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Communicable Diseases and Schools What you need to know

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Title: Communicable Diseases and Schools What you need to know


1
Communicable Diseases and SchoolsWhat you need
to know
  • Presented by the Branch-Hillsdale-St. Joseph
  • Community Health Agency

2
Exposure- Disease Detection Timeline
  • Exposure
  • Onset of Symptoms Some electronic surveillance
  • Seek Medical Care (maybe yes, maybe no) Some
    electronic surveillance
  • Diagnosis
  • Reported to Health Department Surveillance
    (electronic)
  • Reported to State Surveillance (electronic)

3
Topics for Presentation
  • MRSA
  • Norovirus
  • Flu other communicable diseases
  • Head lice.
  • School Closing issues
  • Cleaning
  • Diabetes
  • MI-Child
  • 211

4
What to do about MRSA?
5
What is MRSA?
(Methicillin Resistant Staphylococcus aureus)
  • Super Bug
  • Sometimes called a staph infection
  • Commonly causes skin infections
  • Resistant to penicillin other antibiotics

6
What does MRSA look like?
  • Spider bite
  • Turf burn
  • Impetigo
  • Boil
  • Abscess
  •   

Source LA County Health Department
Source Mark Grubb, MD
Source CDC
Source CDC
Source CDC
7
How do you get MRSA? How does it spread?
  • Skin to Skin Contact
  • Touching skin infections
  • Touching drainage from skin infections
  • Surface to Skin Contact
  • Touching unclean sports equipment, keyboards,
    phones, desktops, doorknobs.
  • Sharing personal hygiene items (skin ointments,
    razors, bar soap, towels)

8
Who is at High Risk for MRSA?
  • People who
  • Live in crowded conditions
  • Lack resources to stay clean
  • Share sports equipment
  • Share personal hygiene items
  • Overuse antibiotics or take them incorrectly
  • Have abraded or injured skin
  • Have severe immune system problems - Cancer,
    Leukemia, HIV
  • However Anyone can get MRSA

9
How is MRSA Treated?
  • By a healthcare provider who may
  • Drain the infection and/or
  • Prescribe an antibiotic and/or
  • Reduce the amount of MRSA on the patients skin

10
Stop the Spread of MRSA!
  • Hand washing is the most important way to
    prevent MRSA
  • Wash your hands often with warm soapy water, use
    friction and scrub for 20 seconds (sing your
    abcs)
  • Use 60 alcohol-based hand sanitizer when soap
    and water are not available
  • Require students to report potential skin
    infections to the school nurse/office
  • Cover open wounds with clean, dry bandages that
    adhere to skin on all 4 sides
  • Dont touch other peoples skin lesions

11
Clean Disinfect to get Rid of MRSA on Surfaces
  • Cleaning gets rid of the dirt you can see
  • Soap water is a good cleaning solution
  • Disinfecting gets rid of most of the germs
  • Follow manufactures guidelines for disinfectants
  • Establish routine cleaning schedules
  • MRSA can stay on environmental surfaces for
    weeks!
  • Clean Disinfect frequently all environmental
    surfaces that may come in direct contact
    with skin

12
Should schools close because of an MRSA
infection?
  • The decision to close a school for any
    communicable disease should be made by school
    officials in consultation with local and/or state
    public health officials. However, in most cases,
    it is not necessary to close schools because of
    an MRSA infection in a student. It is important
    to note that MRSA transmission can be prevented
    by simple measures such as hand hygiene and
    covering infections.
  • In general it is not necessary to close schools
    to "disinfect" them when MRSA infections occur.
    MRSA skin infections are transmitted primarily by
    skin-to-skin contact and contact with surfaces
    that have come into contact with someone else's
    infection.
  • Cleaning and disinfection should be performed on
    surfaces that are likely to contact uncovered or
    poorly covered infections.
  • Cleaning surfaces with detergent-based cleaners
    or registered disinfectants is effective at
    removing MRSA from the environment.
  • Environmental cleaners and disinfectants should
    not be used to treat infections.

