Staying healthy guidelines

This section introduces the Staying healthy guidelines and the roles and responsibilities of early childhood education and care services in preventing infection.

Purpose

Staying healthy: Preventing infectious diseases in early childhood education and care services is a best-practice resource that provides simple and effective ways for education and care services to help limit the spread of infectious diseases.

Infections are common in children and often lead to illness. At home, children are reasonably well protected from infectious diseases because they come into contact with fewer people than they would at education and care services. The adults they meet are usually immune to many childhood diseases because they had these infections as children or have been vaccinated against them.

Many children first enter education and care services at a time when their immune systems are still developing. They may not have been exposed to many common germs that cause infections and they may be too young to be vaccinated against some diseases.

The way children interact in education and care services means that diseases can quickly spread. Children (particularly younger children) have close physical contact with other children, educators and other staff through regular daily activities and play. They often put objects in their mouths, and even older children are only starting to learn about health and hygiene practices (for example, they may not always cover their mouth and nose when coughing or sneezing).

This means that actions to limit the spread of infections in education and care settings are an important part of protecting children and their families. They also help to prevent infections in educators and other staff, and are part of an employer’s responsibility to employees (see Workplace health and safety). Further, these actions reduce the spread of disease in the wider community.

Following best-practice principles and maintaining high standards of hygiene reduces the spread of infectious diseases and promotes good health and safety practices. It is important for all staff in education and care services to lead by example to ensure that educators and other staff, children, visitors and families all remember to practice effective infection prevention and control.

Scope

The advice in the sixth edition of Staying healthy is drawn from established guidelines that are regularly updated using the principles of evidence-based medicine (including the Australian guidelines for the prevention and control of infection in healthcare). It also updates and builds on advice in previous editions of Staying healthy. It is designed to be used by anyone educating and caring for children – the term ‘education and care service’ includes long day care, family day care, preschool, kindergarten and care outside school hours.

The scope of Staying healthy is to provide advice on infectious diseases in children up to school age, and for children attending care services outside school hours, from a public health perspective. It is intended to help reduce the spread of infections that can affect children, educators and other staff, families and friends, and service visitors. This is particularly important if family members, children or other people in the wider contact circle have underlying health conditions.

It is not intended as a guide to managing individual children who are sick.

The key principles of infection prevention and control apply across age groups and the disability sector. However, it is recognised that the risks and issues depend on the age, abilities and developmental capacity of the children. These variations in risks and issues are not considered in this edition of Staying healthy.

Education and care services vary widely, and there is more than one way to do a procedure or maintain a healthy environment. Staying healthy is a best-practice resource that explains the rationales behind procedures and why each step is important.

This enables education and care services – including approved providers, service leaders, educators and other staff – to interpret and adapt advice to make informed decisions that meet the regulatory requirements and quality standards that apply to their service environment and the children attending the service. They can identify the most effective strategies, policies and procedures to implement and to respond to issues as they arise.

This edition also includes scenarios based on real-life situations that illustrate the key messages and appropriate actions to take.

Alignment with the National Quality Framework

The National Quality Framework (NQF) was developed to support quality improvement in education and care services across Australia. The Australian Children’s Education and Care Quality Authority (ACECQA) works collaboratively with the Australian, state and territory governments and guides the implementation of the framework in the education and care sector in Australia. ACECQA has policy guidelines for education and care services about dealing with infectious diseases.

Staying healthy is aligned with the NQF Education and Care Services National Law and Education and Care Services National Regulations, particularly Chapter 4 – Operational requirements, which outlines the requirements for children’s health and safety (Part 4.2), physical environment (Part 4.3) and policies and procedures (Part 4.7, Division 2).

In addition to the National Law and Regulations, the NQF includes the National Quality Standard (NQS). Under these legislative and quality standards, providers, service leaders, educators and other staff must implement and promote effective hygiene practices to safeguard the health and wellbeing of children attending the services.

