{"id":180,"date":"2021-11-02T20:52:02","date_gmt":"2021-11-02T20:52:02","guid":{"rendered":"https:\/\/pressbooks.ccconline.org\/accece\/chapter\/chapter-eight-prevention-of-illness\/"},"modified":"2023-10-20T20:25:02","modified_gmt":"2023-10-20T20:25:02","slug":"chapter-eight-prevention-of-illness","status":"publish","type":"chapter","link":"https:\/\/pressbooks.ccconline.org\/accece\/chapter\/chapter-eight-prevention-of-illness\/","title":{"raw":"Chapter Eight: Prevention of Illness","rendered":"Chapter Eight: Prevention of Illness"},"content":{"raw":"<div class=\"textbox textbox--learning-objectives\"><header class=\"textbox__header\">\n<p class=\"textbox__title\">Chapter 8 Learning Objectives<\/p>\n\n<\/header>\n<div class=\"textbox__content\">\n\nBy the end of this chapter, you should be able to:\n<ul>\n \t<li>Describe each of the five ways illness is transmitted.<\/li>\n \t<li>Explain how immunization prevents illness.<\/li>\n \t<li>Identify standard precautions to prevent illness.<\/li>\n \t<li>Discuss practices to protect children from environmental hazards.<\/li>\n<\/ul>\n<\/div>\n<\/div>\n<div class=\"textbox shaded\">\n\n<strong>Licensing Regulations<\/strong>\n\nRule 3 Regulations that relate to this chapter include:\n\n<strong>9503.0080 EXCLUSION OF SICK CHILDREN.<\/strong> A child with any of the following conditions or behaviors is a sick child and must be excluded from a center not licensed to operate a sick care program. If the child becomes sick while at the center, the child must be isolated from other children in care and the parent called immediately. A sick child must be supervised at all times. The license holder must exclude a child: A. with a reportable illness or condition as specified in part\u00a0<a href=\"https:\/\/www.revisor.mn.gov\/rules\/4605.7040\">4605.7040<\/a>\u00a0that the commissioner of health determines to be contagious and a physician determines has not had sufficient treatment to reduce the health risk to others;\n\nB. with chicken pox until the child is no longer infectious or until the lesions are crusted over;\n\nC. who has vomited two or more times since admission that day;\n\nD. who has had three or more abnormally loose stools since admission that day;\n\nE. who has contagious conjunctivitis or pus draining from the eye;\n\nF. who has a bacterial infection such as streptococcal pharyngitis or impetigo and has not completed 24 hours of antimicrobial therapy;\n\nG. who has unexplained lethargy;\n\nH. who has lice, ringworm, or scabies that is untreated and contagious to others;\n\nI. who has a 100 degree Fahrenheit axillary or higher temperature of undiagnosed origin before fever reducing medication is given;\n\nJ. who has an undiagnosed rash or a rash attributable to a contagious illness or condition;\n\nK. who has significant respiratory distress;\n\nL. who is not able to participate in child care program activities with reasonable comfort; or\n\nM.\u00a0 who requires more care than the program staff can provide without compromising the health and safety of other children in care.\n\n<strong>9503.0085 SICK CARE PROGRAM.\u00a0<\/strong> (This is a specialized program and does not apply to standard child care programs.)\n\n9503.0140 HEALTH.\n\n<strong>Subp. 6.\u00a0 <\/strong><strong>Notice about a sick child.\u00a0<\/strong>\n\nNotices about the illness or condition of a child must be given as required in items A to D:\n\nA. The license holder must ensure that a parent is notified immediately when the parent's child becomes sick at the center.\n\nB.\u00a0 The license holder must require a parent to inform the center within 24 hours, exclusive of weekends and holidays, when a child is diagnosed by a child's source of medical or dental care as having a contagious reportable disease specified in part\u00a0<a href=\"https:\/\/www.revisor.mn.gov\/rules\/4605.7040\">4605.7040<\/a>, or lice, scabies, impetigo, ringworm, or chicken pox.\n\nC.\u00a0 The license holder must post or give a notice to the parents of exposed children the same day a parent notifies the center of a child's illness or condition listed in item B.\n\nD.\u00a0 The license holder must ensure that the health authority is notified of any suspected case of reportable disease as specified in part\u00a0<a href=\"https:\/\/www.revisor.mn.gov\/rules\/4605.7040\">4605.7040<\/a>\u00a0within 24 hours of receiving the parent's report.\n\n<strong>Subp. 7.\u00a0 <\/strong><strong>Administration of medicine.\u00a0<\/strong>\n\nA license holder who chooses to administer medicine must ensure that the procedures in items A to E are followed.\n\nA. The license holder must get written permission from the child's parent before administering medicine, diapering products, sunscreen lotions, and insect repellents. Nonprescription medicines, diapering products, sunscreen lotions, and insect repellents must be administered according to the manufacturer's instructions unless there are written instructions for their use provided by a licensed physician or dentist.\n\nB.\u00a0 The license holder must get and follow written instructions from a licensed physician or dentist before administering each prescription medicine. Medicine with the child's name and current prescription information on the label constitutes instructions.\n\nC.\u00a0 All medicine must be kept in its original container and have a legible label stating the child's name. The medicine must be given only to the child whose name is on the label. The medicine must not be given after an expiration date on the label, and any unused portion must be returned to the child's parent or destroyed. The license holder must ensure that the administration of medicine is recorded and give the name of the child, name of the medication or prescription number, date, time, dosage, and the name and signature of the person who dispensed the medicine. The record must be available to the parent and maintained in the child's record.\n\nD.\u00a0 Sunscreen lotions and insect repellents supplied by the license holder may be used on more than one child. A product to control or prevent diaper rash, including pre-moistened commercial wipes that cannot be dispensed in a manner that prevents cross contamination of the product and container as determined by the health consultant, must be labeled with the child's name and used only for the individual child whose name is written on the label.\n\nE.\u00a0 Medicines, insect repellents, sunscreen lotions, and diaper rash control products must be stored according to directions on the original container and so that they are inaccessible to children.\n\n<strong>Subp. 8.<\/strong>\u00a0 [Repealed, 18 SR 2748]\n\n<strong>Subp. 9.\u00a0 <\/strong><strong>Cleanliness.\u00a0<\/strong>\n\nThe indoor and outdoor space and equipment of the center must be clean.\n\n<strong>Subp. 10.\u00a0 <\/strong><strong>Toilet facilities.\u00a0<\/strong>\n\nThe toilet rooms of the center must be cleaned daily. Toilet training chairs must be emptied, washed with soap and water, and disinfected after each use. Toilets and seats must be washed with soap and water and disinfected when soiled or at least daily.\n\n<strong>Subp. 11.\u00a0 <\/strong><strong>Diaper changing area.\u00a0<\/strong>\n\nA diaper must be changed only in the diaper changing area. The diaper changing area must be separate from areas used for food storage, food preparation, and eating. The area must have a hand sink equipped with hot and cold running water within three feet of the diaper changing surface, a smooth nonabsorbent diaper changing surface and floor covering, and a sanitary container for soiled and wet diapers.\n\n<strong>Subp. 12.\u00a0 <\/strong><strong>Diaper changing procedures.\u00a0<\/strong>\n\nThe center must have and follow diaper changing procedures that have been developed in consultation with a health consultant. The license holder must post the diaper changing procedures in the diaper changing area.\n\n<strong>Subp. 13.\u00a0 <\/strong><strong>Hand washing: child.\u00a0<\/strong>\n\nA child's hands must be washed with soap and water after a diaper change, after use of a toilet or toilet training chair, and before eating a meal or snack. Staff must monitor hand washing and assist a child who needs help. The use of a common basin or a hand sink filled with standing water is prohibited.\n\n<strong>Subp. 14.\u00a0 <\/strong><strong>Hand washing: staff person.\u00a0<\/strong>\n\nA staff person must wash his or her hands with soap and water after changing a child's diaper, after using toilet facilities, and before handling food or eating.\n\n<strong>Subp. 15.\u00a0 <\/strong><strong>Toilet articles.\u00a0<\/strong>\n\nThe license holder shall provide the following supplies and make them accessible to children: toilet paper, liquid hand soap, facial tissues, and single use paper towels or warm air hand dryers.\n\n<\/div>\n<h2>Introduction<\/h2>\nScience and experience tell us that infectious disease, especially gastrointestinal disease, which means vomiting and diarrhea, and respiratory disease, including coughs, colds, sore throats, and runny noses, are increased among children who are cared for in out-of-home group settings. In addition, such children may be at increased risk for certain other infections that may be transmitted by insects or by body fluids. It's also true that children who are cared for in group out-of-home settings are more likely to experience infectious illnesses that are more severe and more prolonged (although 90% of those infections are mild and self-limited, requiring no special treatment).\n\nBut there's good news, too. Infectious illnesses such as pneumonia and influenza, which together were the leading causes of death among U.S. children in the early 20th century, have declined 99.7 percent. Common childhood illnesses such as diphtheria, whooping cough, measles, mumps, and rubella are rare except in communities where immunization rates are low, and polio is unheard of in our country today.\n\nAlthough younger children are more susceptible to infectious illness because their immune systems are immature, as they grow older, the incidents of infectious disease decreases as their immune systems mature. Furthermore, children who experience more infectious disease at an early age in group out-of-home care have a decreasing incidence of infectious disease as they grow older. In fact, they have less infectious illnesses in kindergarten than children who were taken care of exclusively at home. Illness also decreases with years of attendance in out-of-home early care and education settings.\n\n[caption id=\"attachment_179\" align=\"aligncenter\" width=\"300\"]<img class=\"size-medium wp-image-167\" src=\"https:\/\/pressbooks.ccconline.org\/accbertelsen\/wp-content\/uploads\/sites\/160\/2021\/11\/8.1-300x169.png\" alt=\"Table shows that children under 1 year get sick an average of once a month and children older than five years get sick less than 4 times a year.\" width=\"300\" height=\"169\"> Figure 8.1 \u2013 As children get older, they get sick less often. [1][\/caption]There are negative consequences of childhood illness, including:\n<ul>\n \t<li>It\u2019s unpleasant to be sick (for children or the adults that may also become infected).<\/li>\n \t<li>Illnesses that are minor in children can be much more serious for adults and pregnant women.<\/li>\n \t<li>Some illnesses have severe effects (and can even be life-threatening).<\/li>\n \t<li>There are short-term medical costs.<\/li>\n \t<li>There may also be additional child care costs or lost wages for parents\/caregivers of children that must be excluded from group care.<\/li>\n \t<li>Overuse of antibiotics in an effort to get children well contributes to antibiotic resistance among common bacteria.<\/li>\n<\/ul>\nTo prevent illness we need to understand the different ways illness is spread, how immunizations protect children, and what universal precautions early care and education program staff can take to prevent the spread of illness.\n<h2>How Illnesses are Transmitted<\/h2>\nBacteria, viruses, fungi, and parasites that cause illness can be transmitted in five ways, including through:\n<ol>\n \t<li>the respiratory route<\/li>\n \t<li>the fecal-oral route<\/li>\n \t<li>the direct contact route<\/li>\n \t<li>the bodily fluid route (including blood, urine, vomit, and saliva)<\/li>\n \t<li>the vector-borne route<\/li>\n<\/ol>\n<h4>Respiratory Transmission<\/h4>\nMost respiratory germs stay in the nose, sinuses, mouth and throat, or possibly the middle ear. Upper respiratory illnesses (colds) are the most common and the most likely to be transmitted in early care and education settings.\n\nThe more common respiratory illnesses include:\n<ul>\n \t<li>Sinusitis<\/li>\n \t<li>Sore throat<\/li>\n \t<li>Common cold<\/li>\n \t<li>Recurrent middle ear infection<\/li>\n \t<li>Strep throat<\/li>\n \t<li>RSV<\/li>\n \t<li>Pneumonia<\/li>\n \t<li>Bronchitis<\/li>\n<\/ul>\n&nbsp;\n\nPneumonia and bronchitis are rarely the result of an infection picked up in an early education setting. We also have immunizations for many respiratory diseases that are rarely transmitted in early care and education settings today, including:\n<ul>\n \t<li>Mumps<\/li>\n \t<li>Measles<\/li>\n \t<li>Bacterial meningitis<\/li>\n \t<li>Chicken pox<\/li>\n \t<li>Diphtheria<\/li>\n \t<li>Pertussis<\/li>\n \t<li>Pneumonia<\/li>\n \t<li>Seasonal flu<\/li>\n<\/ul>\nIf we could actually see what comes out of a child's mouth along with a cough or a sneeze, we might appreciate the respiratory route of infectious disease transmission more.\n\n[caption id=\"attachment_179\" align=\"aligncenter\" width=\"300\"]<img class=\"size-medium wp-image-168\" src=\"https:\/\/pressbooks.ccconline.org\/accbertelsen\/wp-content\/uploads\/sites\/160\/2023\/10\/8.4-300x198.png\" alt=\"Young boy coughing showing a mist of droplets coming out of his mouth\" width=\"300\" height=\"198\"> Figure 8.4 \u2013 What it might look like if we could see what a child coughs or sneezes. [2][\/caption]The germs that are in this contaminated cloud of exhalation can wind up on surfaces and hands and be transmitted to others. Staff and children who are able to are encouraged to cough into their sleeves. Covering your mouth with your hand only transfers these germs to your hand. This will be addressed more in depth later in the chapter.\n<h4>Fecal-Oral Transmission<\/h4>\nWhen organisms that live in our intestines get into our mouths they can cause illness. Usually, this happens via someone's hands, usually our own. Fecal-oral routes diseases include:\n<ul>\n \t<li>Hepatitis A<\/li>\n \t<li>diarrhea<\/li>\n \t<li>hand, foot, and mouth disease<\/li>\n \t<li>pinworms<\/li>\n \t<li>rotavirus<\/li>\n \t<li>norovirus<\/li>\n \t<li>giardia<\/li>\n \t<li>shigella<\/li>\n \t<li>cryptosporidiosis<\/li>\n<\/ul>\nThat is why it is so important that everyone wash hands after using the bathroom, changing diapers, when preparing food, and before eating.\n<h4>Food Poisoning<\/h4>\n<ol>\n \t<li>coli and salmonella are two of the germs that you may also have heard mentioned in the news when grocery stores send back fresh vegetables, meat, or poultry. These organisms originate with farm animals themselves and they can cause diarrhea and vomiting if children or staff eat contaminated food. Properly preparing and serving fresh produce, meat, and poultry is essential to prevent food poisoning.<\/li>\n<\/ol>\n<h4>Direct Contact Transmission<\/h4>\nDirect contact with another person's skin (or hair) puts infants and children at risk of illnesses such as:\n<ul>\n \t<li>cold sores<\/li>\n \t<li>conjunctivitis<\/li>\n \t<li>pink eye<\/li>\n \t<li>impetigo<\/li>\n \t<li>lice<\/li>\n \t<li>scabies<\/li>\n \t<li>ringworm (a fungus, not a worm).<\/li>\n<\/ul>\n<h4>Bodily Fluid Transmission<\/h4>\nBodily fluids, including saliva, urine, vomit, and blood, can cause illness, such as:\n<ul>\n \t<li>Dental caries (by saliva)<\/li>\n \t<li>Cytomegalovirus or CMV (by urine)<\/li>\n \t<li>Hepatitis B (preventable by vaccine)<\/li>\n \t<li>Hepatitis C (rare in children)<\/li>\n \t<li>HIV (no cases of transmission in an early education setting)<\/li>\n<\/ul>\n<h4>Vector-Borne Transmission<\/h4>\nA vector is a living thing that can transmit disease. We know, for example, that ticks can transmit Lyme disease and Rocky Mountain spotted fever. Fleas are known to transmit Bubonic plague and typhus. Mosquitoes can infect people with St. Louis encephalitis (SLE), dengue fever, Zika virus, and West Nile disease. Rats and mice can transmit leptospirosis, trichinosis, hantavirus, and bacterial food poisoning. Raccoons can spread raccoon roundworm.\n\n[caption id=\"attachment_179\" align=\"aligncenter\" width=\"300\"]<img class=\"size-medium wp-image-169\" src=\"https:\/\/pressbooks.ccconline.org\/accbertelsen\/wp-content\/uploads\/sites\/160\/2023\/10\/8.5-300x257.jpg\" alt=\"Cases of disease caused by mosquitos, fleas and ticks have tripled between 2004-2016. \" width=\"300\" height=\"257\"> Figure 8.5 \u2013 Cases of disease caused by mosquitos, fleas and ticks have tripled between 2004-2016. [3][\/caption]While these illnesses are relatively uncommon, the risk reminds us of the importance of\n<ul>\n \t<li>utilizing integrated pest management techniques to keep insects and rodents out of buildings (covered later in this chapter)<\/li>\n \t<li>using insect repellant specifically recommended for children during outdoor activities<\/li>\n \t<li>removing standing water in which mosquitoes can lay their eggs<\/li>\n \t<li>checking for and removing ticks (addressed in Figure 4.10) in centers when children come back in after playing in or near heavily wooded areas<a href=\"#_ftn4\">[4]<\/a><\/li>\n<\/ul>\n<div class=\"textbox textbox--exercises\"><header class=\"textbox__header\">\n<p class=\"textbox__title\">Pause to Reflect<\/p>\n\n<\/header>\n<div class=\"textbox__content\">\n<table style=\"border-collapse: collapse;width: 100%\" border=\"0\">\n<tbody>\n<tr>\n<td style=\"width: 16.2%\"><img class=\"alignleft wp-image-30 \" src=\"https:\/\/pressbooks.ccconline.org\/accbertelsen\/wp-content\/uploads\/sites\/160\/2023\/10\/Pause-to-reflect-icon-230x300.png\" alt=\"Question mark\" width=\"88\" height=\"115\"><\/td>\n<td style=\"width: 83.8%\">Why is it important to understand how illnesses and diseases are spread?<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<\/div>\n<\/div>\n<h2>Immunizations<\/h2>\nPrevention of infectious disease starts with immunizations (or vaccines). Immunizations are considered the number one public health intervention of the 20th century and one of the top 10 interventions of the first decade of the 21st century.<a href=\"#_ftn5\">[5]<\/a>\n\nOn-time vaccination throughout childhood is essential because it helps provide immunity before children are exposed to potentially life-threatening diseases. Vaccines are tested to ensure that they are safe and effective for children to receive at the recommended ages.<a href=\"#_ftn6\">[6]<\/a> See Figure 8.X for the current schedule of immunizations.\n\nFully vaccinated children in the U.S. are protected against sixteen potentially harmful diseases (see Figure 8.X). Vaccine-preventable diseases can be very serious, may require hospitalization, or even be deadly \u2014 especially in infants and young children.<a href=\"#_ftn7\">[7]<\/a>\n\nHere is the schedule from the CDC to ensure a child is fully vaccinated:\n\n[caption id=\"attachment_179\" align=\"aligncenter\" width=\"904\"]<img class=\"size-full wp-image-170\" src=\"https:\/\/pressbooks.ccconline.org\/accbertelsen\/wp-content\/uploads\/sites\/160\/2023\/10\/8.6.png\" alt=\"2019 Recommended Immunizations for Children from Birth Through 6 years old\" width=\"904\" height=\"591\"> Figure 8.6 \u2013 Immunization schedule. [8][\/caption]The current schedule of vaccines (see Figure 8.6) protects children from the illnesses listed in Table 8.1)\n<div class=\"textbox textbox--examples\"><header class=\"textbox__header\">\n<p class=\"textbox__title\"><strong>Table 8.1 \u2013 Vaccine-Preventable Diseases. <\/strong><a href=\"#_ftn9\"><strong>[9]<\/strong><\/a><\/p>\n\n<\/header>\n<div class=\"textbox__content\">\n<table class=\"grid landscape\">\n<thead>\n<tr>\n<td><strong>Disease<\/strong><\/td>\n<td><strong>Vaccine<\/strong><\/td>\n<td><strong>Disease Spread By<\/strong><\/td>\n<td><strong>Disease Symptoms<\/strong><\/td>\n<td><strong>Disease Complications<\/strong><\/td>\n<\/tr>\n<\/thead>\n<tbody>\n<tr>\n<td>Chick-pox<\/td>\n<td>Varicella vaccine protects against chick pox<\/td>\n<td>Air, direct contact\n\n&nbsp;<\/td>\n<td>Rash, tiredness, headache, fever\n\n&nbsp;<\/td>\n<td>Infected blisters, bleeding disorders, encephalitis (brain\n\nswelling), pneumonia (infection in the lungs)<\/td>\n<\/tr>\n<tr>\n<td>Diphtheria<\/td>\n<td>DtaP* vaccine protects against diphtheria<\/td>\n<td>Air, direct contact\n\n&nbsp;<\/td>\n<td>Sore throat, mild fever, weakness, swollen\n\nglands in neck<\/td>\n<td>Swelling Of the heart muscle, heart failure, coma, Paralysis, death<\/td>\n<\/tr>\n<tr>\n<td>HiB<\/td>\n<td>Hib vaccine protects against Haemophilus\n\nInfluenza type b<\/td>\n<td>Air, direct contact\n\n&nbsp;<\/td>\n<td>May be no symptoms unless bacteria\n\nenter the blood\n\n&nbsp;<\/td>\n<td>Meningitis (infection of the covering around the brain\n\nand spinal cord), intellectual disability. epiglottitis\n\n(life-threatening infection that can block the windpipe\n\nAnd lead to serious breathing problems), pneumonia\n\n(infection in the lungs), death\n\n&nbsp;<\/td>\n<\/tr>\n<tr>\n<td>Hepatitis A<\/td>\n<td>HepA vaccine protects against hepatitis A.<\/td>\n<td>Direct contact, contaminated\n\nfood or water\n\n&nbsp;<\/td>\n<td>May be no symptoms - fever, stomach pain,\n\nloss of appetite. Fatigue, vomiting, jaundice\n\n(yellowing of skin and eyes). dark urine<\/td>\n<td>Liver failure. arthralgia (joint pain), kidney, pancreatic,\n\nand blood disorders\n\n&nbsp;<\/td>\n<\/tr>\n<tr>\n<td>Hepatitis B<\/td>\n<td>HepB vaccine protects against hepatitis B.<\/td>\n<td>Contact With\n\nbody fluids\n\n&nbsp;<\/td>\n<td>May be no symptoms fever, headache,\n\nweakness, vomiting, jaundice (yellowing of\n\nskin and eyes), joint pain\n\n&nbsp;<\/td>\n<td>Chronic liver infection, liver failure, liver cancer\n\n&nbsp;<\/td>\n<\/tr>\n<tr>\n<td>Influenza (Flu)<\/td>\n<td>Flu vaccine protects against influenza.\n\n&nbsp;<\/td>\n<td>Air, direct contact\n\n&nbsp;<\/td>\n<td>Fever, muscle pain, sore throat, cough,\n\nextreme fatigue\n\n&nbsp;<\/td>\n<td>Pneumonia (infection in the lungs)\n\n&nbsp;<\/td>\n<\/tr>\n<tr>\n<td>Measles<\/td>\n<td>MMR* vaccine protects against measles.\n\n&nbsp;<\/td>\n<td>Air, direct contact\n\n&nbsp;<\/td>\n<td>Rash, fever, tough, runny nose, pinkeye\n\n&nbsp;<\/td>\n<td>Encephalitis (brain swelling), pneumonia (infection in\n\nthe lungs). death\n\n&nbsp;<\/td>\n<\/tr>\n<tr>\n<td>Mumps<\/td>\n<td>MMR* vaccine protects against mumps.\n\n&nbsp;<\/td>\n<td>Air, direct contact\n\n&nbsp;<\/td>\n<td>Swollen salivary glands (under the jaw), fever,\n\nheadache, tiredness, muscle pain<\/td>\n<td>Meningitis (infection of the covering around the brain\n\nand spinal cord) , encephalitis (brain swelling), inflammation Of testes or ovaries, deafness\n\n&nbsp;<\/td>\n<\/tr>\n<tr>\n<td>Pertussis\n\n&nbsp;<\/td>\n<td>DTap* vaccine protects against pertussis\n\n(whooping cough).\n\n&nbsp;<\/td>\n<td>Air, direct contact\n\n&nbsp;<\/td>\n<td>Severe cough, runny nose, apnea (a pause in\n\nbreathing in infants)<\/td>\n<td>Pneumonia (infection in the lungs), death\n\n&nbsp;<\/td>\n<\/tr>\n<tr>\n<td>Polio<\/td>\n<td>IPV vaccine protects against polio.\n\n&nbsp;<\/td>\n<td>Air. direct contact, through\n\nthe mouth\n\n&nbsp;<\/td>\n<td>May be no symptoms, sore throat, fever,\n\nnausea. headache\n\n&nbsp;<\/td>\n<td>Paralysis, death\n\n&nbsp;<\/td>\n<\/tr>\n<tr>\n<td>Pneumococcal\n\n&nbsp;<\/td>\n<td>POII 3 vaccine protects against pneumococcus.<\/td>\n<td>Air, direct contact\n\n&nbsp;<\/td>\n<td>May be no symptoms -. pneumonia (infection\n\nin the lungs)\n\n&nbsp;<\/td>\n<td>Bacteremia (blood infection), meningitis (infection of\n\nthe covering around the brain and spinal cord). death\n\n&nbsp;<\/td>\n<\/tr>\n<tr>\n<td>Rotavirus<\/td>\n<td>RV vaccine protects against rotavirus.