DBB(REGULATION) - EMPLOYMENT REQUIREMENTS AND RESTRICTIONS: MEDICAL EXAMINATIONS AND COMMUNICABLE DISEASES
Diseases Covered by This Guideline
These administrative guidelines apply to all communicable diseases as listed in 25 Administrative Code Chapter 97.
The following diseases are to be reported to the County Health Department:
Acquired immune deficiency syndrome;
Chlanydia trachomatic infection;
Creutzfeldt-jakob disease (CJD);
Encephalitis (specify etiology);
Escherichia coli 0157:H7 infection;
Hansen's disease (leprosy);
Hemolytic uremic syndrome (HUS);
Hepatitis, acute viral (specify type);
Human immunodeficiency virus (HIV) infection;
Lead poisoning (adult elevated blood and childhood elevated blood);
Meningitis (specify type);
Pesticide poisoning (acute occupational);
Salmonellosis, including typhoid fever;
Spotted fever group rickettsioses;
Streptococcal disease (invasive);
Vibrio infection; and
The campus nurse (nurse) who has received the information that a staff member has a reportable disease will report the occurrence to the County Health Department.
The District recognizes that certain communicable diseases that staff members may contract are not serious, such as, but not limited to, chicken pox and influenza. For the communicable diseases that are, in the discretion of the nurse, not serious, the following administrative guidelines are permissive rather than mandatory except for provisions relating to reporting requirements and procedures for cleaning up bodily fluid spills.
The right to privacy of the individual will be respected. Therefore, knowledge that a staff member has a communicable disease should be confined to those persons with a direct need to know, if any, as determined by the nurse with the input from a group, which will include the staff member, the nurse, the staff member's physician, and/or a representative from the Harris County Department of Health. This group will provide information to determine if other individuals have a need to know in order to be able to provide assistance for the staff member with a communicable disease and protection for students and other staff members.
Factors to be considered in determining who, if anyone, has a need to know that a staff member has a communicable disease, include:
The nature of the communicable disease,
The modes of transmission of the disease,
The staff member's job assignment,
The risk of transmission,
The possible need to respond to a medical emergency, and
The mental and/or physical condition of the staff member.
Those persons who are determined as having a need to know will be provided an appropriate educational program, which will include information concerning such precautions as may be necessary with regard to the specific communicable disease and directives concerning the necessity of maintaining the confidentiality of the information.
With regard to a staff member who has an HIV infection, those persons with a direct need to know, if any, may be informed of the staff member's HIV infection only if the staff member authorizes such disclosure in writing. The nurse may seek authorization to disclose the information to those persons who have a need to know. Authorization will comply with provisions at CONFIDENTIALITY, above, and AIDS/HIV TEST RESULTS at item 3, below.
Health and Safety Code 81.101(5) of the Communicable Disease Prevention and Control Act defines "test result" to mean any statement or assertion that any identifiable individual is positive, negative, at risk, has, or does not have a certain level of antigen or antibody, or any other statement that indicates that an identifiable individual has or has not been tested for AIDS or HIV infection, antibodies to HIV, or infection with any other probable causative agent of AIDS. Health and Safety Code 81.103 provides that a test result is confidential. Any person, firm, corporation, physician, hospital, blood center, blood bank, laboratory, or other entity that possesses or has knowledge of the test results may not release or disclose a test result or allow a test result to become known.
AIDS / HIV Test Results
A test result concerning AIDS or HIV infection may be released under the following circumstances:
A test result may be released to a local health authority if reporting is required under the Act. With regard to the District, the nurse will notify the County Health Department when an HIV infection is known or suspected in a staff member and will provide all information known concerning any person who has or is suspected of having an HIV infection. The nurse will report to the County Health Department whatever information is deemed by the County Health Department to be necessary in a particular case.
A test result may be released to a physician, nurse, or other health-care personnel who has a legitimate need to know regarding the test result in order to provide for his or her own protection and to provide for the staff member's health and welfare.
A test result may be released if the staff member, or a person legally authorized to consent for the staff member, voluntarily releases or discloses the test result or authorizes the release or disclosure of the test result. The authorization must be in writing and signed by the staff member, or person legally authorized to consent for the staff member, and must state the person or entities, or classifications or persons or entities, to whom test results may be released or disclosed.
Any time any staff member of the District has, or suspects that he or she has, a communicable disease, the staff member is encouraged to report this information immediately to the nurse of the building where the staff member is assigned, who can provide information, education, counseling, and testing referrals.
If the nurse receives information that a staff member has a communicable disease from a source other than the individual believed to have a communicable disease, the nurse will proceed as follows:
When approached by the nurse, if the staff member reported as having a communicable disease confirms the report, the same procedures outlined in this guideline will be followed as when a staff member reports himself or herself.
When approached by the nurse, if the staff member reported as having a communicable disease denies the report, the nurse will offer assistance should it ever be needed but will not pursue the investigation.
The District will establish records on staff members reported as having a communicable disease:
When a staff member confirms that he or she has a communicable disease, the nurse will fill out the Staff Communicable Disease Form.
The staff member reporting that he or she has a communicable disease will be asked to sign a release allowing the nurse to communicate with other individuals who the group has designated as having a need to know regarding the staff member's condition in order to be able to provide assistance such as the immediate supervisor, the associate superintendent for human resources, or the Superintendent. Authorization to disclose that a staff member has an HIV infection will comply with item 3, at AIDS/HIV TEST RESULTS, above.
The file will be secured and will be accessed only by the nurse who is working with the staff member.
Evaluating the Risk
Each case will be handled on an individual basis with the input of the nurse, the staff member, his or her attending physician, and a representative of the County Health Department. The nurse will gather input from members of this group. Contact with the individuals of the group may be made individually by telephone or in a meeting of the group.
