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NURSING SERVICES

HEALTH AND SAFETY PROTOCOLS

PURPOSE The health and safety of our students, staff, and community is a priority. This document describes the procedures the district will follow to maximize the educational and health benefit for students and to mitigate the risk of transmission of the SARS-CoV-2 virus in our schools and our community. As the community epidemiology of the disease changes, adjustments to these policies may change. Symptom Monitoring- Staff and students are urged to self-monitor for symptoms by using the Symptom Check-List (below) before coming to school each day and throughout the school day. Conducting regular screening for symptoms and ongoing self-monitoring can help reduce the transmission of communicable diseases. Social Distancing is an important tool to decrease the spread of COVID-19. Social Distancing or Physical Distancing means keeping space between yourself and other people outside of your home.

• Floor and seating markers at entries and communal spaces • 6 feet spacing markers strategically placed throughout buildings as reminders • Limit non-essential visitors in buildings • Monitor arrival and dismissal to discourage congregating • Choose activities that limit the use of shared equipment and close contact with

other students or staff • Discontinue in-person activities that involve gathering large groups of people

together or that do not allow for social distancing • Limit the total number of students, teachers, and staff within a space, to ensure 6

feet distance can be maintained when individuals will be stationary • Ensure 6 feet distancing in outdoor activities • Arrange or block off furniture so individuals are separated by 6 feet distance from

one another • Minimize opportunities for prolonged exposure (15 minutes or more within 6 feet

distance) between students, staff, and visitors in congregate spaces • Placement of physical barriers at reception areas • Designate areas as one-way, by posting directional signs • Designate entrance and exit doors, if possible, to reduce the chance of face to

face contact when entering and/or exiting a room • Maintain small cohort groups of students and teachers who stay together as

much as possible during the day, and from day to day • Limit mixing between cohort groups as much as possible • Hold physical education outside whenever possible

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Cloth Face Coverings-scientific evidence suggests that wearing face coverings help reduce the spread of COVID-19, especially when the wearer has the virus without symptoms. Cloth face coverings are NOT personal protective equipment (PPE). The use of cloth face coverings provides a barrier between the wearer’s mouth and nose and another individual’s face.

• Educate students and staff on the proper use of cloth face coverings • All students, staff, visitors wear cloth face coverings when they are on buses,

inside school buildings, and anywhere on school grounds • All students, staff, visitors wear cloth face coverings when they are or may be

within 6 feet distance from another individual o Unless it is a family member o When eating o When engaged in strenuous activity o Or are able to maintain 6 feet distance

• Cloth face coverings should not be placed on: o Anyone who is unconscious or who is having trouble breathing o Anyone who would be unable to remove the mask without assistance o Anyone who cannot tolerate the face covering because of developmental,

medical, or behavioral health needs • Provide disposable face coverings for students, staff, or visitors who do not have

a face covering when they arrive at school • Build in time throughout the day when students and staff can take short breaks

from wearing cloth face coverings at times and in settings where risk of transmission is lower

o Outside o When windows can be opened

CDC Guidance It is not known if face shields provide any benefit as source control to protect others from the spray of respiratory particles. CDC does not recommend use of face shields for normal everyday activities or as a substitute for cloth face coverings. Some people may choose to use a face shield when sustained close contact with other people is expected. If face shields are used without a mask, they should wrap around the sides of the wearer’s face and extend to below the chin. Disposable face shields should only be worn for a single use. Reusable face shields should be cleaned and disinfected after each use. Plastic face shields for newborns and infants are NOT recommended.

Masks with Exhalation Valves or Vents The purpose of masks is to keep respiratory droplets from reaching others to aid with source control. Masks with one-way valves or vents allow exhaled air to be expelled out through holes in the material. This can allow exhaled respiratory droplets to reach others and potentially spread the COVID-19 virus. Therefore, CDC does not recommend using masks if they have an exhalation valve or vent.