\n\n&nbsp;<\/td>\n<td>Through the mouth<\/td>\n<td>Diarrhea, fever, vomiting\n\n&nbsp;<\/td>\n<td>Severe diarrhea, dehydration\n\n&nbsp;<\/td>\n<\/tr>\n<tr>\n<td>Rubella<\/td>\n<td>MMR* vaccine protects against rubella.\n\n&nbsp;<\/td>\n<td>Air, direct contact\n\n&nbsp;<\/td>\n<td>Children infected with rubella virus sometimes\n\nhave a rash, fever. swollen nodes<\/td>\n<td>Very serious in pregnant women\u2014can lead to miscarriages, stillbirth, premature delivery, birth defects\n\n&nbsp;<\/td>\n<\/tr>\n<tr>\n<td>Tetanus<\/td>\n<td>DTap* vaccine protects against tetanus.\n\n&nbsp;<\/td>\n<td>Exposure through cuts in skin\n\n&nbsp;<\/td>\n<td>Stiffness in neck and muscles,\n\ndifficulty swallowing, muscle spasms, fever<\/td>\n<td>Broken bones, breathing difficulty, death\n\n&nbsp;<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<\/div>\n<\/div>\n<h2>How Vaccines Work<\/h2>\nThe immune system helps the human body fight germs by producing substances to combat them. Once it does, the immune system \u201cremembers\u201d the germ and can fight it again. Vaccines contain germs that have been killed or weakened. When given to a healthy person, the vaccine triggers the immune system to respond and thus build immunity.\n\nBefore vaccines, people became immune only by actually getting a disease and surviving it. Immunizations are an easier and less risky way to become immune.\n\nVaccines are the best defense we have against serious, preventable, and sometimes deadly contagious diseases. Vaccines are some of the safest medical products available, but like any other medical product, there may be risks. Accurate information about the value of vaccines as well as their possible side effects helps people to make informed decisions about vaccination.\n<h4>Potential Side Effects<\/h4>\nVaccines, like all medical products, may cause side effects in some people. Most of these side effects are minor, such as redness or swelling at the injection site. Read further to learn about possible side effects of vaccines.\n\nAny vaccine can cause side effects. For the most part, these are minor (for example, a sore arm or low-grade fever) and go away within a few days.<a href=\"#_ftn10\">[10]<\/a> Serious side effects after vaccination, such as severe allergic reaction, are very rare.<a href=\"#_ftn11\">[11]<\/a>\n\nRemember, vaccines are continually monitored for safety, and like any medication, vaccines can cause side effects. However, a decision not to immunize a child also involves risk and could put the child and others who come into contact with him or her at risk of contracting a potentially deadly disease.\n<h4>How Well Do Vaccines Work?<\/h4>\nVaccines work really well. No medicine is perfect, of course, but most childhood vaccines produce immunity about 90\u2013100% of the time.\n\nWhat about the argument made by some people that vaccines don\u2019t work that well and that diseases would be going away on their own because of better hygiene or sanitation, even if there were no vaccines?\n\nThat simply isn\u2019t true. Certainly better hygiene and sanitation can help prevent the spread of disease, but the germs that cause disease will still be around, and as long as they are they will continue to make people sick.\n\nAll vaccines must be licensed (approved) by the Food and Drug Administration (FDA) before being used in the United States, and a vaccine must go through extensive testing to show that it works and that it is safe before the FDA will approve it. Among these tests are clinical trials, which compare groups of people who get a vaccine with groups of people who get a control. A vaccine is approved only if FDA makes the determination that it is safe and effective for its intended use.\n\nIf you look at the history of any vaccine-preventable disease, you will virtually always see that the number of cases of disease starts to drop when a vaccine is licensed. Vaccines are the most effective tool we have to prevent infectious diseases.\n<h4>Opposition to Vaccines<\/h4>\nIn 2010, a pertussis (whooping cough) outbreak in California sickened 9,143 people and resulted in 10 infant deaths: the worst outbreak in 63 years (Centers for Disease Control 2011b). Researchers, suspecting that the primary cause of the outbreak was the waning strength of pertussis vaccines in older children, recommended a booster vaccination for 11\u201312-year-olds and also for pregnant women (Zacharyczuk 2011). Pertussis is most serious for babies; one in five needs to be hospitalized, and since they are too young for the vaccine themselves, it is crucial that people around them be immunized (Centers for Disease Control 2011b). Several states, including California, have been requiring the pertussis booster for older children in recent years with the hope of staving off another outbreak.\n\nBut what about people who do not want their children to have this vaccine, or any other? That question is at the heart of a debate that has been simmering for years. Vaccines are biological preparations that improve immunity against a certain disease. Vaccines have contributed to the eradication and weakening of numerous infectious diseases, including smallpox, polio, mumps, chickenpox, and meningitis.\n\n[caption id=\"attachment_179\" align=\"aligncenter\" width=\"238\"]<img class=\"size-medium wp-image-171\" src=\"https:\/\/pressbooks.ccconline.org\/accbertelsen\/wp-content\/uploads\/sites\/160\/2023\/10\/8.7-238x300.jpg\" alt=\"Two young children walking with braces while a nurse looks on.\" width=\"238\" height=\"300\"> Figure 8.7 \u2013 These two young children contracted polio. [12][\/caption]However, many people express concern about the potential negative side effects of vaccines. These concerns range from fears about overloading the child\u2019s immune system to controversial reports about devastating side effects of the vaccines.<a href=\"#_ftn13\">[13]<\/a>\n\nAlthough children continue to get several vaccines up to their second birthday, these vaccines do not overload the immune system. Every day, an infant\u2019s healthy immune system successfully fights off thousands of antigens \u2013 the parts of germs that cause their immune system to respond. Even if your child receives several vaccines in one day, vaccines contain only a tiny amount of antigens compared to the antigens your baby encounters every day.\n\nThis is the case even if your child receives combination vaccines. Combination vaccines take two or more vaccines that could be given individually and put them into one shot. Children get the same protection as they do from individual vaccines given separately\u2014but with fewer shots.<a href=\"#_ftn14\">[14]<\/a>\n\nOne misapprehension is that the vaccine itself might cause the disease it is supposed to be immunizing against.<a href=\"#_ftn15\">[15]<\/a> Vaccines help develop immunity by imitating an infection, but this \u201cimitation\u201d infection does not cause illness. Instead, it causes the immune system to develop the same response as it does to a real infection so the body can recognize and fight the vaccine-preventable disease in the future. Sometimes, after getting a vaccine, the imitation infection can cause minor symptoms, such as fever. Such minor symptoms are normal and should be expected as the body builds immunity.<a href=\"#_ftn16\">[16]<\/a>\n\nAnother commonly circulated concern is that vaccinations, specifically the MMR vaccine (MMR stands for measles, mumps, and rubella), are linked to autism. The autism connection has been particularly controversial. In 1998, a British physician named Andrew Wakefield published a study in Great Britain\u2019s Lancet magazine that linked the MMR vaccine to autism. The report received a lot of media attention, resulting in British immunization rates decreasing from 91 percent in 1997 to almost 80 percent by 2003, accompanied by a subsequent rise in measles cases (Devlin 2008). A prolonged investigation by the British Medical Journal proved that not only was the link in the study nonexistent, but that Dr. Wakefield had falsified data in order to support his claims (CNN 2011). Dr. Wakefield was discredited and stripped of his license, but the doubt still lingers in many parents\u2019 minds.\n\nIn the United States, many parents still believe in the now-discredited MMR-autism link and refuse to vaccinate their children. Other parents choose not to vaccinate for various reasons like religious or health beliefs. In one instance, a boy whose parents opted not to vaccinate returned home to the U.S. after a trip abroad; no one yet knew he was infected with measles. The boy exposed 839 people to the disease and caused 11 additional cases of measles, all in other unvaccinated children, including one infant who had to be hospitalized.\n\n[caption id=\"attachment_179\" align=\"aligncenter\" width=\"300\"]<img class=\"size-medium wp-image-172\" src=\"https:\/\/pressbooks.ccconline.org\/accbertelsen\/wp-content\/uploads\/sites\/160\/2023\/10\/8.8-300x199.jpg\" alt=\"An infant with measles \" width=\"300\" height=\"199\"> Figure 8.8 \u2013 An infant with measles [17][\/caption]According to a study published in Pediatrics (2010), the outbreak cost the public sector $10,376 per diagnosed case. The study further showed that the intentional non-vaccination of those infected occurred in students from private schools, public charter schools, and public schools in upper-socioeconomic areas (Sugerman et al. 2010).<a href=\"#_ftn18\">[18]<\/a>\n<div class=\"textbox textbox--key-takeaways\"><header class=\"textbox__header\">\n<p class=\"textbox__title\"><strong>What about the Flu Vaccine?<\/strong><\/p>\n\n<\/header>\n<div class=\"textbox__content\">\n\nThere are many reasons to get an influenza (flu) vaccine each year. Below is a summary of the benefits of flu vaccination, and selected scientific studies that support these benefits.\n\n\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Flu vaccination\u00a0can keep you from getting sick with flu.\n\n\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Flu vaccination can reduce the risk of flu-associated hospitalization.\n\n\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Flu vaccination is an important preventive tool for people with chronic health conditions.\n\n\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Flu vaccination helps\u00a0protect women during and after pregnancy and helps protect the baby from flu for several months after birth.\n\n\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Flu vaccination can be life-saving in children.\n\n\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Flu vaccination has been shown in several studies to reduce the severity of illness in people who get vaccinated but still get sick.\n\n\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Getting vaccinated yourself may also protect people around you, including those who are more vulnerable to serious flu illness, like babies and young children, older people, and people with certain chronic health conditions.<a href=\"#_ftn19\">[19]<\/a>\n\n[caption id=\"attachment_173\" align=\"aligncenter\" width=\"1024\"]<img class=\"size-large wp-image-173\" src=\"https:\/\/pressbooks.ccconline.org\/accbertelsen\/wp-content\/uploads\/sites\/160\/2023\/10\/8.9-1024x791.png\" alt=\"Manufacturing flu vaccines passes through a rigorous testing process each year.\" width=\"1024\" height=\"791\"> Figure 8.9 \u2013 What goes into the flu vaccine each year. [20][\/caption]<\/div>\n<\/div>\n<div class=\"textbox textbox--exercises\"><header class=\"textbox__header\">\n<p class=\"textbox__title\">Pause to Reflect<\/p>\n\n<\/header>\n<div class=\"textbox__content\">\n<table style=\"border-collapse: collapse;width: 100%\" border=\"0\">\n<tbody>\n<tr>\n<td style=\"width: 16.5%\"><img class=\"alignleft wp-image-30 size-thumbnail\" src=\"https:\/\/pressbooks.ccconline.org\/accbertelsen\/wp-content\/uploads\/sites\/160\/2023\/10\/Pause-to-reflect-icon-150x150.png\" alt=\"Question mark\" width=\"150\" height=\"150\"><\/td>\n<td style=\"width: 83.5%\">Using the information that has been provided about immunizations, think of ways you could respond to the following:\n<p style=\"padding-left: 40px\">1.\u00a0\u00a0\u00a0\u00a0\u00a0 \u201cI don\u2019t believe in giving all of the vaccines, like chicken pox. It\u2019s better for children to just get the disease like we all did when we were kids.\u201d<\/p>\n<p style=\"padding-left: 40px\">2.\u00a0\u00a0\u00a0\u00a0\u00a0 \u201cWhy do they have to give vaccines so early? It seems like it\u2019s too much, too quickly.\u201d<\/p>\n<p style=\"padding-left: 40px\">3.\u00a0\u00a0\u00a0\u00a0\u00a0 \u201cI have heard that vaccines give some kids autism. And even if they don\u2019t, the side effects are just too scary.\u201d<\/p>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<\/div>\n<\/div>\n<h2>Universal Precautions to Prevent the Spread of Illness<\/h2>\nThere are some standard practices that prevent, or reduce the risk of, the spread of illness in early care and education programs. These are modeled after practices in health care, where everyone is treated as being potentially infected with something that is contagious. Many illnesses are actually contagious before the infected person is symptomatic, so waiting until you see signs of illness is an ineffective way of preventing its spread. Child care providers can practice these four things to help control the spread of illness.\n<ol>\n \t<li>Hand washing<\/li>\n \t<li>Use of disposable nonporous gloves when working with bodily fluids<\/li>\n \t<li>Disinfecting potentially contaminated surfaces<\/li>\n \t<li>Proper disposal of potentially contaminated waste<a href=\"#_ftn21\">[21]<\/a><\/li>\n<\/ol>\n<h4>Handwashing<\/h4>\nRegular handwashing is an important step to minimizing the spread of germs. Hands pick up germs from all of the things they touch and then spread them from one place to another. Germs that are on hands can also enter the body when a person eats or when they touch their eyes, nose, mouth, or any area on the body where the skin is broken (because of a cut, rash, etc.).\n\nAll that is needed for handwashing is soap and clean, running water. Handwashing with soap and water removes visible dirt and hidden germs. Studies have demonstrated that handwashing reduced the number of diarrheal illnesses by 31 percent and respiratory illnesses by 21 percent.\n\nHands should be washed:\n<ul>\n \t<li>before eating, feeding, or preparing food. This prevents germs from getting into the mouth from hands. (Hygiene practices related specifically to food safety will be addressed in Chapter 15.)<\/li>\n \t<li>after touching saliva (after feeding or eating), mucus (wiping a nose, using a tissue), bodily fluids (toileting, diapering), food, or animals<\/li>\n \t<li>when visibly dirty, after touching garbage, or after cleaning<\/li>\n<\/ul>\nThe Center for Disease Control recommends the following handwashing steps:\n<ol>\n \t<li>\u201cWet your hands with clean, running water (warm or cold) and apply soap.\u201d<\/li>\n \t<li>\u201cRub your hands together to make a lather and scrub your hands well; be sure to scrub the backs of your hands, between your fingers, and under your nails.\u201d<\/li>\n \t<li>\u201cContinue rubbing your hands for at least 20 seconds. Need a timer? Hum the \u201cHappy Birthday\u201d song from beginning to end twice.\u201d<\/li>\n \t<li>\u201cRinse your hands well under running water.\u201d<\/li>\n \t<li>\u201cDry your hands using a clean towel or air dry them.\u201d<\/li>\n<\/ol>\n[caption id=\"attachment_179\" align=\"aligncenter\" width=\"741\"]<img class=\"size-full wp-image-174\" src=\"https:\/\/pressbooks.ccconline.org\/accbertelsen\/wp-content\/uploads\/sites\/160\/2023\/10\/8.10.png\" alt=\"5 Steps: wet hands, add soap, rub vigorously, rinse and dry\" width=\"741\" height=\"117\"> Figure 8.10 \u2013 Illustrations of the 5 steps of handwashing. \u00a0[22][\/caption]Infants and young children will need help with handwashing. <em>Caring for Our Children<\/em> recommends that caregivers:\n<ul>\n \t<li>Safely cradle an infant in one arm to wash their hands at a sink.<\/li>\n \t<li>Provide assistance with handwashing for young children that cannot yet wash their hands independently.<\/li>\n \t<li>Offer a stepping stool to young children so they may safely reach the sink.<a href=\"#_ftn23\">[23]<\/a><\/li>\n<\/ul>\n<h4>Wearing Disposable Gloves<\/h4>\nTeachers and caregivers should wear gloves when they anticipate coming into contact with any of the following (on a child\u2019s body or a contaminated surface)\n<ul>\n \t<li>Blood or bodily substances (i.e., fluids or solids)<\/li>\n \t<li>Mucous membranes (e.g., nasal, oral, genital area)<\/li>\n \t<li>Non-intact skin (e.g., rashes or cuts and scrapes)<a href=\"#_ftn24\">[24]<\/a><\/li>\n<\/ul>\n&nbsp;\n\nOnce the gloves are soiled, it\u2019s important to remove them carefully.\n<ol>\n \t<li>Using a gloved hand, grasp the palm area of the other gloved hand and peel off the first glove.<\/li>\n \t<li>Hold the removed glove in the gloved hand.<\/li>\n \t<li>Slide fingers of the ungloved hand under the remaining glove at the wrist and peel off the second glove over the first glove.<\/li>\n \t<li>Discard the gloves in a waste container.<a href=\"#_ftn25\">[25]<\/a><\/li>\n<\/ol>\n[caption id=\"attachment_179\" align=\"aligncenter\" width=\"300\"]<img class=\"size-medium wp-image-175\" src=\"https:\/\/pressbooks.ccconline.org\/accbertelsen\/wp-content\/uploads\/sites\/160\/2023\/10\/8.11-300x155.png\" alt=\"Remove gloves without touching the outside, leave inside out and dispose in proper container\" width=\"300\" height=\"155\"> Figure 8.11 \u2013 Safe glove removal. [26][\/caption]&nbsp;\n\nAfter you remove your gloves you should wash your hands. \u201cDo not reuse the gloves: this can spread germs from one child to another\u2026Gloves provide added protection from communicable disease only if used correctly. If you use gloves incorrectly, you actually risk spreading more germs than if you don\u2019t use gloves at all. Pay attention to your gloving technique so that you do not develop a false sense of security (and carelessness) when wearing gloves.\u201d<a href=\"#_ftn27\">[27]<\/a>\n<h4>Cleaning and Disinfecting<\/h4>\nWashing Surfaces Germs spread onto surfaces from hands and objects (tissues or mouthed toys) or from a sneeze or cough. It is important to clean all surfaces well, including toys and any surface that a young child puts in his mouth, because germs cannot be seen and it is easy to overlook surfaces that do not look soiled or dirty.\n\nToileting and diapering involve germs from bodily fluids and fecal material. These germs spread easily in a bathroom onto hands, flushers, and faucets. Routinely washing bathroom surfaces removes most germs and prevents them from spreading. The kitchen is another area of the home where it is important to clean surfaces well.\n\nThe terms \u201ccleaning,\u201d \u201csanitizing,\u201d and \u201cdisinfecting\u201d deserve close attention.\n\n<strong>Cleaning<\/strong> removes visible soil, dirt, and germs. Soap and water will clean most surfaces.\n\n<strong>Sanitizing<\/strong> reduces, but does not totally get rid of, germs to a level that is unlikely to cause disease. Sanitizers may be appropriate to use on surfaces where you eat (such as a table or high chair tray) and with toys that children place in their mouths. It is important to follow the instructions on the label, which may also include rinsing surfaces after using the sanitizing product.\n\n<strong>Disinfecting<\/strong> destroys or inactivates infectious germs on surfaces. Disinfectants may be used on diaper-changing tables, toilets, and counter tops.<a href=\"#_ftn28\">[28]<\/a>\n\nEarly care and education programs can create a bleach and water solution of one tablespoon household bleach to one quart water for surfaces that need to be sanitized or disinfected. To use effectively, the surface must be wetted with the solution and allowed to air dry. A fresh bleach solution should be made each day to maintain effectiveness, and stored in a clearly labeled spray bottle out of children\u2019s reach. Research shows that other chemicals (e.g., ammonia, vinegar, baking soda, Borax) are not effective against some bacteria.<a href=\"#_ftn29\">[29]<\/a> \u201cItems that can be washed in a dishwasher or hot cycle of a washing machine do not have to be disinfected because these machines use water that is hot enough for a long enough period of time to kill most germs.\u201d<a href=\"#_ftn30\">[30]<\/a>\n\nCleaning and disinfecting are essential. Studies have shown that some germs, including influenza virus, can survive on surfaces for two to eight hours; rotavirus can survive up to 10 days.<a href=\"#_ftn31\">[31]<\/a>\n<div class=\"textbox textbox--examples\"><header class=\"textbox__header\">\n<p class=\"textbox__title\"><strong>Table 8.2 \u2013 Schedule for Cleaning and Disinfecting <\/strong><a href=\"#_ftn32\">[32]<\/a><\/p>\n\n<\/header>\n<div class=\"textbox__content\">\n<table class=\"grid landscape\">\n<thead>\n<tr>\n<td><strong>Surface\/Item<\/strong><\/td>\n<td><strong>Clean<\/strong><\/td>\n<td><strong>Disinfect<\/strong><\/td>\n<td><strong>Frequency<\/strong><\/td>\n<\/tr>\n<\/thead>\n<tbody>\n<tr>\n<td>Countertops and Tabletops<\/td>\n<td style=\"text-align: center\">X<\/td>\n<td style=\"text-align: center\">X<\/td>\n<td>Daily and when soiled<\/td>\n<\/tr>\n<tr>\n<td>Food prep and service areas<\/td>\n<td style=\"text-align: center\">X<\/td>\n<td style=\"text-align: center\">X<\/td>\n<td>Before and after use; between prep of raw and cooked food<\/td>\n<\/tr>\n<tr>\n<td>Floors<\/td>\n<td style=\"text-align: center\">X<\/td>\n<td style=\"text-align: center\">X<\/td>\n<td>Daily and when soiled<\/td>\n<\/tr>\n<tr>\n<td>Door and cabinet handles<\/td>\n<td style=\"text-align: center\">X<\/td>\n<td style=\"text-align: center\">X<\/td>\n<td>Daily and when soiled<\/td>\n<\/tr>\n<tr>\n<td>Carpets and large rugs<\/td>\n<td style=\"text-align: center\">X<\/td>\n<td style=\"text-align: center\"><\/td>\n<td>Vacuum daily; clean monthly for infants, every 3 months for other ages and when soiled<\/td>\n<\/tr>\n<tr>\n<td>Small rugs<\/td>\n<td style=\"text-align: center\">X<\/td>\n<td style=\"text-align: center\"><\/td>\n<td>Shake or vacuum daily; launder weekly<\/td>\n<\/tr>\n<tr>\n<td>Utensils, surfaces, and toys that go in the mouth or have been in contact with bodily fluids<\/td>\n<td style=\"text-align: center\">X<\/td>\n<td style=\"text-align: center\">X<\/td>\n<td>After each child\u2019s use<\/td>\n<\/tr>\n<tr>\n<td>Toys not contaminated with bodily fluids<\/td>\n<td style=\"text-align: center\">X<\/td>\n<td style=\"text-align: center\"><\/td>\n<td>Weekly<\/td>\n<\/tr>\n<tr>\n<td>Dress up clothes not worn on the head<\/td>\n<td style=\"text-align: center\">X<\/td>\n<td style=\"text-align: center\"><\/td>\n<td>Weekly<\/td>\n<\/tr>\n<tr>\n<td>Hats<\/td>\n<td style=\"text-align: center\">X<\/td>\n<td style=\"text-align: center\"><\/td>\n<td>After each child\u2019s use<\/td>\n<\/tr>\n<tr>\n<td>Sheets and pillowcases<\/td>\n<td style=\"text-align: center\">X<\/td>\n<td style=\"text-align: center\"><\/td>\n<td>Weekly and when visibly soiled<\/td>\n<\/tr>\n<tr>\n<td>Blankets and sleeping bags<\/td>\n<td style=\"text-align: center\">X<\/td>\n<td style=\"text-align: center\"><\/td>\n<td>Monthly and when visibly soiled<\/td>\n<\/tr>\n<tr>\n<td>Cubbies<\/td>\n<td style=\"text-align: center\">X<\/td>\n<td style=\"text-align: center\"><\/td>\n<td>Weekly<\/td>\n<\/tr>\n<tr>\n<td>Cribs<\/td>\n<td style=\"text-align: center\">X<\/td>\n<td style=\"text-align: center\"><\/td>\n<td>Weekly<\/td>\n<\/tr>\n<tr>\n<td>Handwashing sinks including faucet, soap dispenser, and surrounding area<\/td>\n<td style=\"text-align: center\">X<\/td>\n<td style=\"text-align: center\">X<\/td>\n<td>Daily or when soiled<\/td>\n<\/tr>\n<tr>\n<td>Toilet seats, handles, door knobs or handles in toileting area, floors<\/td>\n<td style=\"text-align: center\">X<\/td>\n<td style=\"text-align: center\">X<\/td>\n<td>Daily and immediately is soiled<\/td>\n<\/tr>\n<tr>\n<td>Toilet bowls<\/td>\n<td style=\"text-align: center\">X<\/td>\n<td style=\"text-align: center\">X<\/td>\n<td>Daily<\/td>\n<\/tr>\n<tr>\n<td>Changing tables<\/td>\n<td style=\"text-align: center\">X<\/td>\n<td style=\"text-align: center\">X<\/td>\n<td>After each child\u2019s use<\/td>\n<\/tr>\n<tr>\n<td>Potty chairs (discouraged in child care because of contamination risks)<\/td>\n<td style=\"text-align: center\">X<\/td>\n<td style=\"text-align: center\">X<\/td>\n<td>After each child\u2019s use<\/td>\n<\/tr>\n<tr>\n<td>Any surface contaminated with bodily fluids (saliva, mucus, vomit, urine, stool, or blood)<\/td>\n<td style=\"text-align: center\">X<\/td>\n<td style=\"text-align: center\">X<\/td>\n<td>Immediately<\/td>\n<\/tr>\n<tr>\n<td>Water containers<\/td>\n<td style=\"text-align: center\">X<\/td>\n<td style=\"text-align: center\">X<\/td>\n<td>Daily<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<\/div>\n<\/div>\n<h4>Disposal of Waste<\/h4>\nProper disposal and storage of garbage waste prevent the spread of disease, odors, and problems with pests. Disposable items (diapers, gloves, paper towels, and facial tissues) should be thrown away immediately in an appropriate container. Make sure the container is water and rodent-proof, operated with a foot pedal, is lined with a plastic bag, within reach of diaper changing area, handwashing sink, and food preparation areas, out-of-reach of and unable to be knocked over by infants and toddlers. The containers should be emptied, cleaned, and sanitized daily. <a href=\"#_ftn33\">[33]<\/a>\n<h4>Diaper Changing<\/h4>\nDiaper changing areas should be smooth and nonporous (such as a plastic-covered pad), have a raised edge to prevent children from falling, be near a sink, be out of reach from children, and away from food preparation areas.