13
Should students with MRSA skin infections be
excluded from attending school or playing sports?
  • Unless directed by a physician, students with
    MRSA infections should not be excluded from
    attending school.
  • Exclusion from school should be reserved for
    those with wound drainage ("pus") that cannot be
    covered and contained with a clean, dry bandage
    and for those who cannot maintain good personal
    hygiene.
  • Students with active infections should be
    excluded from activities where skin-to-skin
    contact is likely to occur (e.g., sports) until
    their infections are healed.

14
Practical Advice for Teachers/School Personnel
  • If you observe children with open draining wounds
    or infections, refer the child to the school
    nurse.
  • Enforce hand hygiene with soap and water before
    eating and after using the bathroom.
  • Students with skin infections may need to be
    referred to a licensed health care provider for
    diagnosis and treatment. School health personnel
    should notify parents/guardians when possible
    skin infections are detected.
  • Use standard precautions (e.g., hand hygiene
    before and after contact, wearing gloves) when
    caring for non-intact skin or potential
    infections.
  • Use barriers such as gowns, masks and eye
    protection if splashing of body fluids is
    anticipated

15
Norovirus
16
What is a Norovirus?
  • Noroviruses are a group of viruses that cause the
    stomach flu, or Gastroenteritis in people. The
    term norovirus is the official name for this
    group of viruses.
  • Approximately 23 million cases each year in U.S.
  • Potentially 500-750 annually in SJ County
  • Leading cause of outbreaks of gastroenteritis

17
Symptoms
  • Nausea, vomiting, diarrhea, abdominal cramps
  • Sometimes low-grade fever, chills, headache,
    myalgia, fatigue
  • Often begins suddenly, and the infected person
    may feel very sick

18
Incubation, Duration, Communicability
  • Incubation period 12 - 48 hours (median in
    outbreaks is 33 - 36 hours)
  • Duration of illness 24 - 60 hours
  • Period of communicability onset through 72 hours
    after recovery

19
Transmission
  • Found in the stool and vomit of infected people
  • Can be transmitted several ways
  • Eating food or drinking liquids that are
    contaminated with norovirus
  • Direct person-to-person spread highly
    contagious
  • Airborne and fomite (think money) transmission in
    droplets contaminating surfaces or entering the
    mouth and being swallowed

20
How serious is it?
  • Usually not serious, although people may feel
    very sick and vomit many times a day
  • Most get better within 1 or 2 days, and they have
    no long-term health effects related to their
    illness
  • Can be serious for the very young, the elderly,
    and persons with weakened immune systems due to
    dehydration

21
St. Joseph County GI ActivityOctober, 2002
through December, 2008Branch-Hillsdale-St.
Joseph Community Health Agency Communicable
Disease Reports
22
Treatment
  • Drink plenty of fluids to prevent dehydration
  • No antiviral medication
  • No vaccine to prevent infection
  • Cannot be treated with antibiotics because
    antibiotics work to fight bacteria and not viruses

23
Prevention - Hand Washing
  • After using restrooms and before eating
  • Be sure ALL hand wash sinks have warm water,
    soap, and paper towels

24
Other Prevention Measures
  • Isolation of symptomatic individuals, and proper
    cleaning and disinfection are critical in
    stopping this virus.
  • Any vomiting episode should be treated as a
    potential norovirus and schools should react
    pro-actively to institute norovirus guidelines
    immediately not throughout a school necessarily,
    but in the classroom or section of the school
    where the incident has happened.  

25
Cleaning and Disinfectingfor Norovirus
26
Cleaning
  • Put on personal protective equipment
  • Remove visible debris with absorbent material and
    place in plastic bag, then follow with
    disinfection.
  • For clean-up of carpet or upholstered furniture,
    remove visible debris with absorbent material and
    place in plastic bag, then steam clean at 158oF
    for 5 minutes or 212oF for 1 minute
  • Launder soiled clothing/linens separately and dry
    in a hot dryer.

