Hi everyone. My name is Claire Nayda and I'm a clinical nurse consultant at the Children's Hospital at Westmead. And I have a love and passion for infectious diseases and I actually work in the infection control unit in our team. So this is written by and for all of us and that it's just means that we just wanted to provide you a lot of information. If you don't think of anything today or can't remember anything I say, you've got to remember the public health 1300 number because they are your resource for you, and they're the ones who are actually going to provide you that information and what to do in regards to anything about infectious diseases or viruses alike.

So this is just really an outline of what I'm going to talk about over this period of time that I have with you guys. So basically what I want to look at is recognising a sick child and basically because you look after these children, you know them, you know what they look like how they arrived, every day how they actually present themselves being able to speak to you and you've just had some fantastic presentations already about, you know, looking out for signs and symptoms of children and that they are not normally in their usual place. You know, you've just had asthma if they're not talking to you in full sentences, in one sentences, there's something going on with them.

And things that we often get asked is well, in paediatrics also is that oh a child's got a temperature... and we always say well, what is it... 37.5... Well 37.5 is actually normal. We consider that normal. So a temperature for a child or an adult can actually be between 36 and 37.5, it's when it's starting to actually creep up into, you know above 38, that you actually starting to be concerned and often with that also at the other symptoms that come. So they are drowsy or they're really sleepy. They're not talking. They're not playing with their favourite friend Jack. They're not wanting to share that toy. They want to sit in the corner and be quiet. They just want to sleep. These are some signs and symptoms for you, that something is not actually going correct right for that child and it is about, you know, they may be recovering from an illness that they've had.

However, then there's questions would be is that is being at the childcare facility that they're in, is it the right place for them to be at a time of where they are. So again, it's about looking at also if they're not drinking or they're drinking too much, if they're actually going to the toilet or what if they are going to the toilet? Are they actually have normal urine output are their bowel motions normal, there's lots of them. Are they vomiting? Do they look green? Do they you know, as some the girls previously talked about are they blue around the lips because they're not getting enough oxygen in and out of their system and being able to do. Also are they sensitive to light? So there's lots of things like, I don't want to I don't want to go out and play I want to do all those things.

And also too, on here is just the face scale of pain, so often, when we in hospital when we're actually working with children, and we're actually trying to do a pain assessment that we're actually looking at their facial expressions to be able to do that and you're able to find all these resources available to look at that because you'll think, well Jack's actually not... there's something wrong with his arm he's not moving it I mean that's not infectious diseases, but it is about this pain scale and how to be able to assess what's going on for them.

So in a really quick nutshell it is about how you're thinking about how you're going to manage a child who you are thinking that is unwell within your organisation. And unfortunately, sometimes that can be within the first half an hour that they've turned up for the day. And that they actually need to be isolated or separated from other children because when you don't know, you're suspecting that there's something not right but too, and you don't know what it is. And so you're actually wanting to be able to separate, so in hospital we call it isolate but also too, you want to have them in eye view, so you're keeping an eye on them at all times so that you, they can monitor. It may be that the whole system of actually putting them in an area the way they could be quiet. So being comfortable. You know lying on a cushion, being in some place where they can actually just lie down and rest.

Being able to monitor them and being able to assess if they are on medications and or asthma and all those things is actually following the guidelines and the management plan that you've negotiated with the family, to do, you know to look after those children and being able to do. And also as you know, you'd be contacting the parents to say, you know, Claire's not well today. She's just, you know, a bit quiet. She's not doing what she's doing. Is there something on, plus you're actually describing those symptoms that are actually happening. So the parent is aware. Unfortunately, you know, in this day and age parents become really frustrated of having to pick up children earlier than they need to, but it's really important, the best place they can be is with their parent, so that their parent actually knows them also, but also to that they're taking them to the GP or having them assessed elsewhere.

