ERIC Identifier: ED437368
Publication Date: 1999-12-00
Author: Grosse, Susan J.
Source: ERIC Clearinghouse on
Teaching and Teacher Education Washington DC.
Educating Children and Youth To Prevent Contagious Disease.
Chronic disease has bypassed contagious disease as a leading cause of death
in the U.S. Still, infectious diseases continue to contribute to illness and
death. For example, pneumonia and influenza are the fifth leading cause of death
among all Americans; AIDS is the leading cause of death for African American 25-
to 44-year-olds; and almost 400,000 people in the U.S. are known to be living
with AIDS (Martin, Smith, Mathews, & Ventura, 1998; CDC, 1999a).
Approximately 3.9 million people are infected with the hepatitis C virus,
between 125,000 and 200,000 with hepatitis A, and there are 140,000-320,000 new
hepatitis B infections each year in the U.S. (CDC, 1999b; 1999c). Mainstreaming
institutionalized special needs children into regular public schools has
increased the risk of hepatitis B infection, as hepatitis B has been described
as endemic in institutions for the mentally disabled (American Academy of
Pediatrics, 1993). Less serious but still a cause of many missed school and work
days each year, pediculosis (head lice) afflicts 6-12 million people worldwide
annually (CDC, 1998).
We teach children to throw their used tissues into the trash and to cover
their mouths when they sneeze. We stress hand washing after using the bathroom.
As children grow, we encourage personal cleanliness and vaccinations. But the
contagious diseases of the twenty-first century require more than these basic
health lessons. This digest looks at ways to prevent the transmission of disease
in school settings.
WHAT ARE THE KEY CONCEPTS IN CONTAGION EDUCATION?
several key concepts about contagious disease prevention (sometimes called
contagion education) that students in all grades should learn. The first and
most important is that any person is potentially contagious. Age, sex, race,
ethnic background, economic status, and even the appearance of health are not
Other basic concepts to learn include the following:
The germs that cause contagious diseases (bacteria, viruses, protozoans, fungi,
and parasites) are present on skin surfaces, in the mouth, nose, and eyes, on
the scalp, and in body fluids.
Body fluids are particularly effective carriers of germs, and blood is the body
fluid of greatest concern in the non-sexual transmission of disease.
While barriers such as gloves can reduce the spread of germs, hand washing is
essential, whether or not gloves are used.
Correct use of biohazard labels and containers can reduce the spread of disease.
Needles and other sharp objects should be handled appropriately.
WHAT ARE UNIVERSAL PRECAUTIONS?
Many of the key concepts of
contagion education fall into a category of behaviors known as universal
precautions. The Centers for Disease Control and Prevention (CDC) defines
universal precautions as a set of precautions intended to prevent the
transmission of hepatitis, HIV infection, and other blood borne pathogens when
providing first aid or health care (National Safety Council, 1997). Universal
precautions should be used when handling blood or body fluids of all
individuals, not only those known to be HIV- or hepatitis-infected. Such
precautions include, but are not limited to:
Using personal protective gear as a barrier when exposure to body fluids is
possible. In school settings, personal protective gear includes water-impervious
vinyl or latex gloves, disposable cloth towels, and wads of gauze or paper
Removing personal protective gear correctly by not touching the contaminated
side of the item, and disposing of used personal protective gear and any
contaminated materials in biohazard containers or biohazard labeled bags. Gloves
should never be re-used.
Washing hands and any contaminated body areas immediately with soap and water.
Seeking medical attention for any significant exposure to blood of another
Cleaning surfaces and/or solid objects that may be contaminated. The hepatitis
virus can survive at least a week in dried blood (National Safety Council,
1997). Surfaces and objects contaminated with saliva or blood should be cleaned
thoroughly with soap and water and disinfected with household bleach diluted
with water at a strength of 1:10 (National Safety Council, 1997). This solution
has a 24-hour shelf life and must be mixed fresh for use each day. Keep
contaminated objects or surfaces in contact with the bleach solution for at
least 30 seconds and either allow to air dry or wipe with a disposable cloth.
Using pick-ups, a broom and dust pan, tweezers, or some other object to pick up
sharp objects ("sharps"), such as broken glass. Dispose of sharps in a solid
container marked with a biohazard label. Do not dispose of sharps in a soft,
plastic garbage bag type of container.
WHAT DOES THIS MEAN FOR MY CLASSROOM?
Each classroom is a
place to model, teach, and practice safe contagion prevention habits.
Students should not share items which could transmit disease. This includes
any item that has been in someone's mouth, such as toys that have been mouthed,
drinking glasses, juice/soda cans, straws, eating utensils, pencils, pens,
towels, lipstick, chapstick, or toothbrushes. Objects that are mouthed should be
cleaned with a 10% bleach solution. Pediculosis transmission can be limited by
keeping coats and personal belongings in individual cubicles, not mixing
clothing in common piles, not sharing hats and combs, and removing hats and
masks from dress-up areas (American Academy of Pediatrics, 1993).
