SAFE HEALTHY CHILDREN A Health and Safety Manual for Childcare Providers

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Natalie Reed
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1 Chapter 2: Staff Health Records TABLE OF CONTENTS Paper Chase: Staff Health Records 2.1 Requirements of the Day Nurseries Act Requirements of the Medical Officer of Health.. Tetanus-Diptheria (Td) booster... Measles Mumps and Rubella (MMR). Chicken Pox Hepatitis A.. Hepatitis B... Influenza (flu shot).. Tuberculin (tb) skin test.. 2.5

2 A healthy staff makes for a healthy, happy, well-run childcare facility. When hiring, make sure that prospective staff members meet immunization requirements and you have all relevant health information on file. Update staff health records on a regular basis. Encourage staff members who are ill to stay home. Although it may be temporarily inconvenient, it will save time and trouble in the long run. 2.1

3 REQUIREMENTS OF THE DAY NURSERIES ACT 62.(1) Every operator of a day nursery shall ensure that prior to commencing employment, each person employed in each day nursery operated by the operator has a health assessment and immunization as recommended by the local medical officer of health. 62.(2) Subsection (1) does not apply where the person objects in writing to the immunization on the ground that the immunization conflicts with the sincerely held convictions of the person based on the person's religion or conscience or a legally qualified medical practitioner gives medical reasons in writing to the operator as to why the person should not be immunized Every operator of a private-home day care agency shall ensure that, prior to any child being provided with private-home day care, each person in charge of a location where private-home day care is provided by the operator and each person ordinarily resident on the location or regularly on the premises has a health assessment and immunization as recommended by the local medical officer of health. 2.2

4 REQUIREMENTS OF THE MEDICAL OFFICER OF HEALTH 1. Ensure that your staff members have the up-to-date immunizations below. 2. Keep a record of immunization in each staff members personnel file. 3. Update staff health and immunization records as necessary. 4. Require employees and volunteers to stay off work when they are ill. *Staff members are encouraged to keep their immunization record up-to-date as their personal record. The yellow immunization card can be used for this purpose. Tetanus-Diptheria (Td) booster Immunization Requirements for Staff To be adequately immunized against tetanus and diphteria, a person must have received three doses of a tetanus-diphtheria containing vaccine. A tetanus-diphtheria booster is recommended every 10 years. It is also recommended that all adults, particularly those working with young children receive one dose of a pertussis-containing vaccine which only comes in combination with the tetanus-diphtheria vaccines (Tdap). This dose of pertussis containing vaccine (Tdap) should be given as soon as possible if it has not already been received, regardless of when the last tetanus-diphtheria vaccine was received. If a staff member has a dirty wound five years or more after receiving their last tetanus containing vaccine, they will need another tetanus-diphtheria booster after the injury. The tetanus shot always comes combined with diphtheria. Measles, Mumps, Rubella vaccine (MMR) Immunization Recommendations for Staff Adults (> 18 years of age) born in 1970 or later require one dose of MMR that should have been given on or after their first birthday. However, for extra protection, it is advisable that adults born in 1970 or later who work with children receive or have received two doses of MMR. Adults born before 1970 are generally considered immune to measles and mumps, but for extra protection and to protect against rubella it is advisable that these adults receive or have received one dose of MMR. If the past vaccination history is uncertain, the MMR vaccine can be administered as there is no additional risks in giving the vaccine if someone is already vaccinated or immune from past infection. Alternatively, a blood test can be done to check for immunity to measles, mumps, and rubella. The MMR vaccine should not be given during pregnancy, and pregnancy should be avoided for at least ONE month after receiving the MMR vaccine.