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SICK DAY GUIDELINES Any student or staff member who is not well MUST stay home. When a student or staff member becomes ill during the school day they will be assessed for symptoms, and sent home immediately. The student should be evaluated by their health care provider. A. Any of the below symptoms require absence:

• Fever ≥ 100.4° F• Chills• Sore throat• Cough• Congestion/Runny Nose• Trouble Breathing/Shortness of Breath• Headache• Fatigue• Muscle/Body Aches• Loss of Sense of Smell/Taste• Diarrhea• Nausea/Vomiting

RETURNING TO SCHOOL Any student or staff member who was absent or sent home related to an illness must be assessed by Nursing Services prior return. A. Requirements for Return to School After Illness if not tested for COVID-19:

• 10 days have passed since the first symptoms began and• 24 hours fever free without the use of fever reducing medications and• Improvement in related symptoms or• If the student’s health care provider determines there is an alternative diagnosis

to COVID-19 causing their symptoms, the student may be allowed back to schoolbefore 10 days and without a negative test as long as the following criteria aremet:

o Symptoms have resolved and they have not had a fever in 24 hourswithout the use of fever reducing medication and

o They present a note from their health care provider stating their symptomsare not related to COVID-19

B. Requirements for Return to School after illness and Testing for COVID-19was done:

• Must remain in home isolation until test results are received• Negative test results and fever free for 24 hours without the use of fever

reducing medication and• Symptoms are improving

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C. Requirements for Return to School After testing positive for COVID-19: • Clearance from the Public Health Department and • At least 10 days have passed since first symptoms began or their positive test,

whichever is earlier and • Fever free for 24 hours without using a fever reducing medication and • Improvement in symptoms

D. Requirements for Return to School After having known close, prolonged contact with an individual or family member who has tested positive for COVID-19:

• Self-quarantine for 14 days after your last exposure with the positive individual • Watch for symptoms and check your temperature twice a day (contact Health

Care provider if symptoms occur) • May return after 14 days have passed without symptoms • A NEGATIVE COVID-19 TEST RESULT WHEN ASYMPTOMATIC DOES NOT

END A 14-DAY QUARANTINE E. Requirements for Return to School After having traveled outside Alaska

within the past 14 days: • Two Negative test results taken 7-14 days apart or • 14-day self-quarantine after return

Definitions: • Isolation separates sick people with a contagious disease from people who are not sick. For COVID-19, an isolation period is 10 days. • Quarantine separates and restricts the movements of people who were exposed to a contagious disease to see if they become sick. Because COVID-19 can take from 2-14 days to incubate, or to grow enough virus to become contagious, a quarantine period for COVID-19 is 14 days from last exposure. STUDENTS WITH UNDERLYING HEALTH CONDITIONS Students and staff who have serious underlying health conditions should be identified. Based on the most current information, these individuals may be at higher risk for severe illness from COVID-19. A. Students with underlying health conditions must have an Individualized

Health Care Plan (IHCP): • Collaborate with student, parent/guardian/health care provider • Develop an individualized plan related to the student’s underlying health

condition • Include interventions to protect and/or minimize the risk of exposure to

Coronavirus • Add a “health alert” to the student’s record so other staff are aware of the plan

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B. Students with underlying health conditions that also have an IndividualizedEducation Plan (IEP) or 504 Plan:

• Contact Special Education staff in your school to add infection controlinterventions to the plan

• Contact counselor to amend the 504 plan to add infection control interventions tothe plan

• When student has an underlying health condition that puts them at risk toCOVID-19 and does not have a 504 plan, submit a 504 referral to the counseloror principal

PROTECTING VULNERABLE INDIVIDUALS Individuals who are considered high risk for severe illness related to COVID-19 include:

• Those who are 65 years of age or older• Have high-risk health conditions Chronic lung disease or moderate to severe asthma Heart disease Compromised immune system Severe obesity Other underlying conditions, especially if not well controlled (diabetes,

renal failure, liver disease)

SCHOOL SUPPORT Decreasing the risk of exposure to Coronavirus, as well as other infectious diseases, requires support from the entire school community. A. Everyone MUST stay home and/or go home when sick

• See Sick Day GuidelinesB. Support when student/staff need to go home

• Every effort should be made to get sick individuals out of the health office as soon as possible

• Having multiple sick students in the health office increases the risk to well students who need to come the office for routine encounters (meds, glucose checks, minor injuries)

C. Support to exclude vaccine non-compliant students:• It is more important than ever to enforce school vaccine laws• Vaccines protect students and staff from viruses/diseases that might otherwise

be life-threatening to those individuals who are unable to be vaccinated.• Families should contact their healthcare provider to schedule an appointment

to have their children immunized• Families can also contact their local pharmacy to check on vaccine availability

