Droplet Precaution Infection Control Education for COVID-19
Mitigating the Spread of COVID-19: Mandatory Staff Training for Millbury Public Schools
Millbury Public SchoolsHealth Services Department
September 2020
COVID-19 Overview
What is it?
➢ COVID-19 is the name of the disease caused by the new coronavirus called SARS-CoV-2, or sometimes just “novel coronavirus”.
How is COVID-19 Different From Other Coronaviruses?
➢ The coronavirus family of viruses includes four common strands of the virus, which often cause mild respiratory infections like the common cold, and three other human coronaviruses: SARS, MERS, and now SARS-CoV-2.
➢ Since this is the first time human immune systems have seen this particular strain, we have not developed immunity yet.
➢ Everyone is at risk of getting COVID-19, including children.
➢ Older adults and people of any age who have serious underlying medical conditions may be at higher risk for more severe illness.
Symptoms➢ COVID-19 symptoms can range from
mild (or no symptoms) to severe illness.
➢ Symptoms develop between 2 and 7 days in 75% of cases and after 14 days in <1% of cases.
➢ Median incubation period is 4-5 days.
➢ Asymptomatic viral shedding may occur at some stage in up to 50% of patients, although this remains contentious.
➢ Fever (100° Fahrenheit or higher), chills, or shaking chills
➢ Cough (not due to other known cause, such as chronic cough)
➢ Difficulty breathing or shortness of breath
➢ New loss of taste or smell
➢ Sore throat
➢ Headache when in combination with other symptoms
➢ Muscle aches or body aches
➢ Nausea, vomiting, or diarrhea
➢ Fatigue, when in combination with other symptoms
➢ Nasal congestion or runny nose (not due to other known causes, such as allergies) when in combination with other symptoms
Daily Symptom Screening➢ Staff must monitor themselves for symptoms
daily.
➢ By showing up for work, you are self-certifying that you:
○ Have no flu-like symptoms, no signs of a fever or a measured temperature above 100 degrees or greater, a cough or shortness of breath within the past 48 hours.
○ Have not had “close contact” with an individual diagnosed with COVID-19 or exhibiting flu-like symptoms in the past 48 hours
○ Have not been asked to self-isolate or quarantine by a doctor or a local public health official.
○ Have been cleared by a Medical Professional to return to work or have been symptom free for at least 3 days without medicine and at least 10 days since symptoms began.
➢ Staff and students must stay home if feeling unwell. Everyone must do their part to protect others and not come to school if they are exhibiting any COVID-19-like symptoms.
➢ If staff have any of these symptoms, they must get a test for active COVID-19 infection prior to returning to school. If a Provider makes an alternative diagnosis for the COVID-19-like symptoms, you may return to school based on the recommendations for that alternative diagnosis (i.e. influenza or strep).
➢ It can take a few days to get your test results and while you are waiting, you should stay home and limit your contact with anyone else.
Covid-19 Transmission: Droplet/ Droplet Contact
What are Droplets?
➢ Secretions greater than 5 microns in diameter, generated from the respiratory tract of the source patient during activities such as coughing, sneezing, singing or talking.
Droplet Transmission
➢ Pathogens spread through close respiratory contact/ mucous membrane contact with respiratory secretions.
➢ You can become infected by coming into close contact (about 6 feet) with a person who has COVID-19.
➢ Covid-19 is primarily spread from person to person.
Droplet/ Contact Transmission
➢ To a much smaller degree, transmission can also occur when contact with virus-laden objects is followed by contact with mucous membranes from face touching.
➢ A recent 2020 literature review published in the Lancet has shown that the chance of transmission through inanimate surfaces in real-life scenarios is very small, warning against excesses that become counterproductive (Goldman 2020).
Covid-19 Transmission: *Of Note● The SARS-CoV-2 virus may also be shed in stool, raising the
unconfirmed possibility of fecal-oral transfer, and reinforcing the need to properly and consistently wash hands.
