CMV PREVENTION TRAINING/RESOURCES FOR EDUCATION PROFESSIONALS, CHILD CARE PROVIDERS AND MOTHERS OF CHILDREN IN GROUP CARE
Top quick list
- CDC flyers in English and Spanish:https://www.cdc.gov/
cmv/resources/pregnant-women- parents.html - CMV Training Module for child care providers (University of Connecticut):https://youtu.be/
k9MFAEYVuLs - Workplace Safety: Cytomegalovirus Protection & Prevention an Issue for Daycare & Childcare Providers by Nellie Brown (the director of Workplace Health and Safety Programs for both the Outreach Division statewide and for the Buffalo Co-Lab of Cornell University’s ILR School): (Starts 3 minutes in) - https://youtu.be/z6S98AFC43I
- Utah's flier for child care providers: https://health.
utah.gov/cshcn/pdf/CMV/CMV% 20What%20Childcare% 20Providers%20Need%20to% 20know.pdf (also available in Spanish) - MN's: CMV and cCMV Fact Sheet for Child Care Providers
- The book, Model Child Care Health Policies, has 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)” (American Academy of Pediatrics, Pennsylvania Chapter, Aronson, SS, ed., 2014, p. 116).
- Texas Health and Human services: free online CMV training module, "The Virus Among Us: Protecting Texas Mothers and Babies from Cytomegalovirus".
- For Employers: Publication: Brown, N. J. (2019, November). "Occupational exposure to cytomegalovirus (CMV): Preventing exposure in child care and educational settings, including OSHA advisories." Ithaca, NY: Cornell University, ILR School. Download video workshop. This publication/presentation is by Nellie Brown, MS, CIH, Certified Industrial Hygienist, and Director, Workplace Health and Safety Program, Worker Institute, Cornell University – ILR School.
Child Care Providers
UCONN Provides CMV Training Video and Quiz
The University of Connecticut recently came out with a CMV training module for child care providers. The link to the video and quiz: https://aural.rehab.
Centers for Disease Control and Prevention (CDC)--advice for Childcare Providers and Parents of Young Children
"People who have frequent contact with young children may be at greater risk of CMV infection because young children are a common source of CMV. By the age of five years, one in three children has been infected with CMV, but usually does not have symptoms. CMV can be present in a child’s body fluids for months after they become infected." CDC: https://www.cdc.gov/cmv/congenital-infection.html#childcare-providers
Centers for Disease Control and Prevention (CDC): Resources for Pregnant Women
Employers:
Occupational Safety and Health Administration (OSHA): "Childcare and healthcare workers are among those at increased risk for exposure to cytomegalovirus (CMV)." See OSHA's webpage on CMV at: https://www.osha.gov/SLTC/cmv/
"Occupational exposure to cytomegalovirus (CMV): preventing exposure in child care and educational settings, including OSHA advisories."
Brown, N. J. (2019, November). Occupational exposure to cytomegalovirus (CMV): Preventing exposure in child care and educational settings, including OSHA advisories. Ithaca, NY: Cornell University, ILR School, Workplace Health and Safety Program. Retrieved from: https://
"Staff Education and Policies on Cytomegalovirus (CMV)," American Academy of Pediatrics, American Public Health Association, National Resource Center for Health and Safety in Child Care and Early Education. (Revised 2017). National Health and Safety Performance Standards: Guidelines for Early Care and Education Programs. Retrieved from Caring for Our Children: http://nrckids.org/CFOC/Database/7.7.1.1. You can download that page as a pdf by clicking on the upper right side of the webpage: "Save as PDF"
Acceptance of Occupational Risk by Staff Members: "Each staff member (paid or
volunteer) is required to review with a supervisor the following acknowledgment of occupational risk and
sign the statement to acknowledge and agree to accept the risk:
“I understand there are health risks related to working in child care. These include, but are not limited to, exposure
to infectious diseases (including infections that can damage a fetus during a pregnancy)..."
