Infectious Diseases/Life-Threatening Health Conditions

In order to safeguard the school and community from the spread of certain communicable diseases the superintendent shall implement procedures assuring that all school buildings are in compliance with state board of health rules and regulations regarding the presence of a person(s) who have or has been exposed to infectious diseases deemed dangerous to the public health. Such procedures shall also prescribe the manner in which safeguards are taken to remove the danger to others.

The district shall require that the parents or guardian shall complete a medical history form and a certificate of immunization status (CIS) form which contain information on
immunity to vaccine preventable, communicable diseases: measles, mumps, rubella, diphtheria, tetanus, Hepatitis B and Haemophilus influenza (Hib). The school nurse may use such reports to advise the parent of the need for further medical attention and to plan for potential health problems in school.

The board authorizes the school principal to exclude a student or staff member who has been diagnosed by a physician or is suspected of having an infectious disease in accordance with the regulations within the most current Infectious Disease Control Guide. The district nurse shall report the presence of suspected case or cases of reportable communicable disease to the appropriate local health authority as required by the State Board of Health. The district nurse shall cooperate with the local health officials in the investigation of the source of the disease.

The fact that a student has been tested for a sexually transmitted disease, the test result and any information relating to the diagnosis or treatment of a sexually transmitted disease must be kept strictly confidential. If the district has a release, the information may be disclosed pursuant to the restrictions in the release.

A school principal or district nurse has the authority to send an ill child or staff member home without the concurrence of the local health officer, but if the disease is reportable, the local health officer must be notified. The local health officer is the primary resource in the identification and control of infectious disease in community and school. The local health officer, in consultation with the superintendent, can take whatever action deemed necessary to control or eliminate the spread of disease, including closing a school.

POLICY 5065 PROCEDURES

An infectious disease is caused by the presence of certain micro-organisms in the body.
Infectious diseases may or may not be communicable or in a contagious state.

Diseases in a contagious state may be controlled by the exclusion from the classroom or by referral for medical attention of the infected student or staff member. Staff members of a school must advise the principal when a student possesses symptoms of an infectious disease. The principal or district nurse must be provided with as much health information as is known about the case in a timely manner so that appropriate action can be initiated. (See Infectious Disease Control Guide).

List of Reportable Diseases. The following diseases require an immediate report to the local health department at the time a case is suspected or diagnosed:

  • Animal Bites (when human exposure to rabies is suspected)
  • Anthrax
  • Botulism (foodborne, infant, wound)
  • Burkholderia mallei (Glanders) and pseudomallei (Meliodosis)
  • Cholera
  • Diphtheria
  • Disease of suspected bioterrorism origin
  • Domoic acid poisoning
  • E.coli- Refer to “Shiga toxin producing E.coli”
  • Emerging condition with outbreak potential
  • Haemophilus influenza (invasive disease, children under age 5)
  • Influenza, novel or unsubtypable strain
  • Measles (rubeola) – acute disease
  • Meningococcal disease (invasive)
  • Monkey pox
  • Outbreaks of suspected foodborne origin
  • Outbreaks of suspected waterborne origin
  • Paralytic shellfish poisoning
  • Plague
  • Poliomyelitis
  • Rabies (confirmed human or animal)
  • Rabies, suspected human exposure (suspected human rabies exposures due to a bite from or other exposure to an animal that is suspected of being infected with rabies
  • Rubella (including congenital rubella syndrome (acute disease only)
  • SARS
  • Shiga toxin-producing E.coli infections (enterohemorrhagic E.coli including, but not limited to, E.coli O157:H7.
  • Smallpox
  • Tuberculosis
  • Tularemia
  • Vaccinia transmission
  • Viral hemorrhagic fever
  • Yellow fever

The following diseases or conditions require a case report to the local health department within 24 hours of diagnosis:

