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

I. Before Flu Season

CONTAGION SURVEILLANCE & INTERVENTION

1) PR – Vaccinate all students who have consent forms, and as many staff as possible, for both seasonal flu and pandemic illness.

2) PR / MI – Identify student isolation areas at each residential campus, and how such areas would be staffed, equipped (e.g., bedding, disposable dishes and utensils) and supported (e.g., housekeeping, food service).

3) PR / MI – Decisions will be made on a case-by-case basis, usually by the program site Head Nurse in conjunction with the shift Supervisor, guided by the general criteria and procedures for moving students out of isolation and back into the population.
10/27 note: Consider purchasing more portable cots for the agency.

4) MI / CO – Ensure availability of medical consultation and advice for emergency response.
Note: Dr. Dempsey and 2 Nurse Practitioners from his group will be available. Severity of the pandemic, among other factors, will determine whether they can see students on campus or at their office.

5) CO – Establish baselines for student flu cases and employee absences.

6) PR / MI – Develop monitoring & reporting procedures for cases of student flu.
• To start, Head Nurses report weekly via email to Nancy & Shaun (cases of flu) using standardized form
• If/when we see numbers climbing, Head Nurses will report daily via email.

7) PR / MI – Develop monitoring procedures for DC staff absences
To start, designated program administrators report weekly to the Payroll Administrator → Shaun (absence for medical reasons, including family illness, and/or non-planned personal time for reasons associated with flu conditions – e.g., day care, school, etc.)
If/when we see climbing staff absence numbers, daily reporting will be implemented.

8) CO – Establish thresholds for Levels 2 (elevated) & 3 (emergency), and procedures for activating and terminating our differential responses to changing levels.

9) PR / MI – Confirm procedures for the use of the Student Monitoring Sheet and the Student Isolation Log for students with flu.

10) PR / MI – a) Install hand sanitizer units at all time clocks
b) Ensure that all sanitizers are operational and refilled regularly.

11) PR / MI – Heighten housekeeping infection control measures, e.g., frequent sanitizing of common use equipment (e.g., time clocks, common space phones, etc.)

12) PR / MI – In general, Housekeeping staff (incl. students having voc ed. experience) are encouraged to wear gloves and masks while cleaning. Masks and gloves will be available for staff to use on a voluntary basis.
All staff, including Housekeeping staff, assigned to any isolation unit must wear gloves and a mask at all times while in the unit.

COMMUNICATIONS & CONSENTS

13) PR – Obtain parental consent for seasonal flu and pandemic illness vaccinations.

14) GEN – Send informational letter to parents/guardians (NM)

15) PR / MI – MI – Disseminate information about the PMP to all employees.

16) Maintain high staff awareness around pandemic illness and the seasonal flu; disseminate programs and materials covering pandemic fundamentals (e.g. signs and symptoms of influenza, modes of transmission, personal and family protection, provide information for the at-home care of ill employees and family members and response strategies).
Anticipate employee fear and anxiety, rumors and misinformation and communicate accordingly.

TRAVEL, VISITATION, ACCESS TO PROGRAM SITES

17) PR / MI – For home visits: Take temperature before leaving and upon return, when nurses are on campus. Monitor for symptoms.

AUTHORITY, AUTHORIZATION

18) CO – Id. Order of Succession of Authority for agency + each site
• @ Agency level, order is CEO → ExVP → VP for Finance → Dir. of HR.
• @ Program level – Use the OS outlined in the site specific COOP plans

19) CO – Per the HEC COOP Plans, if activation of a different level of this plan is necessary, the Department Head and/or the Program Director and/or his/her designee will formally notify all department / program staff, with appropriate instructions, by available means.

20) GEN – Director of Nursing will serve as the Pandemic Management Coordinator, reporting regularly to the Exec. VP.

21) GEN – RTC Head Nurses will serve as Pandemic Management Site Coordinators for their RTC. They will work closely with the PMC, and will report regularly to the RTC PD.

22) Review the Pandemic Management Plans and options with Dr. Dempsey.

RESOURCES & ESSENTIAL SUPPLY CHAINS

23) PR / MI – Order additional medical supplies to have on hand (masks, aspirin, etc.).

24) CO –Emergency supply stock consisting of food.
HEC routinely maintains an approximately 10 day supply of food on hand, and it is not anticipated that the public water supply would be interrupted due to the pandemic.

25) MI / CO – Communicate with local healthcare facilities to share our plans and understand their capabilities and plans; ensure availability of medical consultation and advice for emergency response.

26) CO – Communicate with our local emergency/supplier agencies (Fire, Police, Red Cross, Ambulance, fuel companies, electric companies, etc.) regarding their plans and their abilities to provide us with services if this becomes widespread.
Note that under severe regional disaster conditions, these agencies and resources will not be able to help much.

27) Consider link on website for communicating pandemic status and actions to employees and others inside and outside the worksite in a consistent and timely way.

HUMAN RESOURCES

28) CO – Prepare to address potential staffing shortages throughout flu season.
Note: See Level 1, # 9 below &/or “Plan for Managing Widespread Infection or Contagion” (HEC Infection Control Manual)

29) CO – Update our employee information to insure we have accurate telephone numbers, etc.

