Faculty Handbook Section XI: Health Services and Procedures A. Health Services 1. Physical Exam 2. Immunizations 3. Allergy Policy B. Universal Precautions C. Medical Care 1. Addressing Minor Injuries a. Minor Scrapes and Cuts b. Head Injuries c. Emergency Medical Attention d. Accident Report Procedures 2. School Nurse D. Administration of Medicines in School 1. Responsibility of the School Nurse 2. Responsibility of the Family 3. Responsibility of St,. Thomas’s Day School E. Infectious Diseases F. Health Recommendations for Exclusion from School G. Head Lice H. Concussion I. HIV, AIDS, and Other Infectious Diseases J. Appendix for Section IX

Section XI: Health Services and Procedures 1

​Faculty Handbook Section XI: Health Services and Procedures

A. Health Services St. Thomas’s Day School does not employ a nurse or a doctor on staff. However, a school nurse from the New Haven Public Schools visits St. Thomas’s Day School one day a week to check records and provide care for students who are sick or injured. On days when the nurse is not available, the Administrative Assistant in the Front Office will assist children who are sick or hurt. Teachers should be mindful that the Administrative Assistant has many responsibilities and can therefore only address emergencies. Minor scrapes and bumps should be addressed in the classroom by Head Teachers.

1. Physical Exam All children must have a completed health form with an immunization records on file in the school office prior to the first day of school. Students without a health form will not be allowed to attend classes. After admittance, students in Kindergarten, third and sixth grades are required to have new physical exams which are kept on file in the main office. 6th graders without an up to date health form will not be allowed to graduate.

2. Immunizations Childhood vaccinations protect communities from serious life-threatening diseases. We expect all students to be fully immunized unless documentation demonstrates: 1. Your child is on a “catch up” schedule. 2. Your child has a medical contraindication to vaccination. 3. Your family has elected the “religious exemption” to vaccination.

The Connecticut State Department of Education (“SDE”) and Department of Public Health revised the Regulations regarding immunization requirements for school entry. Effective August 1, 2011, students must comply with several new immunization requirements prior to school entry in prekindergarten, kindergarten and seventh grade.

Among the regulatory changes are requirements that all students entering prekindergarten and kindergarten receive adequate vaccination for hepatitis A and pneumococcal diseases; students entering kindergarten and seventh grade show proof of receipt of a second dose of varicella vaccine; and students in kindergarten through twelfth grade show proof of receipt of a second dose of rubella and mumps vaccine. Further, all students attending public school prekindergarten programs must now receive the influenza vaccine during the flu season they attend such programs, and all students entering seventh grade must show proof of having received the Tdap (tetanus, diphtheria and pertussis) booster vaccine and meningococcal vaccine.”

3. Allergy Policy St Thomas’s Day School is not a nut free school. Children with life threatening allergies (e.g. food, latex, bee sting) must have epinephrine and an Allergy Action

Section XI: Health Services and Procedures 2 Plan at school. Please refer to the Medication Policy for details about medications. We encourage all families to follow new guidelines with regard to the ‘Allergy Action Plan’. These updated forms recommend that Benadryl/diphenhydramine be omitted from your child’s ‘Allergy Action Plan’. Please obtain the most up to date ‘Allergy Action Plan’ form and discuss it with your child’s medical provider.

B. Universal Precautions St. Thomas's is concerned about the spread of serious infections within the school setting. We are accustomed to reacting to infections only when we notice signs or symptoms of illness. Then we rely on exclusion policies to control disease. Unfortunately, the germs causing a disease are often spread days before children appear ill. Infections like colds, diarrhea diseases and skin and eye infections are often contagious three to ten days before you might notice a symptom. Other diseases have a longer incubation period. Germs are spread through contact with respiratory droplets, body wastes, and blood. Rather than waiting to find out who is contagious, we must treat everyone as a potentially infected person. The name of this method is Universal Precautions and it gives a set of guidelines for contact with body fluids and wastes that carry germs.

