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					Canadian International School Bangalore

Clinical Policy 002

                         COMMUNICABLE DISEASE & INFECTION CONTROL

Issued:      2008

For Review: 2009

Reviewer:    Canadian International School Bangalore



  1. Aim

      This policy aims to provide guidance on the detection, spread and
      prevention of the most common school-wide communicable diseases and
      to co-ordinate measures with parents/guardians/house parents,
      tutors/principals and the school nurse. It is not intended to act as a
      guide to diagnosis. This should only be undertaken by an
      appropriately qualified medical practitioner.

  2. Objectives

      To inform parents/guardians/house parents and tutors/principals on the
      detection, spread and prevention of the most common school-wide
      communicable diseases.

      To encourage parents/guardians/house parents and tutors/principals to
      report all students and employees with either suspected or confirmed
      cases of a school-wide communicable disease immediately to the school
      nurse.

      To provide accurate information on school-wide infection control.

      To act quickly in the early detection of outbreaks (2+/clusters).

   3. Communicable Disease and Infection Control

      A communicable disease is an illness caused by a specific infectious
      agent or its toxic products through a direct or indirect mode of
      transmission of that agent from a reservoir. School-wide communicable
      diseases are inevitable. Because several of the diseases addressed in
      this policy are vaccine-preventable, it is expected that their incidence will
      be reduced with parents/guardians/house parents and principals ensuring
   students and employees are up to date with their country of origin’s
   recommended immunisation programmes; along with locally
   recommended programmes specific to their length of stay, and personal
   circumstances, in Bangalore.
   To further control school-wide infections we will 1. promote good
   student/employee hygiene practices; inclusive hand washing, coughing
   and sneezing, and environmental cleaning (see appendix 1) and 2.
   Follow internationally recognised guidelines for the detection, spread and
   prevention of potential, school-wide communicable diseases (see
   appendix 2). All outbreaks cannot be detected or prevented. This
   policy ensures best precautionary measures to reduce risks of
   outbreaks within the school environment.


4. Roles and Responsibilities

      The Role of the Parents/Guardian/House parents

      •   The primary responsibility for the initial identification of a
          communicable disease lies with the parent/guardian/houseparent.
          Confidential advice and support may be sought from the School
          Nurse’s Office. However, the School Nurse’s Office is NOT a
          diagnostic service.

      •   With the exception of head lice, if you suspect a student has a
          communicable disease then you are requested to, confidentially,
          inform the School Nurse’s Office immediately and seek a confirmed
          diagnosis from a medical practitioner. In the interest of other
          student’s/employee’s health, you are then requested to,
          confidentially, inform the School Nurse’s Office of the actual
          confirmed diagnosis.


      •   To follow CISB communicable disease policy and so help CISB
          reduce the risk of a potential outbreak.


      •   To encourage good hand washing, and coughing and sneezing ,
          habits (see Appendix 1).


      •   To keep the student up to date with their immunisation
          programmes.
The Role of the Tutors

•   To ensure that CISB communicable disease policy is followed
    within the school.

•   To avoid promoting advice or action that is not within the CISB
    policy.

•   To inform the school nurse’s office, in confidence, of any student
    they suspect may have a communicable disease.

•   To guide concerned parents to the School Nurse’s Office.

•   To ensure good hygiene practices (see Appendix 1) are promoted
    in his/her teaching environment.

•   To keep up to date with your personal immunisation programmes.


•   For female tutors to inform the nurse’s office of their confirmed
    pregnancies.


The Role of the Principal

•   To minimise the effects of communicable diseases on CISB
    students education.

•   To approve and ensure that CISB policy is followed within the
    school.

•   To avoid promoting advice or action that is not within the CISB
    policy.

•   To ensure all employees have a diagnostic communicable disease
    pre-employment screen at a reputable medical facility.

•   To ensure no pets/stray dogs/monkeys enter onto CISB site.


•   To ensure all tutors are kept up to date with up to date with their
    personal immunisation programmes; and those specific to their
    personal circumstances in Bangalore.
The Role of the School Nurse

•   To ensure that the CISB communicable disease policy is followed
    within the school.