5 Chickenpox (Varicella vaccine) Staff members should be questioned regarding a history of chickenpox. Those known to have had chickenpox are considered immune. Those who have not had chickenpox or are unsure can either receive two doses of the chickenpox vaccine or can have a blood test to assess whether or not they are protected. Staff members who have a blood test and are found not to be protected should receive two doses of varicella vaccine given at least 6 weeks apart. The chickenpox vaccine should not be given during pregnancy, and pregnancy should be avoided for at least ONE month after receiving this vaccine. Hepatitis A Hepatitis A vaccine is publicly funded for men who have sex with men, people who use injection drugs, and people with chronic liver conditions, including people with hepatitis C. Please note that public funding is not available for people who require hepatitis A vaccine only for travel. Hepatitis B Hepatitis B is a virus that is transmitted by the blood and bodily fluids, including saliva, of an infected person. Because staff members can be exposed to hepatitis B through bites from children or when cleaning up blood, the hepatitis B vaccine is recommended. For adults, the hepatitis B vaccine is a series of 3 shots, given over a 6 month period. A blood test to show that the vaccine has worked should be taken one month after the last shot is completed. A record of their hepatitis B vaccinations and blood test results should be maintained in the staff member s personnel file. Please note that a two-dose schedule of hepatitis B vaccine is routinely offered to Ontario school pupils in grade seven. Employees who were vaccinated in grade seven should have a blood test to show the vaccine worked. If the blood test does not indicate the vaccine has worked, please contact the Health Unit for advice. Influenza ( flu shot ) Influenza is a respiratory disease caused by a virus. The virus spreads easily from person-to-person through coughing and sneezing. It can also be picked up through direct contact with surfaces and objects, like unwashed hands and toys. Influenza illness has been shown to peak in children several days before the community peak and children have been shown to disseminate influenza in the community and introduce infection into families. Children less than 24 months of age are considered to be a high-risk group for whom the complications of influenza may lead to hospitalization. Anyone over 6 months of age is offered free influenza vaccine each year and it is strongly recommended that staff members of child care centres receive annual influenza vaccine in order to protect themselves and the children they care for. The influenza vaccine is given each year because the virus that causes influenza changes often. The vaccine is considered safe for pregnant women and for breastfeeding mothers.

6 Tuberculin Skin Test (TBST, or Mantoux testing) In general, employees of child care centres are not at increased risk of developing tuberculosis. However, if they should develop disease, they have the potential of infecting young children. Therefore a tuberculin skin test is recommended for the following staff members: Persons who were born in certain areas and have arrived in Canada within the previous 5 years. These areas include: Asia, Africa, India, The Middle East, Eastern Europe and the Newly Independent States of the Former Soviet Union, Central and South America and the Caribbean. Persons who have spent more than 3 months in certain areas within the previous 5 years. These areas include: Asia, Africa, India, The Middle East, Eastern Europe and the Newly Independent States of the Former Soviet Union, Central and South America and the Caribbean. Persons with high risk medical conditions which include: kidney problems, diabetes, cancer, HIV/AIDS, silicosis, or conditions which require drugs which suppress the immune system. Persons who have been exposed to someone with active tuberculosis disease in the past. Staff who choose to have the TBST at their family physician s office may be required to pay a fee. The TBST test is not covered under OHIP. TBSTs are offered at any regularly scheduled Middlesex-London Health Unit immunization clinic at a cost of $10 per step. A TBST for the recommended groups should be done within one month of employment. A skin test may have been done as a pre-requisite for education or other employment purposes, and should be accepted if performed within the last 12 months. TBST results must be documented on paper, and measured in millimetres. If a staff member has a previous documented positive skin test, they should not have another one. This population may have a chest x-ray instead of a repeat test to rule out TB. Any staff member with a positive skin test must be assessed by a physician to rule out active disease and to discuss preventive medication. Staff members who are TBST positive should report promptly to their physician any symptoms suggestive of tuberculosis (e.g. cough, fever, night sweats, anorexia, weight loss). Annual skin testing for staff is not necessary. Subsequent TB skin testing for staff is only necessary under certain circumstances. Pregnancy is NOT a reason to defer TBST. References: Tuberculosis Control Protocol, Tuberculosis Control Program, Ministry of Health, Public Health Branch, January 1998 Health Protection Branch, Laboratory Centre for Disease Control, Canadian Immunization Guide, 5th edition, Health Canada,

Explanation of Immunization Requirements

Explanation of Immunization Requirements CONTENTS Hepatitis A... 2 Hepatitis B... 3 Influenza... 4 Measles (Rubella), Mumps, and Rubella (MMR)... 5 Pertussis (Tdap)... 6 Tuberculosis (TB) Test... 7 Varicella/Chicken