Model Child Care Health Policies (American Academy of Pediatrics, Pennsylvania Chapter, Aronson, SS, ed., 2014, p. 116). See: http://ecels-
National CMV Foundation: Educational downloads: https://www.nationalcmv.org/resources/educational-downloads
American Academy of Pediatrics (AAP): According to the AAP, children with known CMV should not be excluded from group care; "CMV excretion is so prevalent that attempts at isolation or segregation of children who excrete CMV are impractical and inappropriate" (Red Book, 2015, pg 145.) Red Book, 2015. Retrieved from: https://redbook.solutions.aap.org/DocumentLibrary/Red%20Book%202015%201.pdf
Centers for Disease Control and Prevention (CDC): Resources for Pregnant Women
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, Retrieved from https://www.worksafe.qld.gov.au/injury-prevention-safety/hazardous-exposures/biological-hazards/cytomegalovirus-cmv-in-early-childhood-education-and-care-services).
Meridian Lawyers of Australia 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..." Retrieved from: https://www.meridianlawyers.com.au/insights/infectious-diseases-child-care-what-about-staff-members/
Examples of CMV Protocols in Other Countries:
In Queensland, Australia, suggested control measures include: "relocating workers who are pregnant, or who expect to become pregnant, to care for children aged over two to reduce contact with urine and saliva" (Queensland Government). Retrieved from https://www.worksafe.qld.gov.au/injury-prevention-safety/hazardous-exposures/biological-hazards/cytomegalovirus-cmv-in-early-childhood-education-and-care-services
In Germany, to protect day care workers from primary CMV infection, their “CMV serostatus must be checked at the beginning of their pregnancy.” If the worker “is seronegative, she is excluded from professional activities with children under the age of three years” (Stranzinger et al., 2016). Retrived from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4844919/
Notes and additional resources
On May 22, 2019, OSHA announced: "A common virus, Cytomegalovirus (CMV) affects thousands of workers in childcare centers and healthcare facilities. These workers are at the greatest risk of exposure because the virus is often spread through saliva and other body fluids of young children. OSHA's new webpage on CMV [https://www.osha.gov/
Managing Infectious Disease - Full Curriculum - Instructor and participant manuals are available through the American Academy of Pediatrics (AAP). Click for Webinar video. See online learning module: https://www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/healthy-child-care/Pages/Curriculum-for-Managing-Infectious-Diseases.aspx?utm_source=MagMail&utm_medium=email&utm_term=lisasaunders42@gmail.com&utm_content=Healthy%20Futures%20%2D%20MID%20Webinar%203%2E11%2E2020&utm_campaign=Healthy%20Futures%20%2D%20Managing%20Infectious%20Disease%20Webinar
Managing Infectious Disease - Full Curriculum - Instructor and participant manuals are available through the American Academy of Pediatrics (AAP). Click for Webinar video. See online learning module: https://www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/healthy-child-care/Pages/Curriculum-for-Managing-Infectious-Diseases.aspx?utm_source=MagMail&utm_medium=email&utm_term=lisasaunders42@gmail.com&utm_content=Healthy%20Futures%20%2D%20MID%20Webinar%203%2E11%2E2020&utm_campaign=Healthy%20Futures%20%2D%20Managing%20Infectious%20Disease%20Webinar
CMV prevention video, "Why Moms-to-be Should Care About CMV" (3:37-minutes): https://youtu.
Utah created English/Spanish brochures specifically for childcare providers:
Connecticut Department of Public Health (CT DPH) website has flyers and information: http://portal.ct.gov/DPH/Family-Health/EHDI/CMV. The National CMV Foundation allowed the CT DPH to embed their logo in their “Are You Pregnant” National CMV Awareness Flyer.
You may wish to distribute the above flyer with this letter from Dr. Brenda Balch on the back:
https://drive.google.com/file/d/1xjQKI8SE1awlHPdD-k27ZwG62W7dnlv3/view?usp=sharingLetters to medical community:
CT Department of Public Health (DPH) About CMV For Obstetric Health Care Providers and About CMV Testing for Obstetric Health Care Providers.
CT Department of Public Health (DPH) and American Academy of Pediatrics (AAP) About CMV for Pediatric Care Providers.
Click here to view the National Center for Hearing Assessment and Management (NCHAM) pre-recorded Congenital CMV 101: From Prevention to Treatment webinar or click here for a PDF of the webinar.