  • Brucellosis (Brucella species)
  • Hantavirus pulmonary syndrome
  • Hepatitis A (acute infection)
  • Hepatitis B (acute infection)
  • Hepatitis E (acute infection)
  • Legionellosis
  • Leptospirosis
  • Listeriosis
  • Mumps (acute disease only)
  • Pertussis
  • Psittacosis
  • Q Fever
  • Relapsing fever (borreliosis)
  • Salmonellosis
  • Shingellosis
  • Vancomycin-resistant Staphylococcus aureus (not to include vancomycin-intermediate)
  • Vibriosis
  • Yersiniosis
  • Other rare diseases of public health significance
  • Unexplained critical illness or death

The following diseases or conditions require a case report to the local health department within three (3) business days of diagnosis:

  • Acquired Immunodeficiency Syndrome (AIDS)
  • Arboviral Disease (acute disease only including, but not limited to, West Nile Virus, eastern and western equine encephalitis, dengue, St. Louis encephalitis, La Crosse encephalitis, Japanese encephalitis, and Powassan)
  • Campylobacteriosis
  • Chanchroid
  • Chlamydia trachomatis infection
  • Cryptosporidiosis
  • Cyclosporiasis
  • Giardiasis
  • Gonorrhea
  • Granuloma inguinale
  • Hepatitis B surface antigen + pregnant women
  • Hepatitis C (acute infection)
  • Hepatitis D (acute and chronic infection)
  • Herpes simplex, neonatal and genital (initial infection only)
  • Human immunodeficiency virus (HIV) infection
  • Influenza-associated death (lab confirmed)
  • Lyme disease
  • Lymphogranuloma venereum
  • Malaria
  • Prion disease
  • Serious adverse reactions to immunizations
  • Syphilis
  • Tetanus
  • Trichinosis
  • Varicella-associated death

The following diseases or conditions require a monthly case report to the local health department:

  • Hepatitis B (chronic infection) – initial diagnosis and previously unreported prevalent cases
  • Hepatitis C (chronic infection)

The following disease or condition requires an immediate case report to the state health department at the time a case is suspected or diagnosed:

  • Pesticide poisoning (hospitalized, fatal or cluster)

The following disease or condition requires a case report to the state health department within three (3) business days of diagnosis:

  • Pesticide poisoning (all other)

The following diseases or conditions require a monthly case report to the state health department:

  • Asthma (occupational)
  • Birth defects – autism spectrum disorders, cerebral palsy, alcohol-related birth defects

In addition to rash illness, any unusual cluster of diseases must be reported. In order to prevent outbreaks of measles and spread of the disease in a school, any rash illness suspected of being measles must be reported immediately. The occurrence of any generalized rash with or without fever, cough, runny nose and reddened eyes in school MUST be reported IMMEDIATELY by individual case (by telephone) to the local
health department. Localized rash cases such as diaper rash, poison oak, etc. need not be reported.

Identification and follow-up:
A. The length of absence from school for a student or staff member ill from a contagious disease is determined by the directions given in the Infectious Disease Control Guide or instructions provided by the health care provider or instructions from the local health officer.

B. The principal has the final responsibility for enforcing all exclusions.

C. When the principal suspects a nuisance disease such as pediculosis (lice), the principal may institute screening procedures to determine if, in fact, the disease exists. The principal may exclude the student from school until successfully treated.

PROCEDURES FOR LICE: The health attendant will let the teacher know if there is a student with live lice or nits in the classroom. Students with live lice will have their parents called to pick them up from school, receive a direction of how to remove lice, and directions to apply Lice Out gel to the hair. When the student returns the next day, the head will be checked again for live lice. When there are three or more cases in the classroom, a letter will be sent home.

D.Follow-up of suspected communicable disease cases should be carried out in order to determine any action necessary to prevent the spread of the disease to additional children.

Reporting at Building Level:
A. A student or staff member who is afflicted with a reportable disease shall be reported by the district nurse to the local health officer as per schedule. Employees learning of a student with a sexually transmitted disease shall report directly to the health department and shall otherwise maintain the information in strict confidence.

