SECTION M--Control of Communicable Diseases
CLARK COUNTY SCHOOL DISTRICT
SECTION M CONTENTS
SECTION M - CONTROL OF COMMUNICABLE DISEASES
M-1 Universal Precautions – Guidelines for Handling Body Fluids in Schools
M-2 Handwashing Techniques – Guidelines for Wearing and Removing Gloves
M-3 Communicable and Infectious Diseases
M-5 Health Information From The School Nurse Regarding Communicable Diseases
M-6 Pediculosis/Head Lice – Screening Referral Procedures
M-8 HIV/AIDS General Information
M-9 Role of the School Nurse in Working with Students with HIV/AIDS
M-11 Student to Student Exposure Procedure
M-13 Student to Student Exposure, Parent/Guardian Notification Guidelines
M-14 Student to Employee Exposure Procedure
M-15 Student to Employee Exposure, Procedure for Reporting Post-Exposure to Bloodborne Pathogens
M-17 Guidelines for Care of Employee Exposure Incidents
M-18 Tuberculosis (Detailed procedure for TB screening is located in Section G)
GUIDELINES FOR HANDLING BODY FLUIDS
IN THE SCHOOLS
Education of children with contagious or infectious diseases in the regular school setting has raised several questions regarding the exposure of staff and students to potentially infectious body fluids:
* Does contact with body fluids present a risk of infection?
* What should be done to avoid contact with potentially infected body fluids?
* What should be done if direct contact with body fluids is made?
* How should such fluids be removed from the environment when spilled?
The Contagious and Infectious Disease Procedure Manual, CCF-650, provides
guidelines meant to provide simple and effective precautions against transmission of disease for all persons potentially exposed to the blood or body fluids of any student. No distinction is made between body fluids from students with known disease or those from students without symptoms or with an undiagnosed disease. Every health office must maintain a copy of the Contagious and Infectious Disease Procedure Manual and the Exposure Control Manual for reference.
Does contact with body fluids present a risk?
The body fluids of all persons should be considered to contain potentially infectious agents (wide varieties of germs). The term body fluids includes: blood, semen/vaginal secretions, drainage from secretions (e.g., nasal discharge), and saliva. Contact with body fluids presents a risk of infection from a variety of germs. In general, the risk is very low and dependent on many factors including the type of fluid with which contact is made and the type of contact made with it. However, all body fluids are to be treated as though they are infectious, so that protective practices are always in place (universal precautions). This action ensures protection for all persons at all times. Hand washing and the use of gloves are important components of Universal Precautions procedures.
HAND WASHING TECHNIQUES
In the health office, the most important safety precaution involves frequent hand washing. This is the single most important means of preventing the spread of infection. (Reference Contagious and Infectious Disease Procedures Manual, CCF-650 and the Exposure Control Manual.
- Hands must be washed between contact with each student
- The use of bar soap should be discouraged. Pump soap is best
- Clean under fingernails
- Scrub hands by sudsing and using friction for at least 15 seconds
- Rinse hands under running water
- Dry hands well with paper towels and use paper towel to turn water off
- Apply lotion, if available
GUIDELINES FOR WEARING AND REMOVING GLOVES
Gloves should be worn to avoid skin contact with blood, blood-soiled items, body fluids, excretions, as well as surfaces, materials, and objects exposed to them.
Gloves should be used only once, then discarded after each contact and before leaving the contaminated area. Proper hand washing techniques should be used after removing gloves. Wearing gloves does not replace hand washing.
REMOVAL OF GLOVES
If one glove is used, with two fingers of the opposite hand, grab the glove at the wrist level, touching only the inside of the glove, and pull slowly over and off the hand. If two gloves are used, with two fingers of the opposite hand, grab the glove and pull slowly over and off the hand. Then slip the middle fingers of the free hand under the remaining glove, touching only the inside of the glove, and slowly peel off the glove. The gloves should be placed immediately in a plastic-lined container.
