IN light of the prevalence of infectious illnesses such as COVID-19, mPox, hand foot and mouth disease and influenza, amongst other illnesses, it is imperative that effective infection control strategies be implemente
d in schools. Children, particularly those under 12 years old, are quite vulnerable to spread of infectious illnesses. A hygienic and sanitary school environment is therefore not an option but is actually the right of each child being educated in an institution.

The vulnerability

It is perfectly normal for children, including pre-teens to suffer from some types of infectious illnesses. Nevertheless, one ill child should not make every other child ill. Educators and school administrators must therefore be aware of the importance of implementing hygiene and sanitation policies which includes infection control measures to reduce the spread of infectious illnesses in their institution. Influenza, the common cold and many gastrointestinal illnesses show higher incidence and prevalence in schools and institutions where overcrowded classrooms and inadequate facilities are enhanced by failure to implement and enforce effective hygiene and sanitation policies. The enforcement of measures in schools, which restrict contact between those who are ill with infectious illnesses, is a legal requirement and social necessity. Too often, due to the lack of enforcement of these measures, sick children with contagious illnesses are allowed to attend school as per usual.

School-based presenteeism a contributing factor to the spread of infectious illnesses

Children attending school while sick are described as school-based presenteeism. Children are often victims of this situation as parents and sometimes teachers and caregivers underestimate or misunderstand the particular illness the child is suffering from. The fact is, when infections occur in an institution, it is not just confined to that particular place, hence the implications for a wider spread and a greater negative impact.

How are infections spread

Infections can spread in a variety of ways. Some common routes are through the faecal oral route (water or food contaminated with faecal matter), eg, coli infection; through the respiratory tract (eyes, and nose, mouth) eg, colds and influenza; through direct contact (skin contact with an infectious agent) eg ringworm, scabies and chicken pox; through indirect contact with surfaces or materials such as pencils, toys and tables contaminated by bacteria and other disease causing agents, eg hand foot and mouth disease; and lastly, through ingestion of contaminated food or water eg rota viral gastroenteritis and bacillary dysentery.

A healthy school environment is important for a good education

Many schools lack the required facilities to ensure that whilst children are in school, they are protected from contracting infectious illnesses. According to UNICEF in 2022, 28 per cent of schools lacked basic sanitation services, impacting 539 million schoolchildren; and 42 per cent of schools did not have basic hygiene services, affecting 802 million schoolchildren. Adequate classroom space provided with required amounts of ventilation will not only enhance the teaching and learning experience but is necessary to reduce school absenteeism. The provision of adequate and safe running water for all children in school at approximately five litres per day per child should be a priority agenda item for all stakeholders in education. Consideration must also be made for the daily water needs of staff whilst at work.

What more is needed

It is indisputable that for centuries intertwined in many schools’ daily routine are actions such as the sweeping of classrooms whether by the children themselves or janitorial personnel. Nevertheless, effective infection control measures for schools involve more than sweeping and wiping surfaces. In schools, infections spread easily, as all too often cleaning and disinfection protocols encourage the spread of infectious agents rather than controlling them. For example, household bleach on a cloth used to wipe multiple surfaces can result in the spread of infections rather than controlling the situation. Cleaning protocols which are comprehensive and focus on the proper disinfection of “high touch areas” has been known to effectively reduce the spread of infections in institutions. The implementation of properly documented protocols in which staff are trained is imperative for the control of infections, for example, vomit and diarrhoea clean up plans do not just involve cleaning procedures but integral in the plans are details outlining occupational health and safety requirements. The provision and proper use of personal protective equipment for staff will minimise the risk for spread of infectious illnesses.

Other best practices for a hygienic and sanitary school environment

Development and enforcement of hygiene and sanitation policies in schools are crucial to maintain the health and well-being of students, teachers, and other staff as well as the wider community. Good hygienic practices instilled in children will also promote lifelong health and well-being. Measures such as adhering to proper hand washing techniques reduce the spread of most infectious illnesses by at least 50 per cent. Toilet rooms in schools must be equipped with adequate and suitable facilities to encourage hand washing and other sanitary practices. The provision of suitable and adequate refuse disposal facilities to ensure that infectious and non-infectious waste are properly disposed of will reduce the risk for the spread of infections and the proliferation of pest in schools. The implementation of integrated pest management strategies that uses a combination of approaches to prevent, and control pest has proven useful in reducing vector borne infections in institutions. School canteens must also operate in keeping with regulatory requirements to ensure that meals are prepared and served under hygienic conditions.

Dr Karlene Atkinson is a public health specialist and lecturer at the School of Public Health, University of Technology Jamaica.