Student Health

Kindergarten

and

Student Health

Leslie Currin, RN

Health Services Specialist

Student Learning and Partnerships

Oregon Department of Education

Telephone 503-947-5812

Table of Contents

Bloodborne Pathogens / 3
OAR Health Services / 8
OAR Medication Administration / 10
OAR Infectious Diseases / 13
Asthma / 15
Head Lice / 17
Food Allergies / 24
Child Abuse / 31
Immunizations / 37

Oregon Occupational Safety and Health Division

Department of Consumer and Business Services

Program Directive

Subject:Bloodborne Pathogens

Affected Codes/

Directives:OAR 437-022-1910-1030

Purpose:This instruction establishes policies and provides clarifications to ensure uniform inspection procedures are followed when conducting inspections to enforce the Occupational Exposure to Bloodborne Pathogens Standards.

Scope:This instruction applies OR-OSHA-wide.

Cancellation:This revision of this Program Directive replaces the version of April 24, 2000.

References:1.Oregon OSHA Field Inspection Reference Manual (FIRM).

Program Directive A-216, Citation Policy for Paperwork and

Written Program Requirement Violations, July 1, 1997.

Program Directive A-91, Access to Exposure and Medical Records, October 8, 1993.

Program Directive A-200, Authorization and Procedures for Reviewing Specific Medical Records to Verify Compliance with 29 CFR 1904, October 11, 1993.

Standard Operating Procedure 24, Access to Employee Medical Records, February 20, 1991.

Centers for Disease Control Morbidity and Mortality Weekly Report: “Public Health Service Guidelines for the Management of Health-Care Worker Exposures to HIV and Recommendations for Postexposure Prophylaxis.” May 15, 1998; Vol. 47, No. RR-7.

Federal Level

Bloodborne Pathogens

Information and Training

1910.1030(g)(2)(i)

Employers shall ensure that all employees with occupational exposure participate in a training program which must be provided at no cost to the employee and during working hours.

1910.1030(g)(2)(ii)

Training shall be provided as follows:

1910.1030(g)(2)(ii)(A)

At the time of initial assignment to tasks where occupational exposure may take place;

1910.1030(g)(2)(ii)(B)

Within 90 days after the effective date of the standard; and

1910.1030(g)(2)(ii)(C)

1910.1030(g)(2)(iii)

For employees who have received training on bloodborne pathogens in the year preceding the effective date of the standard, only training with respect to the provisions of the standard which were not included need to be provided.

1910.1030(g)(2)(iv)

Annual training for all employees shall be provided within one year of their previous training.

1910.1030(g)(2)(vii)(A)

An accessible copy of the regulatory text of this standard and an explanation of its contents;

1910.1030(g)(2)(vii)(B)

A general explanation of the epidemiology and symptoms of bloodborne diseases;

1910.1030(g)(2)(vii)(C)

An explanation of the modes of transmission of bloodborne pathogens;

1910.1030(g)(2)(vii)(D)

An explanation of the employer’s exposure control plan and the means by which the employee can obtain a copy of the written plan;

1910.1030(g)(2)(vii)(E)

An explanation of the appropriate methods for recognizing tasks and other activities that may involve exposure to blood and other potentially infectious materials;

1910.1030(h)(3)(ii)

Employee training records required by this paragraph shall be provided upon request for examination and copying to employees, to employee representatives, to the Director, and to the Assistant Secretary.

Occupational Safety & Health Administration (OSHA) Standard

(f) Hepatitis B Vaccination and Post-exposure Evaluation and Follow-up

(f)(1) General.

(f)(1)(i) The employer shall make available the hepatitis B vaccine and vaccination series to all employees who have occupational exposure, and post-exposure evaluation and follow-up to all employees who have had an exposure incident.

(f)(1)(ii) The employer shall ensure that all medical evaluations and procedures including the hepatitis B vaccine and vaccination series and post-exposure evaluation and follow-up, including prophylaxis, are:

(f)(1)(ii)(A) Made available at no cost to the employee;

(f)(1)(ii)(B) Made available to the employee at a reasonable time and place;

(f)(1)(ii)(C) Performed by or under the supervision of a licensed physician or by or under the supervision of another licensed healthcare professional; and

(f)(1)(ii)(D) Provided according to recommendations of the U.S. Public Health Service current at the time these evaluations and procedures take place, except as specified by this paragraph (f).

