infection that can

spread from one individual to the other.
Contagious This is a term used to describe an infection that

spreads easily through contact with infected persons or their
secretions.
CAUSES OF INFECTIONS
Infections are caused by different types of organisms. While most of
them are microscopic (that is, they cannot be seen with the naked
eye), others are large enough to be seen without the aid of a
microscope. Microscopic infectious organisms are called germs and
there are four main types namely: bacteria, viruses, fungi and
protozoa. The larger infectious organisms include arthropods and
helminthes (parasitic worms).
Viruses
Bacteria
Fungi
Protozoa
Helminthes
Arthropods
Viruses
These are very tiny organisms that can only grow and reproduce
inside other living cells. For this reason, they do not survive for long
periods outside their host cells. When they enter the cells of their
host organisms, they bind to internal structures of the hosts cells

and multiply.
Cells generally have special structures on their surface, called

receptors. These receptors vary from one cell type to another. Viruses
have an affinity for and bind to only specific cell receptors. This is
why different viruses attack different kinds of cells. For instance, the
human immunedeficiency virus (HIV) has affinity for the CD4
receptor found on some cells of the immune system. It binds to these
receptors, multiplies and destroys the cells one after the other. This
gradually depletes the CD4 cells and can completely destroy the
immune system if no intervention takes place.
Treatment for viral infections is very difficult because most of them

do not respond to medications. The very few that can be treated
include herpes and influenza virus infections. Treatment for viral
infections generally involves relieving symptoms until the infection
completes its natural course. Fortunately, we recover fully from many
viral infections without medical treatment. There are, however, viral
infections with very severe symptoms, and can cause disability or
even death before completing their course. Important examples
include the viral hemorrhagic fevers (Ebola, Marburg and Lassa fever).
Prevention is always a better approach with viruses since they are

difficult to treat once in the human cells. Good hygiene, healthy
lifestyles and immunization are measures that can prevent viral
infections. Many viral illnesses, such as hepatitis B, measles, mumps

and chicken pox, can be prevented through immunization.
Bacteria
Bacteria are found everywhere, including on and in the human body.
Most of them do not cause any harm, and some are essential for
normal body function. Some, however, can invade the human body
and cause harm. While in the body, they can reproduce very quickly
by dividing this means that a single bacteria can practically give birth
to an entire colony of 30 million. Some bacteria can evade the bodys
immune reaction and some produce toxins which directly damage
cells and tissues.
Bacteria can cause severe illness. Thankfully, medications for

treatment are usually available, and people recover fully if treated
promptly. Examples of bacteria include streptococcus pneumoniae
(which causes pneumonia), salmonella typhi (which causes typhoid
fever), mycobacterium tuberculosis (the most common cause of
tuberculosis), and vibrio cholerae (which causes cholera)
Fungi
These are traditionally classified as plantlike organisms but are
different from plants, animals and bacteria. They may be singlecelled
or multicellular. Examples include molds, yeasts, mildews and
mushroom. They feed on living and dead matter, and are usually
found in damp and warm places. They survive on surfaces for long
periods. While some fungi like edible mushrooms and yeasts are
used cooking and baking, others cause infections. An important
example of a disease causing fungus is candida a type of yeast that
causes thrush, eczema, tinea pedis and athletes foot.
Protozoa
Protozoa are onecelled organisms that are larger than bacteria and
viruses. Most of them live in soil or water. While some are freeliving,
others are parasitic Parasites live on or inside other living things and
feed on their host. Common protozoa are plasmodium (which causes
malaria), amoeba (which causes dysentery) and trypanosomes (which
causes sleeping sickness).
Helminthes
These are large, multicellular and wormlike organisms. They can
invade the human body following ingestion of food or water
contaminated with their eggs. While in the human body, the eggs
hatch and the larvae extract nutrition from their surrounding human
cells. This disrupts the normal function of these cells and causes
clinical symptoms. Examples of helminthes include roundworm,
pinworm, threadworm, guinea worm, tape worm and hook worm.
Arthropods
These are species of animals without backbones and they have their
skeletons located outside their body. Some of them infest the body,
while others cause harm through bites and stings. Examples of
arthropods include ticks, lice, and mites. While arthropods can cause
diseases on their own, many of them are also vectors (carriers of
microscopic organism) that spread other diseases.
SIGNS AND SYMPTOMS OF INFECTIONS

Symptoms and signs are respectively the subjective and objective
characteristics of an infectious disease.
Symptoms refer to the experiences of an individual who has an

infectious disease. They include feeling warm, sweaty or thirsty. Signs
on the other hand are observable changes or conditions associated
with an infectious disease. These changes are observed by others or
discovered by a doctor during examination. An example is a rise in
body temperature detected by a thermometer.
Note: An individual may have an infection but not experience any

symptoms. Such a person is said to be asymptomatic.
Common symptoms and signs of infections in children

include
Fever
Cough
Runny nose or nasal congestion

Itching
Rash
Changes in behavior such reduced activity
Breathing difficulty
Aches and pains
Sores
Vomiting
Diarrhea
INFECTION PROCESS
Key Elements of Infection Process
Infectious
organism
Susceptible Favourable
People Environment
Figure 1.1: Key elements of the infection process

Infectious diseases result from the interaction of infectious organism

(agent), host (susceptible people), and favorable environment.
Normally, infectious organisms will cause infection only in susceptible
persons that are in an environment that favours the growth and/or
spread of infectious organisms.
The mechanism of infection is varied amongst infectious organisms.

This mechanism depends on various factors including the type of
infectious organism, the way it is spread and the bodys reaction to
its presence.
Under favourable conditions, infectious organisms invade or infest

the body, replicate and cause damage. The damage they cause are
manifested in clinical signs and symptoms such as fever, swelling,
redness and pain. Some infections however do not show symptoms.
These are known as asymptomatic or subclinical infections. People
with asymptomatic infections can still spread infections to others
they are called carriers.
Chain of Infection
This refers to the processes an infectious organism undergoes to
cause infection. It describes the sequential interaction between
infectious organisms and people within the environment. An
intervention at any point in the chain can stop the spread of
infection.
Infectious Portal of mode of portal of susceptible

Reservior
organism exit transmission entry host
Figure 1.2: Chain of Infection
The components of the chain of infection include:
The infectious organism

Reservoir
Portal of exit
Modes of transmission
Portal of entry
Susceptible host
The infectious organism is the organism that causes infection such

as a bacterium, virus or fungus.
The reservoir is the usual habitat of the organism where it lives and
multiplies or a place where it survives without multiplying. The
reservoir serves as the source from which infection spreads.
Living reservoirs could be humans or animals with symptomatic or

asymptomatic infections, or those colonized by organisms that have
the potential to cause infections when favourable conditions arise.
Non living reservoirs could be water, soil, objects and equipment.
Portal of exit refers to the route by which an organism leaves the

reservoir. Some infections may have more than one portal. Common
examples include respiratory, faecal, urogenital and skin routes.
Modes of transmission refers to the way through which infections

spread. For transmission to occur, the infectious organism must leave
the reservoir and enter the body of a susceptible person. The
mechanism by which the organism leaves the reservoir and enters
the body of a susceptible host defines the mode of transmission. The
portals of exit and entry define the route of transmission.
The portal of entry is the route by which the organism enters the
susceptible host. These portals include oral, respiratory, skin and
urogenital routes, commonly the same as the portal of exit. Variations
also occur as in the case of faecooral infections.
The susceptible host is one who contracts disease on contact with

an infectious organism. The ability of an infectious organism to cause
an infection in a host will depend on the following:
1. The infectious dose of the organism: While some organisms

need to invade or infest in large numbers to cause infections,
others can cause infection in small numbers. For instance,
shigella dysenteriae causes dysentery at a low infectious dose
(10 100). Comparatively, vibrio cholera, causative agent of
cholera, can only cause with an infectious dose of a million
to hundred million (Diseases and disease transmission n.d.).
2. Virulence of the organism: This is the inherent ability of an
infectious organism to invade the hosts body and cause
disease.
3. Whether the organism can overcome the protective
mechanisms of the body: The human body has many
protective barriers:
The skin
The immune system
The antimicrobial substances in the mucous
membrane
Acidity of the stomach
The strength of these barriers is influenced by the general state of

health of the susceptible host. The healthier an individual is, the
stronger the body defenses will be. Infectious organisms are
therefore less able to infect healthy persons with strong body
defenses. Factors that may increase susceptibility to infection by
disrupting host defenses include malnutrition, alcoholism, and
disease or therapy that impairs the nonspecific immune response
Modes of Transmission
These are the different pathways by which infections are spread in
the human population. There are two major modes of transmission,
namely contact and noncontact. Each of these modes is further
subdivided into three as shown in the diagram below:
Direct
contact
Indirect
Contact contact
Droplet
Modes of
transmission
Airborne
Point source
Vehicle-
Non-contact borne
Continuous
source
Vector-
borne
Figure 1.3: Modes of Transmission
Spread by direct contact occurs when an infection is spread by

direct physical contact between an infected person and a susceptible
individual. At childcare and school setting, it occurs mostly through
skintoskin contact. Examples include Ebola virus and scabies.
Spread by indirect contact takes place when a susceptible individual

touches surfaces that have been contaminated by secretions from an
infected person examples of secretions include vomit, blood, salvia,
urine, sweat, mucus or faeces. Many infections that spread by direct
contact also spread by indirect contact.
Spread through contact with droplets happens when someone

coughs, sneezes or vomits. Mucous secretions containing infectious
organisms are deposited on surfaces in the environment or are
splashed in a way that they are carried in the air for short distances.
Droplets may fall on the body of persons in proximity, and can also
be touched with the hands or inhaled. From the hands, the infectious
organisms get easy access to susceptible locations such as the site
of an injury, mucus membranes of the ear, nose and eyes.
Spread through the air occurs when very tiny particles (aerosols)
containing infectious organisms are carried in the air for long
distances. Persons who have not had any close contact with the
infected person can become infected by inhaling these particles
which may have travelled far propelled by air currents, ventilators
and air conditioners or which may been suspended in the air in an
enclosed environment. Infections that spread this way include
chicken pox, measles and tuberculosis.
Spread by vehicles involves a single contaminated source (known as

the common source) spreading infection to several people. Common
sources of infection include food and water. The common source can
either be a point or continuous source depending on whether people
are infected at the same time or over a period of time. A point source
infection usually occurs in a particular area over a short period of
time while continuous source infections are more widespread and
last for longer periods. For example, children may develop food
poisoning after a particular meal at a childcare centre or school this
is a point source infection. Here, that particular meal is the point
source. On the other hand, an outbreak of cholera in a village, which
occurs over a period of 6 months and is traced to the common water
supply, is a continuous source infection.
Spread by vectors occurs when an infection is spread by insects and

animals. Common diseases spread by vectors include malaria (spread
by mosquitoes), sleeping sickness (spread by tsetse fly), and
onchocerciasis (spread by black fly).
Did You Know This?

