Communicable Diseases and Medical Procedures Resource Manual

Transcription

1 Communicable Diseases and Medical Procedures Resource Manual Table of Contents Introduction... page 03 Communicable Diseases Chickenpox... page 04 Conjunctivitis... page 05 Fifth Disease... page 06 Hand Foot and Mouth Disease... page 08 Hepatitis A... page 09 Hepatitis B... page 10 Hepatitis C... page 12 HIV/AIDS... page 13 Impetigo... page 14 Influenza... page 15 Meningitis (Bacterial)... page 16 Meningitis (Viral)... page 17 Mononucleosis... page 18 Mumps... page 19 Norwalk Virus... page 20 Pediculosis (Head Lice)... page 21 Pinworm... page 22 Ringworm... page 23 Rubella (German Measles)... page 24 Strep Throat / Scarlet Fever... page 25 Tuberculosis... page 26 Whooping Cough... page 28

2 Prevention Hand washing... page 30 Hand Washing Poster... page 31 Hand Sanitizer Poster... page 32 Routine Practices Poster... page 33 Routine Practices Policy # page 34 Regulation # page 35 Warning! Needles Are a Danger Poster... page 41 Adult Vaccination... page 42 Medical Procedures Administration of Medication By Mouth: Policy # page 43 By Mouth: Regulation # page 44 By Injection: Procedure # page 49 Anaphylaxis Procedure # page 54 By Insertion (Guidelines: Emergency Administration of Prescriptive Rectal Medication)... page 78

3 INTRODUCTION Parents, guardians and educational workers are aware that their children will come into contact with a variety of communicable diseases, particularly while they are attending school. Classrooms are ideal environments for the transmission of communicable diseases due to the close contact of students and sharing of materials. Education workers are also at risk for contacting a communicable disease. People expect children to be susceptible to diseases such as measles and chickenpox. They hope they are spared the agony of suffering from hepatitis, meningitis, and tuberculosis. In a school setting, the best method for preventing the transmission of a communicable disease is careful hand washing. In addition, shared surfaces should be kept clean and reduce contact with an infected person. This book is designed to increase the knowledge of Durham District School Board staff about communicable diseases and medical procedures that could take place in the school setting. Information is presented in a format that allows it to be easily shared with parents and guardians. I encourage staff to read the book and keep it handy as an important reference for the future. Please refer also to Durham Board Regulation # Communicable Diseases. Education workers who are anticipating pregnancy or are already pregnant should discuss their job duties and their level of immunity with their health care provider. Staff dealing with students or colleagues who have contacted a communicable disease may want or need more information than is contained in this book. The Durham Region Health Department will provide this as one of its many public services. They can be reached by calling Durham Health Connection Line at or or visit Additional information is available in the Guidelines for Communicable Disease Reporting & Exclusion (flip chart). To obtain visit: click Public Health, then Disease Prevention & Infection Control/Investigation. Near bottom of that page is Guidelines for Communicable Disease Reporting & Exclusion. I would like to thank the committee members who spent much time writing and editing this book. Karen Alexander, CUPE 218 Don Ayotte, Operations Officer Martyn Beckett, Special Education Brenda Cannon, Administrative Assistant Doug Crichton, Special Education Cristal Diemer-Ewles, OSSTF Gary Gibson, Health and Safety Lynda MacGregor, Durham Access to Care Cassandra Massie, Durham Region Health Department Marion Megesi, Durham Region Health Department Carol Moore, Administrative Assistant Shelley Oxley, Durham Region Health Department Marlene Pike, Grove School Alison Wallace, OSSTF Mark Joel Superintendent of Education/Operations FEBRUARY 2008 Durham District School Board: Communicable Diseases page 3

4 CHICKENPOX What is it? Symptoms: Transmission: Chickenpox is a highly infectious disease caused by the varicella zoster virus. Chickenpox often begins with fever and tiredness that quickly develops into a rash of small red bumps that appear on the chest, back, or the stomach. The rash begins like a tiny red dot, quickly becoming filled with clear fluid. Blisters associated with the rash are very itchy and will scab in a few days. Symptoms appear 2-3 weeks after contact with an infected person Transmission of chickenpox is through: direct contact with respiratory droplets from the nose or throat of infected persons via air borne droplets when an infected person coughs or sneezes contact with fluid from the blisters The disease is so contagious in its early stages that an exposed person who is not immune to the virus has a 70% to 80% chance of contracting the virus. Prevention / Treatment: Calamine lotion may reduce the itching. Antiviral or immunoglobulin medications can be prescribed by a physician to decrease the risk of serious disease. Covering the mouth when coughing or sneezing, and hand washing are recommended. Children with chickenpox should stay home until all lesions have crusted over, usually about 5 days after the onset of the rash. Varcella vaccine is available for people twelve (12) months of age and older who do not have immunity to chickenpox. The vaccine is beneficial for susceptible adults if given 3-5 days after exposure, but is not used with pregnant women. Special Considerations: Pregnant women or those individuals with impaired immune systems should consult with their doctor when exposed to an individual with chicken pox. Chickenpox can also be quite serious for adults who have never had chickenpox, people with cancer, newborns, and people who are on chronic or high dose steroid medication. Any medication containing ASA should not be given to infected teens, and children. There may be a link between ASA and Reye s syndrome. Forms of Response: Chickenpox is a reportable disease and must be reported to the Durham Region Health Department at or ext For more information, visit: click Public Health, then Facts About...Chickenpox. Or call Durham Health Connection Line: or Durham District School Board: Communicable Diseases page 4

5 CONJUNCTIVITIS (PINK EYE) What is it? Symptoms: Commonly known as pink eye it is an infection of the conjunctiva or outer covering of the eye. It may be caused by a bacteria or a virus. Red, itchy, painful eye(s) that are sensitive to light. Pus draining from the eyes can lead to crusting of the eyelids during sleep. The eyelids may be swollen and tears are common. For more information, visit: click Public Health, then Facts About...Conjunctivitis (Pink Eye). Or call Durham Health Connection Line: or Transmission: Transmission of conjunctivitis is from person to person through contact with the infected eye, pus or tears; or through contact with the airborne droplets from the nose and mouth when the infected person sneezes or coughs. Prevention/Treatment: Antibiotic eye drops and/or oral antibiotics should be prescribed by a doctor if there is a bacterial cause. Children with conjunctivitis should stay home until 24 hours after treatment begins. Use of a warm, wet paper towel can help to remove crust from around the eyes and should be carefully disposed of once it has contacted the area of the eye. To prevent transmission the infected individual should avoid touching the affected eye(s). Towels, wash cloths and bedding should not be shared, and should be washed in soapy water. Infected persons are encouraged to use paper towels until the infection has disappeared. Careful hand washing can reduce the spread of this disease. Durham District School Board: Communicable Diseases page 5