● Wash hands frequently and well. When you arrive and leave; after ​ wiping/blowing your nose or a child's; before and after toileting, changing a diaper, or assisting a child with toileting; before and after food preparation. Hand sanitizers are installed throughout the school. ● Proper waste disposal. Line all trash cans; use trash cans with lids; bag any soiled ​ first aid wipes or rubber gloves. ● Use gloves for extra protection. With the current concerns regarding the spread ​ of hepatitis and HIV/AIDS, disposable gloves should be worn when dealing with blood or fecal material. ● Bleach. Soap and water make a good cleaning solution, but to sanitize any soiled ​ areas such as counters, use bleach and water (one tablespoon bleach per quart of water) or the school provided sanitizing solution.

C. Medical Care All faculty and staff at St. Thomas’s Day School are required to obtain and update Red Cross and CPR training. As a result, teachers and staff members should work together to address medical concerns when they arise. Minor scrapes and cuts should be addressed in the classroom by the classroom teacher when possible. Children who are sick or need more intense medical care should be sent to the Main Office.

There is a Nurse’s Station in the Main Office where children who become ill after the start of school may lie down until their parents can come and take them home. This space is also the space where children come when accidents occur. When the Nurse is not available, the Administrative Assistant in the Main Office will provide medical care. If the injury is serious, he/she will contact a parent.

1. Addressing Injuries a. Minor Scrapes and Cuts When a child gets a minor skin scrape or cut, the teacher or child should wash the scrape with mild soap and lukewarm water. The area should be dried thoroughly and the wound covered with a sterile gauze pad and tape or a simple Band-Aid. Teachers should always wear gloves as a precaution

Section XI: Health Services and Procedures 3 when dealing with bodily fluids such as blood. Children should only be sent to the Main Office for a medical attention if the cut is severe or the teacher is unable to address the issue safely. b. Head Injuries Most head trauma involves injuries that are minor and don't require specialized attention or hospitalization. However, even minor injuries may cause persistent chronic symptoms, such as headache or difficulty concentrating, and may require some time away from normal activities. Minor head injuries should be watched and the child asked to engage in quiet activities for awhile.

If a serious head injury occurs, the teacher involved should call for help or send an older child to the Main Office to get assistance immediately. The area should be secured to make sure that the other children are safe and the injury should be assessed.

If there is bleeding, the bleeding should be stopping by applying firm ​ pressure to the wound with sterile gauze or a clean cloth. Direct pressure should not be applied to the wound if there is suspicion of a skull fracture.

The child should remain immobile and the teacher should watch for changes in breathing and alertness. If the child shows no signs of circulation (breathing, coughing or movement), the teacher should begin CPR. An ambulance should be called and the parents contacted as soon as possible. c. Emergency Medical Attention In the event that a serious injury occurs and emergency medical attention is required (i.e., broken bone, open wound, concussion, etc.,), teachers should use the following guidelines: ● The child should remain immobile with an adult who will administer simple first aid as required. ● The teacher should send another adult or older child to the Main Office to get assistance. ● The parent will be called and if necessary an ambulance (911). ● If the parent cannot be reached and the child must be transported to the hospital, the child's classroom teacher will accompany the child and remain with him/her until a parent or guardian arrives. ● The child's medical records and emergency card must be taken to the hospital if the parent or guardian cannot be reached. ● The school will continue to try to reach the parent or guardian. ● The Head of School must be apprised of the situation at all times. d. Accident Report Procedures Any accident requiring first aid treatment must be documented with an accident report. This form may be located in the Main Office and on the Faculty Intranet on the school webpage. Teachers should keep several copies of the Accident Report form in their classrooms in case of an emergency.

When an accident requiring first aid occurs, one copy of the Accident Report

Section XI: Health Services and Procedures 4 is given to the parent and the other is for the nurse's file in the Main Office. For all but the most minor situations, it is advisable for the head teacher to notify the parents of the child's injury in person or by phone before the child goes home.

2. School Nurse St. Thomas’s Day School does not employ a nurse or a doctor on staff. However, a school nurse from the New Haven Public Schools visits St. Thomas’s Day School one day a week to check records and provide care for students who are sick or injured.

The school nurse is in charge of making sure all children have a current health examination on file and that all immunization forms have been completed. Children will not be allowed to attend school without evidence of immunization, absent some permissible statutory exemptions. There are two permissible statutory exemptions:

● A medical exemption is offered when a physician testifies, in writing, that ​ the vaccination(s) would jeopardize the health of the child. ● The religious exemption is offered when parents testify, in writing, that ​ their religious beliefs prevent all immunizations.