Again, if a child is really unwell, then it is that... the important... and they're increasing deterioration so if you actually... they've gone and had a lie down and they've fallen asleep and you go to wake them up because it's morning tea time or alike and the child doesn't rouse, then there's something really wrong with this kid, you'd be actually calling an ambulance and being able to go and get for them to be assessed. What's important again and has been reiterated is about documentation so that you're actually documenting what's actually happening, where you're putting it and that's about being able to recall that information that's happening but also to inform and to protect yourself, because you're actually saying well I put Claire over in the corner, she was only 5 meters away from everybody. This is what she was doing at 10 o'clock I looked at her, she had a cough, she had a vomit, okay, we, you know, we want to be able to do those things and this is about being able to provide the journey of that whatever illness is occurring for them. Unfortunately some illnesses occur quite quickly, some actually take a lot longer.

What's really important is that cleaning, again, if the child's actually had a lie down on a cushion or alike, it's actually taking the time when that child has gone home or being sent, taken, picked up by their parent, is actually about cleaning that surfaces and areas that are there. There are pathogens or infections that actually stay on surfaces for quite a while and I'll go over those a bit later to talk about that and, so but it is about making sure that you're doing appropriate cleaning for what's going on in that area.

So then really it's about how if this child was unwell and again depending on the symptoms that they have and depending on what's happening, it is about that exclusion and being able to communicate that to parents that it's there. And I know that you've got guidelines, so through public health units, but also through your regulations about how long children will be, and staff, should I say, be excluded away from being in your services? So that you're not increasing that spread of infection or alike. So if you think about something like gastro, which we are in the season, so change of season at this moment, that you, you know, all regulations and all guidelines say that people need to stay away for 48 hours and when they no longer have those symptoms. So it's about and that's including staff too because this is about withdrawing that the increased risk of that infection to other people but it means that you're actually protecting other staff, other children and alike so, and I'll talk about this, more about gastro in a moment.

So there what's really important is to be aware of those guidelines and those guidelines actually help you with that communication with parents because it's not about, you know, the difficulty is trying to negotiate with a parent and saying well he's fine now, you know, well he didn't have that this morning, he's got gastro now, and he's got to stay away and why two days and why other stuff and it's actually not two days from you know, that loose bowel motion that they've had or the vomiting that they've had, it's you know, because often, and we have had it, is that parents will go well, they stopped vomiting at nine o'clock, but their bowel motion stopped being loose at three o'clock. Well, I'd be going for the three o'clock and 48 hours from there. So it's not about the nine o'clock in the morning mark, it's actually when actually they have been symptom-free and that they are pretty much on that road to recovery and where they're at.

Things that are really important for you to consider is about ensuring that you're consistent with your message to your parents and carers because what's really important is that you don't want to be seen as favouritism or bringing a child back who actually is still unwell and actually can shed that infection quite easily through the child care centre and then take everyone out. And I suppose what's really important for you, it is about conflict resolution too, because it's acknowledging the parents frustration that their child is sick, they caught it from this child care service and how come I have to exclude my child. It's about listening to that.

There's no answer it is about how do we reduce that in risk of infection moving. So things that are important to think to in regards to prevention of infection and that transmission to one to the other is really about hand hygiene. And as I said at this moment, earlier is that if we're in that gastro season now, we're fighting to come out of it because we're getting it's getting warmer, but also to your hand hygiene is something that you would be doing five million times a day and with what you're doing in your work, you know before and after toileting, before and after changing nappies, preparing food, doing... being able to look after yourself, not just children that you're there and it is an amazing opportunity of what you do to actually teach children a lifelong practice.

This is an amazing opportunity you do, you know, my hands are up to you because you do an amazing job in regards to teaching children how to wash their hands and it means that they're going you know, and so they then go home and I've seen it, is that they'll then teach their parents. I have to wash my hands because I'm about to eat my food. I'm about, I have to wash my hands because I've been to the toilet. I've gone, I'm about to wash my hands because I've played with that dog. And so I actually think that you know hats off to you guys. It's an amazing job that you do and you know, it's something that from infection control as I said, if you can't, you know, can't think of anything that hand hygiene is one of the most important things that you'd actually be doing and there are you know, if you've not got all those lovely posters around and bits and pieces about hand hygiene there's lots of resources that are available and I'll give you that information in a moment.

So the other thing is about you know about that prevention is about the exclusion and being aware of what the regulations say. Immunisation is also one of those important things of managing and preventing diseases and that spread of disease. If you're not aware that measles at the moment is going rife through the US. We have had and at the moment here in Australia, we've actually had many cases of measles and it's often been young people from their ages of about 27 to 35 who actually only had one dose of measles vaccine and that they've actually they've actually been in contact with somebody who's actually not being able to, who's brought it into the country they've travelled themselves and alike so even not only for children but also for staff your immunisation schedule is actually really important to do and there are resources that all you would have had access to about who needs immunisation, what immunisations you need and alike so that's there.