D. Update parent contact information• Schools must be able to contact parent/guardian if student needs to go home

E. Monitor absences and report reasons• Documenting the reason will enable Nursing Services to follow-up with families

to adhere to the Return to School Guidelines• Spikes in illnesses must be reported to Public Health

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F. Decreasing health office congestion limits potential exposure of multiple students:• Not all student complaints require a trip to the health office (paper cuts, chapped

lips, minor abrasions, etc.). See Strategies to Keep Students in the Classroom.• Call the health office before sending a student. Only one student can be seen at

a time and there cannot be more than one student waiting outside the office.

Cleaning and Hygiene-Washing hands with soap and water for 20 seconds, or using hand sanitizer when soap and water is not available, reduces the spread of disease.

A. Adequate supplies of soap, hand sanitizer, paper towels and tissues will beavailable

B. Teaching and reinforcing handwashing and the safe use of hand sanitizerC. Monitoring to ensure hand hygiene practices among students and staff

• Supervise the use of hand sanitizer by students• Reinforce handwashing

o Before, during, and after food preparationo Before eatingo After using the toileto After blowing your nose, coughing, or sneezingo After touching objects that have been handled by other individuals

D. Hand sanitizer will be provided:• At every building entrance and exit• In the cafeteria• In every classroom

o Hand hygiene supplies are periodically checked and refilled as neededE. Encourage good respiratory etiquette

• Cough and sneeze in elbow• Cough and sneeze in a tissue (used tissue thrown away and hands washed

immediately afterwards)F. Handwashing and sanitation breaks will be incorporated into daily schedulesG. Time will be allowed between activities for proper cleaning and disinfection of

high-touch surfacesH. Routine environmental cleaning schedules are establishedI. Sharing of supplies will be limitedJ. Classroom materials will be disinfected between usesK. Upholstered furniture or other soft items that cannot be easily cleaned will be

removed from classrooms

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ALL NON-NURSING RELATED ITEMS SHOULD BE REMOVED FROM THE HEALTH OFFICE This reduces the traffic in the health office and potential transmission of disease to healthy individuals:

• Food• Winter Gear• Staff Medication (staff responsible for having their own over the counter

medications)

FIRST AID First aid situations, to the degree possible, should be handled by the student and in the classroom to prevent office congregation and possible cross exposure. The following recommendations are made:

• All classrooms are stocked with first aid supplies.• Nursing Services staff are always available for support via phone or can make

classroom visits if needed.• To the extent possible, students provide self-care with staff direction and physical

distancing.• Teachers should provide a mask to students in the classroom who report not

feeling well before sending to health office• Students are triaged over the phone, only those sent with valid health concerns

are sent for additional treatment to the health office• See the chart below for guidance on when to send students to the office or keep in

the classroom:

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GUIDELINES FOR SENDING STUDENTS TO THE HEALTH OFFICE

Teachers may contact Nursing Service staff located in the building prior to sending a student to the office if uncertain or need guidance about student care. Students should be evaluated before coming to the health office. If students or staff arrive at the office, those feeling ill with potential COVID-19 symptoms should immediately be relocated to an isolation area so the health office is not potentially contaminated, requiring terminal cleaning before being used again.

Health Office Visit Consider Classroom-Based First Aid/Health Services

Symptoms of COVID-19 This is not the entire list of potential symptoms but are the major symptoms being reported by health care professionals at this time:

• Appears feverish • Chills • Coughing • Difficulty Breathing • New rash • Vomiting • Diarrhea • Abdominal pain

Minor toothache/primary (baby) tooth comes out

Scheduled medications Small paper cuts, abrasions, “picked” scabs

Tooth Injury (chipped, cracked, adult tooth comes out)

Ice pack for small bumps and bruises

Scheduled specialized nursing procedures:

• Diabetic care • Catheterization • G-tube feeding

Readily controlled nose bleeds (if lasts longer than 5 minutes call Nursing Services staff)

Altered levels of consciousness Localized bug bites (do not cause unusual swelling along with difficulty breathing)

Difficulty breathing Minor headache or fatigue Head injury/complaining of neck pain (DO NOT move student, stay calm)

