GUIDELINES AND PROCEDURES CONCERNING DIRECT CONTACT COMMUNICABLE DISEASES | Administrative Procedures

8453 - GUIDELINES AND PROCEDURES CONCERNING DIRECT CONTACT COMMUNICABLE DISEASES

Definition

For the purpose of this procedure, an infected individual means:

an individual who is diagnosed as having adirect contact communicable disease; and/or
an individual who is determined to test positive for a direct contact communicable disease but has not yet developed symptoms of the disease.

General Procedures

School principals are responsible for ensuring that all building-site employees are provided training. Training will include the following: a description of direct contact communicable diseases and examples of said diseases, methods of transmission and prevention, universal precautions, and confidentiality*.
*An infected individual, student or employee, shall be provided rights of privacy and confidentiality in accordance with Federal and State laws and Board rules. The only individual who can disclose that a student or employee has a direct contact communicable disease is the parent/guardian of the infected student or, in the case of employees, the infected employee.
Schools will provide developmentally appropriate instruction related to direct contact communicable diseases.
Schools will make "reasonable efforts" to accommodate the special needs of students and employees with a direct contact communicable disease unless the accommodation places "undue burdens" on the school.
Any student or employee with a direct contact communicable disease, whose personal behavior and/or medical condition poses imminent risk to the school community, may be requested to provide an evaluation by the individual's private medical provider (physician) or by the Brevard County Health Department. The physician or health department will determine if restricting contact and/or activities or if continuing attendance or employment at the school is in the best interest of the student or employee and the school community.
Each school shall adhere to universal precautions.

Procedures for Students

Student Admissions - Admissions should not be denied to a qualified student solely on the ground that the student is an infected individual.
Student Suspensions, Leaves of Absence, and Withdrawals - A student should not be required to cease attending the school solely on the basis of a diagnosis of infection. Such decisions should be made only after reasonable accommodations have been made and an examination of the facts on a case-by-case basis demonstrates that the student can no longer perform as required, or that the student presents a health risk to himself/herself or the school community.
Any student who informs the school that s/he is infected should be accorded confidentiality regarding disclosure of the medical condition, in accordance with established statute or case law.

Procedures for School Employees

An infected employee who is not in need of accommodation shall be treated in the same manner as any employee diagnosed as having any other illness, injury, or disability.
In instances where an infected employee is unable to fulfill his/her regular responsibilities or portions of these responsibilities, but is able and desires to continue working in a less mentally and physically demanding capacity, the school should make a reasonable effort, if requested, to accommodate the employee's handicap.
As in the case of any other illness, injury, or disability, a supervisor who believes an infected employee is unable to perform assigned duties due to the illness, may recommend to the Board that the employee be required to submit to a medical examination to determine if the employee is able to perform the duties of the position. Based upon the medical opinion, applicable procedures will be applied.
Any employee who informs the school that s/he is infected should be accorded confidentiality regarding disclosure of the medical condition, in accordance with established statute or case law.
An infected employee should be allowed to use accrued sick or annual leave as needed.
School District employees, while performing their duties, should be required to conform to the School District policy on direct contact communicable diseases when dealing with infected students or employees. In-service will be provided in the following areas:
1. providing reasonable accommodations;
2. providing for the safety of others (measures to minimize risk of possible infection);
3. protection of persons with a direct contact communicable disease (rights of confidentiality);
4. rights of infected individuals. (Infected individuals will not be unnecessarily limited in participating in educational programs/activities.)

Instructional Program for Students

The primary purposes of instruction in direct contact communicable diseases are to inform students of the threat of the diseases and to provide them with appropriate information to avoid risky situations and to make appropriate decisions. Content will focus on the epidemiology of the diseases and provide students an up-to-date report of medical advances being made in the area of these diseases. The instruction will be presented in developmentally appropriate curricula.

Employee In-Service Programs

It is suggested that each principal/designee collaborate with the local County Health Department School Nursing Supervisor to arrange annual up-to-date in-services for their employees in the school on the subject of direct contact communicable diseases, universal precautions, and confidentiality.

Principals will be responsible for providing training to all building-site employees. A designee may present the training, which will consist of defining and identifying and providing examples of direct contact communicable diseases, method of transmission, universal precautions, District policy, and work site considerations.
Custodians will receive additional training in disinfection, use of gloves, and disposal of contaminated objects.
In-service training component #6 410 001 C, Legal and Health Issues for Teachers and Staff, has been developed to include training objectives for this program.
Training will be provided for new staff and as appropriate for trained personnel.

Information for Employees

An ADA (Americans with Disabilities Act) handout, which is applicable to employees, is available from the Office of Human Resources. The ADA handout includes: who is protected by the ADA, an explanation of reasonable accommodations, and employment practices related to the ADA. An accommodation request form and medical release form are also available from the Office of Human Resources.