The part of the body that is most responsible for the spread of
infections is the hands.
When you have an infection, you can easily pass it on to others

through your hands (by touch). The infectious organisms can move
from your secretions vomit, faeces, urine, blood, mucous and sweat
to your hands and from your hands to others hands and from their
hands into their bodies if they touch an open wound or their nose,
mouth and eyes without washing their hands.
Routes of Transmission
This refers to the path of transmission from the reservoir to the
susceptible host. It is defined by the point of exit on the reservoir
and the point of entry on the susceptible host. Common routes of
transmission include:
Respiratory route
Fecal-oral route
Skin-to-skin route
Blood route
Urogenital route
Respiratory route of transmission entails spread of infection through

the respiratory system. The infectious organism leaves the reservoir
through actions such as coughing or sneezing; it enters the
susceptible host through inhalation or direct contact with mucous
membranes of the nose, eyes or mouth. This is a very common route
of transmission in childcare centers and schools. Children are prone
to respiratory infections because of their inadequate hygiene skills
and behaviours. Children do not wash their hands frequently and
when they do, it is usually not done properly. Also, many young
children have the habit of sucking their thumbs and fingers, rubbing
their eyes and nose and also putting things like their toys in their
mouth. This gives easy access to the infectious organism.
Faeco-oral route starts from the faecal shedding of infectious

organisms from infected or asymptomatic individuals; in unsanitary
conditions infectious organisms find their way into the food and
water supply (For instance, through the hands of unhygienic food

handlers). Children are prone to this route of spread due to habitual
mouthing of objects from the environment. In childcare centers and
schools contamination of the environment with faeces (from used
nappies/diapers or a broken septic tank, for instance) and poor hand
washing practices of staff and children are major risk factors for
infections spread through this route.
Skin to skin route spreads organisms through direct skin contact

with an infected person, or contaminated clothing, beddings and
other items. Risk factors for the occurrence of this type of spread in
childcare center or school include sharing of clothing and bedding,
and presence of children with oozing sores.
Blood to blood/mucosa route is taken by organisms that spread

through blood, and sometimes other body fluids as well. The
infectious organism can leave the reservoir through the blood and
enter the blood of a susceptible host through blood transfusions or
needle prick injuries, etc. Diseases that spread this way include HIV
and hepatitis B. This route of transmission is not common in childcare
centers and schools. An interesting example is the entry of
clostridium tetani into the blood stream when a person is injured by
falling or grazing against environmental surfaces, such as roads,
gravel and walls. This results in a lethal condition known as tetanus.
Urogenital route is the spread through the urogenital organs of the

body as in the case of sexually transmitted diseases and some urinary
tract infections. This route of transmission is rare in childcare center

and school settings.
FACTORS THAT CAN CONTRIBUTE TO THE

OCCURRENCE AND SPREAD OF INFECTIONS IN
CHILDCARE CENTRES AND SCHOOLS
The occurrence and spread of infections in childcare centres and
schools is a long documented issue. Infections occur more frequently
in these settings for various reasons. Some are shown in the figure
below. Common infection in children include diarrheal infections,
worms, upper respiratory tract infections and skin infections.
Infections are more common among infants and toddlers. By
preschool age (3 5 years), the risk of infection decreases
significantly, by about 50-80%, according to Shope (2014).
Some of the actors that can contribute to the spread of infections in

childcare centres and schools are as shown in figure 1.4.
Immaturity of children
Children are immature physically and behaviourally and this can
encourage the spread of infections.
Less developed immune systems increase their risks for
infections because they are not protected from certain

diseases.
They rely on adults to take care of them and in the childcare
centres and schools this can encourage the spread of

infections through contact because children come in contact
with various adults who also come in contact with other
children.
Incontinent children can spread infections if they

contaminate the environment with their faeces and urine.
Large
number of
Poor children Small-
hygiene sized
practices facility
Inadequate Inadequate
number of hygiene
staff resources
Factors that can

Immaturity contribute to Untrained
of children the spread of staff
infections
Figure 1.4: Factors that can contribute to the spread of infections in childcare
centres and schools
Young children frequently mouth objects in their
environment. They also cough, sneeze, and drool and this

can contaminate the environment with germs. Respiratory
infections can be easily spread this way.
Young children have short Eustachian tube (a tube in the ear
that connects the middle ear to the back of the ear) and are
therefore more prone to ear infections especially during an
outbreak of respiratory infections in the setting.
Young children are less capable of maintaining basic hygiene
because they do not yet have good hygiene skills.
Large number of children

Children in childcare centres and schools have close interactions with
one another, their teachers and caregivers. These interactions provide
opportunities for infections to spread. Childcare centres and schools
with a greater number of children will have more frequent
interactions, and therefore an increased risk of infection.
Poor hygiene practices

Includes poor hand washing, poor diapering techniques, inconsistent
cleaning routines and poor food hygiene. Poor hygiene practices can
facilitate the spread of infections in any environment, but its impact
is greater in childcare centres and schools where children are more
vulnerable to infections.
Inadequate hygiene infrastructure

Includes a lack of running water, soap, hand sanitizers, gloves,
cleaning liquids and disinfecting solutions. Inadequate hygiene
infrastructure leads to poor hygiene practices, which can result in the
rapid spread of infections within a childcare centre or school.
Untrained staff
Staff in childcare centres and schools who lack experience, education
and training in appropriate hygiene practices will be more likely to
spread infections. Even a staff member with good personal hygiene
may be unaware of proper diapering techniques or how to manage
a sick child, and this can lead to the spread of infections.
Inadequate number of staff

Teachers and caregivers in an understaffed facility will be overworked
and find it more difficult to adhere to good hygiene practices. In
addition, staff who care for and have contact with a large number of
children will be more likely to spread infections than staff who work
with smaller groups.
Childrens age Adult to child ratio Maximum number of
children in a group
Under 6 weeks 1:3 6
6 weeks 18 months 1:4 8
18 36 months 1:5 12
3 years 1:7 18
4 years 1:8 21
5 years 1:9 24
6 9 years 1:10 20
10 12 years 1:15 30
Table 1: Recommended adult to child ratios in childcare centres and

maximum group/class sizes. Source - Child Development Council.
(http://www.childdevelopmentcouncil.org)
Size of the facility

Large facilities with a greater number of children tend to have a
greater risk of infection. However, small facilities also have an
infection risk if there is overcrowding. The size of the facility should
be considered alongside other factors such as the number of
children, general health and hygiene practices, and staff training and
workload when considering the spread of infection.
Common infections in Behaviors that encourage the spread of
childcare centres and infections in childcare centres and
schools schools
Cold Coughing and sneezing into the air

Respiratory
Pneumonia Wiping nose and not washing hands

Chicken pox afterwards
Measles Sharing mouthed toys
Poor ventilation
Food poisoning Not washing hands before food
Gastro-enteritis preparation
Intestinal worms Using dirty utensils when preparing or
eating food
Not cooking food thoroughly.
Contamination of cooked food with raw
food
Not washing hands after changing diapers
Faeco-oral
or using the toilet

Not disinfecting diaper change tables after
use
Sharing mouthed toys
Common infections in Behaviors that encourage the spread of

childcare centres and infections in childcare centres and
schools schools
Eczema Sharing clothing and bedding
Skin to skin
Scabies Touching the skin of an infected person

Ringworm Poor personal hygiene
Lice Lack of cleanliness in facility
Athletes foot
Conjunctivitis Touching the face or rubbing infected eyes
and not washing hands afterwards
Sharing contaminated towels
Other
UNIT TWO
INFECTION
PREVENTION AND
CONTROL STRATEGIES
FOR CHILDCARE AND
SCHOOLS
Infection Prevention and Control Strategies 26
This unit addresses strategies that staff of schools and childcare can
apply to prevent and control the spread of infections in the school
environment.
Topics addressed under this unit include:
How to prevent and control infections ......................................................... 27
Strategies for Infection Prevention and Control in Childcare and

Schools ......................................................................................................................... 27
Ensuring Effective Infection Prevention and Control in Childcare and

Schools ......................................................................................................................... 41
HOW TO PREVENT AND CONTROL INFECTIONS