For social media, a photo of the flyer will be easier to share. Find the jpeg of “Are You Pregnant” by the National CMV Foundation at:
https://drive.google.com/file/d/1AVG9RXGVsbBTwOImOb18NWDdG3rHbHbm/view?usp=sharing
If you need a pdf of the above flyer with information relevant for childcare providers from CT DPH, then: https://drive.google.com/file/d/0B9Klfxar2CmjemlkcElQQkZfQWs/view)
11. Letter from the Commissioner of Health for New York State, HOWARD A. ZUCKER, M.D., J.D, to "Colleagues". Excerpt: "...Congenital CMV infection is the most common intrauterine infection and the leading non-genetic cause of sensorineural hearing loss in children in the U.S...For all infants, it is critical that healthcare providers include careful follow-up of newborn hearing screen results and ensure subsequent auditory evaluation, when recommended, as a part of routine infant care. For newborns with hearing loss without another etiology, consider evaluation for congenital CMV. However, the majority of infants who ultimately develop congenital CMV-associated sensorineural hearing loss (whether they are symptomatic or asymptomatic at birth) will not have detectable hearing loss during the first month of life. Therefore, efforts aimed at the prevention of CMV infection during pregnancy are key to avoid the significant sequelae of congenital CMV infection, including hearing loss...People who have frequent contact with young children may be at greater risk of CMV infection. CMV can be present in especially high amounts in young children's saliva and urine for months after they become infected. While exposure to CMV may be difficult to avoid, particularly for those who have young children already, it is imperative that we give women of reproductive age the information they need to make informed decisions for themselves and their families.. According to the Centers for Disease Control and Prevention (CDC), female workers of reproductive age in child care centers should be educated on CMV and its potential risks, and should have access to appropriate hygiene measures to minimize occupationally-acquired infection... " https://www.health.ny.gov/
12. Article: "An Often Unknown Cause of Hearing Loss in Children: Understanding and Preventing CMV in the Educational Setting" by Balch, Brenda K., MD, AAP EHDI Chapter Champion for Connecticut (Late Feb 2019). Found at: Supporting Success for Children with Hearing Loss. https://successforkidswithhearingloss.com/wp-content/uploads/2020/02/CMV-An-Often-Unknown-Cause-of-Hearing-Loss.pdf
13.Song for mothers who learned too late about protecting their unborn child from congenital CMV--"Had I Known (about CMV): by Debra Lynn Alt: https://drive.google.com/file/
14. Article, "The Danger of Spreading CMV: How We Can Protect Our Children" by Lisa Saunders published by ChildCare Aware of America (June 2017).
15. Article, “Help Childcare Providers Fight CMV” by Lisa Saunders published by National CMV Foundation (March 5, 2018)
16. Daycare.com: Cytomegalovirus webpage: https://www.daycare.com/fastfacts/illness/cytomegalovirus.html
16. Daycare.com: Cytomegalovirus webpage: https://www.daycare.com/fastfacts/illness/cytomegalovirus.html
17. Need CMV studies? See my Bibliography at: http://congenitalcmv.
Other ideas:
Check your state’s childcare care licensing department, department of health, department of labor, and local universities with occupational medicine and public health programs. CMV is a bloodborne Pathogen. See Occupational Safety and Health Administration (OSHA) for bloodborne pathogens: https://www.osha.
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..."
Actions to consider:
1) Childcare providers are typically trained in first aid, CPR, and other topics. CMV prevention should be included in training about preventing infectious diseases. NAEYC (National Association for the Education of Young Children) includes "a. steps to reduce occupational hazards such as infectious diseases (e.g., exposure of pregnant staff to CMV…”
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, AAP, 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...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 in Model Child Care Health Policies, which has 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)” (American Academy of Pediatrics, Pennsylvania Chapter, Aronson, SS, ed., 2014, p. 116).
5) 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).”
6) Hang signs about CMV prevention in child care centers so staff and parents can see them (see CMV resources below--for Connecticut DPH logo in the “Are You Pregnant” poster by the National CMV Foundation, click here). Signs in child care centers are important because mothers of young children in group care are also at increased risk for contracting CMV (Pass et al., 1986) and are unaware of this. "Intervening with child care providers and parents through child care facilities are key opportunities to reduce prevalence of CMV infection and other diseases.” (Thackeray and Magnusson, 2016).