27
Disinfection
  • Bleach works best and is low cost
  • Bleach concentrations and mixing instructions
  • For stainless steel, food/mouth contact items,
    toys use 1 T in 1 gal of water
  • For non-porous surfaces, tile surfaces,
    counter-tops, sinks, toilets use 1/3 cup in 1 gal
    of water
  • For porous surfaces, wooden floors use 1 cup in 1
    gal of water
  • Contact time is 10-20 minutes, then rinse with
    clean water
  • Use a fresh bottle of bleach

28
Cleaning Disinfection in Schools, Healthcare
Facilities, Restaurants
  • Additional guidance is available for cleaning and
    disinfection of these facilities in the document
    Guidelines for Environmental Cleaning and
    Disinfection of Norovirus.
  • This is available at www.bhsj.org/eh/Food/eh_food.
    htm

29
What triggers concern in a school, daycare
center, or similar setting?
  • If you are concerned, contact your local public
    health nurse or environmental health sanitarian.
  • Sanitarians are already familiar with your school
    as they inspect your kitchen and are also
    familiar with the cleaning standards for
    communicable disease control. Call before you
    have a problem if you are at all concerned.
  • A larger than expected number of children or
    individuals out sick with gastrointestinal
    illness in a particular classroom, wing, or
    building.
  • What if you dont act

30
The Flu
31
The Flu
  • The flu is a contagious respiratory illness
    caused by influenza viruses. It can cause mild to
    severe illness, and at times can lead to death.
    The best way to prevent this illness is by
    getting a flu vaccination each fall.
  • Every year in the United States, on average
  • 5 to 20 of the population gets the flu
  • more than 200,000 people are hospitalized from
  • flu complications, and
  • about 36,000 people die from flu.
  • 50 million Americans get the flu
  • Flu season last from about November through
    March, often into April and peaks in February
    and March

32
What are the symptoms of the flu?
  • Dry cough
  • Fever
  • Aches
  • Headache
  • Sore throat
  • Fatigue
  • Transmitted by person to person cough, sneeze
    inhale virus
  • Symptoms usually last 2-7 days

33
Is it contagious? How is it spread?
  • Adults may be contagious from 1 day
    before feeling sick to up to 7 days after getting
    sick.
  • Children can be contagious for longer than 7
    days.
  • Flu is spread when a person who has the flu
    coughs, sneezes, or speaks and spreads virus into
    the air, and other people inhale the virus.
  • The viruses can also be spread when a person
    touches a surface with flu viruses on it (for
    example, a door handle) and then touches his or
    her nose or mouth. Think Hand Washing!!!!!!!

34
The Flu in St. Joseph County Influenza October,
2002 through December, 2008
35
Lice!
  • Note No matter what you do, after hearing this
    next piece of information, for the next 2 hours
    you will itch!
  • Adult Lice compared to a dime
  • Adult lice are about 1/8 inch long.

36
A little lice lingo
  • Nits, Nymphs and adults - Nits are lice eggs.
    They are yellow or white, smaller than a grain of
    rice and difficult to see. They are often
    confused with dandruff.
  • Nymphs are baby lice, reddish brown in color and
    grow to adult lice in about 7 days.
  • Adult lice are about the size of a small grain of
    rice. Adult lice live about 30 days.

37
What, Who, How(So many questions, so little time)
  • What is it? An insect found mostly on the head.
    Head lice are extremely common, as 6-12 million
    people get head lice every year.
  • Who is at risk?? Kids aged 3-10 and their
    families are at the greatest risk.
  • How is it spread? Lice do not hop or jump or
    fly. They crawl. They spread from person to
    person contact during such activities as
  • Slumber parties, sports activities and
    playground activities.
  • Sharing of sports uniforms, coats, scarves,
    hats or hair accessories.
  • Sharing infested brushes, combs or towels.
  • Laying on an infested pillow, stuffed animal,
    bedding or carpet.