•   To avoid promoting advice or action that is not within the CISB
    policy.

•   To ensure that the school nurse is contactable during normal
    working hours by parents and tutors for information, advice and
    support.


•   To develop evidence-based policies on communicable diseases
    and to provide advice on the management of communicable
    diseases within the school environment. He/she should be
    knowledgeable and competent on the subject and be able to teach
    the technique of good hand, and coughing and sneezing hygiene.


•   To seek specific advice from a registered medical practitioner on
    the outbreak of a specific communicable disease.


•   To maintain thorough health histories on all students and tutors with
    special attention to non-vaccinated, vulnerable and pregnant
    individuals. (see Appendix 2).
                                                                       Appendix 1
GOOD HYGIENE PRACTICE


Hand washing



This is one of the most important ways of controlling the spread of infections,
especially those that cause diarrhoea and vomiting and respiratory disease. The
recommended method is the use of liquid soap, water and paper towels.
Students and employees should always wash hands after using the toilet, before
eating or handling food, and after handling animals. All cuts and abrasions
should be covered with water proof dressings.


Coughs and Sneezes Spread Diseases!

Students and employees should be encouraged to cover their mouth and nose
with a tissue and to wash their hands after using or disposing of tissues. Spitting
should be discouraged.

Water Fountains & Beakers

Students and employees should not make direct contact with the nozzle of the
water fountains neither with their hand nor with their beakers.


Cleaning

Cleaning of the environment, including toys and equipment should be frequent,
thorough, with correct decontamination cleaning fluids and equipment used.

Cleaning of blood and body fluid spillages

 All spillages of blood, fasces, saliva, vomit, nasal, and eye discharges should be
cleaned up immediately. When spillages occur, they should be cleaned up using
a product which combines both a detergent and a disinfectant. Use as per
manufacturers instructions and ensure it is effective against bacteria and viruses,
and suitable for use on the affected surface. NEVER USE mops for cleaning up
blood and body fluid spillages. Use disposable paper towels and discard clinical
waste as describe below.
.
Personal Protective Clothing (PPE)

Disposable non powdered vinyl or latex free CE marked gloves and disposable
plastic aprons, should be worn where there is a risk of splashing or
contamination with blood/body fluids. Laundry should be dealt with in a separate
dedicated facility. Soiled linen should be washed separately at the hottest wash
fabric will tolerate. Soiled student’s clothing should be bagged to go home, never
rinse by hand.

Clinical waste

Always segregate domestic and clinical waste. Used nappies/pads, gloves,
aprons and soiled dressings should be stored in correct clinical waste bags in
foot operated bins.
                                                                                                              Appendix 2



                                                            GUIDELINES



Communicable Disease                                          Exclusion Period         Comments



Athletes foot                                                 None                     Athletes foot is not a serious condition.
                                                                                       Treatment is recommended.
Incubation Period: 2-3 wks

Detection: scaling, cracking and peeling of skin



Chicken pox                                                   5 days from onset of     School-wide ‘Alert’ letter to be sent out
                                                              rash.                    with special attention to close contacts
Incubation Period: 14-16 days
                                                                                       and vulnerable students and
Detection: profuse rash on trunk, fever, malaise                                       employees and pregnant employees.



Cholera                                                       Excluded until           Vaccine Preventable. School-wide
                                                              declared fit to return   ‘Alert’ letter to be sent out with special
Incubation Period: 2 hrs – 5 days
                                                              to school by a           attention to non-vaccinated children
Detection: severe diarrhoea, vomiting, dehydration,           registered medical       and employees.
and leg cramps etc.                                           practitioner



Cold Sores (herpes simplex)                                   None                     Students/employees should avoid
                                                                                       kissing and contact with the sores.
Incubation Period: 2-12 days
                                                                                       Cold sores are generally a mild self-
Detection: tingling, blister, crust to mouth or nose                                   limiting disease. Zoviraz is
                                                                                       recommended.
Conjunctivitis

Incubation Period: 1-3 days                                   None.                    Treatment depends on the cause. If an
                                                                                       outbreak occurs then consider
Detection: The eye waters profusely, appears
                                                                                       exclusion.
extremely red, and feels irritated. The eyelid may be
swollen and the student may complain of itching,
pain, and sensitivity to light. Vision is usually normal.
There may be drainage of mucous and pus or clear
liquid.