B. When symptoms of communicable disease are detected in a student or staff member who is at school, the regular procedure for the disposition of ill or injured students shall be followed unless the student is fourteen years or older and the symptoms are of a sexually transmitted disease. In those instances, the student has confidentiality rights that proscribe notification of anyone but the health department. 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 but observed until the parent or guardian arrives
4. Notify the teacher of the arrangements that have been made prior to removing the student from school.
5. Keep the staff member isolated until sent home or a family member can pick up.
NOTE: Pandemic/Epidemic – If anyone within the school is discovered or suspected to have a communicable disease, that may result in pandemic/epidemic, that person shall be quarantined pending further medical examination and local health officials notified immediately. Any student or staff member found to be infected with a communicable disease that bears risk of pandemic/epidemic will not be allowed to attend school until medical clearance is provided indicating that the risk of transmission no longer exists.

First Aid Procedures:
Students should be asked to wash their own minor wound areas with soap and water under staff guidance when practicable. If performed by staff, wound cleansing should be conducted in the following manner:
1. Gloves must be worn when cleansing wounds that may put the staff member in contact with wound secretions.
2. Soap and water are recommended for washing wounds which may put the staff member in contact with wound secretions or when contact with any bodily fluids is possible. Individual packets with cleansing solutions or saline can also be used.
3. Gloves and any cleansing materials will be discarded in a lined trash container that is secured and disposed of daily according to WAC 296-823.
4. Hands must be washed before and after treating the student and after removing the gloves.
5. Treatment must be documented in a health log program.

B. Thermometers shall be handled in the following manner:

1. Only disposable thermometers or non-mercury thermometers with disposable sheath covers and/or temporal scan thermometers should be used when taking student’s temperatures.
2. Disposable sheath cover will be discarded in an aligned trash container that is secured and disposed of daily. Temporal scan thermometers will be disinfected after each use.

Handling of Body Fluid:
A. Body fluids of all persons should be considered to contain potentially infectious agents (germs). Body fluids include blood, semen, vaginal secretions; drainage from scrapes and cuts, feces, urine, vomit, nasal discharge, saliva, tears and respiratory secretions.

B. Gloves must be worn when direct hand contact with body fluids is anticipated ( e.g., treating nose bleeds, bleeding abrasions), when handling clothes soiled by body fluids (e.g., urine and/or feces), when diapering children (and when sanitizing spaces used for diapering). Hand washing is most important intervention the spread of disease and must take place after gloves are removed and between care of multiple students.

C. Used gloves must be discarded in a secured lined trash container and disposed of daily. Hands must then be washed thoroughly.
D. Self-treatment of minor injury, when reasonable, will be encouraged;
E. Sharps will be disposed in an approved container. Sharps containers must be maintained upright throughout use, be tamper-proof and safely out of students’ reach, be replaced routinely and not be allowed to overfill.
F. General cleaning procedures will include use of a 10% bleach solution to kill norovirus and C. difficile spores.

Cleaning and/or Disinfecting Contaminated Surfaces and Rugs:
A. Disinfectants should be used to clean surfaces contaminated by body fluids. Such disinfectants will kill fungi, tubercle bacillus and viruses. The disinfectant chosen should be registered with the US Environmental Protection Agency for use in medical facilities.

B. Hard surfaces should be cleaned in the following manner:
1. Put gloves on both hands.
2. Remove soil.
3. Apply disinfectant with mop or cloth.
4. Dispose of water in toilet or sink designed for contaminated water.
5. If cloths and towels are used, place in plastic bag to be sent to laundry.
6. Place paper towels, gloves and other disposable items in a secured, lined trash container and discard daily.
7. Wash hands thoroughly.

C. Rugs should be handled in the following manner:
1. Apply sanitary absorbent agent.
2. Allow to dry. Vacuum. If necessary, mechanically remove soil with dustpan and broom.
3. Apply rug shampoo using a germicidal detergent. Re-vacuum.
4. Rinse dustpan and broom in disinfectant.
5. Discard non-reusable cleaning equipment in a secured, lined trash container and discard daily.

