Indicates That Precautions Are to Be Taken at All Times and in All Situations

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 Diseases Spread by Contact with this Body Fluid Eye Discharge Conjunctivitis (Pink Eye) Nose or Throat Drainage Colds and Influenza, Strep Blood Hepatitis B, HIV disease Feces Hepatitis A, Shigellosis, Giardiasis Urine 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 weeks- Repeat HIV only

In 3 months- Repeat HIV and Hepatitis C

In 6 months- Repeat 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:

. 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:

. FOOD . MEDICATIONS . INSECT BITES OR STINGS . LATEX

The 3 R’s for treating anaphylaxis:

. 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.

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 Epi- pen® 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:

. 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.