6 FIFTH DISEASE What is it? Symptoms: Transmission: Fifth Disease (erythema infectiosum) is a disease caused by a virus, the human parvovirus B19. The disease begins with a fever and mild respiratory symptoms. Frequently, a red rash on the face appears with the cheeks taking on a flushed appearance as if they have been slapped. A lacy rash may then appear on the trunk, arms and legs. The disease is transmitted by direct contact with the respiratory secretions of an infected person. The disease is usually spread before the onset of the rash. Rarely the disease is spread through contact with the blood of an infected person. Most adults are immune to this virus. Prevention / Treatment: Most people recover from Fifth Disease without any treatment. Due to its viral nature, medication may be given to treat symptoms and to keep the individual comfortable. Proper use and disposal of facial tissues, along with frequent, thorough hand washing is recommended to prevent transmission of the virus. Cover your mouth and nose during coughing or sneezing to prevent the spread to others. Avoid sharing eating and drinking utensils. Special Considerations: Pregnant women should consult with their physician if exposed to Fifth Disease. The disease may be linked to possible anaemia in the fetus. A physician can test for immunity to Fifth Disease in the first pre-natal visit and this is recommended for women considering pregnancy. People who are immune suppressed, and people with anaemia should also see their doctor if exposed. Forms of Response: If there is an outbreak of the disease, all adults and children are to use good hand washing techniques to prevent further infection. The principal will make it a priority to notify all staff as soon as possible if a case of Fifth Disease is reported in the workplace. Teachers prevented by their physician from entering their school or classroom due to communicable disease should notify their principal and will be re-assigned temporarily to another worksite. Fifth Disease is NOT a reportable disease. For more information, visit: click Public Health, then Facts About...Fifth Disease. Or call Durham Health Connection Line: or Durham District School Board: Communicable Diseases page 6

7 Additional Information: Human parvovirus B19 was discovered in England in Erythema Infectiosum is known as fifth disease because it was believed to be the fifth rash-producing childhood illness, following scarlet fever, measles, and rubella. The fourth childhood disease with these characteristics was subsequently shown not to exist. Durham District School Board: Communicable Diseases page 7

8 HAND, FOOT AND MOUTH DISEASE What is it? Symptoms: Transmission: Hand, Foot and Mouth disease is a common childhood disease caused by enteroviruses, usually coxsackie virus. Enteroviruses are viruses that are composed of protein and RNA. One to two days of mild fever followed by sores or blisters in the mouth, palms, fingers, soles of feet and occasionally, the buttocks. Blisters may last 7-10 days. Some infected people may have no symptoms and still transmit the disease. Spread of the virus from person-to-person occurs via direct contact with the respiratory secretions, mucus or stool of an infected person. Symptoms appear 3-7 days from the onset of infection. The virus can persist in the stool for several days. Prevention / Treatment: Hand, Foot and Mouth Disease is caused by a virus. There is no specific treatment other than analgesic medication for the symptoms associated with fever, or pain from mouth ulcers. Children should not be given ASA because of the risk of Reye s Syndrome. Proper use and disposal of facial tissues, along with frequent, thorough hand washing is recommended to prevent transmission of the virus. Cover your mouth and nose during coughing or sneezing to prevent the spread to others. Avoid sharing eating and drinking utensils. Special Considerations: Hand, Foot and Mouth disease is NOT the same as foot-and-mouth disease of cattle, sheep and swine. Forms of Response: Hand, Foot and Mouth Disease is NOT a reportable disease. For more information, visit: click Public Health, then Facts About...Hand, Foot and Mouth Disease. Or call Durham Health Connection Line: or Durham District School Board: Communicable Diseases page 8

9 HEPATITIS A What is it? Hepatitis A is a disease caused by a virus often affecting the liver. Symptoms: Common symptoms include fatigue, fever, abdominal discomfort, loss of appetite, nausea, diarrhea and sometimes jaundice, (skin and whites of eyes turn yellow). Symptoms occur within 50 days of becoming infected, usually days. Transmission: The Hepatitis A virus is found in the stool of infected persons. The virus is usually spread from person-to-person through faecal/oral contact or through contaminated food and water. Disease transmission is most frequent among household and sexual contacts of infected cases. Prevention / Treatment: Good hygiene, thorough hand washing and effective sanitation practices are important. Hepatitis A vaccine provides immunity against the disease. Travellers going into areas with high incidences of Hepatitis A should be vaccinated prior to travel. All individuals involved in food handling and toileting or diapering in child care situations are at greater risk and should maintain excellent hand washing techniques. Forms of Response: Hepatitis A is a reportable disease and must be reported to the Durham Region Health Department, Environmental Division at or ext For more information, visit: click Public Health, then Facts About...Hepatitis A. Or call Durham Health Connection Line: or Durham District School Board: Communicable Diseases page 9

10 HEPATITIS B What is it? Symptoms: Hepatitis B is a highly contagious disease, caused by a virus, which attacks the liver, causing permanent liver damage (cirrhosis or liver cancer). Symptoms may include fatigue, abdominal discomfort, loss of appetite, nausea, vomiting and occasionally, pain, rash and jaundice (skin and whites of eyes turn yellow). Symptoms usually occur within 9 months of infection, and usually occur within 2-3 months. Transmission: Hepatitis B is transmitted through exposure to infected blood and body fluids. Transmission may include sharing needles, sharing of personal items such as razors or manicure tools, needle stick injury, contaminated body piercing and tattooing equipment, sexual contact, and transfer of Hepatitis B virus from an infected mother to baby during birth. Prevention / Treatment: There is no cure for Hepatitis B, just prevention. Hepatitis B vaccine provides immunity against the disease and is routinely given to all grade seven students in Ontario. Avoid sharing personal items (razors, toothbrushes, manicure equipment). Investigate personal service settings for proper infection control practices. Use routine practices. Practice safe sex. Special Considerations: Vaccination is recommended for those involved in the following high risk behaviours: injecting drugs, sexually active with multiple partners, sexual/household contact with infected persons, birth of children to infected mothers, employment in health care and other professions requiring use of needles, people on haemodialysis, and those working with developmentally challenged individuals. Counter indications and risks associated with the vaccine can be found on the Durham Region Health Department web site. Forms of Response: Hepatitis B is a reportable disease and must be reported to the Durham Region Health Department at or ext For more information, visit: click Public Health, then Facts About...Hepatitis B. Or call Durham Health Connection Line: or Durham District School Board: Communicable Diseases page 10

