School Health Services

  • The school nurse (RN) serves in the health office on-site within buildings as the leader of the school health services team in the building and directly supervises in some cases LPNs and health aides. The RN ensures that medical directives, medical advisories, and medical practices, procedures, and protocols written by the School Medical Director are followed.

    Social Distancing

    • Every effort will be made for all students to be kept six feet apart any time a student comes to the health office.
    • Markers will be placed on the floor around the outside door of the health office and will be marked with tape or similar substance cordoning off a minimum of three feet on all sides.
    • Signage stating STOP! WAIT FOR THE NURSE! will be placed on the line. Space markers indicating six feet distancing will be on the floor for waiting students to stand or appropriately spaced chairs for them to sit.
    • A monitor, health aide, LPN, or the school nurse will supervise and triage students outside the health office and return students to class if they do not need to enter the health office.
    • When the health office is full (i.e., proper social distancing is physically impossible inside the health office), the school nurse will notify the building administrator that support is needed to prevent the office from becoming too crowded to maintain six feet of physical distancing.

    Protective Equipment

    • All health office staff will always have and wear a face covering while providing care in the health office.
    • All nursing staff will be fit tested annually for N95 masks. When N95 masks are made available in sufficient supply for health providers outside of the hospital setting, the RN or LPN under the direct supervision of an RN providing direct contact care to students will use an N95 mask. Otherwise, in the absence of N95 masks, the RN and LPN providing direct care may choose to double surgical type masks.
    • All health office staff will have a supply of gowns and gloves. The school nurse and LPN, if present, will have goggles and booties as needed for direct patient care.
    • All students or staff who enter the health office will wear a face covering. If they enter the health office without a face covering, one will be provided. Should the individual have a medical exemption from wearing a face covering, that individual will be strictly quarantined while in the health office six-feet away from anyone, particularly someone who might be ill with COVID-19.
    • If there are two offices available to the school nurse, a clean office and a containment office, the student unable to wear a face covering should be in the clean office unless the school nurse has assessed that the individual is a Person Under Investigation (PUI) for COVID-19. In that case, the person without a mask should stay in the containment room.

    Health Office Space

    • The Coordinator of Student Health will collaborate with building administrators before the start of the school year to attempt to create at least two office spaces during the COVID-19 pandemic: a clean room and a “containment” room.
    • The “containment” room would be used for any potentially ill child who could have an infectious condition, including COVID-19. The clean room, which could be the nurse’s office, would be for routine matters typically encountered in the school health office, such as daily medications, asthma treatments, diabetes testing, treatments of bumps, cuts, and bruises, etc. They will also collaborate on the matter of adult supervision in both rooms.
    • Both rooms need to be near one another so the health office staff can supervise students in each room. Both rooms, if possible, require sinks, windows for ventilation, and supplies appropriate for a health office. Both rooms require cots for students who need to rest until dismissal by a parent. Both rooms need a phone for communication within and outside the building. The RN is best able to work with the building administrator to ensure that both rooms are properly set up for smooth operation before the start of school.
    • In situations where a separate “containment” room is not possible, the health office needs to have the means to cordon off an area inside the health office, ideally near a window that can be open for ventilation, where an ill individual may be held until dismissal and decontamination of that space. A room divider that extends close to the ceiling and floor would be useful and better than curtains. Curtains would suffice if room dividers are not available. Proper ventilation by opening windows in the room will be necessary.
    • The school nurse will measure the health office room(s) before the start of school to determine the maximum number of students who can safely be distanced six feet apart before the room is considered full. As stated above, once that space reaches capacity, the nurse shall place a STOP sign on the door and call the school administrator for assistance. A line of chairs spaced six feet apart outside the health office might serve as a safer waiting area in that event until assistance arrives. If the office is full and a child or staff member has an emergency, the nurse would need to go to the emergency rather than the emergency being brought to the health office.

