Robert Barnett, North Coast Area Health Service, Clayton Abreu, Tropical Population Health Service, Queensland Health, Dianne Penberthy, Macksville Community Health
My name is Robert Barnett and today I will be discussing the Mister Germ Hygiene and Nutrition program.
I work for North Coast Area Health Service which is located on the North Coast of NSW. This is where the Mister Germ program kicked off in NSW and during my presentation I will refer be often referring to the North Coast. I would like to note here that this presentation focuses on the program being delivered to preschools not primary schools.
The North Coast of NSW has experienced ongoing outbreaks of communicable disease in children aged between 0-5. Back in 2006 over 25 children from one preschool became ill with gastro symptoms and this preschool requested assistance from the public health unit on how to manage the outbreak. It was identified that this preschool needed hygiene information for parents and staff and it was felt a handwashing program would benefit the preschool. Young children, especially those in child care are particularly vulnerable to infectious disease for several reasons, exposure to germs in group care, immature immune symptoms, they participate in behaviours that spread germs, like thumb sucking, putting objects in their mouths, and lack of control of bodily fluids.
Also back in 2006, Aboriginal Health requested assistance from the Public Health Unit in resolving outbreaks of communicable disease in several local Aboriginal communities on the North Coast that where particularly affecting children and the elderly. In my role as an environmental health officer, I undertake community environmental health consultations and visited these communities experiencing illness. These communities have many environmental issues including inadequate housing, overcrowding, waste issues, un-maintained sewerage and water infrastructure, high dog numbers and limited pest management.
As a disease prevention strategy the Public Health Unit decided that a hand washing program needed to be established in local schools that is culturally appropriate for Aboriginal children.
Back in 2006 there was no NSW Health hand washing program available targeting Aboriginal children.
However, NSW EHO practitioners that had previously attended the National Indigenous Conference learnt of the Queensland Mister Germ program and felt it may be adopted by NSW. As Clayton mentioned permission was granted for the program to be implemented in NSW. A partnership was formed between various health services within the North Coast Area Health Service and a local AMS to establish how the Queensland program could be adapted for New South Wales. The Queensland model runs over 3 years in primary schools by environmental health workers, however we do not have this staffing model so therefore at this stage it was decided that the program would be adapted for preschools and only delivered to primary schools on request.
I will briefly discuss the program’s components that assist with meeting the programs aim and objectives, the first component being communicable disease information. Schools that participate in the program are provided with the latest information on immunisation, health factsheets on communicable disease i.e. boils and prevention information e.g. nappy changing and cleaning sandpits. This information can also be passed on to parents.
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The second component is the Mister Germ program presenters' activities guide. This guide was modelled from the Queensland presenters’ guide, however was designed to suit preschools. The guide contains a variety of physical, visual and verbal educational activities that show students what germs are, how they spread sickness and how this can be prevented.
Each activity has its own aim and some are compulsory and others are optional.
- introducing Mister Germ
- washing hands activity
- insects carry Mister Germ onto food
- wash my fruit
- put rubbish in the Bin
- patting the dog
- ball activity
Schools may develop their own activities. One school introduced the use of glitter to illustrate the spread of germs and another school has developed an activity called ‘micro nasties’ which encourages children to take their medicine.
A resource kit is provided with equipment and materials to run the activities. Estimate cost of each resource kit is less than $1000, however this does not include the cost of the costumes. However it is possible to run the program without the costumes. The majority of the funding for the program has been sourced from the NSW Aboriginal Environmental Health Branch.
The above picture is taken of the equipment used to deliver the Mister Germ program. As you can see the kit contains many items including the Mister Germ and Germinator Costumes. The Germinator character is a newly created character suggested by a local Aboriginal Elder, Martin Ballangarry.
The Germinator is a good character who teaches children about germs and Mister Germ is a bad character who spread germs.
The posters were updated, good and bad picture cards were designed and promotional items such as stickers, pencils and rulers were purchased.
This program tries to teach children about good and bad germs. We let the kids know it’s ok to play outside and get dirty but the program strongly encourages the children to wash their hands after going to the toilet and we use aids like a toilet seat and glow cream to show the pretend germs on a toilet seat.
After running a series of activities with kids we hope they use soap and wash their hands.
The nutrition component of the Mister Germ program was developed in partnership with the Port Macquarie Dieticians department and is called the Great Lunch Box Dilemma. This resource was sourced from the Department of Health and Human Services, Tasmania. This resource is provided to the preschools in a template format that the preschools can use and display.
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A display board is used to give a visual presentation of healthy lunch box ideas aimed at the parents to see when they come to the preschool.
An example of one of the pictures is of the cost per 1kg of rollups compared to the cost of 1kg of apples. This program aims to hit parents in the pocket. The Mister Germ program is flexible in that any local nutrition program can be incorporated. The idea is to utilise existing resources.
Another component of the program is food safety. On the North Coast of NSW we offer an existing local food safety program in conjunction with the Mister Germ program. The program we use is called ‘Junga-Marlannggu Yurall’ meaning ‘Proper Handling of Food’ in the Gumbaynggirr Nation language. This program was developed by the Regional Health Service Program to provide information to assist preschools to comply with the new Food Handling Legislation Standard 3.3.1 Under The Vulnerable Persons Act.
This legislation is not enacted in New South Wales yet, however it is in other states and territories.
It is still common practice in schools that kids blow out candles on birthday cakes so this part of the program provides information on this activity with focus on preventing the spread of disease.
Parents are still preparing food for the preschool children, meaning therefore it is unknown what ingredients are being used, and how and if any food safety precautions have been taken in the home environment.
In 2007 eight preschools across the North Coast trialled the Mister Germ program consisting of 360 children. Four of these preschools were Aboriginal.
All eight preschools recorded the daily number of sick children over two school terms, however only four schools were introduced to the Mister Germ program and the results were compared, unfortunately given the small number of children, the length of the program and period of the year the program was delivered there wasn’t much difference in the illness rate between the preschools. However the statistics showed there was a higher incidence of illness among the Aboriginal preschool children compared to the non-Aboriginal preschools. On one particular day 49% of children from one Aboriginal preschool were sick with running noses, gastro symptoms.
The evaluation feedback suggested there was a large increase in the frequency of handwashing among children and staff.
Schools are reviewing their policies around handwashing.
This program allows for EH practitioners to provide information on other EH matters e.g. lead, drinking water, copper logs, EH matters of interest to preschools.
There are potential research opportunities around this program to measure the impact of handwashing on reducing the spread of disease in preschool, however none are proposed at this stage. The PHU are happy in what the program has achieved so far. Current evaluations of the program is based on feedback received from the teachers, that has shown that staff and children have both increased their frequency of handwashing.
Just remember handwashing!
For more informationRobert Barnett
Environmental Health Officer
North Coast Area Health Service - NSW Health
PO Box 126, Port Macquarie, NSW 2444
Ph: 02 6588 2750 Email: Robert.Barnett@ncahs.health.nsw.gov.au