38
SymptomsHow do I find those critters?
  • Are there symptoms?
  • 1. A tickling feeling on the scalp.
  • 2. Itching, caused by an allergic reaction to
    the bites.
  • 3. Sores on the head from excessive scratching.
    These sores can sometimes become infected
  • Where should I look? Close to the scalp behind
    the ears and at the neckline in the back of the
    head. A thorough examination of all of your
    childs head is important as these are not the
    only places lice may be hiding.

39
Thoughts on removal
  • Remove clothing before treating
    (clothing may be infested)
  • Work under bright light (sunlight,
    bright indoor lamp)
  • Several treatment options are listed on
    the back of this sheet.
  • Do NOT use crème rinse or conditioning
    shampoo before treatment
  • Put on clean clothes after treatment
  • Comb dead and remaining lice out of
    hair after treatment.
  • Re-treat as necessary, especially for
    long or thick hair.
  • Check treated person for 2 to 3 weeks
    until you are sure all nits and lice are gone.

40
Treatment Options Treatment with Lice Shampoo
  • Wash hair with household shampoo.
  • Completely wet hair with lice shampoo.
  • Add warm water, leave product on head for
    recommended time - usually 10 minutes.
  • Rinse thoroughly with warm water while removing
    any dead lice and nits.
  • Re-treatment may be necessary in seven to 10 days
    as this kills hatching eggs.

41
Option 2A great home remedy
  • 1. (This treatment takes about 12 hours). This
    method has been the most successful.
  • Rub olive oil all over the childs head. Work
    it right down into the scalp.
  • Cover hair with a plastic shower cap (use
    extreme caution with small children under 3)
  • leave cap on for 12 hours.
  • Shampoo several times with a mild shampoo.
  • This method may be repeated a second time for
    very thick or long hair.

42
Do Not Treat Classrooms
  • Lice live their entire life cycle on the human
    body.
  • Lice die within 24 hours after falling off the
    host.
  • Treatment of classrooms with insecticidal sprays
    is unnecessary and may be hazardous.

43
Diabetes
44
What is diabetes?
  • Diabetes is a disease in which the body cannot
    properly use food for energy.
  • The hormone insulin, which is made in the
    pancreas, helps the body to get energy from food.
  • In people with diabetes, either the pancreas
    doesnt make insulin or the body cannot use
    insulin properly.

45
How Insulin Works
  • Sugar is the basic fuel for the cells in the
    body, and insulin takes the sugar from the blood
    into the cells.
  • Without insulin, glucose, the bodys main energy
    source, builds up in the blood.
  • Diabetes can lead to serious problems and
    complications, such as heart disease, blindness,
    kidney failure, lower limb amputations and
    premature death.

46
Diabetes Prevalence
  • In 2007, 17.9 million children and adults have
    been diagnosed with diabetes and there are
    another 5.7 million who are undiagnosed-for a
    total of 23.6 million Americans with diabetes.
  • 3,500 in SJ County

47
Type 1 Diabetes
  • Used to be called insulin-dependent or
  • juvenile-onset.
  • The exact cause is unknown but it appears to be
    an auto-immune disease that develops when the
    bodys immune system destroys pancreatic beta
    cells-the only cells in the body that make the
    hormone insulin which regulates blood glucose.
  • People with type 1 diabetes must take insulin
    every day by injection or pump.

48
Type 2 Diabetes
  • In type 2 diabetes either the pancreas does not
    produce enough insulin or the cells ignore the
    insulin. If the cells are not getting insulin or
    resisting the insulin, then sugars will build
    up in the blood.
  • Most common form of diabetes
  • Can be prevented with lifestyle changes
  • May need pills or insulin to control blood sugar

49
Pre-Diabetes???
  • Before people develop type 2 diabetes, they
    almost always have "pre-diabetes" -- blood
    glucose levels that are higher than normal but
    not yet high enough to be diagnosed as diabetes.
    There are 57 million people in the United States
    who have pre-diabetes. Recent research has shown
    that some long-term damage to the body,
    especially the heart and circulatory system, may
    already be occurring during pre-diabetes.
  • Research has also shown that if you take action
    to manage your blood glucose when you have
    pre-diabetes, you can delay or prevent type 2
    diabetes from ever developing.
  • There are two different tests your doctor can use
    to determine whether you have pre-diabetes
  • Can be prevented with proper diet and exercise.