11 Additional Information: Hepatitis B virus can remain in the body and the individual becomes a chronic carrier. Protection during sexual contact is necessary to avoid the spread. Use protective measures when there is potential contact with other people s blood and body fluid (e.g. gloves, eyewear). Durham District School Board: Communicable Diseases page 11

12 HEPATITIS C What is it? Symptoms: Transmission: Hepatitis C is a highly contagious disease, caused by a virus, which attacks the liver causing permanent liver damage. Symptoms include fatigue, abdominal discomfort, loss of appetite, nausea, vomiting and possible jaundice (skin and whites of eyes turn yellow). Hepatitis C is a blood borne disease transmitted through exposure to contaminated blood. Transmission may include sharing needs, sharing of personal items such as razors or manicure tools, needle stick injury, contaminated body piercing and tattooing equipment, and less often through sexual contact. Prevention / Treatment: Hepatitis C is prevented through screening of blood/organ donors and through programs to encourage high-risk behaviour modification. People should be vaccinated against Hepatitis A and B to prevent further damage to the liver. Avoid sharing personal items (razors, toothbrushes, manicure equipment), needles or other drug use equipment (crack pipes, straws). Investigate personal service settings for proper infection control practices. Use routine practices. Practice safe sex. Forms of Response: Hepatitis C is a reportable disease and must be reported to the Durham Region Health Department at or ext For more information, visit: click Public Health, then Facts About...Hepatitis C. Or call Durham Health Connection Line: or Durham District School Board: Communicable Diseases page 12

13 HIV / AIDS What is it? Symptoms: HIV (Human Immunodeficiency Virus) is caused by a virus that weakens the immune system and gradually destroys its ability to fight illness. It causes infections and diseases to invade the body, leading to AIDS (Acquired Immunodeficiency Syndrome). In the early stages of the infection there are usually no symptoms, although some people may develop flu-like illness within 1-2 months of becoming infected. Over time, some of the symptoms that may develop are: fever, weight loss, swollen glands, extreme fatigue, skin lesions, sores, recurrent pneumonias, forms of cancer, and damage to the nervous system. For women, recurrent yeast infections and abnormal pap tests can occur. It can take up to 10 or more years for AIDS to develop following HIV infection. Transmission: HIV can be spread through sexual contact, by sharing dirty needles to inject drugs, by using contaminated equipment for tattooing and skin piercing, or from mother to baby (before or during birth or by breast feeding). The virus is not spread through casual contact, such as shaking hands, sharing food, sharing a drinking fountain or via a swimming pool, toilet seat or mosquitos. Prevention/Treatment: HIV/AIDS is treated with medications to delay the spread of HIV in the body and to manage infections and cancers associated with the disease. Protection during sexual contact and avoiding the sharing of needles can reduce the spread of HIV. Investigate personal service settings for proper infection control practices. Use routine practices. Practice safe sex. Special Considerations: Infected pregnant women with HIV can take prescribed medication to reduce the risk of infecting their baby. Forms of Response: Practices known as Routine Practices, (see Universal Precautions in this document), should be used for prevention of the transmission of communicable diseases including HIV infection. This may include the use of gloves, eyewear, etc. when in contact with blood and body fluids. HIV/AIDS is a reportable disease and must be reported to the Durham Region Health Department at or ext For more information, visit: click Public Health, then Facts About...HIV/AIDS. Or call Durham Health Connection Line: or Durham District School Board: Communicable Diseases page 13

14 IMPETIGO What is it? Symptoms: Impetigo is an infection of the skin, most commonly affecting areas around cold sores, mouth and nose, caused by Staphylococcus or Streptococcus bacteria. Clusters, red bumps or blisters on the skin that burst and form thick, yellow crusts. Transmission: The spread of bacteria occurs when someone touches the impetigo rash and then touches another person. Occasionally it may be spread when an infected person coughs or sneezes and the airborne droplets touch the rash and then another person. Prevention/Treatment: Impetigo can be treated by antibiotics prescribed by a physician. Children should stay home from school until 24 hours after treatment has been started. Proper use and disposal of facial tissues, along with frequent, thorough hand washing is recommended to prevent transmission of the bacteria. Avoid sharing eating and drinking utensils. Wash any soiled articles in hot, soapy waters. Forms of Response: Impetigo is NOT a reportable disease. For more information, visit: click Public Health, then Facts About...Impetigo. Or call Durham Health Connection Line: or Durham District School Board: Communicable Diseases page 14

15 INFLUENZA What is it? Symptoms: Transmission: Influenza ( the flu ) is an acute, highly infectious viral disease of the respiratory tract. Symptoms include fever, cough, sore throat, runny or stuffy nose as well as headache, chills, muscle aches and often extreme fatigue. Influenza virus is transmitted from easily person to person through coughing and sneezing. It is also spread through contact with unwashed hands, surfaces with influenza virus, toys and utensils that have been contaminated. A person may spread the virus to others up before symptoms are apparent and up to 5 days after symptoms start. Prevention / Treatment: Thorough hand washing, cleaning shared services, proper use and disposal of tissues, covering mouth and nose after sneezing or coughing can assist in preventing the spread of the virus. Medications, known as antivirals, can be used for early treatment of influenza to reduce length and severity of the illness. Annual vaccination against flu is recommended for everyone including those people over sixty-five and those of all ages with chronic diseases of the heart, lung or kidneys, diabetes, and those immunosuppressed or anaemic. Anyone who wants to avoid getting the flu or spreading the flu should consider getting the vaccine. Once a person is infected, they should stay home, increase the amount of fluid intake and rest until recovery. Aches and fever can be treated with analgesics, but children should not be given ASA because of risk of Reye s syndrome. Special Considerations: People with an anaphylactic reaction to egg protein should not receive the vaccine. Forms of Response: Influenza is a reportable disease and must be reported to the Durham Region Health Department, Environmental Division at or ext For more information, visit: click Public Health, then Facts About...Influenza. Or call Durham Health Connection Line: or Durham District School Board: Communicable Diseases page 15

