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H1N1 (Swine Flu) Influenza

Currently, the H1N1 (swine flu) influenza is presenting and spreading like the regular influenza.  Influenza is a serious health risk and may result in death even in a normal flu season.  As of April 29, there are zero confirmed cases in Nebraska. Although the H1N1 Flu is no longer containable, we do have the capability to prevent the spread of the virus to others.

Personal hygiene is the most important preventative tool for everyone.  Wash your hands and have students wash their hands frequently for at least 20 seconds with soap before rinsing.  You may consider having students use hand sanitizers (containing alcohol) in the classrooms and anytime the students move from one area of the school to another.  This is especially important after recess, physical education, and especially before and after lunch and always after restroom use.  Washing hands posters are available at http://www.hhs.state.ne.us/H1N1Flu/WashYourHandsFlyer.pdf

The decision to close schools rests with the local health department and local school authorities.  This is a serious matter that requires all schools to be vigilant. If there is a significant illness in a community, the local health department has the authority to close the school. The Center for Disease Control (CDC) is recommending the dismissal of students and closing of schools be strongly considered when one confirmed case or one suspected case epidemiologically linked to a confirmed case happens.  The CDC interim guidance further recommends that if no additional confirmed or suspected causes are identified among staff and students for a period of seven (7) days, schools may consider reopening.

Although the federal government has issued a declaration of public health emergency, Nebraska has NOT issued a declaration yet.  If Governor Heineman issues a declaration of public health emergency, school administrators should emphasize preventative measures, closely monitor student absences and work in cooperation with the local health department.

You can find more information on the CDC website, http://www.cdc.gov/flu/school/.  Also, see the information regarding school dismissal and childcare facility closure at http://www.cdc.gov/swineflu/

Thank you for your attention to this matter.

Roger D. Breed

Commissioner of Education

Date:    April 29, 2009

To:       LPS Families

From:   Judy Zabel, RN, Supervisor Health Services

Re:       Influenza Prevention

Lincoln Public Schools, in response to the Public Health Advisory regarding Swine Flu, is closely monitoring student illness and continuing its practice of excluding students who exhibit symptoms of illness. Custodial staff has increased its cleaning schedule and all staff has been instructed to implement the preventive steps listed below. We are also in daily communication with the Lincoln Lancaster County Health Department.

The following information is being sent to all LPS families to assist you in making decisions regarding your family’s health and safety.

The symptoms of Swine flu may include:

• Fever (greater than 100 degrees)
• Sore throat
• Cough
• Stuffy nose
• Chills
• Headache and body aches
• Fatigue
• Some people may experience diarrhea and vomiting

Anyone with symptoms who has traveled to an affected area or has been exposed to someone possibly infected with swine flu during the last 7 days should call their health care provider immediately.

If you or a family member is sick:

• Keep your distance from others to protect them
• Stay at home—do not go to work—if your child is sick do not send him/her to school
• Cover your cough with a tissue and throw the tissue in the trash after use
• Wash your hands often, especially after you cough
• Call your doctor

Good health habits can help stop the spread of viruses and germs

• Avoid close contact with people who are sick
• Cover your mouth and nose when coughing or sneezing
• Wash your hands often and assist your children to wash their hands
• Avoid touching your eyes, nose or mouth
• Germs are often spread when a person touches something that is contaminated with germs and then touches his or her eyes, nose, or mouth
• Practice other good health habits
• Get plenty of sleep
• Be physically active
• Manage your stress
• Drink plenty of fluids
• Eat nutritious food

Guidelines for Head Lice (LPS Website)

In order to:

• Better control a nuisance condition
• Reduce absenteeism due to head lice
• Involve parents as partners with the school in control efforts:

1. Children will be sent home from school for live head lice. In the event the child has TWO cases of live lice in a semester he or she will be sent home until free of both live lice and nits (eggs). Nit removal is emphasized for effective management of the condition.
2. Health office staff will provide written treatment information and instructions, including how to check for and identify head lice.
3. A child who is sent home from school for head lice should miss no more than two school days.
4. A child who has been sent home from school due to head lice must come to the health office for inspection before returning to class.
5. A child who returns to class with nits (eggs) will be checked again in 7-10 days.
6. Families are encouraged to report head lice to the school health office.
7. Individual buildings will perform classroom-wide or school-wide head checks as needed in order to control the condition at school.

Head Lice:

Head lice are a common problem that affects children of all ages. The majority of cases result from close contact with an infested person, sharing hair accessories, combs, brushes, caps, etc. Head lice do not jump or fly from person to person. If a student at LPS is identified with head lice, other siblings in the school and the entire classroom and possibly grade level are screened. All students with live lice are excluded from school until treatment is performed. We encourage parents to have their children back in school in 3 or less days. When the child returns to school, they must come to the health office and be checked BEFORE returning to the classroom. Any child who is sent home twice or more in a semester must be lice and nit free to return to school.

Tips for removing head lice safely are as follows:

• Check every member of the family.
• Use a product for treating lice (available at stores or prescription).
• Combing hair with a lice comb to remove all lice and eggs (nits).
• Wash clothing, bedding, towels and recently worn clothes in hot water and dry in a 140 F dryer.
• Items like stuffed animals, pillows, headphones and hats that are not washable can be dry-cleaned or stored in tightly sealed plastic bags for 2 weeks.
• Don’t forget to treat/clean backpacks, coats, and car seats.
• Vacuum floors and furniture.

