Outbreak Response

While not every increase in student absence rates or increased number of students with specific symptoms is determined to be an outbreak, rapid identification of an occurrence in the initial stages is critical to an effective response. The following actions are vital to early recognition:

1. Office managers and/or attendance secretaries will monitor individual building attendance rates, watching for increases in the overall absence rate or an increase in the number of students and/or staff experiencing specific symptoms. Any increasing trend in absence rates and/or >10% of students/staff experiencing similar illness will be immediately reported to the school registered nurse.

2. Health clerks will monitor the number of students and reasons students are being sent home during the school day. When a cluster of students (2 or more) are sent home with similar symptoms, the health clerk will immediately report the occurrence to the​ ​school registered nurse.

3. When a cluster of students is identified, especially when associated by person, place, or time, the building’s school registered nurse will immediately notify the district’s lead school registered nurse.

4. The lead school registered nurse will notify the Weld County Department of Public Health epidemiologist of all clusters and provide other details as requested by health department staff. Identification of an outbreak will be done in conjunction with the epidemiologist. The lead school registered nurse will report the cluster to the Director of Health Services and provide updates as the situation develops.

5. The Director of Health Services will notify the Assistant Superintendent of Academic Achievement of the occurrence and provide updates as the situation unfolds.

6. When the incident is confirmed to be an outbreak, the Assistant Superintendent of Academic Achievement will notify the Superintendent. Communication to the Cabinet and Board of Education will be initiated from the Superintendent.

   See Communication System. Appendix A.

In order to reduce the spread of a disease, students and staff suspected of having a communicable disease must be isolated as much as possible from the general population and must remain out of school or off work until the period of communicability has passed.

When a student or cluster of students is suspected of having a communicable disease, the following steps will be taken:

1. Students identified with an illness will be separated from the general school population by isolating them in the health office or designated triage site with immediate access to a sink and bathroom facilities.

2. District 6 Exclusion Guidelines will be followed unless more stringent parameters are deemed necessary, such as in the case of norovirus. See Appendix D for District 6 Exclusion Guidelines. The​ ​health clerk will use existing procedures to contact parent/guardian and request pick-up from school.

3. Parent/guardian will be provided with written instructions regarding next steps (treatment at home, clinical evaluation by a health care provider, when to return to school, etc.).

4. If transportation is not immediately available, the student will remain in the health office or designated triage site until parent/guardian arrives. Food, water, a comfortable resting spot, and immediate access to a bathroom will be provided.

5. If the number of students experiencing symptoms increases to a point that is not manageable by the health clerk and school registered nurse, additional building back-up support (pre-determined) will be enlisted to manage the incident. The need for additional health office support will be determined on a case by case basis dependent on the number of ill students, nature of the symptoms, size of health office, availability of bathroom facilities, etc.

When a staff member is suspected of having a communicable disease:

1. The health services office, along with the consultation of other appropriate school system personnel, will determine if it is appropriate to exclude the staff member from the work site.

2. If excluded, the staff member will be subject to the same exclusion period as students. See Appendix D

Upon direction from District Administration, all buildings will implement the heightened surveillance and consistent reporting methods described here.

1. Attendance line messages will be changed to predetermined scripts which request detailed information related to a student’s absence, including symptoms specific to the illness causing the outbreak. Scripts for specific diseases are found in Appendix H and I.

2. Office manager and attendance secretaries will request specific symptom information using phone scripts provided for each illness when speaking directly with parents/guardians who are reporting student absences. See Appendix H and I.

3. Attendance staff will attempt to contact parents/guardians when reason for absence is not known. The specific disease phone scripts will be utilized. See Appendix H and I.

4. Consistent coding is critical for data collection. All absences related to the outbreak will be coded using the specific code assigned by Student Information Services at the time of the outbreak.

5. A preliminary number of student and staff absences and number of students and staff sent home with specific symptoms will be reported to the District Lead School Registered Nurse daily at 1PM using the Google survey “Communicable Disease Outbreak Reporting Tool. See Appendix E. Email and phone reporting will not be utilized unless the internet is not functioning. These numbers may be updated ONCE daily after students have left for the day.

6. The school registered nurse and health clerk will track individual student data using the Line List. See Appendix H and I.

7. The lead school registered nurse will track and monitor overall district attendance rates, individual building statistics, etc. using Outbreak Tracking Document. Reports will be made to WCDPHE epidemiologist and District Administration as situation develops.

The following information outlines the systems of communication to support effective and efficient flow of accurate information.

1. Public Health

• The lead school registered nurse will be the primary contact with the Weld County Department of Public Health and Environment Communicable Disease Program (WCDPHE).

• The Assistant Superintendent of Support Services or their designee will be the primary contact(s) with the Weld County Department of Public Health and Environment - Environmental Health Services.

2. District Leadership

• a. After consultation with the Weld County Department of Public Health and Environment epidemiologist to confirm an emerging outbreak, the lead school registered nurse will contact the Director of Health Services who will be responsible to report the outbreak to the District Leadership Team.

3. School Community

• Building administration will be notified by the school registered nurse immediately when a cluster is identified. Building administration will be kept up to date as the event progresses. In order to deliver accurate information, a single source of information to building administration is preferred.

• Any information released to staff, students, parents and the community​ MUST be pre-approved by District Administration, WCDPHE and the lead school registered nurse.

  • Building staff will be notified of the event and kept up to date based on information received from District Administration and WCDPHE as the event progresses. Notification should not be sent to staff until approved by District Administration. They will be provided the information necessary to recognize symptoms and to reduce the spread of infectious disease.

