INFECTION CONTROL/COMMUNICABLE DISEASES
TABLE OF CONTENTS
COMMUNICABLE DISEASES: INTRODUCTION
COMMUNICABLE DISEASE REFERENCE CHART
COMMUNICABLE DISEASES
Chicken Pox (Varicella Virus, Herpes Zoster)
Common Cold
Cytomegalovirus (CMV)
Fifth Disease (Slapped-Cheek Disease)
Hand, Foot and Mouth Disease (Coxsackievirus)
Head Lice (Pediculosis)
Hepatitis A
Hepatitis B
Hepatitis C
Herpes Simplex (Cold Sore, Fever Blister)
HIV/Aids
Impetigo (Sand Sores)
Influenza
Measles (Red Measles, Rubeola)
Meningitis
Mononucleosis (Kissing Disease)
MRSA
Mumps
Pink Eye (Conjunctivitis)
Pinworms
Ringworm
Rubella (German Measles, 3-Day Measles)
Scabies (Itch Mites)
Staphylococcal Infections
Streptococcal Infections – Group A (Scarlet Fever, Strep Sore Throat)
Tuberculosis
Whooping Cough (Pertussis)
STANDARD PRECAUTIONS
Introductions
Hand washing
Handling of Body Fluids
Personal Hygiene
Personal Contacts
Environmental Factors
Equipment and Supplies
DIAPER CHANGING
General Information
Supplies Needed
Procedure
COMMUNICABLE DISEASES
INTRODUCTION
The widespread use of immunizations and antibiotics has tremendously reduced the incidence
of common childhood communicable diseases and infections. However, infectious diseases do
occur, and school personnel have the opportunity for early detection of the student suspected of
having a communicable disease. While school personnel may not have the medical training to
make a diagnosis of a specific disease, their judgment, based upon daily observations of the
student, enables them to detect deviations from normal health.
Student with serious communicable diseases do not always have a fever. Likewise, many
students with temperature elevations above normal (100 degrees in a normal environmental
setting, when quiet) may not have a communicable disease. Any of the following signs and
symptoms may indicate the beginning of a communicable disease:
-Temperature above 101
-Obvious rash
-Repeated episodes of vomiting or diarrhea
-Headache accompanied by fever, vomiting, or stiffness of neck
-Prolonged cough without history of asthma
Once the classroom teacher has identified a student suspected of having a communicable
disease, it is their responsibility to bring it to attention of the school nurse/administrator who
should then evaluate and contact the parent/guardian. Administrators are required to notify the
Supervisor of School Health Services, who will notify the local Department of Health
immediately by telephone of suspected cases of measles, rubella, pertussis, haemophilus
influenza, hepatitis A, diphtheria, or poliomyelitis. The Department of Health must be notified by
the next business day of recognition of any suspected conditions involving mumps, hepatitis B
and C, and chicken pox. Administrators should be aware that, in the event of a
communicable disease outbreak, the Department of Health may declare a communicable
disease emergency and initiate outbreak control measures. A communicable disease
emergency outbreak can include cases of immunizable diseases such as measles,
diphtheria, rubella (German measles), pertussis (whooping cough), poliomyelitis,
haemophilus type b flu, mumps, and chicken pox. If there is noncompliance with the
actions requested, the Department of Health may invoke quarantine powers, which could
lead to the removal of children without proper immunization documentation or with
medical/religious exemptions or, in case of a child care center, to eventual closure.
Most students recover uneventfully from communicable disease. However, there are groups of
students who are at risk for serious, sometimes fatal, complications. This includes students who
are undergoing steroid or other immunosuppressive therapy (including Chemo, or
transplantation), students with sickle cell disease or other chronic diseases those who have a
generalized malignancy (i.e., leukemia), or those who have an immunologic disorder. School
personnel who are aware of such students have the responsibility of informing the parents of
recent outbreaks of communicable diseases in order to prevent their exposure to students with
the disease. In most cases, the student is kept out of school until the outbreak is over.
1
COMMUNICABLE DISEASES
INTRODUCTION (continued)
It is inevitable students will get sick. Diseases can spread easily in schools because large
numbers of students from different families spend hours together in one place. The problem
school staff encounter involve keeping one student’s illness from spreading through the school
to the other students, their families, and staff.
Factors that contribute to the spread of disease include:
-Inadequate hand washing or use of hand sanitizer
-Large number of students in one room
-Small room size relative to the number of children
-Limited bathroom facilities
-Staff who circulate among different age groups
-Staff who work with children as well as handle food
-Failure of staff to observe good hygiene
-Failure to segregate a sick student or staff member
Additional factors to consider with early childhood populations are:
-Mixing diapered students with students not in diapers
-Failure to use good diapering practice
-Students placing objects in mouth
2
COMMUNICABLE DISEASE REFERENCE CHART
The following are general recommendations involving uncomplicated cases. Contacts without
symptoms need not stay home from school, unless so advised by their healthcare provider.
DISEASE
CHICKEN POX - Virus
INCUBATION
PERIOD
Range 14 to 16
days, sometimes as
early as 10 days, or
as late as 21 days
after contact.
MODE OF
TRANSMISSION
Direct contact with
persons with disease;
occasionally thru
airborne respiratory
secretions; contact with
fluid from lesions.
By direct oral contact or
by respiratory droplets:
spread indirectly by
hands and articles
freshly soiled by
discharges of nose and
throat of an infected
person.
By direct person to
person contact with
virus-containing
secretions (excreted in
urine, saliva, breast
milk, cervical
secretions, and semen);
mother to infant before,
during, or after birth.
Direct contact with
respiratory secretions.
COMMON COLD –
Virus
Range 12 to 72
hours, usually 48
hours
CYTOMEGALOVIRUS(CMV)-Virus
Unknown, but
appears to be 3 to
12 weeks
FIFTH DISEASE- Virus
Range 4 to 20 days
HAND, FOOT, MOUTH
DISEASE – Virus
Range 3 to 6 days
Direct contact with
respiratory secretions,
blister fluid and stool of
infected person.
HEAD LICE – Parasite
Lice can survive
only 1 to 2 days
away from the
scalp. Incubation
period of louse egg
is 6 to 10 days.
Direct head to head
contact or through any
object used by infected
person (comb, hat,
towel, clothing etc.).
3
MAY RETURN TO
SCHOOL
6 days after onset of
rash, or if all lesions are
crusted over.
Student should rest at
home if elevated
temperature, too
uncomfortable to attend
school, or repeated
sneezing and coughing.
Upon written
recommendation of the
healthcare provider.
Exclusion from school
not indicated, as they
are not contagious.
Student should rest at
home if elevated
temperature or too
uncomfortable to attend
school. Exclusion from
school is not necessary
if student has no
symptoms.
When student is nit free.
Our “No nit” policy
requires that student be
accompanied by parent
on return to
school.
COMMUNICABLE DISEASE REFERENCE CHART (CONTINUED)
DISEASE
HEPATITIS A – Virus
INCUBATION
PERIOD
Range 15 to 50
days
(average: 28 days)
HEPATITIS B – Virus
Range 45 to 160
days (average:120
days)
HEPATITIS C – Virus
Range 14 to 180
days (average: 45
days)
HERPES SIMPLEX –
Virus
Range 2 to 12 days
HIV-AIDS – Virus
Variable, ranging
from months to
years
MODE OF
TRANSMISSION
Ingestion of fecal
matter. Close personto-person contact and
ingestion of
contaminated food and
drinks.
Person to person via
sexual contacts,
contaminated IV
needles (drug use),
blood and blood
products, and mother to
baby.
Person to person via
sexual contacts,
contaminated IV
needles (drug use),
blood and blood
products, and mother to
baby.
Direct contact with virus
in saliva of infected
person; contact with
fluid from blisters;
sexual contact.
Predominantly via;
1) Sexual contact
2) Exposure to
contaminated
needles or other
sharp
instruments
(commonly drug
use);
3) Mother-to-infant
transmission
before or during
birth, or breastfeeding; and
4) Blood/blood
products.
4
MAY RETURN TO
SCHOOL
Should be excluded
from school for one
week after onset of
illness.
