PDI Perspective

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Overcoming the Fall and Winter Seasonal Germ Blues

Posted by Deva Rea, MPH, BSN, BS, RN, CIC on Aug 24, 2017 1:00:00 PM

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The summer season is nearing its end once again with the start of school, football and fall festivals. And with back to school we bring back the germs! 

There are a few things we can all do to help reduce the potential fall and winter time germy blues. This prevention trifecta includes:

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Vaccinations

There are still cases and outbreaks of vaccine preventable diseases that occur routinely in the United States. Some examples of these diseases include measles, pertussis and mumps.

  • Measles:
    • 100 people from 10 states were reported to have measles from January to May 20, 20171
    • Although measles elimination was documented in the US in 2000, the US experienced a record number of cases in 20141
  • Pertussis (or whooping cough):
    • Almost 6,000 cases of whooping cough were reported in the US and Puerto Rico from January to mid-June, 20161
    • It is important to keep up with the vaccine boosters, as protection from the vaccine wains over time1
  • Mumps:
    • 4,240 infections were reported in 2017 (January – mid-August)2
    • Being in a crowded environment (classes, sports teams, dormitory living) with a person who has mumps can contribute to outbreaks2

According to the Centers for Disease Control and Prevention (CDC), the best way to protect your community and schools from outbreaks is to keep your children up-to-date with vaccinations.1

Hygiene basics: Hand hygiene and Respiratory Etiquette

Hand hygiene and respiratory etiquette are highly effective and simple measures that help reduce the spread of infectious diseases. A recent literature review showed that hand hygiene interventions in elementary schools helped with reducing some absenteeism in students³. The literature review found that hand hygiene interventions such as education, and prompting hand hygiene with soap and water or alcohol based hand sanitizers, helped reduce gastrointestinal (GI) illness and other non-specific illnesses related absenteeism. However, the interesting point of the review was that hand hygiene interventions alone were not as effective on respiratory illness-associated absenteeism.³ Most GI illness is transmitted from hands (fecal-oral), which is one rationale for why hand hygiene interventions help reduce these illnesses. However, respiratory illnesses, can also be transmitted via the droplet or airborne route. This is why respiratory hygiene is so important. Using an elbow or a tissue to cover coughs and sneezes are helpful in reducing the aerosolization of common respiratory germs. Performing hand hygiene after coughing, sneezing or blowing one’s nose is also a critical step in respiratory hygiene.

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Environmental cleaning

To stop or reduce the spread of common fall and winter germs, the CDC recommends routine environmental cleaning and disinfection. Specifically, to disinfect frequently touched surfaces and objects such as toys and doorknobs. This is part of a broader approach in preventing infectious diseases in schools.⁴ In an outbreak scenario, the CDC also offers disease specific environmental cleaning and disinfection recommendations.

Ambulatory settings, such as physician offices and clinics, will see an influx of school-aged children due to physicals and vaccinations required for the start of school. This surge of patients may continue due to the increase in fall and winter illnesses such as norovirus (common gastrointestinal illness) and influenza. It is important that these ambulatory and outpatient settings adhere to cleaning and disinfection guidelines.

Toys in these settings are examples of items that can be vehicles for the transmission of germs. Toys have specific cleaning and disinfection recommendations from the CDC and other regulatory bodies.

  • If toys are soiled, they should first be cleaned (with an appropriate cleaner or soap and water) and then disinfected.
  • If toys are not soiled, it is acceptable to simply disinfect with a disinfectant.
  • Toys that children may put into their mouths are recommended to be rinsed after they are disinfected (after appropriate contact time is achieved).

The CDC specifically states the following regarding toys:

“In facilities that provide health care to pediatric patients or have waiting areas with child play toys (e.g., obstetric/gynecology offices and clinics), establish policies and procedures for cleaning and disinfecting toys at regular intervals. (Category IB)

Use the following principles in developing this policy and procedures (Category II):

  • Select play toys that can be easily cleaned and disinfected
  • Do not permit use of stuffed furry toys if they will be shared
  • Clean and disinfect large stationary toys (e.g., climbing equipment) at least weekly and whenever visibly soiled
  • If toys are likely to be mouthed, rinse with water after disinfection; alternatively wash in a dishwasher
  • When a toy requires cleaning and disinfection, do so immediately or store in a designated labeled container separate from toys that are clean and ready for use⁵.”

Recap:

It is important to stay current on vaccinations; to be diligent with hand hygiene and respiratory etiquette; and to always practice good environmental cleaning. Following these simple strategies can help reduce the germ blues and keep everyone healthy!

 

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¹Centers for Disease Control and Prevention (CDC). School Starts Soon—Is Your Child Fully Vaccinated? August, 2017. Available from: https://www.cdc.gov/features/catchupimmunizations/index.html. Accessed August 24, 2017.

²Centers for Disease Control and Prevention. Mumps. Updated August, 2017. Available from: https://www.cdc.gov/mumps/outbreaks.html. Accessed August 24, 2017.

³Wang, et al. 2017. The effect of hand-hygiene interventions on infectious disease-associated absenteeism in elementary schools: A systematic literature review. Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.ajic.2017.01.018

⁴ Centers for Disease Control and Prevention (CDC). How To Clean and Disinfect Schools To Help Slow the Spread of Flu. October, 2016. Available from: https://www.cdc.gov/flu/school/cleaning.htm. Accessed August 27, 2017.

⁵ Siegel JD, Rhinehart E, Jackson M, Chiarello L, and the Healthcare Infection Control Practices Advisory Committee, 2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings. Available from: https://www.cdc.gov/infectioncontrol/guidelines/isolation/. Accessed August 27, 2017.