● Airborne transmission of SARS-CoV-2 can occur during medical procedures that generate aerosols. WHO, together with the scientific community, has been actively discussing and evaluating whether SARS-CoV-2 may also spread through aerosols in the absence of aerosol generating procedures. Droplets <5 microns in diameter are referred to as droplet nuclei or aerosols.
Chain of Infection
➢ Measures used for diseases that are spread by direct contact through droplet transmission.
➢ Includes universal precautions + additional “droplet precautions”
➢ These measures are intended to break the Chain of Infection at various points in the cycle.
Droplet/ Droplet Contact Precautions:
Universal Precautions
What does it mean?
➢ A set of infection control strategies and standards designed to protect individuals from exposure to potential sources of infectious diseases.
➢ Standard Precautions
How does it look?
➢ Hand Hygiene
➢ Respiratory Hygiene/ Cough Etiquette
➢ Clean and disinfected environmental surfaces
➢ Safe handling of potentially contaminated equipment or surfaces
Hand Hygiene Notes ➢ Wash your hands often with soap and water for at least 20
seconds:
○ After blowing your nose, coughing, or sneezing○ Before and after working with individual students○ After going to the bathroom○ Before and after preparing food○ During food preparation as needed○ Before eating food○ If you touch your face or mask○ After doffing gloves/ PPE
➢ If soap and water are not readily available, use an approved hand sanitizer (greater than 60% ethanol or 70% isopropanol). Cover all surfaces of your hands and rub them together until they feel dry.Proper handwashing technique demonstration
Droplet Precautions in the School SettingStudent Placement
➢ Physical distancing
➢ Space seating/ desks 6 feet apart when feasible, 3 feet minimully
➢ Strict adherence to a specific size of student groups
➢ Staggered drop-offs/ pickups
➢ One way hallways
➢ Cohort classes
➢ Assigned seating
Teacher Strategies
➢ Utilize outdoor space when possible
➢ Limit unnecessary visitors
➢ Implement hand hygiene education and breaks
➢ Disinfect surfaces between students
➢ Don’t share student equipment, or disinfect equipment between uses
➢ Wear a face shield or goggles if in close contact with students
PPE
➢ Universal masking: fabric or 3ply consumer face masks
➢ No masks with exhalation valves or vents
➢ N95 masks for Health Staff assessing probable COVID-19 students
➢ Faceshields or goggles for teachers and staff working in close contact with students
➢ Gloves and gowns when working with certain populations
* Please Remember: If holding in-person meetings in any capacity, sit at least 6 feet apart *
Goal:BreakTheChainof Infection
Assigned Seating➢ Assigned seating is important because it effectively creates even smaller cohorts within classes,
which minimizes transmission.
➢ Assigned seating will assist with contact tracing. Wherever possible, seats should be assigned (including classrooms, specials, buses, and during meals).
➢ Teachers will need to keep a master seating chart and share this chart with administration and nursing.
➢ Do not change students’ seats without noting the date and change in the Master Chart.
➢ Keep accurate records of students you meet with outside of the classroom setting.
Student Groupings
Please aim to decrease the numbers of student (and IA) close contacts.
● If students are working in pairs, always pair with an existing close contact/ keep records of pairings.
● Circle time needs to be distanced with assigned seating, sitting near existing close contacts.
● Student working groups (labs, cooking, etc.) should always be the same, working with existing close contacts/ keep dated grouping records.
● 1:1 students should be kept with the same IA (rotating IAs will result in the quarantining of multiple IAs and/or all of their students with one positive case).
PPE Notes: Masks● Masks are the most important single measure to contain the
spread of COVID-19.
● We require all students and staff to wear masks that adequately cover both their nose and mouth. Exceptions must be made for students with medical, behavioral, or other challenges who are unable to wear masks/face coverings.
PPE Notes: Masks➢ No mask with an exhalation valve (respirator
type masks) will be permitted in the Millbury Public Schools.
