Health protection in early years settings

Infection prevention and control

Infections are common and for most people the risk of severe disease is low. They can start and be spread anywhere, can be spread in different ways, and vary in how easily they can be spread.

It is important to look after children in early years as their immune systems develop whilst they learn about good hygiene practices. Children and adults who are immunosuppressed may be at a higher risk of contracting an infection. Immunosuppressed people and their caregivers should be informed of possible infectious threats so that they are able to get medical advice from their GP or specialist.

Types of infection

Respiratory infections such as colds, Covid-19, flu and whooping cough can spread easily between people - sneezing, coughing, singing and talking may spread droplets from an infected person to someone close by.
Airborne infections can spread by small respiratory particles, without needing close contact with another person. Droplets from the mouth or nose may also contaminate items such as hands, cups and toys.
Direct contact infections such as scabies, headlice, ringworm and impetigo can be spread by contact with the infected area of the body, or by contact with a contaminated surface.
Gastro-intestinal infections such as norovirus, hepatitis A and E-Coli can spread from person to person when infected faeces or vomit are transferred to the mouth either directly or from contaminated food, water, or objects such as toys, door handles or toilet handles.
Blood borne virus spread by contact with infected blood or body fluids, for example, by attending to a bleeding person, from biting which punctures the skin or through injury with a used needle.

Preventing the spread

This is done by:

everyone in the setting using good hygiene behaviours including hand washing, and covering the nose and mouth with a tissue when sneezing and coughing - 'catch it, bin it, kill it'
good ventilation - letting fresh air into indoor spaces can help dilute air that contains viral particles and reduce the spread of Covid-19 and other respiratory infections
maintaining a clean environment, including toys and equipment, reduces the risk of transmission - effective cleaning and disinfection are critical in any education or childcare setting
ensuring that linen and soft furnishings are kept clean and washing regularly
encouraging vaccinations to reduce the likelihood of infection and severe illness.
using Standard Infection Prevention and Control (SIPC) precautions
managing waste safely
excluding someone where necessary - encouraging children and staff to stay at home if they have symptoms of an infection and not return until feeling well and outside of the recommended exclusion period

Where a case of infection is known, take action to reduce or eliminate the risk of spread through information and prompt exclusion of a case. See Gov.uk: Children and young people settings: tools and resources.

Reporting the outbreak

Settings should contact their UK Health Security Agency (UKHSA) Health Protection Team as soon as possible to report any outbreak of serious or unusual illness.

Online: Gov.uk: report a notifiable disease

Phone: 0300 303 8596

Useful links

Resources

Vaccinations

Vaccinations are successful in reducing the instances of diseases.

Children, especially younger children, have a lower immune system due to their limited exposure to germs, this makes them more susceptible to infections and diseases. As well as protecting the child, vaccines also protect other children and staff by preventing the spread of disease. Vaccinations are offered free in the UK and are usually given through a GP.

Parents should be encouraged to have their child immunised to protect both their health and that of the other children in the setting. Vaccines are safe and evidence based, but any parent who is concerned about having their child immunised should talk to their health visitor or GP. It's best to have vaccines on time, but if missed, most vaccines can be caught up on.

Knowing the vaccination status of the child in the setting may be important information should there be an outbreak. Education and childcare settings have a vital role to play to support the routine immunisation programme through sharing of information with parents and caregivers at key points. Settings may wish to speak to their health visitor, school nurse or other setting specific health care worker about the support they can offer.

Useful links

Resources

Antimicrobial resistance

Antibiotic resistance is the increasing ability of the bacteria that cause infections to resist the effects of an antibiotic prescribed by a doctor.

If a bacteria no longer responds to medicine, the infection it causes can become difficult or even impossible to treat. As antibiotics become less effective, even minor surgery and routine operations could become high risk procedures if infections cannot be treated.

The North East and North Cumbria Integrated Care Board (NENC ICB) area is the highest prescriber of antibiotics nationally across all age groups. It is the 10th highest prescriber of antibiotics nationally in the up to 4 years age group.