Dengue fever                                                  Excluded until           Students/employees encouraged to
                                                              declared fit to return   cover their skin and cover exposed skin
Incubation: 3-14 days
                                                              to school by a           with mosquito repellent daily. CISB to
                                                              registered medical       spray site with insecticide.
Detection: rapid development of a fever that may              practitioner

last from 3 to 7 days, intense headache, joint and

muscle pain, loss of appetite, diarrhoea and a rash.

The rash develops on the feet or legs 3 to 4 days

after the beginning of the fever.
                                                      GUIDELINES



Communicable Disease                              Exclusion Period            Comments



Diarrhoea and/or vomiting                         48 hrs from last            All cases of persistent diarrhoea in
                                                  episode of diarrhoea        students/employees , especially if
Incubation Period: 1-25 days
                                                  and/or vomiting.            accompanied by fever and cramps, should
Detection: 2 + episodes of loose                                              be referred to a medical practitioner. There
stools/vomiting within a 24 hr. period and                                    may be a common source of infection if
with/without abdominal pain, nausea,                                          there is an outbreak in a family, classroom,
vomiting, and fever. Organisms causing                                        outdoor education program, pool, hostel etc.
diarrhoea are most commonly viruses, but                                      within a short period of time.
may include bacteria and parasites. The kinds
                                                                              Exclusion from swimming will be for 2 weeks
and severity of symptoms will vary according
                                                                              following last episode of diarrhoea.
to the causative organism and the resistance
of the person infected



Diphtheria                                        Excluded until              Preventable by vaccination. School-wide
                                                  declared fit to return to   ‘Alert’ letter to be sent out with special
Incubation Period: 2-5 days
                                                  school by a registered      attention to close contacts and non-
Detection: infection of the mouth, pharynx,       medical practitioner.       vaccinated children and employees.
nose, or skin characterized by an inflamed
throat and the appearance of a grayish
membrane. The lymph nodes of the neck tend
to be enlarged and there may be marked
swelling of the neck; there may be
mucopurulent nasal discharge; malaise,
anorexia, sore throat, lymphadenitis, fever,
tachycardic; horesness, cough etc.
E. coli 0157 VTEC                                 At least 48 hrs from        School-wide Alert letters will be sent out.
                                                  last episode of
Incubation Period: 1-9 days                                                   Exclusion from swimming will be for 2 weeks
                                                  diarrhoea and/or
                                                                              following last episode of diarrhoea.
Detection: loose stools, abdominal cramps,        vomiting and upon 2
sometimes blood in stools.                        confirmed negative
                                                  stool samples by a
                                                  registered medical
                                                  practitioner.



German Measles (rubella)                          5 days from onset of        Preventable by vaccination. School-wide
                                                  rash.                       ‘Alert’ letter to be sent out with special
Incubation Period: 14-21 days
                                                                              attention to close contacts and non-
Detection: children – rash on face that                                       vaccinated children and employees;
spreads downward. adolescents and adults –                                    vulnerable students and employees and
fever, headache, malaise, anorexia, sore                                      pregnant employees.
throat, conjunctivitis, cough for 1-5 days; and
then rash etc.
Glandular fever                                   None.                       Avoid kissing. 50% of children get the
                                                                              disease before they are 5 and many adults
Incubation Period: 4-6 weeks
                                                                              also acquire the disease without being aware
Detection: swollen glands, fever, blood test                                  of it.
                                                      GUIDELINES



Communicable Disease                              Exclusion Period        Comments



Hand, foot and mouth                              None.                   If an outbreak occurs then consider exclusion.

