Health protection for educational settings

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Introduction

Health protection in children and young people settings, including education is the key guidance for supporting education settings around infection protection control measures, exclusion periods for different infections and advice around when and how to contact the UKHSA South West Health Protection Team. UKHSA have produced resources for schools, education settings and parents/caregivers highlighting the isolation periods for different infections.

The South West UKHSA Health Protection team hold regular free webinars for early years and education settings. These provide an opportunity to hear about, discuss and ask questions about childhood infectious diseases, infection prevention and control, and outbreak management.  Details can be found online at https://www.eventbrite.co.uk/e/health-protection-in-early-years-and-educational-settings-registration-309434836927.

Infection, Prevention and Control (IPC) measures

Key messages

  • Stay at home if you have symptoms of an infection e.g., gastroenteritis (diarrhoea and vomiting) or influenza (flu) like illness and not return to work until 48 hours have passed since last fever and diarrhoea and/or vomiting episode.
  • Hand hygiene is one of the most important ways of controlling the spread of infections, especially those that cause diarrhoea and/or vomiting and respiratory infections.
  • Coughs and sneezes spread diseases. Covering the nose and mouth with a tissue when sneezing and coughing can reduce the spread of infections. Throw the tissue away swiftly and clean your hands. ‘Catch it, bin it, kill it’
  • Keeping education and childcare settings clean, including toys and equipment, reduces the risk of transmission. Effective cleaning and disinfection are critical in any education or childcare setting, particularly when food preparation is taking place.
  • Personal Protective Equipment (PPE) can protect staff and students from contamination with blood or bodily fluids, which may contain germs that spread disease.
  • Letting fresh air into indoor spaces can help dilute air that contains viral particles and reduce the spread of COVID-19 and other respiratory infections.
  • Blood and bodily fluids can contain germs that cause infection. It is not always evident whether a child, young person or staff member has an infection, and so precautions should always be taken.
  • Keep up to date with vaccinations to reduce the likelihood of infection and severe illness.
  • Report outbreaks promptly to UKHSA South West Health Protection Team.

Infection prevention and control in educational settings

Schools are common sites for the spread of infection as children are particularly susceptible. Not all microbes are bad, but there are a few that can cause infectious disease resulting in absenteeism from educational settings and may also cause outbreaks within the setting. Outbreaks and cases of infectious disease represent a burden not only to the unwell child, but to the education setting, parents/caregivers, and the community through days lost in education, parents/caregivers taking time off work and the potential for spread of infection into the wider community. By following the everyday principles of infection prevention below, you will be helping to minimise the impact of sickness with your setting:

  • promptly exclude the unwell child or member of staff
  • check that effective hand hygiene is being carried out routinely
  • check that effective cleaning/environmental hygiene measures are in place, including safe management of blood and bodily fluids
  • ensure occupied spaces are well ventilated and let fresh air in.  Use a CO2 to check that you have adequate ventilation
  • promote vaccinations

Find more information on infection prevention in schools at Preventing and controlling infections – GOV.UK (www.gov.uk)

How are infections spread in schools?

Microbes such as bacteria, viruses and fungi are everywhere and commonly do not cause infection and can even be beneficial! However, some do cause infection resulting in symptoms such as fever and sickness.

Infections are spread in many different ways, but the most common routes are through:

  • Respiratory spread: Contact with cough or other secretions from an infected person. This can happen by being near the infected person when they cough and then you breathe in the organism; or by picking up the organism from an infected item, for example a used tissue or on an object in the environment, and then touching your nose or mouth. Airborne infections can spread without necessarily having close contact with another person via small respiratory particles. Flu is spread this way.
  • Direct contact spread: By direct contact with the infecting organism, for example contact with skin during contact sports such as rugby and in gyms. Impetigo or staphylococcal infections are spread this way.
  • Gastrointestinal spread: Resulting from contact with contaminated food or water (e.g. hepatitis A), contact with infected faeces or unwashed hands after using the toilet (e.g. norovirus).
  • Blood borne virus spread: By contact with infected blood or body fluids, for example while attending to a bleeding person or injury with a used needle (hepatitis B). Human mouths are inhabited by a wide variety of organisms, some of which can be transmitted by bites. Human bites resulting in puncture or breaking of the skin are potential sources of exposure to blood borne infections therefore it is essential that they are managed promptly.

Find out more about the spread of infections at What infections are, how they are transmitted and those at higher risk of infection – GOV.UK (www.gov.uk)

Where a case of infection is known, measures aim to reduce or eliminate the risk of spread through information and prompt exclusion of a case. Further information about the time period an individual should not attend a setting to reduce the risk of transmission during the infectious stage can be found at:

Hand hygiene

Hand washing is one of the most important ways of controlling the spread of infections, especially those that cause diarrhoea and/or vomiting and respiratory infections.

Ensure that staff and pupils have access to liquid soap, warm water and paper towels. Bar soap should not be used. If using electronic hand dryers instead of paper towels, then ensure that they are in good clean working order. Drying hands is an essential part of hand hygiene. It is a good idea to keep a stock of paper towels in case the electric hand dryers breakdown.

