Administrative Rules and Procedures to Implement Policy 404.04
PROCEDURES FOR COMMUNICABLE DISEASE CONTROL
1. Children who are obviously ill or who are known to have a communicable disease shall not attend classes during the course of an illness. (Nebraska Statutes 79- 264)
2. A student exhibiting any of the following symptoms may have a contagious or infectious illness and may be excluded from the classroom until the nature of the illness is known:
Fever, flushed face, headache, aches in muscles or joints, unexplained tiredness or listlessness, loss of appetite, stomach ache, nausea or vomiting, diarrhea, unexplained skin eruptions, sore throat or inflamed eyes.
3. Students excluded for a confirmed communicable disease should not be allowed to return to school until the minimum isolation period has been lapsed and all signs and symptoms of illness have disappeared. Minimum isolation periods are shown on the Classroom Communicable Disease chart which reflects current public health practices as defined by the Director of Health, Department of Health, State of Nebraska. Physician documentation for readmission to the classroom may be requested.
The aforementioned illnesses are not meant to be an all inclusive list of contagious or infectious diseases which would necessitate a student being excluded from classes for a period of time.
Specific recommendations and medical precautions for a particular student/situation will be developed on a case by case basis. If it becomes necessary to develop a more definitive approach, the child’s physicians, other medical consultants, Health Department personnel, Nebraska Department of Education officials and local school administrators will review all available medical and educational information.
Elkhorn Public Schools personnel shall maintain confidentiality of all students’ medical histories including communicable diseases. Personnel are encouraged to review information on file in the Superintendent’s office which deals with communicable disease and the implications for school personnel.
Elkhorn Public Schools personnel who have special health considerations (i.e., pregnancy, immunosuppressed condition, etc.) are responsible to share that information with their supervisor so that assignments can be adjusted as necessary.
ELKHORN PUBLIC SCHOOLS
EXPOSURE CONTROL PLAN
A. EXPOSURE DETERMINATION
The administration will identify classifications of employees who in performance of their duties may have:
1. Reasonably anticipated skin, eye, mucous membrane, or parenteral contact with blood or other infectious materials such as blood, internal body fluids and body fluids visibly contaminated with blood.
2. Reasonably anticipated contact with all body fluids in situations where it is difficult or impossible to differentiate between body fluids.
In addition to being reasonably anticipated, the contact must result from the performance of the employee’s duties. Individual job duties will be considered when determining those employees at risk.
“Employee” shall mean an employee of Elkhorn Public Schools or a student teacher/therapist assigned to and under the supervision of Elkhorn Public Schools.
B. CONTROL METHODS
Universal precautions (UP) are practices and procedures established to assist in the prevention of contact with blood and other body fluids. Although the risk of exposure to bloodborne pathogens (Human Immunodeficiency Virus and Hepatitis B) in the educational setting is low, safe work practices require the assumption that all blood or body fluids be considered potentially infectious (blood, cerebral spinal fluid, amniotic fluid, semen, vaginal fluids, any fluid containing blood, feces, urine, vomitus, drainage from wounds, respiratory secretions and saliva).
The following safe work practices and engineering controls are identified to protect students and employees from exposure to blood and body fluids which could potentially cause infectious disease.
Hand washing
Hand washing is thought to be the most important procedure in preventing the spread of infection.
Hands should always be washed when:
1. Hands are soiled.
2. Handling or preparing food.
3. Eating.
4. Blowing or wiping nose.
5. Using toilet, assisting students with toileting needs or diapering.
6. Coming in contact with contaminated equipment.
7. Skin contacts blood or body fluids.
8. After gloves are removed.
Proper hand washing procedures are:
1. Wet hands with warm water.
2. Apply soap, lather hands and wrists.
3. Scrub all surfaces of the hand, between fingers, under fingernails for a minimum of 15 seconds keeping hands and fingers pointed down.
4. Rinse hands and wrists thoroughly with warm water, allowing water to flow from wrist down.
5. Dry hands well with air dryer or single-use paper towel, turning off faucet using towel before discarding to prevent recontamination.
Barriers
When possible, direct contact with blood and body fluids should be avoided. Barriers reduce the risk of contact as well as control the spread of infections between individuals.
1. Wear disposable gloves when in direct contact with blood or body fluids, handling soiled clothing or equipment, toileting children, when regularly exposed to a student’s saliva or oral cavity or when working with students who have uncovered bloody skin surfaces (i.e., as a result of self-mutilating behaviors). If unanticipated contact occurs, wash hands immediately following contact. Gloves should be removed without touching the outside or other objects. Dispose after each use.
2. Utility gloves may be decontaminated for reuse if the integrity of the glove is not compromised. They should be discarded if they are cracked, peeling, torn, punctured, or exhibit other signs of deterioration.
3. During Cardiopulmonary Resuscitation (CPR) procedures, the use of a one-way protective shield is recommended.
Blood and Other Potentially Infected Material Spill Cleanup
1. Wear disposable gloves. Do not reuse disposable gloves.
2. Use disposable (paper) towels and other absorbent materials to absorb spills.
3. Clean spill area with soap and water.
4. Utilize proper disinfectant utilizing a 1:10 ratio for household bleach solutions or other Environmental Protection Agency (EPA) registered disinfectants.