COMMUNICABLE AND INFECTIOUS DISEASES
To prevent the spread of communicable and infectious diseases in the school setting, a student suspected of having a communicable and/or infectious disease must be suspended from school until the period of communicability has passed or until appropriate treatment has been obtained. This is mandated by the Clark County School District Regulation 5150, refer to the Contagious and Infectious Disease Procedures manual, CCF-650. This manual is in all schools and must be accessible to all staff.
All suspected cases of communicable and infectious diseases must be reported to the school nurse. He/she will take appropriate action. For a description of contagious and infectious diseases, refer to the First Aid/Emergency Guidelines for Handling Accidents and Illnesses Occurring at School, CCF-648 or Control of Communicable Diseases in Man. The communicable disease wall chart is available as a reference for all schools and should be prominently displayed in the health office.
If the condition appears suspicious, the parent/guardian must be notified. In some cases, prompt notification to the school nurse will also need to occur. If indicated, the school nurse will initiate a medical referral. There are Health Services (HS) forms dealing with a variety of communicable and infectious diseases that are available for distribution to parent/guardians. The school nurse will determine if the FASA can distribute these forms. Distribution is guided by the Clark County Health District and Health Services Department.
The school nurse may initiate a Student Health Suspension, CCF-662/Spanish. A copy of this form should be maintained in the FASA Notebook in the Communicable Disease section. The school administrator/designee is to be notified if a Student Health Suspension, is issued. The FASA may not independently initiate a health suspension.
If it is not possible for the parent/guardian to come for their child, the student may remain at school, isolated from other students. The attendance officer may be used to assist with transportation once appropriate supervision has been established. The student may return to school once the school nurse determines that the student is no longer communicable, under appropriate medical treatment or no longer considered contagious by his/her licensed health care provider. Written documentation may be required.
The school nurse is responsible for following up on all communicable and infectious diseases to ensure that students do not remain out of school for a prolonged time and that appropriate care has been obtained. It is the FASA’s responsibility to keep the school nurse informed of students who are absent frequently or who are out of school for a prolonged time.
The school nurse is required to ensure that confirmed cases of those communicable and infectious diseases identified for mandated reporting are reported to the Clark County Health District (CCHD). The FASA is responsible to report communicable diseases noted on the Reportable Diseases of Nevada, to the Health District on a case-by-case basis. These diseases are reportable to the CCHD. See Exhibit M-b. The school nurse serves as a resource to school personnel for all cases of suspected or confirmed cases of communicable or infectious diseases. The school nurse may consult with the CCHD epidemiology nurse as needed.
Role of the FASA
FASAs, under the supervision of the school nurse, are also required to record communicable diseases on the Communicable Disease Worksheet, HS-6, Exhibit M-a. FASA’s may record both confirmed and/or suspected cases on the worksheet. They should note under comments “confirmed, suspected, or reported by parent”. CCHD has recommended that the Chicken Pox Letter, HS-18, be sent home to all students in a class where there is a confirmed case of chicken pox. This is recorded on the Communicable Disease worksheet maintained in the FASA Notebook.
HEALTH INFORMATION FROM THE SCHOOL NURSE REGARDING
SUSPECTED COMMUNICABLE DISEASES
A variety of informational letters from the school nurse are available to share with parent/guardians. These letters were developed jointly with the Clark County Health District (CCHD) and reflect Clark County School District (CCSD) policy as it aligns with the recommendations of the CCHD.
The health information is intended to provide general information to parent/guardians regarding policy and procedures, however any individualized/specific information from a student’s licensed health care provider will always be considered to be the primary document to guide procedures for that student, unless conflicts exist which might affect the health and safety of that or any other students. The school nurse will work with the licensed health care provider, as well as the CCSD Health Services’ Medical Consultant to resolve these issues. Every attempt will be made to resolve any questions in a timely manner to avoid loss of instructional days. Informational letters are available on the School Nurse Interact site under HS Forms.
Role of the FASA:
Under the direction of the school nurse, the FASA may be requested to provide health information letters to the parent or guardian. These informational letters are HS forms, and are not posted on the FASA Interact site. They can be obtained from the school nurse site.