To prevent and control infections, it is important to understand the
chain of infection. The chain of infection has three key links: reservoir
(human, animal or environment), transmission (contact versus non-
contact) and host. (See chain of infection).
The prevention and control of infections involves putting in place

measures to break the links in the chain of infection. The most
common approach is to identify and break the weakest link in this
chain, which in most cases is the transmission phase.
Other links in the chain of infection may be difficult to break. It can

be challenging to eliminate or control infections in the reservoir (e.g.
the environment), or to make the host less vulnerable to infection.
However, the more links in this chain that can be broken, the smaller
the chance that the germs will make it to infect a child. There are
various infection prevention and control methods and they can be
grouped according to the link in the chain of infection that is being
targeted.
STRATEGIES FOR INFECTION PREVENTION AND

CONTROL IN CHILDCARE AND SCHOOLS
Based on the components of the chain of infection there are 3 main
strategies for preventing and controlling infections in childcare
centres and schools. They are:
Human - exclusion/isolation/
quarantine, detection, lab testing &
RESERVOIR treatment
Eliminate infectious Animal - detection, lab testing &
organism treatment, culling/euthanization
Environment - cleaning, disinfection
& destruction (where possible)
Contact - proper hand, respiratory,

TRANSMISSION food and environmental hygiene, use
of barrier/ protective items like gloves
Interrupt/control
transmission of Non-contact - good ventilation,
destruction of vectors and their
infectious organism breeding places, food hygiene, water
treatment
Immunization - giving vaccines to

protect against specific infections.
HOST Chemoprophylaxis - use of drugs to
prevent disease when exposure to
Make the host less organism has occured or is imminent.
vulnerable to infection Living healthy life - to boost body
defences (body care, nutrition, exercise
& rest).
Figure 2.1: Preventing and controlling infection by breaking links in the chain
of infection
Detecting and managing sick children and/or staff to

control the reservoir of infection.
Practicing good hygiene and sanitation to interrupt the
transmission of infection from sick children and staff to
another person.
Boosting body defences - to make children/staff less

vulnerable to infections.
Each of these strategies consists of different measures aimed at

preventing and controlling infections. In this section, we will start
with measures that break the weakest link in the chain of infection,
the transmission phase.
Detection and
Hygiene & Boosting body management of
sanitary practices defences
the sick
Hand Daily health

hygiene Immunization checks
Respiratory Health
hygiene education Exclusion
First Aid/
Nutriton Emergency
Food hygiene services
Care
Environmental Physical
hygiene activity
Figure 3.2: Infection prevention and control methods in childcare centres and
schools
Hygiene and Sanitary Practices

Hand Hygiene
Hand hygiene is the process of keeping the hands free from dirt and
germs in order to prevent the spread of infection. It involves washing
hands with water and soap and/or other cleaning agents (e.g.
alcohol-based hand sanitizers, wipes) to remove dirt and germs.
Hand hygiene also involves caring for the hands to avoid
compromising the skin which acts as a barrier to germs and
infections. This includes using skin lotion or lubricants to avoid skin
chapping (fissuring and cracking of skin as a result of extreme
dryness) and wearing gloves when necessary to protect the hands
from cuts
Hand-washing remains the single most effective way of preventing

the spread of infection in any setting.
The Five Most Effective Methods for the Control of Infection

Transmission in Schools and Childcare Centres
Immunization
Hand washing
Environmental hygiene (especially diapering and
toilet hygiene)
Food hygiene
Daily health check
Respiratory Hygiene
Respiratory hygiene includes precautions which prevent the spread
of respiratory infections. These infections such as colds are very
common in childcare centres and schools. Colds can be passed on
to others through droplets of secretions from the nose and mouth
when a child or staff sneeze or cough without covering their mouth
and nose. Germs can also spread when a child or staff cover their
mouth and nose with their hands and afterwards touch others or
things in the environment without first washing or sanitizing the
hands.
Coughing and sneezing etiquette is a simple example of respiratory

hygiene, and can be taught to children as well as adults. It involves
covering your mouth and nose while sneezing or coughing and
washing your hands afterwards. Teachers and childcare givers should
practice respiratory hygiene and cough etiquette and also teach and
support children in practicing it. The right way to cover your mouth
and nose is by using a tissue and then discarding it immediately in
the dustbin. Afterwards, wash or sanitize your hands as soon as
possible. Alternatively, you can sneeze or cough into your elbow. You
are less likely to touch things with your elbow so there is a lower risk
of spreading germs.
Picking or wiping your nose should also be avoided. This is a bad

habit and can spread germs. If you must pick or wipe your nose, use
tissue paper and dispose of it immediately after use. Afterwards,
wash or sanitize your hands.
Food Hygiene
This refers to conditions and measures taken to ensure that food is
safe for consumption. Children eat while at school or the childcare
facility. Food can be packed by their parents or served in these
settings. Food is an important vehicle for the transmission of
infectious organisms that cause diarrhea and other gastrointestinal
disturbances. Therefore, it is important that schools and childcare
centres take precautions to ensure food is served in good condition
and does not become contaminated. Food should be handled
properly at all times; from the time of purchase to storage,
preparation and service to children. It is important to wash hands
thoroughly before touching food.
Environmental Hygiene and Sanitation

There are microorganisms everywhere. While most are harmless to
humans, many can cause infections under favourable conditions. An
unhygienic environment encourages the growth and transmission of
infectious organisms. Therefore, keeping the environment clean can
prevent their transmission.
Schools and childcare centres are susceptible to environmental

contamination which can lead to the spread of infections. Children
play, use toilet facilities and often spill food and water. In childcare
facilities, babies wear diapers that need to be changed by caregivers
regularly. In addition, surfaces and objects such as diaper-change
tables, toys and door handles are often contaminated with germs. If
the environment is not regularly cleaned up, it can harbour harmful

germs and encourage the spread of infections.
Ways to keep the environment clean in these settings include:
Sweeping and mopping floors daily

Vacuuming carpeted areas and rugs
Cleaning surfaces with soap and water
Disinfecting floors and other surfaces, especially if visibly
contaminated
Cleaning and disinfecting toys, door handles and other items
that are regularly touched
Keeping the outdoor environment free from weeds and litter
Disposing wastes properly
Health Promotion (Boosting Body Defences)

Boosting body defences means improving the bodys ability to resist
infections. In schools and childcare centres, this involves health
promotion activities that improve health knowledge, encourage
behaviour change, strengthen the bodys immunity and enhance
general health.
With the support of families and health services, schools and

childcare can help boost the body defences of children and staff with
the following health promotion activities:
HEALTH EDUCATION
Teach children to eat well,
exercise, rest and care for
their body
IMMUNIZATION
Ensure that children are up-
to-date on their
Ways settings immunization
can help boost
children's body
defences NUTRITION SERVICES
Serve balanced and nutritious
meals
PHYSICAL ACTIVITY
Provide opportunities for
regular physical activity
Figure 3.3: Ways to promote health/boost body defences
Immunization
Immunization is the process of administering vaccines to children
and adults which help them develop immunity against vaccine-
preventable diseases. It is a very effective way of preventing
infections against certain diseases that can easily spread in schools
and childcare facilities. Infections that are preventable with vaccines
include polio, measles, rotavirus infection and whooping cough.
While parents are responsible for ensuring their children are
immunized, it is important that schools facilitate the process through

their policies and practices.
Vaccines are chemical substances developed from weak or dead

infectious organisms which are given to individuals to help their body
develop immunity against these organisms; so that they will be unable
to cause an infection if the individual comes in contact with them in
the future.
Health Education
Health education is an important component of health promotion in
schools and childcare facilities. It involves learning activities that
help improve knowledge and skills on health issues among adults
and children.
Good hygiene, nutrition, moderate exercise and adequate sleep help

strengthen the bodys defences against infections. Children should
learn how to care for their bodies and keep them clean. They should
also learn the importance of eating healthy and balanced meals,
exercising regularly, and having adequate sleep. In addition to
boosting the bodys defences, these activities can have a positive
impact on students academic achievement, employability and future
life choices.
Nutrition Services
Nutrition services are an important component of health promotion
in schools and childcare centres. Healthy and balanced meals provide
the body with energy as well as vitamins and minerals needed for
growth and development. Unhealthy and unbalanced meals can
result in nutritional diseases, stunted growth and under-

development. These conditions lower the bodys defences against
infection and affects growth and academic performance.
Nutrition services in schools include:
Feeding services The Nigerian National School Health

Policy recommends that one nutritionally adequate meal be
provided to school children each school day. This is
commonly lunch, although some schools and childcare
centres also offer breakfast.
Nutrition education Involves teaching children and staff

about food hygiene and nutrition. It usually forms part of
health education and staff health promotion and professional
development.
Identification and management of nutritional problems

Involves identification, assessment, counselling and referral
to specialist services for nutritional problems.
Physical Activity
Physical activity is the movement of the body using energy. It usually
forms part of the physical education curriculum in schools which
includes basic body movements and sports activities. Physical activity
has a positive impact on both physical and mental health. This helps
to improve the bodys defences against infections and reduces the
risk of many chronic diseases. For these reasons, regular physical
activity should be integrated into childcare and school education
programs.
Detection and Management of the Sick

Even with appropriate sanitation and hygiene, infections can
sometimes occur. Infections may be contracted outside the school
or childcare centre and brought into the setting by a child or staff
member. To limit the spread of infections, it is important to promptly
detect and effectively manage those that are already infected.
Strategies for detecting and managing sick children in these
facilities include:
Daily health checks
First aid/emergency care within the setting
Referral to school-linked external health services
Exclusion
Daily Health Checks