16 MENINGITIS (BACTERIAL) What is it? Symptoms: Meningitis is an inflammation of the membranes that cover the brain and the spinal cord. The most common bacteria to cause bacterial meningitis are Neisseria meningitidis (meningococcal meningitis), Streptococcus pneumoniae (pneumococcal meningitis), Haemophilus influenzae type b (Hib). Complications can cause permanent brain damage, or even death. Symptoms of bacterial meningitis include intense headache, high fever, stiff neck, nausea and vomiting, lethargy, irritability, sensitivity to light, and sometimes rash. Transmission: Transmission of the bacteria is through direct contact with saliva or respiratory droplets from the nose or throat of infected persons. Kissing, and sharing of eating utensils and drinks will allow the bacteria to spread. Sharing sleeping space may increase risk of getting the disease. Prevention / Treatment: Proper use and disposal of facial tissues, along with frequent, thorough hand washing is recommended to prevent transmission of the bacteria. Avoid sharing eating and drinking utensils, water bottles, and cigarettes. Bacterial meningitis is treated with antibiotics. Antibiotics are given to close household members and intimate contacts in order to prevent the spread of the disease and to eradicate the bacteria. Seek immediate medical attention if infection is suspected. Special Considerations: Pregnant women and individuals with jaundice or liver disease should not take the antibiotic, Rifampin, used frequently for contacts and cases of Bacterial Meningitis. The National Advisory Committee on Immunization acknowledges that pregnant women and breastfeeding mothers can receive meningococcal C conjugate vaccine without safety concerns. However, the benefits and potential risks of vaccination should be discussed with a doctor. Forms of Response: Seek immediate medical attention if infection is suspected. Bacterial Meningitis is a reportable disease and must be reported to the Durham Region Health Department at or ext For more information, visit: click Public Health, then Facts About...Bacterial Meningitis. Or call Durham Health Connection Line: or Durham District School Board: Communicable Diseases page 16

17 MENINGITIS (VIRAL) What is it? Symptoms: Transmission: Meningitis is an inflammation of the membranes that cover the brain and the spinal cord. This inflammation is caused by a virus. About 90% of cases are caused by enteroviruses, but herpes viruses and mumps can also cause meningitis. Symptoms of viral meningitis include intense headache, fever, stiff neck, nausea and vomiting, lethargy, sensitivity to light and irritability. Symptoms may develop over several hours or may take 1-2 days. Transmission of viral meningitis is through direct contact with saliva or respiratory droplets from the nose or throat of infected persons. Kissing, and sharing of eating utensils and drinks may cause the virus to spread. It can also be spread through inadvertent contact with the feces of an infected person, usually while changing a diaper. Sharing sleeping space may increase risk of getting the disease. Prevention / Treatment: Proper use and disposal of facial tissues, along with frequent, thorough hand washing is recommended to prevent transmission of the bacteria. Avoid sharing eating and drinking utensils, water bottles, and cigarettes. Since it is caused by a virus, there is no specific treatment, other than medications for fever and comfort. Getting plenty of rest and drinking fluids is also recommended. Seek immediate medical attention if infection is suspected. Forms of Response: Seek immediate medical attention. Viral Meningitis is a reportable disease and must be reported to the Durham Region Health Department at or ext For more information, visit: click Public Health, then Facts About...Viral Meningitis. Or call Durham Health Connection Line: or Durham District School Board: Communicable Diseases page 17

18 MONONUCLEOSIS What is it? Symptoms: Transmission: Mononucleosis, often called mono is an infection caused by the Epstein-Barr virus. Symptoms include fever, sore throat, headaches, white patches on the back of the throat, swollen glands, fatigue and lack of appetite. Sometimes, a swollen spleen or liver involvement may develop. The Epstein-Barr virus is found in saliva and mucus. It is usually passed from one person to another through kissing, sharing eating utensils, food and drink, and occasionally via coughing or sneezing. Prevention/Treatment: Since the cause is viral there is no immediate treatment other than to relieve symptoms. Physicians often recommend rest, plenty of fluids and analgesics for muscle aches and pain relief, however, ASA should not be given to children due to the risk of Reye s Syndrome. Special Considerations: A serious concern with mono is that the spleen will enlarge and even rupture. Signs of a ruptured spleen include pain in the left upper part of the abdomen, feeling lightheaded, increased heart rate and difficulty breathing. Exercise, sports activities should be avoided until the physician advises that the risk of rupturing the spleen is minimal, (usually 3-4 weeks after the infection starts). Forms of Response: Mononucleosis is not a reportable disease. Durham District School Board: Communicable Diseases page 18

19 MUMPS What is it? Symptoms: Transmission: Mumps is an acute disease caused by a virus. Common symptoms are fever, headache, and inflammation of one or more of the salivary glands which causes swelling and tenderness of the cheeks and jaw. Swollen and tender testes occur in 20-30% of post pubertal males. Mumps virus is spread by air borne droplets (coughing and sneezing) and with direct contact with the saliva of an infected person. The virus is present from six days before the onset of symptoms up to nine days after salivary gland swelling. Prevention / Treatment: Proper use and disposal of facial tissues, along with frequent, thorough hand washing is recommended to prevent transmission of the virus. Cover your mouth and nose during coughing or sneezing to prevent the spread to others. Avoid sharing eating and drinking utensils, water bottles, and cigarettes. Children should not attend school until 9 days after the onset of swollen salivary glands. Mumps can be prevented with a two dose measles, mumps, and rubella (MMR) vaccine. Special Considerations: Mumps during the first trimester of pregnancy has been associated with a higher chance of miscarriage. Forms of Response: Mumps is a reportable disease and must be reported to the Durham Region Health Department at or ext For more information, visit: click Public Health, then Facts About...Mumps. Or call Durham Health Connection Line: or Durham District School Board: Communicable Diseases page 19

20 NORWALK VIRUS What is it? Symptoms: Transmission: The Norwalk viruses are common causes of gastrointestinal illness. These very small viruses are difficult to detect and are a common cause of outbreaks in institutions such as nursing homes, hospitals, daycares and schools, as well as on cruise ships and at banquets. Symptoms usually occur 1-2 days following contact and include nausea, vomiting, watery diarrhea, stomach cramps, headache, muscle aches and mild fever. Coming into contact with infected persons, swallowing contaminated food or water or contact with infected surfaces such as railings, doorknobs, or bathroom fixtures can cause the disease. Several outbreaks have been related to consumption of contaminated shellfish. Prevention/Treatment: There is no specific treatment however, rest and replacing fluids lost from vomiting and diarrhea is helpful. A replacement electrolyte solution may be recommended for severe cases. Proper hand-washing technique, proper washing of raw fruits and vegetables before consumption and ensuring that shellfish is properly cooked are ways to prevent transmission. People with symptoms should stay home for 48 hours after symptoms resolve. Special Considerations: The virus can persist for up to 12 days on surfaces, so cleaning and disinfecting of shared surfaces and equipment is essential. Forms of Response: Individual cases of Norwalk Virus are not reportable; however, a noted increase in the numbers of cases in any one institutional setting should be reported to the Durham Region Health Department, Environmental Division at or ext For more information, visit: click Public Health, then Facts About...Norwalk Virus. Or call Durham Health Connection Line: or Durham District School Board: Communicable Diseases page 20