Incubation Period: 3-6 days

Detection: fever, sores in the mouth, and a
rash with vesicles . Mild fever, poor appetite,
fatigue, and, frequently, a sore throat. One or
two days after the fever begins, sores develop
in the mouth. The skin rash develops over 1–
2 days. The rash does not itch and it is
usually located on the palms of the hands and
soles of the feet. It may also appear on the
buttocks.
Head lice                                         None.                   Regular wet-combing (grooming) should be
                                                                          carried out for early detection of infestations.
Incubation Period: variable
                                                                          See clinical policy (Headlice) 001.
Detection: 1 live louse
Hepatitis A                                       Until declared non-     Preventable by vaccination. Good personal and
                                                  infectious and fit to   environmental hygiene will minimise any possible
Incubation Period: 2-8 weeks
                                                  return to school by     danger of spread. Alert letter to go to close
Detection: fatigue, loss of appetite, fever,      a professional          contacts.
nausea, abdominal pain, gastrointestinal          medical
upset, and, in some cases, jaundice.              practitioner.

Hepatitis B & C                                   None.                   Hepatitis B & C are not infectious through casual
                                                                          school contact. Good hygiene will minimise any
Incubation Period: 2-6 months
                                                                          possible danger of spread of both hepatitis B &
Detection: fatigue, loss of appetite, anorexia,                           C. Hepatitis B can be prevented by vaccine and
fever, nausea, abdominal pain,                                            is recommended for students living in the hostel.
gastrointestinal upset, and, in some cases,
jaundice.



HIV                                               None.                   HIV is not infectious through casual school
                                                                          contact. There have been no recorded cases of
Incubation Period: 2 wks – 3 months
                                                                          spread within a school. Good hygiene will
Detection: diagnostic; reduced immune                                     minimise any possible danger of spread of HIV.
system, opportunistic infections
Influenza                                         Until recovered.        Influenza vaccination recommended for
                                                                          students/employees with chronic heart, lung and
Incubation Period: unstable                                               metabolic disorders (including severe asthma
                                                                          and diabetes); with kidney problems, or a
Detection: headache, fever, cough, sore                                   lowered immune system due to treatment or
throat, aching muscles and joints.                                        disease; everyone aged 65 years and over, and
                                                                          those in hostel accommodation where influenza,
                                                                          once introduced, may spread rapidly.
                                                       GUIDELINES



Communicable Disease                                   Exclusion Period         Comments



Impetigo                                               Until lesions are        Antibiotic treatment by mouth might speed
                                                       crusted or healed.       healing and reduce infectious period.
Incubation Period: 1-5 days

Detection: bacterial skin infection that may begin
with small vesicles (blisters) that later may
contain pus and become scabbed.
Staphylococcal or streptococcal bacteria cause
this infection of the skin.
Malaria                                                Excluded until           Students/employees encouraged to cover
                                                       declared fit to return   their skin and cover exposed skin with
Incubation: 7-10 days
                                                       to school by a           mosquito repellent daily. CISB to spray site
Detection: fever, chills, sweats, headache,            registered medical       with insecticide.
nausea, vomiting, fatigue, malaise etc                 practitioner.

Measles                                                5 days from onset        Preventable by vaccination. School-wide
                                                       of rash.                 ‘Alert’ letter to be sent out with special
Incubation Period: 10-20 days
                                                                                attention to close contacts and non-
Detection: fever, malaise, cough, conjunctivitis,                               vaccinated children and employees;
koplik spots and then 3-4 days later rash to face                               vulnerable students and employees and
which spreads downwards.                                                        pregnant employees.



Meningococcal meningitis/septicaemia                   Excluded until           Meningitis C is preventable by vaccination.
                                                       declared fit to return   School-wide ‘Alert’ letter to be sent out with
Incubation Period: 2hrs-10 days
                                                       to school by a           special attention to close contacts and non-
Detection: severe headache, fever, vomiting,           registered medical       vaccinated children and employees.
drowsiness, photophobic, irritable, confused,          practitioner.
neck stiffness and a rash of small red-purple
spots or bruises, which do not blanch under
pressure, seizure etc.



Meningitis due to other bacteria                       Excluded until           Hib Meningitis and pneumococcal
                                                       declared fit to return   meningitis are preventable by vaccination.
Incubation Period: 2hrs-10 days
                                                       to school by a           School-wide ‘Alert’ letter to be sent out with
Detection: severe headache, fever, vomiting,           registered medical       special attention to close contacts and non-
drowsiness, photophobia, irritability, confused,       practitioner.            vaccinated children and employees.
neck stiffness, cold, cyanotic skin , seizure, and a
rash of small red-purple spots or bruises, which
do not blanch under pressure etc



Meningitis viral

Incubation Period: 2hrs-10 days                        None.