D. Administration of Medication in School St. Thomas’s Day School has individualized the state guidelines for medication administration to meet our needs. St. Thomas’s is a small, independent day school that receives limited nursing services through the City of New Haven.

Health records are maintained by means of a chart system for each student, and are filed alphabetically by grade in the main office. They are confidential and are kept in a locked drawer. The school nurse updates these annually, or more frequently as issues arise.

The Head of School and the Administration feel that in the absence of a nurse the Head of School, a teacher, or Administrative Assistant may give out medications. These unlicensed assistive personnel (UAP) must be adequately trained in all aspects of medication administration by the nurse. They must demonstrate proper knowledge of the procedural aspects of medication administration, the safe handling and storage of medications, and proper documentation and recording. They must demonstrate an understanding of the child’s condition requiring the medication, the desired effect of the medication as well as potential side effects or untoward reactions. They must understand which symptoms need a physician’s attention. These individuals must be knowledgeable, trusted staff members who know and work closely with the children on a day-to-day basis.

As per Connecticut State law, all medications dispensed at St Thomas’s must have written authorization from a prescribing medical provider. This includes both prescription and over-the-counter medications (i.e. Tylenol, Advil, etc).

1. Responsibility of the School Nurse ● The nurse is responsible for: ● record keeping, physical exam and immunization compliance per state requirements; ● performing mandated vision, hearing and scoliosis screenings once

Section XI: Health Services and Procedures 5 yearly as required by the state; ● ensuring that the School has adequate first aid supplies ● ensuring the School follows safe practices regarding blood borne illnesses and medication administration ● educating the teaching and administrative staff yearly concerning EpiPen and proper administration of medications in the school setting; ● preparing health care plans for children with medical conditions and shares this information with the appropriate faculty; ● sending to parents notices of communicable disease exposure, tracks outbreaks of illnesses in the School and responds accordingly; ● communicating with the state by completing the Health Department Immunization Survey yearly and by notifying them of any reportable disease occurrence in the school; ● serving as a liaison between the School and parents when necessary regarding health, hygiene and safety issues; ● obtaining and adhering to a list of standing medical orders from pediatricians and confers as needed with other health professionals.

2. Responsibility of the Family ● Families must provide the following: ● Medication in original package that displays the prescription information. If the medication is over-the-counter the school must have an unopened package. ● Authorization for the Administration of Medication by School, Child Care, and Youth Camp Personnel’ form (appendix. N2)completed by the prescribing provider and signed by a parent. ● Allergy Action Plan’ if your child requires medications for allergies. i. 3. Responsibility of St. Thomas’s School ● All medication will have an order form completed by the child's health care provide and will be kept in the school office. ● Medications, such as inhalers, EpiPens, Benadryl, etc. will be store in a locked cabinet in the health room (main office). ● Class II narcotics, such as Ritalin, Dexedrine, etc. will be stored in the locked cabinet in the health room (main office). ● All administered medications will be logged and signed for in ink with legal signature on designated form already provided for by the Bureau of Nursing. The form (appendix N3) will be kept with the medication. Narcotics will be counted according to regulations. ● Parents will be notified if children require an “as needed” medication during the school day. ● Medication Incident Report Forms (appendix N4) will be filled out when a medication error has occurred and will be kept on file with the Bureau of Nursing and in the child's CHR. The procedures for notification of medication error will be followed. ● Medications will be monitored and accounted for by the school nurse and in her absence by the head or cooperating teacher.

Section XI: Health Services and Procedures 6 E. Infectious Diseases Children are expected to be in good health when in school. If you feel a child is too sick to be in school, bring the child to the office and the receptionist will contact the parent to pick up the child from school. The child will remain in the office until the parent arrives. Parents are required to notify the school if the child has a contagious disease (you should also notify the office if you are aware of such a child in your class). The receptionist will distribute copies of the appropriate health alert form to you for distribution to your parents and to post outside the classroom. The following are considered highly contagious: impetigo, conjunctivitis, head lice, strep throat, chicken pox, rubella, ringworm, hepatitis, Coxsackie virus, infectious mononucleosis, and scarlet fever.

