Purpose:

To screen all Students for Tuberculosis in order to ensure their safety and control cross infection of students and staff on campus, as recommended by the Centers for Disease Control.

Applies to:

ALL Hillcrest Educational Centers, Inc., Students and Employees.
Components:

1. Routine T.B. Screening
a. ALL new employees, except those known to be skin test positive, shall be given a skin test by Occupational Health using 5 t.u. (.1 ml) of

PPD.
b. ALL students are required to present documentation of PPD screening within 60 days of admission. For past positive reactors, a chest X-ray or TB Clinic Report, prior to acceptance, is required in lieu of testing. Such situations will be reviewed by the medical director on admission and follow up will be done as ordered.
d. ALL students in residence will be given a TB screening every year and a TB test planted if indicated. Positive reactors who have completed adequate preventative treatment do not need repeat chest films, unless they have pulmonary symptoms, which may be due to TB.

2. Testing After Potential Exposure:
a. Immediately following significant exposure to an employee, or student having suspected tuberculosis, all PPD negative persons at risk, will be skin tested. If the test is negative, it will be repeated 12-weeks after exposure, in accordance with CDC Guidelines.
b. Positive reactors do not require a skin test or chest film following exposure, unless they have symptoms suggestive to Tuberculosis.

3. Follow-Up:
a. Employees or Students with a positive skin test, will be required to have a chest X-ray. Those who convert from negative to positive, or have suspicious chest X-rays, will be referred to the Tuberculosis Clinic, or to a private Physician.

4. PPD Skin Test Interpretation
a positive skin test will be defined as follows:
a. 10 mm. induration is considered positive in:
1) Persons having recent close contact with an individual with active T.B.

2) Individuals with a chest X-ray and History consistent with, prior untreated T.B.
b. 15 mm. induration will be considered positive for ALL others.

5. Responsibilities of the Nursing Department
a. Administer TB screenings and TB skin tests if indicated, refer for follow-up, as indicated.
b. Keep appropriate records of each Student.
c. With post-exposure TB testing:

1. Notify exposed personnel, and arrange for skin tests. It is the responsibility of the exposed person to be tested within 5 days of notification.

2. ANY exposed person, who does not have documentation of negative results, cannot return to work, as recommended by the CDC.

3. Notify ALL exposed Personnel and arrange for skin tests to be repeated in 12 weeks.

4. Refer ALL appropriate personnel to a private physician or the Tuberculosis Clinic.

5. Inform the positive (PPD or chest X-ray) personnel to return to work with documented proof of follow-up care, prior to returning to work, as per CDC Guidelines.
d. Notify the Board of Health in accordance with MGL C71, S555A.
e. NO facilities for isolation are available at Hillcrest Educational Centers. If a student who is previously negative is found to have active TB, IMMEDIATE transfer to a health care facility where isolation is available must be arranged.

Policy:
It is the Policy of HEC to have an effective TB Control Program, which includes early detection, and treatment of persons with active TB.

Purpose:
To reduce the risk of TB transmission in the residential setting.

Program:

I. The ICC is responsible for the design, implementation, and maintenance of the TB Infection Control Program.
II. Policies are developed, implemented, and enforced to ensure early detection of Students and staff who may have infectious TB.
III. Prompt triage and appropriate management of Students and staff who may have TB infection, are done in the Outpatient Setting.
IV. Prompt diagnostic evaluation, and treatment for persons who may have infectious TB
V. Education and training of staff about TB and the effective methods for prevention of TB transmission
VI. Prompt evaluation of possible episodes of transmission of TB on the campus, including health care workers Purified Protein Derivative (PPD) skin test conversions, clusters of cases in health care workers or students, and contacts of TB patients who were not promptly detected and isolated.
VII. Coordination of activities with Local Public Health Department, emphasizing reporting, adequate discharge follow-up, ensuring continuation, and completion of therapy.
 

