Download universal - Francis Howell School District

FRANCIS HOWELL SCHOOL DISTRICT
UNIVERSAL
PRECAUTIONS
AND
Severe Allergy
Awareness
Revised May, 2012
Universal Precautions
The strategy of Universal Precautions was developed in the mid-1980’s as a
means of preventing the transmission of blood borne pathogens such as human
immunodeficiency virus (HIV) and hepatitis B virus (HBV). Although Universal
Precautions were initially designed for use in hospitals and clinics, they are
applicable in any workplace setting, including schools, where exposure to blood
or blood-contaminated materials could potentially occur.
The term “universal” indicates that precautions
are to be taken at all times and in all situations.
Universal Precautions involve the following measures:
1. Appropriate barrier precautions should be used to avoid skin or mucous
membrane contact with any of the body fluids. (blood, urine, feces, mucous,
saliva). Such barrier precautions can, based on the given situation, include the
use of standard medical vinyl or latex gloves along with protective eyewear or
masks. If potential contact with a significant amount of blood is anticipated,
latex gloves are preferred. These items should always be available and readily
accessible.
2. Hands and other skin surfaces should be washed immediately and thoroughly
if contaminated. Hands should be washed immediately after gloves are
removed.
3. If any body fluids come in contact with the mucous membrane surfaces of the
mouth or nose, the area should be vigorously flushed with water. If the
mucous membrane surfaces of the eye are contaminated, they should be
irrigated with clear water, or saline solution or sterile irrigants designed for
the purpose.
4. Precautions should be taken to avoid injury with sharp instruments
contaminated with blood. Sharp items such as x-acto knives should be placed
in puncture resistant, leak proof containers for disposal.
5. Persons providing health care who have excessive oozing fluids from skin
lesions or weeping dermatitis should refrain from all direct student care, and
from handling student-care equipment, until the condition resolves.
GUIDELINES FOR HANDLING BODY SUBSTANCES IN SCHOOLS
The following guidelines are meant to provide simple effective precautions
against transmission of disease for all persons, including pregnant women,
potentially exposed to blood or body fluids of any student. No distinction is
made between body substances from persons with a known disease or those
from persons without symptoms or with an undiagnosed disease.
DOES CONTACT WITH A BODY SUBSTANCE PRESENT A RISK?
The body substances of all persons should be considered to contain potentially
infectious agents (germs). The term “body substances” includes, but not limited
to, blood, urine, semen, mucous, drainage from wounds, and saliva. Contact with
body substances presents a risk of infection with a variety of germs. In general,
however, the risk is very low and dependent on a variety of factors including the
type of substance with which contact is made and the type of contact made with it.
It must be emphasized that with the exception of blood, which is normally sterile,
the body substances with which one may come in contact usually contain many
organisms, some of which may cause disease. Furthermore, individuals who have
no symptoms of illness can carry many germs. These individuals may be a
various stages of infections: incubating disease, mildly infected without
symptoms, or chronic carriers of certain infectious agents including the AIDS and
hepatitis viruses. In fact, transmission of communicable disease is more likely to
occur from contact with infected body substances of unrecognized carriers than
from contact with substances from recognized individuals because simple
precautions are not always followed.
WHAT SHOULD BE DONE WHEN HUMAN-TO-HUMAN
BITE/SCRATCH OCCURS?
If the skin is unbroken, wash the area with soap and water and rinse the area with
hydrogen peroxide.
If the skin is broken, wash the area with soap and water, rinse with hydrogen
peroxide and apply antibiotic ointment and a dressing.
All human-to-human bites and scratches are to be reported immediately to the
health office for documentation. For a bite or scratch that opens the skin, the
employee may request follow-up care with Workman’s Compensation at district
expense.
WHAT SHOULD BE DONE IF SKIN CONTACT OCCURS?