Students should learn how to dispose of their own hazardous waste. Throwing
their own used facial tissues into the trash, rather than leaving them for
someone else to pick up, is a start. Doing the same with used band aids is even
more important. Taking care of one's own eating utensils in the lunch room and
picking up one's dirty towels in the locker room also contribute to a
contagion-free lifestyle. Students should be encouraged to dispose of used
tampons and sanitary napkins correctly (wrapped in several layers of paper
towels) and to immediately report blood-contaminated surfaces in restrooms.
Students can learn to attend to their own first aid needs. For minor cuts
students can use an article of clothing or gauze pad and stop their own
bleeding. Even younger children can, with supervision, wash and apply dressings
and bandages to their playground scrapes. A common problem in school-aged
children is nosebleeds, and students can be taught to help a peer with a
nosebleed by tipping the head forward, pinching the nose, and holding tissues
under the nostrils. Students should also know that individuals who administer
first aid need to wear gloves and handle medical supplies carefully.
Students should learn how to dispose of sharps and use sharps containers.
Broken glass or other sharp objects should not be handled with bare hands. Sharp
objects should be disposed of in a solid container specifically marked for that
purpose. Putting sharps into soft bags or regular waste baskets could cause
someone else a blood-related emergency.
Students should learn how to safely handle litter of other people. It is not
wise to pick up body waste litter with bare hands. Used napkins, tissues, toilet
paper, sanitary napkins, tampons, and band aids could carry contagious disease.
Wearing gloves insures against needless contagion risk. When gloves are not
available, placing a barrier between the litter and one's hands (a wad of paper
towels or two plastic bags, for example) can reduce the spread of germs.
Students should know if they have a bleeding accident during play
(playground, gymnasium, athletic venue), they must stop playing. The bleeding
injury should be cleaned and bandaged and any bloody clothing removed and
disposed of before the student returns to the play situation. Although the risk
of HIV infection during sports participation is low, at least two cases of
hepatitis B infection have been reportedly transmitted through sports contact
(American Academy of Pediatrics, 1999). Many athletic conferences have specific
rules regarding competition following a bleeding incident. The American Academy
of Pediatrics provides excellent guidelines for preventing infection
transmission in athletic settings (American Academy of Pediatrics, 1999; Garl,
1993; McGrew, 1995).
Teachers, coaches, and other educational personnel must model correct
contagion prevention behavior at all times. Students will learn from what they
see and experience daily. Educational personnel should--
receive training in first aid and emergency care;
use universal precautions for all first aid emergencies;
keep a first aid kit and a spill kit (including gloves, gauze, bandages/band
aids, small jar of bleach, biohazard disposal bag/stickers) in the classroom or
gymnasium at all times;
have a fanny pack with gloves and bandages for playground duty or on field
use safety precautions when handling sharps;
follow all precautions of the Occupational Health and Safety Administration
(OHSA) and the specific Contagion Exposure Control Plan of their school
(administrators should have copies of both).
Specific lessons in contagious disease
prevention (sometimes called contagion education) can be taught at all ages in a
developmentally appropriate manner. Essential contagion prevention habits should
be taught, modeled, and practiced in the classroom, gymnasium, and school
References identified with an EJ or ED number
have been abstracted and are in the ERIC database. Journal articles (EJ) should
be available at most research libraries; most documents (ED) are available in
microfiche collections at more than 900 locations. Documents can also be ordered
through the ERIC Document Reproduction Service: (800) 443-ERIC.
American Academy of Pediatrics Committee on Sports Medicine and Fitness.
(1999). Human immunodeficiency virus and other blood-borne viral pathogens.
Policy statement. Pediatrics, 104(6), 1400-1403. Also available online at
American Academy of Pediatrics Committee on School Health. (1993). Prevention
of hepatitis B virus infection in school settings. Policy statement. Pediatrics,
91(4), 848-850. Also available online at http://www.aap.org/policy/04324.html.
Centers for Disease Control and Prevention (CDC). (1999a). HIV/AIDS
surveillance report, 11(No. 1), 1-43.
Centers for Disease Control and Prevention (CDC). (1999b). Viral hepatitis B
fact sheet. Available online at
Centers for Disease Control and Prevention (CDC). (1999c). Viral hepatitis C
fact sheet. Available online at
Centers for Disease Control and Prevention (CDC). (1998). Fact sheet: Head
lice infestation (pediculosis). Division of Parasitic Diseases, National Center
for Infectious Diseases. Available online at
Garl, T. (1993). AIDS in athletics: does a collision on the court warrant
cause for concern? Athletic Management. 5(3), 18- 21.
Martin, J. A., Smith, B. L., Mathews, T. J., & Ventura, S. J. (1999).
Births and deaths: Preliminary data for 1998. National Vital Statistics Reports,
McGrew, C. (1995). HIV, hepatitis B, and the athlete: what precautions are
needed? Journal of Musculoskeletal Medicine. 12(3), 14-18.
National Safety Council (1997). Blood borne pathogens (2nd. ed). Sudbury, MA:
Jones and Bartlett.