<a href=\"#_ftn34\">[34]<\/a>\n\nThe following diaper changing procedure should be posted in the changing area and followed to protect the health and safety of children and staff:\n<p style=\"padding-left: 40px\"><strong>Step 1<\/strong>: Before bringing the child to the diaper changing area, perform hand hygiene (including putting on gloves, if using) and bring supplies to the diaper changing area, and place a disposable liner on the changing area.<\/p>\n<p style=\"padding-left: 40px\"><strong>Step 2<\/strong>: Carry\/bring the child to the changing table\/surface, keeping soiled clothing away from you and any surfaces you cannot easily clean and sanitize after the change. Always keep a hand on the child.<\/p>\n<p style=\"padding-left: 40px\"><strong>Step 3: <\/strong>Remove the soiled diaper and clothing without contaminating any surface not already in contact with stool or urine. Put soiled diaper in covered waste container. Put any soiled clothing in a plastic bag that is securely closed to give to family.<\/p>\n<p style=\"padding-left: 40px\"><strong>Step 4<\/strong>: Clean the child's diaper area with disposable wipes and place soiled wipes into a covered waste container.<\/p>\n<p style=\"padding-left: 40px\"><strong>Step 5: <\/strong>Removed the disposable liner and gloves and place in waste container<\/p>\n<p style=\"padding-left: 40px\"><strong>Step 6<\/strong>: Use facial tissue to apply any creams or ointments. Slide clean diaper under the child and fasten it and dress the child.<\/p>\n<p style=\"padding-left: 40px\"><strong>Step 6<\/strong>: Wash the child's hands and return the child to a supervised area.<\/p>\n<p style=\"padding-left: 40px\"><strong>Step 7<\/strong>: Clean and disinfect the diaper-changing surface and any equipment or supplies that were touched (and any other area child soiled before changed).<\/p>\n<p style=\"padding-left: 40px\"><strong>Step 8<\/strong>: Perform hand hygiene and record the diaper change, diaper contents, and\/or any problems.<\/p>\nCaregivers\/teachers should never leave a child unattended on a table or countertop. A safety strap or harness should not be used on the diaper changing table\/surface.<a href=\"#_ftn35\">[35]<\/a>\n<div class=\"textbox textbox--examples\"><header class=\"textbox__header\">\n<p class=\"textbox__title\"><strong>If Using Potty Chairs<\/strong><\/p>\n\n<\/header>\n<div class=\"textbox__content\">\n\nDue to being hard to clean and disinfect, potty chairs are not ideal in a child care environment. If they are used, they should be used in the bathroom only. After each use:\n\n\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Empty contents immediately into the toilet\n\n\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Rinse with water and dump water into the toilet\n\n\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Wash with soap and water (with a paper towel) and empty soapy water into the toilet\n\n\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Rinse again and empty into the toilet\n\n\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Spray with bleach solution\n\n\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Air dry\n\n\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Wash and disinfect sink\n\n\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Wash hands (child and adult)<a href=\"#_ftn36\">[36]<\/a>\n\n<\/div>\n<\/div>\n<div class=\"textbox textbox--exercises\"><header class=\"textbox__header\">\n<p class=\"textbox__title\">Pause to Reflect<\/p>\n\n<\/header>\n<div class=\"textbox__content\">\n<table style=\"border-collapse: collapse;width: 100%\" border=\"0\">\n<tbody>\n<tr>\n<td style=\"width: 17.1%\"><img class=\"alignleft wp-image-30\" src=\"https:\/\/pressbooks.ccconline.org\/accbertelsen\/wp-content\/uploads\/sites\/160\/2023\/10\/Pause-to-reflect-icon-230x300.png\" alt=\"Question mark\" width=\"93\" height=\"121\"><\/td>\n<td style=\"width: 82.9%\">You are at a job interview to become a teacher in an infant room and the director asks you what you would do to prevent the spread of illness in your classroom. What might you want to mention?<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<\/div>\n<\/div>\n<h2>Environmental Health<\/h2>\nSometimes the threat to health comes from the environment itself. Air quality, chemical hazards, drinking water, mold, and pest management are all topics early care and education providers should be aware of.\n<h4>Outdoor Air Quality<\/h4>\nChildren are more susceptible to the effects of contaminated air because they breathe in more oxygen relative to their body weight than adults.<a href=\"#_ftn37\">[37]<\/a> Therefore, they \u201ccan be exposed to a lot of pollution. Children should be kept inside when air quality is poor, or should at least be discouraged from intense outdoor activity. Educators and parents should be aware that nearby construction and traffic can increase pollution. Mowing school lawns should never occur during school hours since this can cause an allergy or asthma attack. Insecticides should never be sprayed while children are in care. Outdoor air can include odors, pollutants from vehicles, and fumes from stored trash, chemicals, and plumbing vents.\u201d<a href=\"#_ftn38\">[38]<\/a>\n<h4>Indoor Air Quality<\/h4>\nThere are so many sources of indoor air pollution in childcare facilities that the air is considered to be two to five times more polluted than outdoor air. Common sources of indoor air pollution include combustion sources such as oil, gas, kerosene, coal, wood, and tobacco products; building materials and furnishings as diverse as deteriorated, asbestos-containing insulation, wet or damp carpet, and cabinetry or furniture made of certain pressed wood products; products for household cleaning and maintenance, personal care, or hobbies; central heating and cooling systems and humidification devices; and outdoor sources such as radon, pesticides, and outdoor air pollution.<a href=\"#_ftn39\">[39]<\/a>\n<div class=\"textbox textbox--key-takeaways\"><header class=\"textbox__header\">\n<p class=\"textbox__title\">Key Takeaways<\/p>\n\n<\/header>\n<div class=\"textbox__content\">\n\n<strong>Environmental Tobacco Smoke &amp; Dangers of E-Cigarettes<\/strong>\n\n[caption id=\"attachment_177\" align=\"aligncenter\" width=\"160\"]<img class=\"size-full wp-image-176\" src=\"https:\/\/pressbooks.ccconline.org\/accbertelsen\/wp-content\/uploads\/sites\/160\/2023\/10\/8.12.jpg\" alt=\"Adult smoking while toddler looks on.\" width=\"160\" height=\"121\"> Figure 8.12 \u2013 Secondhand smoke is dangerous to young children. \u00a0[40][\/caption]Environmental tobacco smoke (ETS), otherwise known as secondhand smoke, is a mixture of the smoke given off by the burning end of a cigarette, or cigar, and the smoke exhaled by smokers. Secondhand smoke contains more than 4,000 substances, several of which are known to cause cancer.Children are particularly vulnerable to the effects of secondhand smoke because they are still developing physically, have higher breathing rates than adults, and have little control over their environment, including where and when the adults in their world choose to smoke. Exposure to secondhand smoke can cause asthma, and places infants and children at increased risk for Sudden Infant Death Syndrome (SIDS), pneumonia, bronchitis, and middle ear infections.<a href=\"#_ftn41\">[41]<\/a><strong>What About E-Cigarettes?<\/strong>The aerosol from e-cigarettes is not harmless. It can contain harmful and potentially harmful chemicals, including nicotine; ultrafine particles that can be inhaled deep into the lungs; flavoring such diacetyl, a chemical linked to a serious lung disease; volatile organic compounds such as benzene, which is found in car exhaust; and heavy metals, such as nickel, tin, and lead.\n\n[caption id=\"attachment_177\" align=\"aligncenter\" width=\"275\"]<img class=\"size-full wp-image-177\" src=\"https:\/\/pressbooks.ccconline.org\/accbertelsen\/wp-content\/uploads\/sites\/160\/2023\/10\/8.13.jpg\" alt=\"e-cigarette\" width=\"275\" height=\"183\"> Figure 8.13 \u2013 Secondhand smoke from e-cigarettes isn\u2019t safe either. [42][\/caption]Scientists are still working to understand more fully the health effects and harmful doses of e-cigarette contents when they are heated and turned into an aerosol, both for active users who inhale from a device and for those who are exposed to the aerosol secondhand. Another risk to consider involves defective e-cigarette batteries that have been known to cause fires and explosions, some of which have resulted in serious injuries. Most of the explosions happened when the e-cigarette batteries were being charged.<a href=\"#_ftn43\">[43]<\/a><\/div>\n<\/div>\n<h4>Mold<\/h4>\nMold is a fungus that thrives indoors when excessive moisture or water accumulates indoors or when moisture problems remain undiscovered or un-addressed. There are molds that can grow on wood, paper, carpet, and foods. There is no practical way to eliminate all mold and mold spores in the indoor environment. \u00a0The way to control indoor mold growth is to control moisture.\n\n&nbsp;\n\nMold needs to be controlled in childcare settings to avoid possible health impacts for infants and children, including allergic reactions, asthma, and other respiratory issues.<a href=\"#_ftn44\">[44]<\/a>\n<h4>Integrated Pest Management<\/h4>\nExposure to pests such as cockroaches, rodents, ants, and stinging insects in childcare centers may place children at risk for disease, asthma attacks, bites, and stings. Improper use of pesticides can also place children at risk. A recent study of pesticide use in child care centers revealed that 75% of centers reported at least one pesticide application in the last year. Several factors increase both children's exposures and their vulnerability to these exposures compared to adults. Children spend more time on the floor, where residues can transfer to skin and be absorbed.\n\nYoung children also frequently place their hands and objects in their mouths, resulting in the non-dietary ingestion of pesticides. Children are less developed immunologically, physiologically, and neurologically, and therefore may be more susceptible to the adverse effects of chemicals and toxins. There is increasing evidence of adverse effects of pesticides on young children, particularly on neurodevelopment.<a href=\"#_ftn45\">[45]<\/a>\n\nIntegrated Pest Management (IPM) is an effective and environmentally sensitive approach to pest management that relies on a combination of common-sense practices. IPM programs use current, comprehensive information on the life cycles of pests and their interaction with the environment.\n\nIntegrated Pest Management \u201c(IPM) is a safer, more effective, longer-lasting method of pest control that emphasizes pest prevention by eliminating pests' access to food, water, and shelter. When using IPM, properly identify the pest and know why it's there so an appropriate combination of different pest control methods can be used for better effectiveness in controlling the pest.\u201d<a href=\"#_ftn46\">[46]<\/a> This information, in combination with the last toxic available pest control methods, is used to manage pest damage by the most economical means, and with the least possible hazard to people, property, and the environment.<a href=\"#_ftn47\">[47]<\/a>\n\n[caption id=\"attachment_179\" align=\"aligncenter\" width=\"300\"]<img class=\"size-medium wp-image-178\" src=\"https:\/\/pressbooks.ccconline.org\/accbertelsen\/wp-content\/uploads\/sites\/160\/2023\/10\/8.14-300x221.png\" alt=\"Trapped insects\" width=\"300\" height=\"221\"> Figure 8.14 \u2013 Using traps can help a program determine what insects they are dealing\u00a0with in order to take the most effective and least hazardous steps to get rid of them. [48][\/caption]\n<h5>Chemical Hazards<\/h5>\nA child born today will grow up exposed to more chemicals than a child from any other generation in our nation's history. \u00a0Of the 85,000 synthetic chemicals in commerce today, only a small fraction has been tested for toxicity on human health.\n\nA 2005 study found 287 different chemicals in cord blood of 10 newborn babies - chemicals from pesticides, fast food packaging, coals, gasoline emissions, and trash incineration. Children are more vulnerable to toxic chemicals because their bodies are still growing and developing.<a href=\"#_ftn49\">[49]<\/a>\n<h2>Plastics in Child Care Settings<\/h2>\nCertain types of plastics contain chemicals such as phthalates, bisphenol A (BPA), polyvinyl chloride (PVC), and polystyrene that may be toxic to children. These plastics can be found in baby bottles, sippy cups, teething rings, pacifiers, and toys. When these items are in a child's mouth or when they are heated (such as in a microwave), children can be exposed to harmful chemicals that have the potential to mimic or suppress hormones and disrupt normal growth and development.<a href=\"#_ftn50\">[50]<\/a>\n<h2>Drinking Water<\/h2>\nThe United States has one of the safest public drinking water supplies in the world. Over 286 million Americans get their tap water from a community water system. The US Environmental Protection Agency (EPA) regulates drinking water quality in public water systems and sets maximum concentration levels for water chemicals and pollutants.\n\nSources of drinking water are subject to contamination and require appropriate treatment to remove disease-causing contaminants. Contamination of drinking water supplies can occur in the source water as well as in the distribution system after water treatment has already occurred. There are many sources of water contamination, including naturally occurring chemicals and minerals (for example, arsenic, radon, uranium), local land use practices (fertilizers, pesticides, concentrated feeding operations), manufacturing processes, and sewer overflows or wastewater releases.\n\n&nbsp;\n\nThe presence of contaminants in water can lead to adverse health effects, including gastrointestinal illness, reproductive problems, and neurological disorders.<a href=\"#_ftn51\">[51]<\/a> Young children are at particular risk for exposure to contaminants in drinking water because, pound for pound, they drink more water than adults (including water used to prepare formula), and because their immature body systems are less efficient at detoxification. Exposure to lead in drinking water is a serious health concern, especially for young children and infants since elevated lead levels in children may result in delays in physical or mental development, lower IQ, and even brain damage.<a href=\"#_ftn52\">[52]<\/a>\n\n[caption id=\"attachment_179\" align=\"aligncenter\" width=\"300\"]<img class=\"size-medium wp-image-179\" src=\"https:\/\/pressbooks.ccconline.org\/accbertelsen\/wp-content\/uploads\/sites\/160\/2023\/10\/8.15-300x199.jpg\" alt=\"Boy drinking from a drinking fountain\" width=\"300\" height=\"199\"> Figure 8.15 \u2013 It\u2019s important for children to have access to safe drinking water. \u00a0[53][\/caption]Under the federal regulations of the Safe Drinking Water Act, all water suppliers must notify consumers quickly when there is a serious problem with water quality. Water systems serving the same people year-round must provide annual consumer confidence reports on the source and quality of their tap water. National drinking water standards are legally enforceable, which means that both U.S. EPA and states can take enforcement actions against water systems not meeting safety standards. <a href=\"#_ftn54\">[54]<\/a>\n<div class=\"textbox textbox--exercises\"><header class=\"textbox__header\">\n<p class=\"textbox__title\">Pause to Reflect<\/p>\n\n<\/header>\n<div class=\"textbox__content\">\n<table style=\"border-collapse: collapse;width: 100%\" border=\"0\">\n<tbody>\n<tr>\n<td style=\"width: 16.5%\"><img class=\"alignleft size-thumbnail wp-image-30\" src=\"https:\/\/pressbooks.ccconline.org\/accbertelsen\/wp-content\/uploads\/sites\/160\/2023\/10\/Pause-to-reflect-icon-150x150.png\" alt=\"Question mark\" width=\"150\" height=\"150\"><\/td>\n<td style=\"width: 83.5%\">What are five important things that early care and education programs should remember about environmental health to keep children healthy?<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<\/div>\n<\/div>\n<h2>Summary<\/h2>\nUnderstanding how illness is spread, helps early care and education programs prevent the spread of illness. Immunizations also play an important role in preventing illness. And when program staff use universal precautions, including handwashing, cleaning and disinfecting, and proper disposal of waste, they also prevent the spread of illness.\n\nPrograms must also be aware of environmental hazards that present a threat to children\u2019s health. These include both indoor and outdoor air quality, mold, and chemicals. Programs should use integrated pest management and make sure that their drinking water is safe as well.\n<div class=\"textbox textbox--examples\"><header class=\"textbox__header\">\n<p class=\"textbox__title\">Engaging Families<\/p>\n\n<\/header>\n<div class=\"textbox__content\">\n\nTeachers can use the following strategies to help families to develop their children\u2019s health habits:\n\n\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Provide families with concise, accurate information about ways to promote and develop good health habits in children; information should be presented in English and the families\u2019 home languages. Capture their interest by addressing topics related to their children\u2019s age and development, as well as topics related to common health risks for children, such as childhood obesity, asthma, and dental caries. Injury prevention and first-aid topics, such as treating burns, bleeding, and choking, are also relevant. Provide written informational materials that are brief and easy to read.\n\n\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Provide individualized information, as well as general health information, to all families through daily contact, workshops, and parent meetings. All information should be presented in English and in the families\u2019 home languages. Accommodate family schedules by providing workshops and meetings at various times (e.g., morning, afternoon, evening), and arrange for child care during meetings.\n\n\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Show family members what the children are learning by sending home examples of work, encouraging families to visit the preschool and observe children in action, and sharing children\u2019s portfolios during home visits. Reinforce children\u2019s learning about health habits through take-home activities, lending libraries of read-aloud books in the languages of the families in the group, and displays of children\u2019s work.\n\n\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 As you introduce health routines (e.g., handwashing, tooth brushing), invite family members to participate and model. Encourage families to contribute ideas or materials to interest areas that reflect diverse health habits at home.\n\n\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Identify community resources related to health habits (e.g., handwashing, tooth brushing) and invite community personnel to participate in and bring resources to family workshops or parent meetings. Emphasize the role of home and family members in helping children to develop health habits, and inform all parents of the availability of free and low-cost community resources.\n\n\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Be sensitive to and respectful of different values or beliefs, as well as varying levels of access to health products and services. Gather information on available and accessible resources in the community, including those for children with special needs, and provide this information to all families, translated into their home languages.