Infection Control in the School Setting

1. Infection Control in the School Setting Susan Shineldecker, BSN RN NCSN August, 2012

2. Objectives • Participants will be able to: • Identify common blood borne pathogens, paths of transmission in school setting and symptoms • Develop protocol to follow after an exposure event that meets individual district guidelines

3. Objectives • Participants will be able to: • Explore tools available to communicate hazards and protect everyone from common communicable diseases • Formulate an educational plan to increase awareness of infection prevention in the school setting

4. Human Immunodeficiency Virus (HIV) • No vaccine for HIV. There is treatment that may decrease severity of illness in people with HIV, but no cure. • HIV attacks the body’s ability to protect itself against disease.

5. Hepatitis • Hepatitis virus triggers an immune response, causing liver inflammation damaging cells Source: MedicineNet.com

6. Tattoo Anyone? Source: MedicineNet.com

7. Hepatitis B Symptoms • Fatigue / weakness • Nausea • Vomiting • Abdominal pain and tenderness • Mild fever • Headache • Jaundice • Muscle and joint ache Source: MedicineNet.com

8. Hepatitis C Symptoms Many have no symptoms when first infected with Hepatitis C • Fatigue and weakness • Abdominal pain & Jaundice • 25% cases self-limited; others chronic

9. After a Possible ExposureWhat Do You Do? • Immediate / Self-care Action • Wash with soap and water • Flush mucous membranes with water • Report incident • Seek physician evaluation, if indicated, get post exposure testing, which should conclude 6 months post exposure

10. Prevention Plan • Standard Precautions: treat ALL bodily fluids as if infectious (Center for Disease Control) • Personal Protective Equipment provided free • Gloves • Goggles • Masks • CPR masks with 2-way valve

11. Prevention Plan • Engineering and Workplace Controls • Sinks with running water (preferably hot & cold water) • Soap and disposable towels • Waterless hand sanitizer • Approved Sharps containers • Needleless system • No eating / drinking, applying cosmetics, inserting contact lenses in workplace

12. Prevention Plan • Housekeeping • Clean work surfaces and trash cans immediately after a spill or contamination • Leak-proof trash can liners • Annual training of Blood borne pathogen safety for all staff

13. Prevention Plan • Designation of Biohazard Classification for job positions • Hepatitis B vaccine free to all staff with determined biohazard classification • Post exposure care and follow-up provided

14. Preventive Plan / Actions • School Inspection Tour • Bathrooms: • Sinks with hot / cold running water • No sinks in toileting area—now what? • Storage areas—not in bathrooms • Must clean and air dry all items stored in bathrooms • Posters in toileting areas and sinks • Waterless hand cleanser • Hand washing area outside cafeteria

15. Preventive Plan / Actions • Student education • 1:1 (students wash hands when entering health room) • Classroom • Encourage student self-care • No over-stuffed sharps containers

16. Preventive Plan / Action • Keep cap on needle until needed • Encourage student to self inject • If drawing up medication, hand student syringe with needle pointed to floor • Student disposes ‘sharp’ in sharps container • NEVER re-cap needle

17. Preventive ActionsGlucometer Lancet Safety • If possible, have student insert lancet into device • If able, student to perform own finger-stick • Student should remove lancet from device and place in sharps container

18. Preventive ActionsEpi-Pen Safety • Remove blue or gray safety cap from top of self injector only when ready to use • Do not place fingers over orange or black tip

19. Preventive ActionsTwin-ject Epi-pen • If second dose of epinephrine needed, caution when unscrewing red safety cap….. Source: Twinject auto-injector • Needle will be exposed

20. Pertussis (Reportable Communicable Disease) • Vaccine-preventable disease • Transmission: respiratory secretions • Incubation: 6-20 days, usually 7-10 days • Symptoms: cold symptoms to severe paroxysmal cough with “whoop” and vomiting; cough lasts 6- 10 weeks • Antibiotic given before paroxysm cough can shorten cough. Erythromycin (Z-Pack) drug of choice. • Excluded from school until 5 days of Erythromycin

21. Varicella (Chickenpox)(Reportable Communicable Disease) • Vaccine-preventable disease • Cause: varicella zoster virus transmitted by respiratory droplets or contact with fluid • Contagious 1-2 days prior to rash • Incubation: 10-21 days, usually 14 days, but exposed are not at risk until day 7 • Students with vesicular rash excluded from school until scabs crusted over-- usually 7 days after onset of rash or cleared by a physician.

22. Varicella Vesicular Rash Source: A.D.A.M. Medical Encyclopedia

23. Shigellosis(Reportable Communicable Disease) • Bacterial infection: causes fever, diarrhea, (may contain blood), and sometimes nausea, vomiting, abdominal cramps • Transmission: ingestion of contaminated food or water, as well as contact from infected person • Incubation: 1-3 days after ingesting bacteria • Illness usually lasts 4-7 days and student may return to school when diarrhea / fever-free 24 hours. • Best Protection: Good hand washing

24. Preventative Action After a Shigellosis Case • Collaborate with local health dept • Elementary School: work with Administration to have teachers incorporate hand washing lessons in morning greeting and throughout the day; parents to reinforce at home • Strict adherence to district's return policy for sick students—free of fever and diarrhea

25. Preventative Action After a Shigellosis Case • Step stools to reach soap and water • Do not store anything in restroom/toilet area, unless stored in a closed cabinet • When removing items stored in restroom, wiped individually and allowed to air dry • Store purchased, individually wrapped items for consumption recommended for special occasions during heighten surveillance period

