Whose responsibility is school hygiene?
The overall responsibility for the health and safety of pupils and staff in schools rests with the employer. This is the local authority for maintained schools, the academy trust for academies which are part of a chain, and the governing body for foundation, voluntary aided and free schools and stand-alone academies. Employers therefore should recommend hygiene procedures for schools to follow. They should also provide further information and training to head teachers, who are responsible for day-to-day management of health and safety in the school, and other school staff.
It must be remembered that although teachers have a duty of care towards the health and safety of pupils in their care, they cannot be obliged to assist with cleaning-up procedures or administer first aid or medicines. The NEU does not favour teachers becoming involved in matters such as these. Instead, procedures should be in place whereby they may notify another member of staff who will deal with matters.
Hygiene and blood-borne viruses
HIV and AIDS
HIV and AIDS can only be transmitted by the introduction of infected blood or blood products into the bloodstream, through sexual intercourse, and from a mother to her baby either during pregnancy or by breast feeding. There will be children in all schools carrying the HIV virus. It is important that the issues surrounding HIV are understood by staff to ensure that any children with a diagnosis do not receive detrimental treatment.
Hepatitis A virus, or infective hepatitis, is a common infection that mainly affects children and young adults. The illness is caused by an infection in the faeces and may be passed from one person to another by contamination of the hands with infected faeces, which may lead to the germ being introduced into the mouth. Although symptoms can sometimes be severe, in most cases they are so mild as not to be apparent. Unlike hepatitis B there is no evidence that the disease results in a permanent carrier state or permanent damage and although the infection is difficult to control, its spread can usually be reduced by simple hygienic measures.
Hepatitis B virus is much more serious, resulting in a permanent carrier state and with a risk of permanent liver damage. The virus may be transmitted through spittle or blood contact. High-risk groups are people requiring blood transfusions, long-term hospital patients or institution residents, and those with natural or acquired immune deficiency. Down’s syndrome children are known to have a higher carrier rate because of a deficiency in their immune system.
School staff can be at risk through contact with children with high-risk groups. An effective vaccine is available and the Department for Education (DfE) has recently recommended that this be considered for staff working with such children. The NEU believes that the vaccine should be offered to any staff who feel they may be at particular risk. Carriers can be identified through screening but generally health authorities are reluctant to screen children and parents also may be unwilling for their children to be screened.
The hepatitis C virus was discovered in 1989 and still very little is known about it. Like hepatitis B, it is spread by blood contact and can cause long-term liver damage. About 50 per cent of those who contract the virus become chronic carriers. There is currently no vaccine against hepatitis C because the virus comes in many forms and can transmute.
Diarrhoeic and vomiting illnesses
There are a range of illnesses which can cause vomiting and diarrhoea including dysentery, salmonella and E coli infection. They vary considerably in severity but in all cases effective hygiene control procedures in schools can substantially reduce the risk of infection and transmission.
Hygiene control guidelines
The following sections set out the basic hygiene procedures for schools recommended by Public Health England (PHE) in Guidance on Infection Control in Schools and Other Childcare Settings. These procedures should be followed by all schools at all times in order to effectively control the risk of infection.
The PHE guidance contains the following advice:
- Effective hand washing is an important method of controlling the spread of infections, especially those that cause diarrhoea and vomiting.
- Always wash hands after using the toilet and before eating or handling food. Use warm, running water and a mild, preferably liquid, soap. Toilets must be kept clean.
- Discard disposable towels in a bin. Bins with foot-pedal operated lids are preferable.
- Encourage use of handkerchiefs when coughing and sneezing.
The NEU recommends that schools also adopt the following additional procedures:
- Razors, toothbrushes or other implements which could become contaminated with blood must not be shared.
- Minor cuts, open or weeping skin lesions, and abrasions should be covered with waterproof or other suitable dressings.
- Nappies and sanitary towels must be burnt in an incinerator or securely bagged and sealed, and disposed of according to local guidance.
- Tampons may be flushed down the toilet; however, it is advisable to dispose of them in the same way as sanitary towels. Local guidance should be followed.
Cleaning up body fluid spills
The PHE guidance contains the following advice:
- Spills of body fluids – blood, faeces, nasal and eye discharges, saliva and vomit – must be cleaned up immediately.
- Wear disposable gloves. Be careful not to get any of the fluid you are cleaning up in your eyes, nose, mouth or any open sores you may have.
- Clean and disinfect any surfaces on which body fluids have been spilled. Use a product which combines a detergent and a disinfectant.
- Discard fluid-contaminated material in a plastic bag along with the disposable gloves. The bag must be securely sealed and disposed of according to local guidance.
- Don’t use mops to clean up blood and body fluid spillages. Use paper towels instead.
- Ensure contaminated clothing is laundered at the hottest wash the fabric will tolerate.
The NEU recommends that the following procedures be adopted to deal with injuries in schools:
- A senior member of staff should be responsible for receiving reports of accidents involving staff and children. Even the most minor incident should not be overlooked. Reportable incidents should include: contamination of cuts or other open skin wounds ie those where blood has been drawn, by blood, spittle or other body fluid; splashes into the eyes or mouth of the same; or cuts and scratches inflicted by a child.
- Normal first aid procedures should be followed, which should include the use of disposable gloves and, where splashing is possible, the use of suitable eye protection and a disposable plastic apron.
- All wounds should be washed immediately in copious amounts of soap and water, treated with a disposable disinfectant tissue and covered with an appropriate adhesive dressing. Any existing wound which has contact with other blood, spittle or other body fluids should also be washed with soap and water. If the accident involves the eye or mouth, this should be washed thoroughly with water.
- Splashes of blood, saliva or other body fluids on the skin should also be washed off with soap and water. Where any of these enter the eye or mouth, this should be washed copiously with water.
- Where there is a risk of contracting a blood-borne virus, the employer should provide adequate information and training in the potential risk and protective clothing and equipment as necessary eg disposable gloves, aprons, medical tissues and disinfectant.