Section 472.31 | Communicable Diseases Procedure

(a.) Isolate the student as appropriate.

(b.) Notify the school nurse, principal, or designee as appropriate. The child’s temperature will be taken and documented on the health room log along with any other relevant information.

(c.) Notify the parents or guardians.

(d.) Exclude the student as appropriate and refer to a health care provider for diagnosis.

1. Report all health related exclusions by using the suspension reporting form, marking out the word “suspension” and writing in “exclusion” in its place.

2. Form should be marked with the appropriate code.

a. 001 Immunizations

b. 002 Personal Health

3. Distribution of the “Exclusion Form”

a. White copy– Child’s File.

b. Yellow copy– Send home to parent.

c. Pink copy– Send to Pupil Services.

d. Goldenrod copy – Send to Pupil Services.

(e.) Notify the Garrett County Health Department of any reportable diseases. Be prepared to give the student’s name, date or birth, parents/guardians, address, phone number (work and home) and the name and number of the health care provider.

(f.) Determine when return to school is appropriate, e.g., a communicable disease is ruled out by the physician, the period of communicability has passed, the student is receiving appropriate treatment, the doctor or health department verifies that the student is no longer infectious, or a team approach has decided that the student may return, etc.

(g.) Maintain the student’s right to privacy. The decision whether to share information concerning the student’s health status should be made on a case-by-case basis with the principal making the final decision in consultation with the school nurse.

(2) Any employee suspected of having a communicable disease will adhere to the following procedure:

(a.) The principal will report all suspected or diagnosed cases of reportable communicable disease to the Garrett County Health Department and the Assistant Superintendent.

(b.) The determination of whether an infected school employee should be permitted to remain employed in a capacity that involves contact with students of other school employees shall be made on a case-by-case basis by a team. The team shall include the employee and/or his representative, the employee’s physician, the principal or supervisor, appropriate personnel designated by the Superintendent, and a representative of the Garrett County Health Department. In making this determination, the team shall consider: (1) the physical condition of the school employee, (2) the expected type of interaction with others in the school setting; and (3) the impact on both the infected school employee and others in that setting.

(3) In a manner which will not compromise the right of an individual to privacy and confidentiality, the principal of a school in which a student or employee is found to have contacted one of the communicable diseases may notify parents and staff of the presence of the disease. The purpose and intent of this notice would be to enable parents to be prepared for a possible outbreak of the disease (such as in the case of Pediculosis, chicken Pox, etc.) or to take precautions with other susceptible students.

COMMUNICABLE DISEASE

A. Reportable Diseases and Conditions

Report to the Garrett County Health Department promptly upon diagnosis or suspected diagnosis student’s or employee’s age, sex, address, and date of onset as required. Report immediately by telephone. (See Appendix B for updated list of reportable disease and instructions.)

An outbreak of any disease or condition of known etiology which may be a danger to the public health should be reported promptly.

Reporting of Student Absentee Rates

Inasmuch as the best indices of the presence of communicable disease in a community is an increase in absentee rate in the local school, whenever the school absentee rate is in excess of what is expected at a particular time of the year the principal shall contact the Director of Pupil Services. Generally when the absentee rate is in excess of 15% the principal, or principal’s designee shall report this information to the Director of Pupil Services who shall report it to the Garrett County Health Department.

Pediculosis (Head Lice)

Head lice are transmitted by close contact with an infested person’s, hair, clothing, combs, brushes, carpets, or linens. Symptoms include itching of the scalp. Nits (eggs) are tightly, attached to the shaft of the hair close to the scalp. Crawling lice seen on the nape of neck, behind the ears, in the eyebrows and eyelashes.

1. If a student is suspected of having head lice the following procedure should be followed:

a. Student should be examined by the school nurse, health room assistant or trained school personnel.

b. Student who has had a positive screening should be excluded from school with their personal belongings. Health Related Exclusion Form should be filled out as previously outlined. Letter (SHP 1) and instructions (SHP 5) should be sent home with the student.

c. Classmates and siblings should be screened. (See procedure in section II.)

d. Student should not be readmitted to school until at least 24 hrs after treatment and hair must be free of nits. Proof of treatment must be provided in the form of a box top from shampoo and note from parent or documentation of adequate treatment from health care provider, or Health Department personnel. Student should be re-examined for lice and nits. If any are found or treatment has not been adequate, student should be sent home with second letter (SHP4) and (SHP5).

e. Student should be re-examined at two to three weeks to be certain that student does not have newly hatched lice.

