COVID-19 Return to School Plan - Clinic Guidelines

  • Purpose: The purpose of this plan is to outline the Azle ISD Health Services return to school guidelines and plan for the reopening of schools within the District during the COVID-19 pandemic. These guidelines have been carefully considered to address and promote the safety, health, and well-being of our students, staff, and community.

    Sick Day Guidelines

    • Symptoms Requiring an Absence for Students/Staff
      • Fever, chills, generalized body aches
        • Exclusion criteria: Fever of ≥100℉
    • Symptoms of COVID-19: Follow Controlling the Spread of COVID-19 Chart
      • Testing Resource TCPH
    • Active Vomiting or Diarrhea
      • The first 24 hours of antibiotic treatment
      • Undiagnosed, new, or untreated rash or skin condition
      • Doctor’s note requiring an individualized plan of care to stay home

    Re-Admittance Criteria

    • Fever: 24 hours fever-free (3 days), without the use of fever-reducing medication
    • COVID-19: Follow Controlling the Spread of COVID-19 Chart
    • Active Vomiting or Diarrhea: 24 hours since last episode (3 days), without using medication
    • Antibiotic Treatment: 24 hours have passed since first dose of antibiotic
    • Doctor’s note of clearance for various student-specific medical conditions
    • If student/staff chooses not to be evaluated by a medical professional, they will be considered a suspect case and required to complete the same three-step process as outlined above.

    Campus Support

    • Students, faculty, and staff will be highly encouraged to stay home if they feel sick or immunocompromised. If an individual presents to school with the above-mentioned “sick day guidelines” symptoms, they will need to go home until “Re-admittance Criteria” is met.

    Clinic Visits

    • All visits require a pass to enter. The pass must include student name, date, time, teacher, and complaint.

    Well Room Visits

    • Students may visit  the designated Well Room for needs such as:
      • Daily medication
      • Daily routine health procedures
      • Diabetic care or blood glucose monitoring

    Sick Room Visits

    • Teachers Must call the nurse prior to sending any student with complaints of the following symptoms:
      • Cough, shortness of breath
      • Congestion, sore throat, runny nose
      • Active vomiting
      • Active diarrhea
      • Severe persistent headache
      • Severe persistent stomach ache
    • Students must wear a mask/face covering and go directly to the area the nurse has relayed to the teacher to send the student. Temperature checks will be completed on every student who visits the Sick Room. Interventions and decisions will be made on a case-by-case basis in regards to appropriate exclusion criteria and communication with parent/guardian if necessary.
    • Students need to be picked up from the sick room within 30-60 minutes of being notified by the campus.

    The Following Conditions do not Need to be Sent to the Clinic:

    • Non-Emergencies
      • In order to prevent potential exposure to infectious diseases, promote isolation, and decrease office congestion, please note that students do NOT need to present to either the SICK ROOM or WELL ROOM with the following common situations:
        • Small paper cuts, abrasions, picked scabs. Have them wash the area and their hands with soap and water. Apply band-aid if needed
        • Localized bug bite - if no allergy history and not spread over a large area of skin, apply a cool paper towel to the area to prevent scratching.
        • Minor headache or fatigue with NO other symptoms. Allow them to get a snack or drink first. If persistently complaining after 20 minutes of waiting- Call Nurse to say you are sending to the SICK Room for a temperature check.
        • Mild stomach ache and/or nausea - allow students to use the restroom, drink water. If persistently complaining after 20 minutes of waiting- Call Nurse to say that you are sending to the SICK Room for a temperature check.
        • Anxiety/Stress/Psychosocial issues - if not affecting breathing or health- try water, take a break, and calming techniques. Contact the campus Counselor for assistance if needed.
    • Emergencies
      • If it is a true emergency, 911 should never be delayed. Activate EMS and delegate as appropriate. The student should stay in place for an in-person evaluation for any of the following signs & symptoms:
        • Confusion/disorientation/not themselves
        • Decreased level of consciousness
        • Shortness of breath/difficulty breathing
        • Dizziness/lightheadedness
        • Head injury/complaining of neck pain- DO NOT MOVE POSITION, keep the student calm and still
        • Vision impairment
        • Diabetic “lows”- unconscious
        • Hemodynamic compromise: Loss of a lot of blood
        • Individualized triage judgment of faculty/staff or based off of reported condition as directed by Nurse