Detection: neck stiffness, photophobia, fever,
vomiting, diarrhoea, aching joints & muscle pain
etc.
                                                      GUIDELINES



Communicable Disease                                         Exclusion Period         Comments



Molluscum contagiosum                                        None                     A self-limiting condition.

Incubation Period: 6-12 weeks

Detection: children and teenagers tend to experience
lesions on the face, trunk, hands and feet whilst adults
tend to have lesions on the lower trunk, genitalia and
inner thighs.


Mumps                                                        5 days from onset of     Preventable by vaccination.
                                                             swollen glands.          School-wide ‘Alert’ letter to be sent
Incubation Period: 14-21 days
                                                                                      out with special attention to close
Detection: fever, headache, malaise, anorexia, followed                               contacts and non-vaccinated
by “earache’ that is aggravated by chewing. 3rd day                                   children and employees.
enlarged parotid gland accompanied by pain and
tenderness etc.



Poliomyelitis                                                Excluded until           Preventable by vaccination.
                                                             declared fit to return   School-wide ‘Alert’ letter to be sent
Incubation period: 7-14 days
                                                             to school by a           out with special attention to close
Detection: mild or severe fever, malaise, gastrointestinal   registered medical       contacts and non-vaccinated
upset, headache, and sore throat. The disease may            practitioner.            children and employees
resolve after 24–48 hours or it may progress to include
marked stiffness of the neck, back, and legs. These
symptoms can then progress to recovery; and then
signs of central nervous system paralysis.




Rabies                                                       Excluded until           Preventable by vaccine.
                                                             declared fit to return
Incubation: 10-60 days
                                                             to school by a
Detection: fever, headache, and general discomfort.          registered medical
Within days, the disease can progress to symptoms such       practitioner
as anxiety, confusion, agitation, abnormal behaviour,
delirium




Ringworm                                                     Until treatment          Encourage check s of pets and
                                                             commenced.               those living in the same
Incubation Period: 2-38 wks
                                                                                      accommodation and other close
Detection: fungal skin lesion on scalp and/or body                                    contacts.
and/or feet.
                                                       GUIDELINES



Communicable Disease                                    Exclusion Period          Comments



Roseola (infantum)                                      None.                     N/A

Incubation Period: 5-15 days

Detection: fever for 3-4 days in child who appears
well then drop in fever to normal with appearance of
rash to trunk etc.



Scabies                                                 After treatment.          Treatment is recommended for affected
                                                                                  individual and to include those living in
Incubation Period: 4-6 weeks
                                                                                  the same accommodation ,and other
Detection: an allergic type rash anywhere on the                                  close contacts.
body but often on the fingers, wrists around the
waist and on the buttocks. Itching.



Scarlet fever                                           5 days after              Anti-biotic treatment is recommended for
                                                        commencing                the affected student/employee. School-
Incubation Period: 2-5 days
                                                        antibiotic treatment.     wide ‘Alert’ letter to be sent out .
Detection: abrupt fever, pulse increased out of
proportion to fever, vomiting, headache, chills,
malaise, abdominal pain, enlarged reddened
tonsils, tongue is coated and papillae become red
and swollen. Non-facial generalised rash.



Shingles                                                Exclude only if rash is   ‘Alert’ letter to be sent out with special
                                                        weeping and cannot        attention to close contacts and
Incubation Period: harboured since chickenpox.
                                                        be covered.               vulnerable students and employees and
Detection: rash - with blister-like spots which                                   pregnant employees.
contain fluid . The rash usually follows the area
where there are nerve pathways - the
trunk, the face and around the eyes are often
affected. Pain - because the rash follows the nerve
pathways.
Slapped cheek/5th disease/Parvovirus B19

