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«The Florida Department of Health in Escambia County 1295 West Fairfield Drive Pensacola, FL 32501 850-595-6500 This manual ...»

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The Florida Department of Health in Escambia


1295 West Fairfield Drive

Pensacola, FL 32501



This manual serves as a tool to encourage common understanding of communicable (infectious) diseases

in schools and child care settings. It is designed for use by school health professionals,

teachers/caregivers, and parents/guardians. This manual is an easy reference guide that addresses:

How Infections are spread School Exclusion Criterion Infection Control Methods Additional Resources and Handouts

This manual is brought to you by:

The Florida Department of Health in Escambia County Preparedness Surveillance and Response Program 1300 West Gregory Street Pensacola, FL 32502 (850)595-6683 Phone (850)595-6268 Fax Available online at: www.escambiahealth.com Unless otherwise specified, the content of this manual was adapted from the Centers for Disease Control and Prevention (CDC) and the American Academy of Pediatrics (AAP).

1 Table of Contents

1. How Infections are spread

1.1 Direct Transmission

1.2 Indirect Transmission

2. Exclusion Criterion

3. School Exclusion Quick Guide

4. Prevention and Control

4.1 Hand washing

4.2 Respiratory Etiquette

4.3 Cleaning, Disinfecting, Sanitizing


5. Disease Fact Sheets

6. Additional Forms/Resources

6.1 Reportable Diseases/Conditions in Florida

6.2 What is a Line List

6.3 Line List Templates

6.4 Posters

–  –  –

Person‐to‐Person The most common way to spread disease is by spreading bacteria, viruses, or other germs from one person to another. This can occur when an individual with the illness touches, coughs on, or kisses someone who is not sick.

Body Fluids Contact with blood or other body fluids of another person usually means a more personal exposure than those that can occur in a group setting. Contaminated blood and other body fluids must come into contact with another person via cuts, scrapes, or mucus membranes (i.e., the inside of your nose or mouth); thus allowing germs to enter the body. While possible, infected children are unlikely to spread infection by biting. Because it is impossible to know who has a blood‐borne disease, routine use of the standard precautions outlined in this manual in the Cleaning, Disinfecting, and Sanitizing section will reduce the chances of spreading germs. Saliva and urine often contain viruses long after a child has recovered from an illness. Good hand washing and standard precautions will help prevent the spread of these viruses.

Animal‐to‐Person Though pets may seem harmless, they often carry many germs. Being bitten or scratched by an animal may make you sick if the animal has an infection that can cause disease in humans. Handling animal waste also can be hazardous. For example, a person can acquire Toxoplasmosis infection from handling the contents of a cat’s litter box. This disease can be incredibly dangerous, especially for pregnant women. It is important to have pets fully vaccinated and routinely checked by a veterinarian.

3 1.2 Indirect Transmission

Many germs can linger on an inanimate object, such as a tabletop, doorknob or faucet handle. When you touch the same doorknob that was touched by someone who was ill, you could pick up the germs he or she left behind. If you touch your eyes, mouth, or nose before washing your hands, you may become infected. Some infections occur from germs that naturally live in the environment but are not passed from person‐to‐person.

Droplet and Airborne When you cough or sneeze, you expel droplets into the air around you. When you are sick, these droplets may contain the germ that caused your illness. Spread of germs in this manner is called droplet spread or droplet transmission. Droplets travel for only about three feet because they are usually too large to stay suspended in the air for a long time. However, if a droplet from an infected person comes in contact with your eyes, nose, or mouth, you may soon experience symptoms of the illness. The most common way droplets are spread is on hands. This is why it is so important to teach children and adults to wash their hands after they cough or sneeze, or to sneeze into a covered area, like the crook of the arm (not the hands). Crowded, indoor environments may also increase the chances of droplet transmission because people are much more likely to be within three feet of each other. Some disease‐causing germs travel through the air in particles considerably smaller than droplets. These tiny particles remain suspended in the air for extended periods of time and can travel in air currents. If you breathe in an airborne germ, you may become infected and show signs and symptoms of the disease. Colds caused by viruses, influenza and tuberculosis are a few types of infectious diseases usually spread through the air, in both particle and droplet forms.

Vectors Some germs rely on insects (such as mosquitoes, fleas, lice, or ticks) to move from host to host. These insects are known as vectors. Mosquitoes can carry the West Nile virus and deer ticks may carry the bacteria that cause Lyme disease. Vector‐borne spread of germs happens when an insect that carries the germ lands on you or bites you. The germs move into your body and can make you sick.

4 Fecal-Oral/Foodborne Children who are in diapers constitute a high risk for the spread of gastrointestinal infections. Diseases can be spread by the child themselves or by the person(s) changing the diaper when hands, toys, or areas become contaminated with fecal material that contain germs. The germs can be ingested during playtime, food preparation, or in the case of young children, just by putting their hands or toys into their mouths. Hand washing is the best prevention method to reduce the risk of spreading these types of


illnesses. Even if you wear gloves, you should always wash your hands after removal of the gloves.

Children attending school or child care should be free of known infectious diseases. When a child becomes ill but does not require immediate medical help, a determination should be made regarding whether the child should be sent home or remain at school. Most illnesses do not require exclusion, however, if any of the following criteria are met, the child should be excluded regardless of the type of illness.