In many instances, unanticipated skin contacts with body substances may occur in
situations where gloves may not be immediately available, such as when wiping a
runny nose, applying pressure to a bleeding injury outside the classroom, or
helping a child in the bathroom. In these instances, hands and other affected skin
areas of all exposed persons should be routinely washed with soap and water after
direct contact has ceased. Clothing and other non-disposable items, such as
towels, should be rinsed and placed in plastic bags prior to laundering them. If
presoaking is required to remove stains, use gloves while rinsing or soaking items
prior to bagging. Clothes should be sent home for washing with appropriate
directions to parents. Contaminated disposable items such as tissues, paper
towels, diapers, should be handled with disposable gloves and disposed of in a
plastic bag.
HOW SHOULD SPILLED BODY SUBSTANCES BE REMOVED FROM
THE ENVIROMENT?
Each school has standard procedures already in place for removing body
substances. These procedures should be reviewed to determine if appropriate
cleaning and disinfection steps have been included. All schools stock sanitary
absorbent agents specifically intended for cleaning body substance spills.
Disposable gloves should be worn when using these agents. The dry material is
applied to the area, left for a few minutes to absorb the fluid, and then vacuumed
or swept up. The vacuum bag or sweepings should be disposed of in a plastic
bag. Broom and dustpan should be cleaned in a disinfectant. No special handling
is required for vacuum equipment. Area should be scrubbed with a disinfectant.
INFECTION CONTROL PROCEDURES FOR SCHOOLS
Having direct contact with body fluids of another person can potentially provide
the means that can transmit infection. Some of the diseases that can result are:
Body Fluid
Eye Discharge
Nose or Throat Drainage
Blood
Feces
Urine
Diseases Spread by Contact with this Body Fluid
Conjunctivitis (Pink Eye)
Colds and Influenza, Strep
Hepatitis B, HIV disease
Hepatitis A, Shigellosis, Giardiasis
CMV infection
It is important to remember that any person could potentially have disease;
having 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 recommended that reasonable steps be taken to prevent
individuals from having direct skin or mucous membrane contact with any body
fluid from another person. Specifically, direct contact should be avoided with the
following:
1. Blood
2. All other body fluids, secretions, and excretions regardless of whether
or not they contain visible blood
3. Non-intact skin (moist skin sores, ulcers, open skin cuts)
4. Mucous membranes (eyes, inside of nose and mouth)
If hands or other skin surfaces are contaminated with body fluids from another
person, washing with soap and water should take place as soon as possible.
In general, standard medical vinyl or latex gloves should be worn whenever the
possibility of direct contact with any body substance from another person is
anticipated. Gloves should be available and easily accessible in any setting where
contact with body fluids could take place. Hands should be washed immediately
after removal of gloves. Pocket masks or other devices for mouth-to-mouth
resuscitation should be available.
RECOMMENDATIONS FOR INFECTION CONTROL IN THE CLASSROOM
1.
Hand washing technique taught to staff and students.
2.
Adequate hand washing facilities: running water, liquid soap and paper
towels.
3.
Time provided for students and staff to wash hands after toileting.
4.
Tissue available in all classrooms.
5.
All waste baskets lined with plastic liners. Covered containers with plastic
bags provided in Health Office and any other areas likely to have disposable
items contaminated with body fluids. Never reuse plastic bags.
6.
Students and staff should have all lesions and cuts covered with a bandage.
7.
All potentially contaminated areas should be sanitized at least once daily. If
surfaces are visibly soiled, wash with soap and water first, then sanitize.
Liquid soap dispensers should be sanitized daily.
8.
Mop water must be changed after a body substance clean up. Mops must be
hung up after sanitizing. Mops and dirty water should not be left standing.
9.
Cleaning sponges should not be used in the classroom.
10.
Disposable dishes should be used in the classroom.
11.