21 PEDICULOSIS (HEAD LICE) What is it? Head Lice are tiny insects that live on the hair of the head. Nits are the tiny eggs that are produced by the female lice and stick to the shaft of the hair 3-4mm from the scalp. It is the grayish-white nits that are usually visible upon inspection. Lice do not cause sickness or death, but they are an uncomfortable nuisance. They have nothing to do with lack of cleanliness. Symptoms: Transmission: Symptoms are itching and scratching of the head. Scratch marks on the neck and scalp may look like a rash. Adult lice are gray to brown in colour and less visible to the human eye. The nits are grayish-white, oval in shape and resemble dandruff, but cannot be flicked off. School children are more susceptible to head lice, because of sharing of head gear, including hats and ear phones; and closer head-to-head contact. Adult lice crawl from head to head and do not jump or fly. Head lice do not live on cats and dogs and so are not transferred to humans from this source. Prevention/Treatment: Action should be taken as quickly as possible. Two treatments, 7-10 days apart are required. Shampoo, cream rinse or lotion for treatment of head lice can be purchased at a pharmacy without prescription and must be used as directed to be effective. Discourage students from sharing headgear, such as helmets and hats, or sharing combs and brushes (as commonly occurs on school photo day). Special Considerations: Extra house cleaning is not needed, however, washing bedding, headgear, towels and clothing in hot water is often recommended. The heat of the water or a hot drying cycle will kill any live lice or nits. For more detailed information See DDSB Procedure #5120 Pediculosis (Head Lice), or contact Durham Region Public Health at: or Durham District School Board: Communicable Diseases page 21

22 PINWORM What is it? Symptoms: Transmission: Pinworms are microscopic intestinal worms that usually affect school children and pre-schoolers. Often more than one family member is affected. Itching around the anus, disturbed sleep and irritability. Pinworm disease is spread from person to person by eating pinworm eggs. The eggs travel to the intestines where they hatch and mature. The mature worms travel to the anus where they deposit a new batch of eggs (usually at night). This results in itchiness. Scratching the infested anal area can transfer the eggs to hands allowing for spread to others directly or indirectly by contaminated clothing, bedding, food, toys or other articles. Prevention/Treatment: Anti-parasitic medication is available from a physician to treat the pinworm infection. Entire families often require treatment if several members are infected. Good hygiene, including daily bathing, cleaning of toilets and laundering of bedding and underclothing as well as proper hand-washing can prevent transmission of the parasites. Special Considerations: Animal pinworms CANNOT be transmitted to humans. Forms of Response: Pinworm is NOT a reportable disease. For more information, visit: click Public Health, then Facts About...Pinworm. Or call Durham Health Connection Line: or Durham District School Board: Communicable Diseases page 22

23 RINGWORM What is it? Symptoms: Transmission: Ringworm is a fungal infection which causes a ring-shaped rash. The rash will often appear to have a raised edge and will be flaky and itchy. When the scalp is infected, an area of baldness is often seen and the hair breaks off slightly above the scalp. When someone with ringworm touches or scratches the rash, the fungus sticks to the fingers or gets under the fingernails and spreads when the person touches someone else. If the ringworm is on the scalp it can be spread by sharing hats, combs or hairbrushes. Animals can spread ringworm to humans. In the sport of wrestling, referees, check athletes for signs of ringworm prior to starting each match. Prevention/Treatment: Ringworm can be cured with medication prescribed by a physician. Treatment usually lasts 4-6 weeks and may be given as an oral medication or more commonly an anti-fungal topical cream. To prevent the spread of ringworm, hands must be thoroughly washed after contacting the affected skin. The area affected should be covered with clothing if possible and avoid using public swimming pools while infected. Special Considerations: In the sport of wrestling, referees check athletes for signs of ringworm prior to starting each match, and infected athletes are not allowed to participate. Forms of Response: Ringworm is NOT a reportable disease. For more information, visit: click Public Health, then Facts About...Ringworm. Or call Durham Health Connection Line: or Durham District School Board: Communicable Diseases page 23

24 RUBELLA (GERMAN MEASLES) What is it? Symptoms: Transmission: Rubella (German Measles) is a disease caused by the Rubivirus. The virus causes fever, swelling of the glands in the neck and behind the ears, and a rash beginning on the face and progressing down the torso, arms and legs. The rash usually lasts for 3 days or less. Joint pain also occurs and is more common in adult women. Up to half of children and adults infected with rubella don t develop any symptoms. Rubella is spread through contact with discharges from the nose or throat through coughing, sneezing, or talking. A person is contagious from 7 days before, to 14 days after the onset of the rash. Prevention / Treatment: Proper use and disposal of facial tissues, along with frequent, thorough hand washing is recommended to prevent transmission of the virus. Cover your mouth and nose during coughing or sneezing to prevent the spread to others. Avoid sharing eating and drinking utensils, water bottles, and cigarettes. Children should not attend school until 7 days after the onset of the rash. Rubella can be prevented with a two dose measles, mumps, and rubella (MMR) vaccine. Special Considerations: Pregnant women who have been exposed to rubella and who are not immune should consult with their physician. Unborn babies have a high risk of complications possibly resulting in miscarriage, mental retardation, deafness and a host of other problems. Death of the fetus is also a possibility. Pregnant women should not get vaccinated. Women planning a pregnancy should not get pregnant within 3 months of getting the vaccine. Forms of Response: Infected individuals should remain home for at least 4 days after the onset of the rash. Rubella is a reportable disease and must be reported to the Durham Region Health Department at or ext For more information, visit: click Public Health, then Facts About...Rubella. Or call Durham Health Connection Line: or Durham District School Board: Communicable Diseases page 24