When symptom free and
written recommendation
from healthcare
provider.
When symptom free
and written
recommendation of
healthcare provider.
Should not be excluded
from school. When
possible, lesions that
are not yet crusted
should be covered.
Attendance permitted.
Refer to Pinellas County
School Board Policy.
COMMUNICABLE DISEASE REFERENCE CHART (CONTINUED)
INFLUENZA – Virus
Direct contact,
coughing sneezing,
hand to mouth, or
articles freshly soiled
with discharges from
nose and throat of
infected persons
Range 8 to 12
Airborne by droplet or
days
by direct contact with
nasal secretions of
infected person from 4
days before rash to 4
days after appearance
of rash.
Varies
REPORT CASES TO
SCHOOL HEALTH
SERVICES AND
SCHOOL NURSE FOR
SPECIFIC
RECOMMENDATIONS.
For Meningitis: Severity of disease and
risk of exposure differs greatly depending
on the causative agent. Risk is greatest to
those people that have close/intimate
contact.
Range 4 to 6
Contact via saliva.
weeks
Kissing increases the
risk/spread of disease
among young adults.
May also be transmitted
via blood transfusion.
5 days after onset of
symptoms or when
active signs of illness
are no longer present.
MRSA - Bacterial
Variable, as long as
lesions continue to
drain. Autoinfection
continues for the
period of nasal
colonization or
duration of active
lesions.
Direct skin-to skin
contact or contact with
shared items or
surfaces with infected
person.
MUMPS – Virus
Range 12 to 25
days(average: 16
to18 days)
Direct contact via
respiratory route.
Exclusion from school
and sport activities
should be reserved for
those with wound
drainage that cannot be
covered and contained
with a clean, dry
bandage and those who
cannot maintain good
personal hygiene.
5 days after onset of
swelling.
MEASLES-Virus
MENINGITIS –
Bacterial or Viral
MONONUCLEOSIS Virus
Range 1 to 3 days
5
7 days after onset of
rash and written
recommendation from
health care provider.
Upon written
recommendation of
healthcare provider.
Upon written
recommendation of
healthcare provider.
PINK EYE
(CONJUNCTIVITIS)Bacterial or Viral
PINWORMS –
Parasite
Bacterial: 24 to 72
hours.
Viral: 12 hours to 3
days
Incubation from egg
to worm 1 to 2
months.
Eggs become
infective within a
few hours on the
skin.
Eggs can remain
infective indoors for
2 to 3 weeks.
Contact with discharge
from eyes.
Direct transfer of eggs
from anal area to
mouth, most frequently
due to ineffective hand
washing. May also be
result of ingestion of
contaminated dirt, raw
vegetables or indirectly
from clothing and
bedding etc. Because
of their small size
pinworm eggs can
become airborne and
ingested while
breathing.
Direct skin to skin
contact with infected
humans, animals, and
objects (ex., combs,
floors, clothing, etc.)
RINGWORM- Fungus
Range 4 to 21
days
RUBELLA – Virus
German Measles
3 –day Measles
Range 12 to 23
days
Direct contact with
respiratory secretions
from infected person.
SCABIES - Parasite
Usually 2 to 6
weeks before onset
of itching
Direct personal contact
with infected untreated
person.
STAPHLOCCOCAL
INFECTIONS –
Bacteria
Variable and
undetermined
Direct contact. with
drainage from open
lesions or airborne from
a cough of infected
person.
6
Not necessary to
isolate/exclude
student.
Advise medical care.
Exclusion not required.
Encourage good hand
washing. Refer student
to healthcare provider
for treatment
No need to exclude.
Must be covered while
in school.
Exception: Ringworm
of scalp requires oral
medication and written
recommendation of
healthcare provider.
May return 7 days after
onset of rash and with
written recommendation
from health care
provider
Exclude student until
after treatment with
prescription medication.
After treatment has
started and sores are no
longer draining.
Depending on the
diagnosis return to
school may require
written recommendation
of healthcare provider.
DISEASE
STREPTOCOCCAL
INFECTIONS –
Bacteria
Scarlet fever
Strep throat
TUBERCULOSISMycobacteria
INCUBATION
PERIOD
Variable: usually 1
to 5 days
MODE OF
TRANSMISSION
Direct or indirect
contact with respiratory
or wound secretions.
MAY RETURN TO
SCHOOL
24 hours after treatment
with antibiotic with
written recommendation
of the healthcare
provider.
2 to 10 weeks for
disease
Spread by airborne
droplet from infected
people by cough,
sneeze or forcibly
exhaled air.
Upon written
recommendation of
health provider.
Close contact with an
infected person via
coughing and sneezing
(respiratory secretions)
5 days after initiation of
treatment with an
antibiotic and written
recommendation of
healthcare provider.
Note:
Positive TB skin
test may not
indicate presence
of active disease,
but does require
follow-up with
healthcare provider.
WHOOPING COUGH
(PERTUSSIS) Bacteria
Range 4 to 21 days
Average 7 to 10
days
7
CHICKEN POX
(VARICELLA, HERPES ZOSTER)
DEFINITION
A highly contagious viral disease; rarely fatal, but has been a frequent antecedent of Reye’s
syndrome.
INCUBATION PERIOD
Usually 14 to 16 days; some cases occur as early as 10 or as late as 21 days after contact.
PERIOD OF COMMUNICABIITY
Most contagious for 1 to 2 days before and shortly after the onset of the rash, and until all
lesions are dry and scabbed over.
MODE OF TRANSMISSION
From person to person by direct contact, droplet or airborne spread of secretions. Indirectly
through articles freshly soiled by discharges from vesicles and mucous membranes of infected
person.
STUDENT COMPLAINTS OR OBSERVABLE SIGNS
 Slight fever
 Malaise
 Severe itching
 Rash rapidly progresses from red spots to a pimple-like sore which open, drain and
crust over.
 Rash starts on chest, back, arms or neck.
NOTE: AVOID USE OF ASPIRIN IN CHILDREN AND ADOLESCENTS TO
PREVENT REYE’S SYNDROME.
PREVENTION AND CONTROL



Preventable with immunization. Current recommendations are for a two dose series
of varicella vaccine for persons older than 12 months of age.
Exclude from school for one week after eruption first appears or until vesicles become
dry.
Standard Precautions for all articles soiled by discharge from nose, throat or
lesions.
RETURN TO SCHOOL
May return to school 6 days after onset of rash or if all lesions/sores have crusted over.
8
SHINGLES
(ZOSTER OR HERPES ZOSTER)
DEFINITION
A virus that stays dormant in the body after a person recovers from chickenpox. For reasons
that are not fully known, the virus can reactivate years later, causing a painful rash.
MODE OF TRANSMISSION
Shingles cannot be passed from one person to another. However, the virus that causes
shingles, the varicella zoster virus, can be spread from a person with active shingles to a
person who has never had chickenpox. In such cases, the person exposed to the virus
might develop chickenpox, but they would not develop shingles. The virus is spread through
direct contact with fluid from the rash blisters.
PERIOD OF COMMUNICABILITY
A person with shingles can spread the virus when the rash is in the blister-phase. A person
is not infectious before blisters appear. Once the rash has developed crusts, the person is
no longer contagious. Shingles is less contagious that chickenpox and the risk of a person
with shingles spreading the virus is low if the rash is covered.
STUDENT COMPLAINTS OR OBSERVABLE SIGNS
Shingles usually starts as a painful rash on one side of the face or body. The rash forms
blisters that typically scab over in 1-7 days and clears up within 2-4 weeks. Before the rash
develops there is often pain, itching or tingling in the area where the rash will develop. This
may happen anywhere from 1-5 days before the rash appears.
Other symptoms of shingles can include:
 Fever
 Headache
 Chills
 Upset stomach
PREVENTION AND CONTROL
The only way to reduce the risk of developing shingles is to get vaccinated. A vaccine for
shingles is licensed for persons aged 60 years and older.
RETURN TO SCHOOL
No exclusion as long as the rash is covered with no drainage.
9
COMMON COLD
DEFINITION
Fever is common in children. Tearing, irritated nose and throat, chilliness, coughing lasting
2 to 7 days.