➢ If you have requested a KN95 mask:○ Please see the nurse to obtain your masks.○ You will receive 4 masks that will be
replaced once monthly (so as to wear each mask 4 times).
○ Wear a disposable or cloth mask over the KN95.
○ Place your KN95 in a labeled paper bag between uses. No not store the KN95 in a sealed plastic bag.
○ Watch the attached video for further explanation.
➢ When removing masks for a mask break or meals, place the mask external side up (like in this video) on a paper towel or designated, disinfected tray.
➢ DISINFECT HANDS BOTH before and after either putting on or taking off your mask!
PPE Notes: GlovesHow to properly doff gloves: Donne: To put on...Doff: To take off
➢ Gloves should not be worn in routine classroom situations or when working with more than one student.
➢ They should only be worn when working directly with one student, if it is anticipated that you will be coming in contact with bodily fluids.
➢ Hands must be washed prior to donning and after doffing gloves.
PPE Notes: Eye Protection
➢ A face shield or goggles can provide extra protection if you will be working within 6 feet of a students to assist them with one to one tasks, such as helping with fine motor skills/ grip issues, assisting with ADLs, etc.
➢ A face shield DOES NOT take the place of a mask, and a mask should still be worn.➢ Acts as a barrier to prevent droplets from entering the body through the eyes-both through person to
person contact and through self-contamination (touching one’s own eyes without cleaning hands first).➢ It is important to disinfect the outer surfaces at least once daily.➢ If you have requested a face shield from the district, please see the nurse to obtain it.
Clinic Access Changes ➢ In an effort to minimize exposure of healthy students to those with potential
infectious disease, changes impacting the Health Office include:
○ Creation of a separate space for suspected respiratory illness (this space will be separate from the open areas of the Nurse’s clinic.
○ RN/LPN/AT travels directly to the ill student’s classroom for evaluation and treatment of minor illness/medical needs (discretion and student privacy will be maintained).
○ If a student needs to physically report to the clinic for care, the teacher will first call the nurse and convey the reason for the visit.
○ No student will be sent directly to the clinic without staff first receiving approval from the nurse. No answer? Don’t send!
COVID Comfort Room➢ Adjacent to Clinic at all schools
➢ A waiting room for students with probable COVID-19 symptoms to isolate
➢ If student or staff is experiencing COVID-19-like symptoms, CALL THE CLINIC
○ Nurse will come get student and escort to waiting room. Please realize that nurses will need to suit up to do a complete respiratory assessment on these students. The nurse will also need to triage and finish care for students already sent down, be patient.
Reminder:➢ It is very important that you DO NOT come to school if you are sick and
experiencing a fever (temp > 100 degrees) or other Covid-19 symptoms.
➢ Be prepared to provide remote learning at all times, should you receive a call in the afternoon that you have been identified as a close contact and will need to teach from home for 2 weeks.
➢ If you or a household member (close contact) are diagnosed with COVID-19 or you are experiencing Covid-19 symptoms, please contact your administrator regarding coverage and they will add your name to the Nurse Shared COVID-19 testing document (for nurse follow up).
➢ You must follow up with the nurse, or administration, regarding your COVID-19 test results, so a return-to-school date can be determined, and the nurses can determine & notify necessary in-school close contacts of positive cases.
Contact Tracing in the School:➢ Close contacts of a positive COVID-19 case should be
tested. For general guidance, DPH defines close contact as:○ Being within less than 6 feet of COVID-19 case for at least 15
minutes. Close contact can occur while caring for, living with, visiting, or sharing an area or room with a COVID-19 case while the case was symptomatic or within the 48 hours before symptom onset,
○ OR having direct contact with infectious secretions of a COVID-19 case (e.g., being coughed on) while not wearing recommended personal protective equipment.
➢
Contact Tracing in the School:➢ The town nurse will provide support/
assistance with contact tracing. However, staff are asked to notify the Nurse Leader or Administration if you test COVID positive.