25 STREP THROAT / SCARLET FEVER What is it? Symptoms: Transmission: Strep throat is caused by the bacteria, Streptococcus A. The bacterium may produce a toxin that leads to Scarlet Fever. Symptoms of strep throat include fever, sore throat and swollen neck glands. If Scarlet Fever occurs, a rash that feels like sand paper will appear on the neck, chest, armpits, elbows and groin. The tongue is often bright red and pitted like a strawberry. Strep throat is usually spread person to person through direct contact. The bacteria is found in the nose and throat and is spread through the air during sneezing or coughing. If Strep throat causing Scarlet Fever is not treated, the bacteria may be spread to other people for up to 3 weeks. Prevention / Treatment: Proper use and disposal of facial tissues, along with frequent, thorough hand washing is recommended to prevent transmission of the virus. Cover your mouth and nose during coughing or sneezing to prevent the spread to others. Avoid sharing eating and drinking utensils, water bottles, and cigarettes. Strep throat must be treated with antibiotics. Children with Strep Throat should stay home for 24 hours after prescribed antibiotics have been started. Special Considerations: Scarlet fever may have latent effects. Kidney and heart problems can develop from ten days to five weeks following infection. Forms of Response: Infected children should be excluded from school until 24 hours after treatment starts and remain on treatment for ten days. Strep Throat or Scarlet Fever is NOT a reportable disease. For more information, visit: click Public Health, then Facts About...Scarlet Fever. Or call Durham Health Connection Line: or Durham District School Board: Communicable Diseases page 25

26 TUBERCULOSIS What is it? Symptoms: Transmission: Tuberculosis (TB) is a disease caused by bacteria called Mycobacterium tuberculosis. The bacteria usually attack the lungs (pulmonary), but may travel via the bloodstream and affect the bones, kidneys, liver, brain, joints, intestines, skin, lymph nodes and reproductive organs (extrapulmonary). People with TB infection will not have any symptoms and won t know they have been infected unless they have a positive TB skin test. Once the infection has progressed to TB disease or active pulmonary tuberculosis, it is marked by a bad cough that lasts longer than 2 weeks, coughing up blood or phlegm, pain in the chest, night sweats, weight loss, weakness or fatigue, and fever. Only about 10% of people with TB infection will develop TB disease. TB is spread through the air. People with active TB in the lungs can transmit the disease through the air by coughing, sneezing, singing, or talking, Prevention / Treatment: Cover your mouth and nose during coughing or sneezing. Proper use and disposal of facial tissues, along with frequent, thorough hand washing is recommended to prevent the spread to others. TB disease is treated with several antibiotics over several months with close medical supervision, usually by an infectious disease specialist. TB infection can also be treated with antibiotics for several months to prevent active disease from developing. All of these antibiotics are available free of charge, arranged through the Durham Region Health Department. Persons with active TB disease are monitored closely to ensure treatment is effective and indicate when the person is no longer infectious to others. They must not attend work, school or public activities until considered non-infectious, meaning they no longer can transmit the disease to others. Special Considerations: Medication to treat either TB infection or disease must be taken exactly as prescribed. Disappearance of TB disease symptoms does not mean disappearance of the disease. Drug resistant strains of TB, caused by poor medicine regimens, are becoming a major cause of concern for health practitioners. Close household contacts must have a TB skin test to determine if they have been infected by the bacteria. A positive skin test indicates TB infection. Further testing is required to see if the infection has progressed to TB disease. Durham District School Board: Communicable Diseases page 26

27 Forms of Response: Tuberculosis is a reportable disease and must be reported to the Durham Region Health Department at or ext All positive skin tests should be reported to the health department as well. For more information, visit: click Public Health, then Facts About...Tuberculosis. Or call Durham Health Connection Line: or Additional Information: The World Health Organization (WHO) is concerned about the world-wide magnitude of the modern TB epidemic and in April 1993 it declared tuberculosis to be a global emergency. People travelling to Asia, Africa, India, the Middle East, Central and South America, and the Caribbean should have a TB skin test before and after the trip as these are places with high rates of Tuberculosis Durham District School Board: Communicable Diseases page 27

28 WHOOPING COUGH (PERTUSSIS) What is it? Pertussis, or whooping cough, is a highly contagious upper respiratory disease, caused by the bacteria, Bordetella pertussis. It can affect all ages. Infants under 6 months of age are at high risk for severe illness. Symptoms: Transmission: Early symptoms resemble those of the common cold including sneezing, runny nose, low-grade fever and a mild cough. Within 1-2 weeks, the cough becomes more severe and includes episodes of numerous rapid coughs followed by a high pitched whoop. Vomiting is common following repeated coughing spells. Vaccinated people who become ill with pertussis usually have only mild illness. Pertussis is spread easily from person to person during coughing and sneezing or direct contact with nose or throat secretions and less commonly through contact with articles freshly contaminated with nose or throat secretions. The incubation period is 9 to 10 days (range 6-20 days). Whooping cough is contagious up to three weeks after the onset of cough if not treated with antibiotics or five days after beginning treatment with antibiotics. Prevention / Treatment: Proper use and disposal of facial tissues, along with frequent, thorough hand washing is recommended to prevent transmission of the virus. Cover your mouth and nose during coughing or sneezing to prevent the spread to others. Avoid sharing eating and drinking utensils, water bottles, and cigarettes. People with whopping cough should stay out of contact with other children, especially babies and women in their 3 rd trimester of pregnancy until 5 days of antibiotics have been taken. All household contacts of a case should also receive antibiotic treatment to prevent the spread. Though antibiotic treatment will shorten the period of communicability in the case, it may not reduce the symptoms. Vaccination against the complications of pertussis is recommended for children beginning at two months of age and ending before seven years of age. For adults, a single dose may be given when the person is due for their next diphtheria and tetanus booster. Proper hand washing, covering the mouth when coughing/sneezing, and good hygiene will prevent the transmission of the bacteria. If a person is ill, they should stay home and isolate themselves as much as possible from family members. Durham District School Board: Communicable Diseases page 28

29 Special Considerations: All children less than seven years of age and not immunized are at risk and should consider vaccination. Forms of Response: Contact your physician if you suspect a pertussis infection. The disease is most infectious during the first two weeks, before the characteristic cough begins. Pertussis is a reportable disease and must be reported to the Durham Region Health Department at or ext For more information, visit: click Public Health, then Facts About...Pertussis. Or call Durham Health Connection Line: or Additional Information: All household contacts of a case should also receive antibiotic treatment to prevent spread. Though antibiotic treatment will shorten the period of communicability in the case it may not reduce the symptoms. Durham District School Board: Communicable Diseases page 29