Daily health checks help to detect infections early in schools and
childcare centres. They are usually conducted in the morning when
children arrive at school. This is especially important for surveillance
during disease outbreaks within the setting and its environs.
It is beneficial if the parents are present during daily health checks,

for example during drop-offs at childcare centres or schools early in
the morning. If the child is sick, then they can easily go home with
the parents. This can stop the spread of infections to others in the
setting. In addition, the childs recovery will benefit as s/he will have
better rest and care at home or hospital than in the childcare/school
facility.
If a child is found to be sick and the parents are unavailable to take

him/her home, then the child may need to be separated from other
children at the facility. Contingency arrangements for transfer to a
hospital may be required if the condition is serious.
Exclusion
Exclusion is the isolation of a sick child or staff member from others
in the facility, with the aim of controlling the spread of infection. In
uncommon instances, a healthy person who is susceptible to
infection may be excluded during an outbreak to prevent him or her
from contracting the disease. Healthy people who are more
susceptible to infections include unimmunized children or staff,
children with special needs and pregnant staff members.
Based on expert recommendations from the American Academy of

Pediatrics (AAP), American Public Health Association (APHA) and
National Resource Center for Health and Safety in Child Care and
Early Education, only a few highly contagious infections require
exclusion. These include polio, whooping cough and rotavirus. Aside
from these, the need for exclusion will depend on how sick a child
feels/looks and the availability of resources to care for the child in
the setting. The length of exclusion will depend on the type of
infection and how long the person is expected to be infectious.
It is important to note that exclusion of sick children does not always

prevent the spread of infections. Many diseases such as the common
cold, measles and chicken pox become contagious before an infected
child develops symptoms. In other cases, a person may still be
contagious after they have recovered from the illness. For example,
the infectious organisms in typhoid continue to be expelled in the
faeces even after a person has recovered.
Child is less active

Child requires more and not
care than the CCE participating in
setting can handle activites
Child has a disease

that requires
exclusion to
Reasons prevent spread
for
exclusion
Figure 3.4: Reasons for the exclusion of sick children in schools
First Aid/Emergency Care

First aid/emergency care in a school or childcare facility is the
treatment given to a child or staff member who suddenly falls ill or
gets injured. The aim is to prevent the condition from worsening or
becoming fatal. Treatment is immediate and continues until an
appropriate healthcare professional can attend the child or staff
member. This may be until a doctor arrives or until the child can be
transported safely to a healthcare facility. First aid can be provided

by a school nurse or other staff members trained to first aid.
High fever
(38C and above)
Coughing up or Sudden/severe pain

vomitting blood in the body
Absence of /
Difficulty
breathing
Excessive Seizures
vomitting or
stooling
Absence of Uncontrolled
pulse bleeding
Some conditions associated with infections that would require first

aid/emergency care
Figure 3.5
The Five Most Effective Methods for the

Control of Infection Transmission in
Childcare Centres and Schools
Immunization
Hand washing
Environmental hygiene (especially diapering and toilet
hygiene)
Food Hygiene
Daily health check
ENSURING EFFECTIVE INFECTION PREVENTION AND

CONTROL IN CHILDCARE AND SCHOOLS
To keep children healthy and safe for effective learning and
development, it is important to prevent and minimize the spread of
infections.
Approaches to infection prevention and control may differ among

facilities due to differences in context and available resources.
However, for effectiveness and sustainability of efforts, it is important
that infection prevention and control activities involves the
foundations (components) of a healthy school.
Proactive
plans and
policies
Good quality
Enabling curriculum,
physical teaching and
environment learning
Foundations activities
for a healthy
school
School-family-
Supportive
community
social climate
partnerships
The following must be done for effective and sustainable infection

prevention and control in schools:
Planning must take place and policies must be developed to

guide and support infection prevention and control activities.
These usually form part of a schools strategy planning and
health and safety policy document.
Training for school staff and learning on health and hygiene

must form part of the settings activities. This builds health
knowledge and skills among children and staff.
Health and hygiene infrastructure must be in place to

support teaching and learning, and to encourage the practice
of infection prevention and control strategies.
Schools should work with families to reinforce learning for

children. They should also work with other services to
support infection prevention and control activities, and
provide coverage for services beyond the capabilities of
teachers and child caregivers.
Health & hygiene Healthcare services

education Family engagement
Teaching Partnership
and learning & services
Health healthy &

policies supportive
environment
Infection prevention
& control policies & Health & hygiene
procedures infrastructure
Figure 3.6: Elements of effective school health and its application to infection
prevention and control
Infection Prevention and Control Policies and Procedures

in Schools and Childcare Centres
Infection prevention and control policies are formal, clear and simple
statements by a school or childcare centre about how it intends to
prevent and control infections. These statements provide guidelines
for what is expected of each person in the facility. They usually form
part of the school or childcare centre health and safety policy.
Infection prevention and control procedures are step-by-step

descriptions of how policies will be put into action.
The overall aim of these policies and procedures is to help promote

effective and consistent strategies which will prevent and control
infections in these facilities.
Importance of Infection Prevention and Control Policies

Communicates to new parents about the rules and
expectations of the facility with respect to infection
prevention and control; thereby eliminating future conflicts
on contentious issues such as exclusion of sick children.
Acts as a guide which staff can refer to when they are unsure
of what to do in the case of infection.
Helps management and staff make consistent decisions on

infection prevention and control. This ensures children and
staff are treated equally and without discrimination.
Keeps the facility in compliance with state/environmental

laws and regulations on infection prevention and control.
Important Notes about Policies and Procedures

Procedures should be backed by policies.
Teachers and caregivers must be able to understand the

policies and procedures and be able to implement them.
Training and ongoing professional development is very
important.
Parents must understand the policies and be able to support

them. Parental engagement is very important.
General Health &

infection immunizationi
control mmunization
practices of children
Infection Policies of
control during food and
outbreaks nutrition
Policies on the Management

health staff of sick
children
Components
School Infection
Prevention and
Control Policies
Figure 3.7
UNIT THREE
HYGIENE AND
SANITATION
PRACTICES
Hygiene and Sanitation Practices 46
This unit contains information on how to practice hygiene and

sanitation appropriately in the school/childcare settings. It is
especially crucial for staff to understand the practices addressed in
this section and apply them properly because hygiene and sanitation
measures are key to the prevention and control of infections in
schools and childcare facilities.
Hand Hygiene ........................................................................................................... 47
General Cleaning and Disinfection .................................................................. 53
Diaper Hygiene ......................................................................................................... 59
Toilet Hygiene ........................................................................................................... 63
Washing and Disinfection of Clothing and Bedding .............................. 66
Washing and Disinfection of Toys ................................................................... 68
Cleaning Spills ........................................................................................................... 69
Food Hygiene ............................................................................................................ 70
Waste Management ............................................................................................... 75

HAND HYGIENE
Hand hygiene is the process of keeping the hands free from dirt and
germs in order to prevent the spread of infections. It involves
washing hands with water and soap or other cleaning agents (e.g.
hand sanitizers) which remove dirt and germs.
Hand Washing
Hand washing with soap and running water is the preferred method
for keeping hands clean. Rubbing hands together with soap helps to
loosen dirt and running water washes it off, leaving the hands clean.
Hand washing procedure

1. Wet your hands with water.
2. Apply some soap.
3. Rub the front and back of your hands together to make the
soap foam. Continue for up to 20 seconds. Make sure you
scrub your palms, in between your fingers and the backs of
your hands.
4. Rinse your hands with clean running water.
5. Turn off the tap with clean paper towel to avoid re-
contaminating your hands. You will not need to do this if the
taps in the facility have valves that can be operated with the
elbow, knee or leg.
6. Dry your hands with clean disposable paper towel. This is

important as it is easy for wet hands to become dirty.
7. Dispose paper towel in a waste bin with cover

When to wash your hands

1. Upon arrival at the facility
2. Whenever hands are visibly dirty
3. After coughing, sneezing or wiping your nose
4. After using the toilet or helping a child use the toilet
5. After cleaning spills on surfaces
6. After disposing waste
7. After taking children to play
8. After handling raw food
9. Before and after food preparation, eating or feeding a child
10. Before and after changing diaper
11. Before and after giving medication
12. Before and after dressing a wound
Hand washing in the absence of running tap water

Running tap water may not be available in some childcare centres
and schools. Bowls filled with stagnant water are not advisable for
hand washing as germs remain in the water and can spread to other
people. An alternative source of running water could be a locally
constructed tippy tap or containers (like buckets) with a tap at the
bottom.
Figure 3-1: Source of running water in

the absence of tap water. Image
Source: CDC
Waterless Hand Hygiene Methods

Low-resource areas may not always have access to water. In these
cases, alcohol-based hand sanitizers can be used. These help to
prevent the spread of infections by reducing the number of germs
on the hands. Alcohol-based hand sanitizers work best if the hands
are not visibly soiled with grease or dirt. Hand sanitizing wipes (small
disposable towels pre-moistened with hand sanitizing solution) can
be used to remove visible grease and dirt before applying alcohol-
based hand sanitizers.
If you use waterless hand hygiene products due to the unavailability of

water, remember to wash your hands whenever you get the
opportunity to do so.
How to use hand sanitizer

1. Put a small quantity of hand sanitizer on your palm (about
the size of a coin).
2. Rub the hand sanitizer all over your hands and fingers.
3. Continue to rub your hands together until they are dry.
Gloves
Gloves act as barrier to infectious organisms and can protect the
hands from injury. They are needed for cleaning heavily
contaminated areas or when there is a chance of getting scratched
or bruised while cleaning. It is also important to wear gloves while
caring for children if there is a chance of coming into contact with
body fluids.
There are two main types of gloves disposable gloves and reusable
gloves. Disposable gloves are often used for food preparation or
caring for children, whereas reusable gloves are thicker and are often
used for cleaning.
Guidelines for using gloves
1. Always wash your hands before wearing gloves. Gloves
protect the hands from contamination and control the
spread of infection. However, they do not substitute hand

washing.
2. To remove gloves, follow these steps:
Pinch the outside of one glove near the wrist and

peel it off so that it turns inside out.
Hold the removed glove in your gloved hand while

you take off the other glove.
To remove the other glove, put one finger of your

ungloved hand inside the wrist of the other glove
and peel it off from the inside, over the first glove.
The two gloves will be inside out with one inside the
other.
3. After removing gloves, follow these steps:
Dispose disposable gloves in a covered waste bin.
Wash, disinfect and air dry reusable gloves.
Wash your hands.