Incubation Period: 4-14 days                            None.                      ‘Alert’ letter to be sent out with special
                                                                                  attention to close contacts and
Detection: headache, body ache, sore throat, low-
                                                                                  vulnerable students and employees and
grade fever, and chills. These symptoms are usually
                                                                                  pregnant employees.
mild and resolve after a few days. Then, following a
week of no symptoms, a bright red rash appears on
the cheeks giving a “slapped face” appearance.
Tetanus                                                 Exclude until
                                                        declared fit to return
Incubation period: 3-21 days                                                      Preventable by vaccine.
                                                        to school by a
Detection: spasm of the jaw muscles, followed by        registered medical
stiffness of the neck, difficulty in swallowing, and    practitioner
stiffness of the abdominal muscles, fever etc.
                                                       GUIDELINES



Communicable Disease                           Exclusion Period                  Comments
Tonsillitis                                    None.                             Avoid kissing. Most cases are due to
                                                                                 viruses and do not need an antibiotic.
Incubation Period: 2-4 days

Detection: painful, swollen, red, inflamed
tonsils; maybe with white spots, fever etc.
May be viral or bacterial.



Tuberculosis                                   We will refer to a                Preventable by vaccination. School-wide
                                               professional medical              ‘Alert’ letter to be sent out with special
Incubation Period: 2-10 wks.
                                               practitioner.                     attention to close contacts and non-
Detection: various; commonly cough                                               vaccinated children and employees and
lasting more than 2 wks., shortness of                                           vulnerable students and employees.
breath, loss of appetite and weight loss,
night fever, extreme fatigue.



Typhoid & Paratyphoid                          Until declared non-               School-wide Alert letters will be sent out.
                                               infectious and fit to return to
Incubation Period: 7-14 days                                                     Exclusion from swimming will be for 2
                                               school by a professional
                                                                                 weeks following last episode of diarrhoea.
Detection: fever, headache, anorexia,          medical practitioner.
abdominal pain, nausea, diarrhoea or
constipation.



Warts and verrucae                             None.                             Verrucae should be covered in the
                                                                                 swimming pool; gymnasium and changing
Incubation Period: 2-3 months
                                                                                 rooms; and hostel areas. Treatment is
Detection: skin lesion.                                                          recommended if the wart/verrucae becomes
                                                                                 painful and/or multiplies.



Whooping cough                                 5 days from commencing            Preventable by vaccination. School-wide
                                               anti-biotic treatment or 21       ‘Alert’ letter to be sent out with special
Incubation Period: 6-20 days
                                               days from onset of illness if     attention to close contacts and non-
Detection: upper respiratory tract infection   no anti-biotic treatment.         vaccinated children and employees and
for 1-2 wks then a dry hacking cough                                             vulnerable students and employees.
becomes severe; particularly at night with
short rapid coughs followed by sudden
inspiration.
                                                                     APPENDIX 3
GUIDANCE NOTES FOR THE SCHOOL NURSE

Assumption of a communicable disease must never be made.

A professional assessment of suspected and/or reported cases of                   a
communicable disease of any student/employee in the school should be made. If
the report is from a tutor of a student suspected with a communicable disease,
then the student should be sent to the school nurse’s office. If the report is from
a parent/guardian/houseparent/employee then it may be necessary to advise on
the procedure to be followed.

Routine childhood vaccinations are currently NOT requested at CISB. When a
vaccine preventable disease is suspected or confirmed then all non-vaccinated
students/employees must be informed immediately. The school nurse must give
parents/guardians/house parents/employees the correct advice, information and
support.

Always contact pregnant           and vulnerable members of staff, and
parents/guardians/house parents with vulnerable students to seek registered
medical advice once a specific communicable disease is suspected and/or
confirmed that may put their health at higher risk.

The school nurse should promote good hand hygiene and coughing and
sneezing practices throughout the school.
                                                                        APPENDIX 4
GUIDANCE NOTES FOR TUTORS

The school nurse gives advice to parents/guardians/houseparents about
communicable      diseases,    and      tutors    are asked to   refer
parents/guardians/houseparents to the school nurse.

The matter should be discussed with the school nurse before “ alert letters” are
issued from school.

Since tutors spend several continuous hours a day with their students, they are
often in an excellent position to detect early physical and behavioural changes in
students at school. Tutors may observe differences in the usual pattern for a
particular student, and deviation from a developmental norm for students of a
given age.


