Why is hygiene and infection control important in schools?
Hygiene is particularly important in the school setting as young school children are recognized as at particular risk of contracting and transmitting enteric (relating to intestines) infection (Finn and Crook, 1998/1999). Children are particularly susceptible because of a number of factors.
It is recognised that infection control focusing on environmental factors and hygiene practices in schools can reduce the transmission of infection. (Black et al, 1981; Krilov et al, 1996). For example, a study of sanitation facilities in schools in Bloomsbury found inadequate provision of soap, toilet paper and towels and the potential for the spread of infectious diseases. (Jewkes and O’Connor, 1990). Another study in Leeds found faecal bacteria (a micro-organism) on environmental surfaces and children’s hands. (Kaltenthaler et al, 1995) and a sample of children’s hands and the environment found contamination in the classroom, on floors, taps, and surfaces (Holaday et al (1990).
What are the potential benefits for schools?
What are micro-organisms? (adapted from Mims)
Micro-organisms, also known as germs, are small living things that cannot be seen by the naked eye. They can be found in many different places and can cause infectious diseases. The main micro-organisms are bacteria, viruses, fungi and parasites.
Bacteria can live anywhere including in food and water or on surfaces. The majority of them are harmless, in fact many of them live on the human body and protect us from other harmful bacteria. In our stomachs, for example, we have bacteria that protect us when we eat and digest food.
However, other germs can cause us harm and give us infections. Infectious diseases caused by bacteria include scarlet fever, meningitis and certain types of food poisoning such as salmonella. Viruses, which are much smaller than bacteria cause many diseases such as measles, mumps, rubella (German measles), chicken pox and HIV. Fungal infections include ringworm and finally, parasites include head lice and scabies.
How do we catch them? (adapted from Mims)
In other words germs are everywhere! As germs, like us, are living organisms we could never eliminate them completely and in fact we need good germs to protect us against the more sinister variety! However, there are things that we can do to make sure that we don’t spread the harmful germs and make ourselves ill. Good toilet facilities and hand washing facilities are two important factors!
Hand Washing (Adapted from the ICNA)
Hand washing is one of the most important ways of preventing infection. Hands can move germs to other places such as from the toilet to the classroom!
The importance of hand hygiene to prevent the risk of infection is well documented. (Pete J, 1987; May, 1998; Hammond et al, 2000). Education around hand hygiene in schools is very important, along with access to appropriate facilities. (May, 1998; Baxter and Cleary, 2002). Liquid soap and paper towels together with warm and cold water are considered the best practice for hand washing (Gould, 2000; Ward, 2000).
Thorough hand washing with warm water and soap will remove germs along with effective hand drying.
When should children wash their hands?
How should children wash their hands?
Studies on toilet facilities have shown children are reluctant to use toilets because of poor sanitary conditions and avoid drinking water in order not to go to the toilet. Low fluid intake has been associated with health problems in children e.g. incontinence, constipation, urinary tract infection and kidney stones (Haines et al, 2000).
One study showed that due to restricted access to toilets (which were also poorly maintained) and restricted access to toilet paper, children did not open their bowels at school, leading to chronic constipation. (Barnes and Maddocks, 2002). Other key research in Sweden and England has addressed the physical and psychological health of children’s experiences of school toilets including bladder dysfunction, urinary tract infection and bullying. (Vernon S, et al 2003).
These studies show the wider implication of poor toilet facilities in schools as well as the potential spread of infectious diseases (Cleary V, et al 2003).
Good toilet facilities and hand washing facilities are considered to be important for infection control.
Barnes P M and Maddocks A (2002) Standards in school toilets – a questionnaire survey. Journal of Public Health Medicine 24(2), 85-87.
Baxter A and Cleary V (2002). Hand hygiene in local primary school children – an infection control and health promotion initiative. BJIC. 3(2) 14-17.
Berg R (1988). Day care for children in the APIC curriculum for infection control practice. Kendall Hunt, Iowa, 1310-1324.
Black R E, Dykes AC Anderson KE et al. (1981). Handwashing to prevent diarrhea in day-care centers. Am J Epidemiology. 113: 445-51.
Cleary, V, Slaughter, R and Heathcock R (2003). Infection Control in primary schools and the wider public health impact. BJIC 4(5) 11-15.
Finn L and Crook S. (1998/1999) Handwashing – Starting off on the right foot? Health Trends 30(4): 94-6
Guinan M, McGuckin M, Dr ScEd, MT (ASCP), Ali, Yusuf (2002). The effect of a comprehensive handwashing program on absenteeism in elementary schools. Am J Infect Control. 2002; 30: 217-20.
Haines L, Rogers J and Dobson P (2000). A study of drinking facilities in schools. Ntplus 96(40) 2-4.
Hammond B, Ali Y, Fendler E, Dolan M, Donovan S (2000) Effect of Hand Sanitiser Use on Elementary School Absenteeism. American Journal Of infection Control: 28 (5): 340-6
Holaday B, Pantell R H, Lewis C C, Gillis C L (1990) Patterns of faecal coliform contamination in day care centres. Public Health Nursing 7(4): 224-227.
ICNA (2002). Hand Decontamination Guidelines. ICNA
Jewkes R K, O’Connor B H (1990) Crisis in our schools: Survey of sanitation facilities in schools in Bloomsbury Health District. Brit Med Journal 301: 1085-1087.
Kaltenhaler EC, Elsworth A, Schweiger M, Mara D Braunholz D (1995) Faecal contamination on Children’s Hands and Environmental Surfaces in Primary Schools in Leeds. Epidemiol. Infect (1995) 115: 527-534
Krilov, LR, Barone, SR, Mandel FS, Cusack, TM, Gaber DJ, Rubino JR (1996). Impact of an infection control program in a specialized preschool. AJIC AM J of Infection Control. 24(3): 167-173
Mims, C, Playfair, J, Roitt, I, Wakelin D and Williams R (1998) Medical Microbiology, Second Edition. Mosby Publishers Ltd, London.
Pete J (1987) Handwashing Practices Amoung Various School Age Students. Health Education December 1986 – January 1987. 37-39
Vernon S, Barbro L and Hellstrom A L (2003) Children’s experiences of school toilets present a risk to their physical and psychological health. Journal of Child: Care, Health & Development. 29(1), 45-53.
Walters K and Cram G (2002) Drinking water in schools: hygiene standards at fountains. Nutrition & Food Science 32(1); 9-12
Ward D (2000) Handwashing facilities in the clinical area: a literature review. British Journal of Nursing. 9(2): 82-6