Why do we wash hands after removing gloves?
Gloves create a warm environment around your hands which
can encourage germs to grow. This can happen when you
wear gloves for a long time.
There may be small holes in the gloves which germs can pass
through and get onto your hands.
When removing gloves, your hands may come into contact

with the outer part of the gloves which has already been
contaminated.
Disposable and Reusable Gloves

Disposable gloves are gloves that are only used once. They are thin and
a person can retain their sense of touch while wearing them. They are
used when there is a chance of coming into contact with body
secretions such as blood, vomit and faeces. They are not suitable to
use for aggressive cleaning. They should be discarded immediately after
use and should never be reused or washed for reuse.
Reusable gloves are gloves that can be used more than once. They are
usually thicker with longer cuffs. A persons sense of touch will be
diminished while wearing reusable gloves. They are usually worn to
protect hands during cleaning and scrubbing. They should be washed,
disinfected and dried between uses. They wear out with use and should
be replaced when necessary.
Hygienic Use of Materials

For Infants and Toddlers
Items such as clothing, bedding and toys should be washed
or disinfected regularly.
Keep separate bins for clean and used toys.
Toys that cannot be washed should not be given to children

in this age group.
Sick infants and toddlers should not share items with other
children.
For Older Children

Toys can be washed or disinfected less frequently, e.g. once
weekly.
Sick children should not share items with other children.
GENERAL CLEANING AND DISINFECTION

Cleaning and disinfection removes dirt and germs from items and
surfaces. These practices are effective in preventing and controlling
the spread of infections in schools and childcare centres. Routine
cleaning removes dirt and reduces germs, but it may not be enough
to prevent infections in the case of contamination e.g. with faecal
matter or other body fluids. Surfaces and items that could be
contaminated should be disinfected after cleaning to effectively
prevent and control the spread of infections.
Cleaning versus Sanitizing versus

Disinfecting
Cleaning is the process of physically removing dirt and germs from
surfaces and items. Activities include sweeping and scrubbing floors,
vacuuming rugs, washing clothes and toys and wiping surfaces.
Cleaning is done with water, soap/detergent and tools such as brooms,
brushes, vacuum cleaners, rags, towels and mops. Cleaning may not
kill all germs but considerably reduces their numbers.
Sanitizing kills most germs and is done with hot water or antimicrobial
agents which are less concentrated (e.g. diluted bleach or methylated
spirits). It reduces germs on surfaces and items to safer levels than
cleaning alone.
Disinfecting is the process of killing or inactivating germs with

antimicrobial substances known as disinfectants
Source: UCSF Institute for Health & Aging, UC Berkeley Center for Environmental
Research and Children's Health, Informed Green Solutions, and California Department
of Pesticide Regulation 2013)
Cleaning Recommendations
Items and surfaces should be cleaned when they are visibly
dirty. Things that are used more frequently should be
cleaned more regularly.
Clean items and surfaces using soap or detergent, water and

appropriate equipment (e.g. broom, brush or mop for floors;
vacuum cleaner for rugs; soft cloth or sponge for toys).
Effective cleaning removes all dirt and most germs.
Avoid using too much soap or detergent. This has no added

benefit and could damage items and surfaces. It could also
give off an unpleasant smell and make floors slippery.
Change cleaning water when it becomes dirty and avoid

using the same water for different areas. For example, water
used to clean toilets should not be used to clean any other
part of the facility.
Disposable or reusable cleaning cloth can be used. Disposal

cloth should be discarded after use whereas reusable cloth
should be washed and dried daily.
Avoid leaving mops in dirty water after cleaning. They should

be washed, disinfected, rinsed, wrung out thoroughly and left
to dry. Water used for cleaning should not be left in cleaning
buckets. Germs will grow in the water and this can become
a source of infection. Buckets should be emptied, washed
and air-dried.
Use of Disinfectants
Routine disinfection of surfaces and items is not
recommended. Only surfaces and items that are easily
contaminated by faeces and body fluids (e.g. diaper-
changing and toilet areas) should be disinfected regularly. It
is also necessary to disinfect toys of infants and toddlers,
especially during outbreaks of infection.
Before using a disinfectant, read the manufacturers

instructions on dilution. Concentrations can vary form one
disinfectant to another and may change over time.
It is safer to pour disinfectant into water than water into

disinfectant. Pouring water into disinfectant can cause
chemical reactions which may be harmful.
Never mix disinfectant with hot water.
Disinfectants work best when they are applied on surfaces

and items that have already been cleaned.
Items and surfaces can be disinfected by dipping, soaking,

spraying or wiping with a cloth soaked in disinfectant.
Spraying disinfectant should be avoided when children are
around.
Do not use disinfectant near food items.
Ensure there is adequate ventilation during disinfection to

reduce inhalation.
People with asthma should avoid areas being disinfected

until the smell has dispersed.
Heat and sunlight make some disinfectants (e.g. bleach) less

effective, so it is best to prepare a fresh solution each day.
Properly label disinfectant and keep out of reach of children.

Preparing Bleach for Disinfection

Household bleach is an effective disinfectant and is widely available
at low cost. The active ingredient, sodium hypochlorite, destroys
germs quickly. Household bleach sold in Nigeria contains between
3.5% and 3.85% sodium hypochlorite.
To prepare bleach for disinfecting, follow these steps:
1. Gather what you need water, bleach, measuring syringe, a

teaspoon (5ml), tablespoon (10ml) or measuring cup (for
larger solutions), and an opaque container with a cover
2. Prepare bleach in a well-ventilated area to avoid inhalation

of fumes.
3. Measure out the required amount of water into the opaque

container.
4. Measure out the correct amount of bleach:
a. For 3.5% bleach (e.g. Hypo), measure 15ml of bleach

per one litre of water or 75ml per 5 litres of water
b. For 3.85% bleach (e.g. Jik), measure 13ml of bleach

per one litre of water or 65ml of bleach per 5 litres
of water
5. Pour bleach into water, mix and use as required 6. Discard

any unused bleach at the end of the day
Recommended Schedule for Cleaning

Area Schedule for cleaning
Toys and play items for After each use

infants and toddlers
Toys and play items for Daily and when visibly dirty
older children
Classrooms Daily and when visibly dirty
Diaper changing area After each use
Potties After each use
Toilets Daily and when visibly dirty
Food preparation surfaces Before and after food

preparation
Kitchen utensils and Before and after each use

cutlery
Non-carpeted floors Daily and when visibly dirty
Carpets Daily and when visibly soiled
Surfaces with body fluid Daily and when spills occur

spills
Clothing After each use
Beddings Weekly and when visibly soiled
Outdoor surroundings Daily

DIAPER HYGIENE
Children who wear diapers can spread infections through
contamination of hands, surfaces and food with faecal matter. To
prevent the spread of infections, strict hygiene procedures must be
adhered to when changing diapers.
It is important that each setting has policies and procedures for

changing diapers. All staff involved in caring for children should be
aware of these policies and procedures and be trained to implement
them.
There are two main types of diapers: disposable diapers and cloth
diapers. Parents usually have a preference based on cost and
convenience.
If you accept cloth diapers from parents, it is best not to wash them
in the setting to avoid cross-contamination. Instead, put soiled cloth
diapers in plastic bags and return to parents to wash at home.
Parents should be made known of this policy beforehand to avoid
misunderstanding. However if you must wash soiled diapers in the
setting, follow instructions for washing clothing and bedding.
Your setting should have a designated area for changing diapers to

prevent cross-contamination. This area should be located away from
where children learn or play. It should have a table covered with a
change mat, preferably a non-absorbent liquid-proof material that
can be easily cleaned. Where possible, the diaper changing area
should be located near a sink with running water. This will allow staff
to wash their hands without leaving children unattended on the

diaper table.
If the layout of the facility is such that the sink is located away from
the diaper change area, after changing a child, wipe your hands with
baby wipes, bring the child down from the diaper table and walk to the
sink to wash your hands and those of the child.
Never leave a child on the diaper table unattended.
Steps for changing diapers