The physical and behavioral indicators listed below are nonspecific and do not in
themselves suggest the presence of an infection.

Appetite
Often, a student who is ill or becoming ill with an infection will exhibit changes in
eating habits. S/he may pick at solid foods, eat lightly, want only certain foods,
and/or prefer liquids.

Behaviour
Irritability may be associated with illnesses, often because of the accompanying
fatigue, fever, and discomfort. Play activities may diminish and the student may
become lethargic (drowsy or indifferent).

Fever
Parent/guardian/house parent and school staff may exhibit a great deal of anxiety
about fever, and yet fever does not automatically require therapy. It rarely causes
harmful effects in itself, according to several scientific studies. Repeated low-
grade fever may occur as the result of physiological changes in the body and
may not cause any discomfort to the student.
Students with fever over 38°C may need to be sent home from school,
especially if other symptoms are apparent. Where you suspect a fever then
please send the student to the school nurse’s office.

Symptomatic treatment of any illness in the school setting should be avoided
unless the parent/guardian/houseparent has complied with CISB Administration
of Medicines Policy. It is not recommended other than in the cases of
maintaining approved, individualized health care plans and emergencies.




Skin Color

A pasty, pale appearance may signal an illness, especially if it is a change from a
student’s normal skin color. A new yellow tinge to the eyes or skin, or a flushed
appearance with rosy cheeks and glassy or red eyes, may also indicate an
illness.

Rash
The diagnosis of rashes can be very difficult and even a registered medical
practitioner may require lab tests to confirm whether a certain disease is
present.
Itchiness of the rash is not a signal of infectiousness or non-infectiousness.
However, itching should also be evaluated. A rash can be a symptom of a
serious or non-serious condition.

Change in Bowel Habit
Diarrhoea may accompany a number of infectious diseases. Conversely,
sluggishness of the bowels and constipation may occur, sometimes with
abdominal cramps. Cramps can be due to the inactivity of the ill student and the
dehydration that often occurs during infections.

Nasal Discharge and Obstruction
Clear nasal discharge may signal a cold or it may indicate an allergic reaction,
especially if accompanied by watery eyes. Yellow or green discharge may
indicate an infection (usually viral) or obstruction by a foreign body. Breathing
may be noisy.

Sore Throat
A sore throat can be a minor problem. However, it may also accompany
potentially more significant infections or even serious generalized illnesses. If a
child is displaying signs of a fever too then send him/her to the school nurse’s
office.

Cough
Coughs accompany some chronic conditions, allergic conditions, and many
infectious diseases. Persistent coughs (lasting 3 weeks or more), especially with
other symptoms such as fever, loss of appetite, and weight loss, need medical
evaluation.


Earache and Discharge From Ear
A student may complain, pull at the ear, or put a hand to the ear if there is
discomfort. When there is an earache, particularly when blood or pus is seen
running from the ear, the student needs to be sent to the school nurse’s office.
Pain (Back, Limbs, Neck, Stomach)
Leg and back pains are not uncommon during the course of infectious diseases.
Stomach pains or cramps usually do not signal serious disease in children,
although appendicitis must be considered when abdominal pain is severe or
persistent. Gastrointestinal disturbances such as vomiting, diarrhoea, and
constipation may be accompanied by abdominal pain.

For all suspected cases of a communicable disease then please, please
send the student to the school nurse’s office.
                                                                                                         APPENDIX 5

EXAMPLE ALERT LETTER FROM THE SCHOOL NURSE/PRINCIPAL




Dear Parent/Guardian/Houseparent/Employee

We have had reports of …………………………..in your child’s class/within the
school community/in Bangalore. We are therefore asking you to …………………
…………………………..../up-date immunisation statuses/be vigilant/seek medical
advice/get in touch with your local consulate for further surveillance reports and
advice.


It is vital .................................................................................................................

If you require any further advice or help about ……………………………. do not
hesitate to contact your school nurse office.

Your school nurse office telephone number is 080 64514002.

We thank you for you co-operation and prompt attention to this request.




Yours sincerely



School Nurse Office                                                                 Principal

				
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