    Designation of Well and Sick Rooms

    • To be determined by each campus

    Interventions to Help Mitigate the Spread

    • Avoid close contact with someone who is sick.
    • Stay home when you feel sick.
    • Cover coughs and sneezes in the bend of your elbow or with a tissue. Throw the tissue in the trash, follow with hand hygiene.
    • Avoid touching mucous membranes such as your eyes, nose, and mouth. If you do, wash your hands afterward.
    • Wash hands often with soap and water (20 seconds).
    • Use hand sanitizer (containing >60% alcohol content) only when soap and water are not available.
    • Clean and disinfect frequently touched objects using a regular household cleaning spray or wipe.
    • Ensure all vaccines are up to date for self and household members.
    • Promote non-contact methods of greeting.
    • Social distancing measures (at least six-feet apart).

     PPE Standards for Clinics

    • Appropriate PPE must be utilized in conjunction with universal precautions and proper hand hygiene.
      • Hand hygiene is required before and after each office encounter and each intervention.
        • Scrubbing with soap and water for 20 seconds is the preferred method. Hand Sanitizer with at least 60% alcohol is also acceptable.
        • Scrubbing with soap and water must be used with gross soiling.
    • Non-Respiratory Condition
      • GI
        • Consider the use of mask/face shield, in the case of active emesis.
        • Move student to separate isolation area in the case of active emesis.
      • Integumentary
        • Standard precautions; evaluate the need for escalation of PPE dependent on clinical picture, i.e.: weeping or draining wounds, potential exposure to bloodborne pathogens
      • Miscellaneous
        • Use clinical judgment to evaluate the risk of exposure
        • And implement appropriate PPE
    • Respiratory condition and Afebrile (No Fever)
      • Upper Respiratory Complaint
        • Utilize respiratory protective protocol (RPP) during assessment to prevent droplet transmission during close contact
          • If the lung sounds auscultated are clear, secretions are clear or absent, and cough is intermittent or absent teach the student proper respiratory etiquette.
          • If the lung sounds auscultated other than clear, secretions are thick, yellow, or green, and cough is persistent - wear a mask, isolate the student, and refer out for further evaluation.
        • Respiratory condition and Febrile (Fever)
          • Per the CDC and NASN, “The use of facemasks for persons with respiratory symptoms and fever >100 is recommended if available and tolerated by the person and developmentally appropriate.”
            • Isolate the student in a separate area.

    Communicable Disease Monitoring

    • Internal
      • Collaborate with campus secretaries and attendance clerks to record symptoms when students are called in for sick days.
        • Health Services to record symptoms in TxEIS Documentation.
          • Nurse will monitor illness for community disease trends.
        • Follow up with the parent to determine if the student will or has been seen by a physician. What is the plan of care?
        • Health Services to record confirmed communicable diseases in TxEIS.
      • Azle ISD will follow TCPHD guidelines for communicable disease notification procedures.
    • Considerations for the Closure of School
      • Follow guidance from TEA and DSHS regarding interventions when considering school closure.
      • Ensure communication with parents of students with medications in school about retrieval, storage, or destruction options. Document communications.
      • Coordinate a plan with the Superintendent and Administrative team.

    CDC Recommendations

    1. Considerations for Schools
    2. Quarantine and Isolation
    3. Public Health Guidance for Community-Related Exposure
    4. Disposition of Non-Hospitalized Patients with COVID-19
    5. COVID19 - Caring for someone at home
    6. Use Cloth Face Coverings to Help Slow Spread
    7. Public Service Announcements (PSAs)
    8. Covid-19 Videos
    9. Guidance for Reopening Buildings After Prolonged Shutdown or Reduced Operation

    References
    How To Remove and Store a Face Mask Safely