INCUBATION PERIOD
Between 12 to 72 hours, usually 48 hours.
MODE OF TRANSMISSION
Presumably, by direct oral contact or by droplet spread. Indirectly by hands and articles
freshly soiled by discharges of nose and throat of an infected person.
PREVENTION AND CONTROL


Avoid crowded living and sleeping quarters.
Education in hand washing, coughing or sneezing into your sleeve, and proper
disposal of used tissues.
RETURN TO SCHOOL
Student should rest at home if temperature of 101 degrees or greater, with persistent
coughing/sneezing, or too uncomfortable to attend school.
10
CYTOMEGALOVIRUS
(CMV)
DEFINITION
An infection which rarely produces symptomatic disease. The most severe form occurs from
congenital infection. Approximately 18% may result in learning disabilities, or physical
disabilities such as hearing loss. Infection later in life can cause a mononucleosis-like illness.
INCUBATION PERIOD
Unknown, but appears to be 3 to 12 weeks.
PERIOD OF COMMUNICABILITY
Virus may be excreted in urine or saliva for months or years.
MODE OF TRANSMISSION
Through intimate contact with virus-containing secretions, such as urine, saliva, breast milk,
cervical secretions and semen. Mother to infant before, during, or after birth.
STUDENT COMPLAINTS OR OBSERVABLE SIGNS




Fever
Sore throat
Swollen lymph nodes
May have no complaints or observable signs
PREVENTION AND CONTROL


Immunization – None
Standard Precautions with frequent hand washing.
RETURN TO SCHOOL
Upon written recommendation of healthcare provider.
11
FIFTH DISEASE
(SLAPPED –CHEEK DISEASE)
DEFINITION
A common disease of school children characterized by a red rash on the cheeks, followed by a
lacy rash on the arms and legs. It usually causes very little illness, although adolescents
sometimes have mild joint pain or swelling.
INCUBATION
4 to 20 days
PERIOD OF COMMUNICABILITY
Uncertain, but appears to be 1 week before rash.
MODE OF TRANSMISSION
Presumably direct contact by infected respiratory secretions.
STUDENT COMPLAINTS OR OBSERVABLE SIGNS



Brief period of elevated temperature, may include headache
Rash first appears on face and cheeks---slapped face appearance
After first day, red spots appear on extremities with lace-like appearance. Rash fades
but may recur for 1 to 3 weeks on exposure to sunlight or heat.
PREVENTION AND CONTROL




Immunization – None
Standard Precautions
Measures to control spread by infected respiratory secretions are recommended. Include
frequent hand washing and proper disposal of tissues.
Pregnant teachers and immunosuppressed students should avoid contact with infected
students. Strict hand washing after patient contact.
RETURN TO SCHOOL
Exclusion from school not indicated, as they are not contagious once rash appears.
WARNINGS
Children with blood problems, such as sickle cell disease, and those with certain cancers or on
chemotherapy can develop severe anemia, usually without a rash. Pregnant women, in contact
with an infected child between 3 days and 2 weeks before the rash, should speak with their
doctor. Blood tests to check for immunity or infection are available. Fortunately, most adults
have had exposure to Fifth Disease (parovirus) during childhood and are no longer at risk of
catching the illness.
12
HAND, FOOT AND MOUTH DISEASE
(COXSACKIEVIRUS)
DEFINITION
Most coxsackie viral infections in humans are mild but can produce a variety of illness.
INCUBATION PERIOD
Usually 3 to 6 days
PERIOD OF COMMUNICABILITY
During the acute stage of illness and perhaps longer, since these viruses persist in stool for
several weeks.
MODE OF TRANSMISSION
Direct contact with infected respiratory secretions and stool of infected persons.
STUDENT COMPLAINTS OR OBSERVABLE SIGNS





Fever
Sore throat
Oral lesions which may persist from 7 to 10 days.
These lesions also occur commonly on the palms, fingers and soles.
Occasionally, lesions appear on the buttocks.
PREVENTION AND CONTROL




Standard Precautions
Reduce person to person contact.
Frequent hand washing and cleaning of shared items.
Specific treatment – none
RETURN TO SCHOOL
Student should rest at home if elevated temperature, persistent drooling or too uncomfortable to
attend school. No exclusion is necessary if no symptoms present.
13
HEAD LICE
(PEDICULOSIS)
DEFINITION
Head lice are parasites which infest human hair, articles of clothing and upholstered furniture.
Head lice pose no great threat to the general public health but cause considerable public and
personal annoyance.
INFECTIOUS AGENT
The fertile louse lays her eggs at the base of the hair shaft, cementing each egg (nit) on the hair
shaft. After 6 to 10 day period the egg hatches, producing a nymph, which requires a blood
meal within 24 hours. The nymph undergoes a molt and after 7 to 10 days, becomes an adult
louse. In her 30 day lifetime, an adult female will produce 50 to 300 eggs.
MODE OF TRANSMISSION
Head lice cannot fly or jump, but they use hooked legs to crawl rapidly. They are not
transmitted by household pets, but can be transmitted by sharing hats, clothing and personal
items. Their presence does not indicate an “unclean” head or home.
METHODS OF CONTROL
All lice and eggs (nits) on the hair and in the environment must be destroyed. The infestation
and reinfestation cycle must be broken by destroying lice through: shampooing of hair with lice
shampoo, wash clothing and bedding in hot water and placing in dryer on hot cycle.
Non-washable household items (toys and stuff animals, etc.) must be dry cleaned, vacuumed,
or “bagged” (in well-sealed plastic bags) for a minimum of 2 weeks. Lice can survive in the
environment for 1 to 2 days. Nits hatch in 6 to 10 days but can be dormant for up to 35 days.
Pinellas County Schools has a No-Nit Policy
A No-Nit Policy calls for



The removal of all lice (including nits and egg cases) following
application of a lice-killing product.
The exclusion of a student from school until such measures have been
successfully accomplished.
Education to ensure that parent/guardian understands their
responsibilities under the No-Nit Policy. Information in hand outs and
lice letters to be sent home with student and class.
Advantages of a No-Nit Policy




Encourages home screening.
Eliminates diagnostic confusion.
Helps prevent self-re -infestation and transmission.
Reduces or eliminates the need for subsequent treatment.
14
HEAD LICE(continued)
PEDICULOSIS SCREENING PROCESS
Target Population
1. Students, who exhibit the following signs or symptoms of head lice and have suspected
infestations, as reported by their classroom teacher, should be examined by school
personnel trained in identifying an infestation of head lice.
-
Student complains of intense head itching.
Student is observed scratching head frequently.
Reddish papules or tiny bite marks may be present on the neck.
A close examination of the scalp will reveal small whitish eggs firmly attached to
hair shaft especially at the nape of the neck, above the ears, and frequently on
the crown. Although dandruff may resemble eggs, dandruff can easily be
removed from the hair. The louse egg is attached to the hair with cement
secreted by the louse and cannot easily be removed.
2. When a case of head lice is confirmed, all students who are close associates of the
infected student and infected student’s siblings should be examined by trained school
personnel. If the student changes classes during the day, a large number of potential
contacts may need to be inspected.
Process
1. All students found to have head lice should be excluded from school for treatment.
Parent/guardian should be notified by school personnel (not volunteers) to pick up the
student as soon as possible.
2. When a case of head lice is found in a classroom, lice-alert notes should go home on the
day of the exam by school personnel.
3. Parent/guardian should be provided current, accurate impartial information to assist with
the treatment process.
4. Treatment and return to school should occur in a timely manner.
5. Parent/guardian should be instructed to come into the school with their lice and nit-free
student for a re-admission check.
6. If family circumstances or financial constraints prevent compliance, the Department of
Health will provide treatment shampoo at a reasonable cost.
7. If the re-admission check shows evidence of continued infestation (visible lice and/or
nits), the parent should be instructed to take the student home and complete the removal
of all lice and nits and re-treat clothing and household items.
8. Should the re-examination reveal a few nits that were missed after treatment at home,
these can be removed and allow the student to remain in school.