Handling of Soiled Clothing, Blankets, Pillowcases:
A. Wear gloves when handling clothing contaminated with blood or body secretions.
If clothing is to be sent home or to laundry, place in plastic bag and tie securely.
At times, a heavily soiled article of clothing must be discarded rather than washed. If so, discard in a lined trash container that is secured and disposed of daily.

B. If washing clothing or bedding at school, wash separately in soap and water on wash cycle.

C. If not color fast, add intermediate level disinfectant to wash cycle.

Treatment of Students with Chronic Medical Conditions (e.g., HIV; AIDS; Hepatitis)

On the disclosure that a student has been identified as having Acquired Immunodeficiency Syndrome (AIDS) or Human Immunodeficiency Virus (HIV) or Infectious Hepatitis. the superintendent, principal, parent, local health officer, school nurse and the student’s licensed healthcare provider will confer as necessary and determine the appropriate placement of the student. The student will be accommodated in the least restrictive manner, free of discrimination, without endangering the other students and the teacher. The student may only be excluded from school on the written concurrence of the public health officer and the student’s licensed healthcare provider, that remaining or returning to school would constitute a risk either to the student or to employees or other students.

All discussions and records will be treated as confidential, consistent with RCW 70.24.105

Release of information regarding the testing, test result, diagnosis or treatment of a student for a sexually transmitted disease may only be made pursuant to an effective release and only to the degree permitted by the release. To be effective, release must be signed and dated, must specify to whom the release may be made and the time period for which the release is effective. Students fourteen and older must authorize the disclosure regarding HIV, sexually transmitted diseases or reproductive healthcare issues. Student’s thirteen and older must authorize disclosure regarding drug or alcohol treatment or mental health treatment. Students of any age must authorize disclosure regarding family planning or abortion. Parents must authorize disclosure pertaining to younger students.

Any disclosure made pursuant to a release regarding reproductive healthcare, including sexually transmitted diseases, HIV/AIDS or drug or alcohol treatment must be accompanied by the following statement:

“This information has been disclosed to you from records whose confidentiality is protected by state law. State law prohibits you from making any further disclosure of it without the specific written consent of the person to whom it pertains, or as otherwise permitted by state law. A general authorization for the release of medical or other information is not sufficient for this purpose.”

The District shall ensure that newly hired school district employees receive the HIV/AIDS training regarding:

  • History and epidemiology of HIV/AIDS
  • Methods of transmission of HIV
  • Methods of prevention of HIV including universal precautions for handling body fluids;
  • Current treatment for symptoms of AIDS and prognosis of disease progression;
  • State and federal laws governing discrimination of persons with HIV/AIDS; and
  • State and federal laws regulating confidentiality of a person’s HIV antibody status.
  • New employee training shall be provided within six months from the first day of employment in the District. Continuing employees will receive information within one year of District receipt from SPI on new discoveries or changes in accepted knowledge of transmission, prevention and treatment of HIV/AIDS.

IMMUNIZATION AND LIFE THREATENING HEALTH CONDITIONS

Immunizations

In order to safeguard the school community from the spread of certain communicable diseases and in recognition that prevention is a means of combating the spread of disease, the board requires a student to present evidence of his/her having been immunized against diseases as required by the State Board of Health.

Exemptions from Immunization

The district shall allow for exemptions from immunization requirements only as allowed for by RCW 28A.210.090.

Meningococcal Immunizations Information Distribution

The district will provide parents and guardians of students in sixth grade and above with information about meningococcal disease at the beginning of every school year. The information will address the characteristics of the disease; where to find additional information about the disease; vaccinations for children; and current recommendations from the Centers for Disease Control and Prevention regarding receiving the vaccine.

Human Papillomavirus Disease Information

At the beginning of every school year, the district will provide parents and guardians of sixth through twelfth grade students with information, provided by the state Department of Health about human papillomavirus disease and its vaccine.

The information will include the causes and symptoms of human papillomavirus, how the disease is spread, the places where parents and guardians may obtain additional information and vaccinations for their children and current recommendations from the Centers for Disease Control Prevention regarding the vaccine.