To help limit the spread of germs among children, staff must be sure they and the children wash hands with soap and running water and dry with a paper towel before eating food, after using the toilet, after blowing the nose (or assisting a child in doing so), touching body secretions, or touching animal secretions.

F. Health Recommendations for Exclusion from School Mild illness is common among children and many children will not need to be excluded from their usual source of care for respiratory illnesses of mild severity, since transmission is likely to have occurred before the child became symptomatic or from children with asymptomatic infection. A sick child should be kept home, however. In general, a medical provider is the best person to consult regarding whether a child should attend school.

Reasons children should not attend school include: ● Illness with fever within the past 24 hours. ● Not feeling well enough to participate in school activities. ● Your child may be contagious to other children. ● Your child requires a higher level of care than St Thomas’s can provide. ● Vomiting or diarrhea within the past 24 hours. ● Undiagnosed illness with rash. ● Fever, lethargy, irritability, persistent crying, difficulty breathing, or other signs of possible severe illness. ● Diarrhea that is not contained by toilet use or stools that contain blood and/or mucus. ● Vomiting two or more times in the previous 24 hours, unless the vomiting is determined to be caused by a non-communicable condition and the child is not in danger of dehydration. ● Mouth sores associated with an inability of the child to control his or her saliva, unless the child's physician or local health department authority states that the child is noninfectious. ● Rash with fever or behavior change, until a physician has determined the illness not to be a communicable disease. ● "Pink Eye" (defined as pink or red conjunctiva with white or yellow eye discharge, often with matted eyelids after sleep and eye pain or redness of the eyelids or skin surrounding the eye), until examined by a physician and approved for re-admission, without treatment. ● Tuberculosis, until the child's physician or local health department authority states that the child is noninfectious. ● Impetigo, until 24 hours after treatment has been initiated. ● Strep Throat, until 24 hours after treatment has been initiated, and until the child

Section XI: Health Services and Procedures 7 has been a febrile for 24 hours. ● Head lice, until the morning after the first treatment. ● Scabies (body lice), until after treatment has been completed. ● Chicken Pox, until the sixth day after onset of rash or sooner if all lesions have dried and crusted. ● Whooping Cough (Pertussis), until five days of appropriate antibiotic therapy has been completed. ● Mumps, until nine days after onset of parotid gland swelling. ● Hepatitis A virus infection, until one week after onset of illness or jaundice if symptoms are mild) or until immune globulin has been administered to appropriate children and staff in the program as directed by the responsible health department.

This list is not all inclusive; parents/ caregivers should use common sense. If a child’s health status is unclear, he/she should stay home that day.

Parents/ caregivers should call the school before 9:00 a.m. if a child will be absent. If a child becomes ill during school, parents will be called to and the child sent home.

G. Head Lice Head lice is a widespread problem. Lice are extremely contagious and may be passed along by shared or commonly kept clothing or headgear, combs, brushes, stuffed animals, pillows, theater seats, etc. Head lice are in no way a reflection of personal hygiene. The school head lice policy is as follows: ● Parents are immediately notified and encouraged strongly to pick up the child as soon as possible. The child should then be treated and thoroughly combed. The child can return to school after treatment and inspection by school nurse/staff, clear the child free of nits. ● Parents are requested to check their child's head before school starts and regularly throughout the year. ○ In a strong light, check for nits—small egg cases attached to individual hairs, usually at the top of the head, back and sides, and behind the ears. ○ Itching is a sign of head lice. ● If a child has lice, treat your child with an anti-lice shampoo prescribed by your doctor. Comb out all adult insects and nits with a Derbac or a very fine steel comb. Continue combing until all nits are gone. This is important because the eggs will only hatch later and you have to begin all over again. A week later there should be a follow-up check and re-treatment if necessary. ● All bedding, upholstered furniture, coats, hats, clothing, etc. should be washed and cleaned thoroughly to prevent re-infestation. Stuffed animals may be put in plastic bags for two weeks. Check the other members of your family. ● If a child is found to have lice at school, the rest of the class will be checked. Parents of affected classes will be notified of any outbreak in the class and a notice placed in the Friday Flyer. ● A child may return to school the next day following treatment, but must be nit- free. If nits are still present, the child will be sent home again.

