Policy Details Page

Regulation 6512R

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Infection Control Program

Procedures for Students and Staff

These procedures are designed to provide effective precautions against transmission of disease in the school setting. They apply to students and staff, and address exposure to blood and other body fluids, viral and bacterial diseases, and acquired immunodeficiency syndrome.

Contagious Diseases

Diseases in a contagious state may be controlled by exclusions from the classroom or by referral for medical attention.

Diagnosis of Disease

Physicians who diagnose any of the following diseases are required by state law to make a report to the Tacoma-Pierce County Health Department. When one of the following diseases is reported to a school, the school nurse is to be notified. The school nurse/designee will notify the Tacoma-Pierce County Health Department and the Department Head of Health Services.

Acquired Immunodeficiency Syndrome (AIDS)	Animal Bites
Botulism (foodborne, infant, and wound)	Brucellosis (Brucella species)
Campylobacteriosis	Chancroid
Cholera	Chlamydia trachomatis infection
Cryptosporidiosis	Cyclosporiasis
Diptheria	Disease of suspected bioterrorism origin (including): Anthrax or Smallpox
Disease of suspected foodborne origin (clusters only)	Disease of suspected waterborne origin (clusters only)
Encephalitis, viral	Enterohemorrhagic E. coli such as E. coli 0157:H7 infection
Giardiasis	Gonorrhea
Granuloma inguinale	Hemophilus influenza (invasive disease, under age 5)
Hantavirus pulmonary syndrome	Hemolytic uremic syndrome
Hepatitis A (acute infection)	Hepatitis B (acute infection)
Hepatitis B surface antigen positive pregnant women	Hepatitis C and NANB (acute infection)
Herpes simplex, neonatal and genital (initial infection only)	Human Immunodeficiency virus (HIV) infection
Legionellosis	Leptospirosis
Listeriosis	Lyme disease
Lymphogranuloma venereum	Malaria
Measles (rubeola)	Meningococcal disease
Mumps	Other rare diseases of public health significance
Paralytic shellfish poisoning	Pertussis
Plague	Poliomyelitis
Psittacosis	Q Fever
Rabies (including the use of post-exposure prophylaxis)	Relapsing fever (borreliosis)
Rubella (including congenital rubella syndrome)	Salmonellosis
Serious adverse reactions to immunizations	Shigellosis
Streptococcus, Group A (invasive disease only)	Syphillis
Tetanus	Tuberculosis infection, active or latent (positive Mantoux skin test)
Trichinosis	Tularemia
Typhus	Unexplained critical illness or death
Vibriosis	Yellow fever
Yersiniosis

Body Fluids/Sources of Infectious Agents

No distinction is made between body fluids from persons with a known disease and those from persons with an undiagnosed illness or without symptoms. Body fluids of all persons would be considered to contain potentially infectious agents. The term “body fluids” includes blood, semen, feces, urine, vomit and respiratory secretions. Table 1 describes examples of infectious agents that may occur in body fluid and the method of disease transmission.

1. A. In order to avoid contact with body fluids, disposable gloves are to be available in school health centers, custodial offices, preschool and child care classrooms, first aid kits located in shop areas, school kitchens, home economics classes, science labs, upon request from classroom teachers and on school buses. Gloves should be worn to:
   1. treat bloody noses;
   2. provide first aid for injuries involving blood or body fluid drainage;
   3. change diapers and ostomy bags and assist students in managing fecal incontinence;
   4. suction tracheotomies;
   5. catheterize students; and
   6. handle clothing soils or spills caused by vomit.
2. Used gloves should be removed inside out and disposed of in a plastic bag or lined trash can. Used tissue, diapers and paper towels should also be placed in a plastic bag for disposal.
3. In the case of unanticipated contact with body fluids when gloves are not available and following the use of gloves, hands and other affected skin areas should be washed with soap and running water with vigorous friction for approximately 10 seconds.
4. Contaminated clothing, towels and other non-disposable washable items should be rinsed and placed in plastic bags before being sent home for washing in the case of personal items. In the case of items belonging to the school and laundered at school, separate from other items and launder using soap, hot water and onehalf cup of household bleach.
5. Contaminated environmental surfaces should be cleaned with a detergent/disinfectant such as Bactisol. Disposable cleaning equipment should be placed in a plastic bag after use for disposal. Used water and disinfectant should be disposed of in a toilet or sewer drain. Non-disposable equipment such as dustpans and buckets should be thoroughly rinsed in disinfectant. After use, mops should be soaked in disinfectant or washed in hot water. Rugs should be cleaned with a germicidal detergent rug shampoo and vacuumed thoroughly.
   