Universal Precautions for School Settings

Definition of Universal Precautions

Universal precautions refer to the usual and ordinary steps all school staff need to take in order to reduce their risk of contracting a direct contact communicable disease (such as HIV or Hepatitis B). They are universal because they refer to steps that need to be taken in all cases, not only when a staff member or student is known to have a direct contact communicable disease. They are precautions because they require foresight and planning, and should be integrated into existing safety procedures.
Protocol for Universal Precautions

In response to the increase in Hepatitis B and Human Immunodeficiency Virus (HIV) infections, the Centers for Disease Control have recommended "universal blood and body-fluid precautions". These measures are intended to prevent transmission of these and other infections, as well as to decrease the risk of exposure for care-providers and students. As it is currently not possible to identify all infected individuals, these precautions must be used with every student, regardless of his/her medical diagnosis.

Universal precautions pertain to blood and body fluids containing blood, cerebrospinal fluid, synovial fluid, vaginal secretions, semen, and pericardial fluid. These precautions do not apply to other body products such as saliva, sputum, feces, tears, nasal secretions, vomit, and urine unless blood is visible in the materials. However, these other fluids and body wastes can be sources of other infections and should be handled as if they are infectious.

The single most important step in preventing exposure to and transmission of any infection is anticipating contact with infectious materials in routine as well as emergency situations. Based on the type of possible contact, the care-giver should be prepared to use the appropriate precautions and techniques prior to providing care. Diligent and proper hand washing, the use of barriers, appropriate disposal of waste products and needles, and proper decontamination of these measures will enhance protection of both the care-giver and the student.
Hand Washing

Proper hand washing is crucial to preventing the spread of infection. Textured jewelry on the hands or wrists (such as rings and stones) should be removed prior to washing and kept off until completion of the care procedure and hands are rewashed. Use of running water, lathering with soap and using friction to clean all surfaces of remaining jewelry and hands is key. Rinse well with running water and dry hands with paper towels. If soap and water are unavailable, use alcohol hand rinse.

Hands should be washed before physical contact with student and after the contact is completed. Hands should be washed after contact with any used equipment. If hands (or other skin) become soiled with blood or body fluids, they should be washed immediately before touching anything else. Hands should be washed whether gloves are worn or not and after gloves are removed.
The Use of Barriers

Barriers include disposable gloves, protective eye wear, masks, and gowns. The use of a barrier is intended to reduce the risk of contact with blood and body fluids for the care-giver as well as to control the spread of infectious agents from student to student. It is essential that appropriate barriers be used when contact with potentially infectious material is
possible.
Gloves should be worn when direct care of the student may involve contact with blood and body fluids. For infection control, it is recommended that gloves be worn as well for contact with urine, feces, and respiratory secretions. Gloves should be disposed of after each use and not reused.
1. Gloves should be worn when changing a diaper or catheterizing a student.
2. Gloves should be worn when changing dressings or sanitary napkins.
3. Gloves should be worn when providing mouth, nose, or tracheal care.
4. Gloves should be worn if the care-giver has broken skin on the hands (even around the nails).
5. Gloves should be worn when cleaning up spills of blood (e.g., nosebleeds) or body fluids and wastes, and soiled supplies.

Gowns or aprons may be worn to protect the care-giver's clothing if spattering of body fluids is possible. The apron or gown should be laundered or disposed of after each care session and should not be reused. In addition, protective eye wear and masks should be worn if splashing of body fluids is likely to occur (such as mouth suctioning or a coughing student).

Chux or other waterproof barriers should be used to cover any work surface if drainage or splashing with blood or body fluids is possible. The barrier should be disposed of after each care session and should not be reused.

Disposal of Waste

All used or contaminated supplies (including gloves and other barriers) except for syringes, needles, and other sharp implements should be placed in a plastic bag which is then sealed. This bag should be placed in a second plastic bag, which is also sealed. The double-bagged waste can then be thrown in the garbage, out of the reach of children or animals.

Needles, syringes, and other sharp objects should be placed in a metal or other puncture-proof container immediately after use. To reduce the risk of an accidental needle stick or cut, needles should not be recapped, bent, or removed from the syringe before disposal. Once it is full, the container should be sealed, double-bagged, and brought to the school clinic for disposal in a large biohazard container. Health services will call biohazard waste disposal company for proper disposal at least annually. Bodily wastes such as urine, vomit, or feces should be disposed of in the toilet.
Clean-Up

Spills of blood and body fluids that are covered under universal precautions should be cleaned up immediately. The CDC method is as follows:
1. wear gloves;
2. mop up the spill with paper towels or other absorbent materials;
3. using a solution of one part household bleach (sodium hypochlorite) in ten parts of water, wash the area well;
4. dispose of gloves, soiled towels, and other waste in sealed double plastic bag in the garbage as outlined above.

