EBBA-R1
Infection Control Regulation and Procedure
Direct contact with the body fluids of another person can potentially provide the means by which many different infectious diseases can be spread. It is important to remember that any person could potentially have disease-causing organisms in their body fluids, even if they have no signs or symptoms of illness. Consequently, the following recommendations should be followed in all situations and not just those involving an individual known to have an infectious disease.
In the school setting, it is essential that reasonable steps be taken to prevent individuals from having direct skin or mucous membrane contact with any moist body fluid from another person. Specifically, direct contact should be avoided with all of the following:
Blood
All other body fluids, secretions, and excretions regardless of whether or not they contain visible blood
Non-intact skin (any area where the skin surface is not intact, such as moist skin, sores, ulcers, or open cuts)
Mucous membrane
UNIVERSAL PRECAUTIONS
Universal precautions refer to the usual and ordinary steps that must be applied by all school staff to reduce their risk of infection with blood-borne diseases. They are “universal” because they refer to actions that must be taken at all times and in all cases, whether or not an individual is known to be infected with HIV, Hepatitis B, or any other disease that can be spread through contact with body secretions.
A. HANDWASHING GUIDELINES
Hand-washing is the first line of defense against the spread of infection. Strict hand-washing must be practiced by the children and staff including, but not limited to the following times:
Before eating, drinking or serving food
Before handling food, utensils or kitchen equipment
After using the toilet or diapering
Before and after providing procedures such as catheterization, suctioning, etc.
After contact with body fluids
After removing soiled clothing or contaminated equipment, diapers or menstrual pads
Frequently between student contacts
After the removal of gloves
Hands should be washed with running water and liquid soap, using friction for 15-30 seconds. Hands should be dried with disposable towels. The faucet should be turned off with a disposable towel so that clean hands are not dirtied.
B. PROTECTIVE EQUIPMENT
The use of personal protective equipment is intended to reduce the risk of contact with blood and other potentially infectious materials for the caregiver and to control the spread of infectious agents from student to student. It is essential that appropriate equipment be used in a consistent manner to reduce the risk of exposure. Personal protective equipment includes:
CDC recommended disposable gloves
Protective eyewear, if applicable
Masks
A combination of eyewear and mask, if applicable
Gloves should be worn when direct care with a student involves possible contact with blood, mucous membranes, non-intact skin, and other potentially infectious material. When providing care for a student with diarrhea or cold or flu-like symptoms, gloves should be worn when coming into contact with feces, respiratory secretions, or any item contaminated with these body substances.
Gloves should be discarded after each use. Hands should be washed whenever gloves are removed. Gloves should be worn at the following times:
When in contact with blood, material infected with blood, mucous membranes, or non-intact skin
When changing diapers or assisting a student after toileting or catheterization
When changing dressings
When the caregiver has broken skin on the hands or around the fingernails
When cleaning up spills of secretions, blood or other potentially infectious material
When touching items contaminated with secretions, blood, or other potentially infectious material
Protective eyewear and masks should also be worn during procedures which may generate splashes of blood or other potentially infectious material.
Absorbent underpads or other water barriers should be used to cover all work surfaces when contamination with body fluids is likely. The barrier should be discarded after each care session and the work surface is decontaminated.
In the event that CPR is necessary a disposable mask with a one-way valve should be used.
C. DISPOSAL OF WASTE
Any disposable item contaminated with blood or other potentially infectious material should be discarded in sturdy plastic bags and tightly closed for transport. State and local department of health regulations for containing, labeling, and transporting medical waste should be followed.
Needles, lancets, syringes and other sharp objects should be placed into sealable puncture-proof containers immediately after use. To reduce the risk of an accidental needle stick, needles should not be recapped, bent, broken, or removed from syringe before disposal. Once the disposal container has been filled, it should be sealed and disposed of according to federal, state, local regulations for medical waste.
Body substances, such as urine, feces, vomit should be disposed of in the sewer (toilet). Care should be taken to minimize splashing when disposing of these substances. Gloves and protective eyewear should be worn during the disposal.
D. CLEANUP OF SPILLS
Spills involving blood and other potentially infectious material should be cleaned up by the custodian immediately. Gloves should be worn during cleaning. If splashing may occur, protective eyewear with a mask should be worn. When a spill involves broken glass or a sharp object, the sharp pieces should be removed using a device, such as a dustpan or brush. Do not use your hands. The spill can be mopped up with paper towels or other absorbent material.
The area should then be decontaminated using any EPA-approved tuberculocidal disinfectant.
