Infectious Disease (Procedure)

PROCEDURE: 
SUBJECT: Infectious Disease

PROCEDURE:

Certain microorganisms in the body cause infectious disease. Infectious diseases may or may not be communicable or in a contagious state.

WSSB may control disease in a contagious state by excluding the student from the classroom and/or cottage or by referring the student for medical attention.  Staff members must advise the school nurse when a student exhibits symptoms of an infectious disease based on the criteria outlined in this procedure.  Staff should provide the school nurse with as much health information as is known about the case in a timely manner so that appropriate action can be initiated (See OSPI’s Infectious Disease Control Guide for School Staff).

I. List of Reportable Diseases

In consultation with the school nurse, WSSB will report suspected disease or disease with known diagnosis to the local health department as indicated on the Notifiable Conditions page of the Washington State Department of Health’s website.

II. Cluster of Cases

The occurrence of any generalized (greater than 75% of the body) rash with or without fever, cough, runny nose, and reddened eyes in a student MUST be reported IMMEDIATELY to the school nurse who will in turn report as necessary to the local health department.  Localized rash cases diagnosed as unrelated to a contagious disease, such as diaper rash, poison oak, etc. need not be reported.  In addition to the rash illnesses, any unusual cluster of infectious disease must be reported to the school nurse, who will report to the local health reported as necessary.

III. Identification and Follow-up

A. The length of absence from school for a student ill from a contagious disease is determined by the directions in the Infectious Disease Control Guide for School Staff or instructions provided by the student’s licensed health care provider, and/or local health officer.

B. The Director of On-Campus Programs has the final responsibility for enforcing all exclusions.

C. In practice, when the school nurse or Director of On-Campus Programs suspects a nuisance disease such as pediculosis (lice) or bed bugs, the school nurse or Director of On-Campus Programs may institute screening procedures to determine if, in fact, the disease exists.  Written instructions as to care are provided to the parent(s) or guardian(s) in suspected cases.

D. Follow-up of suspected communicable disease cases should be carried out in order to determine any action necessary to prevent the spread of the disease to other students.

E. Staff will follow the directions of the school nurse, local health officer, and the Washington Department of Health guidelines for mitigation measures.

IV. Reporting at Building Level

A. Each incident of a student who is absent form school because they are suffering from a communicable disease shall be reported to the school nurse.

B. All major cases of communicable disease shall be reported by the school nurse or Director of On-Campus Programs by telephone to the health services office.

C. A student with a diagnosed reportable disease will be reported by the school nurse or Director of On-Campus Programs to the local health officer (or state health officer if local health officer is not available) as needed.

D. When symptoms of a communicable disease are detected in a student who is on campus, the procedure for the disposition of an ill or injured student will be followed.  In all instances, the school nurse or Director of On-Campus Programs will:

1. Notify the parent/guardian or emergency contact to advise them of the signs and symptoms;
2. Arrange for the parent/guardian to pick up the student as soon as possible recommend and/or require follow-up with a licensed health care provider;
3. Keep the student isolated until the parent/guardian arrives.

Note:  When the student if fourteen (14) years or older and the symptoms are of a sexually transmitted infection, the student has confidentiality rights that PROHIBIT notification of anyone but the Health Department.

E. Environmental surveillance is to be provided by the nurse as needed to prevent the spread of the disease.

F. Any employee of WSSB, to whom it is disclosed that a student has HIV/AIDS, should immediately make and oral report, in person or by telephone, to the school nurse.  The school nurse is the only person to whom the WSSB employee can disclose the information.

G. The school nurse will be responsible for contacting the local public health officer and for maintain a confidential written record of the report.  The report is NOT to be placed in the infected student’s file.

V. First Aid Procedures

A. Students should be asked to wash their own minor wound areas with soap and water under staff guidance when practicable.  If performed by staff, wound cleansing should be conducted in the following manner:

1. Soap and water are recommended for washing wounds;
2. Gloves must be worn when cleansing the wound which may put the staff member in contact with wound secretions or when in contact with any bodily fluids is possible;
3. Gloves and cleansing materials will be discarded in a lined trash container that is disposed of daily according to WAC 296.823 – Occupational exposure to bloodborne pathogens and included in OSPI’s most recent Infections Disease Control Guide for School Staff.
4. Hands must be washed before and after treating the student and removing gloves; and
5. Treatment must be document in a health record.

B.  Thermometers will be handled in the following manner:

1. Only disposable thermometers or non-mercury thermometers with disposable sheath covers and/or temporal scan thermometers should be used when taking a student’s temperatures; and
2. Disposable sheath covers will be discarded in a lined trash container that is secured and disposed of daily.  Temporal scan thermometers will be disinfected after each use.

C. Handwashing Procedures by Building Staff

1. Handwashing is the most important element for preventing the spread of disease.
2. Staff attending to students for first aid, taking temperatures, or in contact with the Health Center should be concerned about clean hands.  Hands should be washed before and after contact.
3. Hands should be vigorously washed with soap under a stream of water for approximately one minute.  Rinse with running water.  Dry hands thoroughly with paper towels.