Life-Threatening Health Conditions

Prior to attendance at school, each child with a life-threatening health condition will present a medication or treatment order addressing the condition. A life threatening health condition means a condition that will put the child in danger of death during the school day if a medication or treatment order providing authority to a registered nurse and nursing plan are not in place. Following submission of the medication or treatment order, a nursing plan will be developed.

Students who have a life-threatening health condition and no medication or treatment order presented to the school will be excluded from school, to the extent that the district can do so consistent with federal requirements for students with disabilities under the Individuals with Disabilities Education Act and Section 504 of the Rehabilitation Act of 1973, and according to the following due process requirements:

A. Written notice to the parents, guardians or persons in loco parentis delivered to the parents in person or by certified mail.

A. Notice of the applicable laws, including a copy of the laws and rules.

B. The order that the student will be excluded from school immediately and until a medication or treatment order is presented.

C. Explain the rights of the parents and student to a hearing, the hearing process and that the exclusion continues until the medication or treatment plan is presented or the hearing officer determines that the student should no longer be excluded from school.

D. If the parents request a hearing, the district will schedule one within three school days of receiving the request, unless more time is requested by the parents.

E. The hearing process will be consistent with the procedures established for disciplinary cases pursuant to Chapter 392-400 WAC.

Certificate of Immunization

Immediately upon enrollment in the district a certificate of immunization status, distributed by the Washington Department of Health, will be completed by the student’s parent or legal guardian. The certificate will be made a part of the student’s permanent record.

If, by the student’s first day of enrollment, a student does not have documentation for receipt of any or all of the required immunizations, he/she will submit evidence of the initiation of an immunization schedule and will be placed in a “conditional admittance” status. Students may attend under conditional admittance status for a limited time. The parent or guardian must provide, within thirty (30) days of the student’s first day of attendance, any missing immunization(s) or provide documentation needed to complete the certificate of immunization. If a student needs additional doses to complete a vaccine series, s/he will remain in conditional admittance status for a maximum of thirty (30) days after the next dose is due until the series is complete. Failure to submit documentation within these timelines will be sufficient cause to exclude the student from school.

Exemptions from Immunization

Any and all exemptions will be processed and recoded on a Certificate of Exemption as distributed by the Washington Department of Health. Exemptions from one or more vaccines will be granted for medical reason upon certification by a physician that there is a medical reason for not administering the vaccine.

Exemptions for personal or religious reasons will be granted upon request of the parent or legal guardian. To request an exemption, a parent or guardian must submit a signed Certificate of Exemption that the parent/guardian has a philosophical, personal, or religious objection to the immunization of the child. Forms must include a statement to be signed by a health care practitioner stating that he or she provided the parent/guardian with information about the benefits and risks of immunization. The form may be signed by a health care practitioner at any time prior to the enrollment of the child in a school or licensed day care. Photocopies of the signed form or a letter from the health care practitioner will be accepted in lieu of the original form.

Any parent or legal guardian of the child who exempts the child due to religious beliefs is not required to have a Certificate of Exemption signed by a health care practitioner if the parent or legal guardian demonstrates on the Certificate of Exemption membership in a religious body or a church in which the religious beliefs or teachings of the church preclude a health care practitioner from providing medical treatment to the child.

The permanent file of students with exemptions will be marked for easy identification should the local department of health order that exempted students be excluded from school temporarily during an outbreak or an epidemic.

If a certificate of exemption is not received upon the student’s enrollment in school, the principal will provide written notice to the parents or guardians informing them of:

A. The immunization requirements;
B. The potential denial of the student’s attendance;
C. The procedural due process rights; and
D. The immunization services available.

Exclusion from School

Following proper notification, the school will exclude the student for noncompliance with the immunization laws pursuant to the appeal process procedures for student expulsions. Parents will have a right to a hearing, provided they notify the school within three days after receiving the exclusion order from the school principal. If the parent requests a hearing, the parent or guardian and school principal will be notified in writing of the time and place for the hearing and will present the case to a hearing officer appointed by the superintendent.