\n\n<\/div>\n<\/div>\n<div class=\"textbox textbox--exercises\"><header class=\"textbox__header\">\n<p class=\"textbox__title\">Chapter 8 Review<\/p>\n\n<\/header>\n<div class=\"textbox__content\">\n\n[h5p id=\"14\"]\n\n<\/div>\n<\/div>\n<div class=\"textbox shaded\">\n\n<strong>Resources for Further Exploration<\/strong>\n\n<a href=\"https:\/\/cchp.ucsf.edu\/sites\/g\/files\/tkssra181\/f\/PHT-Handbook-Student-2018-FINAL.pdf\">Health and Safety in the Child Care Setting: Prevention of Infectious Disease A Curriculum for the Training of Child Care Providers (3rd edition)<\/a>: https:\/\/cchp.ucsf.edu\/sites\/g\/files\/tkssra181\/f\/PHT-Handbook-Student-2018-FINAL.pdf\n\n<a href=\"https:\/\/www.epa.gov\/sites\/production\/files\/documents\/SafeHealthy2012_ENGa.pdf\">Safe and Healthy Child Care Centers<\/a>: https:\/\/www.epa.gov\/sites\/production\/files\/documents\/SafeHealthy2012_ENGa.pdf\n\n<a href=\"https:\/\/www.cdc.gov\/handwashing\/index.html\">Handwashing<\/a>: https:\/\/www.cdc.gov\/handwashing\/index.html\n\n<a href=\"https:\/\/www.cdc.gov\/vaccines\/\">Vaccines<\/a>: https:\/\/www.cdc.gov\/vaccines\/\n\n<a href=\"https:\/\/www.epa.gov\/childcare\">Environmental Health in Child Care<\/a>: https:\/\/www.epa.gov\/childcare\n\n<a href=\"https:\/\/cchp.ucsf.edu\/content\/resources\">California Childcare Health Program\u2019s Publications and Resources<\/a>: https:\/\/cchp.ucsf.edu\/content\/resources\n\n<a href=\"https:\/\/legacy.azdeq.gov\/function\/about\/download\/indoorair.pdf\">Air Quality<\/a>: https:\/\/legacy.azdeq.gov\/function\/about\/download\/indoorair.pdf\n\n<a href=\"https:\/\/www.epa.gov\/mold\/mold-remediation-schools-and-commercial-buildings-guide\">Mold Remediation in Schools<\/a>: https:\/\/www.epa.gov\/mold\/mold-remediation-schools-and-commercial-buildings-guide\n\n<a href=\"https:\/\/www.epa.gov\/sites\/production\/files\/documents\/IPM_CCC.pdf\">Integrated Pest Management in Child Care Centers<\/a>: https:\/\/www.epa.gov\/sites\/production\/files\/documents\/IPM_CCC.pdf\n\n<a href=\"https:\/\/apps.cdpr.ca.gov\/schoolipm\/\">California School &amp; Child Care Integrated Pest Management (IPM)<\/a>: https:\/\/apps.cdpr.ca.gov\/schoolipm\/\n\n<a href=\"https:\/\/apps.cdpr.ca.gov\/schoolipm\/school_ipm_law\/hsa_compliance_childcare_packet.pdf\">Healthy Schools Act Compliance Packet for Childcare Centers<\/a>: https:\/\/apps.cdpr.ca.gov\/schoolipm\/school_ipm_law\/hsa_compliance_childcare_packet.pdf\n\n<a href=\"https:\/\/www.epa.gov\/ground-water-and-drinking-water\/3ts-reducing-lead-drinking-water-toolkit\">EPA\u2019s 3TsWater Quality Tool Kit<\/a>: <a href=\"https:\/\/www.epa.gov\/ground-water-and-drinking-water\/3ts-reducing-lead-drinking-water-toolkit\">https:\/\/www.epa.gov\/ground-water-and-drinking-water\/3ts-reducing-lead-drinking-water-toolkit<\/a>\n\n<\/div>\n<div class=\"textbox textbox--exercises\"><header class=\"textbox__header\">\n<p class=\"textbox__title\">Chapter 8 Workbook<\/p>\n\n<\/header>\n<div class=\"textbox__content\">\n\n[h5p id=\"15\"]\n\n<\/div>\n<\/div>\n<h5>References:<\/h5>\n<div>\n<div>\n\n<a href=\"#_ftnref1\">[1]<\/a> Image by <a href=\"https:\/\/www.canyons.edu\/academics\/onlineeducation\/ztc\/\">College of the Canyons ZTC Team<\/a> is based on image from <a href=\"https:\/\/eclkc.ohs.acf.hhs.gov\/physical-health\/article\/infectious-diseases-prevention-management\">Managing Infectious Disease in Head Start Webinar<\/a> by <a href=\"https:\/\/eclkc.ohs.acf.hhs.gov\/\">Head Start Early Childhood Learning &amp; Knowledge Center<\/a>, which is in the public domain\n\n<\/div>\n<div>\n\n<a href=\"#_ftnref2\">[2]<\/a> Image from <a href=\"https:\/\/eclkc.ohs.acf.hhs.gov\/physical-health\/article\/infectious-diseases-prevention-management\">Managing Infectious Disease in Head Start Webinar<\/a> by <a href=\"https:\/\/eclkc.ohs.acf.hhs.gov\/\">Head Start Early Childhood Learning &amp; Knowledge Center<\/a> is in the public domain\n\n<\/div>\n<div>\n\n<a href=\"#_ftnref3\">[3]<\/a> Image by <a href=\"https:\/\/www.canyons.edu\/academics\/onlineeducation\/ztc\/\">College of the Canyons ZTC Team<\/a> is based on <a href=\"https:\/\/www.cdc.gov\/ncezid\/dvbd\/vital-signs\/california.html\">Image<\/a> by the <a href=\"https:\/\/www.cdc.gov\/ncezid\/dvbd\/\">CDC Division of Vector-Borne Diseases<\/a>, which is in the public domain\n\n<\/div>\n<div>\n\n<a href=\"#_ftnref4\">[4]<\/a> Managing Infectious Disease in Head Start Webinar (Transcript) by <a href=\"https:\/\/eclkc.ohs.acf.hhs.gov\/\">Head Start Early Childhood Learning &amp; Knowledge Center<\/a> is in the public domain\n\n<\/div>\n<div>\n\n<a href=\"#_ftnref5\">[5]<\/a> Managing Infectious Disease in Head Start Webinar (Transcript) by <a href=\"https:\/\/eclkc.ohs.acf.hhs.gov\/\">Head Start Early Childhood Learning &amp; Knowledge Center<\/a> is in the public domain\n\n<\/div>\n<div>\n\n<a href=\"#_ftnref6\">[6]<\/a> <a href=\"https:\/\/www.cdc.gov\/vaccines\/parents\/index.html\">For Parents: Vaccines for Your Children<\/a> by the <a href=\"https:\/\/www.cdc.gov\/\">CDC<\/a> is in the public domain\n\n<\/div>\n<div>\n\n<a href=\"#_ftnref7\">[7]<\/a> <a href=\"https:\/\/www.cdc.gov\/vaccines\/parents\/protecting-children\/index.html\">Vaccines for Your Children: Protect Your Child at Every Age<\/a> by the <a href=\"https:\/\/www.cdc.gov\/\">CDC<\/a> is in the public domain\n\n<\/div>\n<div>\n\n<a href=\"#_ftnref8\">[8]<\/a> <a href=\"https:\/\/www.cdc.gov\/vaccines\/parents\/downloads\/parent-ver-sch-0-6yrs.pdf\">Image<\/a> by the <a href=\"https:\/\/www.cdc.gov\/\">CDC<\/a> is in the public domain\n\n<\/div>\n<div>\n\n<a href=\"#_ftnref9\">[9]<\/a> <a href=\"https:\/\/www.cdc.gov\/vaccines\/parents\/downloads\/parent-ver-sch-0-6yrs.pdf\">Image<\/a> by the <a href=\"https:\/\/www.cdc.gov\/\">CDC<\/a> is in the public domain\n\n<\/div>\n<div>\n\n<a href=\"#_ftnref10\">[10]<\/a> <a href=\"https:\/\/courses.lumenlearning.com\/diseaseprevention\/chapter\/immunity-and-immunizations\/\">Disease Prevention and Healthy Lifestyles<\/a> references <a href=\"http:\/\/hlth21fall2012.wikispaces.com\/\">Contemporary Health Issues<\/a> by Judy Baker, Ph.D., licensed under <a href=\"https:\/\/creativecommons.org\/licenses\/by-sa\/4.0\/\">CC BY-SA 4.0 <\/a>\n\n<\/div>\n<div>\n\n<a href=\"#_ftnref11\">[11]<\/a> <a href=\"https:\/\/www.cdc.gov\/vaccines\/parents\/vaccine-decision\/index.html\">Making the Vaccine Decision<\/a> by the <a href=\"https:\/\/www.cdc.gov\/\">CDC<\/a> is in the public domain\n\n<\/div>\n<div>\n\n<a href=\"#_ftnref12\">[12]<\/a> <a href=\"https:\/\/commons.wikimedia.org\/wiki\/File:Polio_physical_therapy.jpg\">Image<\/a> by the <a href=\"https:\/\/www.cdc.gov\/\">CDC<\/a> is in the public domain\n\n<\/div>\n<div>\n\n<a href=\"#_ftnref13\">[13]<\/a> <a href=\"https:\/\/courses.lumenlearning.com\/diseaseprevention\/chapter\/immunity-and-immunizations\/\">Disease Prevention and Healthy Lifestyles<\/a> references <a href=\"http:\/\/hlth21fall2012.wikispaces.com\/\">Contemporary Health Issues<\/a> by Judy Baker, Ph.D., licensed under <a href=\"https:\/\/creativecommons.org\/licenses\/by-sa\/4.0\/\">CC BY-SA 4.0 <\/a>\n\n<\/div>\n<div>\n\n<a href=\"#_ftnref14\">[14]<\/a> <a href=\"https:\/\/www.cdc.gov\/vaccines\/parents\/vaccine-decision\/index.html\">Making the Vaccine Decision<\/a> by the <a href=\"https:\/\/www.cdc.gov\/\">CDC<\/a> is in the public domain\n\n<\/div>\n<div>\n\n<a href=\"#_ftnref15\">[15]<\/a> <a href=\"https:\/\/courses.lumenlearning.com\/diseaseprevention\/chapter\/immunity-and-immunizations\/\">Disease Prevention and Healthy Lifestyles<\/a> references <a href=\"http:\/\/hlth21fall2012.wikispaces.com\/\">Contemporary Health Issues<\/a> by Judy Baker, Ph.D., licensed under <a href=\"https:\/\/creativecommons.org\/licenses\/by-sa\/4.0\/\">CC BY-SA 4.0 <\/a>\n\n<\/div>\n<div>\n\n<a href=\"#_ftnref16\">[16]<\/a> <a href=\"https:\/\/www.cdc.gov\/vaccines\/parents\/vaccine-decision\/index.html\">Making the Vaccine Decision<\/a> by the <a href=\"https:\/\/www.cdc.gov\/\">CDC<\/a> is in the public domain\n\n<\/div>\n<div>\n\n<a href=\"#_ftnref17\">[17]<\/a> <a href=\"https:\/\/www.flickr.com\/photos\/cdcglobal\/13627881194\">Image<\/a> by <a href=\"https:\/\/www.flickr.com\/photos\/cdcglobal\/\">CDC Global<\/a> is licensed under <a href=\"https:\/\/creativecommons.org\/licenses\/by\/2.0\/\">CC BY 2.0<\/a>\n\n<\/div>\n<div>\n\n<a href=\"#_ftnref18\">[18]<\/a> <a href=\"https:\/\/courses.lumenlearning.com\/diseaseprevention\/chapter\/immunity-and-immunizations\/\">Disease Prevention and Healthy Lifestyles<\/a> references <a href=\"http:\/\/hlth21fall2012.wikispaces.com\/\">Contemporary Health Issues<\/a> by Judy Baker, Ph.D., licensed under <a href=\"https:\/\/creativecommons.org\/licenses\/by-sa\/4.0\/\">CC BY-SA 4.0 <\/a>\n\n<\/div>\n<div>\n\n<a href=\"#_ftnref19\">[19]<\/a> <a href=\"https:\/\/www.cdc.gov\/flu\/prevent\/vaccine-benefits.htm\">What Are the Benefits of Flu Vaccination?<\/a> by the <a href=\"https:\/\/www.cdc.gov\/\">Centers for Disease Control and Prevention<\/a> is in the public domain\n\n<\/div>\n<div>\n\n<a href=\"#_ftnref20\">[20]<\/a> <a href=\"https:\/\/www.cdc.gov\/flu\/pdf\/freeresources\/graphics\/yearly-lab-work-infographic.pdf\">Image<\/a> by the <a href=\"https:\/\/www.cdc.gov\/\">Centers for Disease Control and Prevention<\/a> is in the public domain\n\n<\/div>\n<div>\n\n<a href=\"#_ftnref21\">[21]<\/a> California Child Care Health Program. (2011). <em>Health and Safety in the Child Care Setting: Prevention of Infectious Disease<\/em>. University of California San Francisco. <a href=\"https:\/\/cchp.ucsf.edu\/sites\/g\/files\/tkssra181\/f\/idc2book.pdf\">https:\/\/cchp.ucsf.edu\/sites\/g\/files\/tkssra181\/f\/idc2book.pdf<\/a>\n\n<\/div>\n<div>\n\n<a href=\"#_ftnref22\">[22]<\/a> <a href=\"https:\/\/www.cdc.gov\/handwashing\/pdf\/wash-your-hands-fact-sheet-508.pdf\">Stop Germs! Wash Your Hands<\/a> by the <a href=\"https:\/\/www.cdc.gov\/\">Centers for Disease Control and Prevention<\/a> is in the public domain\n\n<\/div>\n<div>\n\n<a href=\"#_ftnref23\">[23]<\/a> <a href=\"https:\/\/eclkc.ohs.acf.hhs.gov\/sites\/default\/files\/pdf\/health-tips-home-visitors.pdf\">Health Tips for Home Visitors to Prevent the Spread of Illness<\/a> by <a href=\"https:\/\/eclkc.ohs.acf.hhs.gov\/about-us\/article\/national-center-early-childhood-health-wellness-ncechw\">Head Start National Center on Health<\/a> is in the public domain\n\n<\/div>\n<div>\n\n<a href=\"#_ftnref24\">[24]<\/a> <a href=\"https:\/\/www.cdc.gov\/infectioncontrol\/pdf\/strive\/PPE101-508.pdf\">The Basics of Standard Precautions<\/a> by Karen Jones, Linda R. Greene, and Lona Mody is in the public domain\n\n<\/div>\n<div>\n\n<a href=\"#_ftnref25\">[25]<\/a> <a href=\"https:\/\/www.cdc.gov\/hai\/pdfs\/ppe\/ppe-sequence.pdf\">Sequence for Putting On Personal Protective Equipment (PPE)<\/a> by the <a href=\"https:\/\/www.cdc.gov\/\">Centers for Disease Control and Prevention<\/a> is in the public domain\n\n<\/div>\n<div>\n\n<a href=\"#_ftnref26\">[26]<\/a> <a href=\"https:\/\/www.cdc.gov\/hai\/pdfs\/ppe\/ppe-sequence.pdf\">Image<\/a> by the <a href=\"https:\/\/www.cdc.gov\/\">Centers for Disease Control and Prevention<\/a> is in the public domain\n\n<\/div>\n<div>\n\n<a href=\"#_ftnref27\">[27]<\/a> California Child Care Health Program. (2011). <em>Health and Safety in the Child Care Setting: Prevention of Infectious Disease<\/em>. University of California San Francisco. Retrieved from https:\/\/cchp.ucsf.edu\/sites\/g\/files\/tkssra181\/f\/idc2book.pdf\n\n<\/div>\n<div>\n\n<a href=\"#_ftnref28\">[28]<\/a> <a href=\"https:\/\/eclkc.ohs.acf.hhs.gov\/sites\/default\/files\/pdf\/health-tips-home-visitors.pdf\">Health Tips for Home Visitors to Prevent the Spread of Illness<\/a> by <a href=\"https:\/\/eclkc.ohs.acf.hhs.gov\/about-us\/article\/national-center-early-childhood-health-wellness-ncechw\">Head Start National Center on Health<\/a> is in the public domain\n\n<\/div>\n<div>\n\n<a href=\"#_ftnref29\">[29]<\/a> <a href=\"https:\/\/www.cde.ca.gov\/sp\/cd\/re\/documents\/psframeworkvol2.pdf\">California Preschool Curriculum Framework (Volume 2)<\/a> by the <a href=\"https:\/\/www.cde.ca.gov\/\">California Department of Education<\/a> is used with permission\n\n<\/div>\n<div>\n\n<a href=\"#_ftnref30\">[30]<\/a> California Child Care Health Program. (2011). <em>Health and Safety in the Child Care Setting: Prevention of Infectious Disease<\/em>. University of California San Francisco. Retrieved from https:\/\/cchp.ucsf.edu\/sites\/g\/files\/tkssra181\/f\/idc2book.pdf\n\n<\/div>\n<div>\n\n<a href=\"#_ftnref31\">[31]<\/a> <a href=\"https:\/\/www.cde.ca.gov\/sp\/cd\/re\/documents\/psframeworkvol2.pdf\">California Preschool Curriculum Framework (Volume 2)<\/a> by the <a href=\"https:\/\/www.cde.ca.gov\/\">California Department of Education<\/a> is used with permission\n\n<\/div>\n<div>\n\n<a href=\"#_ftnref32\">[32]<\/a> California Child Care Health Program. (2011). <em>Health and Safety in the Child Care Setting: Prevention of Infectious Disease<\/em>. University of California San Francisco. Retrieved from https:\/\/cchp.ucsf.edu\/sites\/g\/files\/tkssra181\/f\/idc2book.pdf\n\n<\/div>\n<div>\n\n<a href=\"#_ftnref33\">[33]<\/a> California Child Care Health Program. (2011). <em>Health and Safety in the Child Care Setting: Prevention of Infectious Disease<\/em>. University of California San Francisco. Retrieved from ps:\/\/cchp.ucsf.edu\/sites\/g\/files\/tkssra181\/f\/idc2book.pdf\n\n<\/div>\n<div>\n\n<a href=\"#_ftnref34\">[34]<\/a> California Child Care Health Program. (2011). <em>Health and Safety in the Child Care Setting: Prevention of Infectious Disease<\/em>. University of California San Francisco. Retrieved from https:\/\/cchp.ucsf.edu\/sites\/g\/files\/tkssra181\/f\/idc2book.pdf\n\n<\/div>\n<div>\n\n<a href=\"#_ftnref35\">[35]<\/a> Diaper Changing Procedure by <a href=\"https:\/\/eclkc.ohs.acf.hhs.gov\/\">Head Start Early Childhood Learning &amp; Knowledge Center<\/a> is in the public domain\n\n<\/div>\n<div>\n\n<a href=\"#_ftnref36\">[36]<\/a> California Child Care Health Program. (2011). <em>Health and Safety in the Child Care Setting: Prevention of Infectious Disease<\/em>. University of California San Francisco. Retrieved from https:\/\/cchp.ucsf.edu\/sites\/g\/files\/tkssra181\/f\/idc2book.pdf\n\n<\/div>\n<div>\n\n<a href=\"#_ftnref37\">[37]<\/a> <a href=\"https:\/\/www.epa.gov\/childcare\/resources-about-indoor-air-quality-child-care-providers\">Resources about Indoor Air Quality for Child Care Providers<\/a> by the <a href=\"https:\/\/www.epa.gov\/\">U.S. Environmental Protection Agency<\/a> is in the public domain\n\n<\/div>\n<div>\n\n<a href=\"#_ftnref38\">[38]<\/a> <a href=\"https:\/\/legacy.azdeq.gov\/function\/about\/download\/indoorair.pdf\">Indoor Air Quality Issues for Child Care Facilities<\/a> by the <a href=\"http:\/\/azdeq.gov\/\">Arizona Department of Environmental Quality<\/a> is in the public domain\n\n<\/div>\n<div>\n\n<a href=\"#_ftnref39\">[39]<\/a> <a href=\"https:\/\/www.epa.gov\/childcare\/resources-about-indoor-air-quality-child-care-providers\">Resources about Indoor Air Quality for Child Care Providers<\/a> by the <a href=\"https:\/\/www.epa.gov\/\">U.S. Environmental Protection Agency<\/a> is in the public domain\n\n<\/div>\n<div>\n\n<a href=\"#_ftnref40\">[40]<\/a> <a href=\"https:\/\/www.epa.gov\/childcare\/resources-about-environmental-tobacco-smoke-child-care-providers\">Image<\/a> by the <a href=\"https:\/\/www.epa.gov\/\">U.S. Environmental Protection Agency<\/a> is in the public domain\n\n<\/div>\n<div>\n\n<a href=\"#_ftnref41\">[41]<\/a> <a href=\"https:\/\/www.epa.gov\/childcare\/resources-about-environmental-tobacco-smoke-child-care-providers\">Resources about Environmental Tobacco Smoke for Child Care Providers<\/a> by the <a href=\"https:\/\/www.epa.gov\/\">U.S. Environmental Protection Agency<\/a> is in the public domain\n\n<\/div>\n<div>\n\n<a href=\"#_ftnref42\">[42]<\/a> <a href=\"https:\/\/pixabay.com\/photos\/e-cigarette-vaping-1301664\/\">Image<\/a> by lindsayfox on <a href=\"https:\/\/pixabay.com\/service\/license\/\">Pixabay<\/a>\n\n<\/div>\n<div>\n\n<a href=\"#_ftnref43\">[43]<\/a> <a href=\"https:\/\/e-cigarettes.surgeongeneral.gov\/knowtherisks.html\">Know the Risks: E-Cigarettes and Young People<\/a> by the <a href=\"https:\/\/www.hhs.gov\/\">U.S. Department of Health and Human Services<\/a> is in the public domain\n\n<\/div>\n<div>\n\n<a href=\"#_ftnref44\">[44]<\/a> <a href=\"https:\/\/www.epa.gov\/childcare\/resources-about-mold-child-care-providers\">Resources about Mold for Child Care Providers<\/a> by the <a href=\"https:\/\/www.epa.gov\/\">U.S. Environmental Protection Agency<\/a> is in the public domain\n\n<\/div>\n<div>\n\n<a href=\"#_ftnref45\">[45]<\/a> <a href=\"https:\/\/www.epa.gov\/childcare\/resources-about-pesticides-and-integrated-pest-management-child-care-providers\">Resources about Pesticides and Integrated Pest Management for Child Care Providers<\/a> by the <a href=\"https:\/\/www.epa.gov\/\">U.S. Environmental Protection Agency<\/a> is in the public domain\n\n<\/div>\n<div>\n\n<a href=\"#_ftnref46\">[46]<\/a> PennState Extension. (2011, October 11). <em>IPM for Child Care and Early Learning Environments<\/em>. PennState Extension. Retrieved from https:\/\/extension.psu.edu\/ipm-for-child-care-and-early-learning-environments\n\n<\/div>\n<div>\n\n<a href=\"#_ftnref47\">[47]<\/a> <a href=\"https:\/\/www.epa.gov\/safepestcontrol\/integrated-pest-management-ipm-principles\">Integrated Pest Management (IPM) Principles<\/a> by the <a href=\"https:\/\/www.epa.gov\/\">U.S. Environmental Protection Agency<\/a> is in the public domain\n\n<\/div>\n<div>\n\n<a href=\"#_ftnref48\">[48]<\/a> <a href=\"https:\/\/www.epa.gov\/sites\/production\/files\/documents\/IPM_CCC.pdf\">Image<\/a> by the <a href=\"https:\/\/www.epa.gov\/\">U.S. Environmental Protection Agency<\/a> is in the public domain\n\n<\/div>\n<div>\n\n<a href=\"#_ftnref49\">[49]<\/a> <a href=\"https:\/\/www.epa.gov\/childcare\/resources-about-chemical-hazards-child-care-providers\">Resources about Chemical Hazards for Child Care Providers<\/a> by the <a href=\"https:\/\/www.epa.gov\/\">U.S. Environmental Protection Agency<\/a> is in the public domain\n\n<\/div>\n<div>\n\n<a href=\"#_ftnref50\">[50]<\/a> <a href=\"https:\/\/www.epa.gov\/childcare\/resources-about-plastics-child-care-settings-parents-and-providers\">Resources about Plastics in Child Care Settings for Parents and Providers<\/a> by the <a href=\"https:\/\/www.epa.gov\/\">U.S. Environmental Protection Agency<\/a> is in the public domain\n\n<\/div>\n<div>\n\n<a href=\"#_ftnref51\">[51]<\/a> <a href=\"https:\/\/www.cdc.gov\/healthywater\/drinking\/public\/water_diseases.html\">Water-related Diseases and Contaminants in Public Water Systems<\/a> by the <a href=\"https:\/\/www.cdc.gov\/\">Centers for Disease Control and Prevention<\/a> is in the public domain\n\n<\/div>\n<div>\n\n<a href=\"#_ftnref52\">[52]<\/a> <a href=\"https:\/\/www.epa.gov\/childcare\/resources-about-drinking-water-child-care-providers\">Resources about Drinking Water for Child Care Providers<\/a> by the <a href=\"https:\/\/www.epa.gov\/\">U.S. Environmental Protection Agency<\/a> is in the public domain\n\n<\/div>\n<div>\n\n<a href=\"#_ftnref53\">[53]<\/a> <a href=\"http:\/\/www.publicdomainfiles.com\/show_file.php?id=13393456893547\">Image<\/a> by Amanda Mills is in the public domain.\n\n<\/div>\n<div>\n\n<a href=\"#_ftnref54\">[54]<\/a> <a href=\"https:\/\/www.epa.gov\/sites\/production\/files\/2015-04\/documents\/epa816f04030.pdf\">Understanding the Safe Drinking Water Act<\/a> by the <a href=\"https:\/\/www.epa.gov\/\">U.S. Environmental Protection Agency<\/a> is in the public domain\n\n<\/div>\n<\/div>","rendered":"<div class=\"textbox textbox--learning-objectives\">\n<header class=\"textbox__header\">\n<p class=\"textbox__title\">Chapter 8 Learning Objectives<\/p>\n<\/header>\n<div class=\"textbox__content\">\n<p>By the end of this chapter, you should be able to:<\/p>\n<ul>\n<li>Describe each of the five ways illness is transmitted.<\/li>\n<li>Explain how immunization prevents illness.<\/li>\n<li>Identify standard precautions to prevent illness.<\/li>\n<li>Discuss practices to protect children from environmental hazards.<\/li>\n<\/ul>\n<\/div>\n<\/div>\n<div class=\"textbox shaded\">\n<p><strong>Licensing Regulations<\/strong><\/p>\n<p>Rule 3 Regulations that relate to this chapter include:<\/p>\n<p><strong>9503.0080 EXCLUSION OF SICK CHILDREN.<\/strong> A child with any of the following conditions or behaviors is a sick child and must be excluded from a center not licensed to operate a sick care program. If the child becomes sick while at the center, the child must be isolated from other children in care and the parent called immediately. A sick child must be supervised at all times. The license holder must exclude a child: A. with a reportable illness or condition as specified in part\u00a0<a href=\"https:\/\/www.revisor.mn.gov\/rules\/4605.7040\">4605.7040<\/a>\u00a0that the commissioner of health determines to be contagious and a physician determines has not had sufficient treatment to reduce the health risk to others;<\/p>\n<p>B. with chicken pox until the child is no longer infectious or until the lesions are crusted over;<\/p>\n<p>C. who has vomited two or more times since admission that day;<\/p>\n<p>D. who has had three or more abnormally loose stools since admission that day;<\/p>\n<p>E. who has contagious conjunctivitis or pus draining from the eye;<\/p>\n<p>F. who has a bacterial infection such as streptococcal pharyngitis or impetigo and has not completed 24 hours of antimicrobial therapy;<\/p>\n<p>G. who has unexplained lethargy;<\/p>\n<p>H. who has lice, ringworm, or scabies that is untreated and contagious to others;<\/p>\n<p>I. who has a 100 degree Fahrenheit axillary or higher temperature of undiagnosed origin before fever reducing medication is given;<\/p>\n<p>J. who has an undiagnosed rash or a rash attributable to a contagious illness or condition;<\/p>\n<p>K. who has significant respiratory distress;<\/p>\n<p>L. who is not able to participate in child care program activities with reasonable comfort; or<\/p>\n<p>M.\u00a0 who requires more care than the program staff can provide without compromising the health and safety of other children in care.<\/p>\n<p><strong>9503.0085 SICK CARE PROGRAM.\u00a0<\/strong> (This is a specialized program and does not apply to standard child care programs.)<\/p>\n<p>9503.0140 HEALTH.<\/p>\n<p><strong>Subp. 6.\u00a0 <\/strong><strong>Notice about a sick child.\u00a0<\/strong><\/p>\n<p>Notices about the illness or condition of a child must be given as required in items A to D:<\/p>\n<p>A. The license holder must ensure that a parent is notified immediately when the parent&#8217;s child becomes sick at the center.<\/p>\n<p>B.\u00a0 The license holder must require a parent to inform the center within 24 hours, exclusive of weekends and holidays, when a child is diagnosed by a child&#8217;s source of medical or dental care as having a contagious reportable disease specified in part\u00a0<a href=\"https:\/\/www.revisor.mn.gov\/rules\/4605.7040\">4605.7040<\/a>, or lice, scabies, impetigo, ringworm, or chicken pox.<\/p>\n<p>C.\u00a0 The license holder must post or give a notice to the parents of exposed children the same day a parent notifies the center of a child&#8217;s illness or condition listed in item B.<\/p>\n<p>D.\u00a0 The license holder must ensure that the health authority is notified of any suspected case of reportable disease as specified in part\u00a0<a href=\"https:\/\/www.revisor.mn.gov\/rules\/4605.7040\">4605.7040<\/a>\u00a0within 24 hours of receiving the parent&#8217;s report.<\/p>\n<p><strong>Subp. 7.\u00a0 <\/strong><strong>Administration of medicine.\u00a0<\/strong><\/p>\n<p>A license holder who chooses to administer medicine must ensure that the procedures in items A to E are followed.<\/p>\n<p>A. The license holder must get written permission from the child&#8217;s parent before administering medicine, diapering products, sunscreen lotions, and insect repellents. Nonprescription medicines, diapering products, sunscreen lotions, and insect repellents must be administered according to the manufacturer&#8217;s instructions unless there are written instructions for their use provided by a licensed physician or dentist.<\/p>\n<p>B.\u00a0 The license holder must get and follow written instructions from a licensed physician or dentist before administering each prescription medicine. Medicine with the child&#8217;s name and current prescription information on the label constitutes instructions.<\/p>\n<p>C.\u00a0 All medicine must be kept in its original container and have a legible label stating the child&#8217;s name. The medicine must be given only to the child whose name is on the label. The medicine must not be given after an expiration date on the label, and any unused portion must be returned to the child&#8217;s parent or destroyed. The license holder must ensure that the administration of medicine is recorded and give the name of the child, name of the medication or prescription number, date, time, dosage, and the name and signature of the person who dispensed the medicine. The record must be available to the parent and maintained in the child&#8217;s record.<\/p>\n<p>D.\u00a0 Sunscreen lotions and insect repellents supplied by the license holder may be used on more than one child. A product to control or prevent diaper rash, including pre-moistened commercial wipes that cannot be dispensed in a manner that prevents cross contamination of the product and container as determined by the health consultant, must be labeled with the child&#8217;s name and used only for the individual child whose name is written on the label.<\/p>\n<p>E.\u00a0 Medicines, insect repellents, sunscreen lotions, and diaper rash control products must be stored according to directions on the original container and so that they are inaccessible to children.<\/p>\n<p><strong>Subp. 8.<\/strong>\u00a0 [Repealed, 18 SR 2748]<\/p>\n<p><strong>Subp. 9.\u00a0 <\/strong><strong>Cleanliness.\u00a0<\/strong><\/p>\n<p>The indoor and outdoor space and equipment of the center must be clean.<\/p>\n<p><strong>Subp. 10.\u00a0 <\/strong><strong>Toilet facilities.\u00a0<\/strong><\/p>\n<p>The toilet rooms of the center must be cleaned daily. Toilet training chairs must be emptied, washed with soap and water, and disinfected after each use. Toilets and seats must be washed with soap and water and disinfected when soiled or at least daily.<\/p>\n<p><strong>Subp. 11.\u00a0 <\/strong><strong>Diaper changing area.