Routine environmental clean-up facilities (such as the health room and bathrooms), does not require any modification unless contamination with blood or body fluids covered under universal precautions should occur. If so, the area should be decontaminated using the procedure outlined above. Regular cleaning on non-contaminated surfaces such as toilet seats and table tops can be done with the standard cleaning and removal of obvious soil. It is more effective than extraordinary attempts to disinfect or sterilize surfaces.

Laundry

Whenever possible, disposable barriers should be used, if contamination with body fluids or blood is possible. If sheets, towels, or clothing do become soiled, they should be handled as little as possible. Wash with hot water and detergent for at least twenty-five (25) minutes. Cool water washing is also acceptable if an appropriate detergent is used for the water temperature.
Accidental Exposure

Accidental exposure to blood, body products, or body fluids places the exposed individual at risk of infection. This risk varies depending on the type of body fluid (blood vs. respiratory vs. feces), the type of infection (salmonella vs. HIV), and the integrity of the skin that is contaminated.
Pregnant Women

Pregnant women are at no higher risk of infection that other care-providers as long as appropriate precautions are observed. However, due to the possibility of in utero transmission of viral infections such as Cytomegalovirus (CMV) or HIV, as well as the potential for adverse outcomes with these congenitally acquired infections, pregnant women should be especially careful to observe universal precautions.

Further information regarding universal precautions and infection control is available from the local public health department and in references at the end of this section.
Personal Hygiene Emergency Procedures

The purpose of the procedures outlined herein is to establish basic procedures intended to assist students who may be having a personal hygiene emergency. Instances of such emergencies may include, but not be limited to, a bleeding nose, sneezing, coughing, uncontrollable urinating, and sudden bowel movement.
The principal shall ensure that all staff are familiar with this policy and that the provisions of this policy are implemented.
The classroom teacher shall:
1. Reassure and calm the student.
2. Have the student report to the appropriate lavatory facility. In some cases, it may be necessary to have another student or a classroom aide accompany the child.
3. Notify the school nurse.
4. Contact the student's parent/guardian to report the incident, and if necessary, request that the parents come to the school to assist.
5. Request that the parents supply a clean set of clothing to be stored at the school for chronic cases.
6. Report action taken to the headmaster/principal.

The school nurse shall:

Meet with the student to recommend the procedure to be followed (i.e., student to be sent back to class, parents to come to school, student to be sent home, etc.).
Assist in ensuring that the student is properly cleansed before returning to class, or await the student's parent's/guardian's arrival.
Provide supervision and a comfortable surrounding, if the student is awaiting the arrival of his/her parent/guardian or awaiting transportation.
Share observations/recommendations with the classroom teacher.

The school custodian shall clean the area where the emergency occurred. Blood, vomit, or any other discharges or any body fluids from any person or child at the school site should be cleaned up as follows: obtain a plastic bag to dispose of all materials used in the clean up.

Human Bite Emergency Procedures

The purpose of the procedures outlined herein is to establish basic procedures intended to assist students and staff who have encountered a human bite that breaks the skin.
Each human bite represents a unique set of circumstances and requires an individualized response. In most biting episodes there are no communicable disease extenuating circumstances and the episodes are treated as general universal precautions. There is a heightened sense of urgency when one of the children has a communicable disease. The school nurse is responsible for guiding the response, working with the headmaster/principal and ensuring that the confidentiality is maintained.
1. Review known medical information of both the "biter" and the "bitee". If there is a known communicable disease issue, then the nurse needs to consult with the local health department for more specific guidance. Confidentiality needs to be respected throughout the consultation.
2. Both the biter and bitee should be referred to their primary care provider for further guidance. This may include any or all of the following: risk counseling; hepatitis, HIV testing; etc. The treatment approach is the decision of the primary care provider and the family.

Background Information

In 1997, the CDC published findings from a State health department investigation of an incident that suggested blood-to-blood transmission of HIV by a human bite. There have been other reports in the medical literature in which HIV appeared to have been transmitted by a bite. Severe trauma with extensive tissue tearing and damage and presence of blood were reported in each of these instances. Biting is not a common way of transmitting HIV. In fact, there are numerous reports of bites that did not result in HIV infection.

The biter is probably more at risk than the bitee as s/he is exposed to the blood from the wound.

The principal shall ensure that all staff are familiar with this policy and that the provisions of this policy are implemented.

The classroom teacher shall:

Reassure and calm the students.
Employ universal precautions in evaluating the bite.
Notify the school nurse.
Contact the student's parent/guardian to report the incident, but only after discussing with the school nurse.
Report action taken to the headmaster/principal.

The school nurse shall:

Gather the appropriate medical information.
Call health services before calling the families if there is known communicable disease issues with one or both of the students.
Be liaison to primary care provider, as requested by parent and within the boundaries of confidentiality.