Head lice is probably one of the most challenging and frustrating problems in schools today. School personnel are often called on to respond to suspected cases of head lice. Instruction will be provided by the school nurse to educate school personnel about the signs/symptoms of infestation and Health Services’ procedures. Although head lice is a nuisance, it is not an emergency. It is an infestation which must be treated at home. School personnel are able to
respond to suspected cases of head lice by notifying their school nurse or FASA. The school nurse may want to refer to Head Lice: Detection, Treatment, and Prevention, Exhibit M-c.
If there is a question or evidence of lice head lice, school personnel are to contact the school nurse and/or FASA. Under the direction of the school nurse, the FASA and/or office personnel are to:
- Notify parent/guardian.
- Send the Head Lice Treatment Suspension Notice, CCF-647/Spanish home with the infested student. Note: suspended students may be allowed to ride the bus home when alternative methods of transportation (e.g., parent, attendance officer), have been exhausted.
- Send home the Checklist for Getting Rid of Head Lice, HS-61, (English/Spanish), with the infested student(s). Optional: send home Head Lice-The Facts, HS-62.
- Notify school nurse of infested student(s).
- Send Head Lice Notice to Parents/Guardians, CCF-646/Spanish, to parents/guardians of each classmate in the affected classroom. Notification at the middle school and high school level may vary depending upon circumstances.
- Maintain the Head Lice Worksheet, HS-63, in the FASA notebook. If nits are seen, but no live lice are evident, contact the school nurse for further direction.
The student does not have to be “nit free” to return to school initially; however, repeated infestation must be brought to the attention of the school nurse. A “no nit” policy will be implemented by the school nurse after the second infestation within the school year. The Checklist For Students Experiencing A Second Head Lice Infestation, HS-86, is
required to be completed by the school nurse and FASA for the second lice infestation in the school year.
Students should return to school within two (2) days. Information regarding treatment must be provided by the parent/guardian at the time of return. Notification of required second treatments should be confirmed by a telephone call to the FASA or School Nurse after completion. The school nurse or FASA is to recheck the infested student upon return and one (1) week later for new nits. Note: Students with problematic cases may need to be checked daily to ensure eradication. Instruct the parent/guardian to follow the manufacturer’s recommendations for treatment and follow-up treatment if required.
The school nurse or FASA is not required to check the entire classroom unless there are two or more cases identified in the same classroom or if repeated cases within the same classroom occur. The custodial staff should be instructed to vacuum the classroom.
The school nurse or FASA will check siblings, close friends and other students with recent close contact (e.g., sleep overs) who attend the school. The school nurse team may be called on to assist the site school nurse if extraordinary circumstances exist (multiple classes/entire school requiring screening). When additional cases are identified, information should be recorded on the Head Lice Worksheet, HS-63 and the same procedures followed.
Students should not be absent for more than two days when suspended for treatment. If the student is absent for more than two days, the FASA should notify the school nurse. At this point, the school nurse should contact the parent/guardian regarding the reason for the extended absence and offer assistance. The school nurse may confer with the site administrator to formulate a plan for meeting with the parent/guardian, if the student does not return. The school nurse should contact Health Services if additional assistance is required.
Record all screenings and referrals on the Head Lice Worksheet, HS-63 maintained in the FASA notebook. This information will be used to compile information for the school nurse monthly report. The school nurse must be kept apprised of students with recurrent lice infestations or sensitive situations.
HEAD LICE TREATMENTS
There are many effective over-the-counter shampoos, cream rinses and lice egg looseners that a parent/guardian can get for treatment of head lice. On occasion, a parent/guardian may choose to get a prescription for a head lice treatment from their licensed health care provider. The school nurse may assist in locating purchase sources for the products.
ALTERNATIVE HEAD LICE TREATMENTS
Parents/guardians may choose to use alternative treatments such as mayonnaise, Vaseline and Olive Oil. Olive Oil, mayonnaise and Vaseline are smothering agents. Olive Oil is the best smothering agent as it has been laboratory tested and found to be effective in killing lice. Olive Oil has few, if any, allergic properties and is relatively inexpensive. Smothering lice is a safe and effective treatment if done properly. (Information taken from http://www.headliceinfo.com/). The procedures for each of the treatments are listed in the FASA Handbook in Chapter 9.