VI.  Handling of Bodily Fluids

A. Bodily fluids of all persons should be considered to contain potentially infectious agents (germs).  Body fluids include blood, drainage from scrapes and cuts, feces, urine, vomitus, saliva, respiratory secretions, semen, and vaginal secretions;

B. Gloves must be worn when in direct hand contact with bodily fluids is anticipated (e.g. treating nose bleeds, bleeding abrasions), when handling clothes soiled by bodily fluids (e.g. urine and/or feces), when diapering students, and when sanitizing spaced used for diapering.  Hand washing is the most important intervention for preventing the spread of disease and must take place after gloves are removed and between care of multiple students;

C. Used gloves must be discarded in a secured lined trash container and disposed of daily according to WAC 296.823 – Bloodborne Pathogens and included in the most recent OSPI Infectious Disease Control Guide for School Staff.  Hands must then be thoroughly washed;

D. Self-treatment of minor injury, when reasonable, will be encouraged;

E. Sharps will be disposed in an approved container.  Sharps containers must be maintained upright through use, be tamper proof, safely out of student’s reach, be replaced routinely, and not be allowed to overfill.

F. For cleaning and disinfection, follow CDC and EPA recommendation.  In addition, WSSB will comply with WAC 296.823 – Bloodborne Pathogens and OSPI’s most recent Infectious Disease Guide for School Staff.

VII. Treatment of Students with Chronic Medical Conditions (e.g., HIV/AIDS, Hepatitis)

A. On the disclosure that a student has been identified as having acquired Human Immunodeficiency Virus (HIV) or Acquired Immunodeficiency Syndrome (AIDS) or infectious Hepatitis, the school nurse, superintendent, Director of On-Campus Programs, parent/guardian, local health officer and the student’s licensed healthcare provider will confer as necessary and determine the appropriate placement of the student.  The student will be accommodated in the least restrictive manner, free of discrimination, without endangering the other students or staff.  The student may only be excluded from school on the written concurrence of the public health officer and the student’s licensed healthcare provider, that remaining or returning to school would constitute a risk either to the student or to other employees or other students.

B. All discussions and records will be treated as confidential, consistent with RCW 70.24.105.

C. Release of information regarding the testing, test result, diagnosis or treatment of a student for a sexually transmitted infection, HIV, drug, alcohol, mental health treatment, family planning, or abortion may be made only as pursuant to an effective release and only to the degree permitted by the release.  To be effective, a release must be signed, dated, must specify to whom the release may be made, and the time period for which the release is effective.  Students fourteen (14) and older must authorize disclosure regarding HIV, sexually transmitted infections, or reproductive healthcare issues.  Students thirteen (13) and older must authorize disclosure regarding drug or alcohol, or mental health treatment.  Students of any age must authorize disclosure regarding family planning or abortion.  Parent(s)/guardian(s) must authorize disclosure pertaining to younger students.

D. Any disclosure made pursuant to a release regarding reproductive healthcare, including sexually transmitted infections, bloodborne pathogens, drug or alcohol treatment must be accompanied by the following statement:

“This information has been disclosed to you from records whose confidentiality is protected by state law.  State law prohibits you from making further disclosure of it without the specific written consent of the person to whom it pertains, or as otherwise permitted by state law.  A general authorization for the release of medical or other information is not sufficient for this purpose.”

E. WSSB will ensure that newly hired employees receive bloodborne pathogens training regarding;

1. History and epidemiology of bloodborne pathogens;
2. Methods of transmission of bloodborne pathogens;
3. Methods of prevention of bloodborne pathogens including universal precautions for handling of bodily fluids;
4. Current treatment for symptoms of bloodborne pathogens and prognosis of disease progression
5. State and federal laws governing discrimination of persons with bloodborne pathogens; and
6. State and federal law regulating confidentiality of a person’s bloodborne pathogens.

F. WSSB will ensure that new employees receive this training within six (6) months form the first day of employment at WSSB.

G. Continuing employees will receive information, within one year of WSSB’s receipt from OSPI, on new discoveries or changes in accepted knowledge of transmission, prevention, and treatment for bloodborne pathogens.

VIII. Disinfecting Contaminated Surfaces by Staff

A. Intermediate level disinfectant will be used to clean surface contaminated by bodily fluids.

1. Disinfectants

a) Household bleach diluted one part to 10 parts water.  This is preferred for objects that may be put in the mouth.  Note: this solution must be mixed on a daily basis due to evaporation of bleach;

b) 70% ethyl or isopropyl alcohol

c) Phenolic germicidal detergent, 1% solution (e.g. Lysol); or

d) Quaternary ammonia germicidal detergent in 2% aqueous solution (e.g. Triquat).

2.  Procedures

a) Remove soil;

b) Apply disinfectant with mop or cloth;

c) Dispose of water in toilet or sink designated to contaminated water;

d) If cloths and towels are used, these should be placed in a plastic bag until laundered; and

e) Paper towels and other disposable items should be placed in a lined trashed can which is secure and discarded daily.

3. Disinfection of Rugs

a) Apply sanitary absorbent agent;

b) Let dry and vacuum.  If necessary, mechanically remove with broom and dustpan.

c) Apply rug shampoo using germicidal agent;

d) Re-vacuum;

e) Rinse dustpan and broom in disinfectant; and

f) Discard non-reusable cleaning equipment in lined trash container that is secure and discarded daily.

IX. Handling of Soiled Clothing and Bedding

1. If clothing is to be sent home or laundered, place in plastic bag and tie securely;
2. The responsible person will use discretion as when to discard when indicated;
3. If washing at school, wash separately in soap and water on wash cycle.  If material is bleachable, add ½ cup household bleach to wash cycle; and
4. If not bleachable, add ½ cup color safe bleach to wash cycle.

Legal References:
RCW 70.02

RCW 28A.210.010

RCW 70.24.290

WAC 246.110

Related Documents:      Office of the Superintendent of Public Instruction – Infectious Disease Control Guide for School Staff