\u00a0<\/strong><\/p>\n<p>A diaper must be changed only in the diaper changing area. The diaper changing area must be separate from areas used for food storage, food preparation, and eating. The area must have a hand sink equipped with hot and cold running water within three feet of the diaper changing surface, a smooth nonabsorbent diaper changing surface and floor covering, and a sanitary container for soiled and wet diapers.<\/p>\n<p><strong>Subp. 12.\u00a0 <\/strong><strong>Diaper changing procedures.\u00a0<\/strong><\/p>\n<p>The center must have and follow diaper changing procedures that have been developed in consultation with a health consultant. The license holder must post the diaper changing procedures in the diaper changing area.<\/p>\n<p><strong>Subp. 13.\u00a0 <\/strong><strong>Hand washing: child.\u00a0<\/strong><\/p>\n<p>A child&#8217;s hands must be washed with soap and water after a diaper change, after use of a toilet or toilet training chair, and before eating a meal or snack. Staff must monitor hand washing and assist a child who needs help. The use of a common basin or a hand sink filled with standing water is prohibited.<\/p>\n<p><strong>Subp. 14.\u00a0 <\/strong><strong>Hand washing: staff person.\u00a0<\/strong><\/p>\n<p>A staff person must wash his or her hands with soap and water after changing a child&#8217;s diaper, after using toilet facilities, and before handling food or eating.<\/p>\n<p><strong>Subp. 15.\u00a0 <\/strong><strong>Toilet articles.\u00a0<\/strong><\/p>\n<p>The license holder shall provide the following supplies and make them accessible to children: toilet paper, liquid hand soap, facial tissues, and single use paper towels or warm air hand dryers.<\/p>\n<\/div>\n<h2>Introduction<\/h2>\n<p>Science and experience tell us that infectious disease, especially gastrointestinal disease, which means vomiting and diarrhea, and respiratory disease, including coughs, colds, sore throats, and runny noses, are increased among children who are cared for in out-of-home group settings. In addition, such children may be at increased risk for certain other infections that may be transmitted by insects or by body fluids. It&#8217;s also true that children who are cared for in group out-of-home settings are more likely to experience infectious illnesses that are more severe and more prolonged (although 90% of those infections are mild and self-limited, requiring no special treatment).<\/p>\n<p>But there&#8217;s good news, too. Infectious illnesses such as pneumonia and influenza, which together were the leading causes of death among U.S. children in the early 20th century, have declined 99.7 percent. Common childhood illnesses such as diphtheria, whooping cough, measles, mumps, and rubella are rare except in communities where immunization rates are low, and polio is unheard of in our country today.<\/p>\n<p>Although younger children are more susceptible to infectious illness because their immune systems are immature, as they grow older, the incidents of infectious disease decreases as their immune systems mature. Furthermore, children who experience more infectious disease at an early age in group out-of-home care have a decreasing incidence of infectious disease as they grow older. In fact, they have less infectious illnesses in kindergarten than children who were taken care of exclusively at home. Illness also decreases with years of attendance in out-of-home early care and education settings.<\/p>\n<figure id=\"attachment_179\" aria-describedby=\"caption-attachment-179\" style=\"width: 300px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-167\" src=\"https:\/\/pressbooks.ccconline.org\/accbertelsen\/wp-content\/uploads\/sites\/160\/2021\/11\/8.1-300x169.png\" alt=\"Table shows that children under 1 year get sick an average of once a month and children older than five years get sick less than 4 times a year.\" width=\"300\" height=\"169\" srcset=\"https:\/\/pressbooks.ccconline.org\/accece\/wp-content\/uploads\/sites\/160\/2021\/11\/8.1-300x169.png 300w, https:\/\/pressbooks.ccconline.org\/accece\/wp-content\/uploads\/sites\/160\/2021\/11\/8.1-768x432.png 768w, https:\/\/pressbooks.ccconline.org\/accece\/wp-content\/uploads\/sites\/160\/2021\/11\/8.1-65x37.png 65w, https:\/\/pressbooks.ccconline.org\/accece\/wp-content\/uploads\/sites\/160\/2021\/11\/8.1-225x127.png 225w, https:\/\/pressbooks.ccconline.org\/accece\/wp-content\/uploads\/sites\/160\/2021\/11\/8.1-350x197.png 350w, https:\/\/pressbooks.ccconline.org\/accece\/wp-content\/uploads\/sites\/160\/2021\/11\/8.1.png 821w\" sizes=\"auto, (max-width: 300px) 100vw, 300px\" \/><figcaption id=\"caption-attachment-179\" class=\"wp-caption-text\">Figure 8.1 \u2013 As children get older, they get sick less often. [1]<\/figcaption><\/figure>\n<p>There are negative consequences of childhood illness, including:<\/p>\n<ul>\n<li>It\u2019s unpleasant to be sick (for children or the adults that may also become infected).<\/li>\n<li>Illnesses that are minor in children can be much more serious for adults and pregnant women.<\/li>\n<li>Some illnesses have severe effects (and can even be life-threatening).<\/li>\n<li>There are short-term medical costs.<\/li>\n<li>There may also be additional child care costs or lost wages for parents\/caregivers of children that must be excluded from group care.<\/li>\n<li>Overuse of antibiotics in an effort to get children well contributes to antibiotic resistance among common bacteria.<\/li>\n<\/ul>\n<p>To prevent illness we need to understand the different ways illness is spread, how immunizations protect children, and what universal precautions early care and education program staff can take to prevent the spread of illness.<\/p>\n<h2>How Illnesses are Transmitted<\/h2>\n<p>Bacteria, viruses, fungi, and parasites that cause illness can be transmitted in five ways, including through:<\/p>\n<ol>\n<li>the respiratory route<\/li>\n<li>the fecal-oral route<\/li>\n<li>the direct contact route<\/li>\n<li>the bodily fluid route (including blood, urine, vomit, and saliva)<\/li>\n<li>the vector-borne route<\/li>\n<\/ol>\n<h4>Respiratory Transmission<\/h4>\n<p>Most respiratory germs stay in the nose, sinuses, mouth and throat, or possibly the middle ear. Upper respiratory illnesses (colds) are the most common and the most likely to be transmitted in early care and education settings.<\/p>\n<p>The more common respiratory illnesses include:<\/p>\n<ul>\n<li>Sinusitis<\/li>\n<li>Sore throat<\/li>\n<li>Common cold<\/li>\n<li>Recurrent middle ear infection<\/li>\n<li>Strep throat<\/li>\n<li>RSV<\/li>\n<li>Pneumonia<\/li>\n<li>Bronchitis<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p>Pneumonia and bronchitis are rarely the result of an infection picked up in an early education setting. We also have immunizations for many respiratory diseases that are rarely transmitted in early care and education settings today, including:<\/p>\n<ul>\n<li>Mumps<\/li>\n<li>Measles<\/li>\n<li>Bacterial meningitis<\/li>\n<li>Chicken pox<\/li>\n<li>Diphtheria<\/li>\n<li>Pertussis<\/li>\n<li>Pneumonia<\/li>\n<li>Seasonal flu<\/li>\n<\/ul>\n<p>If we could actually see what comes out of a child&#8217;s mouth along with a cough or a sneeze, we might appreciate the respiratory route of infectious disease transmission more.<\/p>\n<figure id=\"attachment_179\" aria-describedby=\"caption-attachment-179\" style=\"width: 300px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-168\" src=\"https:\/\/pressbooks.ccconline.org\/accbertelsen\/wp-content\/uploads\/sites\/160\/2023\/10\/8.4-300x198.png\" alt=\"Young boy coughing showing a mist of droplets coming out of his mouth\" width=\"300\" height=\"198\" srcset=\"https:\/\/pressbooks.ccconline.org\/accece\/wp-content\/uploads\/sites\/160\/2023\/10\/8.4-300x198.png 300w, https:\/\/pressbooks.ccconline.org\/accece\/wp-content\/uploads\/sites\/160\/2023\/10\/8.4-65x43.png 65w, https:\/\/pressbooks.ccconline.org\/accece\/wp-content\/uploads\/sites\/160\/2023\/10\/8.4-225x148.png 225w, https:\/\/pressbooks.ccconline.org\/accece\/wp-content\/uploads\/sites\/160\/2023\/10\/8.4-350x231.png 350w, https:\/\/pressbooks.ccconline.org\/accece\/wp-content\/uploads\/sites\/160\/2023\/10\/8.4.png 379w\" sizes=\"auto, (max-width: 300px) 100vw, 300px\" \/><figcaption id=\"caption-attachment-179\" class=\"wp-caption-text\">Figure 8.4 \u2013 What it might look like if we could see what a child coughs or sneezes. [2]<\/figcaption><\/figure>\n<p>The germs that are in this contaminated cloud of exhalation can wind up on surfaces and hands and be transmitted to others. Staff and children who are able to are encouraged to cough into their sleeves. Covering your mouth with your hand only transfers these germs to your hand. This will be addressed more in depth later in the chapter.<\/p>\n<h4>Fecal-Oral Transmission<\/h4>\n<p>When organisms that live in our intestines get into our mouths they can cause illness. Usually, this happens via someone&#8217;s hands, usually our own. Fecal-oral routes diseases include:<\/p>\n<ul>\n<li>Hepatitis A<\/li>\n<li>diarrhea<\/li>\n<li>hand, foot, and mouth disease<\/li>\n<li>pinworms<\/li>\n<li>rotavirus<\/li>\n<li>norovirus<\/li>\n<li>giardia<\/li>\n<li>shigella<\/li>\n<li>cryptosporidiosis<\/li>\n<\/ul>\n<p>That is why it is so important that everyone wash hands after using the bathroom, changing diapers, when preparing food, and before eating.<\/p>\n<h4>Food Poisoning<\/h4>\n<ol>\n<li>coli and salmonella are two of the germs that you may also have heard mentioned in the news when grocery stores send back fresh vegetables, meat, or poultry. These organisms originate with farm animals themselves and they can cause diarrhea and vomiting if children or staff eat contaminated food. Properly preparing and serving fresh produce, meat, and poultry is essential to prevent food poisoning.<\/li>\n<\/ol>\n<h4>Direct Contact Transmission<\/h4>\n<p>Direct contact with another person&#8217;s skin (or hair) puts infants and children at risk of illnesses such as:<\/p>\n<ul>\n<li>cold sores<\/li>\n<li>conjunctivitis<\/li>\n<li>pink eye<\/li>\n<li>impetigo<\/li>\n<li>lice<\/li>\n<li>scabies<\/li>\n<li>ringworm (a fungus, not a worm).<\/li>\n<\/ul>\n<h4>Bodily Fluid Transmission<\/h4>\n<p>Bodily fluids, including saliva, urine, vomit, and blood, can cause illness, such as:<\/p>\n<ul>\n<li>Dental caries (by saliva)<\/li>\n<li>Cytomegalovirus or CMV (by urine)<\/li>\n<li>Hepatitis B (preventable by vaccine)<\/li>\n<li>Hepatitis C (rare in children)<\/li>\n<li>HIV (no cases of transmission in an early education setting)<\/li>\n<\/ul>\n<h4>Vector-Borne Transmission<\/h4>\n<p>A vector is a living thing that can transmit disease. We know, for example, that ticks can transmit Lyme disease and Rocky Mountain spotted fever. Fleas are known to transmit Bubonic plague and typhus. Mosquitoes can infect people with St. Louis encephalitis (SLE), dengue fever, Zika virus, and West Nile disease. Rats and mice can transmit leptospirosis, trichinosis, hantavirus, and bacterial food poisoning. Raccoons can spread raccoon roundworm.<\/p>\n<figure id=\"attachment_179\" aria-describedby=\"caption-attachment-179\" style=\"width: 300px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-169\" src=\"https:\/\/pressbooks.ccconline.org\/accbertelsen\/wp-content\/uploads\/sites\/160\/2023\/10\/8.5-300x257.jpg\" alt=\"Cases of disease caused by mosquitos, fleas and ticks have tripled between 2004-2016.\" width=\"300\" height=\"257\" srcset=\"https:\/\/pressbooks.ccconline.org\/accece\/wp-content\/uploads\/sites\/160\/2023\/10\/8.5-300x257.jpg 300w, https:\/\/pressbooks.ccconline.org\/accece\/wp-content\/uploads\/sites\/160\/2023\/10\/8.5-65x56.jpg 65w, https:\/\/pressbooks.ccconline.org\/accece\/wp-content\/uploads\/sites\/160\/2023\/10\/8.5-225x192.jpg 225w, https:\/\/pressbooks.ccconline.org\/accece\/wp-content\/uploads\/sites\/160\/2023\/10\/8.5-350x299.jpg 350w, https:\/\/pressbooks.ccconline.org\/accece\/wp-content\/uploads\/sites\/160\/2023\/10\/8.5.jpg 650w\" sizes=\"auto, (max-width: 300px) 100vw, 300px\" \/><figcaption id=\"caption-attachment-179\" class=\"wp-caption-text\">Figure 8.5 \u2013 Cases of disease caused by mosquitos, fleas and ticks have tripled between 2004-2016. [3]<\/figcaption><\/figure>\n<p>While these illnesses are relatively uncommon, the risk reminds us of the importance of<\/p>\n<ul>\n<li>utilizing integrated pest management techniques to keep insects and rodents out of buildings (covered later in this chapter)<\/li>\n<li>using insect repellant specifically recommended for children during outdoor activities<\/li>\n<li>removing standing water in which mosquitoes can lay their eggs<\/li>\n<li>checking for and removing ticks (addressed in Figure 4.10) in centers when children come back in after playing in or near heavily wooded areas<a href=\"#_ftn4\">[4]<\/a><\/li>\n<\/ul>\n<div class=\"textbox textbox--exercises\">\n<header class=\"textbox__header\">\n<p class=\"textbox__title\">Pause to Reflect<\/p>\n<\/header>\n<div class=\"textbox__content\">\n<table style=\"border-collapse: collapse;width: 100%\">\n<tbody>\n<tr>\n<td style=\"width: 16.2%\"><img loading=\"lazy\" decoding=\"async\" class=\"alignleft wp-image-30\" src=\"https:\/\/pressbooks.ccconline.org\/accbertelsen\/wp-content\/uploads\/sites\/160\/2023\/10\/Pause-to-reflect-icon-230x300.png\" alt=\"Question mark\" width=\"88\" height=\"115\" srcset=\"https:\/\/pressbooks.ccconline.org\/accece\/wp-content\/uploads\/sites\/160\/2023\/10\/Pause-to-reflect-icon-230x300.png 230w, https:\/\/pressbooks.ccconline.org\/accece\/wp-content\/uploads\/sites\/160\/2023\/10\/Pause-to-reflect-icon-65x85.png 65w, https:\/\/pressbooks.ccconline.org\/accece\/wp-content\/uploads\/sites\/160\/2023\/10\/Pause-to-reflect-icon-225x293.png 225w, https:\/\/pressbooks.ccconline.org\/accece\/wp-content\/uploads\/sites\/160\/2023\/10\/Pause-to-reflect-icon.png 240w\" sizes=\"auto, (max-width: 88px) 100vw, 88px\" \/><\/td>\n<td style=\"width: 83.8%\">Why is it important to understand how illnesses and diseases are spread?<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<\/div>\n<\/div>\n<h2>Immunizations<\/h2>\n<p>Prevention of infectious disease starts with immunizations (or vaccines). Immunizations are considered the number one public health intervention of the 20th century and one of the top 10 interventions of the first decade of the 21st century.<a href=\"#_ftn5\">[5]<\/a><\/p>\n<p>On-time vaccination throughout childhood is essential because it helps provide immunity before children are exposed to potentially life-threatening diseases. Vaccines are tested to ensure that they are safe and effective for children to receive at the recommended ages.<a href=\"#_ftn6\">[6]<\/a> See Figure 8.X for the current schedule of immunizations.<\/p>\n<p>Fully vaccinated children in the U.S. are protected against sixteen potentially harmful diseases (see Figure 8.X). Vaccine-preventable diseases can be very serious, may require hospitalization, or even be deadly \u2014 especially in infants and young children.<a href=\"#_ftn7\">[7]<\/a><\/p>\n<p>Here is the schedule from the CDC to ensure a child is fully vaccinated:<\/p>\n<figure id=\"attachment_179\" aria-describedby=\"caption-attachment-179\" style=\"width: 904px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-170\" src=\"https:\/\/pressbooks.ccconline.org\/accbertelsen\/wp-content\/uploads\/sites\/160\/2023\/10\/8.6.png\" alt=\"2019 Recommended Immunizations for Children from Birth Through 6 years old\" width=\"904\" height=\"591\" srcset=\"https:\/\/pressbooks.ccconline.org\/accece\/wp-content\/uploads\/sites\/160\/2023\/10\/8.6.png 904w, https:\/\/pressbooks.ccconline.org\/accece\/wp-content\/uploads\/sites\/160\/2023\/10\/8.6-300x196.png 300w, https:\/\/pressbooks.ccconline.org\/accece\/wp-content\/uploads\/sites\/160\/2023\/10\/8.6-768x502.png 768w, https:\/\/pressbooks.ccconline.org\/accece\/wp-content\/uploads\/sites\/160\/2023\/10\/8.6-65x42.png 65w, https:\/\/pressbooks.ccconline.org\/accece\/wp-content\/uploads\/sites\/160\/2023\/10\/8.6-225x147.png 225w, https:\/\/pressbooks.ccconline.org\/accece\/wp-content\/uploads\/sites\/160\/2023\/10\/8.6-350x229.png 350w\" sizes=\"auto, (max-width: 904px) 100vw, 904px\" \/><figcaption id=\"caption-attachment-179\" class=\"wp-caption-text\">Figure 8.6 \u2013 Immunization schedule. [8]<\/figcaption><\/figure>\n<p>The current schedule of vaccines (see Figure 8.6) protects children from the illnesses listed in Table 8.1)<\/p>\n<div class=\"textbox textbox--examples\">\n<header class=\"textbox__header\">\n<p class=\"textbox__title\"><strong>Table 8.1 \u2013 Vaccine-Preventable Diseases. <\/strong><a href=\"#_ftn9\"><strong>[9]<\/strong><\/a><\/p>\n<\/header>\n<div class=\"textbox__content\">\n<table class=\"grid landscape\">\n<thead>\n<tr>\n<td><strong>Disease<\/strong><\/td>\n<td><strong>Vaccine<\/strong><\/td>\n<td><strong>Disease Spread By<\/strong><\/td>\n<td><strong>Disease Symptoms<\/strong><\/td>\n<td><strong>Disease Complications<\/strong><\/td>\n<\/tr>\n<\/thead>\n<tbody>\n<tr>\n<td>Chick-pox<\/td>\n<td>Varicella vaccine protects against chick pox<\/td>\n<td>Air, direct contact<\/p>\n<p>&nbsp;<\/td>\n<td>Rash, tiredness, headache, fever<\/p>\n<p>&nbsp;<\/td>\n<td>Infected blisters, bleeding disorders, encephalitis (brain<\/p>\n<p>swelling), pneumonia (infection in the lungs)<\/td>\n<\/tr>\n<tr>\n<td>Diphtheria<\/td>\n<td>DtaP* vaccine protects against diphtheria<\/td>\n<td>Air, direct contact<\/p>\n<p>&nbsp;<\/td>\n<td>Sore throat, mild fever, weakness, swollen<\/p>\n<p>glands in neck<\/td>\n<td>Swelling Of the heart muscle, heart failure, coma, Paralysis, death<\/td>\n<\/tr>\n<tr>\n<td>HiB<\/td>\n<td>Hib vaccine protects against Haemophilus<\/p>\n<p>Influenza type b<\/td>\n<td>Air, direct contact<\/p>\n<p>&nbsp;<\/td>\n<td>May be no symptoms unless bacteria<\/p>\n<p>enter the blood<\/p>\n<p>&nbsp;<\/td>\n<td>Meningitis (infection of the covering around the brain<\/p>\n<p>and spinal cord), intellectual disability. epiglottitis<\/p>\n<p>(life-threatening infection that can block the windpipe<\/p>\n<p>And lead to serious breathing problems), pneumonia<\/p>\n<p>(infection in the lungs), death<\/p>\n<p>&nbsp;<\/td>\n<\/tr>\n<tr>\n<td>Hepatitis A<\/td>\n<td>HepA vaccine protects against hepatitis A.<\/td>\n<td>Direct contact, contaminated<\/p>\n<p>food or water<\/p>\n<p>&nbsp;<\/td>\n<td>May be no symptoms &#8211; fever, stomach pain,<\/p>\n<p>loss of appetite. Fatigue, vomiting, jaundice<\/p>\n<p>(yellowing of skin and eyes). dark urine<\/td>\n<td>Liver failure. arthralgia (joint pain), kidney, pancreatic,<\/p>\n<p>and blood disorders<\/p>\n<p>&nbsp;<\/td>\n<\/tr>\n<tr>\n<td>Hepatitis B<\/td>\n<td>HepB vaccine protects against hepatitis B.<\/td>\n<td>Contact With<\/p>\n<p>body fluids<\/p>\n<p>&nbsp;<\/td>\n<td>May be no symptoms fever, headache,<\/p>\n<p>weakness, vomiting, jaundice (yellowing of<\/p>\n<p>skin and eyes), joint pain<\/p>\n<p>&nbsp;<\/td>\n<td>Chronic liver infection, liver failure, liver cancer<\/p>\n<p>&nbsp;<\/td>\n<\/tr>\n<tr>\n<td>Influenza (Flu)<\/td>\n<td>Flu vaccine protects against influenza.<\/p>\n<p>&nbsp;<\/td>\n<td>Air, direct contact<\/p>\n<p>&nbsp;<\/td>\n<td>Fever, muscle pain, sore throat, cough,<\/p>\n<p>extreme fatigue<\/p>\n<p>&nbsp;<\/td>\n<td>Pneumonia (infection in the lungs)<\/p>\n<p>&nbsp;<\/td>\n<\/tr>\n<tr>\n<td>Measles<\/td>\n<td>MMR* vaccine protects against measles.<\/p>\n<p>&nbsp;<\/td>\n<td>Air, direct contact<\/p>\n<p>&nbsp;<\/td>\n<td>Rash, fever, tough, runny nose, pinkeye<\/p>\n<p>&nbsp;<\/td>\n<td>Encephalitis (brain swelling), pneumonia (infection in<\/p>\n<p>the lungs). death<\/p>\n<p>&nbsp;<\/td>\n<\/tr>\n<tr>\n<td>Mumps<\/td>\n<td>MMR* vaccine protects against mumps.<\/p>\n<p>&nbsp;<\/td>\n<td>Air, direct contact<\/p>\n<p>&nbsp;<\/td>\n<td>Swollen salivary glands (under the jaw), fever,<\/p>\n<p>headache, tiredness, muscle pain<\/td>\n<td>Meningitis (infection of the covering around the brain<\/p>\n<p>and spinal cord) , encephalitis (brain swelling), inflammation Of testes or ovaries, deafness<\/p>\n<p>&nbsp;<\/td>\n<\/tr>\n<tr>\n<td>Pertussis<\/p>\n<p>&nbsp;<\/td>\n<td>DTap* vaccine protects against pertussis<\/p>\n<p>(whooping cough).<\/p>\n<p>&nbsp;<\/td>\n<td>Air, direct contact<\/p>\n<p>&nbsp;<\/td>\n<td>Severe cough, runny nose, apnea (a pause in<\/p>\n<p>breathing in infants)<\/td>\n<td>Pneumonia (infection in the lungs), death<\/p>\n<p>&nbsp;<\/td>\n<\/tr>\n<tr>\n<td>Polio<\/td>\n<td>IPV vaccine protects against polio.<\/p>\n<p>&nbsp;<\/td>\n<td>Air. direct contact, through<\/p>\n<p>the mouth<\/p>\n<p>&nbsp;<\/td>\n<td>May be no symptoms, sore throat, fever,<\/p>\n<p>nausea. headache<\/p>\n<p>&nbsp;<\/td>\n<td>Paralysis, death<\/p>\n<p>&nbsp;<\/td>\n<\/tr>\n<tr>\n<td>Pneumococcal<\/p>\n<p>&nbsp;<\/td>\n<td>POII 3 vaccine protects against pneumococcus.<\/td>\n<td>Air, direct contact<\/p>\n<p>&nbsp;<\/td>\n<td>May be no symptoms -. pneumonia (infection<\/p>\n<p>in the lungs)<\/p>\n<p>&nbsp;<\/td>\n<td>Bacteremia (blood infection), meningitis (infection of<\/p>\n<p>the covering around the brain and spinal cord). death<\/p>\n<p>&nbsp;<\/td>\n<\/tr>\n<tr>\n<td>Rotavirus<\/td>\n<td>RV vaccine protects against rotavirus.<\/p>\n<p>&nbsp;<\/td>\n<td>Through the mouth<\/td>\n<td>Diarrhea, fever, vomiting<\/p>\n<p>&nbsp;<\/td>\n<td>Severe diarrhea, dehydration<\/p>\n<p>&nbsp;<\/td>\n<\/tr>\n<tr>\n<td>Rubella<\/td>\n<td>MMR* vaccine protects against rubella.<\/p>\n<p>&nbsp;<\/td>\n<td>Air, direct contact<\/p>\n<p>&nbsp;<\/td>\n<td>Children infected with rubella virus sometimes<\/p>\n<p>have a rash, fever. swollen nodes<\/td>\n<td>Very serious in pregnant women\u2014can lead to miscarriages, stillbirth, premature delivery, birth defects<\/p>\n<p>&nbsp;<\/td>\n<\/tr>\n<tr>\n<td>Tetanus<\/td>\n<td>DTap* vaccine protects against tetanus.<\/p>\n<p>&nbsp;<\/td>\n<td>Exposure through cuts in skin<\/p>\n<p>&nbsp;<\/td>\n<td>Stiffness in neck and muscles,<\/p>\n<p>difficulty swallowing, muscle spasms, fever<\/td>\n<td>Broken bones, breathing difficulty, death<\/p>\n<p>&nbsp;<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<\/div>\n<\/div>\n<h2>How Vaccines Work<\/h2>\n<p>The immune system helps the human body fight germs by producing substances to combat them. Once it does, the immune system \u201cremembers\u201d the germ and can fight it again. Vaccines contain germs that have been killed or weakened. When given to a healthy person, the vaccine triggers the immune system to respond and thus build immunity.<\/p>\n<p>Before vaccines, people became immune only by actually getting a disease and surviving it. Immunizations are an easier and less risky way to become immune.<\/p>\n<p>Vaccines are the best defense we have against serious, preventable, and sometimes deadly contagious diseases. Vaccines are some of the safest medical products available, but like any other medical product, there may be risks. Accurate information about the value of vaccines as well as their possible side effects helps people to make informed decisions about vaccination.<\/p>\n<h4>Potential Side Effects<\/h4>\n<p>Vaccines, like all medical products, may cause side effects in some people. Most of these side effects are minor, such as redness or swelling at the injection site. Read further to learn about possible side effects of vaccines.<\/p>\n<p>Any vaccine can cause side effects. For the most part, these are minor (for example, a sore arm or low-grade fever) and go away within a few days.<a href=\"#_ftn10\">[10]<\/a> Serious side effects after vaccination, such as severe allergic reaction, are very rare.<a href=\"#_ftn11\">[11]<\/a><\/p>\n<p>Remember, vaccines are continually monitored for safety, and like any medication, vaccines can cause side effects. However, a decision not to immunize a child also involves risk and could put the child and others who come into contact with him or her at risk of contracting a potentially deadly disease.<\/p>\n<h4>How Well Do Vaccines Work?<\/h4>\n<p>Vaccines work really well. No medicine is perfect, of course, but most childhood vaccines produce immunity about 90\u2013100% of the time.<\/p>\n<p>What about the argument made by some people that vaccines don\u2019t work that well and that diseases would be going away on their own because of better hygiene or sanitation, even if there were no vaccines?