WHAT IS HIV?
HIV is the name of the virus which causes AIDS. HIV stands for Human Immunodeficiency Virus. The virus may lie dormant in the body for many years before any signs or symptoms of the disease occur.
WHAT IS AIDS?
AIDS is a disease which breaks down a part of the immune system leaving the person vulnerable to a variety of unusual and life-threatening illnesses. AIDS is the end result of HIV infection. An AIDS diagnosis is given when an individual meets certain medical criteria. This is usually in the advanced stages of HIV infection. AIDS stands for Acquired Immunodeficiency Syndrome.
The transmission of HIV in the school setting poses little risk. The virus is not spread by casual contact. The virus can be transmitted through the exchange of body fluids such as semen, vaginal secretions or blood; through the sharing of contaminated needles; from an infected pregnant woman to her unborn child during or shortly after birth; and through receiving contaminated blood products.
The CCSD considers the body fluids of all persons as potentially infectious. Body fluids include, but are not limited to, blood, semen/vaginal secretions, drainage from secretions and saliva. The practice of universal precautions is strictly adhered to by all school personnel.
HIV/AIDS IN THE SCHOOL SETTING
It is the intent of the CCSD to provide its students with an education consistent with the laws of the State of Nevada. As a general rule, a student with health problems should be allowed to attend school in a general education classroom with written approval of the student’s primary health care provider. In the case of an infectious or communicable disease, the District’s responsibility is to consider the risk of transmission to others as well as the safety of the infected student. The school nurse and FASA play an important role in ensuring a safe environment for all students. The Director of Health Services must be made aware of all cases of HIV/Aids in the school setting. Refer to page M-8 and to the CCF-650 for a detailed procedure.
THE ROLE OF THE SCHOOL NURSE IN
WORKING WITH STUDENTS WITH HIV/AIDS
NRS 441A.190 Control of Disease within schools, child care facilities, medical facilities, and correctional facilities clearly describes required reporting procedures. Refer to the Contagious and Infectious Disease Procedures Manual, CCF-650. While confidentiality is essential, designated school personnel knowledgeable about the presence of HIV in the school must inform the superintendent’s designee, who will in turn notify the Clark County Health District of this information. The superintendent’s designee is the only person with whom this information can be shared without parent/guardian permission. The Superintendent’s designee for students is the Director of Health Services. Likewise, the health authority of a student entering or attending the CCSD with HIV must inform the superintendent’s designee of this information.
After the initial disclosure, the superintendent’s designee must keep all information confidential unless permission from the parent/guardian and student (if of legal age) is obtained. The decision to disclose is the parent/guardian’s and student’s right. If initial disclosure is to the FASA, he/she is to follow the above procedures and inform the person
disclosing that he/she is required, under regulation NRS 441A.190, to report the information to the superintendent’s designee. Immediately inform the parent/guardian that all information will remain confidential unless permission to disclose is obtained. At this point, the superintendent’s designee becomes the parent/guardian/student contact. If there is a medical “need to know”, the superintendent’s designee will work with the parent/guardian and primary care provider to ensure appropriate disclosure to school staff. The school nurse will manage disclosure procedures in conjunction with the parent/guardian/student, Director of Health Services and/or the site administrator, as needed.
ROLE OF THE SCHOOL NURSE WITH STUDENTS WITH HIV/AIDS
- Determine the need for staff education and/or notification regarding areas of medical concern via medical alerts/health care plans. Dependent upon disclosure allowance, the school nurse will provide educational offerings to any staff with a need to know and oversee the management of the student’s health care needs while at school. Th school nurse will ensure that a mechanism is in place for parent/guardian notification of communicable diseases within the classroom and/or school if appropriate.
- Practice universal precautions for all students and staff to ensure that all staff have received training in this area.