Your cooperation is vital to prevent or minimize any outbreak of head lice. Thank you for your help. Section XI: Health Services and Procedures 8

H. Concussions St. Thomas’s strives to get children back in the classroom after a concussion in a safe, timely and thoughtful manner. Returning to school following a concussion requires a team-based approach that is individualized to the student’s physical and emotional health. We will work with families and medical providers in whatever way we can to ensure the safety of the child.

Under the direct care of a medical provider, families should develop a plan for their child’s concussion recovery. The family is responsible for monitoring the plan’s effectiveness and make adjustments as needed. Families should educate themselves about all aspects of concussion management.

We advise that children recovering from a concussion begin school-specific activities at home in a controlled setting. As a general guideline, once a child is able to complete 1-2 hours of school work at home without symptoms, he/she can consider returning to school.

St. Thomas’s Day School is able to provide some accommodations for students recovering from concussions if provided with a formal, written plan from a medical provider. These accommodations may include a shortened school day, reduced amounts of academic work, and scheduled rests throughout the day.

I. HIV, AIDS, and Other Infectious Diseases The central concerns about individuals who have AIDS and/or other infectious diseases are the risk of spreading illness to others in the school community and ability of the individuals to participate in the normal school program. If there is no reasonable expectation of increased risk to others in the school, children and staff who have a communicable disease would be permitted, under most circumstances, to attend and function at the school as his or her physical condition allows. St. Thomas's is a caring community and would respond with compassion and understanding to individuals who are ill.

It is now widely recognized that HIV is infectious but is not a contagious disease in elementary school settings. Additionally, it is known that children of elementary school age may unknowingly be infected with HIV and be asymptomatic. In such circumstances, if universal precautions for handling body fluids (see above) are practiced, the virus is generally not contagious to others. Therefore, in keeping with current public school policies and with the philosophy of St. Thomas's, children with HIV may attend the St. Thomas's Day School. St. Thomas's is a caring and supportive community, dedicated to the education and nurturing of its children.

Children with HIV, who do have a contagious illness, will be asked to stay home, in keeping with our policy on school attendance for all students.

If a child is known to be infected with HIV, the school requests verbal communication of the child's diagnosis directly to the School Head. If, in the judgment of the Head of School, it is deemed in the child's interest to share the information with a teacher or other professional, this will only be done with the verbal consent of the parent or guardian.

Section XI: Health Services and Procedures 9 The school recognizes and will attempt to adhere to the attached guidelines (Universal Precautions) for handling all incidents involving body fluids.

The school will educate its students and faculty about HIV and other infectious conditions. Accurate, age-appropriate information about the causes, transmission, effects and prevention of infections including HIV will be included in the Kindergarten through Grade Six health curriculum.

1. The school should educate its students and other constituencies about infectious diseases, such as hepatitis, tuberculosis and AIDS. Accurate, age-related information about the causes, effects and prevention of such illnesses and diseases should be included in the health curriculum or other programs. 2. The school should establish standard procedures for cleaning up after injuries or incidents involving blood or body fluid and the disposal of the material. For instance, disposable towels and gloves should be used and the soiled surfaces should be washed with disinfectant. All blood or body fluids should be considered potentially contaminated. 3. The school will not require children, employees or applicants to be tested for AIDS. 4. Any employee, student or applicant (or his/her) parents shall be responsible for informing the school if he/she is HIV sero-positive or has any other infectious disease. 5. When an employee or student of the school is known to be HIV seropositive or have any other infectious disease, the Safety and Standards Committee of the Board of Trustees will be asked to determine, on a case-by-case basis, the extent of that individual's participation in the school's activities and the kind of support the school can reasonably provide to the individual and the school constituencies. The Committee will evaluate the risk to both the person and others, as well as the need for any special care or supervision. As the case is reviewed, the Safety and Standards Committee may consult legal counsel, the patient's family and physician, (with the appropriate patient permission) and other medical advisors. 6. Although the school respects the privacy of the individual who is HIV seropositive or has any other infectious disease, the school will ask for written permission from the individual to inform appropriate faculty and staff of the individual's condition. 7. The school should periodically review this policy, as well as new research and developments regarding AIDS and other infectious diseases.

Section XI: Health Services and Procedures 10