Students:

1. Prior to admission, every attempt is made to obtain an up-to-date Immunization Record on ALL students.
2. If records are not obtainable, or are not complete, a re-immunization schedule or completion schedule is started. Guidelines for immunizations are followed as recommended by the: Massachusetts Department of Public Health, in compliance with Chapter 76, Section 15 of the General Laws of Massachusetts. (See, Standing Orders in the Policy and Procedure Manual).
3. All required immunizations will be completed as necessary and ordered by the physician.

Staff:

1. ALL staff are encouraged to, and given the opportunity to have the Hepatitis B Vaccine series, if desired.
2. A form is provided by Hillcrest’s designated employee health care provider (e.g., Occupational Health), at the provider’s facility, requiring signed consent or refusal.
3. If refused, Staff may re-consider at any time during their employment, and receive the Vaccine.
4. At time of employment, all staff are encouraged to review their current immunization status with their own primary health care provider.

The PMSC role for the program site is filled by the site’s Head Nurse.

FUNCTIONAL DESCRIPTION:

In conjunction with the HEC Pandemic Management Coordinator, the Site Coordinator serves as program site’s coordinator for the primary aspects of pandemic management during the flu season, including but not limited to:
• medical and nursing activities,
• communication to staff and students regarding prevention and mitigation activities,
• consultation on and monitoring of the HEC Pandemic Management Plan,
• coordinating and communicating student illness data to the HEC Pandemic Management Coordinator,
• monitoring and communicating state and regional influenza data and reports provided by the HEC Pandemic Management Coordinator to the Program Director,
• other duties as assigned by the HEC Pandemic Management Coordinator.

The PMC role is filled by the HEC Director of Nursing Services.

FUNCTIONAL DESCRIPTION:

This person serves as HEC’s coordinator for the primary aspects of pandemic management during the flu season, including but not limited to:
• medical and nursing activities,
• communication to staff and students regarding prevention and mitigation activities,
• consultation on and monitoring of the HEC Pandemic Management Plan,
• coordinating and communicating student illness and staff absence data to the ExVP and SMT,
• monitoring and communicating state and regional influenza data and reports to the ExVP and SMT,
• communicating with local and regional medical and emergency resources as needed/indicated,
• other duties as assigned by the CEO or ExVP.

A) Goals:
To ensure —
1. The continuity of essential functions and services.
2. The safety and well-being of students and staff.
3. The emergency delegation of authority, as necessary.
4. The adequate and accurate documentation of pandemic management activities and risk management activities vital to the agency.

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B) Assumptions:
1. Significant numbers of students and staff may be affected by seasonal flu and PANDEMIC ILLNESS.
2. Staff levels may be significantly reduced due to high levels of illness and hospitalization.
3. Remaining workers may be psychologically affected by disease, family concerns, concerns about economic loss, or fear, and require behavioral assistance.
4. Staff may be reduced by the need for some workers to attend to family illness or to children remaining at home due to school closures.
5. Staffing reductions may be temporary or long-term.
6. Local and regional support resources and infrastructure may be negatively affected. (e.g., schools, medical facilities, transportation systems, supply chains.)

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C) Staffing Thresholds Premises
1).. Each RTC staffs at 1 to 3 staff over ratio on each shift including the Supe and Asst. Supe.
2) HC has 1 Supe and 3 Asst. Supes on the Academic and Residential shifts, and 1 Supe and 1 Asst. Supe on the Overnight shifts. (= 10 supe staff per day).
HP has 1 Supe and 2 Asst. Supes on the Academic shift, and 1 Supe and 3 Asst. Supes on the Residential shifts, and 1 Supe and 2 Asst. Supe on the Overnight shifts. (= 10 supe staff per day)
BS/ITU has 1 Supe and 2 Asst. Supes on the Academic and Residential shifts, and 1 Supe and 1 Asst. Supe on the Overnight shifts. (= 5 supe staff per day)
3) If necessary to remain at required staff : student ratio, some number of supervisory staff can move “into the count”.
4) Absences for all employees, both DC and non-DC employees, throughout the year, including ‘flu season’, average 6.1/day, with a range from 4.2/day to 8.7/day.
5) It is neither necessary nor practical to develop thresholds for Non-Direct Care staff because any urgency associated with their absence depends directly on their location, role, function and the depth of backup available for their role / position. .