- Maintain confidentiality of the student’s health status and health records.
- Maintain a safe and clean environment in the health office.
- Be familiar with the Contagious and Infectious Disease Procedures Manual, CCF-650.
- Be knowledgeable about HIV/AIDS, risk of transmission, confidentiality and health care needs of all students.
The superintendent’s designee for the Clark County School District is the Director of Health Services.
STUDENT TO STUDENT
Refer to the Contagious and Infectious Disease Procedures Manual, CCF-650, the section labeled “Body Fluid Guidelines”, regarding any exposure to potentially infectious body fluid or the Exposure Control Plan. This plan maybe downloaded from Exposure Control Plan. There must be a current copy in the health office.
BODILY FLUID EXPOSURE – DEFINITIONS
- Exposure incident is defined as a specific exposure to the eye, mouth, other mucous membrane, or non-intact skin, to blood or other potentially infectious materials by punctures, human bites and abrasions.
- The body fluids of all persons should be considered to contain potentially infectious agents. The term body fluids includes blood, semen/vaginal secretions, drainage from secretions (e.g., nasal discharge) and saliva.
- No distinction is made between body fluids from students with a known disease or those from students without symptoms or with an undiagnosed disease.
FIRST AID FOR DIRECT SKIN CONTACT
- Hands and other affected skin areas should be routinely washed with soap and water immediately after direct contact has ceased. Note: The area of the body which came in contact with the body fluid should be carefully examined to see if there is a break in the skin. If there is no true exposure, no further action is necessary.
- Laundry contaminated with blood or other potentially infectious materials will be handled as little as possible and with a minimum of agitation. CCSD utilizes Universal Precautions in the handling of all soiled laundry (i.e. all laundry is assumed to be contaminated).*
- Contaminated clothing is to be removed, bagged using universal precautions and sent home with the student.
- Adhere to the regular cleaning schedule, referenced in the Exposure Control Plan, using the appropriate CCSD procedure.
1. An on-site school representative should attempt to notify the parent/guardian by phone.
2. The Notification of Possible Infectious Contact letter, CCF-635 and CCF-635.1 should be sent to parent/ guardian after phone contact is made. A copy of the parent/guardian letter should be provided to the nurse. Details of the exposure should be documented on the health card by the nurse.
3. For a true exposure, notify the school nurse by phone that an incident has occurred and parent/guardian contact has been made.
4. Advise the parent/guardian to seek medical advice concerning evaluation of possible infectious exposure.
5. Maintain information regarding all conversations with the parent/guardian.
6. If the parent/guardian or physician of the exposed person (e.g., the student who was bitten) requests lab testing or health information on the source person (e.g., the biter);
- Do not initially release any information to either party.
- Notify the site administrator and Risk Management.
- CCSD may offer to act as a messenger between the two parties.
7. Possible school nurse follow-up:
- Suggest that the physician or parent/guardian write a letter to CCSD. The letter should contain the name of the exposed person and the nature of the request (e.g., an inquiry regarding the health status of the source person).
- If lab testing of the source person is requested by the parent/guardian or physician of the exposed person, the exposed person may want to consider offering to pay for it and should so state in the letter.
- Forward the letter to the family of the source person (e.g., the biter), with a letter stating they have the option of complying with and/or contacting the family or physician of the exposed person. Note: Unless the exposure occurred as a result of gross negligence by a school district employee, CCSD is under no legal obligation to intervene.
1. Complete an Exposure Incident Investigation Form, CCF-640.
2. Be sure to include date and time exposure occurred.
3. Complete a Notification of Possible Infectious Contact, CCF-635/Spanish.
4. Disposition of forms: originals are sent to Risk Management; copies should be confidentially maintained at the school and Health Services.
5. Documentation of information regarding exposure is recorded on the health card by the school nurse.
NOTE: DO NOT COMPLETE AN ACCIDENT REPORT
NOTIFICATION OF HEALTH SERVICES AND RISK MANAGEMENT
1. All student to student true body fluid exposures should be reported to Health Services and the Risk Management Department, using the Exposure Incident Investigation Form.