ANIMALS: Guidelines should be in place that recognize animals carry and
transfer diseases to humans.
a. Keep animals in closed cages that have floors. Do not allow them to
roam freely in the classroom.
b. If the animal has symptoms of illness, such as diarrhea, drainage or
crusting of the eyes or ears, or hair loss, it should be examined by a
veterinarian.
c. All litter boxes should be placed within the animal’s cage so that fecal
matter does not come in contact with the classroom floor.
d. If a student is assigned to clean litter box, he/she must wear plastic
gloves and be supervised. Stress the importance of this.
e. Any bite or scratch by an animal must be washed thoroughly with soap
and water. Soap kills the rabies virus. All bites must be reported to
the Health Office.
12.
SHARPS: broken glass, razor blades, etc.
a. DO NOT use hands to pick up broken glass, use brush and dustpan.
b. Always place broken glass and sharp objects in a hard sided sealed
container before placing it in the trash.
HEPATITIS A PREVENTION GUIDELINES
Hepatitis A, or viral hepatitis, is a form of infectious hepatitis, a liver disease. It
is characterized by slow onset of symptoms, such as fever, nausea, vomiting, loss
of appetite and jaundice. The Francis Howell School District has an obligation to
protect students, parents, employees, and the public from unnecessary exposure to
illness. The following guidelines and recommendations are presented to reduce
risk of transmission of Hepatitis A in Francis Howell School District schools.
Careful attention should be paid to thorough hand washing with soap and
warm water immediately prior to eating or distributing foods.
Children may NOT distribute food. A teacher or responsible adult must
do distribution of food.
The sharing of lunches or snacks by students should be monitored and
eliminated.
Organizations or instructors that prepare food or food products should be
given training in proper food preparation as a precaution at least once a
year. (Training is available through the contracted food service company)
These guidelines will be printed and distributed to all students, staff, parents and
organizations in the Francis Howell School District annually. Should the St.
Charles Department of Health and the Environment declare an emergency or
epidemic, additional guidelines or requirements may be added to this list with the
approval of the Superintendent of Schools.
HELP CONTROL COMMUNICABLE DISEASES
Vaccines are now available to control the majority of diseases that have caused
illnesses and death in children in the past. Medical treatments help to control
many others, but schools continue to play and important role in controlling the
spread of communicable disease. By enforcing state communicable disease
regulations, excluding children who are ill, and promptly reporting all suspected
cases of communicable disease, personnel working with children can help insure
the good health of the children in their care.
Be alert for signs of illness such as elevated temperatures, skin rashes, inflamed
eyes, flushed, pale, or sweaty appearances. If a child shows these or other signs
of illness or physical distress, he/she should be evaluated by the school nurse.
Children and staff with certain communicable diseases will not be allowed to
attend or work in a school or child care setting, until they are no longer
contagious. The school nurse and administration will determine exclusion based
on state recommendations.
The nurse coordinator should report all suspected cases of communicable disease
promptly to the city, county, or district health unit. Prompt reporting is the first
step to insuring the appropriate outbreak control measures.
Copies of the current Missouri Laws accompanied by Department of Health Rules
Governing the Control of Communicable and Other Diseases Dangerous to Public
Health, may be obtained from the Missouri Department of Health, Films and
Literature Unit, PO Box 570, Jefferson City, MO 65102.
EMPLOYEES
Blood-Borne Exposure Policy
An exposure to blood-borne pathogens poses a serious occupational threat to district employees. Universal
Precautions will not completely eliminate the risk and prophylactic treatment will remain an important
component of prevention effects.
Definition of Exposure
“Exposure” is an occupational contact that may place a district employee at risk for Human Immunodeficiency
Virus (HIV) or Hepatitis B (HBV) or Hepatitis C (HCV) infections. Exposures are defined as contacts of the
eyes, mouth, other mucous membranes, or broken skin and/or needle contact with blood or other potentially
infectious materials. Common exposures include needle stick injuries or cuts with sharp objects. Significant
skin exposures may include contact of infectious material with an open wound or non-intact skin, i.e. chapped,
abraded, or weeping skin.)
