The Program Director consults with Laura Li, MD, our Program Health Consultant at Tufts Medical Center and other regulatory agencies (Department of Early Education and Care, Department of Public Health, and Boston Public Health Commission) for medical conditions, health concerns, and disease outbreaks. Dr. Li also comes on site 3-4 times a year to review children’s medical records, go over our health care policy, approve first aid and CPR training materials, and provide medication/ allergy training as needed.

In addition to our regular Health Care Policy, Red Oak also developed the Infectious Disease Outbreak Management Plan (IDOMP).

Infectious diseases are disorders caused by organisms — such as bacteria, viruses, fungi or parasites. Many organisms live in and on our bodies. They're normally harmless or even helpful, but under certain conditions, some organisms may cause disease. Some infectious diseases can be passed from person to person. Some are transmitted by bites from insects or animals. And others are acquired by ingesting contaminated food or water or being exposed to organisms in the environment. Signs and symptoms vary depending on the organism causing the infection, but often include fever and fatigue. Mild complaints may respond to rest and home remedies, while some life-threatening infections may require hospitalization.

An outbreak is a sudden rise in the occurrence (the number of cases) of a disease. Some outbreaks are expected each year, like influenza, hand-foot-and-mouth disease, and bronchiolitis. Other outbreaks need to be reported to the public health authorities, especially those where public health officials can advise about control measures and help ensure accurate communications among health professionals, childcare personnel, and parents. An outbreak of an unusual or severe illness must be reported to public health authorities immediately. For example, an unusual illness would be if, on the same day, several children in the same group had severe vomiting, or an unusual rash and fever.

In the event an infectious disease outbreak takes place, Red Oak fully cooperates with the regulatory public health agencies to contain the disease outbreaks. The following procedures will be put in place at Red Oak Afterschool and Summer Program:

• The Director will immediately report the outbreak to the Boston Public Health Commission (BPHC) and notify the following personnel: our Health Care Consultant, Laura Li, MD at Tufts Medical Center, Bernadette Davidson - BCNC Director of Childcare and Enrichment Services, and Red Oak staff as soon as the outbreak is identified. Red Oak will send home notices and letters to update families of infectious disease outbreaks within 48 hours (need time for Chinese translation). Available bilingual handouts and letters on file will be sent out within 24 hours.

• BPHC may send a nurse and notify Boston Inspectional Health Department to schedule a routine visit to Red Oak. At the visit, the health inspector will observe how our staff store, prepare and deliver meals to the classrooms; check food and dish washer temperature; and kitchen cleaning services. They will meet with the program director to investigate the details of the outbreak, the steps we have taken to prevent the outbreak, and the symptoms children are exhibiting. They will also check the log/absences, the menu and food ordering logs. They will read notices that were sent home to families and staff. The inspector may also sit in a classroom to see how food is served and monitor proper hand washing procedures. The public health nurse will perform the same tasks, except for monitoring food preparation.

• The Director will have the classroom teachers track adults’ and children’s absences as well as symptoms using the Symptoms Monitoring Log daily. The Director will submit data to BPHC upon request.

• Please note each infectious disease outbreak exclusion period may vary. We follow the recommended guidelines as set by the public health regulatory agencies. For instance, based on the Boston Public Health Department guidelines, the exclusion period for COVID-19 infection or COVID-19-like symptoms is 24 hours free of symptoms (fever, coughing) for school re-admittance. Schools or childcare centers are required to have adequate staffing to supervise and monitor children’s hand washing during the outbreak period because proper hand washing is the #1 defense against the spread of germs. A doctor note stating the patient is symptom-free must be submitted to a Red Oak administrator, should a staff or child want to come back in less than 24 hours. Staff who handle food must observe a 72-hour exclusion period.

• In addition to following the attached regular cleaning schedule and the universal precaution section of the health care policy, adults and children are required to practice proper hand washing frequently throughout the day: first thing when parents or teachers drop off the children to the program, when coming from outside, before and after these activities (sand, water, computer), before /after lunch, after bathroom time, after contact with fluid. For sanitizing, use the disinfecting wipes in addition to using regular cleaning (soap + water) and Spray Nine Multi-Purpose Cleaner and Disinfectant (EPA approved noro-virus agent) on table surfaces, toilet seats, doorknobs. During outside play, staff will use disinfectant wipes to wipe off play structures, toys, and strollers that kids may encounter. Please follow the attached guidelines for Clean-up and Disinfection.

• The Director will notify BCNC Operation Manager, Victoria Yue, of the infectious disease outbreak and will request an increased frequency of cleaning of the rug (once a day or after each soiling incident) in the classroom using EPA Approved Multi-Purpose Cleaner and Disinfectant. BCNC has an outside cleaning company, System 4, which comes on site every night to clean the building. The Director will put a request with the Operation Manager for a thorough cleaning and sanitizing of the classrooms.

• The Director will have close contact with staff and families to monitor the outbreak situation. She will meet with each team and kitchen staff to go over the necessary guidelines to implement and procedures to follow. Food allergy, foodborne illnesses and universal precaution training is required annually. She will also give appropriate updates to her supervisor and the center’s health care consultant.