9. When a student is temporarily excluded from school due to head lice infestation, the
parent/guardian should be reminded to check everyone in the family and to inform
parents/guardians of playmates who may not be students at the school. The
parent/guardian should also be advised to check the family for 2 to 3 weeks and then
regularly as part of routine home hygiene.
NOTE: Parent/guardian MUST accompany child for re-entry head check.
15
HEAD LICE (continued)
PREVENTING TRANSMISSON AT SCHOOL
1. At the beginning of school, notify parents/guardians of the school policy, reminding them
to check their students regularly and requesting that they send their students to school
lice/nits free. Parent/guardian should also be encouraged to report cases of lice in their
families to the school.
2. Students can be educated by teachers and parent/guardian not to share coats, scarves,
hats, helmets, combs, brushes, hair ribbons, head bands, pillows, ear pieces or other
personal items. Head-to-head contact should be avoided.
3. Assigned lockers are the preferred storage for outside clothing. If hooks are used for
coats, jackets and sweaters, they should be at least 12 inches apart. If crate-type
storage bins are used, students should be encouraged to place towels and clothing
inside plastic bags before putting into bins.
4. Caps, gloves and scarves should be stored in individual bags marked with the student’s
name and kept at the individual desk.
Allow students to hang their jackets on the backs of their seats.
5. School buses should be monitored to keep personal articles separated.
6. Unlike fleas, lice do not live and breed in the environment. However, it is important to
vacuum carpets daily (especially where students take naps on carpet flooring using
towels or mats), upholstered surfaces, tumbling mats, etc. for the removal of nits.
Vacuuming is always a desirable alternative to spraying. Though they usually feed
every 3 to 5 hours, lice are capable of surviving about 48 hours without a host. Nits are
capable of hatching within 6 to 10 days if the environmental temperature remains
constant.
7. In P.E. classes, changes of transmission can be lessened by any of several methods
that keep clothing separated:
 Number all clothes hooks and assign a hook to one student for each period.
 Assign lockers to one student for each period.
Note: Several students may use the same hook of locker during the day, but the
numbers of persons at risk will be narrowed to only those few students. If hooks and
lockers were used at random, the whole class would be at risk.
8. Students may be more likely to contract lice if they sit on the floor with other students, if
they share a table instead of sitting in an individual desk, and if they share headsets for
classroom activities. Headsets should be carefully checked before use and cleaned with
alcohol as needed.
9. Students who ride crowded buses and those with long hair may be more susceptible.
10. With public attention currently focused on student safety and the quality of student’s
health care, the school health program would be incomplete without addressing
pediculosis. Because of its highly communicable nature, all students are vulnerable to
local outbreaks. The negative effects they suffer range from the discomfort and social
stigma of lice to the loss of valuable class time and repeated exposure to potentially
toxic pesticidal shampoos and sprays. In turn, families and school communities are
victimized by anxiety, frustration, anger and confusion that often accompany pediculosis
outbreaks. Our message to parent/guardian must center on the importance of learning
how to diagnose and treat head lice properly and on scheduling family head checks as
part of routine home hygiene.
16
HEPATITIS A
DEFINITION
An inflammation of the liver caused by a virus usually resulting in jaundice (yellowish
skin and eyes) and, in some instance, liver enlargement.
INCUBATION PERIOD
15 to 50 days, average 28 days.
PERIOD OF COMMUNICABILITY
During the latter half of t he incubation period and continuing for a few days after onset
of jaundice.
MODE OF TRANSMISSION
Person to person via contact with stool of infected person and taken in by mouth (usually
a result of ineffective hand washing). Less often spread by swallowing food or water that
contains the virus.
RISK GROUPS
Children in daycare, people who eat raw shellfish, and travelers.
STUDENT COMPLAINTS OR OBSERVABLE SIGNS
 Fever
 Malaise
 Loss of Appetite
 Nausea
 Abdominal discomfort
 After a few days, may exhibit jaundice (skin and white of eyes turn yellow)
PREVENTION AND CONTROL
 Standard Precautions
 Hand washing is the most important preventive practice.
 Immunization with Hepatitis A Vaccine – recommended for all children at
age 1 year
RETURN TO SCHOOL
Most cases are noninfectious after the first week of jaundice. Student may return to
school upon written recommendation of healthcare provider.
17
HEPATITIS B
DEFINITION
A viral infection of the liver that can become chronic. Symptoms include loss of appetite, vague
abdominal discomfort, nausea, vomiting, and often progressing to jaundice (yellowish coloring of
skin and eyes). Mild fever may be present, but some people have the disease without
observable symptoms.
INCUBATION PERIOD
Usually: 45 to 160 days, average 120 days.
PERIOD OF COMMUNICABILITY
During the incubation period and acute stage of the disease. Some persons become chronic
carriers of the virus and may be infectious for years to life.
MODE OF TRANSMISSION
Transmission is primarily sexual and from exposure to blood and body fluids and mother to
baby.
STUDENT COMPLAINTS OR OBSERVABLE SIGNS
 Fever
 Malaise
 Loss of appetite
 Nausea
 Abdominal discomfort
 After a few days, may exhibit jaundice (skin and white of eyes turn yellow)
PREVENTION AND CONTROL
 Use of Standard Precautions is essential
 Immunization is required for students for school entrance and available for some staff
 Frequent hand washing practice is always advisable
 Since the Hepatitis B virus can live outside the body on surfaces for an indefinite time
(days), cleaning of all exposed surfaces with an EPA-approved disinfectant is
recommended.
RETURN TO SCHOOL
May return to school upon written recommendation of healthcare provider.
18
HEPATITIS C
DEFINITION
A viral inflammation of the liver.
INCUBATION PERIOD
Range of 14 to 180 days, average 45 days
PERIOD OF COMMUNICABILITY
From one or more weeks before onset of the first symptoms throughout the acute course of the
disease and indefinitely in the chronic carrier stages.
MODE OF TRANSMISSION
Exposure to contaminated blood through IV drug use, sexual contact, or mother to baby.
STUDENT COMPLAINTS OR OBSERVABLE SIGNS
 low-grade fever
 nausea or vomiting
 weight Loss
 fatigue
 joint pain or muscle pain
 headaches
 abdominal pain and cramps (right upper quadrant)
 May be followed by jaundice (yellowish coloring of skin or eyes) and dark urine.
PREVENTION AND CONTROL
 Use of Standard Precautions are essential.
 Immunization is not available at this time.
 Blood donor screening
RETURN TO SCHOOL
May return to school upon written recommendation of healthcare provider.
19
HERPES SIMPLEX
(COLD SORE, FEVER BLISTER)
DEFINITION
Viral lesions that form on the face and lips which crust and heal within a few days.
INCUBATION PERIOD
Range 2 to 12 days
PERIOD OF COMMUNICABILITY
Usually brief (3 days) until lesions crust.
MODE OF TRANSMISSION
Direct contact with virus in saliva of infected person, contact with fluid from blisters, and infected
respiratory secretions.
STUDENT COMPLAINTS OR OBSERVABLE SIGNS


Cluster of painful, 1mm to 2mm bumps or blisters on the outer lip
Often appear only on one side of the mouth
PREVENTION AND CONTROL






Use of Standard Precautions
Frequent hand washing
Personal hygiene and health education
Immunization- None available
Suggest limiting student’s contact with newborns, children with eczema, or
immunosuppressed students
Do not allow sharing of objects that are placed in mouth
RETURN TO SCHOOL
Students with herpes simplex should not be excluded from school. When possible, lesions that
are not crusted should be covered.
20
HIV/AIDS
(HUMAN IMMUODEFICIENCY VIRUSES/
ACQUIRED IMMUNEDEFICIENCY SYMDROME)
DEFINITION
HIV- The Human Immunodeficiency Virus (HIV infection). It is the virus that can lead to acquired
immune deficiency syndrome, or AIDS.
AIDS – HIV may be in the body for many years before there are signs of the illness. As HIV
weakens the immune system, symptoms may appear and other illnesses may occur. Acquired
Immune Deficiency Syndrome (AIDS) represents the most severe end of the disease spectrum.