All staff and pupils should be advised to wash their hands, for example:

  • after using the toilet
  • before eating or handling food
  • after playtime
  • after touching animals

All cuts and abrasions should be covered with a waterproof dressing.

Hand sanitisers can be used if appropriate hand washing facilities are not available but should not replace washing hands particularly if hands are visibly soiled or where there are cases of gastroenteritis (diarrhoea and vomiting) in the setting. Note: not all hand sanitisers are effective against norovirus. Check the manufacturer’s instructions for further advice about the product.

Hand Hygiene Posters to download and print out:

Respiratory hygiene

Coughs and sneezes spread diseases. Covering the nose and mouth during sneezing and coughing can reduce the spread of infections. Spitting should be discouraged.

Educate children and young people on why respiratory hygiene is so important.

Anyone with signs and symptoms of a respiratory infection, regardless of the cause, should follow respiratory hygiene and cough etiquette, specifically:

  • cover nose and mouth with a tissue when coughing and sneezing, and dispose of used tissues and perform hand hygiene
  • cough or sneeze into the inner elbow (upper sleeve) if no tissues are available, rather than into the hand
  • keep contaminated hands away from the mucous membranes of the eyes and nose
  • carry out hand hygiene after contact with respiratory secretions and contaminated objects and materials

Posters to prevent spread of infection:

Safe management of the environment

Keeping the setting clean, including toys and equipment, reduces the risk of infection. It is especially important to clean surfaces that people touch a lot. Cleaning with detergent and water is adequate for day-to-day cleaning as it removes the majority of microbes that can cause infection. In the event of an outbreak of infection at your setting, your UKHSA Health Protection Team may recommend enhanced or more frequent cleaning, to help reduce transmission.

It is important that cleaning schedules clearly describe the activities required, the frequency of cleaning and who will carry them out. Cleaning standards should be monitored regularly by the setting.

All staff with cleaning responsibilities should be appropriately trained and have access to the appropriate personal protective equipment (PPE), such as gloves, aprons, and fluid resistant TIIR surgical masks.

There should be a designated area if there is a need for laundry facilities.

Any spillages of blood, faeces, saliva, vomit, nasal and eye discharges should be cleaned immediately, wearing appropriate PPE.

Under the waste management duty of care, schools must ensure that all waste produce is dealt with by a licensed waste management company.

Find out more about managing the environment safely, including management of laundry and linen, at Preventing and controlling infections – GOV.UK (www.gov.uk)

Ventilation

Ventilation is the process of introducing fresh air into indoor spaces while removing stale air. Letting fresh air into indoor spaces can help remove air that contains virus particles and prevent the spread of respiratory infections such as flu and coronavirus. Good ventilation has also been linked to health benefits such as better sleep and concentration, and fewer sick days off from work or school. Use a CO2 monitor to check that there is adequate ventilation.

Find out more at:

IPC self-assessment checklist

This checklist is designed to support educational settings with meeting the required standards to protect all its people from infectious diseases within that setting. All education settings are encouraged to complete at the beginning of term and repeat on a regular basis to help ensure that all measures remain in place. The checklist can also be used to inform the educational settings whole site risk assessment. It supports compliance and adherence with the infection prevention and control measures that are required to meet those standards.

The UKHSA South West Health Protection Team also produce a useful checklist in their Winter Preparedness resources:

Further information

Teaching resources

  • Home (e-bug.eu) e-Bug provides free resources for educators, community leaders, parents, and caregivers to educate children and young people and ensure they can play their role in preventing infection outbreaks and using antimicrobials appropriately.
  • Join Us On A Germ’s Journey | A Germ’s Journey (germsjourney.com) explore a germ’s journey and the importance of handwashing, through games, activities and informational tools.

Vaccinations

Immunisation is a key intervention to help give children the best start in life. The School Aged Immunisation Team will contact schools to arrange clinics for eligible children. Vaccinations are planned and timed to be given to children when they are at greatest risk of infection and most likely to experience the severe consequences of the disease. Further information about how you can support immunisation in schools with the school aged immunisation team, as well as the full immunisation schedule for children if required can be found in the Health protection in children and young people settings, including education guidance.

Flu (influenza)

Groups eligible for flu vaccination each year are based on the advice of the Joint Committee on Vaccination and Immunisation (JCVI). The programme aims to provide direct protection to those who are at higher risk of flu associated morbidity and mortality and to reduce transmission to all age groups through the vaccination of children. In 2022/23 pre-school children aged 2 and above (or aged 6 months – 2 years in an at-risk group) will be vaccinated by clinics in primary care settings.

Primary and secondary school aged children will be vaccinated in school by the school aged immunisation team, starting with the youngest primary aged and then moving through to secondary aged. Full details of groups eligible for flu vaccine in 2022-23 can be found at National flu immunisation programme 2022 to 2023 letter – GOV.UK (www.gov.uk).

Covid-19

The latest guidance around eligibility for first, second and booster doses of Covid-19 vaccine are available on the booking site.