(1) If positive for lice or nits repeat above steps (b) through (e).

(2) If negative, no action needs to be taken.

2. Classmates and siblings of the student positive for having head lice should be screened using the following procedure:

a. The classmates and siblings (that are enrolled in public school) of the student that was found to have head lice or nits should be screened by the school nurse, health room assistant, or trained school personnel.

(1) If possible, a letter should be sent home prior to the screening. (SHP 2)

(2) The entire school community does not need to be informed unless the principal has reason to believe that the possible infestation extends beyond the student in a particular classroom or classrooms.

b. If the classmates and siblings are found not to have head lice or nits (SHP 3) should be sent home and no other actions should be taken.

c. If the classmates and/or siblings are positive for head lice or nits, the procedure in section I should be followed.

D. General Guidelines for minimizing the transmission of Communicable Diseases.

Hand washing is the single most important technique for preventing the spread of disease and should be done frequently. Protocol for hand washing should include the following steps:

Essential Steps	Key Points and Precautions
1. Remove all jewelry.	Jewelry should not be worn when working with students who require repeated physical contact and care. Micro-organisms can become lodged in settings or stones or rings.
2. Wet hands with running water.	Combine soap and water to wash water. Running water is necessary to carry away dirt and debris.
3. Apply liquid or dispensable	Liquid soap or powder is preferred to bar soap machine type soaps and lather well. Bacteria grow on bar soap and in soap dishes.
4. Wash hand using a circular motion and friction for 15 to 20 seconds.	Include front and back surfaces of hands, between knuckles, around nails, and the entire hand area. Avoid harsh scrubbing to prevent skin breaks.
5. Rinse hands well under running water.	Hold hands under the water so that water drains from wrist area to fingertips.
6. Dry hands well with paper towels and use paper towel to turn off faucet immediately.	Because of frequent hand washing, it is important to dry gently and thoroughly to avoid chapping. Using a paper towel to turn off faucets keeps hands from being contaminated.
7. Apply lotion as desired.	Lotion helps keep skin soft and reduces chapping.
8. Disinfect jewelry before wearing by washing with soap and water.	Micro-organisms can become lodged in jewelry.

E. Environmental Controls

Infectious agents can be spread through contact with environmental surfaces. Each facility that has a known or suspected carrier of a communicable disease in school attendance must make provisions for personal and environmental cleanliness:

1. Provide ready access to hand washing facilities.

2. After each use, clean surfaces used for diapering and food handling, and items that have been mouthed by students, such as mats, wedges, and special chairs. Health room cots and contaminated surfaces should be cleansed between students. Use a fresh (prepared daily) solution of ¼ cup household bleach to one gallon of water, or a “Hospital Disinfectant” as outlined in the Garrett County Exposure Control Plan. Pay special attention to cleanup of blood and body fluid spills and follow approved procedures for clean up.

3. Maintain storage areas for clean clothing, linens, utensils, equipment, and disposable items. These areas must be separate from areas used for storage of soiled items. The handling of food, first aid supplies, and medications are not to be in close proximity to areas for soiled items.

4. Keep soiled disposable items (such as gloves, sanitary napkins, diapers, and paper towels soiled with body fluids) in covered waste receptacles lined with disposable plastic bags. At the end of the day, the plastic bags are to be tied and placed within another plastic bag and tied – then discarded with normal garbage.

5. Keep soiled cloth diapers separate from soiled linens in covered waste receptacles lined with disposable plastic bags. Since infection can be spread through damp porous material, cloth laundry bags should not be used. These bags should also be put into another plastic bag and laundered. Cloth diapers should be laundered separately from other linens.

6. Provide custodial staff with a cleaning schedule. Areas of increased contamination such as health rooms, restrooms, and areas used for diapering and toileting should be mopped and disinfected daily.