1. Assemble everything you need Check that everything you
need is within reach of the diaper table. Items include: clean
diaper, disposable baby wipes, disposal changing
pads/paper, barrier cream such as Vaseline or Sudocream (if
provided), plastic bags for soiled clothing, disposable gloves
and waste disposal bag.
2. Place a disposable changing pad or paper on the diaper-

changing table.
3. Wash your hands. If using gloves, put them on afterwards.
4. Carry the child to the diaper changing area and lay on the
diapering table; being careful to avoid coming in contact with
soiled clothing
5. Clean-up the child following the steps below:
a. Remove bottom clothing. If soiled, put in a plastic

bag immediately.
b. Unfasten the soiled diaper and gently lift the infants

legs with one hand.
c. Wipe the babys bottom with the front (inner side) of

the diaper if it is not soiled, as you remove it. (While
this is not compulsory, it will help to remove a
significant amount of faeces from the babys bottom)
d. If the diaper isnt excessively soiled, leave it folded

over under the babys bottom as you wipe the
bottom clean with disposable wipes. This will help
absorb any new urine or stool that the infant may
pass during changing.
6. Remove the soiled diaper
a. When you have finished cleaning the babys bottom

remove the soiled diaper and wipes;
i. For disposable diapers, fold the diaper with

the soiled wipes inside and dispose them in
a lined covered bin.
ii. For cloth diapers, fold up with the soiled part

inside and put in a plastic bag or container
for parents to take home; while you dispose
of the wipes.
b. Remove the disposable pad or paper and put into

the bin.
7. Wipe hands
a. If wearing gloves, remove and put them in the bin.
b. Clean hands with wipes.
c. Also wipe the childs hands if s/he touched his/her

bottom during diaper-change.
8. Put on a clean diaper
a. Place the clean diaper under the infants bottom.
b. Firmly secure the new diaper making sure there

arent any gaps.
9. Dress the child.
10. Wash your hands and the childs hands before taking the
child back to the childrens area in the facility.
11. Clean and disinfect the diaper-changing area.
12. Wash your hands.
Other notes for diaper change

A diaper table with side hinges and/or straps for holding the
child is preferable to prevent the child from rolling off the
table
Never leave a child unattended to on the diaper table. If your

hands become soiled with faeces during diaper change, wipe
your hands with wet wipes. Do not leave the child on the
table to go to the hand washing area.
Always wipe girls from front to back to prevent urinary

tract/vaginal infections
If changing a boys diaper, keep a diaper or cloth over the

boys penis to avoid being sprayed with urine if he decides
to ease himself.
Cleaning diaper-changing areas

1. Clean surface with soap and water to reduce germs
2. Dry with clean cloth or paper towel
3. Wet the surface with bleach solution
4. Allow to air-dry
.
Note:
Disposable diapers are preferred in schools and childcare centres. This
is because they do not require washing and are less likely to leak, and
therefore less likely to contaminate the environment
TOILET HYGIENE
Keeping toilets and bathrooms clean is very important to prevent
and control the spread of infections. This is especially important in a
facility where children are undergoing toilet training.
Cleaning toilets and bathrooms

Toilets and bathrooms should be cleaned and disinfected
daily and whenever they are visibly dirty.
Areas to be cleaned and disinfected include the toilet bowl

and seat, sink area, bathtubs, floors and other surfaces.
The toilet bowl can be conveniently cleaned with a product

that removes lime scale and also kills germs.
Particular attention should be paid to surfaces that are

frequently touched (such as door handles, toilet flush handles
and taps) as they are more likely to be contaminated with
germs.
Cleaning the toilet bowl

Apply a cleaning product to the bowl covering the whole
surface.
Leave for a few minutes to loosen lime scale.
Using a toilet brush, scrub the inside of the bowl thoroughly.
Flush the toilet to remove dirt and product.
Apply disinfectant to the bowl (only if the cleaning product

used did not contain disinfectant)
Note: other surfaces such as door handles, sinks and floors should
be cleaned and disinfected at least once a day.
Toilet training
Toilet training is done with potties, child-size toilets or normal toilets
with toddler-size seats and stepping stools. In schools and childcare
centres, child-size or modified toilets are preferable to potties as they
are easier to clean and are less likely to contaminate the
environment.
Child-size and modified toilets should be cleaned like adult toilets

(see above). However if potties are used for toilet training, the
following steps will help prevent the spread of infections:
Place potties on floors that can be easily cleaned and

disinfected.
Before each use, ensure that the potty is clean and dry.
Ensure that the potty is stable and fixed to the ground to

avoid stool and urine spilling onto the floor.
Cleaning potties
Immediately after use, carefully empty the contents of the
potty into a toilet.
Rinse the potty with water and empty into the toilet.
Wash the potty with soap and water.
Dispose soapy water into the toilet and rinse again.
Spray or wipe potty with bleach solution and allow to air dry.
After cleaning and disinfecting the potty, wash your hands

and assist children in washing their hands.
WASHING AND DISINFECTION OF CLOTHING AND

BEDDING
Schools and childcare centres should launder the facility bedding and
may occasionally launder clothing for children who require a change
but do not have any spare clean clothes. Most facilities do not
provide routine laundry services for clothing brought from home.
General Recommendations
The laundry room should be located away from classrooms
and childrens play areas.
Wash bedding regularly and clothing as required.
Clothing and bedding contaminated with faeces or body

fluids also require disinfection. However, routine disinfection
is not recommended.
Use gloves when handling soiled clothing, especially if you

have cuts or grazes on your hands.
Clothing soiled with faeces

There are different policies for washing clothing soiled with faeces.
Whichever policy you choose, ensure parents are aware in advance
to avoid any misunderstandings.
Policy one: Clothing soiled with faeces should be sent home and
washed by the childs family, rather than being washed in the
facility (California Child Care Health Program).
This is to reduce the risk of staff and children becoming exposed to

infectious organisms. However, there is still a risk of germs spreading
if the soiled clothing is not handled properly before being sent home.
Follow these steps to prevent the spread of infections:
1. Empty the faeces into a toilet, taking care to avoid splashing.
2. Put the soiled clothing in a plastic bag, seal tightly and keep
out of reach of children.
3. At pick up time, hand the sealed bag to the adult who comes
to pick up the child.
Policy two: Clothing soiled with faeces can be washed in the facility
but with strict adherence to standard hygienic practices (National
Day Nurseries Association, UK).
To prevent the spread of germs:
1. Preferably, washing soiled clothing should be done by

cleaning/laundry staff and not by staff who have direct
contact with children.
2. If washing must be done by staff who care for children, place

soiled clothing in a bucket with a tightly fitted lid or a strong
water-proof bag until the end of the day. Wash clothing at
the end of the day once children have gone home.
3. If using a washing machine, wash soiled clothing as a

separate load at the hottest temperature fabric can withstand
and then rinse with disinfectant solution.
4. If hand-washing, use a bucket or basin designed for this

purpose alone. Afterwards, rinse clothing and bucket with
disinfectant solution.
5. Always wash your hands after handling soiled clothing.
WASHING AND DISINFECTION OF TOYS

To clean and disinfect hard plastic toys:
Scrub the toy with a soft sponge using warm, soapy water.
Use a brush to scrub inside the crevices.
Rinse the toy in clean water.
Place the toy into a pre-prepared disinfecting solution (such

as mild bleach solution).
Remove the toy from the solution after a few minutes.
Rinse thoroughly and allow to air dry.

To clean stuffed toys that can absorb water like teddy

bears:
Wash weekly unless the toy is used frequently or becomes
soiled easily, then wash more often.
Wash with soapy water and rinse with clean water before
disinfecting. Disinfecting is especially important for toys used
by younger children.
Air-dry completely.
CLEANING SPILLS
Cleaning spills of potentially contaminated fluids (e.g.
urine, vomit)
Wear disposable gloves.
Use a cloth/mop (depending on surface) and soapy water.

Take care for fluids not to splash on you.
Disinfect surface after cleaning.
Discard cloth immediately after use.
Wash mops thoroughly and disinfect after use, then wring

out and hang outside to dry.
Wash hands thoroughly.
Cleaning spills of uncontaminated fluids (e.g. water,

juice)
For water, use a cloth/mop (depending on surface).
For non-water fluids (e.g. juice), also use soapy water.
Disinfection is not necessary.
Wash cloths and allow to air dry.
Rinse mops in soapy then clean water, then wring out and
hang outside to dry.
Wash hands thoroughly.
FOOD HYGIENE
Food Packed from Home
Food from home is usually packed in lunch boxes, and if properly
prepared, should be fine to consume at lunch time.
For infants
Infants may drink breast milk or formula and eat complementary
foods such as cereals. In Nigeria, exclusive breast feeding until 6
months of age is the gold standard. This can be achieved in schools
and childcare centres with adequate facilities for storing breast milk.
However, policies and practices can vary from one childcare centre
to another. Some childcare centres accept expressed breast milk
whereas other facilities, especially those in low-resource settings,
may not be able to due to limited infrastructure (e.g. lack of
refrigerators or irregular power supply).
Mothers should be encouraged to feed their babies expressed breast

milk if the facility has a functioning refrigerator/freezer and a regular
power supply.
Breast milk contains antibodies which help prevent infants from

becoming ill. Mothers with infants up to 12 months of age should be
encouraged and supported to breast feed or provide expressed breast
milk to their infants.
Recommendations for handling infants food
Mothers can bring in fresh breast milk each day when they
drop off their babies.
Bottles of breast milk should be labelled clearly with the

name of the child and the date it was brought in.
Avoid storing breast milk overnight in the facility, especially

if there is an irregular power supply.
Bring in baby formula and cereals unprepared. These can be

prepared and fed to infants during meal times in the facility.
Always wash your hands before preparing infants food.
Clean surfaces, bottles and other equipment that will be used

for preparing food.
Follow the manufacturers instructions for preparing the

correct concentration of formula.
Avoid storing baby food like formula and cereal it is best

to prepare fresh for each feed and give to the child as soon
as it has cooled.
Discard any leftover formula or cereal.
Note: any formula feed must be consumed within 2 hours of

preparation, unless it has been kept in the refrigerator. Formula kept
in the refrigerator should be consumed before the day ends.
For young children

