This procedure should be followed by Rainbow staff if there are two or more cases of vomiting and diarrhea in the same week.
Recognition
Infection can be spread within any establishment very easily. By implementing this infection control policy notifying promptly to our local health protection unit, Rainbow are confident that the necessary action can be taken which will minimise the spread of infection.
Actions
- Practical management
The germs responsible for diarrhoea & vomiting outbreaks are usually either bacterial or viral. The important part in controlling an outbreak is prevention of the spread of the disease & protection of the unaffected children, staff and visitors. Disease can be introduced to the nursery by people being in close contact with a person who is ill with symptoms. Disease can also be between people within the nursery due to poor infection control practices. It is not always possible to identify staff or children suffering with, or incubating, a disease. Therefore ensuring robust infection control practice is in place is an important infection control measure.
Transmission routes for spreading germs can be either one or more than one of the following:
- food
- hand to mouth
- airborne
Symptoms will vary depending on the germ causing illness and may be either just diarrhoea or vomiting or both.
The three most important practical aspects for the management of diarrhoea and vomiting outbreaks are:
- Exclusion of affected children & staff during illness and for 48 hours after symptoms have stopped (til the following full nursery day)
- Enhanced cleaning of the environment and equipment
- Effective hand washing
- Exclusion
Exclusion is vital for any symptomatic staff or children. They should not return to the nursery for 48 hours after normal bowel habits have returned and/or vomiting has stopped. Children are not permitted to enter the gan part way through a day after the exclusion period gas expired, they must wait until the following day. Following any exclusion, the manager should ensure that appropriate checks are made to ensure that all staff are fit to return to work and have observed the 48 hour exclusion period, and may only return at the next full day of nursery (for example children cannot return to nursery part way through a day, if they are sent home at 1pm on a Monday, they can return to nursery at the earliest Thursday morning, providing they have not have not experienced any further episodes of diarrhoea or vomiting )
- Cleaning of the environment and equipment
During and directly after any outbreak, Rainbow will increase the cleaning regime to ensure that adequate additional measures are being taken to control any possible infections. We will increase the frequency of environmental cleaning using clean, disposable cloths, dedicated mops/mop buckets for toilet areas, hot water and diluted bleach (in recommended dilutions for environmental cleaning) in communal areas. Particular attention focus will be on toilet seats, door/ toilet handles and sink taps, on soft play areas, changing areas and water play areas.
Bleach will be used as the cleaning agent of choice, as it will kill both bacteria and viruses. It is important that diluted bleach is used according to manufacturers’ instructions and is used to clean the areas where the most likely to transmit the germs as mentioned above. Obviously on some surfaces (i.e. on carpets/soft furnishings) bleach will not be suitable to use, in which case steam cleaning (or machine washing in the case of soft furnishings) will be deployed instead.
During an outbreak, hard toys will be washed daily in Milton and rinsed and dried. Stock rotation should occur to limit the number of toys accessible at once. Soft toys should not be used during an outbreak, nor should the sand and water play areas or play dough. Cookery activities for the children should also be suspended for the duration of the outbreak.
Guidance on cleaning up vomit
If a vomiting outbreak occurs the person vomiting can spread the infection some distance. Virus particles contained in the vomit can land and contaminate the environment, which will mean other children and staff can become infected. Vomit should be cleaned up immediately and the area contained. People who clear up the vomit should protect themselves by wearing disposable gloves, a plastic apron and ensure the area is well ventilated. Paper towels or tissues should help soak up the excess liquid and prevent further contamination. Water and detergent should be used in the first instance and pouring bleach directly onto vomit produces large amounts of chlorine gas.
- Hand washing
Hand washing is vital to prevent person-to-person transmission. Hand-washing should be frequent and it will be actively encouraged for both staff and children.
For staff, alcohol hand-rub (70% alcohol content plus emollient) is sometimes a useful addition to soap and water for hand decontamination during outbreaks of infection. Alcohol gel is not recommended for use on norovirus (winter vomiting disease). It can be used after hand-washing as an extra measure to using soap and water during an outbreak or as an alternative to soap and water ON HANDS THAT ARE VISIBLY CLEAN ONLY. Alcohol hand-rub cannot be used to clean organic matter from hands. In order to prevent the build up of alcohol hand rub on the hands, hands should be washed with liquid soap and water after three applications and when hands are visibly dirty.
Duty of Care
Everyone has a duty of care to protect themselves and others. They therefore should disclose relevant information/ symptoms etc. asked for and take the necessary action advised by such agencies as the local Health Protection Unit. Adherence by everyone to policies, record keeping, hand washing, cleaning and prompt exclusion will stop the transmission of the germs quickly.
Clarification on exclusion periods
Whilst the exclusion periods are usually expressed as hours (eg – 24 hours, 48 hours etc)… to clarify children cannot return to nursery part-way through a nursery day. If for example their exclusion period expires at 12 lunchtime, they may not attend nursery for they afternoon, they need to wait until the next nursery day to attend.