   In the case of a known student hepatitis B carrier, pre-exposure vaccination may be recommended for school staff after reviewing by the district’s medical consultant. This recommendation would be based on the age of the student and the student’s ability to independently handle hygiene needs.
   
   A preschool student or older student requiring significant adult assistance in meeting hygiene needs may increase the risk of exposure to hepatitis for staff. In such cases, the cost of the recommended vaccine would be paid for by the district.

Viral Infections

Persons with common viral infections such as colds and flu will be advised to remain at home:

1. During the acute phase of the illness; and
2. For 24-hours following illness accompanied by fever.

Procedures Applicable to Students Only

Contagious Diseases

1. A. Tacoma School District No.10 will follow the guidelines established by the office of the superintendent of public instruction in the Infectious Disease Control Guide for School Staff regarding control of the spread of communicable diseases and exclusion from school of students with a variety of viral or bacterial communicable diseases.
2. Except for a case involving AIDS, the school principal/building administrator is authorized to exclude a student who has been diagnosed by a physician or is suspected of having an infectious disease in accordance with the regulations within the most recent edition of the Infectious Disease Control Guide (state superintendent of public instruction). The principal and/or school nurse shall report the presence of suspected cases of communicable disease to the appropriate local health authority as required by the State Board of Health.
3. When symptoms of a communicable disease are observed in a student while at school, the regular procedure for the disposition of ill or injured students shall be followed. The principal or designee will:
   1. Call the parent, guardian or emergency phone number to advise him/her of the signs and symptoms;
   2. Determine when the parent or guardian will pick up the student;
   3. Keep the student isolated until the parent or guardian arrives; and
   4. Notify the teacher of the arrangements being made prior to removing student from school.

Acquired Immunodeficiency Syndrome (AIDS)

Acquired Immunodeficiency Syndrome (AIDS) is caused by infection with Human Immunodeficiency Virus (HIV). The following procedures apply to students who do not have symptoms but have antibodies to this infection in the bloodstream (HIV positive) and students with active symptoms of AIDS. Should a student with AIDS be identified in the district, the following guidelines developed by the Center for Disease Control, the State Department of Social and Health Services, and the American Academy of Pediatrics and reviewed by a representative group of community physicians will be followed.

