A nursery successfully relaxed its strict sickness policy on conjunctivitis after a parent – who happened to be a GP – campaigned to highlight that sending infected children home is not necessary.
Guidance from Public Health England (PHE) states that sending children home is not needed and recommends antibiotics only in severe cases.
After his own toddler was sent home with the infection by the University of Birmingham’s nursery, Dr Sam Finnikin embarked on a research project, which found a large proportion of settings and prescribers were not following PHE’s advice (see box).
Dr Finnikin, a father of twins, a practising GP and researcher at the university, said the setting also required his daughter to be treated with antibiotics before she was allowed to return.
Despite the guidance, he found that 87 per cent of the 164 nurseries he surveyed had policies to exclude children with conjunctivitis, and almost half demanded antibiotic treatment before an infected child is allowed to return. The study, ‘Nursery sickness policies and their influence on prescribing for conjunctivitis: audit and questionnaire survey’ was published this month in the British Journal of General Practice.
Nursery World also found a number of nursery policies published online that fall foul of PHE’s advice, although it did also see a few that were in line with the guidance, including that of Bright Horizons.
Dr Finnikin said it was ‘totally understandable’ why settings feel the need to exclude infected children – for fear of an outbreak.
But he added that he regarded the ‘harms and costs of unjustifiable policies’ to ‘outweigh these potential risks’.
‘As doctors, we’re very careful to avoid unnecessary medications, particularly antibiotics, as all medicines have the potential to cause side effects, and overuse of antibiotics is contributing to the very serious issue of antimicrobial resistance,’ he said.
The GP recently approached the University of Birmingham’s nursery manager to discuss his research, and the setting’s role in it, and she told him that since the episode nearly two years ago it had ‘changed their policy about conjunctivitis and no longer exclude children with conjunctivitis and do not require antibiotics’.
Dr Finnikin added, ‘I was really pleased to hear about this change and followed up with the obvious question, “Have you seen more cases of conjunctivitis?” Her response was really insightful. She said they haven’t had any problems since changing the policy because they also made sure their infection control measures, such as hand cleaning and toy cleaning, were improved at the same time.’
His research also revealed that nurseries’ strict conjunctivitis policies are influencing prescribers, with almost 43 per cent admitting they have prescribed antibiotics to some extent because of them.
More than 15 per cent cited settings’ policies as the main reason for issuing such a prescription.
Some 1.2 million children attend non-domestic settings countrywide, with 20 per cent presenting with the infection at medical practices each year. This means an estimated 240,000 consultations, 120,000 antibiotic prescriptions and 360,000 lost work days for parents – many of them unnecessary.
Dr Finnikin said he hoped to get the study’s findings disseminated as widely as possible. He added that PHE and the Royal College of General Practitioners are taking the findings seriously and are thinking of ways to help nurseries become more compliant with PHE guidance.
Cliodna McNulty, head of the Primary Care Unit at PHE, reiterated that guidance for GPs was to use antibiotics only in ‘severe [conjunctivitis] cases, as most are viral or self-limiting’.
Ms McNulty added that 65 per cent of bacterial conjunctivitis cases resolve without antibiotic treatment by day five.
She continued, ‘[GPs] should really try not to be influenced by local nursery policies.’
Infection or complaint Recommended period to be kept away from school, nursery or childminders CommentsConjunctivitis None If an outbreak/cluster occurs, consult your local PHE centre
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