Up-to-date advice for COVID-19 infection control in EY settings

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Up-to-date advice for COVID infection control in EY settings

Nurseries and childcare providers have been working tirelessly to provide the best possible care for children, despite the major challenges of Covid. This can be particularly challenging when you are responsible for younger children who are naturally extremely tactile and do not understand these new social boundaries. Here, Emma Hammett of First Aid for Life aims to provide clear direction for staff working in childcare settings and covers topics such as infection control, first aid and resuscitation in childcare settings

Effective infection control measures

In all childcare settings, it is vital to reduce the possibility both of direct transmission (from being in close contact with an infected person) and indirect transmission (via touching contaminated surfaces).

Most childcare providers are already undertaking most of the following recommendations to try and reduce the likelihood of further viral spread, but they bear repetition:

  • minimising contact with individuals who are unwell by ensuring that those who have coronavirus (COVID-19) symptoms, or who should be quarantining, do not attend the childcare setting. This should apply to parents, students and siblings.
  • cleaning hands more often than usual and continually reinforce the importance of hand and respiratory hygiene. Facilitating times for handwashing throughout the day.
  • regularly cleaning frequently touched surfaces such as light switches, computer screens and mice, door knobs, lift buttons, bannisters, taps, loo flushes... COVID-19: cleaning of non-healthcare settings guidance
  • avoiding the sharing of toys and equipment wherever possible. If it is essential that equipment is shared and cannot easily be cleaned, it should be appropriately quarantined.
  • minimising contact and mixing as much as possible.
  • ensuring communal spaces are well-ventilated and using outdoor space whenever possible.

If someone becomes unwell in a childcare setting:

If someone becomes unwell with Covid-19 symptoms, they must be sent home and advised to follow the COVID-19: guidance for households with possible coronavirus (COVID-19) infection guidance.

If a child is awaiting collection, they should ideally be isolated from others in a well-ventilated room. If it is not possible to isolate them, they should be re-located to an area at least two metres away from other people.

If they need to go to the bathroom while awaiting collection. The bathroom should be cleaned and disinfected using standard cleaning products before being used by anyone else.

PPE should be worn by staff caring for the child while they await collection if a distance of two metres cannot be maintained (such as for a very young child or a child with complex needs).

In a life-threatening emergency, call 999 if they are seriously ill or injured – state that you suspect Covid-19.

If a member of staff has helped someone with symptoms, they do not need to go home unless they develop symptoms themselves. They should wash their hands thoroughly for 20 seconds after contact with someone who is unwell. All contaminated areas must be thoroughly cleaned once the patient has left,

What if a child is unconscious and not breathing and needs CPR?

Here is Resuscitation Council UK and Government guidance

There is also temporary CPR advice specifically for use during the Covid-19 panedemic:

For an adult:

  • During Covid-19, it is no longer advised to look listen and feel with your head above the casualty’s mouth and nose, to check for normal breathing. Instead, recognise cardiac arrest by looking for the absence of signs of life and absence of normal breathing. If you are in any doubt whether or not they are breathing normally, start chest compressions until help arrives. 
  • Call 999 for an ambulance and advise the emergency service if Covid-19 is suspected. 
  • If there is a perceived risk of infection, lightly place a cloth/towel over the victim’s mouth and nose and start compression only CPR and early defibrillation until the ambulance arrives. Place hands on the centre of the chest and push hard and fast.
  • Early use of a defibrillator (AED) significantly increases the person’s chances of survival and does not increase risk of infection. 
  • Wear personal protective equipment (PPE), such as gloves and face mask, if possible.
  • After performing compression-only CPR, all rescuers should wash their hands thoroughly with soap and water or use alcohol-based hand gel. They should also seek advice from the NHS 111 coronavirus advice service or medical adviser. 

 

Covid-19 advice for a child who is unconscious and not breathing:

The Government gives this advice:

Cardiac arrest in children is more likely to be caused by a respiratory problem (asphyxial arrest), therefore chest compressions alone are unlikely to be effective.

If a decision is made to perform mouth-to-mouth ventilation in asphyxial arrest, use a resuscitation face shield where available.

Should you have given mouth-to-mouth ventilation there are no additional actions to be taken other than to monitor yourself for symptoms of possible COVID-19 over the following 14 days. Should you develop such symptoms you should follow the advice on what to do on the NHS website.

Resuscitation Council UK give more detailed guidance:

“We are aware that paediatric cardiac arrest is unlikely to be caused by a cardiac problem and is more likely to be a respiratory one, making ventilations crucial to the child’s chances of survival. However, for those not trained in paediatric resuscitation, the most important thing is to act quickly to ensure the child gets the treatment they need in the critical situation,” it says.

“For out-of-hospital cardiac arrest, the importance of calling an ambulance and taking immediate action cannot be stressed highly enough. If a child is not breathing normally and no actions are taken, their heart will stop and full cardiac arrest will occur. Therefore, if there is any doubt about what to do, this statement should be used. 

“It is likely that the child/infant having an out-of-hospital cardiac arrest will be known to you. We accept that doing rescue breaths will increase the risk of transmitting the COVID-19 virus, either to the rescuer or the child/infant. However, this risk is small compared to the risk of taking no action as this will result in certain cardiac arrest and the death of the child”.

Further to the above advice, the following statement was issued by Resus UK, in direct response to a letter from the Group Health and Safety Manager at the Harris Federation requesting clarification on this topic: 

“Resuscitation Council UK Paediatric Guidance was written with the general public in mind as we know that many sudden cardiac arrests occur in the home hence: It is possible that the child/infant having an out-of-hospital cardiac arrest maybe known to you. 

“However, we recognise that in the school situation this may not always be the case. In this instance, the actions taken by the rescuer would be guided by dynamic/rapid risk assessment, considering such factors as the history of the child’s collapse and any known medical history, the presence or otherwise of COVID–19 signs/symptoms and the medical history of the rescuer. 

“We accept that doing rescue breaths will increase the risk of transmitting the COVID-19 virus, either to the rescuer or the child/infant (hence the need for a rapid dynamic risk assessment at the point of collapse). If the decision is to give rescue breaths, this may be mitigated by the use of airway adjuncts such as face shield, pocket mask or bag-valve-mask device if training has been received in the use of such devices. The choice of airway adjunct is dependent on the local environment, the level of training available to staff, and local supply chains.”

Emma Hammett runs www.firstaidforlife.org.uk and www.onlinefirstaid.com, the award-winning, Covid-secure first aid training specialising in First Aid for Childcare Providers, Schools and Nurseries. Taught by highly experienced medical, health and emergency services professionals and tailored to your needs. Providing socially distanced, practical courses, online and remote learning first aid throughout the UK. Award-winning online staff refreshers, upskilling and CPD courses. Please email emma@firstaidforlife.org.uk or call 0208 675 4036