5. Rugs contaminated with body fluids may be cleaned by using a sanitary absorbing agent. Allow to dry as directed. Vacuum or mechanically r emove with dust pan and broom; apply rug shampoo (containing germicidal detergent and revacuum.
6. Dispose of waste (gloves, paper towels, etc.) in leakproof plastic bag.
7. Clean and disinfect reusable equipment.
8. Wash hands thoroughly with warm water and soap.
Cleanup of Objects Contaminated With Blood or Other Potentially Infected Material (i.e., athletic equipment)
1. Wear disposable gloves. Do not reuse disposable gloves.
2. Discard contaminated items that cannot be cleaned or disinfected into lined container.
3. Wash objects using warm water and general purpose cleaner.
4. Disinfect the object using EPA approved disinfectant or 1:10 ratio household bleach solution.
5. Dispose of contaminated cleaning materials in leakproof plastic bag.
6. Wash hands thoroughly with warm water and soap after gloves are removed.
First Aid/Health Care
Whenever possible and appropriate, employees should practice self-management of injuries and should teach students the same. The principle of self-management includes self treatment, cleaning and disposing of contaminated materials to avoid contact by a second party.
When that is not possible:
1. Wear gloves.
2. Use paper toweling or gauze pads to wipe injury and, if appropriate, allow student to rinse injury with running water.
3. Place soiled materials in a waste container that is plastic bag lined.
4. Soiled clothing should be removed and placed into a plastic bag, secured, and sent home.
5. Assist in cleaning affected area and applying bandage as necessary.
6. Dispose of gloves along with other soiled materials in plastic lined waste container, secured, and disposed of properly.
7. Wash hands thoroughly after removing gloves.
Regulated wastes are defined by Occupational Safety and Health Act (OSHA) as liquid or semi-liquid blood or other potentially infectious materials and caked dried blood capable of releasing the waste if compressed. If regulated waste is generated, it must be properly bagged, labeled, and disposed of.
Eating, drinking, applying cosmetics or lip balm, and the handling of contact lenses should be prohibited in areas where there is a reasonable likelihood of occupational exposure.
Contaminated Sharps
(broken glass, needles, lancets, knives, blades)
1. Tongs or dustpan and broom should be used to pick up contaminated sharps such as blood-covered broken glass to avoid direct contact.
2. Gloves should be worn when handling contaminated sharps.
3. Needles, lancets and other contaminated sharps should not be bent, recapped or removed.
4. Sharps should be placed in puncture-resistant, labeled, leak proof container, able to be closed after each use.
5. Sharps containers should be disposed of properly.
Clothing/Laundry
Clothing and other non-disposable items soaked with body fluids should be placed in plastic bags. If rinsing or presoaking is needed, wear gloves. If washing clothes contaminated with body fluids, clothes should be washed separately from other items. Wash as usual, add 1/2 cup bleach to wash cycle if bleachable. Add 1/2 cup non-chlorine bleach if unbleachable.
Diaper Changing Procedure
1. Wear disposable gloves.
2. Place student on a clean changing table using waterproof pad with two clean paper towels for each change.
3. Remove the soiled diaper and place in a plastic bag.
4. If other clothing is soiled, place in a plastic bag and mark with the child’s name.
5. Clean skin in diaper area using individual disposable wipes or other cleansers provided by parents when special consideration to skin cleansing is needed for an individual student and apply clean diaper.
6. Wash pad after each change with soap and water and follow with household bleach solution or EPA approved disinfectant.
7. Remove gloves and place in plastic bag.
8. Wash hands with soap and water before and after diaper change.
9. Never leave child unattended on the changing area.
10. Supplies should be stored close to the changing area and out of the child’s reach.
11. Report any abnormal conditions (blood or pus in diaper area, diarrhea, light colored stools, skin rashes, bruises or breaks in the skin) to the child’s teacher.
Toy Sanitation Technique
If children drool on mouth toys, special consideration for the sanitation of the toys should follow:
1. Sanitize by putting through a dishwasher cycle.
2. If dishwasher is not available, wear gloves and wash toys with soap and water.
3 . Rinse with hot water.
4. Disinfect in a 1:100 bleach solution 10 minutes.
5. Air dry.
Dish washing Sanitation Technique
If it should be necessary to wash dishes in the classroom the following should be followed:
1. The dish washing area should be separate from the hand washing area.
2. Dish pans should be used.
3. Wash in hot soap and water.
4. Rinse with hot water.
5. Soak in a 1:100 bleach solution 10 minutes.
6. Drain and air dry.
Disinfectants
1. All cleaning supplies must be kept in labeled containers.
2. All cleaning supplies must be kept out of the reach of students in locked cabinets.
3. Custodial staff will follow guidelines from their department as relates to disinfectants.
4. If household bleach water is used as disinfectant, it must be mixed daily.
5. Ratio of bleach to water for disinfectant solution = 1:10. A ratio of 1:100 bleach solution is considered an intermediate cleaning solution.