  • Students will be informed about the situation according to their developmental level.

  • Parents/guardians will be provided information as necessary and as determined by guidance from WCDPHE, District Administration and lead school registered nurse.

4. District Departments, e.g. Facilities, Nutrition & Transportation

a. District Administration will notify individual departments as the situation warrants..

5. Widespread Community

• General announcements to the community will be made through the Office of Communications.

• All information provided to the public will be reviewed by the lead school registered nurse and the Office of Communication to assure accuracy

• Information may be provided via written documents, the Greeley-Evans District 6 website, individual building websites and social media platforms (Facebook, Twitter, etc.).

6. District Medical Advisor

• The lead school registered nurse will notify and keep the district medical advisor updated of the event and its progression.

7. Health Care Providers

• a. Community health care providers will be advised of the outbreak, specific symptoms and exclusion guidelines by (​TBD- possibly Health Alert Network at WCDPHE, through District Medical Advisor or through District 6 Office of Communications​).

8. Media

• All media requests will be directed to and handled by the Office of Communications

A contagious disease outbreak will require implementation of specific disinfecting procedures outside of the routine disinfecting procedures typically used.

1. The building’s school registered nurse will contact the building manager to initiate heightened disinfecting procedures when a cluster of illness is identified.

2. Widespread notification of specific disinfecting procedures or other information required by custodial services will be dispersed through the Assistant Superintendent of Support Services or his/her designee.

A contagious disease outbreak with the potential of being linked to a food-borne or infectious agent transmitted via the oral-fecal route will trigger an immediate response in Nutrition Services. It is critical that measures to prevent the spread of communicable diseases between individual buildings and the production kitchen or other buildings. Nutrition Services must be notified immediately in the following situations:

1. Health care provider diagnosis of one case of norovirus in student or staff member

2. Public health confirmation of an outbreak of food borne illnesses such as Hepatitis A, Salmonella Typhi, Shigella, E. coli, and norovirus

Building kitchen staff will immediately utilize the procedure outlined in the document Norovirus Disinfecting for Surfaces Contaminated with Body Fluids (Appendix C-4).

Students and staff with certain special health needs may be more vulnerable to contracting a communicable disease and may experience more severe consequences, up to and including death. It is important to identify these people and create plans for them during a suspected or confirmed infectious disease outbreak.

1. Building school registered nurse will identify students and staff (when known) who are medically fragile or immunocompromised.

2. Building school registered nurse will contact parents to discuss plans for attendance during the outbreak and determine whether student should remain at home to decrease the risk of exposure to communicable diseases.

3. Building school registered nurse and administration will discuss individual plans with staff who have disclosed they have special health needs that may place them at risk during the outbreak.

During suspected or identified infectious disease outbreaks, district employees will be required to miss work when they are ill. In order to limit the spread of the illness, the following steps will be taken:

1. District 6 will enforce the same exclusion policies for staff as are applied to students. A longer period of exclusion may be necessary in the event of certain infectious diseases.

2. Staff may be required to show proof of immunity (immunizations received or blood titers indicating immunity) to Human Resources in the event of an outbreak of a vaccine-preventable infectious disease (i.e. measles). Unimmunized staff may be required to stay home during the contagion period of a vaccine-preventable disease.

3. District Administration will determine whether employees must use personal sick days when absent due to the specific disease occurring during the outbreak.

4. Determine and communicate policies for employee work during outbreak

   • Work at school when classes are suspended

   • Work at home/telecommute

   • Combination work at home/work at school

During a suspected or identified infectious disease outbreak, several social distancing measures can be taken to reduce the spread of a contagious disease:

1. Discourage hand shaking.

2. Discourage the sharing of drinks or eating out of the same container (chip bag, etc.).

3. Avoid touching eyes, nose or mouth.

4. Avoid face-to-face meetings; utilize phone, conference call, video conference, email, etc.

5. Cancel or postpone non-essential meetings, gatherings, assemblies, field trips, workshops, or training.

6. Consider flexible work hours, staggered shift

During a suspected or identified infectious disease outbreak, every effort will be made to prevent interruption of student learning time. District 6 Administration will need to consider the following situations:

1. Itinerant Staff

   • Itinerant staff (specialized service providers and substitutes) who may be exposed to a communicable disease in a particular building, must be monitored to prevent the spread of the disease to other buildings

   • Itinerant staff may be required to refrain from going to buildings not involved in the outbreak during the incubation period and/or period of communicability.

   • Itinerant staff will be subject to the same exclusion policies as students.

2. Building Support

   • When the number of staff out limits a building’s ability to provide curriculum and monitor student safety, the building administration may request additional staff support.

   • District Administration will determine the best way to meet these requests.

3. School Dismissal

   • WCDPHE does not typically issue guidance on school closures. The decision to close schools will be made by Greeley-Evans District 6 Administration. Student or staff absence rate of 30% is a common threshold. Factors to consider include:

     • Are there enough staff to properly teach/monitor students?

     • Is the number of absent students going to affect the delivery of the curriculum?

   • Final decision to close school(s) will be announced by the Superintendent or his/her designee.

4. Resumption of normal operations

   • Collaborate with WCDPHE to determine when to resume normal operations

   • Office of Communications will create and disseminate public notice of return to school, keeping in mind:

     • Details of timing, procedures associated with return to school

     • Public perception of safety of returning to school

   • Support Services department will complete final disinfection procedures in all buildings prior to return of students and staff.

The checklists found in Appendix J provide step-by-step instructions for district departments and individuals involved in the response to communicable disease outbreaks.