<\/p>\n<p>That simply isn\u2019t true. Certainly better hygiene and sanitation can help prevent the spread of disease, but the germs that cause disease will still be around, and as long as they are they will continue to make people sick.<\/p>\n<p>All vaccines must be licensed (approved) by the Food and Drug Administration (FDA) before being used in the United States, and a vaccine must go through extensive testing to show that it works and that it is safe before the FDA will approve it. Among these tests are clinical trials, which compare groups of people who get a vaccine with groups of people who get a control. A vaccine is approved only if FDA makes the determination that it is safe and effective for its intended use.<\/p>\n<p>If you look at the history of any vaccine-preventable disease, you will virtually always see that the number of cases of disease starts to drop when a vaccine is licensed. Vaccines are the most effective tool we have to prevent infectious diseases.<\/p>\n<h4>Opposition to Vaccines<\/h4>\n<p>In 2010, a pertussis (whooping cough) outbreak in California sickened 9,143 people and resulted in 10 infant deaths: the worst outbreak in 63 years (Centers for Disease Control 2011b). Researchers, suspecting that the primary cause of the outbreak was the waning strength of pertussis vaccines in older children, recommended a booster vaccination for 11\u201312-year-olds and also for pregnant women (Zacharyczuk 2011). Pertussis is most serious for babies; one in five needs to be hospitalized, and since they are too young for the vaccine themselves, it is crucial that people around them be immunized (Centers for Disease Control 2011b). Several states, including California, have been requiring the pertussis booster for older children in recent years with the hope of staving off another outbreak.<\/p>\n<p>But what about people who do not want their children to have this vaccine, or any other? That question is at the heart of a debate that has been simmering for years. Vaccines are biological preparations that improve immunity against a certain disease. Vaccines have contributed to the eradication and weakening of numerous infectious diseases, including smallpox, polio, mumps, chickenpox, and meningitis.<\/p>\n<figure id=\"attachment_179\" aria-describedby=\"caption-attachment-179\" style=\"width: 238px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-171\" src=\"https:\/\/pressbooks.ccconline.org\/accbertelsen\/wp-content\/uploads\/sites\/160\/2023\/10\/8.7-238x300.jpg\" alt=\"Two young children walking with braces while a nurse looks on.\" width=\"238\" height=\"300\" srcset=\"https:\/\/pressbooks.ccconline.org\/accece\/wp-content\/uploads\/sites\/160\/2023\/10\/8.7-238x300.jpg 238w, https:\/\/pressbooks.ccconline.org\/accece\/wp-content\/uploads\/sites\/160\/2023\/10\/8.7-65x82.jpg 65w, https:\/\/pressbooks.ccconline.org\/accece\/wp-content\/uploads\/sites\/160\/2023\/10\/8.7-225x283.jpg 225w, https:\/\/pressbooks.ccconline.org\/accece\/wp-content\/uploads\/sites\/160\/2023\/10\/8.7-350x440.jpg 350w, https:\/\/pressbooks.ccconline.org\/accece\/wp-content\/uploads\/sites\/160\/2023\/10\/8.7.jpg 476w\" sizes=\"auto, (max-width: 238px) 100vw, 238px\" \/><figcaption id=\"caption-attachment-179\" class=\"wp-caption-text\">Figure 8.7 \u2013 These two young children contracted polio. [12]<\/figcaption><\/figure>\n<p>However, many people express concern about the potential negative side effects of vaccines. These concerns range from fears about overloading the child\u2019s immune system to controversial reports about devastating side effects of the vaccines.<a href=\"#_ftn13\">[13]<\/a><\/p>\n<p>Although children continue to get several vaccines up to their second birthday, these vaccines do not overload the immune system. Every day, an infant\u2019s healthy immune system successfully fights off thousands of antigens \u2013 the parts of germs that cause their immune system to respond. Even if your child receives several vaccines in one day, vaccines contain only a tiny amount of antigens compared to the antigens your baby encounters every day.<\/p>\n<p>This is the case even if your child receives combination vaccines. Combination vaccines take two or more vaccines that could be given individually and put them into one shot. Children get the same protection as they do from individual vaccines given separately\u2014but with fewer shots.<a href=\"#_ftn14\">[14]<\/a><\/p>\n<p>One misapprehension is that the vaccine itself might cause the disease it is supposed to be immunizing against.<a href=\"#_ftn15\">[15]<\/a> Vaccines help develop immunity by imitating an infection, but this \u201cimitation\u201d infection does not cause illness. Instead, it causes the immune system to develop the same response as it does to a real infection so the body can recognize and fight the vaccine-preventable disease in the future. Sometimes, after getting a vaccine, the imitation infection can cause minor symptoms, such as fever. Such minor symptoms are normal and should be expected as the body builds immunity.<a href=\"#_ftn16\">[16]<\/a><\/p>\n<p>Another commonly circulated concern is that vaccinations, specifically the MMR vaccine (MMR stands for measles, mumps, and rubella), are linked to autism. The autism connection has been particularly controversial. In 1998, a British physician named Andrew Wakefield published a study in Great Britain\u2019s Lancet magazine that linked the MMR vaccine to autism. The report received a lot of media attention, resulting in British immunization rates decreasing from 91 percent in 1997 to almost 80 percent by 2003, accompanied by a subsequent rise in measles cases (Devlin 2008). A prolonged investigation by the British Medical Journal proved that not only was the link in the study nonexistent, but that Dr. Wakefield had falsified data in order to support his claims (CNN 2011). Dr. Wakefield was discredited and stripped of his license, but the doubt still lingers in many parents\u2019 minds.<\/p>\n<p>In the United States, many parents still believe in the now-discredited MMR-autism link and refuse to vaccinate their children. Other parents choose not to vaccinate for various reasons like religious or health beliefs. In one instance, a boy whose parents opted not to vaccinate returned home to the U.S. after a trip abroad; no one yet knew he was infected with measles. The boy exposed 839 people to the disease and caused 11 additional cases of measles, all in other unvaccinated children, including one infant who had to be hospitalized.<\/p>\n<figure id=\"attachment_179\" aria-describedby=\"caption-attachment-179\" style=\"width: 300px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-172\" src=\"https:\/\/pressbooks.ccconline.org\/accbertelsen\/wp-content\/uploads\/sites\/160\/2023\/10\/8.8-300x199.jpg\" alt=\"An infant with measles\" width=\"300\" height=\"199\" srcset=\"https:\/\/pressbooks.ccconline.org\/accece\/wp-content\/uploads\/sites\/160\/2023\/10\/8.8-300x199.jpg 300w, https:\/\/pressbooks.ccconline.org\/accece\/wp-content\/uploads\/sites\/160\/2023\/10\/8.8-65x43.jpg 65w, https:\/\/pressbooks.ccconline.org\/accece\/wp-content\/uploads\/sites\/160\/2023\/10\/8.8-225x149.jpg 225w, https:\/\/pressbooks.ccconline.org\/accece\/wp-content\/uploads\/sites\/160\/2023\/10\/8.8-350x232.jpg 350w, https:\/\/pressbooks.ccconline.org\/accece\/wp-content\/uploads\/sites\/160\/2023\/10\/8.8.jpg 438w\" sizes=\"auto, (max-width: 300px) 100vw, 300px\" \/><figcaption id=\"caption-attachment-179\" class=\"wp-caption-text\">Figure 8.8 \u2013 An infant with measles [17]<\/figcaption><\/figure>\n<p>According to a study published in Pediatrics (2010), the outbreak cost the public sector $10,376 per diagnosed case. The study further showed that the intentional non-vaccination of those infected occurred in students from private schools, public charter schools, and public schools in upper-socioeconomic areas (Sugerman et al. 2010).<a href=\"#_ftn18\">[18]<\/a><\/p>\n<div class=\"textbox textbox--key-takeaways\">\n<header class=\"textbox__header\">\n<p class=\"textbox__title\"><strong>What about the Flu Vaccine?<\/strong><\/p>\n<\/header>\n<div class=\"textbox__content\">\n<p>There are many reasons to get an influenza (flu) vaccine each year. Below is a summary of the benefits of flu vaccination, and selected scientific studies that support these benefits.<\/p>\n<p>\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Flu vaccination\u00a0can keep you from getting sick with flu.<\/p>\n<p>\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Flu vaccination can reduce the risk of flu-associated hospitalization.<\/p>\n<p>\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Flu vaccination is an important preventive tool for people with chronic health conditions.<\/p>\n<p>\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Flu vaccination helps\u00a0protect women during and after pregnancy and helps protect the baby from flu for several months after birth.<\/p>\n<p>\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Flu vaccination can be life-saving in children.<\/p>\n<p>\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Flu vaccination has been shown in several studies to reduce the severity of illness in people who get vaccinated but still get sick.<\/p>\n<p>\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Getting vaccinated yourself may also protect people around you, including those who are more vulnerable to serious flu illness, like babies and young children, older people, and people with certain chronic health conditions.<a href=\"#_ftn19\">[19]<\/a><\/p>\n<figure id=\"attachment_173\" aria-describedby=\"caption-attachment-173\" style=\"width: 1024px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" class=\"size-large wp-image-173\" src=\"https:\/\/pressbooks.ccconline.org\/accbertelsen\/wp-content\/uploads\/sites\/160\/2023\/10\/8.9-1024x791.png\" alt=\"Manufacturing flu vaccines passes through a rigorous testing process each year.\" width=\"1024\" height=\"791\" srcset=\"https:\/\/pressbooks.ccconline.org\/accece\/wp-content\/uploads\/sites\/160\/2023\/10\/8.9-1024x791.png 1024w, https:\/\/pressbooks.ccconline.org\/accece\/wp-content\/uploads\/sites\/160\/2023\/10\/8.9-300x232.png 300w, https:\/\/pressbooks.ccconline.org\/accece\/wp-content\/uploads\/sites\/160\/2023\/10\/8.9-768x593.png 768w, https:\/\/pressbooks.ccconline.org\/accece\/wp-content\/uploads\/sites\/160\/2023\/10\/8.9-65x50.png 65w, https:\/\/pressbooks.ccconline.org\/accece\/wp-content\/uploads\/sites\/160\/2023\/10\/8.9-225x174.png 225w, https:\/\/pressbooks.ccconline.org\/accece\/wp-content\/uploads\/sites\/160\/2023\/10\/8.9-350x270.png 350w, https:\/\/pressbooks.ccconline.org\/accece\/wp-content\/uploads\/sites\/160\/2023\/10\/8.9.png 1165w\" sizes=\"auto, (max-width: 1024px) 100vw, 1024px\" \/><figcaption id=\"caption-attachment-173\" class=\"wp-caption-text\">Figure 8.9 \u2013 What goes into the flu vaccine each year. [20]<\/figcaption><\/figure>\n<\/div>\n<\/div>\n<div class=\"textbox textbox--exercises\">\n<header class=\"textbox__header\">\n<p class=\"textbox__title\">Pause to Reflect<\/p>\n<\/header>\n<div class=\"textbox__content\">\n<table style=\"border-collapse: collapse;width: 100%\">\n<tbody>\n<tr>\n<td style=\"width: 16.5%\"><img loading=\"lazy\" decoding=\"async\" class=\"alignleft wp-image-30 size-thumbnail\" src=\"https:\/\/pressbooks.ccconline.org\/accbertelsen\/wp-content\/uploads\/sites\/160\/2023\/10\/Pause-to-reflect-icon-150x150.png\" alt=\"Question mark\" width=\"150\" height=\"150\" \/><\/td>\n<td style=\"width: 83.5%\">Using the information that has been provided about immunizations, think of ways you could respond to the following:<\/p>\n<p style=\"padding-left: 40px\">1.\u00a0\u00a0\u00a0\u00a0\u00a0 \u201cI don\u2019t believe in giving all of the vaccines, like chicken pox. It\u2019s better for children to just get the disease like we all did when we were kids.\u201d<\/p>\n<p style=\"padding-left: 40px\">2.\u00a0\u00a0\u00a0\u00a0\u00a0 \u201cWhy do they have to give vaccines so early? It seems like it\u2019s too much, too quickly.\u201d<\/p>\n<p style=\"padding-left: 40px\">3.\u00a0\u00a0\u00a0\u00a0\u00a0 \u201cI have heard that vaccines give some kids autism. And even if they don\u2019t, the side effects are just too scary.\u201d<\/p>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<\/div>\n<\/div>\n<h2>Universal Precautions to Prevent the Spread of Illness<\/h2>\n<p>There are some standard practices that prevent, or reduce the risk of, the spread of illness in early care and education programs. These are modeled after practices in health care, where everyone is treated as being potentially infected with something that is contagious. Many illnesses are actually contagious before the infected person is symptomatic, so waiting until you see signs of illness is an ineffective way of preventing its spread. Child care providers can practice these four things to help control the spread of illness.<\/p>\n<ol>\n<li>Hand washing<\/li>\n<li>Use of disposable nonporous gloves when working with bodily fluids<\/li>\n<li>Disinfecting potentially contaminated surfaces<\/li>\n<li>Proper disposal of potentially contaminated waste<a href=\"#_ftn21\">[21]<\/a><\/li>\n<\/ol>\n<h4>Handwashing<\/h4>\n<p>Regular handwashing is an important step to minimizing the spread of germs. Hands pick up germs from all of the things they touch and then spread them from one place to another. Germs that are on hands can also enter the body when a person eats or when they touch their eyes, nose, mouth, or any area on the body where the skin is broken (because of a cut, rash, etc.).<\/p>\n<p>All that is needed for handwashing is soap and clean, running water. Handwashing with soap and water removes visible dirt and hidden germs. Studies have demonstrated that handwashing reduced the number of diarrheal illnesses by 31 percent and respiratory illnesses by 21 percent.<\/p>\n<p>Hands should be washed:<\/p>\n<ul>\n<li>before eating, feeding, or preparing food. This prevents germs from getting into the mouth from hands. (Hygiene practices related specifically to food safety will be addressed in Chapter 15.)<\/li>\n<li>after touching saliva (after feeding or eating), mucus (wiping a nose, using a tissue), bodily fluids (toileting, diapering), food, or animals<\/li>\n<li>when visibly dirty, after touching garbage, or after cleaning<\/li>\n<\/ul>\n<p>The Center for Disease Control recommends the following handwashing steps:<\/p>\n<ol>\n<li>\u201cWet your hands with clean, running water (warm or cold) and apply soap.\u201d<\/li>\n<li>\u201cRub your hands together to make a lather and scrub your hands well; be sure to scrub the backs of your hands, between your fingers, and under your nails.\u201d<\/li>\n<li>\u201cContinue rubbing your hands for at least 20 seconds. Need a timer? Hum the \u201cHappy Birthday\u201d song from beginning to end twice.\u201d<\/li>\n<li>\u201cRinse your hands well under running water.\u201d<\/li>\n<li>\u201cDry your hands using a clean towel or air dry them.\u201d<\/li>\n<\/ol>\n<figure id=\"attachment_179\" aria-describedby=\"caption-attachment-179\" style=\"width: 741px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-174\" src=\"https:\/\/pressbooks.ccconline.org\/accbertelsen\/wp-content\/uploads\/sites\/160\/2023\/10\/8.10.png\" alt=\"5 Steps: wet hands, add soap, rub vigorously, rinse and dry\" width=\"741\" height=\"117\" srcset=\"https:\/\/pressbooks.ccconline.org\/accece\/wp-content\/uploads\/sites\/160\/2023\/10\/8.10.png 741w, https:\/\/pressbooks.ccconline.org\/accece\/wp-content\/uploads\/sites\/160\/2023\/10\/8.10-300x47.png 300w, https:\/\/pressbooks.ccconline.org\/accece\/wp-content\/uploads\/sites\/160\/2023\/10\/8.10-65x10.png 65w, https:\/\/pressbooks.ccconline.org\/accece\/wp-content\/uploads\/sites\/160\/2023\/10\/8.10-225x36.png 225w, https:\/\/pressbooks.ccconline.org\/accece\/wp-content\/uploads\/sites\/160\/2023\/10\/8.10-350x55.png 350w\" sizes=\"auto, (max-width: 741px) 100vw, 741px\" \/><figcaption id=\"caption-attachment-179\" class=\"wp-caption-text\">Figure 8.10 \u2013 Illustrations of the 5 steps of handwashing. \u00a0[22]<\/figcaption><\/figure>\n<p>Infants and young children will need help with handwashing. <em>Caring for Our Children<\/em> recommends that caregivers:<\/p>\n<ul>\n<li>Safely cradle an infant in one arm to wash their hands at a sink.<\/li>\n<li>Provide assistance with handwashing for young children that cannot yet wash their hands independently.<\/li>\n<li>Offer a stepping stool to young children so they may safely reach the sink.<a href=\"#_ftn23\">[23]<\/a><\/li>\n<\/ul>\n<h4>Wearing Disposable Gloves<\/h4>\n<p>Teachers and caregivers should wear gloves when they anticipate coming into contact with any of the following (on a child\u2019s body or a contaminated surface)<\/p>\n<ul>\n<li>Blood or bodily substances (i.e., fluids or solids)<\/li>\n<li>Mucous membranes (e.g., nasal, oral, genital area)<\/li>\n<li>Non-intact skin (e.g., rashes or cuts and scrapes)<a href=\"#_ftn24\">[24]<\/a><\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p>Once the gloves are soiled, it\u2019s important to remove them carefully.<\/p>\n<ol>\n<li>Using a gloved hand, grasp the palm area of the other gloved hand and peel off the first glove.<\/li>\n<li>Hold the removed glove in the gloved hand.<\/li>\n<li>Slide fingers of the ungloved hand under the remaining glove at the wrist and peel off the second glove over the first glove.<\/li>\n<li>Discard the gloves in a waste container.<a href=\"#_ftn25\">[25]<\/a><\/li>\n<\/ol>\n<figure id=\"attachment_179\" aria-describedby=\"caption-attachment-179\" style=\"width: 300px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-175\" src=\"https:\/\/pressbooks.ccconline.org\/accbertelsen\/wp-content\/uploads\/sites\/160\/2023\/10\/8.11-300x155.png\" alt=\"Remove gloves without touching the outside, leave inside out and dispose in proper container\" width=\"300\" height=\"155\" srcset=\"https:\/\/pressbooks.ccconline.org\/accece\/wp-content\/uploads\/sites\/160\/2023\/10\/8.11-300x155.png 300w, https:\/\/pressbooks.ccconline.org\/accece\/wp-content\/uploads\/sites\/160\/2023\/10\/8.11-65x34.png 65w, https:\/\/pressbooks.ccconline.org\/accece\/wp-content\/uploads\/sites\/160\/2023\/10\/8.11-225x116.png 225w, https:\/\/pressbooks.ccconline.org\/accece\/wp-content\/uploads\/sites\/160\/2023\/10\/8.11-350x181.png 350w, https:\/\/pressbooks.ccconline.org\/accece\/wp-content\/uploads\/sites\/160\/2023\/10\/8.11.png 570w\" sizes=\"auto, (max-width: 300px) 100vw, 300px\" \/><figcaption id=\"caption-attachment-179\" class=\"wp-caption-text\">Figure 8.11 \u2013 Safe glove removal. [26]<\/figcaption><\/figure>\n<p>&nbsp;<\/p>\n<p>After you remove your gloves you should wash your hands. \u201cDo not reuse the gloves: this can spread germs from one child to another\u2026Gloves provide added protection from communicable disease only if used correctly. If you use gloves incorrectly, you actually risk spreading more germs than if you don\u2019t use gloves at all. Pay attention to your gloving technique so that you do not develop a false sense of security (and carelessness) when wearing gloves.\u201d<a href=\"#_ftn27\">[27]<\/a><\/p>\n<h4>Cleaning and Disinfecting<\/h4>\n<p>Washing Surfaces Germs spread onto surfaces from hands and objects (tissues or mouthed toys) or from a sneeze or cough. It is important to clean all surfaces well, including toys and any surface that a young child puts in his mouth, because germs cannot be seen and it is easy to overlook surfaces that do not look soiled or dirty.<\/p>\n<p>Toileting and diapering involve germs from bodily fluids and fecal material. These germs spread easily in a bathroom onto hands, flushers, and faucets. Routinely washing bathroom surfaces removes most germs and prevents them from spreading. The kitchen is another area of the home where it is important to clean surfaces well.<\/p>\n<p>The terms \u201ccleaning,\u201d \u201csanitizing,\u201d and \u201cdisinfecting\u201d deserve close attention.<\/p>\n<p><strong>Cleaning<\/strong> removes visible soil, dirt, and germs. Soap and water will clean most surfaces.<\/p>\n<p><strong>Sanitizing<\/strong> reduces, but does not totally get rid of, germs to a level that is unlikely to cause disease. Sanitizers may be appropriate to use on surfaces where you eat (such as a table or high chair tray) and with toys that children place in their mouths. It is important to follow the instructions on the label, which may also include rinsing surfaces after using the sanitizing product.<\/p>\n<p><strong>Disinfecting<\/strong> destroys or inactivates infectious germs on surfaces. Disinfectants may be used on diaper-changing tables, toilets, and counter tops.<a href=\"#_ftn28\">[28]<\/a><\/p>\n<p>Early care and education programs can create a bleach and water solution of one tablespoon household bleach to one quart water for surfaces that need to be sanitized or disinfected. To use effectively, the surface must be wetted with the solution and allowed to air dry. A fresh bleach solution should be made each day to maintain effectiveness, and stored in a clearly labeled spray bottle out of children\u2019s reach. Research shows that other chemicals (e.g., ammonia, vinegar, baking soda, Borax) are not effective against some bacteria.<a href=\"#_ftn29\">[29]<\/a> \u201cItems that can be washed in a dishwasher or hot cycle of a washing machine do not have to be disinfected because these machines use water that is hot enough for a long enough period of time to kill most germs.\u201d<a href=\"#_ftn30\">[30]<\/a><\/p>\n<p>Cleaning and disinfecting are essential. Studies have shown that some germs, including influenza virus, can survive on surfaces for two to eight hours; rotavirus can survive up to 10 days.