All items contaminated during cleanup should be double bagged, discarded or sent home. Broken glass or sharps should be placed in a sealable puncture-proof container.
Mops, buckets, and other cleaning equipment should be disinfected with fresh cleaning solution.
E. DISPOSAL OF SHARPS
The nurse will dispose of sharps in a disposable sharps container immediately after use. Needles should NEVER be recapped or broken from syringes. The sharps container will be sealed when full and delivered to recommended disposal location.
F. LAUNDRY
Gloves should be worn when handling laundry or clothing contaminated with blood or other potentially infectious material.
G. ACCIDENTAL EXPOSURE
Accidental exposure to blood and other potentially infectious material, as defined by OSHA, places all individuals in a school setting at risk of infection. All employees are encouraged to receive the Hepatitis B vaccine series; all students are required by law to have this immunization. If exposure to broken skin, blood, or eyes, noses or mouths occurs:
Wash the area immediately with soap and water or rinse eyes, nose and mouth if appropriate.
Notify each student’s parent or guardian about the incident.
Report the incident to the school nurse and the principal within 2-4 hours.
Document the incident on the appropriate accident form (student or employee), describing in detail what occurred.
Contact a physician for further care within 2-4 hours of the incident.
H. PREGNANT WOMEN
Pregnant women are at no higher risk of infection than other employees. Because of the possibility of certain viral infections that can cause congenital diseases, pregnant women are at higher risk of an adverse outcome from an infection. The consistent use of universal precautions and hand washing greatly reduces the risk of exposure to blood and other potentially infectious material for all individuals.
EXCLUDABLE ILLNESSES
The school nurse will assess the student regarding his/her condition and determine the need for exclusion. The nurse will then contact the parents to discuss the treatment plan. Disclosure of the nature of the illness will be shared on a need-to-know basis and the privacy of individual students and families will be protected at all times.
A. PROCEDURE
In consultation with the principal, the school nurse will notify teachers in affected classrooms of the nature of the infectious illness.
The nurse will instruct teachers and custodians about precautions within the classroom and the disinfection of school equipment for the purpose of decontamination.
The nurse will notify other parents when necessary of the presence of the infection and precautions to be taken at home.
B. EXCLUSION FROM SCHOOL
The following conditions are considered excludable, therefore, if a student has or is exposed to any of these conditions, the nurse will make a recommendation to the principal that the child be excluded:
Fever – Any child with a fever of 100F or greater should remain home until 24 hours fever free without medication.
Chicken Pox – May return to school in 5 to 7 days when all lesions are dried and scabbed over.
Conjunctivitis – May return to school 24 hours after treatment has begun or after a full day’s worth of doses.
Diphtheria – The student must stay home until completely recovered. Complete recovery has occurred when the student has had two negative nose and throat cultures taken at least 24 hours apart.
German Measles – The student should remain home for 7 days following the appearance of the rash.
Impetigo – The student cannot return to school until 24 hours after topical or oral antibiotics have been started.
Measles – The student should remain home for 7 days following the onset of the illness. The child may or may not experience a fever, cough or appearance of the rash.
Molluscum Contagiosum – due to the longevity of the rash, students may attend school as long as lesions are covered and under a doctor’s care.
Mumps – The student should stay home for at least 9 days from the onset of the illness or until all swelling is gone.
Pediculosis (Lice) – The nurse will evaluate student to determine appropriate action. If live lice are present, child will be sent home for appropriate treatment/
Pertussis (Whooping Cough) – The student must remain home for 5 days after initiation of antibiotic treatment.
Scabies – The student can return to school once treatment has been started. Because it is not unusual for the rash to last four to six weeks, students may return if the rash is still present.
Shigella – The student must remain home for 48 hours after the initiation of oral antibiotics and diarrhea has subsided.
Strep Throat – The student cannot return to school until 24 hours after antibiotics have been started.
Ringworm of the Scalp – The student may return after the first dose of oral medication.
Ringworm of the Skin – The student may return after the first dose of topical medication.
Tuberculosis – The student should stay home until the treatment is initiated if the TB is active.
C. REENTRY
Students will be readmitted according to the above criteria for specific illnesses. The student should have a note from his/her provider of the case of the aforementioned illnesses or if they have been out of school for a week or more. The note must be presented to the school nurse upon return to school. The school nurse will provide the classroom teachers with any information necessary to support a student’s safe return to school.
First Reading: 08/06/02 Second Reading: 09/10/02 ADOPTED: 09/10/02 Revised: 05/26/15