HIV Prevention Education Program

Policy Guidance on Communicable Diseases

The continuing expansion of medical knowledge about communicable diseases and expanding statutory and case law on the rights of individuals who may have the diseases make it imperative that local boards of education routinely review their policies and procedures for dealing with communicable diseases to be sure they are both legal and effective.

The State Board of Education periodically reviews and updates its policy guidance on communicable diseases and distributes the revised documents to public schools. The policy guidance was last revised in November, 1995. It consists of two parts: Communicable Disease-Student and Communicable Disease-Employee. Throughout the document, reference is made to Infection Control Procedures for Schools, published by the Missouri Department of Health and Senior Services.

The State Board of Education recommends that all local boards of education review their policies and procedures and make adjustments where necessary.  This policy guidance was approved by the Missouri State Board of Education in October, 1987 and revised in October, 1988, June 1989, September 1990 and November, 1995.

Communicable Disease - Student
Purpose
The School Board recognizes its responsibility to protect the health of students and employees from the risks posed by infectious diseases. The Board also has the responsibility to uphold the rights of affected individuals to privacy and confidentiality, to attend school and to be treated in a nondiscriminatory manner.

Immunization
Students cannot enroll and/or attend school unless immunized as required by Missouri law.

Universal Precautions
The district requires all staff to routinely observe universal precautions to prevent exposure to disease-causing organisms, and the district should provide necessary equipment/supplies to implement universal precautions.

Categories of Potential Risk
Students with infectious diseases that can be transmissible in school and/or athletic settings (such as, but not limited to, chicken pox, influenza and conjunctivitis) should be managed as specified in: (a) the most current edition of the Missouri Department of Health and Senior Services document entitled: Prevention and Control of Communicable Diseases: A Guide for School Administrators, Nurses, Teachers, and Day Care Operators and (b) documents referenced in 19 CSR 20-20.030 and (c) in accordance with any specific guidelines/recommendations or requirements promulgated by the local county or city health department.

A student infected with a bloodborne pathogen such as hepatitis B virus (HBV), hepatitis C virus (HCV), or human immunodeficiency virus (HIV) poses no risk of transmission through casual contact to other persons in a school setting. Students infected with one of these viruses shall be allowed to attend school without any restrictions which are based solely on the infection. The district cannot require any medical evaluations or tests for such diseases.

Exceptional Situations: There are certain specific types of behaviors (for example, biting or scratching) or conditions (for example, frequent bleeding episodes or uncoverable, oozing skin lesions) which could potentially be associated with transmission of both bloodborne, and non-bloodborne pathogens. No student, regardless of whether he or she is known to be infected with such pathogens, should be allowed to attend school unless these behaviors or conditions are either absent or appropriately controlled in a way that avoids unnecessary exposure.

In these exceptional instances, an alternative educational setting may be warranted. In certain instances, a designated school administrator may want to convene a Review Committee. The number of persons on the Review Committee should be limited. It is recommended that members be limited to: 1) the parent(s)/guardian(s), 2) medical personnel (student's physician, school nurse) 3) building administrator, 4) superintendent and/or designee. Local health department officials may be consulted and/or included as members of the review team. If the student is identified as having a disability, any change of placement would need to be effected through the Individualized Education Program (IEP) process. In the case of a student who is disabled, but not identified under the Individuals with Disabilities Education Act, any change of placement would need to be effected through a multidisciplinary team meeting.

Specific mechanisms should be in place to ensure the following are consistently done:

a)  All episodes of biting, and all children who exhibit repeated instances of significant aggressive behavior, should be reported to the designated school administrator.

b)  The school nurse, and the designated school administrator when appropriate, should be informed of any child who has recurrent episodes of bleeding or who has uncoverable, oozing skin lesions.

c)  The school nurse, and the designated school administrator when appropriate, should be promptly informed of any child with an illness characterized by a rash.

d)  The school nurse and designated school administrator shall be informed promptly of any instance in which the significant potential for disease transmission occurs.

Confidentiality

The superintendent or designee shall ensure that student confidentiality rights are strictly observed in accordance with law. Missouri law (§191.689 RSMo. (1994)) identified two groups of people within a school system who could be informed of the identity of a student with HIV infection on a “need to know” basis. They are:

1.  Those designated by the school district to determine the fitness of an individual to attend school (see recommended Review Committee membership listed above); and

2.  Those who have a reasonable need to know the identity of the child in order to provide proper health care.

Examples of people who need to know are: school nurse, review team members, and IEP team if applicable. Security of medical records will be maintained. Breach of confidentiality may result in disciplinary action, a civil suit, and/or violation of the Family Educational Rights and Privacy Act.

Education - Student
All students should receive age-appropriate information about the prevention and control of communicable diseases, to include the use of universal precautions.  Instruction should be incorporated within a comprehensive school health curriculum in grades K-12 as stated in Missouri School Improvement Program Standards.