Young children should be supervised during meal times.
Ensure children wash their hands before eating.
Check childrens food to make sure it isnt sour before they

start eating.
Leftover food should be discarded after meal times. If

children put food back in their lunch packs it may become
sour. This will make children sick if they eat it later.
For older children
Older children do not require supervision during meal times.
However, it should still be a rule for everyone to wash their hands
before and after eating.
Food Prepared and Served in the Setting

To prevent food-borne infections, food must be properly stored,
prepared and served. The cook or caterer should be aware of the
facilitys policy on food hygiene and safety.
Food purchase and storage

Food and ingredients for cooking should be bought from
trusted sources.
Dont use cans of food that are bulging or leaking.
Frozen foods should be stored in the freezer immediately

after purchase.
Ensure that the temperature of the freezer is cold enough

for foods to remain frozen.
Foods stored in the refrigerator should be covered.
Refrigerators and dry food storage areas should be cleaned

weekly or when visibly dirty.
Freezers can be cleaned less frequently unless there are

visible spills.
Food preparation
Wash your hands with soap and water before food
preparation.
Always clean surfaces in the kitchen before and after use.
Wash utensils before and after use.
Never use the same cutting boards for raw meat and
vegetables. Raw meat contains organisms that can
contaminate vegetables. If contaminated vegetables are
eaten raw, this can lead to infection.
Always wash vegetables before eating.
Cook meat thoroughly.
Do not change diapers in areas where you prepare, store or

serve food.
Do not allow pets into the kitchen.
Serving food
Food can be reheated once before serving. Never reheat
food more than once.
Ensure plates are clean before using to serve food.
Store leftover food in a sealed container in the refrigerator

or freezer, depending on how soon it will be consumed.
Any uneaten food on childrens plates should be discarded.
Dispose food waste in covered, lined waste bins and empty

when full or at the end of each day. Never leave food waste
in bins inside the facility overnight, as this can attract pests
like rats and cockroaches.
Conduct During meals

Make sure children wash their hands before meals.
Children should eat with clean spoons, forks and other

utensils; not with their hands.
Children should not share utensils and cups.

Children should be taught to turn away from food when they

cough or sneeze, and to wash their hands afterwards.
If you are interrupted to care for another child while

preparing food or feeding an infant, wash your hands before
returning to your task.
WASTE MANAGEMENT
Waste management includes waste handling, storage, disposal, and
recycle. Proper waste management prevents unpleasant smell in the
environment and controls the spread of infection in the
childcare/school facility. It also prevents infestations of pests such as
rats and insects. Recommendations for waste management are
outlined below:
Waste bins should be available in each area to avoid carrying

waste across rooms. Areas in schools and childcare centres
that require waste bins include the toilet, diaper-changing
area, hand washing area, and food preparation area.
Waste bins should be emptied regularly and appropriately.

Many schools and childcare centres have waste collectors
who come with trucks to pick up waste. Make sure waste is
ready for removal when waste collectors arrive.
Dispose soiled items like diapers in water-proof and rodent-

free bins lined with polythene bags and whose lid can be
operated with a foot pedal.
The contents of waste bins should not be accessible to

children.
Waste bins should be washed after waste has been emptied.
Educating children on waste disposal and

environmental hygiene
Children should be educated and encouraged to ensure that correct
waste disposal learnt and practised.
Children and teachers can participate in litter picking and tidying up

activities within the school as part of raising awareness about waste
disposal and environment hygiene.
Teachers must accompany and supervise children in such activities to

prevent children from picking up objects that are potentially hazardous
or eating while on a litter picking activity as there is a risk of hand-to-
mouth contamination.
Importantly, children taking part in litter picking should be

encouraged to wash their hands thoroughly after each session and
especially when food is likely to be consumed.
UNIT FOUR
HEALTH PROMOTION:
BOOSTING BODY
DEFENCES
Health Promotion Boosting Body Defences 78
This unit explains the common ways of promoting the health of

children so as to boost their immunity against infections. These
include ensuring that they are immunized against vaccine-
preventable disease, providing health education, nutritional services
and opportunities for physical activity.
Immunization ............................................................................................................. 79
Health Education ...................................................................................................... 82
Nutrition Services .................................................................................................... 85
Physical Activity ........................................................................................................ 86

IMMUNIZATION
Immunization is the process of protecting children and adults from
specific infections by administering vaccines that help them develop
immunity against these infections.
Ensuring that children receive all the necessary vaccines remains the
responsibility of parents. However, schools and childcare
practitioners have a duty to keep the children and staff in their
facilities healthy and safe and therefore must take precautions to
prevent outbreak of vaccine-preventable diseases in their facilities.
They need to make sure that children and staff are up-to-date on
their immunization.
Ways to ensure that children and adults in your setting

are up to date on age-appropriate immunization
Ensure that every child and staff undergoes a comprehensive
health assessment as part of the admission and recruitment
process. This includes identifying all vaccines received since
birth. A health assessment can be done at a hospital and the
medical report sent to the childcare centre or school.
Ensure that your setting has a policy that makes it mandatory

for all children and staff to be up to date on age-appropriate
immunization, except for those known to have severe
reactions to vaccines.
Put up notices about immunization to encourage parents to

immunize their children.
Review childrens health record each term to determine those

behind in their immunization and send reminders to their
parents.
In the event of an outbreak of a vaccine-preventable

infection, determine those who have not been immunized,
assess their risk of contracting the disease, and act
accordingly. This could involve monitoring for low risk cases,
or exclusion for high risk cases and diseases which are severe.
Common vaccines and diseases they protect against

Vaccines Diseases they protect against
BCG Tuberculosis
Hepatitis B (Hep-B) Hepatitis B
Pentavalent vaccine Diphtheria, tetanus, pertussis,

(Penta) haemophilus influenza-B, hepatitis B
Pneumococcal Pneumonia caused by

vaccine pneumococcus
Oral polio vaccine Polio

(OPV)
Vaccines Diseases they protect against
Rotavirus vaccine Rotavirus infection (characterized by

severe diarrhea, vomiting, fever and
dehydration)
Measles Measles
Yellow fever Yellow fever
MMR Measles, mumps, rubella
DTP Diphtheria, tetanus, pertussis
Chickenpox Chickenpox
Meningococcal Meningitis
vaccine
Typhoid Typhoid
HPV vaccine Human papilloma virus infection ( a

common cause of cervical cancer)
Immunization Schedule
Age Due Vaccine
At birth BCG, OPV, Hep-B
At 6 weeks OPV-1, Penta-1, Rota-1*, PCV-1*
At 10 weeks OPV-2, Penta-2, Rota-2*, PCV-2*

Age Due Vaccine
At 14 weeks OPV-3, Penta-3, PCV-3*
At 6 months Vit A
At 9 months Measles-1, Yellow fever
At 12 15
months Measles-2 or MMR*, Vit A, chicken pox
18 months DTP booster, Vit A, OPV
2 years Vit A, Tyhoid*, Meningitis*
4 5 years OPV, Hep-B booster, Vit A, DTP booster
Source: (Paediatric Association of Nigeria 2012)
* Vaccine not currently part of the national immunization program

and unavailable at public health centres. Can be obtained at private
health facilities in Nigeria.
HEALTH EDUCATION
Health education is the process of educating people about health. It
empowers people to take actions that enhance their health by
providing them with relevant knowledge and skills. Health education
is an important strategy for boosting body defences in children and
adults. Actions that enhance health include good personal hygiene,
eating healthy balanced meals, exercising regularly and having

adequate rest.
In school and childcare settings, health education should be targeted

at these three different groups:
School and childcare staff
Childrens families
Children
Health education for teachers and childcare staff

Understandings and healthy practices among staff of schools and
childcare facilities play a key role in keeping children healthy.
Teachers serve as role models and can play a valuable role in health
promotion in the classroom. It is therefore crucial that staff
have adequate knowledge of health risks and infections and are also
aware of measures to prevent and control infections in these settings.
Schools and childcare centres should organize regular training
sessions for staff on health issues. Training and staff evaluation
should go hand in hand to make sure staff understand and adhere
to procedures on preventing and controlling infections appropriately.
Schools can work with health professionals to implement special
training courses as part of staff orientation process and professional
development.
Health education for parents

Schools and childcare centres should collaborate with parents to
promote health skills in children. As long as children have continuous
and consistent practice at both schools and home, they will be able
to build up healthy lifelong habits. Importantly, parents need to be
educated on the importance of immunization, hand washing and
good nutrition. Avenues for educating parents include newsletters,
forums, PTA meetings and specially organized workshops.
Health education for children

Health education should be made an interesting subject for children.
Teachers can use participatory approaches to involve children in
building class activities including informational and practical sessions
about infections. For children to be more connected to the
curriculum, the content of the sessions should be made as visual and
lively as possible. Topics that are encouraged to be taught to children
and which would help boost their body immunity include: hygiene
and sanitary practices, food and nutrition, physical activity and rest.
Tips for Effective Health Education

Children should be taught about health, provided
opportunities to practice what they have learnt under
supervision, and exposed to situations that reinforce learning.
Health lessons should include verbal instructions and visual

demonstrations.
To keep children interested and engaged, health education

should include a variety of activities including classroom
teachings and extracurricular activities.
Involve parents in health education activities at your facility.