26. Bacterial Meningitis(Reportable Communicable Disease) • Vaccine Preventable • Meningococcal vaccine required in 7th – 10th grades • Transmission: person to person through droplets • Incubation period: 2-10 days • Highly infectious. Student excluded until cleared by physician

27. Bacterial MeningitisSymptoms • Sudden onset of headache, fever, chills, muscle and joint pain, stiff neck, vomiting, irritability and photophobia (light sensitivity) • Skin rash with petechiae or purpura, hypotension (low blood pressure), seizures • Symptoms can change rapidly, often within a few hours; May need to be transported by EMS

28. Surveillance/Management of Possible Rabies Exposure • Center for Disease Control: rabies exposure occurs when person bitten or scratched by potentially rabid animal, or when abrasions, open wounds or mucous membranes contaminated with saliva, brain or nervous system tissue of potentially rabid animal

29. Bat in School or on School Grounds • Educate staff and students about safe handling of bats • School Nurse notified immediately if bat found • Keep people away and call Animal Control • Do not handle with bare hands. Bats can bite through all but thickest gloves.

30. Tuberculosis • Tuberculosis (TB) is caused by a bacterium, Mycobacterium tuberculosis • Transmission: airborne, respiratory droplets • TB disease when latent TB infection becomes active • Symptoms of TB disease include: • cough that lasts 3 weeks or longer, hemoptosis • Chest pain • weakness or fatigue • Loss of appetite, weight loss • Fever, chills • Night sweats

31. Staphylococcus Aureus (Not a reportable communicable disease) • Staphylococcus Aureus: bacteria frequently causes skin and soft tissue infections. • Common sites on body: armpit, groin, genital area and nose • Transmitted when makes contact with break in protective skin barrier (abrasions, floor burns, shaving, etc.)

32. Staph Infection Source: MedicineNet.com

33. Methicillin Resistant Staphylococcus Aureus (MRSA) (Not a reportable communicable disease) • MRSA: bacteria resistant to Methicillin, an antibiotic. Source: MedicineNet.com

34. MRSA Source: MedicineNet.com

35. Preventive ActionsWound Care • May require surgery, hospitalization, intravenous antibiotics, skin grafts • Wounds must be covered and dry • Nurse monitors/case-manages skin infections • Student may participate in NON-contact activities • Notify Health Department of large clusters of confirmed MRSA in a school

36. Preventive Actions Human Bite • Human bites: potential blood borne pathogen exposure • Reported to parent, school administrator • School Nurse discusses recommended actions with parents of biter and bitten • Parent letter: event description, Hepatitis B and Tetanus vaccine history • Confidential: Names and health history

37. Ringworm of the Scalp (TineaCapitas) • Transmitted: skin to skin contact or indirectly through contact from contaminated barber clippers, seats, combs, hairbrushes, clothing and hats. • Treatment: Griseofulvin orally and medicated shampoo • Student is excluded until cleared by physician Source: A.D.A.M. Medical Encyclopedia

38. Ringworm of the Body (Tineacorporis) • Transmitted: infected skin contact from humans or animals, contaminated linens, shower stalls /benches, etc. • Treatment: topical antifungal twice daily until cleared for a week Source: A.D.A.M. Medical Encyclopedia

39. Scabies(NOT a reportable communicable disease) • Caused by a mite burrowing under the skin and laying eggs. • Common sites: around finger webs, wrists, belt-line, genital area, buttocks, axilla, skin folds. • Transmission: prolonged, close, personal contact with infected person • Incubation: 4-6 weeks, if not previously exposed; 1-4 days if repeated exposure

40. Scabies Source: MedicineNet.com Appears as small, raised, red bumps or blisters in lines with intense itching, especially at night

41. Fifth DiseaseErythema Infectiosum(NOT a reportable communicable disease) • Incubation: 4-14 days, up to 21 days • Transmission: respiratory droplets Person not contagious after rash appears and fever free. Student not excluded from school Source: MedicineNet.com

42. Fifth DiseaseLacy Rash Source: hardinmd.lib.uiowa.edu After cheek rash fades, a lacey rash appears on the trunk and extremities

43. Influenza(NOT a reportable communicable disease) • Acute viral illness with sudden onset of fever, headache, sore throat, cough, chills, lack of energy and muscle aches • Highly contagious with epidemics • Incubation: 1-5 days • Transmission: Airborne & direct contact • Recovery usually in 2-7 days

44. Hand washing Resources • hand washing video: http://www.cdc.gov/cdctv/handstogether/ • CDC hand washing podcast: http://www2c.cdc.gov/podcasts/player.asp?f=770473 • http://www.cdc.gov/ounceofprevention/docs/oop_brochure_eng.pdf • http://www.cdc.gov/flu/pdf/freeresources/updated/cleaning_disinfecting_schools.pdf • Mypersonalhygiene.com

45. References • American Academy of Pediatrics Report of the Committee on Infectious Diseases 2000 • CDC Website: www.cdc.gov • Haymann, David: Control of Communicable Diseases Manual, American Public Health Association 2004 • MedicineNet.com • Recommendations for the Prevention and Control of communicable Diseases in a Group-Care Setting; Department of State Health Services • Selekman, Janice: School Nursing: A Comprehensive Text, F.A. Davis and Company 2006

46. Questions?