Mild stomach ache or nausea (without vomiting)

Sudden vision impairment Severe abdominal pain Seizure (follow first aid for seizures) Unusual rash, swollen red eyes, hands

Exposure to known allergen

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PREPARING, EVALUATING, MONITORING SYMPTOMATIC STUDENTS & SICK SPACE A. If it is determined a student needs additional support nursing services staff should be

notified prior to sending the student to the health office. B. For a person who is not coughing or sneezing, did not undergo an aerosolized

generating medical procedure (AGP), and occupied the room for a short period of time, any risk to health care personnel and subsequent patients likely dissipates over a matter of minutes. In addition to ensuring sufficient time for enough air changes to remove potentially infectious particles, healthcare personnel should clean and disinfect environmental surfaces and shared equipment before the room is used for another student.

C. Ideally, the school should designate three areas for managing student health needs: • General Waiting

o Unscheduled needs o Waiting to be evaluated

• Well Students o Scheduled procedures or medication

• Students with COVID-19 Symptoms (Isolation)

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General Waiting Well Students Symptomatic Students

Students with non-COVID-19 symptoms

Well students with healthcare needs that cannot be addressed in the classroom

Isolation areas for students with COVID-19 symptoms

Physical Distancing Marked Off

Physical Distancing Marked Off

Physical Distancing Marked Off

• Ask if they have been near someone with COVID-19

• Ask if they have traveled outside Alaska (within the past 14 days)

IF YES, SEND TO ISOLATION AREA AND SEND HOME

• Ask if they have been near someone with COVID-19

• Ask if they have traveled outside Alaska (within the past 14 days)

IF YES, SEND TO ISOLATION AREA AND SEND HOME

• An area away from others

• When separate rooms are not available for individual sick students make sure the room can accommodate at least 6ft physical distance between students

Staff must wear appropriate PPE when triaging students

Nursing Services staff provide care and will wear appropriate PPE while delivering care

• Additional non-nursing services staff may be necessary to monitor student areas not visible by Nursing Services staff

• Staff must wear appropriate PPE while monitoring sick students

• Students wash or sanitize hands on entry

• Students wash or sanitize hands on entry

• Students wash or sanitize hands on entry

• Surgical mask placed on student

• High touch surfaces

cleaned and disinfected after each student

• High touch surfaces cleaned and disinfected after each student

• Terminally clean after sick student(s) has left the room

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OUTBREAK RESPONSE An outbreak status will be determined by school district administration, in cooperation with local public health and medical advisors on a case by case basis. A. Staff and parents should be encouraged to share information

• Awaiting test results • Positive test results • Close contact with a positive individual

B. District facilities should keep visitor logs and classroom logs and staff are encouraged to keep a log of everyone they have been in close contact with for an extended period of time • Used as a way to identify individuals who may have been in close contact with an

individual who tested positive C. When a positive case is identified in a district facility local public health, community

medical advisors, and district administration will collaborate to determine the district response • Determine if exposures have occurred in the facility • Inform close contacts to quarantine for 14 days beginning the day of their last

contact with the positive individual and monitor symptoms • Follow cleaning/disinfection protocols

D. Reasons part of a school, an entire school, feeder schools, or the entire district may temporarily go to remote learning

• Transmission of the virus within the school is greater than that of the community

• A school is the source of the outbreak • Absenteeism should be monitored

E. Any two or more individuals in a facility with similar illness should be reported to designated COVID-19 point of contact in the building

Definitions: • Epidemic refers to an increase, often sudden, in the number of cases of a disease

above what is normally expected in that population in that area. • Outbreak carries the same definition of epidemic, but is often used for a more

limited geographic area. • Cluster refers to an aggregation of cases grouped in place and time that are

suspected to be greater than the number expected, even though the expected number may not be known.

• Pandemic refers to an epidemic that has spread over several countries or continents, usually affecting a large number of people.

NURSING SERVICES PROTOCOL FOR MANAGING SICK STUDENTS

- ISOLATION ROOM MUST BE TERMINALLY CLEANED/DISINFECTED AFTER EACH STUDENT LEAVES- HEALTH OFFICE FLAT CONTACT/HIGH TOUCH SURFACES AND EQUIPMENT USED MUST BE CLEANED/DISINFECTED

AFTER EACH STUDENT ENCOUNTER

- DOCUMENT ALL STUDENT ENCOUNTERS IN CAREDOX- USE COVID-SUSPECTED FOR REASON FOR VISIT AND ADD SPECIFIC SYMPTOMS THE STUDENT IS PRESENTING

WITH THAT MAKE YOU SUSPECT COVID (COVID SUSPECTED, COUGH, CONGESTION, RASH, ETC.)

