Chronic Communicable Diseases and Risk Management in the Schools*

Transcription

1 Language, Speech, and Hearing Services in Schools, Volume 22, Chronic Communicable Diseases and Risk Management in the Schools* Committee on Quality Assurance Judith I. Kulpa (Chair), Sarah W. Blackstone, Christina C. Clarke, Margaret M. Collignon, Elizabeth B. Griffin, Bradley F. Hutchins, Lesley R. Jernigan, Kathleen Eccard Mellott, Paul R. Rao, Carol M. Frattali (ex-officio), Charlena M. Seymour (Vice President for Quality of Service) American Speech-Language-Hearing Association, Rockville, MD!"# $"% & #''( #)'( ''#'(( )'(#!&*() + +* '(#)#+&'& #)#+&'& '( )'& # &(##)&,! ' # * '-)'&#'- &+! ''( ',.* ''& -& $./%(*&& *)0 '# + )#-& $1/% #'( (# # 2) & &&!!'+ () )'&3'(+ '! '# )&'+&$ '# ) &&# '##!"' ''#&#!"* )4 '#5%, 5 ".6& # ' # 7 )' && *2)&( ''# ) # '( " #. #! /& $./% '# &&&' &*() + + * '(#)#+&'& #)#+&'&'#2''understand current risks '# manage these risks 3()*#-+ )'&-&'# *&#& 3'( # '# * '& 3(# ( - "8./, 9(&''# ) **)&'(**)& &2 :*#' * '; "8./; *) '#&!# "*(< + += '(#)#+&'& #)#+&'&: (Asha, >% 0* &'( '#)(## 2)& & *-'# + '- #&3#?&'+&)+ '(&(##)&)& '&, 9 (& 3#?& &*() + + * '(#)#+&'& #)#+&'& *)# '# )&'+& #'#&&?&'#( )'( * '#!'(*#!&&# ) * ',.#3-2 &./1/ E9(& *#' *&'& '( ) '-!!#' #! '( 2&#!'(".# '#7 )'&& ; '(,)* ( F" ( G,)?&'#F(&', )?F 1 + ' 1, #)+#F 4)H 2'(,!!F ) B,.'(&F <&), + F '() 4 1)#'F = ), #F #)1,B ' )40!!#F( ) 1, " #F/=&'!#7 )'#!"-, I "*(< &&# '#.* ''& (*&& *)0 & &&'( '''#2 (# 2' & '''##'(&'( &?&#! ' & &&#'# )' +-&'##'(()! '& '( &#!*+ '3# '#'(!'& 32#, 9( 0 *)& '( ' )&' ' 3( 2#'( '( *2) *#!&&# )# ' ( -#& ;,1/& # 2)& &' & ''(#+( 2#)!)&, ' &*- )' ()! )'& '# ) -# '&, ' ) #' ' 3'( 1/ + *+ &)'! '& 3'( &- ( + * ' ' )' '#2 )* )& 8#-& ) * '$ 5@%,, *#' 2'(.#&")' # ''# () A#'( B )&*'&'( 2#! () '( +#!3(#( -"3) &>C 2 '# + ' '( >>> && $.#& ")' # ''#()A#'( B )&5D%,, )'(#+(#) C#! )*&#& +#& &( -+ " )&& '( > &#) #+() C 2'3 '( +& #! > $ '# ) " ) +(#& >%, -'()#+ 2 '#*# 2'3./!'# ** #!& *'# & ) + '# +#&& #! " $,, ( )! #! '(#&!'-)#*"3'(> &% ( - '(!'# & ' +&,./8" & ' & ''(#+( 2)### 2#)!)& #' + -&2)2)##, )'(#+('('&!#& &#'#)$%( -2 '- *#-+ +)&!# () 3'(!'#& & && &(##)&''+&&# &' ' '# ) +& $"4"% )# ) '# +& $<4&% ( - #' *) '!'##'#)*# >@@88>>>,>>8>