Also introducing a cough etiquette so that you actually have really aware of what's happening and again another opportunity that you get to teach coughing to children and being able to do that. And because it's it's no good when a child is already in hospital really sick and going I just want you coughing in your elbow, they're going like yeah, no, [coughing sound] coughing everywhere because they're actually that unwell to actually think about anything. They just want to get a breath in they want to feel better. They don't want nauseous. They don't want to be sick. They don't want a fever. So this is a really a great opportunity for what you actually do.

The other thing is also is about the appropriate cleaning that you do in your organisation and being able to follow guidelines and making sure things are clean and being able to do. What's also important is about the notification and being able to, you know, look at the guidelines of what you need to follow being able to make sure that if you have, you know, for public health, it really is about a vaccine preventable disease. So what's on the immunisation schedule, so things like pertussis, measles, mumps very rarely rubella, but you know chicken pox, those things are actually if you've got a child who turns up or who's been in contact with someone you might want to ring that 1300 number to have a conversation with them because they're going to tell you the appropriate actions to take. So it is about making sure that you do that. So why and I also too it's not only notifying public health at the same time you're probably going to be making that other phone call to, yeah, Early Childhood, sorry and Regulation Authority so that they actually are aware that there are things going on. And so and I always say if in doubt make a phone call, have a conversation with someone, make sure that you're actually on board, and it's also too about, not... it's about you know, staff members communicating with the director or manager of services so that that information happens so that something doesn't occur and someone goes all that's happened two days ago. You want to know to want to know now you want to keep an eye on those and being able to do that.

So in these resources that are here, this is, a lot of this you would have access to already and you probably already know. So things are the Department of Health fact sheets, which actually helps you with providing information to parents and families and also to, parents can actually access that too. So it has a lot of childhood illnesses that are there and it means that they are actually providing that information and backup information, especially if he's having to say to a family, I'm, your child needs to be excluded for 48 hours for a gastro symptoms. And it means that they're actually, you're providing that backup information and not just pulling, you know, you're not being accused of pulling a number out of your hat, it's nice clear. It's consistent.

So in child care services as well as hospitals for staff and patients, it's exactly the same. We sit with the same and aged care facilities. Other ones that are there, you know your information in regards to immunisation. I'm sure you are all really aware of currently the gastro pack for child care services, and if not take it, it's an amazing, if you've not read it fantastic resource. And the reason why I say that it's got information in there about what your cleaning solution should be when you're you when you're mixing bleach and water instead of just splashing bleach in regards to cleaning. It's about you know, a really small amount is like 25 mils of bleach and 1 litre of water and you use that for whatever you're needing to clean at that time to be able to be to be used.

Also got really good hand hygiene colouring in sheets. It's also got hand hygiene so you can actually make charts for your areas that are there. It's a really good resource got the 1800 number that is in there. And it means that you've actually being able to use the resources that are available to you for free and it means that it is you're not having to reinvent things. You're going to adopt these guidelines straight away and say we're going to follow this and it's actually quite a good path.

Notifications, you've also got from the Australian Children and Education and Care Quality Authority. You've got their guidelines about what you need to do in regards to notifying Public Health also and being and what's also helpful, I mean it is the fifth edition and it's 2013 is the staying healthy in Childcare Center. That's a really good manual to use and it is, you know, even though that it's still there but using the New South Wales health information that you get but also too, these guidelines are really handy to use and to be able to resource to be able to do. The immunisation toolkit, which is something that you'd be doing when you're asking parents to fill in all that information about what their immunisation status is when they're signing up and also to you've got, you know, the immunisation resources that you will be able to provide to parents and alike for what they do. So it's handy.

