HFMD – Child Care Infection Control Management

Submitted by insider

HFMD is common among ccs. The ability of it being able to spread like fire among children is well known. Some parents blame the ccs for being dirty and therefore the ccs have to go through HFMD pain. Here are some insight into HFMD in ccs:

  • HFMD cannot be originated from ccs on its own. The virus has to be brought in by a certain infected child. This child usually can pass through the temperature and visual check without problems coz of the incubation period of the disease. By the time he shows symptoms, usually he has infected several other kids. So, this point is to tell parent that the cause of HFMD is not because a cc does not keep their place clean (therefore the notion that the appearance of HFMD = centre not clean = false).
  • The moment the first HFMD case is being detected, how swift the cc moves into action shows the efficiency of a cc. Swift action cuts the number of casualty down effectively (without such, HFMD can really spread like fire). In my experience, an average round of HFMD will have about 8 to 10 kids infected continuously (meaning everyday or every alternate day) within a 14 days period. Note that these 8 to 10 kids number is referring to cc having good class size instead of those specified by MCYS (those 25 kids in a class may have higher casualty).
  • All staff in a cc frowned upon the first sight of HFMD coz it means a lot of additional chore for them to do. CCs usually will start to keep at least 50% of their toys and have the remaining ones washed daily. They limit certain activities (such as outdoors), stop congregation of children (such as assembly time), sterilize their utensils daily, changing to disposable plates/cups/culteries (if they are not using dish washer or the amount of plates/cups/culteries is too much of a chore to sterilize daily), etc, etc. All have to bite their teeth for about 2 weeks from the last HFMD case to the day whereby no more new cases are reported (meaning a new case will re-start the whole 2 weeks cycle before they can be declared HFMD free due to the incubation period of the virus). The moment the word “HFMD” is announce to teachers, the feeling is similar to a thunder strike!
  • Responsible ccs will rope in professional sanitizing services to sanitize the whole premises thoroughly (cost is about $500 – $600 for a 4000 sq ft centre). This sanitizing service can only be done after school hours (meaning the time when the last child leave the centre). Such service can last from 30 minutes to 2 hours, depending on the type of method used. Staff frowned upon such OT and most centres are not willing to fork out $500-600/round of sanitizing service each time there is a case of HFMD. Good enough ccs will do it weekly on a Friday night so that the premises remain virus free over the weekend to prepare kids for a new week and if there is still a new case on the following week, they may repeat the Friday night sanitization. Average one will do it once in 10days/fortnightly. Those who don’t do at all…..you think yourself.
  • HFMD brings tremendous stress to ccs and parents. Parents will tend to query why a cc has HFMD. I feel that that should not be a meaningful question that they should be asking but they should know how a centre will tackle HFMD upon the discovery of the FIRST case. CCs have no control over which child walks into the premises with a hidden virus. If a cc has all the control management right, parents should trust the cc instead of trying to transfer their kids to another cc which may not have HFMD YET but it is inevitable that one day some kids will walk into the premises with the virus undetected. I hate to receive parents who hopped cc coz there is an outbreak somewhere and they worry their kids may get infected and so they want to transfer cc. All sensible ccs should not receive this kind of parents as it is risky since the intended-to-be-transferred child may carry the virus himself and introduce it to the new cc. Certain kind of money is just not right to be made.
  • Doctors nowadays are very ‘generous’ in their diagnosis of HFMD. Some may see one or two ulcers in the mouth and they will write “mild HFMD’ and that’s it, MOH and MCYS will be notified and ccs will have to notify parents and got staff to busy and parents to panic. After a full 2 weeks of stress and anxiety among staff with all additional expenses incurred (for better ccs), there are no additional cases. This kind of scenario is likely to be false alarm case with a miss diagnosis. In the past, ccs didn’t need to inform parents with the first case of HFMD coz the first case may be a false alarm but they had to inform parents upon the onset of the second case. But due to parental concerns, now all ccs have to inform parents upon the discovery of the first case – there are pro and con about it. Pro is parents can be more watchful of any symptoms show up in their kids. Con is it maybe after all a false alarm.
  • Generally, if a centre can control infection rate at less than 4 kids per round (about 14 days) of HFMD cases, their infection prevention management is effective. 8 is the average, and if above 8 cases, then the ccs may have to relook at their entrance and in-between lessons screening procedure, their firmness in turning away parents who insisted that their kids are screen though with ulcers in mouth (quite common), their cleaning and sanitizing procedure, etc. If above 10-12 cases within 2 weeks may imply a serious lapse in their infection prevention management.
  • The worse nightmare of a cc when facing HFMD is when fronting unreasonable parents – those who want their kids to be in despite their kids showing obvious signs of unwell. These parents are capable of making things very difficult for the teachers (kicking a big fuss / making a big scene / etc) and my firm instruction to my staff is always rather to lose this type of inconsiderate parents than to lose the rest of my good ones. Effective infection prevention management means stringent SOP – no means no – no negotiations or bargains…

So if you want to ask a cc about whether they have any outbreak of HFMD. The more meaningful questions will be:

  1. When was your last 2 outbreaks of HFMD?
  2. How many child/children were infected in each of the outbreak?

From the answers, you will know whether your child will be in good hands in the event of an HFMD outbreak…

Forum discussion thread.

Fri 28/11/2008