2. Notification of the Health Services Department should be made by phone as soon as possible after the incident.
STUDENT TO STUDENT EXPOSURE
When a student sustains a true exposure to a potentially infectious body fluid, the school should make every attempt to notify the parent/guardian prior to sending the parent/guardian letter.
The following script may be helpful in facilitating the phone conversation:
1. Describe the incident and what you did. Example: “Kris was trying to help another student who had a nosebleed. Some of the blood got on Kris’ hand. We washed her hands with soap and water and found a fresh cut on the same hand.”
2. State the school district policy. Example: “Because there could be various germs in the blood, we are required to call and let you know about Kris’ accident and to tell you that you may need to obtain medical advice from your doctor or the Clark County Health District concerning possible infectious exposure.”
3. Inform the parent/guardian that a letter will be sent to the home to provide further information. Example: “We will be sending you a letter describing what happened.” “If you have questions, you can speak to the school nurse by calling 799-####.”
4. Do not give out the name or any information regarding the other student if requested by the parent/guardian of the exposed student. All information needs to remain confidential.
STUDENT TO EMPLOYEE EXPOSURE PROCEDURE
1. Refer to the Exposure Control Plan. For detailed policies and procedures regarding exposures. Each Health office is to maintain a current copy of the Exposure Control Plan. The plan can be downloaded from Exposure Control Plan site.
2. For CCSD procedures for post exposure to bloodborne pathogens refer to Student to Employee Exposure CCSD Procedure for Reporting Post-Exposure to Bloodborne Pathogens.
STUDENT TO EMPLOYEE EXPOSURE
CLARK COUNTY SCHOOL DISTRICT
PROCEDURE FOR REPORTING POST-EXPOSURE
TO BLOODBORNE PATHOGENS
When a suspected exposure incident occurs at a Clark County School District (CCSD) work site, these procedures are to be followed:
INITIATE APPROPRIATE FIRST AID
* For closed or intact skin exposures, clean with soap and water. You may wish to use school district-issued antiseptic wipes afterwards. (Intact skin is a good barrier, so you will most likely not be referred for evaluation.)
* For puncture wounds and other percutaneous (through the skin) injury exposures, clean the wound or area of exposure with soap and water for 15 minutes. Treat the area with an appropriate skin disinfectant, such as 70% isopropyl alcohol, hydrogen peroxide or Bactine.
* For eye exposures, flush eye(s) with large amounts of clear water or saline for 5 minutes.
* For mouth exposures, rinse vigorously with clear water and spit out. Repeat at least 5 times.
The employee will call the Employee Health Nurse at 799-0767 as soon as possible after the incident. This must be reported within 24 hours of the occurrence. The Employee Health Nurse or alternative contact person, such as the school nurse or supervisor, should refer the employee for immediate medical care, if it is determined that this is a possible exposure. The employee will be referred to the District’s contracted medical provider for exposure follow-up. If the incident happens after 5pm or during weekend hours, the employee should report to Southwest Medical Urgent Care at 888 S Rancho, 877-8600. For post -exposure prophylaxis employees should seek care within 2 hours particularly if there is a higher probability of valid exposure.
Forms can be filled out after first aid has been administered. If the employee needs immediate medical attention, forms can be completed as soon as feasible. Otherwise, forms must be completed at the time of exposure.
* Notice of Injury or Occupational Disease (Form C-1), filled out by the employee.
* Supervisor’s Accident/Incident Investigation Report (CCF-99), filled out by the supervisor and sent to the Safety Manager.
The employee’s supervisor will review, sign, and date all forms.
For all questions relating to bloodborne pathogen exposures for employees contact the Employee Health Nurse at 799-0767.
GUIDELINES FOR CARE
EMPLOYEE EXPOSURE INCIDENTS
Step 1 Intact skin is a good barrier and generally is not a referred injury. Direct the employee to wash the exposed area with soap and water for 15 minutes. Apply skin disinfectant to broken/punctured skin. For eye exposures, flush the eye(s) with large amounts of water or saline. For mouth exposures, rinse the mouth with clear water.