So what I'm going to just do is go through over a few little diseases and things and be able to provide some information for it. So as I said we actually, the additional resources that will be with the webinar goes over how diseases are spread so droplet contact and and skin contact and alike and airborne so that you just get that background and I know that you would know this. It's also summarised in this early staying healthy in childcare centres. So gastroenteritis, what a... what a year... foof. It is very common in paediatrics and in children, sorry and using the term, and often it is caused by a virus by bacteria or parasite. So in pathogens are actually build to the, you know, bind to the stomach lining and causes an inflammation and then we get gastro. So then comes out with that the nausea and with vomiting and alike it means that we actually, what happens is that children lose fluid very quickly because they vomit they'll have explosive diarrhoea. They'll actually become very unwell, very quickly.

So when we look at viral, viral tends to be more common in winter and changing of the seasons which we've just had, so in our hospital we've actually had lots of kids coming in with Norovirus which is far far far, it's a virus spreads really quickly highly infectious means that we actually looking at where we isolate children. And so we keep them apart from other children to be able to look for that. Often we'll start with vomiting. So it is that you know, I feel sick and start vomiting instantly it often is a quite quick onset virus. And then basically the watery stools can actually follow. So often and they can have abdominal pain and fever but you know, it's not as high as if it was a bacterial bug. It can usually last for three or four days. And again, it depends on the child. So this is when a parent says oh, yes Johnny's better tomorrow, you know, you've sent him home because he's started vomiting and had a bout of diarrhoea and they go and he's back the next day. One, it's against the guidelines and two, you like the recommendations of exclusion, but two it's also about how you know, you want to look after everybody else. I've that's around and it is, you know parents go they're okay, and it might be like, yeah no, it's not, because and that's why the guidelines are there for that.

Some bacterial bugs will actually cause vomiting and diarrhoea but also to it is that really intense abdominal pain curling over really quite sore with fever. And again that they can, their stools can become quite mucusy and with blood in it. That's when there's actually some other thing going on for them and often it's actually bacterial is often like connected to a type of food poisoning. So they've actually ingested something that's contaminated and for us at hospital we actually have a busy season around about February where children have all come back from overseas holidays and they've actually eaten something, come home and then they end up with salmonella and that's there.

Transmission for gastro is often person-to-person contact. So that's why it is so infectious and why it can and it actually... high-risk areas are child care services and well, aged care facilities, but it is about how do we get a large number of children together and you're the services that actually do that. And it is often that a somebody's feeling unwell, they may actually ingest that, so sharing of toys, you know that actually haven't been in cleaned between children is really important and viral gastro actually spreads really quickly and through and can go through like wildfire. So it's really important as you know that we actually isolate or we separate these children away from other children until they can actually go home in child care centre. And the reason being is that you're not just going to have one child who's got vomiting and and and then eventually goes to diarrhoea they actually, you'll start having five six seven staff members and alike that's there.

So signs and symptoms would actually be the frequency of number of stools and the type of stools that you know, and the volume that especially that they're not making it to the toilet or accidents accidents that that rush of sudden wanting to go to the toilet. Watery loose with vomiting or nausea together. Some will have abdominal cramping, possibly fever, but not always. Headache and the headache is often because of loss of fluid and being generally unwell with that weakness and lethargy. Things that and the viral gastro is what actually has been going through a lot of child care centres.

As of say the end of the season is, you know, and Norovirus is one of those really good examples. Norovirus highly infectious starts with that single vomit and it can come on as I said as sudden sudden sudden onset and what that means is that with that child who's actually vomiting when from infection control perspective we call it this is a an infection that is droplet and contact so droplet, so they're vomiting, the vomit airalises that you know, small drop particles. We're standing next to them trying to help them and you know, there there comfort them or, you know doing all those things that we're actually inhaling what they're vomiting and that we can go down within a short period of about two hours. So vomiting comes first followed by diarrhoea and it actually can be quite quick and sudden, as I said. It's what I've, like a low infectious dose. You don't need much for Norovirus to actually go through a Childcare Centre or a ward really quickly because it is just so infectious.

And then again, it's that contact of being, you know, helping change nappies cleaning up vomit helping toilet children and alike. Hopefully that your toilets might have lids on them so that when and you're also teaching children that when once they've been to the toilet is that they closed the lid before they push the button because again if they've got loose stools are alike what is actually happening is you're pressing that button and again you're airalising all of that that fluid and water that happens with that and it means that you're actual and it's also sticking on surfaces. So Norovirus is one of those is an acute... acute virus that actually will stay on surfaces for a really long time. So I think I read that Norovirus can stay on paper for up to three weeks.