1. Students infected with the Human Immunodeficiency Virus, except for those subject to the conditions described in (8) below, should be allowed to attend school in an unrestricted manner because of the apparent nonexistent risk of transmission of the Human Immunodeficiency Virus.
2. The infected student should be considered eligible for all rights, privileges and services provided by law and local policy of the district.
3. Following consent for release of information provided by the parent or guardian of an infected student, communication will be established with the student’s physician. The physician will be able to provide the guidance described in (4) and will also serve as part of the team described in (5) to be used in making decisions about preschool or neurological handicapped children who lack control of their body secretions, or who display behavior such as biting.
4. For most infected students, the benefits of a normal school setting would outweigh the risks of their acquiring potentially serious infections in that setting. Assessment of the risk to the immunosuppressed student of attending school in an unrestricted setting is best made by the student’s physician, who is aware of the student’s immune status.
5. A few infected students may potentially pose more of a risk to others. Students who lack control of their body secretions, who display behavior such as biting or who have other medical conditions such as uncoverable oozing lesions, require a more restricted environment until more is known about transmission of the virus under these conditions. Individual judgments need to be made regarding placement of students with questionable behavior, impaired neurological development or other medical conditions in the normal school setting. These decisions are best made using the team approach. The team should include the student’s physician; the parents or guardian of the student; the principal, school nurse and teacher or preschool/child care program leader from the proposed educational setting; a physician with expertise in AIDS; and a pediatrician with expertise in infectious disease. The department head of Health Services will be responsible for selecting and convening this team. In each case, risks and benefits to both the infected student and to others will be weighed. If the decision is unanimous it shall stand as the decision of the district. In the case of dissent, the majority recommendation of the team and any dissenting opinions will be submitted to the superintendent for a final decision.
6. If a student is considered eligible for special education services, procedures applicable to such a student shall be followed.
7. Confidentiality requirements in regard to information about any student shall be respected and limited to those persons who have a need to know.

Procedures Applicable to Staff Only

Immunizations

Staff members, including substitutes, student teachers and volunteers, are encouraged to complete an Immunization History form to be placed on file at the district office. In the event of an outbreak of a vaccine-preventable disease in school, the local health officer has the authority to exclude all susceptible persons. This authority would likely be exercised in the event of one or more cases of measles or rubella within the school. Susceptible persons are all staff members, regardless of age, who are unable to provide documentation of measles immunity.

A staff member may claim an exemption for health, religious or philosophical reasons. However, such a staff member who files an exemption may be excluded if an outbreak occurs at his/her school. A staff member who is excluded is not eligible to receive sick leave benefits unless he/she is ill or physically disabled or is otherwise provided for in the collective bargaining agreement.

If a staff member needs to be immunized, he/she should contact a personal physician or clinic. Immunizations may also be available at a nominal cost from the county health department.

Infection Control Program

The district’s infection control program shall be consistent with WAC 296-62-08001, Bloodborne Pathogens and the Guidelines for Implementation of Hepatitis B and HIV School Employee Training published by the superintendent of public instruction.

All employees with reasonably anticipated on-the-job exposure to blood or other potentially infectious material shall be identified. Potentially infectious human body fluids are blood, semen, vaginal secretions, cerebrospinal fluid, synovial fluid, pleural fluid, pericardial fluid, peritoneal fluid, amniotic fluid, saliva in dental procedures, any body fluid that is visibly contaminated with blood and all body fluids in situations where it is difficult to differentiate between body fluids.

Examples of employees with reasonably anticipated risk of exposure include, but are not limited to: school nurses, assistant nurses and school health clerks. All job duties should be evaluated for the risk of exposure to blood or potentially infectious material. The district shall maintain a list of job classifications with reasonably anticipated exposure to blood or other potentially infectious material.

All employees identified as having reasonably anticipated exposure to blood or other potentially infectious material shall be offered the Hepatitis B vaccine at the district’s expense.

If an employee has a specific exposure to blood or other potentially infectious material, the district will provide a free and confidential medical evaluation and follow-up performed by an appropriately trained and licensed health care professional. Any necessary post-exposure treatment shall be provided.

Employees with reasonably anticipated exposure to blood and other potentially infectious material shall participate in district-provided training within ten days of employment and annually. The training shall include:

1. a general description of bloodborne diseases;
2. an explanation of modes of transmission of bloodborne pathogens;
3. an explanation on the use and limitations of methods of control;
4. information about personal protective equipment;
5. information on the Hepatitis B vaccine;
6. a description of procedures to follow if an exposure incident occurs;
7. an explanation of signs, labels, tags and color coding used to designate biohazards;
8. where to obtain a copy of WAC 296-62-08001, bloodborne pathogens;
9. an explanation of the district’s infection control plan and how to obtain a copy;
10. how to identify tasks and activities that may involve exposure to blood or other potentially infectious material; and
11. appropriate actions to take in emergencies involving blood or other potentially infectious material.