Standard Universal Precautions apply to blood or other body fluids including, but not limited to semen, vaginal
secretions, cerebral spinal fluid, and any body fluid with visible blood, vomit or excrement. Saliva has been
documented as a potential infectious material in regards to Hepatitis B and bite wounds have been documented
as a route to transmission of this disease although the risk of infection via saliva or bites is low.
EMPLOYEES
GENERAL PROCEDURE AFTER AN EXPOSURE OCCURS
A. The area should be immediately washed with soap and water. When a splash occurs to the eyes, immediate
flushing with normal saline or water should be done at time and place of exposure.
B. The employee should complete the Accident/Incident report and have it signed by appropriate personnel,
i.e., building principal or immediate supervisor. Call the Benefits Office, 636-851-4030. If no answer, call
636-851-4058.
C. The employee should follow the Worker’s Compensation procedures. If there has been a significant
exposure to an HIV positive source, the first dose of antiretroviral prophylaxis should be taken while other
evaluations are underway.
Any needle stick or significant exposure will result in the following blood work:
1st visit- SGPT, Hepatitis B Antibody, Hepatitis C Antibody and HIV.
* If Hepatitis B non-reactive:
Booster, if they know they have had the series.
Re-draw Hepatitis B Antibody in 30 days
In six weeksRepeat HIV only
In 3 monthsRepeat HIV and Hepatitis C
In 6 monthsRepeat HIV and Hepatitis C
In the event at the time of a particular exposure, the then-current, appropriate medical protocol is inconsistent
with the procedures set forth herein, the District reserves the right to implement the procedures or protocol that
is deems appropriate to the specific exposure.
PERSONNEL SERVICES
Policy 4820 GE
Regulation 4820 GE
Employee Welfare
Employees with Communicable Diseases
An employee may be excluded from work if the employee (1) has, or has been exposed to, an acute (short
duration) or chronic (long duration) contagious or infectious disease, and (2) is liable to transmit the contagious
or infectious disease, unless the Board of education or its designee has determined, based upon medical
evidence, that the employee:
1. No longer has the disease.
2. Is not in the contagious or infectious stage of an acute disease.
3. Has a chronic infectious disease that poses little risk of transmission in the school environment with
reasonable precautions.
School officials may require an employee suspected of having a contagious or infectious disease to be
examined by a physician and may exclude the employee from work, in accordance with the procedures
authorized by this policy, so long as there is a substantial risk of transmission of the disease in the school
environment.
Employees with acute or chronic contagious or infectious diseases have a right to privacy and confidentiality.
Only staff members who have a medical reason to know the identity and condition of such employees will be
informed. Willful or negligent disclosure of confidential information about an employee’s medical condition by
staff members will be cause for disciplinary action.
The District will implement reporting and disease outbreak control measures in accordance with the provisions
of Missouri Department of Health publication PACH-16, “Prevention and Control of Communicable Diseases:
A Guide for School Administrators, Nurses, Teachers and Day Care Operators,” a copy of which shall be on
file in the office of the District Nurse Coordinator and in the office of each school nurse.
July 2000
PERSONNEL SERVICES
Regulation 4820 GE
Employee Welfare
Employees with Communicable Diseases
If an employee has, or has been exposed to an infectious or contagious disease or is reasonably believed to have
an infectious or contagious disease the following guidelines apply:
1. The employee may be required to undergo a medical examination at District's cost
by a physician of the District's choosing.
2. While a determination is made concerning the status of an employee, that employee may be placed on a paid
leave of absence. Except in unusual circumstances such leaves will not exceed ten (10) days.
3. If the employee is determined to be infectious or contagious, he/she will be required to take such leave as
provided by Board policy until it is medically determined that the employee is no longer able to transmit the
disease.
4. Where a question exists concerning an employee's status, an individual assessment of the employee will be
completed by a Review Team comprised of the employee's physician, a school nurse, a physician selected by
the District, a county health official, the Superintendent and the employee's supervisor. Other individuals may
be included, as is reasonably necessary and as designated by the Superintendent.