How you can help

The Healthier Together uses a traffic light system to help parents and carers decide what action to take when their child is sick. It also includes the Little Orange Book, which is a great resource for common illnesses. Share this resource with parents and carers of young children.
Encourage parents and carers to contact their local pharmacy for self care advice and support. Many common conditions, such as sore throat, sinusitis and ear infections, can be managed with self care and over the counter medicines.
If children are prescribed antibiotics, please encourage parents and carers to ensure their child completes the full course and does not just stop when they start to feel better.
Promote good infection prevention and control measures (eg flu vaccination for 2 to 3 year olds) to reduce the risk of getting infections which in turn would reduce the frequency of needing antibiotic prescriptions.
Become an Antibiotic Guardian.

For more information see Antibiotic resistance.

Adverse weather

Cold and hot weather can affect children.

Keep up to date with UK weather warnings, sign up to Gov.uk: weather-health alerting system.

Cold weather

While time spent outdoors, exercise and play are all integral for children and young people's wellbeing and development, children can be at risk of harm from adverse cold weather, ice and snow because of their physiology and behaviours. Among children and young people, those aged 5 years and under are at greatest risk of harm from adverse cold weather, especially if they have underlying health conditions.

Ensure buildings and premises are prepared for cold weather and actions are taken to reduce health and safety risks in the event of cold weather:

Ventilate indoor spaces for short periods of time to reduce the risk of infection spreading.
Follow guidance on thermal comfort to optimise a comfortable learning environment.
Promote messages on staying well in winter such as vaccination, infection prevention measures and appropriate clothing.
Signpost vulnerable families to key sources of support during cold weather periods (such as Welcome Spaces, Help with your heating and energy bills).
It is important to remember that whilst we must protect children and babies from the cold, we should not allow children to get too hot as this can cause them to overheat as this can cause Sudden Infant Death and other health complications.

Further information

Hot weather

Children can be at risk from hot weather because of their physiology, behaviours and activity levels. Children potentially at greater risk include those aged under 4 years, with health conditions or taking certain medications.

Heat related illness can range from mild heat stress to potentially life-threatening heatstroke. The most common risks from heat are dehydration (not having enough water in the body) and sunburn. If sensible precautions are taken, children are unlikely to be adversely affected by hot conditions.

While outdoors children should:

not take part in vigorous physical activity on very hot days
have access to shaded areas if outdoors
wear sunscreen (at least a sun protection factor (SPF) of 30 and a UVA rating of 4* or more - which should be applied every 2 hours or after activities which remove them)
wear hats
be encouraged to stay hydrated by drinking water

You can also consider relaxing any uniform measures and recommend loose and light coloured clothing.

While indoors:

if it is safe and appropriate, open windows early in the morning to allow stored heat to escape from the building and if possible, close windows during the day when it is hotter outside than inside while considering the need to maintain adequate ventilation and air quality
shade sun-facing windows if possible, and close indoor blinds or curtains to keep the heat out
switch off all electrical equipment, including computers, monitors and printers when not in use - do not leave equipment in 'standby mode' as this generates heat
if possible, use classrooms or other spaces which are less likely to overheat, and adjust the layout of teaching spaces to avoid direct sunlight on children
use oscillating mechanical fans to increase air movement if temperatures are below 35°C (above this temperature they may be counterproductive)
consider rearranging school start, finish, and play times to avoid teaching during very hot conditions
encourage children to eat normally and drink plenty of water

Further information

Air quality

Air pollution is a mix of different harmful gases and very small particles, released into the air around us and is in the air we breathe.

Air pollution (dirty air) and good air quality (clean air) affects us all, every day for the whole of our lives. Clean air is better for us. Damage to our general health may not be noted straight away and can build up over time. Those people most at risk are:

pregnant women
young babies through to school age children
the elderly
people with lung and heart conditions

Outdoor air quality is more managed and regulated meaning indoor air quality is becoming more of a concern. We spend up to 80% of our day indoors.

To protect the health of others and reduce air pollution:

encourage people to turn off their car engines when stationary (especially in vulnerable areas such as early years settings, schools, health centres, hospital car parks and care homes), and use the automatic start and stop functions in vehicles
swap local car journeys for bus rides, car sharing, walking or cycling and avoiding polluted routes
keep any fuel burning devices such as gas fired boilers well maintained, as this ensures they are as efficient as possible
avoid or replace strong cleaners, or other items in the setting which could affect your breathing
keep windows and doors closed during rush hours, if you are close to a busy road

For more information see Air pollution, your health and what you can do.