MODE OF TRANSMISSION
HIV is mainly spread through sexual intercourse (vaginal, oral, and anal); sharing needles for
drug use, steroids, or other blood rituals with an HIV-infected person; and from HIV-infected
mothers to their infants before, during or after birth (through breast feeding).
HIV is not spread through day to day activities, such as sharing cooking/eating utensils, shaking
hands, hugging, casual kissing, toilet seats, food, pets, or mosquitoes.
INCUBATION PERIOD
The window period of time it takes a person’s body to create HIV antibodies after being infected
is approximately 6 months. A person who has been infected with HIV, but does not yet test
positive for the virus, can transmit the virus to others.
The incubation period refers to the length of time between becoming infected with the virus and
being diagnosed with AIDS. It is variable, ranging from months to years. A person can be
infected with HIV for many years before any signs of illness develop.
PERIOD OF COMMUNICABILITY
From the time of infection with the HIV virus
STUDENT COMPLAINTS OR OBSERVABLE SIGNS
The signs and symptoms may vary from asymptomatic to severe. 2 or more signs/symptoms
need to be present in adolescents and children.
-fever
-loss of appetite/failure to thrive
-weight loss
-chronic fatigue
-skin rashes
-swollen lymph glands
-night sweats
-hepatitis
-recurrent upper respiratory tract infections
-chronic /recurrent diarrhea
-recurrent bacterial and viral infections
PREVENTION AND CONTROL
 use of Standard Precautions
 abstinence from drug use and sex
 safe sex- latex condoms during each and every sexual encounter (vaginal, oral or anal)
RETURN TO SCHOOL
Student may not be excluded due to diagnosis of HIV/AIDS School personnel are to maintain
strict confidentiality. See Pinellas County School Board Policy
11/11
21
IMPETIGO
(SAND SORES)
DEFINITION
Bacterial infection which causes skin lesions/sores which begin as small blisters which break
and form yellow crusts.
INCUBATION PERIOD
Variable: range is commonly 1 to 10 days.
PERIOD OF COMMUNICABIITY
While sores are draining.
MODE OF TRANSMISSION
Spread by direct contact with drainage from open sores or nasal secretions.
STUDENT COMPLAINTS OR OBSERVABLE SIGNS
 Onset of small red skin blisters.
 Pustules form, open and discharge fluid, which forms crusts.
 Multiple lesions/sores are common. These can rapidly spread to other areas of the body.
 May complain of itching
PREVENTION AND CONTROL
 Use of Standard Precautions
 Regular personal hygiene.
 Refer to healthcare provider for antibiotic treatment
RETURN TO SCHOOL
May return 24 hours after treatment with topical or oral antibiotics. Areas with lesions/sores
should be covered (band aid) during school hours.
22
INFLUENZA
DEFINITION
This is an acute viral disease of the respiratory system with seasonal patterns in the winter
months most common.
INCUBATION PERIOD
Usually 1 to 3 days.
PERIOD OF COMMUNICABILITY
From 1 day before symptoms to 7 days after symptoms
MODE OF TRANSMISSION
Spread through air by coughing, sneezing, hand to mouth or nose discharge of infected
persons.
STUDENT COMPLAINTS OR OBSERVABLE SIGNS
 stuffy nose, sore throat, cough
 muscle pain, headache, fatigue
 fever- It is important to note that not everyone with the flu will have a fever.
 nausea, vomiting, diarrhea
NOTE: AVOID USE OF ASPIRIN IN CHILDREN AND ADOLESCENTS TO
PREVENT REYE’S SYNDROME.
PREVENTION AND CONTROL
 Use of Standard Precautions.
 Immunization is recommended for people of all ages.
 Recommend measures to control spread of droplet infections-coughing, sneezing, and
proper disposal of tissues.
 Recommend frequent hand washing.
RETURN TO SCHOOL
May return 5 days after onset of symptoms or when active signs of illness are no longer present.
If fever was present, at least 24 hours after fever is gone.
23
MEASLES
(RED MEASLES, RUBEOLA)
DEFINITION
An acute, highly communicable viral disease
INCUBATION PERIOD
Symptoms usually begin 8 to 12 days after exposure to the virus.
PERIOD OF COMMUNICABILITY
From 4 days before the beginning of cold symptoms until 4 days after appearance of the rash.
MODE OF TRANSMISSION
Spread by airborne droplet infection and direct contact with nasal or throat secretions of
infected persons.
STUDENT COMPLAINTS OR OBSERVABLE SIGNS
 3-4 days of red eyes, runny nose, fever and cough before the rash begins.
 Pronounced blotchy red rash starting on the face and spreading downward
over the entire body. Rash can last from 3 to 7 days.
 White specks (Koplik’s spots) on the buccal mucosa of the mouth. Especially near the
molars.
PREVENTION AND CONTROL
 Required immunization given after the age of one year, with booster before kindergarten.
 Older children or adults may receive a booster dose at any age.
 When a case of measles is reported, contact Pinellas County Schools Health Services
Supervisor for further instructions.
RETURN TO SCHOOL
7 days after onset of rash with written recommendation of healthcare provider.
24
MENINGITIS
(BACTERIAL or VIRAL)
DEFINITION
Inflammation of the meninges that may be caused by either a virus (rarely a serious disease) or
bacteria (more serious).
VIRAL MENINGITIS
DEFINITION
A relatively common, but rarely serious, form of meningitis. Viral meningitis no longer requires
reporting to the Department of Health.
INCUBATION PERIOD/ PERIOD OF COMMUNICABILITY
Vary with specific viral causative agent
MODE OF TRANSMISSION
Most commonly spread by respiratory secretions of person with a recent viral infection.
STUDENT COMPLAINT OR OBSERVABLE SIGNS
Early symptoms are very similar to the more serious bacterial form of meningitis, and include:
 abrupt onset with fever, chills, headache
 light sensitivity
 may have back or neck stiffness
PREVENTION AND CONTROL
 No immunization available for viral form of meningitis
 Use of Standard Precautions
 Avoid sharing food, drink, utensils and cigarettes.
RETURN TO SCHOOL
Upon written recommendation of healthcare provider.
BACTERIAL MENINGITIS
DEFINITION
Meningococcal meningitis is an acute bacterial disease. It requires early diagnosis and prompt,
aggressive antibiotic treatment in the individual in order to prevent serious complications and
possible death.
INCUBATION PERIOD
Varies from 2 to10 days, commonly 3 to4-days.
PERIOD OF COMMUNICABILITY
Until meningoccocci bacteria are no longer present in discharges from nose and mouth, usually
within 24 hours after appropriate treatment started.
25
BACTERIAL MENINGITIS (continued)
MODES OF TRANSMISSION
By direct contact, including respiratory secretions, saliva, and discharges from nose and throat
of infected persons. Healthy carriers may also be the source of infection.
STUDENT COMPLAINT OR OBSERVABLE SIGNS
 Abrupt onset with fever, chills, headache, back or neck stiffness and vomiting, quickly
followed by changes in alertness, consciousness or orientation to person, place, or time.
 Extreme irritability and agitation.
 Seizures may occur.
 Neck stiffness may be marked.
PREVENTION AND CONTROL
 Use of Standard Precautions
 Vaccine against invasive meningococcal disease is recommended for children aged 2 –
11 years of age for certain high-risk groups and for all persons aged 11 years and older.
 Avoid sharing food, drinks, utensils, cigarettes, etc.
 Household and intimate contacts of the infected person may be at higher risk of
exposure to develop the disease.
 Contact Pinellas County Schools Health Services supervisor with any
reported/suspected cases of Bacterial Meningitis for investigation and further
directions.
RETURN TO SCHOOL
Upon written recommendation of healthcare provider.
26
MONONUCLEOSIS
(KISSING DISEASE)
DEFINITION
A viral infection most commonly caused by the Epstein-Barr virus.Ninety percent (90%) of the
people who have mononucleosis are asymptomatic. In children, it is generally mild and difficult
to recognize.
INCUBATION PERIOD
Range: 4 to 6 weeks.
PERIOD OF COMMUNICABILITY
Indeterminate: prolonged as communicability may exist for a year or more after the infection.
MODE OF TRANSMISSION
Virus is spread from person to person via saliva. Kissing and sharing drinks, utensils, etc.
increases the spread of disease.