➢ The school nurses, with assistance from the educator and/ or administration, will determine and notify close contacts of positive cases within the school
➢ (Employees should not directly reach out to student families and/ or other staff members).
➢ Examples of close contacts:
○ You live in the same home.○ You share a small work space.○ You are intimate partners. ○ You rode in the same car.
➢ NOT examples of close contacts:
○ You were their cashier at the grocery store.
○ You are a teacher who gave the student the pass.
○ You were in front of the person in line in the lunch line.
○ You transitioned with the student for 5 minutes.
Contact Tracing in the School:➢ In school settings, close contacts include other students and staff
who were within 6 feet of the student or staff for at least 15 minutes in a classroom, in other school spaces, on the bus, or at an extracurricular activity.
➢ Possible close contacts will not be allowed to come back to school until self-quarantined for 14 days, regardless of testing. Testing is still helpful in regards to determining if a close contact is an asymptomatic carrier, however CDC recommendations are fluid.
Contact Tracing in the School:➢ Specific Scenarios DESE Guidance
● If a student is at school when they learn they were in close contact with an individual who tested positive for COVID-19, they should be masked for the remainder of the day (including K-1 students) and adhere to strict physical distancing. At the end of the day, they should go home and should not take the bus home. They should stay at home and be tested 4 or 5 days after their last exposure.
○ NOT an urgent situation.○ Exposures have already taken place.○ Moving student out of their daily routine will create additional close contacts should student
eventually test positive.○ If student is in school, they are not symptomatic AND they should NOT be sent to the
COVID Comfort room, as this is for confirmed positive or symptomatic students.○ Student should not be tested for 4 to 5 days from last exposure. ○ We are universally masking and distancing under the theory that anyone could be a close
contact.
When can I return to school after I had or likely have had COVID-19?
I think or know I had COVID-19, and I had symptoms:
➢ You may return after 3 days with no fever AND➢ symptoms improved AND➢ 10 days since symptoms first appeared
Depending on your healthcare provider’s advice and availability of testing, you might get tested to see if you still have COVID-19.
***If you will be tested, you may return when you have no fever, symptoms have improved, and you receive two negative test results in a row, at least 24 hours apart.***
When can I return to school after I had or likely have had COVID-19?
I tested positive for COVID-19 but had NO symptoms:
➢ If you continue to have no symptoms, you may return after 10 days have passed since testing.
Depending on your healthcare provider’s advice and availability of testing, you might get tested to see if you still have COVID-19. If you will be tested, you can be around others after you receive two negative test results in a row, at least 24 hours apart.
If you develop symptoms after testing positive, follow the guidance in the previous slide for “I think or know I had COVID, and I had symptoms”
Travel GuidelinesAll individuals arriving in Massachusetts by any means or mode, including Massachusetts residents who have left the state for anything more than transitory travel, MUST quarantine for 14 days unless they:
(1) are coming from a lower-risk state, or
(2) or meet the exemption criteria (lower-risk states, transitory travel, persons commuting for work/school, patients seeking/receiving medical treatment, workers providing critical infrastructure services)
Please see Mass.gov regarding latest travel orders...
Q&A➢ COVID-19 Questions → Nurses
➢ Testing Centers → Here
➢ Building Specific Infection Control Questions→ Facilities Manager
➢ Sick time/ FFCRA specifics → Business Office
➢ Please refer to your Primary Care Physician for any individual questions or concerns regarding your health during the COVID-19 pandemic.
➢ Please feel free to email the nurse leader with questions regarding this presentation: [email protected] or talk to your own school nurse.
➢ Refer to the CDC website for additional information and printable infographics: https://www.cdc.gov/coronavirus/2019-ncov/index.html
➢ The information presented in this slideshow was obtained from the CDC, WHO, NIH, DESE, The Lancet, and recommendations from the AAP.