7. Hand washing must be done:

a. before putting on and after taking off protective clothing and equipment;

b. before and after drinking, eating;

c. before handling clean utensils or equipment;

d. before and after handling student’s food or medication;

e. before and after assisting or training the student in toileting and feeding;

f. before and after going to the bathroom;

g. after contact with body secretions, such as blood (including menstrual), urine, feces, mucus, saliva, or drainage from wounds;

h. after handling soiled diapers, menstrual pads, garments, or equipment;

i. after caring for any student, especially those with nose, mouth, or ear discharges;

j. after removing disposable gloves; and

k. after caring for any student, especially those with nose, mouth, or ear discharge or drainage, and before initiating contact with another student.

NOTE: The wearing of disposable gloves is not a substitute for hand washing. Hands must be washed thoroughly after removing gloves. SEE INSTRUCTIONS FOR REMOVING GLOVES Appendix C.

8. All staff members should practice specific hygiene principles designed to protect themselves and others from infection. They should do the following:

a. maintain optimum health through effective daily health practices such as adequate nutrition, rest, exercise, stress reduction, regular medical care, etc;

b. avoid rubbing or touching eyes;

c. wash hands frequently;

d. remove jewelry, such as rings and dangling bracelets and earrings, during working hours;

e. use their own personal are items, such as combs, fingernail files, nail clippers, lipsticks, and toothbrushes;

f. keep fingernails clean and trimmed short;

g. cover mouth and nose when coughing or sneezing and dispose of tissues appropriately;

h. avoid the mouthing of toys, pencils, and other items shared by students.

9. Clean-Up of Blood/Body Fluids

a. Disposable gloves should be worn. Disposable cleaning cloths should be used to clean up spills of blood and other body fluids.

b. Surface debris should be removed first. Then a 1:10 solution of common household bleach solution (one part bleach to nine parts water) or appropriate disinfectant should be used to disinfect the area. If a disinfectant is used, check the label and follow instructions for recommended dilution and surface contact time.

c. Disinfectants: A hospital-grade disinfectant should be used to clean surfaces contaminated with body fluids. Such disinfectants will kill vegetative bacteria, fungi, tubercular bacilli, and viruses. The disinfectant should be registered by the U.S. Environmental Protection Agency (EPA) for use as a disinfectant in hospitals.

10. Cleaning of Equipment/Clothing

a. Gloves should be worn when handling soiled clothing.

b. Soiled clothing should be handled as little as possible to prevent gross microbial contamination of the air and employees. If immediate laundering is not possible, soiled clothing should be double bagged and sealed until removed by parent or guardian.

c. Laundry should be washed with detergent on the hot cycle. Clothing soaked with blood, and other body fluids should be washed separately from other items. Presoaking may be required for heavily soiled clothing.

d. There is no epidemiologic evidence of HIV/HBV transmission from soiled laundry. The effect of dilution, pH changes, and heat while laundering renders the risk of HIV and HBV transmission negligible.

e. Sponges, mops, or other non-disposable equipment that have been contaminated with blood and other body fluids should be cleansed with soap and water and soaked in a 1:10 bleach and water solution for at least 10 minutes. (NOTE: Bleach solutions may be damaging to some materials.)

F. Specific Guidelines for Controlling Communicable Disease:

A Health Team may have to be convened to make recommendations to the Superintendent/designee regarding the educational or employment setting and programs for individuals with specific diseases. The team should include: the school nurse, a representative from the Garrett County Health Department, school principal, student’s parents or guardians, student’s health care provider if possible, central office personnel as appropriate (i.e., transportation staff, etc. In making the recommendation, the team may request information from other appropriate persons, such as teachers, staff, and other disease specialists, as needed.

G. Exposure Control

Every school must follow and have available the Garrett County Public Schools Exposure Control Plan – Occupational Exposures to Blood Borne Pathogens.

1. All employees who may have been exposed to blood fluids will follow the procedures as outlined in the Exposure Control Plan.

2. The school nurses will annually provide information to employees on the procedure for reporting a potential exposure, standard precautions, proper use and removal of gloves and hand washing.

Adobe Acrobat is required to view the following Appendices. Download free at http://www.adobe.com/products/acrobat/readstep2.html

Appendix A Communicable Disease Summary

Appendix B Confidential Morbidity Reports

Appendix C Glove Usage

Head Lice Notification, SHP-1

Head Lice Possible Outbreak, SHP-2

Head Lice Clearance, SHP-3

Head Lice Follow-up Exam, SHP-4

Instructions for Treatment of Head Lice, SHP-5


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