STUDENT COMPLAINT OR OBSERVABLE SIGNS
 fatigue
 sore throat
 fever
 nasal congestion
 enlarged lymph nodes
 A skin rash may occur, especially in young children and those taking ampicillin.
PREVENTION AND CONTROL
 Use Standard Precautions
 Immunization – None available
 Education regarding transmission
 Sanitary disposal of articles soiled with nose and throat discharges
 Medical evaluation of symptoms
 Report to school personnel.
RETURN TO SCHOOL
Upon written recommendation of healthcare provider. Return to active physical activity should
also be under recommendation of healthcare provider.
27
MRSA
(METHICILLIN-RESISTANT STAPHYLOCOCCUS AUREUS)
DEFINITION
A bacterial skin infection, which must be treated with appropriate antibiotics.
INCUBATION PERIOD
Variable and indefinite
PERIOD OF COMMUNICABILITY
As long as wounds/lesions continue to drain.
MODE OF TRANSMISSION
Direct skin- to- skin contact with draining lesion or contact with shared items or surfaces with
infected person.
STUDENT COMPLAINTS OR OBSERVABLE SIGNS
Skin infections or sores which may be red, swollen, painful, and/or have pus or other drainage.
PREVENTION AND CONTROL
 Use of Standard Precautions
 Wash hands frequently and thoroughly with soap and water.
 Antibiotic therapy as prescribed by healthcare provider.
 Clean all surfaces and equipment used by infected person with 1:10 bleach solution (1
part bleach and 9 parts water that would be 1 2/3 cups of chlorine bleach in 1 gallon of
water) daily.
 Keep sores clean and covered and dry at all times until healed.
 Do not share personal items like towels, washcloths, clothing or sports equipment.
 Avoid contact with wounds or soiled bandages.
RETURN TO SCHOOL
Student may return to school after being treated by a healthcare provider.
Wounds must be covered and have no drainage through bandage.
28
MUMPS
(PAROTITIS)
DEFINITION
An acute viral disease characterized by fever and swelling and tenderness of one or more
salivary/parotid glands.
INCUBATION PERIOD
Range 12 to 25 days with an average of 16 to 18 days.
PERIOD OF COMMUNICABILITY
Usually 1-2 days, but has been reported to be as long as 7 days before swelling appears and
until 9 days after.
MODE OF TRANSMISSION
Virus is spread by direct contact with airborne or droplets of respiratory secretions or saliva.
STUDENT COMPLAINTS OR OBSERVABLE SIGNS
 Swollen tender salivary/parotid gland, in front of the ear and crossing the corner of the
jaw under the chin.
 Pain increased by jaw movement- such as eating, chewing, talking
 Fever (over 100 Fahrenheit)
PREVENTION AND CONTROL
 Use of Standard Precautions
 Immunization with single vaccine or combination vaccine with rubella and measles
(MMR) after 1 year of age- 2nd dose prior to kindergarten (older children and adults are
recommended to receive a 2nd dose at any age).
 Report to Pinellas County Schools Health Services supervisor for further investigation
and directions.
RETURN TO SCHOOL
May return to school 5 days after onset of swelling.
29
PINK EYE
(CONJUNCTIVITIS)
DEFINITION
An acute, highly-contagious infection of one or both eyes. May be a viral or bacterial infection.
INCUBATION PERIOD
Bacterial: 24-72 hours
Viral: 12 hours to 3 days
PERIOD OF COMMUNICABILITY
During course of active infection.
MODE OF TRANSMISSION
Contact with discharges from the conjunctivae or upper-respiratory tract of infected person.
STUDENT COMPLAINTS OR OBSERVABLE SIGNS
 Redness of the white part of the eye
 Redness of eyelids
 White or yellow discharge
 Crusting at corners of the eye and along eyelashes
 Sensitivity to light
PREVENTION AND CONTROL
 Use of Standard precautions.
 Immunization - none
 Good and frequent hand washing practices.
 Discourage sharing eye make-up and applicators.
RETURN TO SCHOOL
Infected students should be allowed to remain in school once indicated therapy is implemented,
except when viral or bacterial conjunctivitis is accompanied by systemic signs of illness.
30
PINWORMS
DEFINITION
A very common, but not serious, parasitic infection.
INCUBATION PERIOD
Life cycle requires 2-6 weeks to be completed. Symptomatic disease usually evident some
months after initial exposure. Egg to worm 1 to 2 months. Eggs become infective within a few
hours on the skin. Eggs can remain infective indoors for 2 to 3 weeks.
PERIOD OF COMMUNICABILITY
As long as gravid females are discharging eggs on perianal skin, usually about 2-6 weeks.
MODE OF TRAMSMISSIONS
Direct transfer of eggs from anal area to mouth, most frequently due to ineffective hand washing
or ingestion of infested dirt. Indirectly through clothing, bedding, or food contaminated with eggs
or parasite.
STUDENT COMPLAINTS OR OBSERVABLE SIGNS
 The child may awaken during the night complaining of itching around the anal area.
 The itching causes scratching which contaminates the hands with eggs, especially under
finger nails.
 Females may develop irritation around the vulva or vagina.
PREVENTION AND CONTROL
 Refer to healthcare provider for treatment. Frequently, all household members are
treated.
 Education in personal hygiene and particularly in proper hand washing techniques after
toileting and before eating.
RETURN TO SCHOOL
Does not require exclusion from school.
31
RINGWORM
DEFINTION
It is a contagious disease of the hair, nails and skin.
INCUBATION PERIOD
Range: 4 to 21 days
PERIOD OF COMMUNICABILITY
As long as active lesions/sores are present.
MODE OF TRANSMISSION
Skin contact with infected humans, animals, and objects (combs, floors, clothing, etc.)
STUDENT COMPLAINTS OR OBSERVABLE SIGNS
 Ring-shaped pink patch with scaly, raised border.
 Ring slowly increases in size.
 May be mildly itchy.
 Cracking of the skin, especially between the toes.
PREVENTION AND CONTROL
 See healthcare provider for treatment
 Education regarding personal hygiene and general cleanliness in showers, dressing
rooms, and other common areas.
 Treatment may be topical or oral route- specific drugs for fungal infections
RETURN TO SCHOOL
No need to exclude. Affected area should be covered (band aid) during school hours.
EXCEPTION: Ringworm of the scalp requires oral medication, therefore written
recommendation of the healthcare provider is required for return to school.
32
RUBELLA
(GERMAN MEASLES, 3 DAY MEASLES)
DEFINITION
A mild, febrile viral infection characterized by rash, swollen glands, and slight fever
INCUBATION PERIOD
Range: 12 to 23 days
PERIOD OF COMMUNICABILITY
One week before and at least 5 to 7 days after onset of rash.
MODE OF TRANSMISSION
Virus is spread by contact with nose and throat secretions or by direct contact with articles
freshly soiled. Highly contagious.
STUDENT COMPLAINTS OR OBSERVABLE SIGNS
 Widespread pink-red spots usually starting on face and spreading down to cover body
within 24 hours, not lasting more than 3 days.
 Enlarged lymph nodes at base of neck and/or behind ears (appears 5-10 days before
rash begins)
 Mild fever
 May complain of sore throat; no cough.
PREVENTION AND CONTROL
 Use Standard precautions
 Immunization required- 2 MMRs after the age of 12 months and before entry to
kindergarten.
 Avoid exposure of susceptible pregnant women and immunosuppressed children to
infected individuals. School staff of childbearing age should be immunized to prevent
the risk of congenital rubella damage to their own unborn children.
 Report to Pinellas County Schools Health Services supervisor for investigation and
directions.
RETURN TO SCHOOL
May return 7 days after onset of rash and with written recommendation of from healthcare
provider.
33
SCABIES
(ITCH MITES)
DEFINITION
An infectious disease caused by a mite that burrows under the skin. Highly contagious.
INCUBATION PERIOD
Usually 2 to 6 weeks before the onset of itching. Persons with previous infestations develop
symptoms 1 to 4 days after re-exposure.
MODE OF TRANSMISSION
Direct, prolonged, skin to skin contact with a person who is infested.
