POSSIBLE CMV PROTOCOLS FOR CHILDCARE CENTERS

by 

Lisa Saunders

Most child care providers have never heard of CMV despite NAEYC: National Association for the Education of Young Children  including "a. steps to reduce occupational hazards such as infectious diseases (e.g., exposure of pregnant staff to CMV…”

Perhaps if the following protocols can be put in place, child care providers/teachers will reduce chances of contracting CMV:

1. CMV prevention education added to the licensing training. Childcare providers are typically trained in first aid, CPR, and other topics. CMV prevention should be included in training about preventing infectious diseases.  
2. Give each childcare employee/volunteer a CMV brochure (see Utah's brochure for childcare providers).
3. CMV prevention added to a childcare center’s handbook. See Staff Education and Policies on Cytomegalovirus (Caring for Our Children, American Academy of Pediatrics, et al.): "Female employees of childbearing age should be referred to their primary health care provider or to the health department authority for counseling about their risk of CMV infection. This counseling may include testing for serum antibodies to CMV to determine the employee’s immunity against CMV infection…Up to 70% of children ages 1 to 3 years in group care settings excrete the virus...With regard to child-to-staff transmission, studies have shown increased rates of infection with CMV in caregivers/teachers ranging from 8% to 20%...it is also important for the child care center director to inform infant caregivers/teachers of the increased risk of exposure to CMV during pregnancy.” Print Staff Education and Policies on CMV by clicking "Save as PDF" at: nrckids.org/CFOC/Database/7.7.1.1 

4. CMV information added to a New Staff Orientation Form. The form should be signed to show the childcare provider read and understood they should consult their healthcare provider about their risk for CMV. See sample wording below.*
5. CMV Prevention discussed at a childcare center’s parent orientation.
6. Signs about CMV prevention hanging in day care centers so staff and parents can see them (see CMV resources below).
7. See the guide,  “Infectious Disease in Child Care Settings Training Module version 3, revised 4/23/13,” at: https://www.ncemch.org/child-care-health-consultants/Part1/1-10_m_infectious_disease.pdf (citation: The National Training Institute for Child Care Health Consultants. Infectious disease in  child care settings version 4. Chapel Hill (NC): The National Training Institute for Child  Care Health Consultants, Department of Maternal and Child Health, The University of  North Carolina at Chapel Hill; 2013. )
8. Consider the protocol posted on the website in Queensland, Australia. They  relocate workers who are pregnant, or “expect to become pregnant, to care for children aged over two to reduce contact with urine and saliva.” See their list of safety measures in “Cytomegalovirus (CMV) in early childhood education and care services,” on the Workplace Health and Safety webpage. See: https://www.worksafe.qld.gov.au/injury-prevention-safety/workplace-hazards/hazardous-exposures/biological-hazards/cytomegalovirus-cmv-in-early-childhood-education-and-care-services
9. Potential Cost of Not Warning Child Care Providers about CMV: 
   In New South Wales, “a childcare worker and her severely disabled son were awarded $4.65 million. A Court of Appeal ruled that the child's disabilities resulted from the woman being infected with cytomegalovirus (CMV) at work (Hughes v SDN Children's services 2002)” (Queensland Government, Australia).  Meridian Lawyers stated: "The allegations of negligence were that Sydney Day Nursery breached its duty of care to Linda ...by failing to warn her of the risks of CMV in circumstances where the centre knew or ought to have known of the risks of CMV to pregnant women...” See their suggested policy at: www.meridianlawyers.com.au/insights/infectious-diseases-child-care-what-about-staff-members/, which states: 

   
   

   As a starting point, unless already doing so, operators of child care centres should consider taking steps to implement the following policies:

   1. Ensure that Staying Healthy in Childcare (or its equivalent publication) is always visible and accessible to staff at the centre.
   2. That the induction process for new female employees, whether pregnant or not, include drawing the employees attention to Staying Healthy in Childcare (or its equivalent publication) and in particular the pages regarding CMV and infectious diseases.
   3. That written confirmation be obtained from the new employee that they have read and understood Staying Healthy in Childcare and in particular the sections regarding infectious diseases.
   4. That upon learning that a child care worker is pregnant, the worker again be referred to Staying Healthy in Childcare (or its equivalent publication), and given time to read all sections regarding infectious diseases including CMV, and that this be documented.
   5. That upon learning that a female child care worker is pregnant, she be advised by the centre director to see her GP to consider the risks of continuing to work in child care and to take advice from her GP about undergoing blood tests to check for susceptibility to things like primary CMV infection.
   6. That pregnant workers be given the option or be restricted to work with toilet trained children, and that pregnant workers not be permitted to perform nappy changing or to assist with toileting.

   
   

   If you operate a child care centre or work in child care, please contact Tamir Katz  (tkatz@meridianlawyers.com.au) or Kellie Dell’Oro (fkdelloro@meridianlawyers.com.au) or more information.

*The book, Model Child Care Health Policies, includes a sample document to be signed by staff (paid or volunteer) to show “Acceptance of Occupational Risk by Staff Members,” which includes “exposure to infectious diseases (including infections that can damage a fetus during pregnancy)” (p. 116). The book states that programs should describe their commitment “to best practice, as indicated in CFOC3 [Caring For Our Children 3rd Edition, which includes CMV education]...A policy might specify intended compliance with accreditation standards, such as those of the National Association for the Education of Young Children (NAEYC) (www.naeyc.org) [which mentions CMV as an “occupational hazard”] for center-based care or the National Association for Family Child Care (www.nafcc.org)..." (page xviii). (Pennsylvania Chapter of the American Academy of Pediatrics. Model Child Care Health Policies, 5th Edition, Aronson, SS, ed. (2014). Elk Grove Village, IL. Copyright © 2014 Pennsylvania Chapter of the American Academy of Pediatrics. All rights reserved. Permission is granted to reproduce or adapt content for use within a child care setting. These policies are for reference purposes only and shall not be used as a substitute for medical or legal consultation, nor be used to authorize actions beyond a person’s licensing, training or ability.)

RESOURCES FOR EDUCATING CHILD CARE PROVIDERS/TEACHERS

·       CDC flyers: "Congenital CMV Facts for Pregnant Women and Parents" In English and En Español at: cdc.gov/cmv

·       Utah Department of Health, required by law to educate child care providers about CMV, has brochures in English and Spanish, “CMV What Childcare Providers Need to Know (English)” | “Lo qué los proveedores de cuidado infantil necesitan saber sobre CMV (Spanish)” at:health.utah.gov/cshcn/programs/cmv.html

·       National CMV Foundation: Wall posters: www.nationalcmv.org/resources/educational-downloads

Connecticut DPH logo in the “Are You Pregnant” poster by the National CMV Foundation at: https://drive.google.com/file/d/1AVG9RXGVsbBTwOImOb18NWDdG3rHbHbm/view?usp=sharing

Note: The Child Care and Development Block Grant Act of 2014 has created regulatory changes. The Administration for Children and Families published Caring for our Children Basics (based on Caring for Our Children) in 2015 to “align basic health and safety efforts across all early childhood settings." In the section, “Prevention of Exposure to Blood and Body Fluids,” it states: “Caregivers and teachers are required to be educated regarding Standard Precautions [developed by CDC] before beginning to work in the program and annually thereafter. For center-based care, training should comply with requirements of the Occupational Safety and Health Administration (OSHA).”