HPV

The HPV vaccine helps protect against cancers caused by HPV, including cervical cancer, some mouth and throat cancers and some cancers of the anal and genital areas. It also helps protect against genital warts. In England, girls and boys aged 12 to 13 years are routinely offered the 1st HPV vaccination when they’re in school Year 8. The 2nd dose is offered 6 to 24 months after the 1st dose. School aged immunisation teams will contact schools to arrange dates for vaccinations and provide required information to be shared with parents and students. Further information about the vaccines can be found at:

School Year 9 vaccinations for tetanus, diphtheria, polio and meningococcal A, C, W and Y

The teenage booster, also known as the 3-in-1 or the Td/IPV vaccine, is given to boost protection against 3 separate diseases: tetanus, diphtheria and polio. The MenACWY vaccine is also given at the same time. Both vaccines are routinely given at secondary school during school year 9. School aged immunisation teams will contact schools to arrange dates for vaccinations and provide required information to be shared with parents and students. Further information about the vaccines can be found at:

Anti-vaccination activity

Should schools experience any anti-vaccination activity the process for reporting and managing this is outlined at:

Responding to and dealing with incidents and outbreaks

Education and childcare settings are asked to contact their UKHSA Health Protection Team as soon as possible to report any outbreak or serious or unusual illness listed below or based on guidance in the Managing specific infectious diseases section of the Health protection in children and young people, in education guidance which outlines what to do if you have an outbreak and how to contact UKHSA.

  • E. coli 0157 or E coli STEC infection
  • food poisoning
  • norovirus (if experiencing higher than previously experienced or rapidly increasing absence due to diarrhoea and vomiting)
  • hepatitis
  • measles, mumps, rubella (rubella is also called German measles)
  • meningococcal meningitis or septicaemia
  • scarlet fever (if an outbreak or co-circulating chicken pox)
  • tuberculosis (TB)
  • typhoid
  • whooping cough (also called pertussis)
  • acute respiratory infections (ARI) (see flow chart below) – Contact UKHSA only when:
    • a higher than previously experienced and/or rapidly increasing number of staff or student absences due to acute respiratory infection (ARI)
    • overnight hospital admission for treatment due to acute respiratory infection of a staff member or child
    • death of a child or staff member
    • co-circulation of acute respiratory infection (ARI)/non – ARI infections or differential diagnosis (e.g. Flu, Covid-19)
    • setting that provides care for children with severe neuro-disability or other students considered very high risk from acute respiratory infections

The Health Protection in Childcare and Young People Settings guidance has a section providing guidance on what to do when a setting has a suspected outbreak or incident, the type of information that will be required, types of actions that may be advised and how to contact the UKHSA South West Health Protection team.

The school may also be contacted directly by UKHSA. Registered medical practitioners in England and Wales have a statutory duty to notify their local authority or local UKHSA Health Protection Team of suspected/confirmed cases of certain (notifiable) infectious diseases and UKHSA may then contact the setting if there are actions required as part of public health management.

Flowchart for high cases of acute respiratory infections (including Covid 19 and flu-like illness)

Education settings operational issues

Emergency planning

There is DfE guidance on general emergency planning and response which includes public health incidents. Devon schools should move away from a specific Covid-19 action plan to using either the school’s emergency planning document or business continuity plan with a section specifically on dealing with infectious diseases outbreaks

It is important that if an educational setting has an outbreak puts into place its Emergency Planning or business continuity plan.

Closure due to operational issues

If you believe you are unable to continue to offer full-time face to face education due to operational issues regarding safe staffing levels or compliant staffing on site and are either a DCC maintained school or an academy trust, please contact Simon Niles simon.niles@devon.gov.uk and the Schools priority mailbox educate.schoolspriorityalerts-mailbox@devon.gov.uk indicating:

  • Overview of types of illness and sickness across the school for children and staff and the issues of the year group needing to go to remote learning
  • Confirmation that the school were unable to secure supply staff and/or redistribute staff across the school
  • Confirmation that an onsite offer has been maintained to vulnerable and key worker children
  • Any other context in terms of not being complaint due to appropriate trained staff
  • For early years settings with operational issues, it is advised contacting your Early Years locality with the above information and for advice and support.

Health and safety support

For those schools or settings that buy into Devon County Council Health and Safety Service SLA for competent advice please contact the Health and Safety team at healthandsafety@devon.gov.uk if you need advice. For other settings and schools not part of the SLA, contact your health and safety competent person for advice.

Department for Education Incident Support Helpline

The Department for Education Incident Support helpline is available to answer any questions you have about Covid-19 or the current situation in Ukraine, as they relate to education and childcare settings and children’s social care, or other national emergency issues.

Guidance

Resources

Infection Prevention Control

Ventilation

  • CoSchools – tools for healthy schools resources aimed to explain how CO2 monitors can help teachers manage their classroom ventilation to provide a more comfortable and healthier learning environment.
  • Home (e-bug.eu) e-Bug provides free resources for educators, community leaders, parents, and caregivers to educate children and young people and ensure they can play their role in preventing infection outbreaks and using antimicrobials appropriately.
  • Join Us On A Germ’s Journey | A Germ’s Journey (germsjourney.com) explore a germ’s journey and the importance of handwashing, through games, activities and informational tools.

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