References:

• https://www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/children-and-disasters/documents/midccsoutbreaks.pdf

• http://www.mayoclinic.org/diseases-conditions/infectious-diseases/basics/definition/con-20033534

Contacts for Regulatory Agencies:

紅屋主任請教本中心的健康顧問Laura Li, MD. 和其他監管機構（麻省早期幼兒教育局，公共衛生局和波士頓公共健康衛生局）有關醫療政策，健康問題和傳染病疫。Laura目前是塔夫茨醫學中心及其他監管機構的職業護士。 Laura每年3-4次來到紅屋審查兒童的醫療記錄和我們的醫療政策。根據需要，她將會提供用藥/急救和心肺問題的培訓。

本校除了常規的醫療保健政策外，還有管理傳染病疫的步驟（IDOMP）。

傳染性疾病是由生物體疾病- 如細菌、病毒、真菌或寄生蟲引起。許多生物活在我們的體內通常是無害或甚至有益的，但在某些條件下，它們可以導致疾病，並且人傳人。有些是由昆蟲或動物咬傷傳播。有時通過攝取受污染的食物或水或在暴露於環境中的微生物獲得的。體徵和症狀取決於該生物體引起的感染，包括發燒和疲勞。輕微的症狀留在家裡休息，而一些嚴重的感染可能需要留院治療。

疫情爆發是指疾病的發生（病例數）突然增加。 預計每年都會爆發一些疾病，例如流感，手足口病和細支氣管炎等等。我們必會呈上麻省和波士頓公共衛生部門，他們會向我們提供控制措施和指引，並幫助衛生專業人員、兒童保健人員與家長的溝通。一個不尋常的或嚴重的疾病爆發，必須立即上報公共衛生部門。例如：在同一天幾個孩子在同一個班有嚴重的嘔吐，或發生不尋常的皮疹和發熱。

在傳染病疫情發生的情況下，本中心完全配合監管公共衛生機構以遏制疫情。本中心處理過程如下：

• 紅屋主任Shaina將立即把疫情報告波士頓公共健康衛生局（BPHC），並通知下列人員：我們的保健顧問塔夫茨醫學中心的Laura，BCNC 托兒部主任Bernadette和本中心人員疫情一經發現，工作人員便會盡快處理。 Shaina 將48小時內書面通知（需要時間英譯中）關於最新傳染病爆發的消息。我們將在24小時內提供雙語講義指南給每個家庭。

• 波士頓公共健康衛生局會派一名護士，同時食物衛生局也會有專業檢查員來觀察紅屋。在觀察過程中，衛生檢查員會觀察廚房的工作人員儲存食品，並準備送餐到教室的過程，檢查食品和洗碗機溫度和廚房清潔步驟。他/她將與紅屋主任見面調查疫情的細節，我們已經採取措施來防止疫情的步驟，以及孩子們表現出的症狀。她還將檢查日誌/缺勤、菜單和訂餐記錄。她/他會檢查並閱讀被送回家的孩子和工作人員的書面通知。衛生檢查人員還會坐在一個教室裡，看看食品供應和監督正確的洗手方法。公共衛生護士將執行相同的任務除了監督食品的準備。

• 主任要求任課教師每天記錄成人和兒童的出勤錄和缺席的理由及症狀，主任會把所有的數據傳送波士頓公共健康衛生局（BPHC）。

• 根據不同的疾病的症狀，停課的日期有所不同。我們遵循健康管理機構的準則來執行。例如，根據波士頓公共衛生部門指導，病毒感染或（COVID-19）新型冠狀病症狀（發熱、腹瀉和/或嘔吐）。沒有此症狀24小時後，孩子和員工可以回校，我們確保有足夠的工作人員來監督洗手程序。學校或託兒所都要求有充足的人員進行監督，並在爆發期監督兒童洗手，因為正確洗手是排名第一的防禦病菌的傳播。如果孩子/員工在24小時內回來中心，我們需要醫生的證明確保沒有任何的症狀。 處理食物的員工如果有病毒感染或（COVID-19）新型冠狀病症狀（發熱，咳嗽），必須遵守72小時內沒有以上症狀方可上班。

• 除了下面所附的定期清洗計劃和醫療保健政策的普遍預防措施部分，大人和孩子都需要經常練習正確全天洗手：當父母或者學校老師送到孩子來課室，從外面操場/外出回來，活動前/後（沙、水、電腦），用餐前/後，使用洗手間後，流鼻涕後。對於消毒的方法，使用消毒濕巾，除了使用常規的清洗（肥皂+水）和噴霧清潔劑（EPA認可）清潔桌面、換片區、馬桶、門把手。在外面玩耍時，用消毒濕巾清潔所有孩子們有接觸的玩具和嬰兒車。請遵循清理和消毒的病毒感染或（COVID-19）新型冠狀病症狀（嘔吐和腹瀉事故）所附的指南。

• 主任將通知負責BCNC傳染病爆發的運營經理Victoria Yue，並且將要求使用清潔噴霧消毒劑清洗地毯（每天一次或每個污染事件發生後）。BCNC有一個外部的清潔公司，每天晚上會來本中心清潔教室。主任將會與業務經理溝通，要求進行徹底的清洗教室和消毒。

• 主任將與工作人員及每個家庭密切溝通，以監察發生的狀況。她將與各班房老師和廚房工作人員開會，給予指導方針，以落實和程序可循。並且每年培訓有關食物過敏，食源性疾病和普遍的預防措施。她也將給予她的上司和中心的健康顧問適當更新的信息。

參考:

• https://www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/children-and-disasters/documents/midccsoutbreaks.pdf

• http://www.mayoclinic.org/diseases-conditions/infectious-diseases/basics/definition/con-20033534

監管機構的聯繫方式: