Infection
control is an important and ongoing concern in Head Start programs. Children's
health is promoted by limiting the potential spread of infection among children
and staff. The infection control procedures necessary when HIV-infected children
may be in a program are the same procedures that should always be in place for
the safety of all children, whether or not an HIV-infected child is in the
program. Having children with HIV infection enrolled in a Head Start program may
make staff more conscious of infection control procedures. However, the
principles of infection control remain constant, whether HIV or other infectious
agents are the cause for concern.
In
addition to the risk of infection from sexual contact, HIV can be transmitted
through transfusion with HIV-infected blood or blood products, or from a needle
stick injury involving a needle used by an HIV-infected person. The most common
form of transmission of HIV by needles occurs when persons using illegal
injecting drugs share needles. It is also possible to become infected when
infected blood, or a bodily fluid containing infected blood, comes in contact
with mucous membranes or skin that is broken or open. Universal precautions have
been recommended for anyone who might come in contact with blood or body fluids.
These precautions
apply also to body fluids that contain blood and to certain body fluids that are
not generally found outside the body, for example, vaginal secretions, semen,
and cerebrospinal fluid. Bodily fluids to which universal precautions do not
apply (unless blood is present in them) include feces, tears, sputum, saliva,
nasal secretions, vomitus, and urine. However, these fluids can contribute to
the spread of infections other than HIV, so some precautions should be taken in
handling them.
Hand
washing is the cornerstone of infection control. Good practice mandates that
staff members always wash their hands
As protection against the blood-related modes of transmission, health and child care workers should use universal precautions when coming in contact with the blood of all clients, or bodily fluids containing blood.
Staff member
should adhere to the following universal precautions:
·
Wear latex gloves when coming into contact
with blood, skin and mucous membrane cuts, or any open skin lesion.
Strict adherence
to universal precautions prevents exposure to blood-borne pathogens including
HIV and hepatitis B.
Nasal secretions,
saliva, sputum, sweat, tears, urine, vomitus, and feces are not implicated in
the transmission of HIV unless they contain visible blood. Gloves are not
necessary for diaper changing unless the health or child care worker has open
skin lesions or the child has diarrhea or visible blood in the stool. Casual
contact between infected and uninfected individuals does not transmit HIV.
Often staff worry
that they will be confronted with a blood spill when they are unprepared, such
as a child's fall on the playground or an unexpected nosebleed. If gloves are
not readily available, the use of a barrier -- such as a diaper or towel between
the staff member and the blood can be used until appropriate materials are
available. Older children can be taught to hold the towel or gauze over the
bleeding area themselves. A practical approach used by one school system is to
give all teachers pocket-size kits, consisting of gloves, and gauze in a
zippered plastic sandwich bag, to keep in their desks and carry on the
playground or field trips. Hands should be washed thoroughly and immediately if
the should come into contact with blood.
When health
services are provided, disposable needles and syringes should be placed into
puncture-resistant containers near the areas in which they were used. No attempt
should be made to recap, bend, or manipulate used needles since these activities
increase the risk of needle stick injuries. Such injuries have seldom been
implicated in the transmission of HIV, however. Clothing, bed sheets, and other
items that may have come in contact with the blood should be isolated and
disinfected or disposed of as medical waste. Contact the local health department
about the proper disposal of medical waste.
Staff
may be concerned that children with HIV infection are exposed to infections from
other children. In general, the benefits of a Head Start program to children
with HIV infection outweigh the risks of exposure to common illnesses. However,
staff should remind parents to tell their health care providers that their
children are receiving child care in a group setting. If a child's resistance to
infection is seriously compromised, the health care provider may recommend a
smaller group setting or a home-based program.
Outbreaks of
childhood illnesses can pose a risk to children with HIV infection. Chicken pox,
which is a relatively mild illness in healthy children, can be serious for
children with HIV and measles can be life threatening. Head Start programs
should have a policy to routinely notifying all parents of outbreaks of chicken
pox or measles. Families should then notify their health care providers
immediately that the child has been exposed. Medical interventions (including
immunizations) can be offered that will decrease the child's risk of contracting
the disease, but such interventions can be offered only in a very brief time
period after exposure.
Policies
that temporarily exclude children from Head Start programs for selected
infectious diseases are based on state child care regulations and Head Start
standards, and they apply to all children, regardless of any other health
problems or disabilities they may have. Children with HIV infection should have
the same routine screening tests as other children and should be excluded from
participation only if they have one of the communicable diseases described in
the exclusion policy. Each program should review its own exclusion policy to be
certain that it is current.
If
you have any questions, or would like to offer information, please send e-mail
to ortegaes@umdnj.edu or call (973)
972-0410.
(Document provided by the National Pediatric and Family HIV Resource Center.)