Strategies to Prevent & Reduce the Spread of Communicable Disease

1. Hand washing is one of the most effective ways to control the spread of disease

2. Hands should be washed regularly, but especially at the following times:

   • Before and after using the bathroom

   • After sneezing, coughing, or blowing your nose

   • Before and after preparing food

   • Before and after eating or drinking

   • Before and after assisting students with feeding and toileting or diapering

   • Before and after the administration of medication or medical procedures

   • Before putting on and after taking off personal protective equipment

   • After caring for any student, especially those with nose, mouth, eye or ear discharge or drainage and before initiating contact with another student

   • After contact with blood, body fluids, secretions and excretions

   • Before handling contact lenses or cosmetics

   • After handling animals or animal waste

3. Hands should be washed using soap and water. After soap is applied, the hands should be scrubbed for at least 20 seconds, paying close attention to all surfaces including nails and between fingers. See Appendix B for handwashing poster

4. Running water, soap and paper towels shall be available at all district buildings

5. Students, staff and visitors are encouraged to wash their hands regularly

6. In the event that soap and water are not available, an alcohol-based hand sanitizer may be used. The sanitizer must contain at least 60% alcohol. The use of hand sanitizer is temporary; hands should be washed with soap and water as soon as it is available

1. Coughing and sneezing release respiratory droplets that may be infectious into the air

2. Students, staff and visitors are encouraged to cover their mouth when coughing or sneezing

3. Cover Your Cough etiquette, using upper sleeve rather than the hands, will be taught and reviewed annually. See Appendix B for Cover Your Cough poster

4. Wash hands with soap and water after coughing or sneezing

1. Blood and body fluids from other people may spread infectious diseases. Staff may be exposed while performing their job (occupational exposure)

2. Annual standard precautions training will be provided to staff most likely to encounter bodily fluids and blood. All district staff is welcome but not required to complete this training

3. Students will be taught not to touch blood and bodily fluids from other people

4. Best Practice: If it’s wet and it’s not yours, don’t touch it without gloves

School attendance is monitored for multiple reasons in every building. It is important to notify the school registered nurse when absence rates increase, especially when the absences are associated with a specific pattern of illness.

In order to track average attendance rates for each building, attendance secretaries and office managers are encouraged to monitor the following Infinite Campus attendance reports at a minimum of every week, more often if absence rates are climbing:

1. ADM (Average Daily Membership) and ADA (Average Daily Attendance) Detail. The summary version displays data for each Calendar/Grade selected and a grand total for all Calendars for the selected date range. This is useful to calculate average attendance rates over a period of time, identify decreases in average attendance rates and determine if specific grade levels are involved.

2. Classroom Monitor. This tool monitors classroom attendance. By clicking on the session beside each teacher, the reason for the absence of each student (if known) will populate in the roster. This can be useful in determining whether the illness is localized to one classroom/grade or if it is occurring randomly throughout the building.

District health clerks and school registered nurses are responsible for sending students home from school when they are ill. NOTE: Students should ​NOT​ be sent home for illness by school staff (teachers or administration) without consulting the health office team.

When a cluster of students (two or more) are sent home with specific symptoms, the health clerk will notify the building school registered nurse. The building school registered nurse will in turn notify the lead school registered nurse and continue to monitor the situation.

Immunizations significantly reduce occurrences of vaccine-preventable disease. Colorado State Law requires ALL students to present proof of immunizations received or signed exemption upon enrollment, prior to beginning to attend school (Board of Health rule 6 CCR 1009-2). Colorado follows the Advisory Committee on Immunization Practices (ACIP) guidelines to determine which vaccines are required. If a student does not meet the minimum requirements, the family is given two weeks to obtain the needed vaccines or present proof of an appointment to do so. Students that fail to meet state immunization requirements may be excluded from school until they receive the necessary vaccinations. Parents and guardians may choose to sign a non-medical exemption. In the event of a vaccine-preventable communicable disease occurrence, students with immunization exemptions can be excluded from school as a disease control measure.

Infectious agents can be spread through contact with environmental surfaces (indirect transmission). In addition to routine cleaning procedures, it is important to consider the following:

1. Keep commonly touched surfaces (stairway railings, door handles, computer keyboards, computer storage carts, bathroom faucets and surfaces, bathroom stall locks, light switches, drinking fountains, telephones and elevator buttons, etc.) clean by frequently wiping them down with the cleaning agent approved by District 6 Facilities. See Appendix H.

2. The health office ​must be thoroughly cleaned every day​:

   • Health clerks will spray cots with disinfectant approved by the district at least once daily and more often if ill students have rested on cots.

   • The building manager or custodian will disinfect the health office bathroom following any use by a student experiencing vomiting or diarrhea

   • All surfaces in the health office (including cots, floors, counters, sinks and toilets) will be thoroughly disinfected daily by the building manager or lead night custodian after students have left for the day using approved disinfectants and allowing for the minimum amount of contact time required for the products used.

3. Treat all vomiting and stool events as if they are contaminated with a highly infectious agent.

   • If at any time a student or staff member experiences a vomiting or stool event in a place other than a bathroom, the room will be emptied and the contaminated area cleaned and disinfected by the building manager as a matter of urgency. Infectious agents found in vomit can become airborne and contaminate surfaces within at least a 25-foot radius. Virus particles may remain on surfaces for weeks.

   • If vomiting or stool event occurs on carpet:

     • Do not vacuum vomit or fecal material.

     • Wearing gloves, clean up physical material, using disposable towels.

     • Utilize viricide in a detergent solution

     • Ideally, a steam cleaner should be used. If the machine has a. temperature gauge, clean for 5 continuous minutes at 170° F or for 1 continuous minute at 212° F. If the steam cleaner does not have a temperature gauge, turn the heat as high as it will go and clean for at least 5 minutes.

   • After cleaning and disinfecting the area, let the area sit for 10 minutes before students/staff return.

4. The person cleaning and disinfecting should wear personal protective equipment (gloves are mandatory; mask, protective eyewear and plastic disposable apron when available). Personal protective equipment (PPE) should be discarded immediately upon completion of the task and should not be worn to another area in the building. Hands must be washed or sanitized at the end of the procedure.

5. All cleaning materials must be contained within the area. For example, utilize disposable towels and do not carry them from one place to another.

6. When a staff member or student with a suspected infectious disease is identified and has left the building, it is important their work area, along with any other known places they have been, are thoroughly cleaned and disinfected to minimize exposure to others. Clean the surface to remove dirt and soil with the approved cleaning agent and disinfect following manufacturer’s instructions. If norovirus is suspected, a district-approved disinfectant or bleach solution at the proper concentration must be used as other disinfectants do not kill norovirus.

Building administration, in conjunction with health services personnel, are responsible to make the following decisions to prepare for a potential outbreak:

1. Identification of secondary triage site to separate infectious students from other students requiring medication, first aid, etc. Factors to consider include:

   • Line of site to health office

   • Immediate access to bathroom and sink

2. Identification of a minimum of two back-up personnel available to assist in the health office when the health clerk and school registered nurse request help to render care to ill students. 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.

   • Back-up personnel must be trained and delegated to administer medications and provide first aid, comfort care to students.

   • CPR/First Aid certification is preferred.

Initial training and annual refresher training will be provided to all health services personnel, including school registered nurse, health clerks and substitute health clerks during professional development time. Topics covered should include the following:

1. General knowledge of infectious disease, modes of transmission, standard precautions, District 6 Exclusion Guidelines, routine surveillance and what/when to report to school registered nurse.

2. Annual review of District 6 Exclusion policy.

3. Annual review of the District 6 Management of Communicable Disease plan

4. Annual review of the roles and responsibilities of health clerks and school registered nurses

Initial training and annual refresher training will be provided to all office staff, including office managers, attendance secretaries and others that may work with attendance. Topics covered should include the following:

1. Importance of attendance tracking and monitoring ADA and ADM reports in Infinite Campus.

2. Importance of accurate documentation and use of specific attendance codes when needed. For example, during the flood of 2013, a special numeric code was employed to track student absences specifically related to that event.

3. Introduction to/review of attendance line and phone call scripts for particular infectious diseases.

4. Importance of follow-up calls to determine the exact reason for student absences.

5. Who to contact when there is an increase in absence rate (​>​ 10% of student enrollment) or unusual number of students exhibiting a specific disease pattern.

6. Introduction to Communicable Disease Outbreak Reporting Tool to be shared when an outbreak is declared.

Initial training will be provided by the Custodial Department to all new custodial staff, including building managers, lead night custodians and part-time staff. A training packet covering the 13 steps of disinfection, how to clean up bodily fluids and how to use and properly remove personal protective equipment (gloves mandatory, mask and eye protection optional) is completed. All new staff must sign an acknowledgment of their understanding of the material presented. Custodial personnel are not required to complete standard precautions training. All custodial staff will receive annual training to review disinfection protocols. ​A​dditional meetings and/or bulletins will be held when specific training issues arise.

The checklists found in Appendix J provide step-by-step instructions for district departments and individuals involved in preparation and early recognition of potential disease outbreaks.