Symptomatic Student

- Fever >100F/Chills- Cough- Shortness of Breath or

Difficulty Breathing- Sore Throat- Congestion/Runny Nose- Fatigue- Muscle/Body Aches- Headache- Loss of taste or smell- Nausea/Vomiting- Abdominal Pain- Diarrhea- Skin lesions/rash

Isolate from others until

parent/guardian pick up

Recommend contact with Healthcare

provider

YES

Usual Assessment

Protocols

NO

Health Care Provider

Documentation of Chronic Condition Causing

Symptoms?

No Fever?

Back to Class

Home isolation for 10 days from

onset of symptoms AND 24 hours

fever free without the use of

fever-reducing medication and symptoms are getting better

Health Care Provider

Documentation of Chronic Condition

Causing Symptoms?

NO DIAGNOSIS OF COVID-19

Negative COVID-19 test

results

OR

OR

- USE SURGICAL MASK, EYE PROTECTION, AND GLOVES IF INDICATED, WHEN ASSESSING STUDENTS

- AVOID FACE TO FACE CONTACT IF POSSIBLE- DEFER INSPECTION OF MOUTH/THROAT AND TAKE

TEMPERATURE WITH NON-CONTACT THERMOMETER TO AVOID INDUCING COUGHING

- FACE SHIELDS AND MASKS ARE NOT INTERCHANGEABLE

STUDENT MUST GO

HOME

Notify Principal and Director of Nursing Services

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NURSING SERVICES PROTOCOL FOR MANAGAING SICK STUDENTS

- Daily at home screening for symptoms of COVID-19 is expected to be done by parents before sending their student to school. - Sick Students should not be sent to school.- When a Student Becomes Sick at School they will be assessed by the Nursing Services staff or a designated staff member will use triage guidelines to

determine if the student needs to be sent home.

Green NO Community Transmission Yellow Red

PROTOCOLS WILL CHANGE DEPENDING ON THE OPERATIONAL ZONE THE FAIRBANKS NORTH STAR BOROUGH SCHOOL DISTRICT IS IN

Student found to have any of the following:

- Fever at or above 100.4 degrees F- Vomiting- Diarrhea- Undiagnosed, new and/or untreated skin

condition- Other symptoms of COVID-19

Nurse Assessment in Separate Assessment/Isolation Room Students No Longer in School Buildings

Contact your child's doctor's office with any concerns of

COVID-19

Student found to have any of the following COVID-19 symptoms:

Student will be isolated and sent home from school and may return to school:- If the student has a negative COVID-19 test, they may return to school

once it has been 24 hours since they had a fever (without the use of fever-reducing medication) AND symptoms are improving.

- If the student does not get a COVID-19 test or if their test is positive, they must stay home from school for a minimum of 10 days. They may return when 10 days have passed, they have not had a fever in 24 hours (without the use off ever-reducing medication), AND symptoms are improving.

- Students and staff who test positive for COVID-19 must stay home for a minimum of 10 days, even f they are asymptomatic.

Nurse Assessment in Separate Assessment Isolation Room

Student will be isolated and sent home from school and may return to school: When it has

been 24 hours since they had a fever (without the use of fever-reducing medication) AND

their symptoms are improving.

- Students with symptoms that are not new and are associated with a chronic medical problem should have documentation their healthcare provider that verifies the symptom(s) is related to a non-COVID-19 chronic medical condition. Students will not be excluded from in-person school for that symptom as long as it has not worsened and they have no new symptoms. Any new or worsening symptoms associated with COVID-19 should be regarded as possible COVID-19.

- Fever/Chills- Cough- Shortness of

Breath/Difficulty Breathing- Farigue- New Muscle/Body Aches- Abdominal Pain

- Headache- Runny Nose/Congestion- Sore Throat- Nausea/Vomiting- Diarrhea- New Loss of Taste or Smell- New Rash