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3 9<4,Chronic communicable diseases and risk management factors. Likelihood of Extent of risk Body fluids` that can transmission to for those Contagion Population at risk carry contagion Transmission providers infected Treatment Prevention strategies a Hepatitis B >All ages (less common in >Blood (cuts, * Bloodstream through Moderate High (if chronic) Hyper immune Children) nosebleeds, cuts, abrasions, bites gamma globulin * Highly prevalent in contaminated >Direct sexual contact after exposure residents & staff of needles, menses) secretions custodial institutions J >Semen and vaginal people in high-risk groups secretions HIV/AIDS >Unborn children of >Blood (and body * Bloodstream Low High >No known cure infected mothers fluids containing >Direct sexual AIDS virus >Homosexuals visible blood) contact Many treatmen >IV drug users >Semen and vaginal for HIV infec secretions in experiment *Breast milk phases CMV >Unborn children of mothers >Urine EUnknown High (most people Low (unless None infected for first time >Feces carry virus) pregnant & infected >Adults w/immunodeficiency >Semen for the *Vaginal secretions first time) >Breastmilk *Blood transfusion Herpes >Unborn children of mothers ESaliva ESexual contact Low (unless giving ENone Birth) Infected during birth ESores Moderate for persons procedures procedures EAll women who give birth >Vaginal secretions with active lesions >(shortens outbreak) 'Blood, semen: mucous, cerumen, tears, urine, breast milk, saliva

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5 Infection control procedures and universal precautions cannot be implemented in my setting." "I don't have time to do this!" problems, to be at risk. Performing a routine oral peripheral exam puts you at risk. Common occurrences such as a cut, nosebleed, loss of a baby tooth, a draining ear, may also put you at risk. Simple precautions such as hand washing, use of latex gloves for oral exams, and disinfecting work surfaces can be easily implemented (see next section). Moist antiseptic towelettes may substitute for soap and water if you don't have access to a sink. Other materials are easily available through your local pharmacy. Infection control proce dures can take less than a minute per session. You can't afford not to. If you don't implement infection control procedures you risk contracting a serious, chronic, infectious disease. SUGGESTED PRECAUTIONS ASHA's Committee on Quality Assurance has adapted CDC's Universal Precautions to meet the needs of speech-language pathologists and audiologists in educational settings. It is the committee's recommendation that infection control procedures described below be implemented to: (a) prevent transmission of chronic infectious diseases; (b) protect the health of clients receiving speech-language pathology and audiology services, professionals providing speech-language pathology and audiology services and other health and education workers, family members and so on; and, (c) ensure all persons' rights to privacy. One should, of course, be cognizant of and follow the infection control policies and procedures of local and state educational agencies. The following checklists can be removed, individually laminated, and displayed in your setting. RISK MANAGEMENT KULPA ET AL.: Chronic Communicable Diseases 349 term body fluids includes: blood, semen, drainage from scrapes and cuts, feces, urine vomitus, respiratory secretions (nasal discharge), and saliva. Contact with body fluids presents a risk of infection with a variety of germs that cause chronic infectious diseases. /'##,#0/,$# School policy in place for risk management. Person designated responsible for implementation of policy. Committee established at the building level for identifying risk management policy and procedures, as follows: _ Identifying risk management needs Developing risk management procedures for implementing precautions _ Implementing precautions _ Assessing effectiveness of precautions Modifying precaution policy, as indicated Mechanism established for purchase of required materials to implement infection control procedures. INFECTION CONTROL SUPPLY CHECKLISTS A. The following materials are needed to implement proper infection control procedures. - Latex gloves _ Alcohol/antiseptic wipes _ Soap Access to sink/running water _ Paper towels Disinfection solution (1 part household bleach to 10 parts water) Spray bottle (to mix water and disinfectant solution) Tissue _ Plastic bags that seal (e.g., Ziploc) _ Trash bags _ Household bleach _ Hand lotion _ Absorbent powder for bodily secretions B. In addition, these infection control materials should be used when implementing procedures that could expose the professional to blood, semen, or other bodily secretions that contain visible blood (e.g., oral peripheral examinations, procedures involving tracheostomy tubes, etc.) Mask Goggles Gowns _ Red trash bags (for disposal of Materials that could be harmful if handled casually) Definitions of risk. The body fluids of all persons should be considered potentially infectious agents. The 49