7) 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.
8) Examples of CMV Protocols in Other Countries:
In Queensland, Australia, suggested control measures include: "relocating workers who are pregnant, or who expect to become pregnant, to care for children aged over two to reduce contact with urine and saliva" (Queensland Government).
In Germany, to protect day care workers from primary CMV infection, their “CMV serostatus must be checked at the beginning of their pregnancy.” If the worker “is seronegative, she is excluded from professional activities with children under the age of three years” (Stranzinger et al., 2016).
Note from me, Lisa Saunders:
I am the leader of the Child Care Providers Education Committee, National CMV Foundation. Using the song,"Had I Known (about CMV)," by Debra Lynn Alt, I created a public service announcement (PSA) on Congenital CMV: Music Video--"Had I Known (about CMV)". The video is geared to those who care for young children. YouTube version at https://youtu.be/1WoGjfieRhY. You are welcome to share this on TV, online, in presentations, etc.
Websites:
For more information on Cytomegalovirus (CMV) and Congenital CMV Infections, visit the Centers for Disease Control and Prevention at https://www.cdc.gov/cmv or the National CMV Foundation at https://www.nationalcmv.org
Handwashing: Centers for Disease Control and Prevention (CDC) has a video and posters on handwashing procedures and what to do if soap and water are not available: https://www.cdc.gov/handwashing/index.html
Materials produced by the "ChildCare Providers Fighting CMV" project
1) Above-sink wall flyer on hand-washing, "Share a Meal Not the Germs"
Colored in version of wall sign, "Share a Meal Not the Germs" :Above-sink wall flyer for hand-washing, "Diaper Wipes Don't Kill CMV"
https://drive.google.com/file/d/1wcGpHOfu3lLKl9vYR_KhI5LIqI_h1tvC/view?usp=sharing
For children to color in version: "Share a Meal Not the Germs":
2) Wall Flyer For Women Who Care for Toddlers:
3) Fun Teaching Tool Kit for Students and Families: Fairytale tells how to “Share a Meal, Not the Germs.”
Click here for free, two-pages of story and placemat for coloring.
Click here for free, two-pages of story and placemat for coloring.
a. An educational “coloring book, Once Upon a Placemat: A Table Setting Tale by Lisa Saunders and Jackie Tortora. Free pdf version of Once Upon a Placemat: A Table Setting Tale (or the educational fairy tale can be purchased as a bound coloring book, visit Amazon for $5.38). Or, download the words only for a one-page read a loud. OR, READ THE 2ND EDITION IN COLOR. Click here for PowerPoint or pdf.
b. Placemats: Side one: Placemat with tableware characters with space for your coloring artist's name (perfect for laminating and using as a table-setting reminder): https://drive.google.com/file/d/0B9Klfxar2Cmjd21OTjB6SjNfYVU/view
c. Side two: Germ prevention tips and hand-washing instructions.