So [laughs] don't worry about that, hand hygiene is so important cleaning of what you're doing is actually is really important to be able to do that and it is about making sure that you're you know, what you're doing is what you're doing and if you look at the guidelines, they talked about doing a bleach clean and being able to clean surfaces. So with your soap and water and being able to clean with bleach is really important to be able to to manage that and again, what you do in childcare is what we need to do in hospitals and we do exactly the same. We isolate we, fortunately have masks because of what the work that we do, but also too, we wear gloves appropriately, we clean we clean our hands, we're cleaning surfaces and the like to ensure that we're reducing that spread of infection that is around. And it is, unfortunately what happens is that you have to document staff, if you start feeling unwell, I would be seriously thinking of your strategy on possibly going home and how you would get there. So bacterial, lot easier and nicer one to handle is more because it is just purely about how if you're handling, poo, you know nappies or anything like that more bacterial and that you're actually making sure it's often by contaminated food or fluids and ingested that way. For you it's what's important is again hand hygiene cleaning of your surfaces and alike.

The last one is often if people get a parasite and they ingested as again ingested parasites in what you're doing. I can't believe I'm doing this just before lunch [laughs] hand hygiene is being able to do but it is a note of like and again if you've got any suspicion of a child or anything of gastro any type of gastro you're ringing you're actually going to ring I know, isn't it a great picture and you know you want to be able to make sure that you're notifying Public Health, you're actually ringing and asking what do I need to do? Do I need to notify you? This is what's going on and it's not just what's happening. You might say. Oh, you know, I've got a kid vomiting and again the 48 rule stands so that you actually know what's happening.

So in your gastro packs, and as I said, if you haven't read it, do read it. Get your staff to read it, because it is your action plan of what you need to do and as it's got there really nicely, you know informal staff, don't forget about the cleaner or the lady who's making lunches and alike that there's a problem going, you know Houston, there's a problem... you want to actually make sure that you're actually following the guidelines. It's nice and easy. It's nice and clear. Notify, implement your infection control measures. Being able to display the signs, being able to contact Public Health. 1300 number they put it everywhere so that it's there inform your parents. It's about how do you get that information out. Being able to complete your illness register that you've actually got and again that's about protecting you in that documentation.

I think one of the biggest things is about making sure that if it's, you know, where it says sorry informed Public Health Unit, if three days have passed since the child staff had stopped vomiting and that's about trying to close that they close the loop on their notification and what they do and being able to, you know, remove that... feeling comfortable to remove that sign so you've got to be able to notify because the thing is parents will really quickly say to you you haven't let me know you didn't inform me that there was a problem. So it's all those things about making sure that one you're covering yourself in that communication strategy that you've got for people to be able to do.

So the other part is that you, I do know that public health will actually send out notifications and you'll actually get that information through your services and your authorities that that communication that there is a problem. So often you might, the two things that might come is that there's a gastro outbreak in your area. It's a change of season and also too that there's an increase of respiratory illnesses that are there. So this was just to really about making sure that you know, people are aware of what's going on in their community. And and being to be alert of what they're doing for those areas and alike, so I'm not going to spend a lot of time on respiratory because I think you've had a lot of background in regards to from the asthma educators that they've actually done some amazing giving you great information.

But what I wanted to show you here is that this is what's been going on with respiratory infections this year. So as the ladies talked about is that you know, they've shown you the pictures about respiratory and for asthma but it is very similar. It will cause symptoms of being you know, tightening of and inflammation. We often get peaks, well, they... ha... I always laugh and go peak in winter and early spring. We've actually had it all year. We're getting a lot of children that are admitted to the hospital with bronchiolitis. So they don't put the name on the bug. They're just showing that this is an inflammation of the bronchioles and it means that children are needing info and support in regards to their breathing being able to look at but for us for infection control is about trying to reduce that spread from one child to another and being able to do.

So as the girls also talked about or rhinorrhea like that runny nose poor feeding because actually having trouble eating and breathing at the same time. That they'll actually look at the cough the sneezing the fevers and and all the other symptoms that have actually been described and shown in those videos that you've already seen. All of those so not... does not necessarily mean asthma but there is a respiratory illness that actually causes very similar issues that are there.