All quality areas from the NQS have been considered in this edition of Staying healthy:

• Quality Area 1 – ‘Educational program and practice’ includes a framework to guide learning and development outcomes
• Quality Area 2 – ‘Children’s health and safety’ includes standards for hygiene and infection control in education and care services
• Quality Area 3 – ‘Physical environment’ includes standards to ensure that the physical environment in education and care services is safe and suitable
• Quality Area 4 – ‘Staffing arrangements’ includes professional standards for staff practices
• Quality Area 5 – ‘Relationships with children’ includes standards about positive educator and child interactions
• Quality Area 6 – ‘Collaborative partnerships with families and communities’ includes standards to help services develop productive relationships with families
• Quality Area 7 – ‘Governance and leadership’ includes the policies and procedures that education and care services must have in place.

The guidance provided in Staying healthy is also applicable to centre-based and in-home care services that may be out of the scope of the NQF.

What’s changed since the fifth edition

The sixth edition of Staying healthy combines new evidence and perspectives from the past 10 years to inform the update of the guidelines.

The guidelines continue to meet the National Health and Medical Research Council (NHMRC) standard for guidelines. General service practices have not changed between the fifth and sixth editions, but guidance has been updated and expanded throughout to capture new evidence and ensure the guidance is comprehensive and clear. Improvements have been made to the structure and language to ensure users can easily find and understand the information. The structure has been updated to remove repetition and consolidate information. Parts of the guideline have been renamed so service providers can easily find information.

Following the COVID-19 pandemic, information on the use of gloves, ventilation, hand hygiene and cleaning practices has been updated to ensure the content is clear and easy to implement in education and care services. The guidelines contain 5 recommendations on specific issues.

In the sixth edition, the scenarios used in the fifth edition have been updated to align with new advice. Some new scenarios have been added. These may help service providers implement the guidance.

In response to community comments and enquiries received by NHMRC on the fifth edition, fact sheets on symptoms and diseases have been added to the guideline. Both fact sheet format and content have been updated to present clear information about symptoms and conditions for educators and other staff, parents and carers. This includes exclusion recommendations.

The new fact sheets for symptoms are:

• Diarrhoea or vomiting (gastroenteritis)
• Eye discharge
• Fever
• Rash
• Respiratory symptoms.

The new fact sheets for specific conditions are:

• Asthma
• COVID-19
• Human metapneumovirus
• Pneumonia
• Hepatitis E
• Typhoid and paratyphoid fever
• RSV (respiratory syncytial virus)
• Shingles
• Trachoma.

Technical and administrative reports

The technical and administrative reports are available in the download section. The reports include information on the scoping review and evidence review processes, GRADE (Grading of Recommendations, Assessment, Development and Evaluation) process and the development of recommendations. There is also a summary report of the public consultation comments and the advisory committee responses.

Early childhood education and care services

Responsibilities of services in infection control

Every education and care service must ensure that risks associated with infection are prevented or minimised as far as is reasonably practical. This includes having strategies to:

• prevent or minimise exposure to infectious diseases
• safely store and minimise exposure to chemicals used to manage infection risks
• ensure that infection control practices are implemented and maintained.

Workplace health and safety

Workplace health and safety legislation in Australian states and territories places a duty of care on people conducting a business. This duty of care is to ensure the health and safety of workers and others as far as is reasonably practical, including where there is potential for the spread of infectious diseases. Education and care services should monitor, manage and minimise risks for managers, educators, other staff and students in their workplace.

All managers, educators, students, volunteers and other staff and contractors (including cooks, cleaners and administrative staff) should be aware of the service’s policies on health and safety and their own duty to contribute to a safe work environment. This includes following appropriate infection control and immunisation policies as part of their employment and reporting their infectious status. If educators or other staff are feeling sick because of an infection or infectious disease, they should not be at work (see section 4.2 If a staff member is sick).

People at the service who are pregnant or are planning on becoming pregnant – including educators, other staff and visitors to the service such as family members – must be aware that some infections can affect pregnancy and their unborn child, and take appropriate action (see section 2.8 Protecting pregnant staff and visitors).

Volunteers and students on placements in education and care services should also be aware of and follow all policies and procedures, including the service’s policies on immunisation, hand hygiene, nappy changes and infectious diseases.