Reporting and Disease Outbreak Control
Reporting and disease outbreak control measures will be implemented in accordance with state and local laws and Department of Health and Senior Services rules governing the control of communicable and other diseases dangerous to public health, and any applicable rules promulgated by the appropriate county or city health department.

Notification
Superintendents who supply a copy of a board-approved policy that contains provisions substantially similar to this guideline to the Department of Health and Senior Services shall be entitled to confidential notice of the identity of any district child reported to the Department as HIV-infected and known to be enrolled in the district (whether in a public or private school). The parent or guardian is also required by law to provide such notice to the superintendent.

Review
Districts should periodically review their policies and procedures and make revisions when necessary.

Approved:

Legal Refs:        §§167.191, 191.650-.703 RSMo.
                        Americans with Disabilities Act (42 U.S.C. 12101 et seq.)
                        P.L. 94-142 Individuals with Disabilities Education Act of 1973 (20 U.S.C. 1400 et seq.)
                        P.L. 92-112, Section 504 of the Rehabilitation Act of 1973
                        19 CSR 20.20.010 through 20.20.060 and 20.28.010

Communicable Disease - Employee
Purpose
The School Board recognizes its responsibility to protect the health of students and employees from the risks posed by infectious diseases. The Board also has the responsibility to uphold the rights of affected individuals to privacy and confidentiality, to continue their employment, and to be treated in a nondiscriminatory manner.

Universal Precautions
The district requires all staff to routinely observe universal precautions to prevent exposure to disease-causing organisms, and the district should provide necessary equipment/supplies to implement universal precautions.

Categories of Potential Risk
Employees with infectious diseases that can be transmissible in school and/or athletic settings (such as, but not limited to, chicken pox, influenza and conjunctivitis) should be managed as specified in: (a) the most current edition of the Missouri Department of Health and Senior Services document entitled: Prevention and Control of Communicable Diseases: A Guide for School Administrators, Nurses, Teachers, and Day Care Operators and (b) documents referenced in 19 CSR 20-20.030 and (c) in accordance with any specific guidelines/recommendations or requirements promulgated by the local county or city health department. A medical release may be required of the employee in certain circumstances.

An employee infected with a bloodborne pathogen such as hepatitis B virus (HBV), hepatitis C virus (HCV), or human immunodeficiency virus (HIV) poses no risk of transmission through casual contact to other persons in a school setting. Employees infected with one of these viruses shall be allowed to continue work without any restrictions which are based solely on the infection.

Exceptional Situations: There are certain specific conditions (for example, frequent bleeding episodes or uncoverable, oozing skin lesions) which could potentially be associated with transmission of both bloodborne, and non-bloodborne pathogens. No employee, regardless of whether he or she is known to be infected with such pathogens, should be allowed to continue work unless these conditions are either absent or appropriately controlled in a way that avoids unnecessary exposure.

Specific mechanisms should be in place to ensure the following are consistently done:

a)   The school nurse, and the designated school administrator when appropriate, should be informed of any staff member who has recurrent episodes of bleeding or who has uncoverable, oozing skin lesions.

b)  The school nurse, and the designated school administrator when appropriate, should be promptly informed of any employee with an illness characterized by a rash.

c)  The school nurse and the designated school administrator shall be informed of any instance in which the significant potential for disease transmission occurs.

Confidentiality
The superintendent or designee shall ensure that an employee's confidentiality rights are strictly observed in accordance with law. Security of medical records will be maintained and such records will be kept separate from other personnel records. Breach of confidentiality may result in disciplinary action and/or civil suit.

Training - Employee
All employees should receive training annually on  and the Communicable Disease Policy.

Testing - Employee
Requiring medical evaluations or tests of employees will not normally be authorized under the Americans with Disabilities Act (ADA) and Section 504 of the Rehabilitation Act. Schools may require post-offer, preemployment or annual physical examinations if the exam is job-related and if conducted on all employees or applicants for similar positions. Requiring medical evaluations or tests for infection with bloodborne pathogens is not allowed by law.

Reasonable Accommodations
Districts should develop procedures to respond to employee requests for reasonable accommodations when an employee has a disability as defined by Section 504 and/or the ADA.

Reporting and Disease Outbreak Control
Reporting and disease outbreak control measures will be implemented in accordance with state and local laws and Department of Health and Senior Services rules governing the control of communicable and other diseases dangerous to public health, and any applicable rules promulgated by the appropriate county or city health department.

Review
Districts should periodically review their policies and procedures and make revisions when necessary.

Approved: 

Legal Refs:       §§167.191, 191.650-.703 RSMo.
                       Americans with Disabilities Act (42 U.S.C. 12101 et seq.)
                       P.L. 93-112, Section 504 of the Rehabilitation Act of 1973
                       19 CSR 20.20.010 through 20.20.060 and 20.28.010