- Schools are an ideal environment for the spread of infectious diseases because so many people share the premises every day.
- There is a broad plan of action that schools can follow to prevent the spread of diseases.
- Staff, pupils and their parents should be informed of the standard incubatory periods for infectious diseases.
Public Health England (PHE) has published updated guidance on infection control for schools (http://bit.ly/ZhTfgs). The updated guidance gives advice on the prevention of infections and provides recommended periods for children to be excluded from school if infected.
Infectious diseases are those that can be passed from person to person. They are caused by micro-organisms, such as bacteria or viruses, which typically gain access to the body by being passed on by touch, by being eaten, by being breathed into the air – for example, when someone coughs or sneezes – or through bodily fluids, such as blood. Once in the body, a person's immune system will try to fight the infection and they may go through an incubation period before any symptoms emerge.
Diseases passed from person to person by physical contact are often described as contagious or communicable diseases. In some diseases, once the symptoms have disappeared, the person may remain infectious for a period and still capable of passing the micro-organism on to other people. In such cases it is important that staff do not return to work, or pupils return to school, before it is safe to do so.
Schools are an ideal environment for the spread of infectious diseases because so many people share the premises every day. In addition, difficulties in maintaining high standards of hygiene amongst children are well known. Good infection control measures are therefore essential to protect both children and staff if high levels of staff and pupil sickness are to be avoided.
Those most at risk are the very young and the elderly, and those who are immuno-compromised. Immuno-compromised individuals may have a condition, or are receiving a treatment that suppresses their normal immune response, which leaves them vulnerable to infection. This includes those being treated for leukaemia or other cancers, or those on high doses of steroids. Information about such treatments or conditions should be included in a pupil's healthcare plan and appropriate actions agreed with parents.
While infectious diseases cannot be eliminated entirely, there is much that a school can do to prevent diseases being spread. The updated PHE advice, Guidance on infection control in schools and other childcare settings, lists key actions as:
- routine immunisation
- high standards of personal hygiene, particularly hand-washing
- maintaining a clean environment.
An effective cleaning regime should be in place whereby the school is kept in a clean and hygienic condition. Dirt and grime provide a breeding ground for bacteria, and many infectious organisms can exist on uncleaned surfaces.
Cleaning of premises and equipment should be frequent and thorough. Special attention should be paid to kitchens, dining rooms, washrooms, changing areas and medical rooms.
Cleaning standards should be closely monitored, and good practice should be followed. For example, colour-coded equipment should be used to ensure that the same items are not used in areas such as kitchens and toilets.
Spillages and waste disposal
Any spillage of bodily fluids, or body waste such as blood, faeces and urine, should be cleaned up as quickly as possible and with caution. Staff should assume that spillages are infectious and should wear appropriate personal protective equipment, such as disposable gloves.
A suitable cleaning product should be used that combines both a detergent and a disinfectant to kill any micro-organisms. The manufacturer's instructions should be followed and precautions taken in compliance with the Control of Substances Hazardous to Health Regulations 2002 (COSHH).
Mops should not be used for cleaning up blood and bodily fluid spillages. Disposable paper towels are a far safer option. Used towels should be discarded as clinical waste.
A made-up spillage kit should be available for blood spills. This should contain disposable aprons, gloves, clinical waste bags, paper towels, disinfectant cleaning products and instructions for use.
Infectious waste should be segregated from ordinary waste, placed in clinical waste bags and stored securely until collected by a specialist waste contractor. As well as waste from spillages, potentially infectious waste includes items such as soiled dressings.
Hand hygiene is the single most important way of reducing infection and preventing its spread. Hands should be washed after using the toilet, after blowing the nose, coughing or sneezing, and before eating or handling food.
Public health experts recommend the use of liquid soap, hot water and paper towels. Bar soaps and fabric roller-towels can quickly become soiled and damp, and can harbour micro-organisms themselves.
Hand-cleaning notices can be posted by sinks to remind both staff and pupils to wash their hands after using the toilet, and all opportunities should be taken to teach the importance of hand hygiene to pupils.
Information and exclusion
Children who are ill with an infectious disease should not be in school.
Staff, pupils and parents should be informed of the standard incubatory periods for infectious diseases and of the importance of preventing the further spread of infection by excluding infected pupils from school.
Those showing symptoms of an infectious disease should be advised as to the recommended minimum exclusion periods. These may vary from one area to another according to advice from local authorities (LAs), but the PHE guidance gives typical examples for common diseases. These include:
- Diarrhoea and/or vomiting – 48 hours from last episode of diarrhoea or vomiting
- E.coli O157 VTEC/Typhoid (enteric fever)/shigella (dysentery) – should be excluded for 48 hours from the last episode of diarrhoea, with further exclusion required for some children
- Flu (influenza) – until recovered
- Whooping cough (pertussis) – five days from starting antibiotic treatment, or 21 days from onset of illness if no antibiotic treatment
- Head lice – none
- Meningococcal meningitis/septicaemia – until recovered
- Viral meningitis – none
- Threadworms – none
- Tonsillitis – none
- German measles (rubella) – four days from onset of rash
- Scabies – after first treatment.