Education and care services should regularly review and update their policies and procedures to reflect changes in staff and the circumstances of the service. Contact your work health and safety authority for more information on what is required in your jurisdiction:

• ACT - WorkSafe ACT
• New South Wales - SafeWork NSW
• Northern Territory - NT WorkSafe
• Queensland - Workplace Health and Safety Queensland
• South Australia - SafeWork SA
• Tasmania - WorkSafe Tasmania
• Victoria - WorkSafe Victoria
• Western Australia - WorkSafe Western Australia

Responsibilities of management and staff

Infection control is a shared responsibility. Management (including approved providers, service leaders and managers) and staff (including educators, other staff and volunteers) all have roles to play.

To reduce the risk and spread of infectious diseases, approved providers, service leaders and managers should:

• ensure that clear policies and procedures, informed by guidance from recognised authorities, are established and communicated to educators and other staff, including by
  • ensuring policies are easily accessible and understood
  • providing supporting documentation and resources
  • providing information in various formats in the language(s) used in the community; for example, by using photographs, infographics, audio and video recordings, posters, information sheets, checklists and templates
  • including health and safety policies and responsibilities in new employee induction processes
• regularly seek feedback from employees about health and safety policies and procedures to identify areas for improvement and opportunities to strengthen best practice (for example, by dedicating time for discussion during team meetings)
• regularly monitor the health and safety procedures used across the service, and audit compliance with them
• support educators and other staff to comply with policies and procedures, including by identifying reasons for noncompliance and supporting quality improvement actions
• provide educators and other staff with regular and ongoing learning opportunities (and dedicated time) to ensure their knowledge, understanding and application of best practice on health and safety is up to date and informed by recognised authorities (such as Australian, state or territory health departments)
• embed and discuss implementation of health and safety policy and procedures as part of regular performance reviews
• communicate with and seek input from families about the service’s health policies and procedures
• share policies and health information with families in their own language(s) and in various formats; for example, by using photographs, infographics, audio and video recordings
• keep families informed of updates and changes to policies and procedures before they are implemented (in line with regulation 172 of the National Education and Care Services Regulations).

To reduce the risk and spread of infectious diseases, educators and other staff should:

• be familiar with, regularly refer to and comply with the Staying healthy guidelines
• follow immunisation guidance and requirements
• follow all service policies and procedures related to infection prevention and control
• stay home if sick
• actively participate in reviews of the service’s health and safety policies and procedures and discuss with service leaders any concerns or opportunities for improvement that they identify in the service and its procedures
• actively participate in professional development and learning opportunities on health and infection control.

Publication details

• Publication title: Staying healthy: Preventing infectious diseases in early childhood education and care services
• Published: 2024
• Publisher: National Health and Medical Research Council (NHMRC)
• Publication reference: CH56
• Online version: nhmrc.gov.au/publications
• ISBN Print: 9780648464440
• ISBN Online: 9780648464457 9780648464457
• Suggested citation: National Health and Medical Research Council (2024). Staying healthy: preventing infectious diseases in early childhood education and care services, NHMRC, Canberra.
• Cover image: Adobe Stock, 245289887, Young children playing with educational toys

Copyright

© Commonwealth of Australia 2024

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Acknowledgements

Staying Healthy Advisory Committee: Professor Chris Blyth (Chair), Dr Ruby Biezen, Professor Allen Cheng, Dr Celia Cooper, Professor Mark Ferson, A/Professor Amanda Gwee, Dr Briony Hazelton, Ms Miranda Ihanimo, Ms Rhonda Livingstone, Ms Samantha Page, Ms Leeanne Pena, Emeritus Professor Malcolm Sim AM, Dr Gabriela Willis

NHMRC Project Team: Ms Alice Downing, Ms Stephanie Goodrick, Ms Margie Morrison, Ms Sharon Hoffman, Ms Sara Lai, Mr Geraint Duggan

Writers and editors: Biotext Pty Ltd Research: Health Technology Analysts Pty Ltd

Design: Leading Hand Design Pty Ltd

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