<a href=\"#_ftn31\">[31]<\/a><\/p>\n<div class=\"textbox textbox--examples\">\n<header class=\"textbox__header\">\n<p class=\"textbox__title\"><strong>Table 8.2 \u2013 Schedule for Cleaning and Disinfecting <\/strong><a href=\"#_ftn32\">[32]<\/a><\/p>\n<\/header>\n<div class=\"textbox__content\">\n<table class=\"grid landscape\">\n<thead>\n<tr>\n<td><strong>Surface\/Item<\/strong><\/td>\n<td><strong>Clean<\/strong><\/td>\n<td><strong>Disinfect<\/strong><\/td>\n<td><strong>Frequency<\/strong><\/td>\n<\/tr>\n<\/thead>\n<tbody>\n<tr>\n<td>Countertops and Tabletops<\/td>\n<td style=\"text-align: center\">X<\/td>\n<td style=\"text-align: center\">X<\/td>\n<td>Daily and when soiled<\/td>\n<\/tr>\n<tr>\n<td>Food prep and service areas<\/td>\n<td style=\"text-align: center\">X<\/td>\n<td style=\"text-align: center\">X<\/td>\n<td>Before and after use; between prep of raw and cooked food<\/td>\n<\/tr>\n<tr>\n<td>Floors<\/td>\n<td style=\"text-align: center\">X<\/td>\n<td style=\"text-align: center\">X<\/td>\n<td>Daily and when soiled<\/td>\n<\/tr>\n<tr>\n<td>Door and cabinet handles<\/td>\n<td style=\"text-align: center\">X<\/td>\n<td style=\"text-align: center\">X<\/td>\n<td>Daily and when soiled<\/td>\n<\/tr>\n<tr>\n<td>Carpets and large rugs<\/td>\n<td style=\"text-align: center\">X<\/td>\n<td style=\"text-align: center\"><\/td>\n<td>Vacuum daily; clean monthly for infants, every 3 months for other ages and when soiled<\/td>\n<\/tr>\n<tr>\n<td>Small rugs<\/td>\n<td style=\"text-align: center\">X<\/td>\n<td style=\"text-align: center\"><\/td>\n<td>Shake or vacuum daily; launder weekly<\/td>\n<\/tr>\n<tr>\n<td>Utensils, surfaces, and toys that go in the mouth or have been in contact with bodily fluids<\/td>\n<td style=\"text-align: center\">X<\/td>\n<td style=\"text-align: center\">X<\/td>\n<td>After each child\u2019s use<\/td>\n<\/tr>\n<tr>\n<td>Toys not contaminated with bodily fluids<\/td>\n<td style=\"text-align: center\">X<\/td>\n<td style=\"text-align: center\"><\/td>\n<td>Weekly<\/td>\n<\/tr>\n<tr>\n<td>Dress up clothes not worn on the head<\/td>\n<td style=\"text-align: center\">X<\/td>\n<td style=\"text-align: center\"><\/td>\n<td>Weekly<\/td>\n<\/tr>\n<tr>\n<td>Hats<\/td>\n<td style=\"text-align: center\">X<\/td>\n<td style=\"text-align: center\"><\/td>\n<td>After each child\u2019s use<\/td>\n<\/tr>\n<tr>\n<td>Sheets and pillowcases<\/td>\n<td style=\"text-align: center\">X<\/td>\n<td style=\"text-align: center\"><\/td>\n<td>Weekly and when visibly soiled<\/td>\n<\/tr>\n<tr>\n<td>Blankets and sleeping bags<\/td>\n<td style=\"text-align: center\">X<\/td>\n<td style=\"text-align: center\"><\/td>\n<td>Monthly and when visibly soiled<\/td>\n<\/tr>\n<tr>\n<td>Cubbies<\/td>\n<td style=\"text-align: center\">X<\/td>\n<td style=\"text-align: center\"><\/td>\n<td>Weekly<\/td>\n<\/tr>\n<tr>\n<td>Cribs<\/td>\n<td style=\"text-align: center\">X<\/td>\n<td style=\"text-align: center\"><\/td>\n<td>Weekly<\/td>\n<\/tr>\n<tr>\n<td>Handwashing sinks including faucet, soap dispenser, and surrounding area<\/td>\n<td style=\"text-align: center\">X<\/td>\n<td style=\"text-align: center\">X<\/td>\n<td>Daily or when soiled<\/td>\n<\/tr>\n<tr>\n<td>Toilet seats, handles, door knobs or handles in toileting area, floors<\/td>\n<td style=\"text-align: center\">X<\/td>\n<td style=\"text-align: center\">X<\/td>\n<td>Daily and immediately is soiled<\/td>\n<\/tr>\n<tr>\n<td>Toilet bowls<\/td>\n<td style=\"text-align: center\">X<\/td>\n<td style=\"text-align: center\">X<\/td>\n<td>Daily<\/td>\n<\/tr>\n<tr>\n<td>Changing tables<\/td>\n<td style=\"text-align: center\">X<\/td>\n<td style=\"text-align: center\">X<\/td>\n<td>After each child\u2019s use<\/td>\n<\/tr>\n<tr>\n<td>Potty chairs (discouraged in child care because of contamination risks)<\/td>\n<td style=\"text-align: center\">X<\/td>\n<td style=\"text-align: center\">X<\/td>\n<td>After each child\u2019s use<\/td>\n<\/tr>\n<tr>\n<td>Any surface contaminated with bodily fluids (saliva, mucus, vomit, urine, stool, or blood)<\/td>\n<td style=\"text-align: center\">X<\/td>\n<td style=\"text-align: center\">X<\/td>\n<td>Immediately<\/td>\n<\/tr>\n<tr>\n<td>Water containers<\/td>\n<td style=\"text-align: center\">X<\/td>\n<td style=\"text-align: center\">X<\/td>\n<td>Daily<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<\/div>\n<\/div>\n<h4>Disposal of Waste<\/h4>\n<p>Proper disposal and storage of garbage waste prevent the spread of disease, odors, and problems with pests. Disposable items (diapers, gloves, paper towels, and facial tissues) should be thrown away immediately in an appropriate container. Make sure the container is water and rodent-proof, operated with a foot pedal, is lined with a plastic bag, within reach of diaper changing area, handwashing sink, and food preparation areas, out-of-reach of and unable to be knocked over by infants and toddlers. The containers should be emptied, cleaned, and sanitized daily. <a href=\"#_ftn33\">[33]<\/a><\/p>\n<h4>Diaper Changing<\/h4>\n<p>Diaper changing areas should be smooth and nonporous (such as a plastic-covered pad), have a raised edge to prevent children from falling, be near a sink, be out of reach from children, and away from food preparation areas.<a href=\"#_ftn34\">[34]<\/a><\/p>\n<p>The following diaper changing procedure should be posted in the changing area and followed to protect the health and safety of children and staff:<\/p>\n<p style=\"padding-left: 40px\"><strong>Step 1<\/strong>: Before bringing the child to the diaper changing area, perform hand hygiene (including putting on gloves, if using) and bring supplies to the diaper changing area, and place a disposable liner on the changing area.<\/p>\n<p style=\"padding-left: 40px\"><strong>Step 2<\/strong>: Carry\/bring the child to the changing table\/surface, keeping soiled clothing away from you and any surfaces you cannot easily clean and sanitize after the change. Always keep a hand on the child.<\/p>\n<p style=\"padding-left: 40px\"><strong>Step 3: <\/strong>Remove the soiled diaper and clothing without contaminating any surface not already in contact with stool or urine. Put soiled diaper in covered waste container. Put any soiled clothing in a plastic bag that is securely closed to give to family.<\/p>\n<p style=\"padding-left: 40px\"><strong>Step 4<\/strong>: Clean the child&#8217;s diaper area with disposable wipes and place soiled wipes into a covered waste container.<\/p>\n<p style=\"padding-left: 40px\"><strong>Step 5: <\/strong>Removed the disposable liner and gloves and place in waste container<\/p>\n<p style=\"padding-left: 40px\"><strong>Step 6<\/strong>: Use facial tissue to apply any creams or ointments. Slide clean diaper under the child and fasten it and dress the child.<\/p>\n<p style=\"padding-left: 40px\"><strong>Step 6<\/strong>: Wash the child&#8217;s hands and return the child to a supervised area.<\/p>\n<p style=\"padding-left: 40px\"><strong>Step 7<\/strong>: Clean and disinfect the diaper-changing surface and any equipment or supplies that were touched (and any other area child soiled before changed).<\/p>\n<p style=\"padding-left: 40px\"><strong>Step 8<\/strong>: Perform hand hygiene and record the diaper change, diaper contents, and\/or any problems.<\/p>\n<p>Caregivers\/teachers should never leave a child unattended on a table or countertop. A safety strap or harness should not be used on the diaper changing table\/surface.<a href=\"#_ftn35\">[35]<\/a><\/p>\n<div class=\"textbox textbox--examples\">\n<header class=\"textbox__header\">\n<p class=\"textbox__title\"><strong>If Using Potty Chairs<\/strong><\/p>\n<\/header>\n<div class=\"textbox__content\">\n<p>Due to being hard to clean and disinfect, potty chairs are not ideal in a child care environment. If they are used, they should be used in the bathroom only. After each use:<\/p>\n<p>\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Empty contents immediately into the toilet<\/p>\n<p>\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Rinse with water and dump water into the toilet<\/p>\n<p>\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Wash with soap and water (with a paper towel) and empty soapy water into the toilet<\/p>\n<p>\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Rinse again and empty into the toilet<\/p>\n<p>\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Spray with bleach solution<\/p>\n<p>\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Air dry<\/p>\n<p>\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Wash and disinfect sink<\/p>\n<p>\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Wash hands (child and adult)<a href=\"#_ftn36\">[36]<\/a><\/p>\n<\/div>\n<\/div>\n<div class=\"textbox textbox--exercises\">\n<header class=\"textbox__header\">\n<p class=\"textbox__title\">Pause to Reflect<\/p>\n<\/header>\n<div class=\"textbox__content\">\n<table style=\"border-collapse: collapse;width: 100%\">\n<tbody>\n<tr>\n<td style=\"width: 17.1%\"><img loading=\"lazy\" decoding=\"async\" class=\"alignleft wp-image-30\" src=\"https:\/\/pressbooks.ccconline.org\/accbertelsen\/wp-content\/uploads\/sites\/160\/2023\/10\/Pause-to-reflect-icon-230x300.png\" alt=\"Question mark\" width=\"93\" height=\"121\" srcset=\"https:\/\/pressbooks.ccconline.org\/accece\/wp-content\/uploads\/sites\/160\/2023\/10\/Pause-to-reflect-icon-230x300.png 230w, https:\/\/pressbooks.ccconline.org\/accece\/wp-content\/uploads\/sites\/160\/2023\/10\/Pause-to-reflect-icon-65x85.png 65w, https:\/\/pressbooks.ccconline.org\/accece\/wp-content\/uploads\/sites\/160\/2023\/10\/Pause-to-reflect-icon-225x293.png 225w, https:\/\/pressbooks.ccconline.org\/accece\/wp-content\/uploads\/sites\/160\/2023\/10\/Pause-to-reflect-icon.png 240w\" sizes=\"auto, (max-width: 93px) 100vw, 93px\" \/><\/td>\n<td style=\"width: 82.9%\">You are at a job interview to become a teacher in an infant room and the director asks you what you would do to prevent the spread of illness in your classroom. What might you want to mention?<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<\/div>\n<\/div>\n<h2>Environmental Health<\/h2>\n<p>Sometimes the threat to health comes from the environment itself. Air quality, chemical hazards, drinking water, mold, and pest management are all topics early care and education providers should be aware of.<\/p>\n<h4>Outdoor Air Quality<\/h4>\n<p>Children are more susceptible to the effects of contaminated air because they breathe in more oxygen relative to their body weight than adults.<a href=\"#_ftn37\">[37]<\/a> Therefore, they \u201ccan be exposed to a lot of pollution. Children should be kept inside when air quality is poor, or should at least be discouraged from intense outdoor activity. Educators and parents should be aware that nearby construction and traffic can increase pollution. Mowing school lawns should never occur during school hours since this can cause an allergy or asthma attack. Insecticides should never be sprayed while children are in care. Outdoor air can include odors, pollutants from vehicles, and fumes from stored trash, chemicals, and plumbing vents.\u201d<a href=\"#_ftn38\">[38]<\/a><\/p>\n<h4>Indoor Air Quality<\/h4>\n<p>There are so many sources of indoor air pollution in childcare facilities that the air is considered to be two to five times more polluted than outdoor air. Common sources of indoor air pollution include combustion sources such as oil, gas, kerosene, coal, wood, and tobacco products; building materials and furnishings as diverse as deteriorated, asbestos-containing insulation, wet or damp carpet, and cabinetry or furniture made of certain pressed wood products; products for household cleaning and maintenance, personal care, or hobbies; central heating and cooling systems and humidification devices; and outdoor sources such as radon, pesticides, and outdoor air pollution.<a href=\"#_ftn39\">[39]<\/a><\/p>\n<div class=\"textbox textbox--key-takeaways\">\n<header class=\"textbox__header\">\n<p class=\"textbox__title\">Key Takeaways<\/p>\n<\/header>\n<div class=\"textbox__content\">\n<p><strong>Environmental Tobacco Smoke &amp; Dangers of E-Cigarettes<\/strong><\/p>\n<figure id=\"attachment_177\" aria-describedby=\"caption-attachment-177\" style=\"width: 160px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-176\" src=\"https:\/\/pressbooks.ccconline.org\/accbertelsen\/wp-content\/uploads\/sites\/160\/2023\/10\/8.12.jpg\" alt=\"Adult smoking while toddler looks on.\" width=\"160\" height=\"121\" srcset=\"https:\/\/pressbooks.ccconline.org\/accece\/wp-content\/uploads\/sites\/160\/2023\/10\/8.12.jpg 160w, https:\/\/pressbooks.ccconline.org\/accece\/wp-content\/uploads\/sites\/160\/2023\/10\/8.12-65x49.jpg 65w\" sizes=\"auto, (max-width: 160px) 100vw, 160px\" \/><figcaption id=\"caption-attachment-177\" class=\"wp-caption-text\">Figure 8.12 \u2013 Secondhand smoke is dangerous to young children. \u00a0[40]<\/figcaption><\/figure>\n<p>Environmental tobacco smoke (ETS), otherwise known as secondhand smoke, is a mixture of the smoke given off by the burning end of a cigarette, or cigar, and the smoke exhaled by smokers. Secondhand smoke contains more than 4,000 substances, several of which are known to cause cancer.Children are particularly vulnerable to the effects of secondhand smoke because they are still developing physically, have higher breathing rates than adults, and have little control over their environment, including where and when the adults in their world choose to smoke. Exposure to secondhand smoke can cause asthma, and places infants and children at increased risk for Sudden Infant Death Syndrome (SIDS), pneumonia, bronchitis, and middle ear infections.<a href=\"#_ftn41\">[41]<\/a><strong>What About E-Cigarettes?<\/strong>The aerosol from e-cigarettes is not harmless. It can contain harmful and potentially harmful chemicals, including nicotine; ultrafine particles that can be inhaled deep into the lungs; flavoring such diacetyl, a chemical linked to a serious lung disease; volatile organic compounds such as benzene, which is found in car exhaust; and heavy metals, such as nickel, tin, and lead.<\/p>\n<figure id=\"attachment_177\" aria-describedby=\"caption-attachment-177\" style=\"width: 275px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-177\" src=\"https:\/\/pressbooks.ccconline.org\/accbertelsen\/wp-content\/uploads\/sites\/160\/2023\/10\/8.13.jpg\" alt=\"e-cigarette\" width=\"275\" height=\"183\" srcset=\"https:\/\/pressbooks.ccconline.org\/accece\/wp-content\/uploads\/sites\/160\/2023\/10\/8.13.jpg 275w, https:\/\/pressbooks.ccconline.org\/accece\/wp-content\/uploads\/sites\/160\/2023\/10\/8.13-65x43.jpg 65w, https:\/\/pressbooks.ccconline.org\/accece\/wp-content\/uploads\/sites\/160\/2023\/10\/8.13-225x150.jpg 225w\" sizes=\"auto, (max-width: 275px) 100vw, 275px\" \/><figcaption id=\"caption-attachment-177\" class=\"wp-caption-text\">Figure 8.13 \u2013 Secondhand smoke from e-cigarettes isn\u2019t safe either. [42]<\/figcaption><\/figure>\n<p>Scientists are still working to understand more fully the health effects and harmful doses of e-cigarette contents when they are heated and turned into an aerosol, both for active users who inhale from a device and for those who are exposed to the aerosol secondhand. Another risk to consider involves defective e-cigarette batteries that have been known to cause fires and explosions, some of which have resulted in serious injuries. Most of the explosions happened when the e-cigarette batteries were being charged.<a href=\"#_ftn43\">[43]<\/a><\/div>\n<\/div>\n<h4>Mold<\/h4>\n<p>Mold is a fungus that thrives indoors when excessive moisture or water accumulates indoors or when moisture problems remain undiscovered or un-addressed. There are molds that can grow on wood, paper, carpet, and foods. There is no practical way to eliminate all mold and mold spores in the indoor environment. \u00a0The way to control indoor mold growth is to control moisture.<\/p>\n<p>&nbsp;<\/p>\n<p>Mold needs to be controlled in childcare settings to avoid possible health impacts for infants and children, including allergic reactions, asthma, and other respiratory issues.<a href=\"#_ftn44\">[44]<\/a><\/p>\n<h4>Integrated Pest Management<\/h4>\n<p>Exposure to pests such as cockroaches, rodents, ants, and stinging insects in childcare centers may place children at risk for disease, asthma attacks, bites, and stings. Improper use of pesticides can also place children at risk. A recent study of pesticide use in child care centers revealed that 75% of centers reported at least one pesticide application in the last year. Several factors increase both children&#8217;s exposures and their vulnerability to these exposures compared to adults. Children spend more time on the floor, where residues can transfer to skin and be absorbed.<\/p>\n<p>Young children also frequently place their hands and objects in their mouths, resulting in the non-dietary ingestion of pesticides. Children are less developed immunologically, physiologically, and neurologically, and therefore may be more susceptible to the adverse effects of chemicals and toxins. There is increasing evidence of adverse effects of pesticides on young children, particularly on neurodevelopment.<a href=\"#_ftn45\">[45]<\/a><\/p>\n<p>Integrated Pest Management (IPM) is an effective and environmentally sensitive approach to pest management that relies on a combination of common-sense practices. IPM programs use current, comprehensive information on the life cycles of pests and their interaction with the environment.<\/p>\n<p>Integrated Pest Management \u201c(IPM) is a safer, more effective, longer-lasting method of pest control that emphasizes pest prevention by eliminating pests&#8217; access to food, water, and shelter. When using IPM, properly identify the pest and know why it&#8217;s there so an appropriate combination of different pest control methods can be used for better effectiveness in controlling the pest.\u201d<a href=\"#_ftn46\">[46]<\/a> This information, in combination with the last toxic available pest control methods, is used to manage pest damage by the most economical means, and with the least possible hazard to people, property, and the environment.<a href=\"#_ftn47\">[47]<\/a><\/p>\n<figure id=\"attachment_179\" aria-describedby=\"caption-attachment-179\" style=\"width: 300px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-178\" src=\"https:\/\/pressbooks.ccconline.org\/accbertelsen\/wp-content\/uploads\/sites\/160\/2023\/10\/8.14-300x221.png\" alt=\"Trapped insects\" width=\"300\" height=\"221\" srcset=\"https:\/\/pressbooks.ccconline.org\/accece\/wp-content\/uploads\/sites\/160\/2023\/10\/8.14-300x221.png 300w, https:\/\/pressbooks.ccconline.org\/accece\/wp-content\/uploads\/sites\/160\/2023\/10\/8.14-65x48.png 65w, https:\/\/pressbooks.ccconline.org\/accece\/wp-content\/uploads\/sites\/160\/2023\/10\/8.14-225x166.png 225w, https:\/\/pressbooks.ccconline.org\/accece\/wp-content\/uploads\/sites\/160\/2023\/10\/8.14-350x258.png 350w, https:\/\/pressbooks.ccconline.org\/accece\/wp-content\/uploads\/sites\/160\/2023\/10\/8.14.png 468w\" sizes=\"auto, (max-width: 300px) 100vw, 300px\" \/><figcaption id=\"caption-attachment-179\" class=\"wp-caption-text\">Figure 8.14 \u2013 Using traps can help a program determine what insects they are dealing\u00a0with in order to take the most effective and least hazardous steps to get rid of them. [48]<\/figcaption><\/figure>\n<h5>Chemical Hazards<\/h5>\n<p>A child born today will grow up exposed to more chemicals than a child from any other generation in our nation&#8217;s history. \u00a0Of the 85,000 synthetic chemicals in commerce today, only a small fraction has been tested for toxicity on human health.<\/p>\n<p>A 2005 study found 287 different chemicals in cord blood of 10 newborn babies &#8211; chemicals from pesticides, fast food packaging, coals, gasoline emissions, and trash incineration. Children are more vulnerable to toxic chemicals because their bodies are still growing and developing.<a href=\"#_ftn49\">[49]<\/a><\/p>\n<h2>Plastics in Child Care Settings<\/h2>\n<p>Certain types of plastics contain chemicals such as phthalates, bisphenol A (BPA), polyvinyl chloride (PVC), and polystyrene that may be toxic to children. These plastics can be found in baby bottles, sippy cups, teething rings, pacifiers, and toys. When these items are in a child&#8217;s mouth or when they are heated (such as in a microwave), children can be exposed to harmful chemicals that have the potential to mimic or suppress hormones and disrupt normal growth and development.<a href=\"#_ftn50\">[50]<\/a><\/p>\n<h2>Drinking Water<\/h2>\n<p>The United States has one of the safest public drinking water supplies in the world. Over 286 million Americans get their tap water from a community water system. The US Environmental Protection Agency (EPA) regulates drinking water quality in public water systems and sets maximum concentration levels for water chemicals and pollutants.<\/p>\n<p>Sources of drinking water are subject to contamination and require appropriate treatment to remove disease-causing contaminants. Contamination of drinking water supplies can occur in the source water as well as in the distribution system after water treatment has already occurred. There are many sources of water contamination, including naturally occurring chemicals and minerals (for example, arsenic, radon, uranium), local land use practices (fertilizers, pesticides, concentrated feeding operations), manufacturing processes, and sewer overflows or wastewater releases.<\/p>\n<p>&nbsp;<\/p>\n<p>The presence of contaminants in water can lead to adverse health effects, including gastrointestinal illness, reproductive problems, and neurological disorders.<a href=\"#_ftn51\">[51]<\/a> Young children are at particular risk for exposure to contaminants in drinking water because, pound for pound, they drink more water than adults (including water used to prepare formula), and because their immature body systems are less efficient at detoxification. Exposure to lead in drinking water is a serious health concern, especially for young children and infants since elevated lead levels in children may result in delays in physical or mental development, lower IQ, and even brain damage.<a href=\"#_ftn52\">[52]<\/a><\/p>\n<figure id=\"attachment_179\" aria-describedby=\"caption-attachment-179\" style=\"width: 300px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-179\" src=\"https:\/\/pressbooks.ccconline.org\/accbertelsen\/wp-content\/uploads\/sites\/160\/2023\/10\/8.15-300x199.jpg\" alt=\"Boy drinking from a drinking fountain\" width=\"300\" height=\"199\" srcset=\"https:\/\/pressbooks.ccconline.org\/accece\/wp-content\/uploads\/sites\/160\/2023\/10\/8.15-300x199.jpg 300w, https:\/\/pressbooks.ccconline.org\/accece\/wp-content\/uploads\/sites\/160\/2023\/10\/8.15-768x510.jpg 768w, https:\/\/pressbooks.ccconline.org\/accece\/wp-content\/uploads\/sites\/160\/2023\/10\/8.15-65x43.jpg 65w, https:\/\/pressbooks.ccconline.org\/accece\/wp-content\/uploads\/sites\/160\/2023\/10\/8.15-225x149.jpg 225w, https:\/\/pressbooks.ccconline.org\/accece\/wp-content\/uploads\/sites\/160\/2023\/10\/8.15-350x232.jpg 350w, https:\/\/pressbooks.ccconline.org\/accece\/wp-content\/uploads\/sites\/160\/2023\/10\/8.15.jpg 958w\" sizes=\"auto, (max-width: 300px) 100vw, 300px\" \/><figcaption id=\"caption-attachment-179\" class=\"wp-caption-text\">Figure 8.15 \u2013 It\u2019s important for children to have access to safe drinking water. \u00a0[53]<\/figcaption><\/figure>\n<p>Under the federal regulations of the Safe Drinking Water Act, all water suppliers must notify consumers quickly when there is a serious problem with water quality. Water systems serving the same people year-round must provide annual consumer confidence reports on the source and quality of their tap water. National drinking water standards are legally enforceable, which means that both U.S. EPA and states can take enforcement actions against water systems not meeting safety standards. <a href=\"#_ftn54\">[54]<\/a><\/p>\n<div class=\"textbox textbox--exercises\">\n<header class=\"textbox__header\">\n<p class=\"textbox__title\">Pause to Reflect<\/p>\n<\/header>\n<div class=\"textbox__content\">\n<table style=\"border-collapse: collapse;width: 100%\">\n<tbody>\n<tr>\n<td style=\"width: 16.5%\"><img loading=\"lazy\" decoding=\"async\" class=\"alignleft size-thumbnail wp-image-30\" src=\"https:\/\/pressbooks.ccconline.org\/accbertelsen\/wp-content\/uploads\/sites\/160\/2023\/10\/Pause-to-reflect-icon-150x150.png\" alt=\"Question mark\" width=\"150\" height=\"150\" \/><\/td>\n<td style=\"width: 83.5%\">What are five important things that early care and education programs should remember about environmental health to keep children healthy?<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<\/div>\n<\/div>\n<h2>Summary<\/h2>\n<p>Understanding how illness is spread, helps early care and education programs prevent the spread of illness. Immunizations also play an important role in preventing illness. And when program staff use universal precautions, including handwashing, cleaning and disinfecting, and proper disposal of waste, they also prevent the spread of illness.<\/p>\n<p>Programs must also be aware of environmental hazards that present a threat to children\u2019s health. These include both indoor and outdoor air quality, mold, and chemicals. Programs should use integrated pest management and make sure that their drinking water is safe as well.<\/p>\n<div class=\"textbox textbox--examples\">\n<header class=\"textbox__header\">\n<p class=\"textbox__title\">Engaging Families<\/p>\n<\/header>\n<div class=\"textbox__content\">\n<p>Teachers can use the following strategies to help families to develop their children\u2019s health habits:<\/p>\n<p>\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Provide families with concise, accurate information about ways to promote and develop good health habits in children; information should be presented in English and the families\u2019 home languages. Capture their interest by addressing topics related to their children\u2019s age and development, as well as topics related to common health risks for children, such as childhood obesity, asthma, and dental caries. Injury prevention and first-aid topics, such as treating burns, bleeding, and choking, are also relevant. Provide written informational materials that are brief and easy to read.