So I wanted to talk about one that again is on our immunisation schedule and then basically we want to talk about so pertussis is a main one. So again, we vaccinate against this. It is a droplet infection so it is about that to person coughing in that area and being able to spread it is not just children who get pertussis, you know, I hear people say, oh my GP caught it that I've got the hundred day cough. It means that you've actually had pertussis. That also means that you've actually been infectious for up to 21 days and that you've spread it with everyone that you've had. So pertussis again is one of those infections breathed in quite when you're nearby someone who's coughing in your general direction, but also too that you can get it by, you know, if you've some a child or somebody's blowing their nose you pick up those dirty tissues, you've touched that surface that they're on, all those things and actually touched your face. Those are the areas that you can put yourself at risk.

And again when we're vaccinated we do, you know, we still can get a mild version of it. Will not last as long but it means that because no vaccine is a hundred percent effective. But it means that we're actually, the majority of us are protecting that each other. In children when you've got an immunisation rate of around about 94-95 percent. You're actually doing a lot better in trying to do that herd immunity, but it's when we're adults that vaccine weans we need to think about our own immunisation, we also need to think about the testing so that we're not introducing diseases into our workplace, to be able to do that.

So as I talked about is that with pertussis infection, you can be infectious up to 21 days and incubation period can be 4 to 21 days, but to me, depending on when you were exposed, so if I had pertussis and I was here beautifully, you know coughing, these ladies and gentlemen in the first row could be at risk and then they'd be going, oh god... I've you know, I've got this awful cough I've been to the GP, they diagnose where, you know, Pertussis where did I get it from. Means well, you'd be going tracing back that girl who was actually up there presenting and coughing on splattering all over us. It's all those things and that's how easy it can be done.

Again, you know, and again if you if you've got children who are, have been exposed to pertussis and have had and the appropriate antibiotics. They could you know, the antibiotics is only for five days, but they will continue to cough for up to a hundred days because it is, you can't, you're just getting rid of by having antibiotics you're getting rid of the infection, but you're not getting rid of the symptoms. So they will still cough and that's where that conversation with parents about have they had antibiotics? What did they have? When do they have it? Because your parents are going to say but Claire's coughing all the time and what's going on with her. Well she at you know, and then you think about how you maintain confidentiality and go, you know, she's actually, she's not infectious. We know we've got a letter from the GP we've had appropriate treatment and alike. But it is, and it's the same with adults if you happen to have it, you know pertussis antibiotics you will cough up to three months. So it's those things are being aware of what you're doing.

Again, what's really important, and this is really about just respiratory is again thinking about your cough etiquette and having that opportunity to teach children how to cough appropriately and there are lots of signs around and and being able to do that. And remembering that hand hygiene, again is one of those things that are really important if somebody's going to cough, blow their nose, disposing of tissues, so teaching children how to dispose of their own tissues and alike and then being able to then wash their hands appropriately. So they're not they're not going off and playing and realising that infecting everyone else for that.

So I wanted to just bring to discuss measles. With our immunisation rate of around about 94-95 percent what children are actually doing pretty well, it's us adults or younger adults, not as old as I am, but measles is actually a vaccine preventable disease, highly highly infectious. So with all these doors closed and let's just assume that none of you have been vaccinated or had the disease, but I had it I'm sitting on we're all sitting on an airplane. We're flying somewhere nice. I just have to breathe, don't even have to talk... you're all at risk. That's how infectious measles is. That's why measles at the moment is a huge issue in public health. So when you see on the TV that there's been an airplane from New Zealand, a 27 year old who's come back from holidays being flying over and being to multiple venues. That means it all those people are actually at risk so it is about how do we actually do it? So measles is highly highly infectious and it is about how do we manage that to be able to do it.

For children, they do come out with a rash. So if you've got a child who's come with a rash first thing you're going to do is you're going to bring the parents and get them to pick up the child and take it home. Then think about what you're actually doing and isolating, mind you children again, you know again, we're being able to do that notification. Talk to Public Health. They'll actually, you'll be giving details of who that child was. They're going to follow that where that child's been, they're going to talk to you know, when if the child is actually got measles then the first question that gets asked to parents is what childcare centre do they go to, where did they hang out? What are they done with that all those things. And again, it's stuff that stuff that's really important.