30 HAND WASHING IMPORTANCE: Proper hand washing is THE MOST IMPORTANT thing you can do to prevent transmission of communicable diseases. Classrooms are especially conducive to the spread of infection because of the close proximity students and the sharing of materials and resources. WHEN SHOULD YOU WASH YOUR HANDS? when hands are visibly soiled after using the washroom after assisting a student with toileting after changing a diaper after blowing your nose or coughing or sneezing into your hands before and after eating or handling food, (especially raw meat, fish, or poultry) after handling garbage HOW DO I WASH MY HANDS PROPERLY? use warm water and wet your hands thoroughly use 1-3 ml of liquid soap (or clean bar soap if that is all that is available) and lather well. Friction will help to remove dead skin and other particles that contain potentially harmful organisms. Soap breaks down skin oils that tend to hold these particles, so that they are easier to remove. Continue to scrub for 15 seconds, including between fingers and around fingernails Rinse hands under warm running water. Point hands down and rinse from wrists to fingertips. It is best to dry hands with a paper towel and to use this towel to turn off taps. A clean, cloth towel could also be used, but it should not be shared. If no towels are available, dry hands with a hot air dryer. If a hot air dryer is used, then you should attempt to protect your hands when turning off the tap or touching other surfaces as you exit the washroom. OTHER CONSIDERATIONS: Cover cuts or open sores with bandages and wear gloves where practical Keep your hands away from your eyes, nose or mouth Assume that any contact with human body fluids is infectious Where hand-washing facilities are not available, hand sanitizers may be used, but these should never be relied upon when there has been known contact with body fluids. SEE THE FOLLOWING PAGES FOR POSTERS ON HAND WASHING AND HAND SANITIZERS AND THE HAND WASHING DVD AVAILABLE IN EACH SCHOOL HAND WASHING Durham District School Board: Communicable Diseases page 30

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34 ROUTINE PRACTICES Category: Personnel Policy #4244 Durham District School Board Policy: Communicable Diseases 1.0 The Durham District School Board will make every effort to provide a safe environment for students and employees. At the same time, the laws providing confidentiality to the student or employee infected with a communicable disease will be fully enforced in co-operation with the Ministry of Health and the Medical Officer of Health. 1.1 Recognizing that education has a vital role to play in the prevention of transmission of communicable diseases, instruction about certain of these illnesses, including AIDS, shall be included in the curriculum. Appendix: None Document Links: Effective Date 88/10/24 Amended 2006/08/08 Durham District School Board: Communicable Diseases page 34

35 ROUTINE PRACTICES Category: Personnel Regulation #4244 Durham District School Board Regulation: Communicable Diseases RESPONSE TO INCIDENTS INVOLVING BLOOD AND BODY FLUIDS INTRODUCTION TO BLOOD AND BODY FLUIDS Hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV) are bloodborne viruses that are transmitted from one person to another through body fluids such as blood, semen, vaginal secretions, feces, nasal secretions, sputum and vomitus. An exposure to these viruses can occur from a needle stick injury with a used needle, an injury with a sharp object that has been in contact with a body fluid, nonintact skin (rash, or open wound) that has come in contact with a body fluid, splashing of blood or body fluids into the mouth, eye, or open wound (i.e. vomit that has blood in it) or a bite that breaks the skin. 1.0 OBJECTIVE To establish procedures for responding to incidents involving blood and other body fluids in order to prevent transmission of blood-borne infections such as Hepatitis B, Hepatitis C and Human Immunodeficiency Virus. 2.0 RESPONSIBILITY 2.1 The Durham District School Board will make every effort to provide a safe environment for students and employees. According to the Personal Health Information Protection Act (PHIPA) and the Municipality Freedom of Information Act (MFIPA), providing confidentiality to the student or employee infected with an infectious disease will be fully enforced. 2.2 Recognizing that education has a vital role to play in the prevention of transmission of infectious diseases, education about blood-borne infections of interest, including AIDS, shall be included in the curriculum. Durham District School Board: Communicable Diseases page 35

36 ROUTINE PRACTICES 2.3 All staff must be informed of and adhere to policies, procedures, and guidelines regarding occupational exposure to blood-borne infections. 2.4 Staff responsible for responding to this policy will include but not be limited to: Superintendents; Area supervisors; and School principals. 3.0 PROCEDURES 3.1 The term routine practices is used to describe specific procedures that must be utilized at all times during potentially hazardous situations and to minimize and/or prevent the transmission of potential blood-borne infections. 3.2 Routine practices shall be used whenever administering first aid or cleaning spills of blood or body fluids. Body fluids are defined as semen, vaginal secretions, feces, nasal secretions, sputum, vomitus, and other body fluids containing blood Key Components of Routine Practices: Hand hygiene Use of protective barriers (Personal Protective Equipment (PPE)) Cleaning and disinfection of potentially contaminated surfaces Safe handling/disposal of potentially contaminated material A disinfectant, for purposes of this procedure, is defined as a Durham District School Board approved disinfectant 3.4 Hand Hygiene: Frequent hand washing is the most effective way to prevent the spread of infectious diseases in schools Wash hands frequently and thoroughly, especially after contact with any blood and body fluids or a contaminated surface Wet hands with warm water and apply soap Rub hands vigorously together and scrub all surfaces (backs of hands, between fingers, thumbs and around fingernails) for at least 15 seconds. The soap, combined with the scrubbing action, helps dislodge dirt/soil and remove germs Thoroughly rinse hands under warm running water, removing all traces of soap lather. Durham District School Board: Communicable Diseases page 36

37 ROUTINE PRACTICES Dry hands with a paper towel. Taps should be turned off using the towel, then discard paper towel. If hot air dryers are available, ensure hands are completely dry. 3.5 Protective Barriers: Always wear appropriate protective barriers (disposable gloves) when contact with blood and body fluids is expected The Occupational Health and Safety Act (OHSAct) requires the employer to provide and maintain personal protective equipment in good condition, to require their use, and to train the worker on their use. [OHSAct s. 25 (1)(b), (d) and (2)(a), (h)] Protective barriers reduce the risk of exposure to potentially infectious substances through contact with broken skin or mucous membranes Gloves: Disposable medical grade nitrile gloves offer the optimal protection against viruses that may be present in blood or body fluids Gloves are necessary for cleaning and disinfecting potentially contaminated surfaces and handling of potentially contaminated waste Change gloves after each task or exposure If using disposable gloves, discard after each use; gloves should be removed inside-out, one at a time, and dispose as contaminated waste Wash hands thoroughly with warm water and soap after removing gloves. (see 3.4 Hand Hygiene) Personal Protective Equipment (PPE): Protective eye glasses and a mask (medical, surgical or procedural) must be provided and used where blood and body fluids are likely to splash on the mucous membranes of the eyes, nose or mouth Safety goggles and/or face shields should also be worn when using the disinfectant. Where the spill or area of contamination is extensive, an impervious disposable coverall and shoe protectors (booties) as well as a mask should be worn. Gowns, lab coats or aprons must be provided and worn when clothing is likely to be soiled Resuscitation Devices: To minimize your exposure during emergency mouth-to-mouth resuscitation, mouthpieces or other resuscitation devices should be provided and utilized Resuscitation devices should be a disposable type and available in every first aid kit and discarded after each use. Durham District School Board: Communicable Diseases page 37