Remind your students NOT to share hair accessories of any kind with others.

Information regarding Staph Infection:

The current media reports of Staph infections and particularly the MRSA strain of staph infection bring questions about how does this happen and what can I do to prevent an infection?

To prevent staph or MRSA skin infections the CDC recommends:

• Keep your hands clean by washing thoroughly with soap and water or using an alcohol-based hand sanitizer.
• Keep cuts and scrapes clean and covered with a bandage until healed.
• Avoid contact with other people’s wounds or bandages.
• Avoid sharing personal items such as towels or razors.

“Staph or MRSA infections in the community are usually manifested as skin infections, such as pimples and boils, and occur in otherwise healthy people.”  Please contact your healthcare provider if any family member has a skin lesion that does not heal quickly or if the person has any fever.

LPS Custodial staff clean and disinfect locker rooms, bathrooms and other areas on a regular basis. School Health Office staff reinforce the above prevention steps and work with students who do have scrapes and cuts to be sure they are cleaned and covered. All LPS staff are encouraged to reinforce the need for frequent hand washing which is the best way to prevent the spread of infections of all types.

Additional information is available at www.cdc.gov/

Over the Counter Medication Guidelines:

SPECIFIC MEDICATION PRODUCTS

Over the Counter Products

Because numerous over the counter products may be utilized in the school setting for personal hygiene, skin care, first aid, as well as for therapeutic purposes, such products are identified in four general categories for the purposes of describing authorization to administer. Section 1 products are used without specific consent, and are provided by the school. Section 2 and 3 products are used with written parental consent only. Section 2 products are provided by the parent; Section 3 products are provided by the school. Section 4 refers to all other medication administration products which require both written parental and medical authorization prior to administration.

1. PRODUCTS FOR TOPICAL APPLICATION THAT MAY BE USED IN HEALTH OFFICES INTERMITTENTLY AT DISCRETION OF HEALTH SERVICES STAFF:

Note: the products listed below may or may not be available in individual health offices depending on the discretion of the School Nurse assigned to the building. Written parental consent is not required prior to use.

• Skin Lotion
• Dacriose or Isotonic saline eye solution
• Deodorant
• Sting-Kill Swabs
• Vaseline
• Generic “Triple” topical antibiotic
• Aloe Gel
• Rubbing Alcohol
• Hydrogen Peroxide (for tracheostomy care)
• Hydrocortisone 1% topical (at the discretion of the School Nurse)
• Topical diphenhydramine
• Saline/Wetting solution for contact lenses

2. PRODUCTS THAT MAY BE USED AT PARENT REQUEST (INTERMITTENTLY OR CONTINUOUSLY)

Note: Parent provides supplies in original, labeled container. Parent also should provide signed written instructions for use of products.

• Desitin ointment
• Teething Gel
• A&D ointment
• Powders (talcum and/or medicated products)
• Sunscreen
• Orajel
• Aquaphor ointment
• Insect Repellent
• Isotonic/Lubricating Opthalmic drops (nonprescription) i.e. "Artificial Tears"
• Non-prescription antiseptic products not listed in Section 1, above.
• Non-prescription cough drops

3. “FORMULARY PROJECT”: ACETAMINOPHEN AND IBUPROFEN IN PARTICIPATING SCHOOLS

Note: Parent provides written consent, Attachment H. Product are supplied by school district. Dose and indications per this guideline, shown in Attachment I. For additional information, see next section of these guidelines.

4. PRODUCTS THAT REQUIRE BOTH WRITTEN PARENTAL CONSENT AND INSTRUCTIONS AND MEDICAL AUTHORIZATION

Note: Parent provides supplies in original, labeled container. Parent also provides written instructions and consent for use of products. Medical prescription also required for use.

• Any topical products not listed above, e.g. anti-fungal ointments.
• Any over-the-counter topical products not listed in Sections 1 or 2, above.

Exclusion Criteria

Guidelines for the Dismissal of Students with Health Concerns

1. The student with a temperature of 100 degrees or more.

2. The student with an undiagnosed rash/skin lesion. (Exception: If the student is taken to a physician, he/she may be readmitted with the doctor's written permission stating the rash is not contagious.)

3. Head lice.

4. Other conditions which may warrant a student being sent home include:

• Inflamed red eyes and/or drainage
• Vomiting and/or diarrhea
• Frequent persistent cough
• Earache and/or drainage from the ear
• Questionable illness or injuries which may require evaluation by a physician
• Sores that appear infected or are draining

Note: School nurses do assessments but do not diagnose.

Readmission

Parents or guardian report illness to the school office. Students having absences of three days or more due to communicable disease or injury should be readmitted through the health office. In questionable cases, a statement from the physician may be requested by the school nurse.

Students returning after a contagious disease may be admitted when free of symptoms (recommended temperature normal for 24 hours) at the discretion of the nurse. The communicable disease chart may be referred to as a guide. Additional resources include the Public Health Department and the Health Services Coordinator.

For complete infection control guidelines, contact the School Nurse.