1. The child has a fever equal or greater than 100.4°F.

2. The child is vomiting repetitively (more than 2 times in 24 hours and is not from a known condition).

3. The child has diarrhea (more than two loose stools above normal for that child).

The following Exclusion Quick Guide outlines the recommendations for specific diseases. If you suspect or know of a child attending child care /private school that has one of the conditions listed below with a reportable conditions symbol, please call the Florida Department of Health in Escambia County, Division of Epidemiology, at 850.595.6683 to report. Public schools should notify their immediate supervisor, according to agency protocol. For more information about any of these conditions, please visit www.escambiahealth.com or www.cdc.gov.

–  –  –


4. PREVENTION AND CONTROL The close, prolonged contact of children to one another in the school/child care setting may expose them to many different germs. Though it is not possible to completely eliminate every germ from every surface, reducing their numbers can greatly protect one from illness. The two best practices for controlling exposure to germs are: 1) hand washing and 2) cleaning, sanitizing, and disinfecting contaminated objects and surfaces. It should also be noted that proper disposal of contaminated items is essential to keeping children and staff healthy. It is easy to forget how tiny germs are that cause disease and to overlook commonly contaminated items simply because they do not look dirty. Similarly, children who do not show symptoms of illness may not be suspected of carrying or spreading germs, even though they may be just as infectious as those children who have symptoms.

4.1 Hand Washing Keeping hands clean is one of the best ways to keep from getting sick and spreading illnesses. Practicing good hand hygiene gets rid of bacteria and viruses from contact with other people or surfaces. Schools and child care centers play a key role in supporting hand hygiene. This involves teaching good handhygiene practices and providing hand-hygiene information to students and families. In addition to education, providing hand soap and paper towels is also necessary to reduce the spread of infectious diseases in the school environment.Studies have shown that unwashed or improperly washed hands are the primary carriers of infections. Lack of hand washing and poor hand washing techniques contributes to many outbreaks of diarrhea among children and staff in school and child care settings, while adherence to good hand washing techniques consistently demonstrates a reduction in disease transmission. When working with children, teachers/caregivers should not wear elaborate jewelry or long artificial fingernails because these interfere with effective hand washing.

When should you wash your hands?

 Before, during, and after preparing food  Before eating food  Before and after caring for someone who is sick  Before and after treating a cut or wound

–  –  –

What is the right way to wash your hands?

Wet your hands with clean, running water (warm or cold), turn off the tap, and apply soap.

• Lather your hands by rubbing them together with the soap. Be sure to lather the backs of your hands, • between your fingers, and under your nails.

Scrub your hands for at least 20 seconds. Need a timer? Hum the "Happy Birthday" song from • beginning to end twice.

Turn on the tap and rinse your hands well under clean, running water.

• Dry your hands using a clean towel and turn off the tap with a paper towel.

What if I don’t have soap and running water?

Washing hands with soap and water is the best way to reduce the number of microbes in most situations. If soap and water are not available, use an alcohol-based hand sanitizer that contains at least 60% alcohol. Alcohol-based hand sanitizers can quickly reduce the number of microbes on hands in some situations, but sanitizers do not eliminate all types of germs. Hand sanitizers are not as effective when hands are visibly dirty or greasy.

For more information on keeping hands clean, visit CDC’s hand washing page at:


For educational materials and posters on hand washing, see Additional Forms/Resources on page 42.


4.2 Respiratory Etiquette Respiratory infections can spread from person to person in respiratory droplets of coughs and sneezes.

Droplets from a cough or sneeze of an infected person can be propelled through the air and land on the mouth or nose of people nearby. To prevent the spread of respiratory illnesses, the nose and mouth should be covered with a tissue when coughing or sneezing and the tissue should be thrown in the trash immediately after use. Schools can teach respiratory etiquette to students and staff — including coughing or sneezing into the arm if no tissue is available — and can ensure that tissues are available. For more information on covering your cough, visit CDC’s “Cover Your Cough” page at http://www.cdc.gov/flu/protect/covercough.htm.

4.3 Cleaning, Disinfecting, and Sanitizing Cleaning, disinfecting, and sanitizing are part of a broad approach to preventing infectious diseases in schools. Best practices must be followed routinely whether or not surfaces or items appear to be soiled or children appear to be ill. There are numerous diseases that can be spread by soiled items, blood, and body fluids that may not cause an individual to appear ill. It is also important to treat the cleanup of blood or body fluids seriously, as they have the potential to spread illness.

1. Know the difference between cleaning, disinfecting, and sanitizing Cleaning removes germs, dirt, and impurities from surfaces or objects. Cleaning works by using soap (or detergent) and water to physically remove germs from surfaces. This process does not necessarily kill germs, but by removing them, it lowers their numbers and the risk of spreading infection.

Disinfecting kills germs on surfaces or objects. Disinfecting works by using chemicals to kill germs on surfaces or objects. This process does not necessarily clean dirty surfaces or remove germs, but by killing germs on a surface after cleaning, it can further lower the risk of spreading infection.

Sanitizing lowers the number of germs on surfaces or objects to a safe level, as judged by public health standards or requirements. This process works by either cleaning or disinfecting surfaces or objects to lower the risk of spreading infection.


2. Clean and disinfect surfaces and objects that are touched often Follow your school’s standard procedures for routine cleaning and disinfecting. Typically, this means daily sanitizing surfaces and objects that are touched often, such as desks, countertops, doorknobs, computer keyboards, hands-on learning items, faucet handles, phones, and toys. Some schools may also require daily disinfecting these items. Standard procedures often call for disinfecting specific areas of the school, like bathrooms.

Immediately clean surfaces and objects that are visibly soiled. If surfaces or objects are soiled with body fluids or blood, use gloves and other standard precautions to avoid coming into contact with the fluid.

Remove the spill, and then clean and disinfect the surface.

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