<\/p>\n<p>\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Provide individualized information, as well as general health information, to all families through daily contact, workshops, and parent meetings. All information should be presented in English and in the families\u2019 home languages. Accommodate family schedules by providing workshops and meetings at various times (e.g., morning, afternoon, evening), and arrange for child care during meetings.<\/p>\n<p>\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Show family members what the children are learning by sending home examples of work, encouraging families to visit the preschool and observe children in action, and sharing children\u2019s portfolios during home visits. Reinforce children\u2019s learning about health habits through take-home activities, lending libraries of read-aloud books in the languages of the families in the group, and displays of children\u2019s work.<\/p>\n<p>\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 As you introduce health routines (e.g., handwashing, tooth brushing), invite family members to participate and model. Encourage families to contribute ideas or materials to interest areas that reflect diverse health habits at home.<\/p>\n<p>\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Identify community resources related to health habits (e.g., handwashing, tooth brushing) and invite community personnel to participate in and bring resources to family workshops or parent meetings. Emphasize the role of home and family members in helping children to develop health habits, and inform all parents of the availability of free and low-cost community resources.<\/p>\n<p>\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Be sensitive to and respectful of different values or beliefs, as well as varying levels of access to health products and services. Gather information on available and accessible resources in the community, including those for children with special needs, and provide this information to all families, translated into their home languages.<\/p>\n<\/div>\n<\/div>\n<div class=\"textbox textbox--exercises\">\n<header class=\"textbox__header\">\n<p class=\"textbox__title\">Chapter 8 Review<\/p>\n<\/header>\n<div class=\"textbox__content\">\n<div id=\"h5p-14\">\n<div class=\"h5p-iframe-wrapper\"><iframe id=\"h5p-iframe-14\" class=\"h5p-iframe\" data-content-id=\"14\" style=\"height:1px\" src=\"about:blank\" frameBorder=\"0\" scrolling=\"no\" title=\"Chapter 8 Quiz\"><\/iframe><\/div>\n<\/div>\n<\/div>\n<\/div>\n<div class=\"textbox shaded\">\n<p><strong>Resources for Further Exploration<\/strong><\/p>\n<p><a href=\"https:\/\/cchp.ucsf.edu\/sites\/g\/files\/tkssra181\/f\/PHT-Handbook-Student-2018-FINAL.pdf\">Health and Safety in the Child Care Setting: Prevention of Infectious Disease A Curriculum for the Training of Child Care Providers (3rd edition)<\/a>: https:\/\/cchp.ucsf.edu\/sites\/g\/files\/tkssra181\/f\/PHT-Handbook-Student-2018-FINAL.pdf<\/p>\n<p><a href=\"https:\/\/www.epa.gov\/sites\/production\/files\/documents\/SafeHealthy2012_ENGa.pdf\">Safe and Healthy Child Care Centers<\/a>: https:\/\/www.epa.gov\/sites\/production\/files\/documents\/SafeHealthy2012_ENGa.pdf<\/p>\n<p><a href=\"https:\/\/www.cdc.gov\/handwashing\/index.html\">Handwashing<\/a>: https:\/\/www.cdc.gov\/handwashing\/index.html<\/p>\n<p><a href=\"https:\/\/www.cdc.gov\/vaccines\/\">Vaccines<\/a>: https:\/\/www.cdc.gov\/vaccines\/<\/p>\n<p><a href=\"https:\/\/www.epa.gov\/childcare\">Environmental Health in Child Care<\/a>: https:\/\/www.epa.gov\/childcare<\/p>\n<p><a href=\"https:\/\/cchp.ucsf.edu\/content\/resources\">California Childcare Health Program\u2019s Publications and Resources<\/a>: https:\/\/cchp.ucsf.edu\/content\/resources<\/p>\n<p><a href=\"https:\/\/legacy.azdeq.gov\/function\/about\/download\/indoorair.pdf\">Air Quality<\/a>: https:\/\/legacy.azdeq.gov\/function\/about\/download\/indoorair.pdf<\/p>\n<p><a href=\"https:\/\/www.epa.gov\/mold\/mold-remediation-schools-and-commercial-buildings-guide\">Mold Remediation in Schools<\/a>: https:\/\/www.epa.gov\/mold\/mold-remediation-schools-and-commercial-buildings-guide<\/p>\n<p><a href=\"https:\/\/www.epa.gov\/sites\/production\/files\/documents\/IPM_CCC.pdf\">Integrated Pest Management in Child Care Centers<\/a>: https:\/\/www.epa.gov\/sites\/production\/files\/documents\/IPM_CCC.pdf<\/p>\n<p><a href=\"https:\/\/apps.cdpr.ca.gov\/schoolipm\/\">California School &amp; Child Care Integrated Pest Management (IPM)<\/a>: https:\/\/apps.cdpr.ca.gov\/schoolipm\/<\/p>\n<p><a href=\"https:\/\/apps.cdpr.ca.gov\/schoolipm\/school_ipm_law\/hsa_compliance_childcare_packet.pdf\">Healthy Schools Act Compliance Packet for Childcare Centers<\/a>: https:\/\/apps.cdpr.ca.gov\/schoolipm\/school_ipm_law\/hsa_compliance_childcare_packet.pdf<\/p>\n<p><a href=\"https:\/\/www.epa.gov\/ground-water-and-drinking-water\/3ts-reducing-lead-drinking-water-toolkit\">EPA\u2019s 3TsWater Quality Tool Kit<\/a>: <a href=\"https:\/\/www.epa.gov\/ground-water-and-drinking-water\/3ts-reducing-lead-drinking-water-toolkit\">https:\/\/www.epa.gov\/ground-water-and-drinking-water\/3ts-reducing-lead-drinking-water-toolkit<\/a><\/p>\n<\/div>\n<div class=\"textbox textbox--exercises\">\n<header class=\"textbox__header\">\n<p class=\"textbox__title\">Chapter 8 Workbook<\/p>\n<\/header>\n<div class=\"textbox__content\">\n<div id=\"h5p-15\">\n<div class=\"h5p-iframe-wrapper\"><iframe id=\"h5p-iframe-15\" class=\"h5p-iframe\" data-content-id=\"15\" style=\"height:1px\" src=\"about:blank\" frameBorder=\"0\" scrolling=\"no\" title=\"Chapter 8 Workbook\"><\/iframe><\/div>\n<\/div>\n<\/div>\n<\/div>\n<h5>References:<\/h5>\n<div>\n<div>\n<p><a href=\"#_ftnref1\">[1]<\/a> Image by <a href=\"https:\/\/www.canyons.edu\/academics\/onlineeducation\/ztc\/\">College of the Canyons ZTC Team<\/a> is based on image from <a href=\"https:\/\/eclkc.ohs.acf.hhs.gov\/physical-health\/article\/infectious-diseases-prevention-management\">Managing Infectious Disease in Head Start Webinar<\/a> by <a href=\"https:\/\/eclkc.ohs.acf.hhs.gov\/\">Head Start Early Childhood Learning &amp; Knowledge Center<\/a>, which is in the public domain<\/p>\n<\/div>\n<div>\n<p><a href=\"#_ftnref2\">[2]<\/a> Image from <a href=\"https:\/\/eclkc.ohs.acf.hhs.gov\/physical-health\/article\/infectious-diseases-prevention-management\">Managing Infectious Disease in Head Start Webinar<\/a> by <a href=\"https:\/\/eclkc.ohs.acf.hhs.gov\/\">Head Start Early Childhood Learning &amp; Knowledge Center<\/a> is in the public domain<\/p>\n<\/div>\n<div>\n<p><a href=\"#_ftnref3\">[3]<\/a> Image by <a href=\"https:\/\/www.canyons.edu\/academics\/onlineeducation\/ztc\/\">College of the Canyons ZTC Team<\/a> is based on <a href=\"https:\/\/www.cdc.gov\/ncezid\/dvbd\/vital-signs\/california.html\">Image<\/a> by the <a href=\"https:\/\/www.cdc.gov\/ncezid\/dvbd\/\">CDC Division of Vector-Borne Diseases<\/a>, which is in the public domain<\/p>\n<\/div>\n<div>\n<p><a href=\"#_ftnref4\">[4]<\/a> Managing Infectious Disease in Head Start Webinar (Transcript) by <a href=\"https:\/\/eclkc.ohs.acf.hhs.gov\/\">Head Start Early Childhood Learning &amp; Knowledge Center<\/a> is in the public domain<\/p>\n<\/div>\n<div>\n<p><a href=\"#_ftnref5\">[5]<\/a> Managing Infectious Disease in Head Start Webinar (Transcript) by <a href=\"https:\/\/eclkc.ohs.acf.hhs.gov\/\">Head Start Early Childhood Learning &amp; Knowledge Center<\/a> is in the public domain<\/p>\n<\/div>\n<div>\n<p><a href=\"#_ftnref6\">[6]<\/a> <a href=\"https:\/\/www.cdc.gov\/vaccines\/parents\/index.html\">For Parents: Vaccines for Your Children<\/a> by the <a href=\"https:\/\/www.cdc.gov\/\">CDC<\/a> is in the public domain<\/p>\n<\/div>\n<div>\n<p><a href=\"#_ftnref7\">[7]<\/a> <a href=\"https:\/\/www.cdc.gov\/vaccines\/parents\/protecting-children\/index.html\">Vaccines for Your Children: Protect Your Child at Every Age<\/a> by the <a href=\"https:\/\/www.cdc.gov\/\">CDC<\/a> is in the public domain<\/p>\n<\/div>\n<div>\n<p><a href=\"#_ftnref8\">[8]<\/a> <a href=\"https:\/\/www.cdc.gov\/vaccines\/parents\/downloads\/parent-ver-sch-0-6yrs.pdf\">Image<\/a> by the <a href=\"https:\/\/www.cdc.gov\/\">CDC<\/a> is in the public domain<\/p>\n<\/div>\n<div>\n<p><a href=\"#_ftnref9\">[9]<\/a> <a href=\"https:\/\/www.cdc.gov\/vaccines\/parents\/downloads\/parent-ver-sch-0-6yrs.pdf\">Image<\/a> by the <a href=\"https:\/\/www.cdc.gov\/\">CDC<\/a> is in the public domain<\/p>\n<\/div>\n<div>\n<p><a href=\"#_ftnref10\">[10]<\/a> <a href=\"https:\/\/courses.lumenlearning.com\/diseaseprevention\/chapter\/immunity-and-immunizations\/\">Disease Prevention and Healthy Lifestyles<\/a> references <a href=\"http:\/\/hlth21fall2012.wikispaces.com\/\">Contemporary Health Issues<\/a> by Judy Baker, Ph.D., licensed under <a href=\"https:\/\/creativecommons.org\/licenses\/by-sa\/4.0\/\">CC BY-SA 4.0 <\/a><\/p>\n<\/div>\n<div>\n<p><a href=\"#_ftnref11\">[11]<\/a> <a href=\"https:\/\/www.cdc.gov\/vaccines\/parents\/vaccine-decision\/index.html\">Making the Vaccine Decision<\/a> by the <a href=\"https:\/\/www.cdc.gov\/\">CDC<\/a> is in the public domain<\/p>\n<\/div>\n<div>\n<p><a href=\"#_ftnref12\">[12]<\/a> <a href=\"https:\/\/commons.wikimedia.org\/wiki\/File:Polio_physical_therapy.jpg\">Image<\/a> by the <a href=\"https:\/\/www.cdc.gov\/\">CDC<\/a> is in the public domain<\/p>\n<\/div>\n<div>\n<p><a href=\"#_ftnref13\">[13]<\/a> <a href=\"https:\/\/courses.lumenlearning.com\/diseaseprevention\/chapter\/immunity-and-immunizations\/\">Disease Prevention and Healthy Lifestyles<\/a> references <a href=\"http:\/\/hlth21fall2012.wikispaces.com\/\">Contemporary Health Issues<\/a> by Judy Baker, Ph.D., licensed under <a href=\"https:\/\/creativecommons.org\/licenses\/by-sa\/4.0\/\">CC BY-SA 4.0 <\/a><\/p>\n<\/div>\n<div>\n<p><a href=\"#_ftnref14\">[14]<\/a> <a href=\"https:\/\/www.cdc.gov\/vaccines\/parents\/vaccine-decision\/index.html\">Making the Vaccine Decision<\/a> by the <a href=\"https:\/\/www.cdc.gov\/\">CDC<\/a> is in the public domain<\/p>\n<\/div>\n<div>\n<p><a href=\"#_ftnref15\">[15]<\/a> <a href=\"https:\/\/courses.lumenlearning.com\/diseaseprevention\/chapter\/immunity-and-immunizations\/\">Disease Prevention and Healthy Lifestyles<\/a> references <a href=\"http:\/\/hlth21fall2012.wikispaces.com\/\">Contemporary Health Issues<\/a> by Judy Baker, Ph.D., licensed under <a href=\"https:\/\/creativecommons.org\/licenses\/by-sa\/4.0\/\">CC BY-SA 4.0 <\/a><\/p>\n<\/div>\n<div>\n<p><a href=\"#_ftnref16\">[16]<\/a> <a href=\"https:\/\/www.cdc.gov\/vaccines\/parents\/vaccine-decision\/index.html\">Making the Vaccine Decision<\/a> by the <a href=\"https:\/\/www.cdc.gov\/\">CDC<\/a> is in the public domain<\/p>\n<\/div>\n<div>\n<p><a href=\"#_ftnref17\">[17]<\/a> <a href=\"https:\/\/www.flickr.com\/photos\/cdcglobal\/13627881194\">Image<\/a> by <a href=\"https:\/\/www.flickr.com\/photos\/cdcglobal\/\">CDC Global<\/a> is licensed under <a href=\"https:\/\/creativecommons.org\/licenses\/by\/2.0\/\">CC BY 2.0<\/a><\/p>\n<\/div>\n<div>\n<p><a href=\"#_ftnref18\">[18]<\/a> <a href=\"https:\/\/courses.lumenlearning.com\/diseaseprevention\/chapter\/immunity-and-immunizations\/\">Disease Prevention and Healthy Lifestyles<\/a> references <a href=\"http:\/\/hlth21fall2012.wikispaces.com\/\">Contemporary Health Issues<\/a> by Judy Baker, Ph.D., licensed under <a href=\"https:\/\/creativecommons.org\/licenses\/by-sa\/4.0\/\">CC BY-SA 4.0 <\/a><\/p>\n<\/div>\n<div>\n<p><a href=\"#_ftnref19\">[19]<\/a> <a href=\"https:\/\/www.cdc.gov\/flu\/prevent\/vaccine-benefits.htm\">What Are the Benefits of Flu Vaccination?<\/a> by the <a href=\"https:\/\/www.cdc.gov\/\">Centers for Disease Control and Prevention<\/a> is in the public domain<\/p>\n<\/div>\n<div>\n<p><a href=\"#_ftnref20\">[20]<\/a> <a href=\"https:\/\/www.cdc.gov\/flu\/pdf\/freeresources\/graphics\/yearly-lab-work-infographic.pdf\">Image<\/a> by the <a href=\"https:\/\/www.cdc.gov\/\">Centers for Disease Control and Prevention<\/a> is in the public domain<\/p>\n<\/div>\n<div>\n<p><a href=\"#_ftnref21\">[21]<\/a> California Child Care Health Program. (2011). <em>Health and Safety in the Child Care Setting: Prevention of Infectious Disease<\/em>. University of California San Francisco. <a href=\"https:\/\/cchp.ucsf.edu\/sites\/g\/files\/tkssra181\/f\/idc2book.pdf\">https:\/\/cchp.ucsf.edu\/sites\/g\/files\/tkssra181\/f\/idc2book.pdf<\/a><\/p>\n<\/div>\n<div>\n<p><a href=\"#_ftnref22\">[22]<\/a> <a href=\"https:\/\/www.cdc.gov\/handwashing\/pdf\/wash-your-hands-fact-sheet-508.pdf\">Stop Germs! Wash Your Hands<\/a> by the <a href=\"https:\/\/www.cdc.gov\/\">Centers for Disease Control and Prevention<\/a> is in the public domain<\/p>\n<\/div>\n<div>\n<p><a href=\"#_ftnref23\">[23]<\/a> <a href=\"https:\/\/eclkc.ohs.acf.hhs.gov\/sites\/default\/files\/pdf\/health-tips-home-visitors.pdf\">Health Tips for Home Visitors to Prevent the Spread of Illness<\/a> by <a href=\"https:\/\/eclkc.ohs.acf.hhs.gov\/about-us\/article\/national-center-early-childhood-health-wellness-ncechw\">Head Start National Center on Health<\/a> is in the public domain<\/p>\n<\/div>\n<div>\n<p><a href=\"#_ftnref24\">[24]<\/a> <a href=\"https:\/\/www.cdc.gov\/infectioncontrol\/pdf\/strive\/PPE101-508.pdf\">The Basics of Standard Precautions<\/a> by Karen Jones, Linda R. Greene, and Lona Mody is in the public domain<\/p>\n<\/div>\n<div>\n<p><a href=\"#_ftnref25\">[25]<\/a> <a href=\"https:\/\/www.cdc.gov\/hai\/pdfs\/ppe\/ppe-sequence.pdf\">Sequence for Putting On Personal Protective Equipment (PPE)<\/a> by the <a href=\"https:\/\/www.cdc.gov\/\">Centers for Disease Control and Prevention<\/a> is in the public domain<\/p>\n<\/div>\n<div>\n<p><a href=\"#_ftnref26\">[26]<\/a> <a href=\"https:\/\/www.cdc.gov\/hai\/pdfs\/ppe\/ppe-sequence.pdf\">Image<\/a> by the <a href=\"https:\/\/www.cdc.gov\/\">Centers for Disease Control and Prevention<\/a> is in the public domain<\/p>\n<\/div>\n<div>\n<p><a href=\"#_ftnref27\">[27]<\/a> California Child Care Health Program. (2011). <em>Health and Safety in the Child Care Setting: Prevention of Infectious Disease<\/em>. University of California San Francisco. Retrieved from https:\/\/cchp.ucsf.edu\/sites\/g\/files\/tkssra181\/f\/idc2book.pdf<\/p>\n<\/div>\n<div>\n<p><a href=\"#_ftnref28\">[28]<\/a> <a href=\"https:\/\/eclkc.ohs.acf.hhs.gov\/sites\/default\/files\/pdf\/health-tips-home-visitors.pdf\">Health Tips for Home Visitors to Prevent the Spread of Illness<\/a> by <a href=\"https:\/\/eclkc.ohs.acf.hhs.gov\/about-us\/article\/national-center-early-childhood-health-wellness-ncechw\">Head Start National Center on Health<\/a> is in the public domain<\/p>\n<\/div>\n<div>\n<p><a href=\"#_ftnref29\">[29]<\/a> <a href=\"https:\/\/www.cde.ca.gov\/sp\/cd\/re\/documents\/psframeworkvol2.pdf\">California Preschool Curriculum Framework (Volume 2)<\/a> by the <a href=\"https:\/\/www.cde.ca.gov\/\">California Department of Education<\/a> is used with permission<\/p>\n<\/div>\n<div>\n<p><a href=\"#_ftnref30\">[30]<\/a> California Child Care Health Program. (2011). <em>Health and Safety in the Child Care Setting: Prevention of Infectious Disease<\/em>. University of California San Francisco. Retrieved from https:\/\/cchp.ucsf.edu\/sites\/g\/files\/tkssra181\/f\/idc2book.pdf<\/p>\n<\/div>\n<div>\n<p><a href=\"#_ftnref31\">[31]<\/a> <a href=\"https:\/\/www.cde.ca.gov\/sp\/cd\/re\/documents\/psframeworkvol2.pdf\">California Preschool Curriculum Framework (Volume 2)<\/a> by the <a href=\"https:\/\/www.cde.ca.gov\/\">California Department of Education<\/a> is used with permission<\/p>\n<\/div>\n<div>\n<p><a href=\"#_ftnref32\">[32]<\/a> California Child Care Health Program. (2011). <em>Health and Safety in the Child Care Setting: Prevention of Infectious Disease<\/em>. University of California San Francisco. Retrieved from https:\/\/cchp.ucsf.edu\/sites\/g\/files\/tkssra181\/f\/idc2book.pdf<\/p>\n<\/div>\n<div>\n<p><a href=\"#_ftnref33\">[33]<\/a> California Child Care Health Program. (2011). <em>Health and Safety in the Child Care Setting: Prevention of Infectious Disease<\/em>. University of California San Francisco. Retrieved from ps:\/\/cchp.ucsf.edu\/sites\/g\/files\/tkssra181\/f\/idc2book.pdf<\/p>\n<\/div>\n<div>\n<p><a href=\"#_ftnref34\">[34]<\/a> California Child Care Health Program. (2011). <em>Health and Safety in the Child Care Setting: Prevention of Infectious Disease<\/em>. University of California San Francisco. Retrieved from https:\/\/cchp.ucsf.edu\/sites\/g\/files\/tkssra181\/f\/idc2book.pdf<\/p>\n<\/div>\n<div>\n<p><a href=\"#_ftnref35\">[35]<\/a> Diaper Changing Procedure by <a href=\"https:\/\/eclkc.ohs.acf.hhs.gov\/\">Head Start Early Childhood Learning &amp; Knowledge Center<\/a> is in the public domain<\/p>\n<\/div>\n<div>\n<p><a href=\"#_ftnref36\">[36]<\/a> California Child Care Health Program. (2011). <em>Health and Safety in the Child Care Setting: Prevention of Infectious Disease<\/em>. University of California San Francisco. Retrieved from https:\/\/cchp.ucsf.edu\/sites\/g\/files\/tkssra181\/f\/idc2book.pdf<\/p>\n<\/div>\n<div>\n<p><a href=\"#_ftnref37\">[37]<\/a> <a href=\"https:\/\/www.epa.gov\/childcare\/resources-about-indoor-air-quality-child-care-providers\">Resources about Indoor Air Quality for Child Care Providers<\/a> by the <a href=\"https:\/\/www.epa.gov\/\">U.S. Environmental Protection Agency<\/a> is in the public domain<\/p>\n<\/div>\n<div>\n<p><a href=\"#_ftnref38\">[38]<\/a> <a href=\"https:\/\/legacy.azdeq.gov\/function\/about\/download\/indoorair.pdf\">Indoor Air Quality Issues for Child Care Facilities<\/a> by the <a href=\"http:\/\/azdeq.gov\/\">Arizona Department of Environmental Quality<\/a> is in the public domain<\/p>\n<\/div>\n<div>\n<p><a href=\"#_ftnref39\">[39]<\/a> <a href=\"https:\/\/www.epa.gov\/childcare\/resources-about-indoor-air-quality-child-care-providers\">Resources about Indoor Air Quality for Child Care Providers<\/a> by the <a href=\"https:\/\/www.epa.gov\/\">U.S. Environmental Protection Agency<\/a> is in the public domain<\/p>\n<\/div>\n<div>\n<p><a href=\"#_ftnref40\">[40]<\/a> <a href=\"https:\/\/www.epa.gov\/childcare\/resources-about-environmental-tobacco-smoke-child-care-providers\">Image<\/a> by the <a href=\"https:\/\/www.epa.gov\/\">U.S. Environmental Protection Agency<\/a> is in the public domain<\/p>\n<\/div>\n<div>\n<p><a href=\"#_ftnref41\">[41]<\/a> <a href=\"https:\/\/www.epa.gov\/childcare\/resources-about-environmental-tobacco-smoke-child-care-providers\">Resources about Environmental Tobacco Smoke for Child Care Providers<\/a> by the <a href=\"https:\/\/www.epa.gov\/\">U.S. Environmental Protection Agency<\/a> is in the public domain<\/p>\n<\/div>\n<div>\n<p><a href=\"#_ftnref42\">[42]<\/a> <a href=\"https:\/\/pixabay.com\/photos\/e-cigarette-vaping-1301664\/\">Image<\/a> by lindsayfox on <a href=\"https:\/\/pixabay.com\/service\/license\/\">Pixabay<\/a><\/p>\n<\/div>\n<div>\n<p><a href=\"#_ftnref43\">[43]<\/a> <a href=\"https:\/\/e-cigarettes.surgeongeneral.gov\/knowtherisks.html\">Know the Risks: E-Cigarettes and Young People<\/a> by the <a href=\"https:\/\/www.hhs.gov\/\">U.S. Department of Health and Human Services<\/a> is in the public domain<\/p>\n<\/div>\n<div>\n<p><a href=\"#_ftnref44\">[44]<\/a> <a href=\"https:\/\/www.epa.gov\/childcare\/resources-about-mold-child-care-providers\">Resources about Mold for Child Care Providers<\/a> by the <a href=\"https:\/\/www.epa.gov\/\">U.S. Environmental Protection Agency<\/a> is in the public domain<\/p>\n<\/div>\n<div>\n<p><a href=\"#_ftnref45\">[45]<\/a> <a href=\"https:\/\/www.epa.gov\/childcare\/resources-about-pesticides-and-integrated-pest-management-child-care-providers\">Resources about Pesticides and Integrated Pest Management for Child Care Providers<\/a> by the <a href=\"https:\/\/www.epa.gov\/\">U.S. Environmental Protection Agency<\/a> is in the public domain<\/p>\n<\/div>\n<div>\n<p><a href=\"#_ftnref46\">[46]<\/a> PennState Extension. (2011, October 11). <em>IPM for Child Care and Early Learning Environments<\/em>. PennState Extension. Retrieved from https:\/\/extension.psu.edu\/ipm-for-child-care-and-early-learning-environments<\/p>\n<\/div>\n<div>\n<p><a href=\"#_ftnref47\">[47]<\/a> <a href=\"https:\/\/www.epa.gov\/safepestcontrol\/integrated-pest-management-ipm-principles\">Integrated Pest Management (IPM) Principles<\/a> by the <a href=\"https:\/\/www.epa.gov\/\">U.S. Environmental Protection Agency<\/a> is in the public domain<\/p>\n<\/div>\n<div>\n<p><a href=\"#_ftnref48\">[48]<\/a> <a href=\"https:\/\/www.epa.gov\/sites\/production\/files\/documents\/IPM_CCC.pdf\">Image<\/a> by the <a href=\"https:\/\/www.epa.gov\/\">U.S. Environmental Protection Agency<\/a> is in the public domain<\/p>\n<\/div>\n<div>\n<p><a href=\"#_ftnref49\">[49]<\/a> <a href=\"https:\/\/www.epa.gov\/childcare\/resources-about-chemical-hazards-child-care-providers\">Resources about Chemical Hazards for Child Care Providers<\/a> by the <a href=\"https:\/\/www.epa.gov\/\">U.S. Environmental Protection Agency<\/a> is in the public domain<\/p>\n<\/div>\n<div>\n<p><a href=\"#_ftnref50\">[50]<\/a> <a href=\"https:\/\/www.epa.gov\/childcare\/resources-about-plastics-child-care-settings-parents-and-providers\">Resources about Plastics in Child Care Settings for Parents and Providers<\/a> by the <a href=\"https:\/\/www.epa.gov\/\">U.S. Environmental Protection Agency<\/a> is in the public domain<\/p>\n<\/div>\n<div>\n<p><a href=\"#_ftnref51\">[51]<\/a> <a href=\"https:\/\/www.cdc.gov\/healthywater\/drinking\/public\/water_diseases.html\">Water-related Diseases and Contaminants in Public Water Systems<\/a> by the <a href=\"https:\/\/www.cdc.gov\/\">Centers for Disease Control and Prevention<\/a> is in the public domain<\/p>\n<\/div>\n<div>\n<p><a href=\"#_ftnref52\">[52]<\/a> <a href=\"https:\/\/www.epa.gov\/childcare\/resources-about-drinking-water-child-care-providers\">Resources about Drinking Water for Child Care Providers<\/a> by the <a href=\"https:\/\/www.epa.gov\/\">U.S. Environmental Protection Agency<\/a> is in the public domain<\/p>\n<\/div>\n<div>\n<p><a href=\"#_ftnref53\">[53]<\/a> <a href=\"http:\/\/www.publicdomainfiles.com\/show_file.php?id=13393456893547\">Image<\/a> by Amanda Mills is in the public domain.<\/p>\n<\/div>\n<div>\n<p><a href=\"#_ftnref54\">[54]<\/a> <a href=\"https:\/\/www.epa.gov\/sites\/production\/files\/2015-04\/documents\/epa816f04030.pdf\">Understanding the Safe Drinking Water Act<\/a> by the <a href=\"https:\/\/www.epa.gov\/\">U.S. Environmental Protection Agency<\/a> is in the public domain<\/p>\n<\/div>\n<\/div>\n","protected":false},"author":32,"menu_order":2,"template":"","meta":{"pb_show_title":"on","pb_short_title":"","pb_subtitle":"","pb_authors":[],"pb_section_license":""},"chapter-type":[47],"contributor":[],"license":[],"class_list":["post-180","chapter","type-chapter","status-publish","hentry","chapter-type-standard"],"part":149,"_links":{"self":[{"href":"https:\/\/pressbooks.ccconline.org\/accece\/wp-json\/pressbooks\/v2\/chapters\/180","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/pressbooks.ccconline.org\/accece\/wp-json\/pressbooks\/v2\/chapters"}],"about":[{"href":"https:\/\/pressbooks.ccconline.org\/accece\/wp-json\/wp\/v2\/types\/chapter"}],"author":[{"embeddable":true,"href":"https:\/\/pressbooks.ccconline.org\/accece\/wp-json\/wp\/v2\/users\/32"}],"version-history":[{"count":2,"href":"https:\/\/pressbooks.ccconline.org\/accece\/wp-json\/pressbooks\/v2\/chapters\/180\/revisions"}],"predecessor-version":[{"id":355,"href":"https:\/\/pressbooks.ccconline.org\/accece\/wp-json\/pressbooks\/v2\/chapters\/180\/revisions\/355"}],"part":[{"href":"https:\/\/pressbooks.ccconline.org\/accece\/wp-json\/pressbooks\/v2\/parts\/149"}],"metadata":[{"href":"https:\/\/pressbooks.ccconline.org\/accece\/wp-json\/pressbooks\/v2\/chapters\/180\/metadata\/"}],"wp:attachment":[{"href":"https:\/\/pressbooks.ccconline.org\/accece\/wp-json\/wp\/v2\/media?parent=180"}],"wp:term":[{"taxonomy":"chapter-type","embeddable":true,"href":"https:\/\/pressbooks.ccconline.org\/accece\/wp-json\/pressbooks\/v2\/chapter-type?post=180"},{"taxonomy":"contributor","embeddable":true,"href":"https:\/\/pressbooks.ccconline.org\/accece\/wp-json\/wp\/v2\/contributor?post=180"},{"taxonomy":"license","embeddable":true,"href":"https:\/\/pressbooks.ccconline.org\/accece\/wp-json\/wp\/v2\/license?post=180"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}