50
Diabetes Management in School
  1. Diabetes Medical Management Plan
  2. Monitoring Blood Glucose
  3. Diabetic Emergencies
  4. Meal Plan/ Exercise
  5. Special Occasions (cake, cookies, parties,
    Halloween)

51
Blood Glucose Monitoring
  • Cornerstone of Diabetes Management
  • Indicated for all children with diabetes
    (supplies provided by parents)
  • Brings up issue of policy and procedures for
    school personnel
  • Are students monitored or assisted policy?
    training?
  • What is the school policy for sharps disposal?
    Is there one?

52
Risk Factors for Diabetes
  • are ages 45 and older
  • are overweight
  • are African American, Hispanic/Latino American,
    Asian American or Pacific Islander, or American
    Indian
  • have a parent, brother, or sister with diabetes
  • have high blood pressure (above 140/90)
  • have low HDL (good cholesterol) and high levels
    of blood fats
  • have had diabetes when pregnant or gave birth to
    a large baby (over 9 pounds)
  • are active less than three times a week

53
MI-Child SCHIP for Michigan Families
54
MIChild
  • How can I get MIChild? - Call 1-888-988-6300 for
    an application.
  • If you need an interpreter call 1-888-988-6300.
  • TTY for persons with hearing disabilities
    1-888-263-5897. These calls are free.
  • To qualify, children must
  • Be citizens of the U.S. (some legal immigrants
    qualify)
  • Live in Michigan, even for a short time
  • Be under 19 years old
  • Have no health insurance
  • Meet the income requirements

55
MIChild
  • What does MIChild cover
  • Regular checkups
  • Shots
  • Emergency care
  • Dental care
  • Pharmacy
  • Hospital care
  • Prenatal care and delivery
  • Vision and hearing
  • Mental health and substance abuse services

56
MIChild Co-pays and eligibility
  • You pay a monthly premium of only 10. Even if
    you have more than one child you pay only 10 a
    month. There are no co-pays and no deductibles.
  • The adjusted gross income must be at or above
    150 and below 200 of the federal poverty level.
    For children under 1 year of age, the adjusted
    gross income must be above 185 and at or below
    200 of the federal poverty level. Paid child
    support is considered a deduction. Included with
    the notification of eligibility is the family's
    right to appeal and the Request for Department
    Review form.
  • Forms are on-line. Application can be completed
    on-line as well.
  • http//www.michigan.gov/mdch/1,1607,7-132-2943_484
    5_4931---,00.html

57
Income Eligibility
  • in Family MIChild Income Eligibility -
    approximate
  • Monthly
    Income Annual Income
  • 1 1,735 to 2,167
  • 2 2,335 to 2,917
  • 3 2,935 to 3,667 44,000
  • 4 3,535 to 4,417
    53,000
  • 5 4,135 to 5,167 62,000
  • More than 5 - for each additional family member
    Add 750 for each

58
211 Now in SJ County!
  • For cell phone users - 800-250-5628

59
211 Now Available in SJ County
  • Easy to remember, confidential and Free
  • Connects caller to information about critical
    health and human services available in our
    community.
  • Information about where to volunteer in your
    community
  • One-stop service for vital information.
  • With just one simple call to 211 you will have
    access to thousands of programs so you can GET
    HELP or GIVE HELP!
  • 211 went live on 12/12/2008 in St. Joseph County
  • Sponsored by more than 20 orgainzations in SJ
    County
  •  

60
Questions???

For more information Branch-Hillsdale-St.
Joseph Community Health Agency 269-273-2161
Three Rivers site 269-659-4013 Sturgis
site Website www.bhsj.org SODON -
269-273-4309 Website www.diabetesinmichigan.org
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