6 SUMMARY This paper provides information about four chronic communicable diseases. Both legal and professional considerations are discussed.. Guidelines for speech-language pathologists and audiologists, particularly applicable to those who work in public and private schools, day care centers, and other institutional environments, are suggested. The goal of the paper is to increase awareness and to encourage use of appropriate risk management procedures. Speech-language pathologists and audiologists are encouraged to share this information with their administrators and colleagues. The role of the speech language pathologist and audiologist in the schools includes protection of their clients, themselves, and coworkers. ACKNOWLEDGMENTS The ASHA Committee on Quality Assurance would like to recognize the ASHA Committee on Language, Speech and Hearing Services in the Schools (Monica L. Ferguson, Chair); the ASHA Executive Board; the other select peer reviewers who are ASHA members, and officials from the Centers for Disease Control who contributed to the content of this important document. REFERENCES ADLER, S. (1989). CMV in child day care. New England journal of Medicine, 321(19), AMERICAN SPEECH-LANGUAGE-HEARING ASSOCIATION. (1990, December). Report Update: AIDS/HIV: Implications for speech-language pathologists and audiologists. Asha, 31(6),33. AUTHORS. (1987). A generation in jeopardy: Children and AIDS. (1987). House Select Committee on Children, Youth, and Families. BLACKMAN, J., 8L APPEL, B. (1987). Epidemiologic and legal considerations in the exclusion of children with acquired immunodeficiency syndrome, cytomegalovirus, or herpes simplex virus infection from group care. Pediatric Infectious Disease, 6(3), BRADY, M. (1986). CMV Infection. Occupational risk for health professionals. American Journal Infection Control, 14(5), 197. CENTERS FOR DISEASE CONTROL HIV/AIDS Surveillance Report. (1990, February). National Aids Clearing House: Centers for Disease Control. CENTERS FOR DISEASE CONTROL. (1990, February). Protection against viral hepatitis: Recommendations of the immunizations practices advisory committee. Morbidity and Mortality Weekly Report, 39(2) Supplement, 1. HARVEY, D., 8L DECKER, C. (1989). HIV infection legal issues: An introduction for developmental services. Technical Report on Developmental Disabilities and HIV Infection. Silver Spring, MD: AAUAP. NATIONAL ASSOCIATION OF STATE DIRECTORS OF SPECIAL EDUCATION. (1989). Communicable Diseases-AIDS, Hepatitis, and Students: Legal issues and policy considerations. Liaison Bulletin, 15(4), 1. Received August 1990 Accepted October 1990 Requests for reprints may be sent to Carol M. Frattah, Ph.D., American Speech-Language-Hearing Association, Rockville Pike, Rockville, MD Decreasing the possibility of transmitting disease through treatment materials. What to Disinfect When to Disinfect How to Disinfect Evaluation and treatment materials (e.g., toys", games, storage boxes, therapy materials). Work surfaces. Clean tabletop and materials after each use. If materials, work surfaces, electronic equipment or seating surfaces contain visible blood, use Universal Precautions. Use soap and water or a 1 to 10 solution of household bleach to water, spray, and wipe thoroughly. Use disposable materials (e.g., latex gloves, etc.) when possible. Electronic equipment and accessories. Seating surfaces. Materials, supplies and instruments to examine oral mechanism. 'Note: Toys made of fabric and fur should be avoided due to the tendency to harbor microorganisms. 50

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