420 Procedure: Students and Employees with Communicable Diseases and Infectious Conditions

I.    DEFINITION OF COMMUNICABLE DISEASE OR INFECTIOUS CONDITION

Communicable disease or infectious condition includes all conditions identified by the Minnesota Department of Health (MDH) that are subject to mandatory reporting to MDH pursuant to Minnesota Rules (Minnesota Rule 4605.7040).

II.    CONDITIONS CREATING SIGNIFICANT RISK OF TRANSMISSION 

Determinations of whether a contagious individual’s school/work attendance creates a significant risk of the transmission of the illness to others will be made on a case by case basis. Such decisions will be based upon the nature of the risk (how the disease/infection is transmitted), the duration of the risk (how long the carrier is infectious), the severity of the risk (what is the potential harm to third parties), and the probabilities the disease will be transmitted and will cause varying degrees of harm.  When a student is disabled, such a determination will be made in consultation with the student’s individualized education program (IEP) or Section 504 team.  Some students and employees, because of special circumstances, positions and conditions, may pose greater risks for the transmission of infectious conditions than other persons infected with the same illness.  (Examples include students who display biting behavior, students or employees who are unable to control their bodily fluids, who have oozing skin lesions, or who have severe disorders which result in spontaneous external bleeding.)  Such circumstances need to be taken into account and considered in assessing the risk of transmission of the disease and the resulting effect upon the educational program of the student or employment of the employee by consulting with the Commissioner of Health, the physician of the student or employee, the district/school nurse and the parent(s)/guardian(s) of the student.

III.    PRECAUTIONS TO LIMIT RISK OF EXPOSURE

A.    Procedures for Exposure to Blood and Bodily Fluids. The school district will comply with OSHA Standards (29 CFR 1910.1030) which addresses routine procedures for handling blood spills and other potentially infected body fluids and for education of employees about these procedures. The school district will develop a Bloodborne Pathogens Exposure Control plan that informs employees about applicable workplace requirements/standards, the bloodborne pathogens and infectious diseases they may be exposed to, and measures to take to protect themselves.  The objectives of the control plan will be to reduce or eliminate occupational exposure to hepatitis B virus (HBV), hepatitis C virus (HCV), immunodeficiency virus (HIV), and other bloodborne pathogens, physical agents and infectious agents that are present in the workplace.  The District will provide information, training and personal protective equipment to those who are routinely exposed.

B.    Precautions Related to Students. Students who create a significant risk of transmission based upon the factors set forth in Paragraph II (including Students who have not been immunized as anticipated by Minnesota Statute 121A.15) may be required to temporarily receive alternative educational services in a manner that limits exposure to others.  The school district or school nurse, in consultation with the infected individual’s physician, the infected individual or parent(s)/guardian(s), and others, if appropriate, will weigh risks and benefits to the student and to others, consider the least restrictive appropriate educational placement, and arrange for periodic reevaluation as deemed necessary by the state epidemiologist.  Procedures for the inclusion of students with communicable diseases within the school environment will include any applicable educational team planning processes (e.g. IEP team or 504 team), including a review of the educational implications for the student and others with whom the student comes into contact.  Students who are prevented from attending school as a result of a communicable disease or infection and who are placed in their home or other facility for care and treatment by their medical doctor for 15 consecutive school days or more should be provided educational services consistent with state law.

C.    Guidelines for Release to Home of Students Based Upon Illness. School nursing staff will utilize their training and discretion to determine whether a student is suffering from an illness, disease or infection that warrants removal from school.  Consistent with state and county health guidelines, the following symptoms should be considered when determining whether to remove/send a student home due to illness:

1.    Fever. An elevation of body temperature above normal and accompanied by behavior changes, stiff neck, difficulty breathing, rash, sore throat, and/or other signs or symptoms of illness; or is unable to participate in routine activities. Temperature should be measured before giving medications to reduce fever. Axillary (armpit) temperature: 100 F or higher Oral temperature: 101 F or higher Rectal temperature: 102 F or higher. 

2.    Signs/Symptoms of Possible Severe Illness.  Child is unusually tired, has uncontrolled coughing, unexplained irritability, persistent crying, difficulty breathing, wheezing, or other unusual signs for the child. Exclude until a health care provider has done an evaluation to rule out severe illness.

3.    Diarrhea.  Diarrhea is defined as an increased number of stools compared with a child's normal pattern, along with decreased stool form and/or stools that are watery, bloody, or contain mucus. Exclude until 24 hours after diarrhea stops or follow specific disease exclusion if the pathogen is known; or until a medical exam indicates that it is not due to a communicable disease. Vomiting Child has vomited two or more times in the previous 24 hours. Exclude for 24 hours after last episode of vomiting, unless it is determined to be caused by a non-communicable condition and the child is not in danger of dehydration.

4.    Mouth Sores with Drooling. Exclude until a medical exam indicates the child may return or until sores have healed.

5.    Rash with Fever or Behavior Change Exclude until a medical exam indicates these symptoms are not those of a communicable disease that requires exclusion.

6.    Eye Drainage Purulent (pus) drainage with fever and/or eye pain. Exclude until examined by a heath care provider and approved for readmission.

7.    Unusual Color of Skin, Eyes, Stool, or Urine Exclude until a medical exam indicates the child does not have hepatitis A. Symptoms of hepatitis A include yellow eyes or skin (jaundice), gray or white stools, or dark (tea or cola-colored) urine. 

D.    Parent Determinations.  Parents, guardians and students will be advised in parent or student handbooks about those symptoms (listed in Section III C) which should result in a decision to keep the student at home due to suspected illness. 

E.    Precautions Related to Employees.  The District and an employee with a communicable disease/infection that poses a significant risk of transmission will undertake mutual efforts to develop and employ reasonable measures (e.g. protective garb, reassignment of duties/position to minimize risk or leave of absence) that adequately reduce the risk of transmission of the communicable disease/infection. The employee’s physician (with the consent of the employee) or other qualified medical care provider may be consulted to address concerns over risk of transmission.

IV.    Information Sharing

A.    Employee health information will be shared within the district only with those whose jobs require such information and with those who have legitimate need to know, and will be shared only to the extent required to perform the functions of the job.

B.    Student health information will be shared within the District only with those employees whose duties require access to such information and with those who have legitimate, educational interest.  Information may also be released as required to address a health and safety emergency or maybe released to appropriate health authorities to the extent necessary to administer immunization programs and for bona fide epidemiologic investigations which the commissioner of health determines are necessary to prevent disease or disability to individuals in the public educational agency or institution in which the investigation is being conducted).

C.    Student and Employee health data will be shared outside the district only in accordance with state and federal law and with district policies on employee’s records.

V.    Reporting

If a medical condition of an employee threatens public health, it must be reported to the Department of Health as required by the Minnesota Communicable Disease Reporting Rule (Chapter 4605).

VI.    Vaccination and Screening

The District will develop procedures regarding the administration of Hepatitis B vaccinations in keeping with current state and federal law.

Created/Revised
Revised: 04/17/2018 (Procedure 547 repealed 04/17/2018 – combined with Procedure 420: 04/17/2018)
Revised: 12/7/99
Revised: 3/7/89
Created: 5/20/86

Legal References
OSHA Standard 29 CFR 1910.1030
42 U.S.C. § 1771 et seq. (Child Nutrition Act of 1966)
Minn. Stat. § 13.32 Subd. 3(d)&(f)
Minnesota Communicable Disease Reporting Rule (Chapter 4605)
Hennepin County General Exclusion Guidelines for Ill Children/Staff (2015)