Parents will be able to complement and reinforce learning at
home. They can integrate health promoting activities in their
childrens routine, supervise their children during practice at
home, and serve as good role models for their children.
Provide
Teach opportunities
for practice
Supervise Reinforce
learning
Building Health Skills

in Children Effectively
NUTRITION SERVICES
Nutrition services in schools and childcare centres include feeding
services, nutrition education and identification and management of
nutrition problems. These services can help address nutritional
deficiencies, build childrens knowledge about nutrition and

positively influence their attitude and behaviour towards food.
Tips for Effective Nutrition Services

Provide nutrition training for food service staff.
Nutrition education should follow guidelines for effective

health education.
Serve healthy, nutritionally balanced meals in appropriate

portion sizes.
Coordinate nutrition services between food service staff and

physical/health education teachers.
Monitor and supervise children during meals.
Involve parents. If you do not provide feeding services,

encourage parents to pack healthier meals for children.
Provide/refer to counselling and other services for children

with nutrition problems.
PHYSICAL ACTIVITY
Physical activity in school can help boost body defences and reduce
the risk of chronic diseases and obesity.
Tips for Effective Physical Activity

Children require 60 minutes or more of physical activity every
day. Childcare centres or schools can provide at least 30
minutes of physical activity for children during school hours
(8am to 3pm). The remaining 30 minutes can be attained at
home.
Children who spend the whole day in childcare centres or

schools (7am to 6pm) should be provided with opportunities
for at least 60 minutes of physical activity per day.
Opportunities for physical activity include:
School break periods
Physical education outdoor classes
Sports activities and events
After school programs

UNIT FIVE
DETECTION AND
MANAGEMENT OF THE
SICK
Detection and Management of the Sick 89
This section provides guidelines/ recommendations for identifying

sick children and managing them properly, in a way that prevents
the spread of infections to others
Daily Health Checks ................................................................................................ 90
First Aid ........................................................................................................................ 92
Exclusion ...................................................................................................................... 93
DAILY HEALTH CHECKS

Daily health checks enable early detection of infections in schools
and childcare centres. They involve a brief (3 5 minute) assessment
of a childs appearance and behavior each day. If a childs
appearance, behaviour or routine seems unusual, this could indicate
ill health and further investigation may be needed.
Common signs of illness include:
Unusual quietness and/or sleepiness
Reduced participation in class activities
Skin changes such as rash, bruising, scratches or sores
Unusual lateness to school
Fever
Tiredness
Headache or pain
Irritability (e.g. bad temper or excessive crying)
Vomiting
Excessive stooling/diarrhea
Persistent stomach ache
Unusual drooling
Pink eyes with discharge
Breathing difficulty
Guidelines for Daily Health Checks

1. Teachers and nannies should perform daily health checks for
a designated group of children. A timetable can be drawn to
rotate the task among staff.
2. Staff conducting health checks should have basic knowledge

of common health issues among children and know what
signs and symptoms to look out for.
3. Daily health checks should be done in the morning when the

child is dropped off, preferably in the presence of the
parent/guardian. The parent/guardian will be able to help
assess whether the childs appearance and behaviour is
normal.
4. Children found to be fine during health check should still be

observed throughout the day for any signs of illness. If illness
is observed, this should be managed accordingly.
Conducting A Health Check

As a child enters the facility, meet with him/her and the
parent/guardian.
Greet the parent/guardian and ask about the child. Examples of
acceptable questions include: How is s/he today? Did s/he
have a good night?
While talking with the parent/guardian, observe the child for any
signs of illness.

How do you observe?
Look out for abnormal appearance, behaviour or routine
Listen to parent or child for complaints of illness
Feel childs forehead for warmth
Be alert for unusual odours.

FIRST AID
First aid is the treatment given to a child or staff member who
suddenly falls ill or becomes injured. The aim of first aid is to prevent
a condition from worsening or becoming fatal.
Children are vulnerable to infections and injuries, so it is important

that schools and childcare centres are able to provide first aid
services. Some infections can have serious symptoms that arise
suddenly and without warning. It is important to monitor all children
in the facility for signs of illness so they can be managed in a timely
manner. This will prevent a condition from worsening, becoming fatal
or spreading to others in the facility.
Guidelines for First Aid/Emergency Care

Each facility should have an equipped first aid kit and at least
one staff member trained to provide first aid (including CPR)
in the facility at all times.
It is important that the facility has up-to-date health records

and emergency contact numbers for each child. These will
be required if a child requires first aid.
Facilities should make arrangements with a nearby hospital

to provide professional care for children and staff in the case
of an emergency.
Do not give children medications without parental consent.

Medications should be over-the-counter drugs or those
prescribed by a licensed doctor.
Staff providing first aid should adhere to standard infection

prevention and control practices. These include hand
washing and wearing gloves if there is a risk of coming into
contact with body fluids.
Some Conditions Requiring First Aid/Emergency Care

High Fever (Body temperature at 38 Celsius or above)
Breathing difficulties Sudden/severe pain Persistent cough
Persistent vomiting
Persistent stooling
Absence of pulse
Uncontrolled bleeding Seizures
EXCLUSION
Exclusion is a strategy for managing children with infections. It
involves keeping a sick child separate from others in the setting to
prevent the infection spreading. The need for exclusion and the
length of time a child is excluded depends on: how easily the
infection can spread, how long the child is likely to be infectious and
how severe the disease can be.
Components of Health Records in Schools

and Childcare Centres
History of medical assessments and treatments, updated
yearly.
Immunization record.
Information on special health problems such as allergies,
sickle cell anaemia, asthma and other chronic health
conditions. Information should include what triggers the
condition and how to prevent/manage the condition in the
facility.
Contact information of the childs parents/guardian
including names, home and office addresses and telephone
numbers.
Contact information of the childs doctor or hospital.
Reasons for exclusion

Child has an infection that requires exclusion (see below for
symptoms that require exclusion)
Child is too ill to participate in activities
Child requires more care than the setting can provide
These children may be excluded temporary in the school/childcare

facility until their parents/guardians pick them up. Thereafter, they
should spend time recuperating at home or in the hospital (as may
be appropriate) until they no longer pose a threat to others and can
participate fully in activities.
Symptoms that require Symptoms that DO NOT

exclusion require exclusion
Severe cough Mild cough

Repeated vomiting Runny nose
Frequent Diaper rash
stooling/diarrhea
Fever combined with
symptoms such as
vomiting, diarrhea or
body rash
Oozing sores
BIBLIOGRAPHY
Bibliography 97
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http://nrckids.org., 2011.
Aronson, S, Donoghue, E and Shope, T. Curriculum for managing

infectious diseases in early education and child care settings. s.l. :
American Academy of Paediatrics.
Asekun-Olarinmoye, E. O, Oyemade, A. A and Lawoyin, T. O. Health

status of children aged under two years cared for in day-care centres
and the home environment in Ibadan, Nigeria. Journal of Community
Medicine and Primary Health care, 2005, Vol. 17, pp. 33-37.
Bacteria In Day Care Environment. Olaitan, J and Adeleke, O. 1, 2006,

The Internet Journal of Microbiology, Vol. 3.
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Infection Prevention and Control Manual For Schools and Childcare Facilities

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Infection Prevention and Control

Compiled and Edited

This material provides basic information that teachers and caregivers

What is infection? ............................................................. 3

Causes of infections ...4

Signs and symptoms of infections 8

Infection Process ..9

Factors that can contribute to the occurrence and spread of

INFECTION PREVENTION AND CONTROL STRATEGIES.....25

How to prevent and control infections .27

Strategies for Infection Prevention and Control in Childcare

Ensuring Effective Infection Prevention and Control in

HYGIENE AND SANITATION PRACTICES45

Hand Hygiene ....47

General Cleaning and Disinfection 53

Diaper Hygiene ..59

Toilet Hygiene .63

Washing and Disinfection of Clothing and Bedding ...66

Washing and Disinfection of Toys ..68

Cleaning Spills ....69

Food Hygiene .....70

Waste Management ..75

HEALTH PROMOTION: BOOSTNG BODY DEFENCES...77

Health Education .82

Nutrition Services ..85

Physical Activity ....86

DETECTION AND MANAGEMENT OF THE SICK....88

Daily Health Checks .90

Understanding infections is essential for preventing and controlling

Topics addressed in this unit include:

What is infection? ....................................................................................................... 3

Causes of infections .................................................................................................. 4

Signs and symptoms of infections ..................................................................... 8

Infection Process ......................................................................................................... 9

Factors that can contribute to the occurrence and spread of

The presence of organisms in the body triggers some reactions

Common terms related to infection:

Infectious diseases These are illnesses resulting from an infection.

Colonization This is when microorganisms are found living on a

Infestation This is the invasion of the body, either the surface or

Communicable/transmissible This refers to an infection that can

Contagious This is a term used to describe an infection that

host organisms, they bind to internal structures of the hosts cells

Cells generally have special structures on their surface, called

Treatment for viral infections is very difficult because most of them

Prevention is always a better approach with viruses since they are

infections. Many viral illnesses, such as hepatitis B, measles, mumps

Bacteria can cause severe illness. Thankfully, medications for

SIGNS AND SYMPTOMS OF INFECTIONS

Symptoms refer to the experiences of an individual who has an

Note: An individual may have an infection but not experience any

Common symptoms and signs of infections in children

Runny nose or nasal congestion

Figure 1.1: Key elements of the infection process

Infectious diseases result from the interaction of infectious organism

The mechanism of infection is varied amongst infectious organisms.

Under favourable conditions, infectious organisms invade or infest

Infectious Portal of mode of portal of susceptible

Figure 1.2: Chain of Infection

The components of the chain of infection include:

The infectious organism

The infectious organism is the organism that causes infection such

Living reservoirs could be humans or animals with symptomatic or