38 ROUTINE PRACTICES Cleaning of contaminated surfaces: Consider the use of PPE before cleaning and disinfecting a contaminated area/surface (e.g. single use gloves, disposable gown, surgical mask and eye goggles/face shield) Discard all contaminated clean-up materials (i.e. paper towels, rags) in double plastic bags If necessary, absorb the blood or body fluids (e.g. vomitus) using paper towels, and dispose of Clean contaminated surfaces or objects with detergent and water. Rinse surfaces with clean water to remove detergent film After a thorough cleaning and rinsing, disinfect the surface, object or area by applying disinfectant with a clean paper towel/cloth or pouring onto area. Only use clean cloths/paper towels; do not reuse. Avoid spraying on disinfectant when possible. For floors, soak a mop in the disinfectant and wipe the floors. Some toys or other objects can be immersed directly in the disinfectant Leave the disinfectant in contact with the surface or object for at least 10 minutes, or according to the manufacturer s instructions. Rinsing is not necessary, unless it is a food contact surface Double bag and seal contaminated clothing. Have employees bring their contaminated clothing home to wash and dry on a hot cycle Carefully remove gloves so as to avoid contaminating the hands Contaminated disinfectant may be disposed of by pouring it down the drain For outdoor toys and equipment (i.e. shovels, buckets, climbers and swings) follow the process for cleaning, disinfecting, and disposal of clean-up materials as above If there is blood in sandboxes or other ground surfaces, remove the blood-soaked sand or dirt, and discard appropriately Carpets should be thoroughly cleaned with detergent and water, and rinsed thoroughly with water. If practical, absorb the blood or body fluid using paper towels, prior to cleaning, and dispose of appropriately. Where the spill is extensive, shampooing should be done with a germicidal carpet shampoo after the blood and/or body fluids have been removed Following clean-up, discard gloves and wash hands with soap and water. Dispose of PPE appropriately. Durham District School Board: Communicable Diseases page 38

39 ROUTINE PRACTICES Safe handling/disposal of contaminated material: Discard all contaminated clean-up materials in double plastic bags Consider all contaminated waste as infectious Wear disposable gloves and handle all contaminated wastes carefully to prevent body contact Any object that could cut or puncture the skin such as needles or broken glass may carry infectious disease material and should be handled with caution. Dispose of sharps in a Durham District School Board approved unbreakable, non-pierceable containers that have a lid. Never place sharps in the regular trash (see Warning! Needles are a Danger poster). 3.6 Routine Preventative Measures: Discard cracked and broken toys In classrooms where younger children may mouth toys, regularly clean toys, rinse, disinfect toys and rinse again Toothbrushes and other personal items are not to be shared Keep other children away from areas where blood and body fluid spills have occurred, to minimize exposure to blood Broken skin (i.e. cuts, abrasions) should be covered with a bandage so that it is protected from contact with blood and body fluids. The bandage also contains any leakage of blood from site, therefore preventing potential contamination of surfaces. 3.7 Precautions to Take When Applying First Aid: Disposable gloves should be part of a first aid kit, and used when performing first aid. However, DO NOT delay first aid if gloves are not available During first aid, use clean/sterile disposable materials on open wounds. Cover cuts or open wounds with clean/sterile bandages Use direct or indirect pressure to control the bleeding depending on the type of wound and based on your first-aid training. Wash any visible blood off of the intact skin with warm, soapy water if it does not compromise first-aid measures and the situation is stable. Discard blood stained clean-up materials appropriately. Durham District School Board: Communicable Diseases page 39

40 ROUTINE PRACTICES 4.0 POST EXPOSURE PROPHYLAXIS It is very important to be aware of the risks of exposure to infectious diseases and to understand how to prevent or minimize the risk of exposure. Exposures can be prevented by following routine practices, implementing appropriate procedures, and utilizing personal protective equipment (PPE). If there has been an exposure to blood or body fluids, the individual should go immediately to a local Emergency Department for medical assessment by a physician. If the Emergency Room physician examines the individual and identifies that an exposure occurred, he/she will determine the need for prophylactic treatment or vaccination to prevent infection from the exposure. In addition, baseline blood work for HIV, Hepatitis B and Hepatitis C will be done with additional follow up blood work at 3 months and 6 months after the date of exposure. 5.0 STEPS TO BE FOLLOWED BY DURHAM DISTRICT SCHOOL BOARD STAFF TO ENSURE INFECTION CONTROL WITHIN SCHOOLS 5.1 Staff shall consult the Durham District School Board resource: Communicable Diseases and Medical Procedures Resource Manual, and the Durham Region Health Department resource: Guidelines For Communicable Disease Reporting & Exclusion, to assist in the control and management of communicable diseases. 5.2 The principal shall inform the Superintendent of Education/Operations of any trends in cases of infectious disease. The superintendent will consult with the Durham Region Health Department to ensure proper precautions are in place to maintain confidentiality for the student(s) involved. The identity of the student and the details of the infection are to be kept in strict confidentiality. 5.3 The Superintendent of Education/Operations, in consultation with the Durham Region Health Department, parent(s), guardian(s), school staff, or student where appropriate, will develop a course of action to protect the student and school community involved. The dissemination of information to students/staff/ community, if at all, will be determined, ensuring confidentiality and privacy of information to all involved. 5.4 Students will be excluded from school only when advised by a physician or Medical Officer of Health or per the resource, Guidelines For Communicable Disease Reporting & Exclusion. The Durham Region Health Department is available for consultation as needed. 5.5 Alternate instruction may be provided if determined that the student must be excluded from school due to the infectivity of the illness. Decisions regarding alternate instruction shall be made on a case-by-case basis. Teachers and other education workers who provide alternate instruction will be informed of required precautions as necessary and should not be placed at risk for transmission of the illness. Durham District School Board: Communicable Diseases page 40

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