d. Video: Short introduction of the tableware characters by Lisa Saunders at: https://www.youtube.com/edit?video_id=_0jDOKPFg4M
4) Tri-fold Flyer for Daycare Directors/Providers:
https://drive.google.com/file/d/1h5g6P5qV_PmdedbWRHjAsKuefifrkhP6/view?usp=sharing
https://drive.google.com/file/d/1h5g6P5qV_PmdedbWRHjAsKuefifrkhP6/view?usp=sharing
5) Book, Help Childcare Providers Fight CMV: People can click here for the free 133-page pdf manuscript or at:
or purchase the bound paperback for $6.19 on Amazon for sharing with others:
https://www.amazon.com/Help-Childcare-Providers-Fight-CMV/dp/1984328697?SubscriptionId=AKIAJ2F6RDUSIYCWQMFQ&tag=sa-sym-new-20&linkCode=xm2&camp=2025&creative=165953&creativeASIN=1984328697
https://www.amazon.com/Help-Childcare-Providers-Fight-CMV/dp/1984328697?SubscriptionId=AKIAJ2F6RDUSIYCWQMFQ&tag=sa-sym-new-20&linkCode=xm2&camp=2025&creative=165953&creativeASIN=1984328697
6) PowerPoint Presentation:" Help Childcare Providers Fight CMV": Available as:
c. YouTube Presentation by Lisa Saunders: https://youtu.be/dDkICFULA7M
.Mov files: CMV Narration 720 H624.mov: https://drive.google.com/file/d/17dgtUzr1IRJOsSqRDHYX5XwSKW92LXik/view?usp=sharing
CMV Narration 1080 H624.mov:
https://drive.google.com/file/d/19KD1-yWLOaC39MxfMWVpmDa_7gD4uinT/view?usp=sharing
https://drive.google.com/file/d/19KD1-yWLOaC39MxfMWVpmDa_7gD4uinT/view?usp=sharing
7) Warning Photograph for Wall/Sharing on Social Media:
Suggested lesson plan for children
Staff can work into STEAM (science, technology,
engineering, art and math) theme*
Read aloud the fairytale, "Once Upon a Placemat: A Table-Setting
Tale," then share a meal together (see author introduce the story here or on YouTube). Help the children wash their hands and set their
place setting by referring to the tableware characters. You can say things
like, "remember, Mr. Knife is afraid the dish will run away with the
spoon, so put his teeth toward Mr. Plate" and "Miss Cup hates it when
people share her without giving her a bath first because of those naughty
germs."
If possible, give each child a "share a meal, not the
germs" picnic kit with these suggested items:
- Bag (paper or reusable
insulated bag).
- Plate, cup, napkin, fork,
spoon, knife.
- Crayons or washable markers.
- Placemat with tableware characters (free pdf for coloring and possible laminating).
- Picnic food (homemade or
prepackaged that would use all utensils, such as peanut butter, crackers,
applesauce and cake).
- Hand sanitizer or sanitizing
wipes.
- Sink hand-washing sign and tri-fold flyer on CMV prevention to take home (found on congenitalcmv.blogspot.com)
- Free pdf of story, Once Upon a Placemat: A Table Setting Tale, found at: congenitalcmv.blogspot.com. If funds are available, give a child their own bound copy of Once Upon a Placemat: A Table Setting Tale to color and share with their families so their parents can reinforce the table-setting lesson and learn how to prevent CMV, the #1 birth defects virus, as well as other diseases (book available on Amazon for $5.38).
*STEAM is a popular way to package and
present the interconnectedness of Science, Technology, Engineering, Art
and Math in the regular curriculum. When you talk about germs, the coloring
book, “Once Upon a Placemat” (Art and Literacy), introduces germs (science,
biology) in a format that integrates the arts. Drawing and writing
activities can be planned to further integrate those domains. Teachers
can further bring in technology and engineering by designing activities that
help the children to "invent" equipment or machines to help better
wash hands, keep food fresh and germ free, etc. Math can enter into the
plan by graphing how long children wash their hands, how often they wash their
hands, keep track how many uses the classrooms get out of a single pump bottle
of hand soap, etc. With a little more thought (and a few trips to Pinterest!)
lots of germ-based activities can be created and integrated.
ABOUT
Lisa Saunders, Founder of “ChildCare Providers Againt CMV”
Lisa Saunders, a former licensed childcare provider and graduate of Cornell University, was instrumental in helping Connecticut pass a CMV testing law in 2015. She is the parent representative of the Congenital Cytomegalovirus Foundation, an award-winning writer, and SEC-TV talk show host living in Mystic, Connecticut, with her husband, Jim. She is the content coordinator for the magazine, Groton-Mystic Neighbors, author of 10 books, and a part-time history interpreter at Mystic Seaport. Lisa writes extensively about congenital CMV in her books and through articles such as "The Danger of Spreading CMV: How We Can Protect Our Children" (ChildCare Aware of America, 2017) and “Help Childcare Providers Fight CMV” (National CMV Foundation, 2018) Lisa's CMV-related books include:
Japan: Elizabeth and Riley the Miracle Dog (Japanese translation of Anything But a Dog! The perfect pet for a girl with congenital CMV). (S. Nakai, Trans.) Tokoyo: Thousands of Books Japan. Retrieved from http://shop.thousandsofbooks.jp/items/5173204