The training shall be provided by a qualified person and shall include opportunities for questions.

The district shall provide training to all employees regarding HIV/AIDS. The training shall be provided within six months of initial employment. The training shall include:

1. history and epidemiology of HIV/AIDS;
2. methods of transmission of HIV;
3. methods of prevention of HIV infection including universal precautions for handling body fluids;
4. current treatment for symptoms of HIV and prognosis of disease prevention;
5. state and federal laws barring discrimination against persons with HIV/AIDS; and
6. state and federal laws regulating the confidentiality of a person’s HIV antibody status.

Significant new discoveries or changes in accepted knowledge regarding HIV/AIDS shall be transmitted to employees within one calendar year of notification from the superintendent of public instruction, unless the Department of Health notifies the district that prompter dissemination of the information is required.

The Hepatitis B vaccination status and records regarding any occupational exposure, if any, shall be kept in strict confidence during employment plus thirty years, for any employee with reasonably anticipated exposure to blood or other potentially infectious material. The records of occupational exposures shall include:

1. the employee’s name and social security number;
2. the employee’s Hepatitis B vaccination status;
3. examination results, medical testing and follow-up procedure records;
4. the health care professional’s written opinion; and
5. a copy of information provided to the health care professional.

The district shall also keep records of training sessions including the dates, a summary of the material, names and qualifications of the trainers and names of employees attending the training. These records shall be kept for three years.

AIDS/HIV

Acquired Immunodeficiency Syndrome (AIDS) is caused by infection with Human Immunodeficiency Virus (HIV). The following procedures apply to staff who do not have symptoms but have antibodies to this infection in the blood stream (HIV positive); and staff with active symptoms of AIDS. Should a staff member with AIDS be identified in the district, the following guidelines developed by the Centers for Disease Control and the State Department of Social and Health Services and reviewed by a representative group of community physicians will be followed.

Medical evidence has indicated that the Human Immunodeficiency Virus is communicable, but that the Human Immunodeficiency Virus is not transmitted by casual contact whether in the work force or schools. Therefore, the district will deal with an employee with AIDS or HIV as it deals with an employee with a disability. A current or prospective employee shall not be discriminated against on the basis that the employee has, or is perceived to have, AIDS or HIV.

Upon identification of an employee by a competent medical authority as having Acquired Immune Deficiency Syndrome (AIDS) or HIV, the following procedures will be followed:

1. The assistant superintendent for Human Resources and or the district’s ADA administrative officer may communicate with the employee and request the employee to provide information from the employee’s personal physician regarding the employee’s current health condition and/or disability in order to determine whether and to what extent reasonable accommodations for the employee are needed.
2. Any decisions regarding the employee’s status shall be made based upon the medical evidence available.
3. Confidentiality requirements in regard to information about an employee shall be respected and limited to those persons who have a “need to know”.

Approved 2/12/02

Revised 11/27/07

Body Fluids	Organisms of Concern	Method of Transmission
Blood Cuts/abrasions Nosebleeds Menses	Hepatitis B virus HIV (Human Immunodeficiency Virus) Cytomegalo virus	Bloodstream inoculation through cuts and abrasions on hands, bites, or contaminated needles
Feces Incontinence	Salmonella bacteria Shigella bacteria Hepatitis A virus	Oral inoculation from contaminated hands
Urine Incontinence	Cytomegal virus	Bloodstream and oral Inoculation from contaminated hands
Respiratory secretions Saliva, nasal discharge	Mononucleosis virus Common cold virus Influenza virus	Oral inoculation from contaminated hands
Vomit	Gastrointestinal viruses	Oral inoculation from contaminated hands
Semen	Hepatitis B virus HIV Gonorrhea	Sexual contact (intercourse)