C. HEPATITIS B VACCINATION
The Hepatitis B vaccination series will be offered, at no cost, to all identified employees whose jobs involve the risk of directly contacting blood or other potentially infectious materials.
1. The vaccination will be made available after the employee has received the required training and within 20 working days of work assignment, unless,
a. The employee has previously received the complete Hepatitis B vaccination series.
b. Antibody testing has revealed that the employee is immune.
c. Vaccine is contraindicated for medical reasons.
d. The employee chooses to decline the Hepatitis B vaccination.
2. Vaccination shall be given under the supervision of a licensed health care professional.
3. The employee may decline the Hepatitis B vaccination (statement must be signed) at the time it is offered but at a later date decide to accept the vaccination.
D. OCCUPATIONAL EXPOSURE
Occupational exposure relates to the reasonable anticipation that blood or other infectious body fluids will come in contact with an employee’s mucous membranes (eye, nose, mouth), skin, or through parenteral contact (skin piercing) while performing job duties.
If an exposure would occur by staff or student, the following should occur:
1. Wash exposed area immediately with soap and water.
2. If mucous membrane, irrigate or wash thoroughly.
3. Report exposure immediately.
a. If student, notify parent or guardian. Medical provider should be consulted.
b. If employee, report immediately to administration.
E. POST-EXPOSURE EVALUATION AND FOLLOW-UP
Following the report of an exposure incident, Elkhorn Public Schools will make a confidential medical evaluation and follow-up available to the exposed employee. This evaluation and follow-up will:
1. Be made at no cost to the employee.
2. Be made available at a reasonable time and place.
3. Be performed by a licensed physician or trained health care professional.
4. Document the exposure incident including identification and documentation of source individual.
5. Provide health care professional a copy of the 29 CFR 1910.1030 regulation and other required information.
F. TRAINING OF EMPLOYEES
Elkhorn Public Schools will require all employees to participate in a training program. The training program will:
1. Be provided at no cost during work hours. 2. Occur annually, within one year of the previous training.
3. Be conducted by an individual knowledgeable in the subject area.
4. Contain the following elements:
a. An accessible copy of the regulation and explanation of its contents.
b. A general explanation of the epidemiology and symptoms of bloodborne pathogens.
c. An explanation of the modes of transmission of bloodborne pathogens.
d. An explanation of the exposure control plan and how employees can obtain a copy.
e. An explanation of appropriate methods for recognizing tasks and other activities that may involve exposure.
f. An explanation of the use and limitations of methods that will prevent or reduce exposure.
g. Information on the types, proper use, location, removal, handling and disposal of equipment and contaminated materials.
h. Information on the Hepatitis B vaccine, including efficacy, safety, method of administration, benefits, and the conditions under which it is offered, free of charge, to employees.
i. An explanation of the procedure to follow if an exposure incident occurs including information on post exposure and follow-up.
j. An opportunity for questioning the individual conducting the training session.
Training records will contain the following information and be maintained for 3 years from the date training occurs:
a. Dates of the training sessions.
b. Contents or a summary of the training sessions.
c. Names and qualifications of persons conducting the training.
d. Names and job titles of all persons attending the training sessions.
G. RECORD KEEPING
An immunization record will be maintained for each employee with occupational exposure. This record will be kept in their personnel file. This record will include:
1. Demographic Data (name and social security number)
2. Documentation regarding Hepatitis B vaccination status including the dates of all the hepatitis B vaccinations and any medical records.
3. A copy of all results of examinations, medical testing, and follow-up procedures.
4. A signed consent form or refusal to participate form pertaining to the Hepatitis B vaccination.
All materials will be kept confidential and not disclosed or reported without the employee’s express written consent. Documentation of personnel participation in the training program will be maintained as well.
H. POST EXPOSURE REPORT
Occupational exposure related to the reasonable anticipation that blood or other infectious body fluids will come in contact with an employee’s mucous membranes (eye, nose, mouth), skin, or through parenteral contact (skin piercing) while performing job duties. Should an exposure occur, the following procedure should be followed:
1. Wash the exposed area immediately with soap and water.
2. If mucous membrane, irrigate or wash thoroughly.
3. Report exposure immediately:
a. If student
Notify parent or guardian.
Recommend consultation with medical provider.
b. If employee
Report incident immediately to administrator.
Complete worker’s compensation form as this is considered a work related incident/accident.
Complete post exposure form
Consult with personal medical provider. It is recommended that you consult directly with your physician since many clinics are unfamiliar with occupational exposure incidents. Medical evaluation should occur within 24 hours to facilitate appropriate treatment promptly.
I. FORMS – The following forms are to be used to implement Policy 404.04: 1 Exposure Determination, 2 Description of Exposure Incident, 3 Hepatitis B Vaccine – Decline, 4 Hepatitis B Vaccine – Informed Consent, 5 Hepatitis B Vaccine – Physician Approval, 6 Exposure Incident Follow-up, and 7 Training Program