(f)(1)(iii) The employer shall ensure that all laboratory tests are conducted by an accredited laboratory at no cost to the employee.

(f)(2) Hepatitis B Vaccination.

(f)(2)(i) Hepatitis B vaccination shall be made available after the employee has received the training required in paragraph (g)(2)(vii)(I) and within 10 working days of initial assignment to all employees who have occupational exposure unless the employee has previously received the complete hepatitis B vaccination series, antibody testing has revealed that the employee is immune, or the vaccine is contraindicated for medical reasons.

(f)(2)(ii) The employer shall not make participation in a prescreening program a prerequisite for receiving hepatitis B vaccination.

(f)(2)(iii) If the employee initially declines hepatitis B vaccination but at a later date while still covered under the standard decides to accept the vaccination, the employer shall make available hepatitis B vaccination at that time.

(f)(2)(iv) The employer shall assure that employees who decline to accept hepatitis B vaccination offered by the employer sign the statement in Appendix A.

(f)(2)(v) If a routine booster dose(s) of hepatitis B vaccine is recommended by the U.S. Public Health Service at a future date, such booster dose(s) shall be made available in accordance with section (f)(2)(ii).

(f)(3) Post-exposure Evaluation and Follow-up. Following a report of an exposure incident, the employer shall make immediately available to the exposed employee a confidential medical evaluation and follow-up, including at least the following elements:

(f)(3)(i) Documentation of the route(s) of exposure, and the circumstances under which the exposure incident occurred;

(f)(3)(ii) Identification and documentation of the source individual, unless the employer can establish that identification is infeasible or prohibited by state or local law;

(f)(3)(ii)(A) the source individual’s blood shall be tested as soon as feasible and after consent is obtained in order to determine HBV and HIV infectivity. If consent is not obtained, the employer shall establish that legally required consent cannot be obtained. When the source individual’s consent is not required by law, the source individual’s blood, if available, shall be tested and the results documented.

(f)(3)(ii)(B) When the source individual is already known to be infected with HBV to HIV, testing for the source individual’s known HBV or HIV status need not be repeated.

(f)(3)(ii)(C) Results of the source individual’s testing shall be made available to the exposed employee, and the employee shall be informed of applicable laws and regulations concerning disclosure of the identity and infectious status of the source individual.

(f)(3)(iii) Collection and testing of blood for HBV and HIV serological status;

(f)(3)(iii)(A) The exposed employee’s blood shall be collected as soon as feasible and tested after consent is obtained.

(f)(3)(iii)(B) If the employee consents to baseline blood collection, but does not give consent at that time for HIV serologic testing, the sample shall be preserved for at least 90 days. If, within90 days of the exposure incident, the employee elects to have the baseline sample tested, such testing shall be done as soon as feasible.

(f)(3)(iv) Post-exposure prophylaxis, when medically indicated, as recommended by the U.S. Public Health Service;

(f)(3)(v) Counseling; and

(f)(3)(vi) Evaluation of reported illnesses.

OAR581-022-0705

Health Services

(1) The school district shall maintain a prevention oriented health services program for all students which provides:

(a) Health care and space that is appropriately supervised and adequately equipped for providing first aid, and isolates the sick or injured child from the student body;

(b) Communicable disease control, as provided in Oregon Revised Statutes;

(c) Health screening information, including required immunizations and TB certificates, when required by ORS 433.260 and 431.110 and OAR 333-019-0405;

(d) Services for students who are medically fragile or have special health care needs;

(e) Integration of school health services with school health education programs and coordination with health and social service agencies, public and private;

(f) Vision and hearing screening;

(g) Compliance with OR-OSHA Bloodborne Pathogens Standards for all persons who are assigned to job tasks which may put them at risk for exposure to body fluids (ORS 1910-1030); and

(h) Policy and procedures for medications, as per ORS 339.870.

(2) School districts shall adopt policies and procedures which consider admission, placement and supervision of students with communicable diseases, including but not limited to Hepatitis B (HBV), Human Immunodeficiency Virus (HIV) and Acquired Immune Deficiency Syndrome (AIDS) (OAR 333-019-0015).