These persons, individually and/or as a group, will be responsible for the following:
Confirming the diagnosis and the probable duration of the disease;
Determining whether the staff member diagnosed with a communicable disease might pose a risk of transmission to other people in the District, the severity of the risk, and the nature of the risk;
Providing information to the staff member concerning the transmission of the communicable disease;
Providing information concerning the need to attend to the disease through medical care and personal hygiene;
Providing suggested sources for educational and psychological counseling;
Providing information concerning the avoidance of high risk behavior;
Providing transportation concerning the staff member's assignment as needed; and
Determining the need and procedure for follow-up: future group meeting and/or contact between members of the group.
Effect on Assignment
Staff members diagnosed as having a communicable disease who are determined, based on input from the group designated to evaluate the risk, not to pose a direct threat to the health or safety of others or to themselves and are able to perform the duties of their job, will be permitted to continue in normal work activities in an unrestricted manner.
Recommendations from the group, if any, concerning the person's employment status, conditions of employment, and/or assignment will be made to the Superintendent by the nurse or the assistant superintendent for human resources if the assistant superintendent has been approved in writing to function in the group by the staff member reported as having a communicable disease.
A staff member may be removed from his or her position temporarily or permanently whenever the staff member's condition constitutes a direct threat to the health or safety of others or when the staff member is unable to perform the duties of the job.
Current policies and procedures will be used to determine:
When the immunodeficient individual may need to be absent from assigned work duties for his or her own protection when cases of other acute or short-term communicable diseases, such as measles or chicken pox, are occurring in the District population.
When there is a question of whether the individual is physically or emotionally capable of performing his or her duties as a staff member of the District.
If the staff member wishes to contest decisions made by the Superintendent concerning his or her employment status, conditions of employment, and/or assignment, the procedures relative to any such appeal will be those provided by applicable District policies and procedures. [See DGBA]
In each instance of a person reported as having a communicable disease, the case will be reevaluated by the group when deemed necessary, or at least on an annual basis, so long as the staff member has a communicable disease and remains employed.
The nurse will routinely monitor the medical status of all staff members identified as having a communicable disease:
The nurse will function as the liaison with the staff member's physician regarding the individual's health status. When appropriate, the nurse will inform the staff member and/or his or her physician when the nurse receives information that a communicable disease is occurring in District staff or student populations. Such contact will be documented.
The nurse will function as the coordinator of services, if any, provided by other staff.
Should changes in the staff member's medical status warrant removal from his or her duties or assignment, before a staff member is removed from his or her duties or assignment, the nurse will convene the group authorized above to evaluate the individual to consider any new circumstances that may warrant removal from the District program.
The nurse will continue to monitor, as appropriate, the circumstances that necessitated the removal from duty and will determine whether the condition precipitating removal has changed.
Minimizing the Transmission of Communicable Diseases
Extreme caution will be taken in cleaning up blood or bodily fluid spills after a staff member reported as having a communicable disease has an accident or injury on campus or in any District program.
The District will be prepared to refer a staff member to sources of competent and confidential testing for a communicable disease upon a request from the staff member for such screening. All testing will be at the staff member's expense. In addition, the District will be prepared to refer those desiring to be tested to qualified counselors outside of the District. Such counseling will be at the staff member's expense.
Notifying Pregnant Staff Members
The school nurse is responsible for notifying pregnant personnel of the presence of the following communicable diseases in the school setting such as, but not limited to chicken pox, Fifth's Disease, hepatitis, measles, and meningitis. Such notice is limited to diseases that are known or suspected of adverse reproductive health effects.
The staff member will notify her personal physician.
A written statement from the physician will be given to the principal if there is a need for a placement change of the staff member.
The principal will notify the human resources division if a placement change is needed. The human resources division will work with the staff member and the physician.
The following precautions will be taken by staff members to help prevent the transmission of communicable diseases:
Hand washing with soap and running water for 15–30 seconds and drying with disposable paper towels is the single most important technique for preventing the spread of disease and should be done frequently:
Before eating, drinking, or smoking.
Before handling clean utensils or equipment.
Before and after handling a student's food.
Before and after assisting or training the student in toileting and feeding.
Before and after using the bathroom.
After contact with body secretions and excretions, i.e., blood, urine, feces, mucus, saliva, or draining from wounds.
After handling soiled diapers, feminine hygiene products, garments, or equipment.
After caring for any student, especially those with nose, mouth, or ear discharges.
Note: The wearing of disposable gloves is not a substitute for hand washing. Hands must be washed thoroughly after removing gloves.
The mouthing of toys, pencils, and other shared items by students should be strongly discouraged.
Kissing on the mouth, between caregivers and students or among students, is prohibited.
Daily sanitation of all surfaces involved in food handling or diapering and all surfaces or items that have been mouthed by students (including toys) should be done using a freshly prepared solution of 1/4 to 1/2 cup of household bleach in one gallon of water.
Exposure of open skin lesions or mucus membranes to blood or body fluid should be avoided. If open lesions are present, disposable gloves should be worn.
Surfaces soiled with blood or body fluids should be immediately and thoroughly cleaned. It is advisable to cover the blood/body fluids with paper towels, flood with a solution of one cup of household bleach in nine cups of water, and allow it to remain for at least 15 minutes before disposing of the paper towels.
Disposable materials (e.g., gloves, paper towels, and sanitary napkins) should be promptly discarded into sealable plastic bags.
Mops and other nondisposable cleaning materials are not recommended, but if used, should be rinsed in the disinfectant.
All students should be educated about appropriate hygienic measures to prevent the spread of communicable diseases. Those students who are known carriers of a communicable disease should be educated about the additional control measures for minimizing transmission of the specific disease. [See FFAD]