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D) Activities and functions covered by the PM Plan :
1. Prevention (PR)
2. Mitigation (MI)
3. Continuity of Essential Operations & Functions (CO)
4. General flu related activities (e.g., information, communications, reassurance, ensuring lines of leadership/authority) (GEN)

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E) Levels of threat/contagion, key indicators, operational status:
Essential activity: close monitoring and reporting of student illnesses and
staff absences.

Level 1 – “Routine” conditions –
a) relatively low and relatively stable frequencies
of flu cases among students and of staff absences .
b) No noticeable increase in cases or staff absences.
• Operations are essentially unaffected or only slightly affected. Few, if any, operational modifications are needed.

Level 2 – “Elevated” conditions –
a) higher than average incidence of flu cases among students and
of staff absences.
b) notably increasing numbers of cases
• Operations are affected and operational modifications are indicated or necessary.

Level 3 – “Emergency” conditions –
a) abnormally high numbers of cases and/or of staff absences
b) sharply climbing numbers of cases among students and staff absences.
c) unusually severe symptoms
• Operations are significantly affected; devolution of function and/or authority and major modifications of operations are required.
Primary goal is continuity of essential functions and operations.

The PMSC role for the program site is filled by the site’s Head Nurse.

FUNCTIONAL DESCRIPTION:

In conjunction with the HEC Pandemic Management Coordinator, the Site Coordinator serves as program site’s coordinator for the primary aspects of pandemic management during the flu season, including but not limited to:
• medical and nursing activities,
• communication to staff and students regarding prevention and mitigation activities,
• consultation on and monitoring of the HEC Pandemic Management Plan,
• coordinating and communicating student illness data to the HEC Pandemic Management Coordinator,
• monitoring and communicating state and regional influenza data and reports provided by the HEC Pandemic Management Coordinator to the Program Director,
• other duties as assigned by the HEC Pandemic Management
NM/DH/BG OCTOBER 2009

The PMC role is filled by the HEC Director of Nursing Services.

FUNCTIONAL DESCRIPTION:

This person serves as HEC’s coordinator for the primary aspects of pandemic management during the flu season, including but not limited to:
• medical and nursing activities,
• communication to staff and students regarding prevention and mitigation activities,
• consultation on and monitoring of the HEC Pandemic Management Plan,
• coordinating and communicating student illness and staff absence data to the ExVP and SMT,
• monitoring and communicating state and regional influenza data and reports to the ExVP and SMT,
• communicating with local and regional medical and emergency resources as needed/indicated,
• other duties as assigned by the CEO or ExVP.

NM/DH/BG OCTOBER 2009

In view of the recent information regarding the swine influenza (PANDEMIC ILLNESS) the following procedures will be available for all HEC campuses. These steps include:

• Level 1-“Routine” conditions:
a) Follow regular menu
b) Emergency supplies for routine levels of infection
1. Canned RTE soups
2. Carnation Instant Breakfast
3. Snack Bars
4. Bottled Water
5. One week supply of disposable plastic ware and utensils

• Level 2- “ Elevated “conditions:
a) Follow “Routine” condition procedures

• Level 3- “Emergency” conditions”
a) Cook out one side of week -on call Cook provides service
b) Cooks out on both sides of week- food prepared at satellite site and transported by Staff
c) All Kitchens can provide food for every Campus. We will schedule two Cooks on each side of the week for this emergency service, three cooks if one kitchen is to provide for all four sites.

Although each case should be evaluated on an individual basis, the following guidelines may be used:

• Nasopharengeal culture that is negative for type A influenza
• Temp less than 100 for 24 hours without medication
• Decreased cough/ respiratory symptoms
• Taking physician ordered antiviral medication for at least 24 hours

Any questions regarding the use of isolation or the removal of a student who does not meet the full criteria should be discussed with the Nursing Director and/or Dr. Dempsey/ Nurse Practitioners.

APPROVED – Decisions about moving students who are negative for PANDEMIC ILLNESS out of isolation will be made on a case-by-case basis, usually by the program site Head Nurse in conjunction with the shift Supervisor.

NM 9/09