STUDENT COMPLAINTS OR OBSERVABLE SIGNS
 Intense itching usually becomes unbearable at night.
 Small red, raised lesions with associated tunnels.
 Found in folds of the skin: between fingers, waist line, and groin region.
PREVENTION AND CONTROL
 Students with reddened, itching skin should be sent to the health room area for
inspection.
 Because scabies is highly contagious, it is recommended that gloves be worn by school
personnel when touching the skin, followed by thorough hand washing.
 Advise student to be seen by healthcare provider for diagnosis and treatment.
 Exclude infested individual from school until treated
 Wash down classroom and clinic area that may have been touched by the student with a
disinfectant; vacuum carpeted areas; wash towels and clothing used by infected person
in hot water.
RETURN TO SCHOOL
Once treated by prescribed medication (usually one day) and with written recommendation of
healthcare provider.
34
STAPHYLOCOCCUS INFECTIONS
DEFINITION
Bacteria commonly carried on the skin or in the nose of healthy people. Staph bacteria can
cause infections which can be minor (pimple) or serious (see MRSA).
INCUBATION PERIOD
Variable and undetermined
PERIOD OF COMMUNICABILITY
Variable depending on the infection.
MODE OF TRANSMISSION
Direct contact with drainage from lesions or airborne from a cough of infected person.
STUDENT COMPLAINTS OR OBSERVABLE SIGNS
Skin infections or sores which may be red, swollen, painful and/or have pus or other drainage.
See MRSA information for severe infections.
PREVENTION AND CONTROL
 Cover wound
 Standard precautions
 Good hand washing technique
 Do not share personal items
 See healthcare provider for treatment. Antibiotic therapy may be required
RETURN TO SCHOOL
After treatment has started and sores are no longer draining. Depending on the diagnosis
return to school may require written recommendation.
35
STREPTOCOCAL INFECTIONS – GROUP A
(SCARLET FEVER, STREP SORE THROAT)
DEFINITION
A variety of acute communicable diseases.
INCUBATION PERIOD
Variable: Usually 1 to 5 days.
PERIOD OF COMMUNICABILITY
10-21 days without adequate antibiotic treatment; only 24 hours with antibiotic treatment
MODE OF TRANSMISSION
Results from direct or intimate contact with patient’s or carrier’s respiratory secretions. Indirect
contact through objects or hands is rare.
STUDENT’S COMPLAINTS OR OBSERVABLE SIGNS
 Abrupt onset of high fever, increased pulse rate, vomiting, headache, and chills.
 Tonsils become enlarged, reddened, and covered with white patches. Tongue may have
appearance of strawberry skin.
 Rash may appear within 12 hours.
 Severe and sudden sore throat without coughing, sneezing or other cold symptoms.
PREVENTION AND CONTROL
 Use of Standard Precautions.
 Isolation and exclusion of students with a rash, pending diagnosis.
RETURN TO SCHOOL
After 24 hours of antibiotic treatment begins and written recommendation from healthcare
provider.
36
TUBERCULOSIS
(TB)
DEFINITION
Pulmonary tuberculosis is an infectious disease of the lungs.
INCUBATION PERIOD
2 to 10 weeks for disease.
PERIOD OF COMMUNICABILITY
If untreated, as long as the infectious tubercle bacilli are being discharged.
MODE OF TRANSMISSION
Spread by airborne droplet produced when infected people cough, sneeze or forcibly exhale.
STUDENT COMPLAINTS OR OBSERVABLE SIGNS
 Positive skin test does not represent presence of disease, but does require follow-up
with healthcare provider.
 May include cough, pain and tightness in the chest, fever, loss of appetite with weight
loss.
PREVENTION AND CONTROL
 Use of Standard Precautions
 Notify Pinellas County Schools Health Services supervisor for investigation and
directions.
RETURN TO SCHOOL
Only with approval of Department of Health and upon written recommendation of healthcare
provider.
37
PERTUSSIS
(WHOOPING COUGH)
DEFINITION
This is an acute bacterial infection of the respiratory tract. Whooping cough is characterized by
a prolonged period of respiratory symptoms progressing to prolonged episodes of coughing that
end with a “whooping ” sound, which may be followed by vomiting.
INCUBATION PERIOD
4 to 21 days, usually 7-10 days.
PERIOD OF COMMUNICABILITY
From 6 days after exposure to 3 weeks after onset of respiratory symptoms.
MODE OF TRANSMISSION
Close contact with an infected person via coughing, sneezing, respiratory secretions.
STUDENT COMPLAINTS OR OBSERVABLE SIGNS
 Begins with symptoms of upper respiratory infection.
 Persistent dry hacking cough that becomes more severe, especially at night.
 Characteristic series of short rapid coughs often followed by high-pitched whoop and
vomiting.
PREVENTION AND CONTROL
 Use of Standard Precautions
 Required immunization- completed 4-5 doses of DPT/DTaP prior to entering
kindergarten, with booster of Tdap before entering 7th grade.
 Education regarding the effectiveness of early immunization (DTaP.)
 Wash thoroughly all articles soiled with discharges from nose and throat of infected
individuals.
 Antibiotics can shorten the period of communicability but not length or severity of illness.
 Notify Pinellas County Schools Health Services supervisor for investigation of any
possible cases.
RETURN TO SCHOOL
Upon the written recommendation of the healthcare provider 5 days after beginning antibiotic
therapy.
38
STANDARD PRECAUTIONS
INTRODUCTION
People who work in the educational setting encounter a wide variety of illnesses daily. The
common cold, flu, chickenpox, and many other contagious diseases are spread from person to
person routinely. Bloodborne pathogens, especially those which cause HIV (Human
Immunodeficiency Virus) and HBV (Hepatitis B) present an additional health risk to school
district employees.
This covers some of the facts concerning bloodborne diseases which can be used to help
protect employees against contracting them in the workplace. By exercising the proper
precautions against infection, the risk to an employee’s health is minimal.
WHAT ARE BLOODBORNE PATHOGENS?
Bloodborne pathogens are disease-carrying microorganisms which are present in human blood
or other body fluids which can cause several serious diseases such as:
 HIV/AIDS
 HBV/Hepatitis B
 Hepatitis C
WHAT SHOULD I KNOW ABOUT THESE DISEASES?
 HIV/AIDS attacks the body’s immune system, thereby allowing infections to invade the
body.
 HBV is much more easily transmitted than HIV, because it is a stronger and more
concentrated virus
 HIV and HBV are transmitted through direct contact with blood or other body fluids.
 The usual routes of entry are by mucous membranes, broken skin or puncture by an
infected object.
 They cannot be spread by casual contact (i.e. sharing of work space, using same tools,
telephones, or rest rooms)
 They cannot be spread by hugging, touching, or shaking the hand of an infected
individual
WHAT IS THE RISK OF WORKPLACE EXPOSURE?
Contact with the blood or body fluids of another individual presents the greatest risk of
exposure. “Exposure Incidents” occur when the mucous membranes or broken skin of an
individual come in contact with the blood of another. The chances of being infected with
bloodborne diseases in the educational workplace are small if proper precautions are taken.
WHAT PRECAUTIONS SHOULD I TAKE?
Use STANDARD PRECAUTIONS – handle all blood and other body fluids as if they were
infected.
Components of Universal Precautions include:
1. Personal protective equipment e.g. gloves
2. Frequent hand washing using disinfectant soap or antiseptic towelettes.
3. Decontamination- clean contaminated surfaces with 1:10 bleach solution
4. Waste Disposal- dispose of contaminated waste properly.
HAND WASHING IS THE MOST EFFECTIVE WAY TO REDUCE THE SPREAD OF DISEASE
39
HAND WASHING
HAND WASHING IS CONSIDERED ONE OF THE MOST EFFECTIVE
INFECTION CONTROL METHODS.
When to wash your hands?






Before and after contact with wounds- even though you wear
gloves
Before and after procedures
Before giving medicine
Between contact with all patients (students and staff)
Before eating
After toileting
How to Wash your hands










Wet hands thoroughly by holding them under running water.
Hold your hands lower than your elbows so that the water
flows from arms to fingertips.