Staff should immediately inform the headteacher if they have concerns about a pupil. The headteacher should comply with LA policies, where applicable, and work with the pupil's parents to have the pupil seen by a GP.
Where necessary, schools should seek advice from the local Consultant in Communicable Disease Control (CCDC).
People can be protected from many infectious diseases, such as measles, mumps, rubella and chickenpox, by being immunised.
Both pupils and staff should be encouraged to be up to date with the immunisations recommended for them. The immunisation status of staff should be checked through an occupational health check before starting employment. Pupils will have been offered various vaccinations through the childhood immunisation scheme, and their compliance with this should be checked at school entry. Missed vaccinations for pupils should be addressed with their parents and followed up by the school nurse.
The childhood vaccination programme is subject to change. Schools and parents can find the latest news on the NHS Choices website. In 2013 there was a major MMR vaccination catch-up initiative in a number of schools, following concerns about rising numbers of measles cases.
School catering or kitchen staff who work around open food while suffering from certain infections (mainly from bacteria and viruses) can contaminate food and may spread infection. If a member of the school meal service develops the symptoms of any communicable disease or infection, they should inform their line manager and be excluded from food handling until symptom-free and fit to return to work.
Common food-poisoning organisms causing gastrointestinal infections include salmonella, campylobactor and E.coli.
Blood-borne infections are those that can be spread through contamination by blood and other body fluids. Examples are HIV, hepatitis B, hepatitis C and viral hemorrhagic fevers.
Common routes of transmission include so-called 'sharps' accidents, where someone is injured by a contaminated syringe needle, intravenous drug use, or bites.
To avoid sharps injuries, any used needles should be discarded in specialist 'sharps' bins. In the event of a sharps injury, or a bite wound, staff should contact their GP or occupational health, or go immediately to A&E.
Action to take during an outbreak
An outbreak is said to occur where two or more children suffer from the same disease at the same time.
If an outbreak of infectious disease is suspected, schools should contact their local health protection unit immediately. They should comply with advice and guidance given and cooperate fully with the CCDC, who may require information about ill pupils health records, associations and movements.
Schools should ensure that all staff and parents are made aware of the outbreak but should coordinate any public announcements with the communicable disease team. Making public announcements about potentially serious illnesses without causing undue alarm is a sensitive task, and schools should ensure that a public health professional takes responsibility for managing the situation. Local CCDCs are used to handling such situations and dealing with the public concerns that usually accompany them.
In extreme cases a school may be closed temporarily, although this is very rare.
During an outbreak, increased environmental cleaning may be appropriate. Headteachers should arrange for toilets and facilities to be cleaned more often to reduce the risk of transmission of the infection via environmental contamination – e.g. a focus on the cleaning of toilet seats, toilet flushes and door handles in the event of diarrhoea or vomiting, etc.
In some cases, schools and children may be an 'early warning' for the community spread of an infection or an epidemic, and public health professionals will want to work closely with schools to collect data and build awareness.
It is a statutory requirement that doctors report a notifiable disease to the proper officer of the LA, usually the CCDC. In addition, schools may be required, via locally agreed arrangements, to inform their local PHE centre.
Notifiable diseases include German measles, measles, scarlet fever, diptheria, hepatitis, typhoid, whooping cough, mumps, meningococcal meningitis and viral meningitis.
Infection control policies
All schools should have a policy on infection control, which should be read by all staff. The policy should include education and training of employees in infection prevention and control issues, including outbreaks of infection, and protocols for hand-washing.
According to PHE guidelines, if a pregnant woman develops a rash or is in direct contact with someone with a potentially infectious rash, this should be investigated by a doctor.
Specific risks include:
- chickenpox – which can affect the pregnancy if a woman has not already had the infection
- German measles (rubella)
- slapped cheek disease (parvovirus B19)
- measles – during pregnancy this can result in early delivery or even loss of the baby.
- Guidance on infection control in schools and other childcare settings is available from the GOV.UK website (http://bit.ly/ZhTfgs).
Use the following items in the Toolkit to help you put the ideas in this article into practice:
- Policy – School infection control (worked example)126.07 KB
- Handout – Staff infection control: hand-washing107.98 KB
- Handout – Factsheet for parents: norovirus124.6 KB
- Policy – Spillages of body fluids (worked example)115.7 KB
- Worked example – Suggested letter for parents61.87 KB
About the author
Martin Hodgson MSc, PGCEA has worked in adult education for most of his career and has been a governor of a large technology college for nearly 10 years. His special interests are premises management and health and safety.
First published on this website in December 2014.