5. The review team will consider all available medical evidence and will determine the employee's medical
condition, the employee's ability to return to work and whether the employee's infectious status requires any
restrictions on the employee's work assignment. Normally the team will be convened within seventy two (72)
hours of notice of the employee's contagious status. The employee's status will be reviewed thereafter as
appropriate.
6. The written determination of the Review Team is subject to an appeal to the Board of Education where
determination shall be final.
March 30 2000
SEVERE ALLERGY AWARENESS
Anaphylaxis is a sudden, severe allergic reaction. The anaphylactic reaction can be mild to life-threatening. It
can involve various areas of the body such as the skin, respiratory tract, gastrointestinal tract and the
cardiovascular system. Symptoms can occur within minutes to two hours after contact with the allergy-causing
substance. In rare cases, the symptoms can appear up to four hours after contact.
Symptoms may include, but not limited to:
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Tingling sensation
Itching/Hives
Metallic taste in mouth
Sensation of warmth
Swelling of the mouth and throat area
Difficulty breathing
Wheezing/Coughing
Vomiting
Diarrhea/cramping
Loss of consciousness
Common causes of anaphylaxis include:
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FOOD
MEDICATIONS
INSECT BITES OR STINGS
LATEX
The 3 R’s for treating anaphylaxis:
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Recognize symptoms
React quickly
Review
Treatment
Epinephrine is the drug of choice for treating an anaphylactic reaction. Epinephrine, also known as adrenalin,
is a naturally occurring hormone. In the human body, the adrenal gland releases epinephrine into the blood
stream, along with other hormones, signaling the heart to pump harder, increasing blood pressure, opening
airways in the lungs, narrowing blood vessels in the skin and intestine to increase blood flow to major muscle
groups. It works to reverse the symptoms and helps prevent further progression of anaphylaxis.
Antihistamines, such as BENADRYL and steroids can be used to minimize reactions, but cannot reverse the
symptoms of a severe allergic reaction. They should be used with caution.
©2006, the Food Allergy & Anaphylaxis Network. Used with permission.
What is an Epi-pen®?
Severe allergic reactions are often unavoidable. Once anaphylaxis has begun, the treatment of choice is an
immediate injection of epinephrine, (Epi-pen®). Epinephrine rapidly constricts the blood vessels, relaxes the
muscles in the throat and lungs, reverses swelling, and increases the heartbeat, reversing the most dangerous
effects of an anaphylactic reaction. Since there is no way to predict the severity of a reaction, and because
anaphylaxis can progress very quickly, waiting for the school nurse to administer epinephrine may greatly
increase the risk of death. Recent studies have shown that in most cases a second dose of epinephrine is
required.
Epi-pen® administration does not replace medical help, therefore the school nurse (if
available), building administrator and 911 should be contacted immediately after an Epipen® has been given to any district student, staff member or visitor.
How do I use an Epi-pen® ?
To use the epi-pen injection device, follow these steps:
1. Hold the device firmly in your fist with the orange tip pointing down. Do not touch the orange tip; hold
only the cylinder.
2. Remove the blue activation cap.
3. Move your hand so the orange tip is near outer thigh.
4. Swing your hand away from your body, then jab the orange tip firmly into outer thigh at a 90-degree
angle. You will inject the needle through clothing that is covering the thigh.
5. Keep the device firmly in this position for 10 seconds.
6. Remove the device from thigh and rub the area with your fingers, for 10 seconds.
7. Look at the orange tip to see if the outer covering has been extended.
8. If it has, the full dose of epinephrine has been injected. Save used epi-pen to give to emergency medical
personnel when they arrive.
9. Call school nurse (if available), building administrator and 911 immediately
Are there side effects to epinephrine?
Side effects of epinephrine may include:
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Palpitations
Rapid heart rate
Sweating
Nausea
Vomiting
Respiratory difficulty
The number of students and staff members with severe allergies is steadily increasing. By providing Epi-pen®
training to all district staff, we are taking the necessary steps to increase the awareness of severe allergies and to
provide the knowledge needed to provide the best possible care to our school community.