So with parent and also for staff, they need to know their immunisation status. They need to know that if they've had one or two doses of measles vaccine containing vaccines and being able to do the right thing. But again like measles every infection starts out with red eyes runny nose, dry cough fever irritability lethargy and can be able to do that. So but it's those things that are actually really really important. That's there. I think what's great is that the New South Wales Health fact sheets. All this information is there and it's nice and neat and it's in a nice way of being able to do that. People can be actually infectious up to 3... 3 to 5 days prior to coming out with a rash, but that's when you start, you know, staff and children or more-so staff because we they talk more, is that they'll actually say oh, I just got a bit of a headache... Oh, I just feel a bit rundown. Oh, I just feel like I'm doing that.

Yeah, I know... Chickenpox is another one vaccine preventable. The hardest thing is that when we have, and as we get older that we actually have... [laughs] I'm looking at the faces... [laughs] that again highly infectious spread through droplet because people are breathing in that area but also contact because they're actually red eyes runny nose, dry cough blowing their nose putting on surfaces sitting on surfaces and alike and being able to do that. But remember that even as an adult, shingles is another like is came has been developed from or not been developed has come from chickenpox. So when I was a kid, I had chickenpox. It sits in my nerve ending. It can be triggered later in life. If I'm highly stressed unwell, immunocompromised or alike or being exposed again, and it actually can cover come out in pastoral and partial soars again big rash and being able to do that. Again, it's about that exclusion period of all those things that are really important and following the guidelines.

Meningococcal, again, we're in that we're about to come into that season again of meningococcal what happens is, it comes at the change of season around October November December and we actually monitor that really closely and it's about the disease itself. If you've got a child that comes into child care with a rash that you happen to be, you know, changing a nappy or you just lift their shirt or see something or they go I don't feel unwell, you would actually be ringing parents and going this is really important stuff that we need to do. Impetigo, so again, you would have that, you know, your lovely sores that you know, it is a Streptococcus infection, but it means that what's really important for you is again children who have got anything, you know, we're very children under 18 months very oral with what they do, but also to it just doesn't mean that stays on one part of their body of what they're doing. And again, it is about excluding, treating, and being able to do.

Hand foot and mouth. You've all seen that haven't you? [laughs] And it means again it is that contact and droplet. They've got runny nose, they're actually being able to do it kids touch other kids other kids touch other toys being able to do that for that for those things that are there. And being able to make sure that parents are actually aware of what they're doing for the right thing excluding those children are really important cleaning environmental cleaning for your services is so crucial about reducing that information for infection. Parvovirus, slap face, flat slapped cheek, that's my favourite because kids can be with big red cheeks, and they've got fever, now just look, you know irritable and the like but again runny nose, dry cough, can feel unwell being able to do that.

Again the biggest thing that is really important for you is to think about hand hygiene. And this is why I think you know, I thank you for teaching children to wash their hands, you know, and that they actually then spread that to all that they've got. Herpes and again, it's really quite painful to for children, but you might get a child that comes and they develop and it might happen so quickly over the day... that's there. It's also important for staff. So it's not just children to exclude. It's about staff and having those regulations of what you do for that.

Always as I said, if you can't think of anything by today 1300 number from public health, but also to wash your hands and what I want to take away because I know that you're about to eat and I think it's really important [audience laughter]... Is yeah I seem to always get this... Yeah, wash your hands and but also to I want you to think about what what is it that you need to implement in your in your organisation about managing infectious diseases and communicating that with staff making sure that everyone, you know says, you know oh, Claire's just been to the toilet now is you know, it was watery and she's vomiting and feeling really nauseous. It's about their communication to everybody and letting everyone know what they need to do.

And also too, it's about how do you maintain that confidentiality of providing that information about not saying, oh, well, it was Claire again who brought that infectious disease into the to us and shut down our child care centre. You know, how dare she because it would be like, you know, it's... we all get viruses. We all get unwell, but it's about how we actually reduce any infection to one to the other. Any questions or comments? I think you're all just need to wash your hands and go and eat lunch. But thank you. Cheers. [audience clapping].