    In-Person Care

    • All students or staff entering the health office will wash their hands or use 60% or greater hand sanitizer.
    • If the suspected infectious condition is COVID-19 and an N95 mask is available, the nurse will don that mask. If one is not available, the nurse may choose to don two surgical type masks.
    • Limiting unnecessary student trips to the health office will be a primary goal to lessen the risk of spread of infection throughout the building.
    • All teachers will be supplied with a small supply of band aids, tooth boxes or envelopes, feminine hygiene products, etc., that they can use to keep students within the classroom to the best of their ability. This procedure will reduce students leaving their cohorts to roam in the hallways.
    • When a teacher must send a student to the health office, the teacher should call the school nurse who may choose to come or send a designate to the classroom and triage the student outside the classroom door. After an initial assessment, the nurse may return the student to the classroom or take the student to the health office for further assessment, treatment, or dismissal home.
    • The District will ask all parents of students on daily medications to discuss dosing schedules with their private physicians. They should attempt to ascertain whether long-acting medications or timing of medicines can be altered to allow delivery before and after school rather than requiring dosing in the middle of the school day to avoid trips to the health office, namely wandering in the hallways.
    • The school nurse will create a safe medication delivery system in a setting free from potential contamination. If a “clean” room is not available, a medication cart that is supervised at all times might be set up at critical medication times with a water pitcher and cups outside the office door. This setup will prevent students from having to enter the health office that might have ill students awaiting pick up when containment rooms are not available. Alternately, depending on school configuration and number of medications, the school nurse may consider taking medications to students and administering to them outside the classroom door, assuring the privacy and dignity of the student to the best of their ability.
    • Students with non-infectious respiratory conditions such as asthma who are on regular inhaler or nebulizer use need particular attention. Nurses will discuss with parents the importance of checking with private prescribers whether children are responsible and ready to carry and use medications independently to avoid trips to the health office needlessly. Students previously on nebulizers should discuss whether Metered Dose Inhalers (MDI) and spacers during the pandemic may be a safer choice rather than coming to the health office and using the nebulizer, even with their own tubing and mouthpiece.
    • For students who still need to use a nebulizer, nebulizers may not be used in the same space where there are other individuals. The nebulizer may not be used in either the clean or containment health office rooms. The nebulizer may cause the COVID-19 virus to persist in droplets in the air for one to two hours or longer. The administration of albuterol via a nebulizer must be in a location that minimizes exposure to other persons. It must be in a location where air is less likely to be recirculated into the general area of use by others. All dependent surfaces in the area of a nebulizer require disinfection. Ideally, doing the treatment outside on a porch is best, weather permitting. Lacking that, a small closet area that will not be used for 24 hours is another option. A school nurse must wear an N95 mask to assist the student with a nebulizer. Proper handwashing by the student and the nurse before and after the procedure is essential. The nurse will use standard precautions, don and doff a fit-tested N95 mask, gown, eye protector, and gloves, and assist the student using judicious avoidance. Following the procedure, the nurse will decontaminate and disinfect the entire machine and area and dispose of all contaminated tubing, mouthpiece, and PPE properly. Similar safety procedures shall be applied to students in need of suctioning during the school day, keeping in mind the risk for aerosolizing of the virus could cause the persistence of the virus in the air and on surfaces for several hours after the procedure. Because of the high risk of both of these procedures, if the school nurse is unable to find a safe location to conduct these procedures, the school nurse will alert the building principal to consider alternate solutions.
    • Parents of children with diabetes should discuss whether their children have become independent or self-directed enough to test in the classroom with minimal assistance from the classroom teacher to lessen the number of visits to the health office. Lacking that, consideration might be given to having a nurse or aide go to the student in the classroom rather than having the student walk in the hallways to go to the health office.
    • For students and staff already in school who become ill, school nurses will use the Fever/Symptom Flowsheet for triage.

    Hygiene, Cleaning, and Disinfection

    • The school nurse will adhere to and promote hygiene, cleaning, and disinfection guidance of the health office beyond the routine cleaning and disinfection that commonly occurs each day by District maintenance staff.
    • The health office will have posters that reinforce and educate proper handwashing, cough and sneeze etiquette, mask wearing, and physical distancing.
    • The school nurse will participate in classroom instruction on these issues at the request of classroom teachers.
    • The school nurse will maintain hygiene and disinfection within the health office by using spray disinfectant and disposable towels on cots and chairs between student use, treatment areas, sinks, bathrooms, and high-touch surfaces after use and whenever dirty or potentially contaminated.
    • The school nurse will ensure that health office staff are doing the same by assigning responsibility as needed.
    • Disinfection of the health office will occur after the care of a student, whenever the office is dirty or contaminated, as well as at the end of each day.
    • Handwashing or use of hand sanitizer will occur before and after treatment of or interaction with any new individual, whenever hands are dirty, after toileting, before and after eating, after using a tissue or sneezing and coughing, after removing gloves, and at least every two hours.

    Ventilation

    • Health office doors and windows will be opened to circulate fresh air to the greatest extent possible, weather permitting, while maintaining health and safety protocols.
    • In health offices where there are no windows, Directors of Facilities will ensure that appropriate filters are in place and are changed with proper frequency to decrease the risk of recirculated infectious and particulate matter. A “containment” room door will always be closed to the public; however, the windows may be opened for outdoor air, weather permitting, while maintaining health and safety protocols.

    Contact Tracing, Attendance and Reporting

    • The main office staff or teacher will notify the school nurse of reported cases of positive COVID-19.
    • The nurse will notify the Coordinator of Student Health Services who will notify the local public health department of positive confirmed cases as required by law. Confidentiality is always maintained by the school health office for all medical matters, except as required for a reportable disease to the public health department.
    • The school nurse, as a medical professional, and the main attendance officer or teacher who monitors attendance as District employees, shall not disclose medically confidential information to others.
    • The nurse will notify the public health department and the school physician if there is a detected uptick in cases or clusters of illness or more than 10% of the student body or staff showing signs of the same illness even if testing COVID-19 negative.

    Student Return to School

    • When the school has a confirmed positive student case of COVID-19, the school nurse will follow the Fever/Symptoms Protocols Flowsheet, including the return to school protocol.
    • The criteria include the CDC recommendations of:
      • Three days with no fever, and respiratory symptoms have improved (e.g., cough, shortness of breath) and
      • Ten days since symptoms first appeared.

    On-site Staff Illness

    • For staff who may become ill during the day and require nursing intervention, the Fever/Symptom Flowsheet is appropriate for use by the school nurse for employees in determining when to release an individual based on an assessment of possible COVID-19 illness.

    Return to work protocols will be managed by the Benefits Department since Federal and State regulations play a role in employee matters.