Step 2 Direct the employee to inform their supervisor and to contact the Employee Health Nurse to report the exposure. He/she will be available to answer questions, provide information, offer assistance and determine whether the employee needs to be seen by a physician. Risk Management personnel, at 799-2967, will assist you in her absence. Report all needle stick or injuries with a sharp object possibly contaminated with infectious material to the Employee Health Nurse at 799-0767.
Step 3 Have the employee complete form C-1 unless it is an emergency. This form may be completed later. The CCF-99 form is to be completed by the employee’s supervisor. Both the C-1 and CCF-99 forms are reviewed, dated
and signed by the employee’s supervisor.
Note: The Student Exposure form CCF-640 is not to be used.
Step 4 The employee will be directed to the district’s contracted medical provider for exposure follow-up.
Step 5 If the exposure occurs before 8:00 a.m. or after 5:00 p.m., direct the employee to seek medical care at Southwest Urgent Care at 888 S. Rancho, 877-8600 (open 24 hours). (Located at the NW corner of Rancho and Charleston on the North side).
Step 6 Refer to the current CCSD’s Exposure Control Plan.
Step 7 Do not contact the parent/guardian of the student involved in this incident to request that blood be drawn. That will be the responsibility of the CCSD’s Employee Health Nurse, if the medical provider has determined the exposure was valid.
Tuberculosis is a communicable/infectious disease caused by the Myocbacterium Tuberculosis. It most commonly affects the respiratory system, but other parts of the body may become infected. Tuberculosis is found worldwide. Although the incidence has decreased, it is still prevalent in underdeveloped countries. Recently there has been an increased incidence of cases in the United States, which may be related to the large influx of foreign-born individuals.
Unlike adult tuberculosis, childhood tuberculosis usually is not contagious. Young children (under the age of five) with childhood tuberculosis do not cough up tuberculosis germs; rather the germs settle in the part of the lung where there is little risk of coughing up the germ into the air. Older children and teenagers may develop the adult type of TB with cystic pulmonary changes. This adult-type of TB is contagious.
Skin tests are the most important diagnostic test to confirm exposure to the tuberculosis germ. The Mantoux Skin Test, Purified Protein Derivative (PPD), is the standard method used to screen for tuberculosis. The test is administered to district employees when hired and at five-year intervals. Confirmation of active disease requires a chest x-ray and sputum cultures. While skin testing is provided to school employees, routine testing of students is not performed. If student testing were needed school nurses would work with the Clark County Health District to determine the need for skin testing. All employees with a positive reaction are referred to a contracted follow-up facility for a
TB tests are given by nurses at the Education Center and by school nurses at designated school sites. FASAs at designated sites may be involved in reading negative test results. School nurses assigned to the designated sites are responsible for training and determining the FASA’s competency in this area. The school nurse assigned to a designated site is responsible for reading all positive tests and for making referrals to the contracted follow-up site. In the event that the FASA is not capable of being trained to read negative test results, the school nurse has the responsibility of reading the tests. Under no circumstances is a FASA allowed to refer anyone to the Clark County Health District or contracted follow-up facility, nor sign the nurse’s name on the TB Test form. School nurses assigned to the clinic are also responsible for checking with the FASA the day before the scheduled reading to ensure that he/she will be available to read the tests. The assigned school nurse is ultimately responsible for the successful completion of the TB testing for his/her assigned clinic. Each TB clinic site will be stocked with adequate supplies and forms. The school nurse assigned to a designated clinic site provides Health Services with the names of back-up personnel.
School nurses at school sites other than designated TB test sites can refer employees for a chest x-ray if the employee has had a past positive skin test. The school nurse can provide the employee with the appropriate paperwork. These forms can be obtained from Health Services. Both the CCF-673 “Tuberculin Test Form” and referral form for a Chest X-ray are required. A school nurse signature is required on both forms. The signature must be legible or Desert Radiology may refuse the referral.
See Section G for a detailed Procedure for the Tuberculosis Screening Procedure