(3) School districts which employ nurses to provide health services shall employ persons currently licensed to practice as Registered Nurses or Nurse Practitioners in Oregon:

(a) School districts may employ Licensed Practical Nurses, providing that their practice is supervised by a Registered Nurse or Nurse Practitioner with the above stated qualifications;

(b) Job descriptions shall reflect assignments complying with the Oregon State Board of Nursing (OSBN) Scope of Practice Administrative Rules for all levels of licensed providers, OAR 851-450-0000 to -0010 and 851-050-0000 and -0005; and

(c) If school districts employ Registered Nurses or Nurse Practitioners who are not licensed by Teacher Standards and Practices Commission as school nurses, the district shall not designate such personnel as "school nurse" by job title as per ORS 342.475 and 342.495.

(4) Each school shall have, at a minimum, at least one staff member with a current first aid card for every 60 students enrolled, or an emergency response team per building consisting of no less than six persons who hold current first aid/CPR cards and who are trained annually in the district and building emergency plans.

(5) The school district shall have policies and/or administrative procedures concerning employees with communicable diseases, including but not limited to Hepatitis B (HBV), Human Immunodeficiency Virus (HIV) and Acquired Immune Deficiency Syndrome (AIDS).

(6) Each school building must have a written plan for response to medical emergencies; such plan should be articulated with general emergency plans for buildings and districts as required by OAR 581-022-1420.

Stat. Auth.: ORS 326 & ORS 342
Stats. Implemented: ORS 326.051
Hist.: 1EB 19-1980, f. 6-17-80, ef. 9-1-80; 1EB 16-1981 (Temp), f. & ef. 11-3-81; 1EB 12-1982, f. & ef. 3-24-82; EB 21-1988, f. & cert. ef. 4-26-88; EB 17-1996, f. & cert. ef. 11-1-96

OAR581-021-0037

Administration of Prescription and Nonprescription Medication to Students

(1) As used in this rule, definitions of terms shall be as follows:

(a) "Designated staff" means the school staff person who is designated by the building level school administrator, either the principal or head teacher, to administer nonprescription or prescription medication pursuant to district policy and procedure;

(b) "Instruction from physician, physician assistant or nurse practitioner" means a written instruction for the administration of a prescription medication to a student which shall include:

(A) Name of student;

(B) Name of medication;

(D) Route;

(E) Frequency of administration; and

(F) Other special instruction, if any.

(c) The prescription medication label prepared by a pharmacist at the direction of a physician, physician assistant or nurse practitioner will meet the requirements for a written instruction if it contains the information listed in (A) through (F) above;

(d) "Instruction from the student's parent or guardian" means a written instruction for the administration of a nonprescription medication to a student which shall include:

(A) Name of student;

(B) Name of medication;

(D) Route;

(E) Frequency of administration;

(F) Other special instructions; and

(G) Signature of parent or guardian.

(e) "Student self-medication" means students must be able to administer medication to him or herself without requiring a trained school staff member to assist in the administration of the medication;

(f) "Training" means the instruction to be provided to designated school staff on the administration of prescription and nonprescription medications, based on requirements set out in guidelines approved by the Department of Education, including discussion of applicable district policies, procedures and materials;

(g) "Nonprescription medication" means only commercially prepared, nonalcohol-based medication to be taken at school that is necessary for the child to remain in school. This shall be limited to eyes, nose and cough drops, cough suppressants, analgesics, decongestants, antihistamines, topical antibiotics, anti-inflammatories and antacids that do not require written or oral instructions from a physician. Nonprescription medication does not include dietary food supplements;

(h) "Physician" means a doctor of medicine or osteopathy or a physician assistant licensed to practice by the Board of Medical Examiners for the State of Oregon, or a nurse practitioner with prescriptive authority licensed by the Board of Nursing for the State of Oregon, or a dentist licensed by the Board of Dentistry for the State of Oregon, or an optometrist licensed by the Board of Optometry for the State of Oregon, or a naturopathic physician licensed by the Board of Naturopathy for the State of Oregon. "Physician" also may include individuals licensed in the categories set out above by comparable licensing agencies in adjoining states;

(i) "Prescription medication" means any noninjectable drug, chemical compound, suspension or preparation in suitable form for use as a curative or remedial substance taken either internally or externally by a student under the written direction of a physician. Prescription medication does not include dietary food supplements;

(j) "Age appropriate guidelines" means the student must be able to demonstrate the ability, developmentally and behaviorally, to self medicate with permission from parent (guardian), building administrator and in the case of a prescription medication a physician.

(2) Each school district shall adopt policies and procedures that provide for:

(a) The administration of prescription and nonprescription medication to students by trained school personnel; and

(b) Student self-medication including age appropriate guidelines.