Use warm water.
Apply soap to hands.
Use firm, rubbing, circular movements.
Wash palm, back and wrist of each hand
Interface fingers and thumbs and move hands back and forth for 10-15
seconds.
Good hand washing should take about 15 seconds- about the time it takes to
sing “Happy Birthday to You”.
Dry hands and arms thoroughly with paper towels.
Turn off water using paper towels to prevent picking up bacteria from the
handles.
40
HANDLING OF BODY FLUIDS
PURPOSE
In order to prevent transmission of infectious agents, such as HIV, Hepatitis B, staph, CMV, etc,
personnel must consider ALL blood, blood products, and body fluids potentially infectious.
Potentially infectious body fluids include: vomit, oral secretions, sputum, urine, feces, wound
drainage, mucus.
EQUIPMENT (As needed)
1. Disposable gloves
2. Masks
3. Paper gowns- moisture resistant
4. Eye protection
5. Puncture-resistant containers
6. Impermeable bags
7. Disinfectant
PROCEDURE
1. Gloves must be worn whenever blood or other body fluids are handled.
2. Paper gowns, masks and/or eye protection will be worn for procedures that may
involve splashing or spraying of body fluids.
3. Hands will be washed thoroughly after removing gloves and immediately after
contact with ANY body fluid. When running water is unavailable, hands should be
washed with a waterless hand wash, e.g. (62% alcohol-based hand sanitizer), followed
by soap and water ASAP.
4. Vomit will be cleaned up by HPO following their procedure. Gloves are
supplied for this. Any disinfecting by the nurse will be done with disinfectant solution.
5. Disposable needles and syringes will be placed in a puncture-resistant sharps container
or use disintegrators after use. DO NOT RE-CAP, BEND OR CUT NEEDLES.
6. Potentially-infected waste must be placed in plastic bags and covered
containers, securely tied prior to disposal.
7. For assistance with sharps containers call: Gerry Lees at 547-7100.
PERSONAL HYGIENE
1. Hand washing is the keystone of good hygiene.
a. Facilities should be readily available to the classroom.
b. Soap should be in a dispenser. When classroom facilities are not available
62% alcohol-based waterless hand sanitizer should be used.
c. Hands should be washed between handling children, before eating and handling
food and after handling items which have been soiled.
2. Take special care of cuts, burns, or breaks in the skin. Gloves should be worn if
these are present.
3. Use disposable paper towels to dry hands and turn off faucets.
PERSONAL CONTACTS
1. Kissing and mouth-to-mouth sharing of food, toys and learning aids should be
discouraged.
2. Each student should have his/her own personal toiletry items such as toothbrush, comb,
rest-mat, dishes and utensils. Disposable eating items are preferred.
41
ENVIRONMENTAL FACTORS
1. Changing tables should have a washable surface and be sanitized with 1:10 bleach
solution between students. Disposable examining table paper should also be used.
2. All surfaces involved in food handling should be sanitized at least one time per day, with
1:10 bleach solution.
3. The use of disposable non-sterile gloves is required when contact with
blood, other body fluids (vomit, urine, feces), mucous membranes, or handling
items or surface soiled with body fluids is anticipated. Double gloving is
recommended if a large amount of blood is present. Gloves should be changed
after contact with each student.
4. Toys, learning materials, musical instruments, equipment, etc, should be washed daily
with 1:10 bleach solution ( 1 tbsp. chlorine bleach in 1 quart of water), and thoroughly
rinsed after exposure to saliva (through mouthing toys or drooling).
5. Tiled floors that are contaminated with body fluids should be wet
mopped/scrubbed immediately. If Blood, please see HPO procedure.
6. Carpeting contaminated with body fluids should be shampooed immediately.
7. When appropriate, maintain a change of clothing for each child and change
the child’s clothing if it has become soiled by vomit, excrement, nasal
secretions or extensive drooling.
Employees are encouraged to keep a change of clothes available. Areas of skin where
body fluids have soaked through, clothing needs to be washed thoroughly with soap and
water ASAP.
8. Require plastic pants or long pants for children with diarrhea. Current guidelines state
that a student who has more than 2 episodes of diarrhea at school should be sent home
early.
9. Diapers, cleaning rags/towels, gauze pads and other materials that are soiled should be
discarded in closed plastic bags, stored in bio-hazard storage area, and properly
disposed.
10. Hands must be washed thoroughly after removing gloves and immediately after contact
with any body fluid. When running water is unavailable, hands should be washed with a
waterless hand cleaner (e.g. Cal Stat) followed by soap and water scrub ASAP.
EQUIPMENT AND SUPPLIES
1. A dishwasher should be used to sterilize dishes with water temperature between
120-140 degrees.
2. A washer and dryer should be available for soiled clothes and cleaning materials. Clothes
soiled with body secretions should be laundered separately. Gloves should be used
when handling laundry.
3. Use disposable items when possible (e.g. latex gloves, dishes and utensils, paper towels,
examining table paper, face masks).
4. Use washable mats and rugs.
5. Have an approved disinfectant solution available.
Compliance with these Standard Precautions is the responsibility of all PCSB employees.
Failure to implement these guidelines in everyday work situations may result in
disciplinary action.
RESOURCE: PCSB Risk Management Department
42
DIAPER CHANGING
GENERAL INFORMATION
1. There should be an area separate from each classroom designated for diaper changes.
This diaper area could be partitioned from the rest of the classroom or be a separate
room, such as the bathroom with a changing table. A sink is recommended in the diaper
changing area. No other activities, such as feedings, play, or therapy, should be
conducted in this area.
2. It is recommended that the sink used for hand washing after diaper changes or toileting
not be the same sink that contains food items such as dishes, wash cloths or water
drinking fountains. If only one sink is available to a classroom, all dishes should be
collected in a plastic dishpan and carried to the central kitchen for cleaning in an
automatic dishwasher.
3. It is highly recommended that the person designated to change a student’s diapers not
be the same person involved in any feeding activities of other students. If this cannot
occur, close attention to good hand washing is essential.
4. It is the responsibility of the school staff to promote good skin care, including regular
diaper changes, while the student is at school.
5. If the student is able, he/she should be encouraged to assist in gathering supplies,
carrying the clean diaper or helping with the removal of the diaper. If the student assists
with any part of the diaper changing, he/she must wash his/her hands before and after
the procedure. Any assistance by the student will enhance his/her self-esteem, make the
procedure less embarrassing and aid in progress towards personal care independence.
6. All students should was their hands after toileting.
7. All diapers should be checked every two (2) hours, and BM changes should occur
immediately to prevent skin irritations. There could be circumstances when this schedule
would be altered due to field trips and other activities. A reasonable alternative plan
should be developed for these special occasions. It is suggested that students in diapers
have toilet logs.
SUPPLIES NEEDED
1.
2.
3.
4.
5.
6.
7.
Clean diaper
Towelettes, or wet, soapy paper towel
Toilet paper
Small plastic bag
Table, paper and disinfectant
Gloves
Step-on covered trash can with plastic bag liner
43
DIAPER CHANGING (continued)
PROCEDURE
1. Wash hands.
2. Assemble supplies and place clean paper on changing table.
3. Assist or take student to changing area or bathroom.
4. Place student on changing table. DO NOT LEAVE STUDENT UNATTENDED
5. Be sensitive to the fact that some students are uncomfortable with the height of the table
or embarrassed by the procedure.
6. Put on gloves.
7. Remove soiled or wet diaper and immediately place in plastic bag and then in trash can.
8. Do not place a wet or soiled diaper on the table, floor, or sink.
9. Remove loose BM with toilet paper. Wash the skin of the genital area gently with
antiseptic towelettes, soapy water, or wet paper towels.
10. Dry the area well. Over-the-counter diaper creams, lotions, or powders need a
physician’s order.
11. Apply a clean diaper
12. Remove gloves and dispose of in trash can.
13. Secure outer clothes
14. Assist student off the changing table. DO NOT LEAVE STUDENT IN BATHROOM OR
CHANGING AREA ALONE.
15. Wash hands of child and self.
16. Clean table with 1:10 bleach solution.
17. Return supplies to designated areas, and put clean table paper in place.
44