(3) Policies and procedures shall:

(a) Include a process to designate, train and supervise appropriate staff;

(b) Permit designated staff to administer prescription medication under the written permission from the student's parent or guardian and instruction from a physician, physician assistant or nurse practitioner if, because of its prescribed frequency, the medication must be given during school hours;

(c) Permit designated staff to administer nonprescription medication under the written permission and instruction from the student's parent or guardian; and

(d) Permit student self-medication.

(4) Policies and procedures related to administration of prescription and nonprescription medication and student self-medication must discuss:

(a) Safe storage, handling, monitoring supply and disposing of medications;

(b) Record keeping and reporting of medication administration, including errors in administration;

(d) Student confidentiality.

Stat. Auth.: ORS 326.051
Stats. Implemented: ORS 339.870
Hist.: ODE 3-1998(Temp), f. & cert. ef. 2-27-98 thru 8-25-98; ODE 6-1998, f. & cert. ef. 4-23-98; ODE 10-1999, f. & cert. ef. 2-12-99

OAR581-022-1440

Infectious Diseases Including Acquired Immune Deficiency Syndrome (AIDS), Human Immunodeficiency Virus (HIV), and Hepatitis B and C

(1) Each school district shall teach an age-appropriate plan of instruction focusing on infectious diseases, including Acquired Immune Deficiency Syndrome (AIDS), Human Immunodeficiency Virus (HIV), and Hepatitis B and C as an integral part of the health education and other subjects, throughout its elementary, middle, and senior grade levels. In addition, the plan shall provide for instruction, at least annually, for all students grades 6-12 on AIDS, HIV, and Hepatitis B and C.

(a) The plan of instruction required by this rule shall be developed cooperatively by parents, teachers, school administrators, local health department staff, other community representatives, and persons from the medical community who are knowledgeable of the latest scientific information and effective education strategies.

(b) Local school boards shall approve the plan of instruction and require that it be reviewed and updated biennially in accordance with new scientific information and effective education strategies.

(c) Any parent may request that his/her child be excused from the portion of the instructional program required by this rule under the procedures set forth in ORS 336.052(2) or OAR 581-022-0415.

(2) The plan of instruction shall include information and skills-based teaching strategies:

(a) That promotes abstinence for school-age youth and mutually monogamous relationships for adults as the safest and mostly responsible sexual behaviors;

(b) That is designed to allay those fears concerning HIV that are scientifically groundless:

(c) About contraceptive and other disease reduction measures that reduce the risk of exposure to HIV, Hepatitis B and C and other sexually transmitted infections;

(d) About responsible sexual behaviors that may reduce or eliminate exposure to HIV, Hepatitis B and C and other sexually transmitted infections;

(e) About the high risks of contracting HIV, Hepatitis B and C and other infectious diseases through sharing of needles or syringes for injecting drugs including steroids, for tattooing, and body-piercing; and

(f) Is culturally and gender sensitive.

(3) Each school district shall designate a staff person as the district infectious disease/HIV prevention contact person to facilitate communication between the Mental Health and Addiction Services, Department of Human Services, Health Services, Oregon Department of Education, and district teaching staff regarding up-to-date information, staff development needs, effective educational strategies and other opportunities.

Stat. Auth.: ORS 326.051
Stats. Implemented: ORS 336.455
Hist.: EB 18-1996, f. & cert. ef. 11-1-96; EB 2-1997, f. & cert. ef. 3-27-97; ODE 25-2002, f. & cert. ef. 11-15-02

74th OREGON LEGISLATIVE ASSEMBLY--2007 Regular Session

Enrolled

Senate Bill 1040

Sponsored by Senators COURTNEY, KRUSE (at the request of American Lung Association ofOregon)

CHAPTER ......

AN ACT

Relating to students with chronic illnesses; and declaring an emergency.

Be It Enacted by the People of the State of Oregon:

SECTION 1. (1) As used in this section:

(a) “Asthma” means a chronic inflammatory disorder of the airways that requires ongoing

medical intervention.

(b) “Medication” means any prescription for bronchodilators or autoinjectable

epinephrine prescribed by a students Oregon licensed health care professional for asthma

or severe allergies.

such as food, pollen or dust.

(2) A school district board shall adopt policies and procedures that provide for selfadministration

of medication by kindergarten through grade 12 students with asthma or severe