MISCELLANEOUS
30) CO – Identify essential functions, e.g.
a) Ensure adequate shelter and living space for students
b) Provide adequate food and water for students
c) Assure to the extent possible proper necessary staff-to-student ratios at all times
e) Provide of adequate medical care and medication management
f) Provide safety and security
g) Ensure essential communication (e.g. telephones, two-way radios, cellular phones or “runner”)
h) Ensure information management functions (e.g. student case files, personnel files, business and financial files)
i) Be able to pay people (e.g., payroll staff redundancies)
(also see site specific COOPs)
 
II – Flu Season

Level 1 – Routine conditions
Student threshold:
0 to 20% of student population in isolation
(e.g., @ 50 students, 20% = 10 students in isolation)

DC Staff thresholds:
Up to 20% of Direct Care staff scheduled to work (by program site, by shift) are absent. (Note: the # scheduled to work is usually above the required staff:student ratio)

Non-DC Staffing:
Non-Direct Care staff absences are monitored by work site and department. Actions in response to absences depends directly on the absent staff’s location, role, function and the depth of backup available for their role / position. .

Level 1 Direct Care Staffing
Condition: Staff absences are relatively routine for both Direct Care and non-DC staff. The routine level of absences allows the programs to operate at ratio, primarily by utilizing On-Call staff and/or over time as needed.
Absences are monitored daily at the campus + Department level.
Absences are reported weekly by campus and by Department to the Senior Management Team and the Nursing Director.
Weekly reports are reviewed for upward trending.

Level 1 Actions

1. PR / MI – Close monitoring and reporting of a) student flu cases b) staff absences.

2. PR / MI – Maintain high housekeeping efforts

3. PR / MI – Housekeeping staff (incl. students having voc ed. experience) should wear gloves while cleaning outside of isolation areas. Masks are optional (outside of isolation areas).

4. PR / MI – Follow plans to separate / isolate students with flu.

5. PR / MI – Per the HEC “Plan for Managing Widespread Infection or Contagion” (HEC Infection Control Manual), any student found to have a serious communicable illness that can’t be safely managed by on-campus isolation will be referred to an appropriate medical facility by an HEC physician.

6. PR / MI – Per the HEC “Plan For Managing Widespread Infection Or Contagion” (HEC Infection Control Manual), in the event that a student cannot be cared for separately from other students, but does not require referral for intensive medical care, transport to the home of a parent, legal guardian or responsible family member will be considered.

7. PR / MI – Per the HEC “Plan For Managing Widespread Infection Or Contagion” (HEC Infection Control Manual), in the event that the number of students affected by a serious contagious illness, and/or the status of staffing and resources, make it impossible to care for ill students at the program site, transport to the home of a parent, legal guardian, responsible family member, or referral to a hospital will be considered.

8. PR / MI – Per the HEC “Plan For Managing Widespread Infection Or Contagion” (HEC Infection Control Manual), in the event that the availability of staff is negatively affected by a serious and wide spread contagious illness or infection, the following steps will be considered and/or implemented if necessary to maintain adequate care for students and safe conditions for students and staff.
a) Increased use of on-call and part time staff.
b) Voluntary overtime.
c) Imposition of mandatory overtime.
d) Deployment of administrative and support staff to direct care functions.
e) The temporary reduction of student census (e.g., sending students on approved and plans visits) will be considered.
f) Temporary consolidation of teams, units and/or program sites.

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Level 2 – Elevated conditions
Student threshold:
21% to 40% of student population in isolation
(e.g., @ 50 students, 40% = 20 students in isolation)

DC Staff thresholds:
Between 21% and 30% of Direct Care staff scheduled to work (by program site, by shift) are absent. (Note: the # scheduled to work is usually above the required staff:student ratio)

Non-DC Staffing:
Non-Direct Care staff absences are monitored by work site and department. Actions in response to absences depends directly on the absent staff’s location, role, function and the depth of backup available for their role / position. .

In the event that the Executive Vice President and Pandemic Management Coordinator (Dir. of Nursing) determine that Level 2 conditions do or will soon exist, they will call an Emergency Meeting to determine which action steps will be implemented for Levels 2 and 3.
The following reps will participate in this meeting:
Executive Vice President, Pandemic Management Coordinator (Dir. of Nursing), Worker’s Comp Administrator, Director of Support Services, Director of Special Projects.

Level 2 Direct Care Staffing
Condition: Staff absences are higher than average and/or staff absences are notably increasing in numbers and duration. The elevated level of absences increasingly requires the programs to maintain staff: student ratio by utilizing a combination of On-Call staff, over time, and moving as many as possible Asst. Supes into the count. Other actions (e.g., mandatory overtime) will be considered as needed.
Absences are monitored daily at the campus + Department level.
Absences are reported daily by campus and by Department to the Senior Management Team and the Nursing Director.
Reports are reviewed for upward trending.

Level 2 Actions

1. MI – Nursing Director checks MA Health Dept. and CDC web sites daily.

2. At Level 2 or 3, identify staff who would be willing to come in if short staffed and staff that would be willing to do “infirmary duty” if necessary (i.e., those without families to take care of, etc.).

3. PR / MI – Implement guidelines to support social distancing (maintaining 6 foot distances between people) and to modify the frequency and type of face-to-face contact (e.g. hand-shaking, frequencies of meetings, seating in meetings, etc.).

4. PR / MI – Institute procedures for visits to program sites (minimize movement on campus; modify programming; isolate visitors).

5. PR / MI – Consider limiting staff travel outside the HEC area.

6. PR / MI – Limit student home visits.

7. PR / MI – If severity increases, at the beginning of the workday and with each new shift, all employees should be asked about symptoms consistent with an influenza illness (e.g., fever, chills AND cough or sore throat).

8. CO – Utilize non-direct care staff in DC positions as needed to maintain ratios.

9. CO – Monitor inventories of food and essential supplies.

10. CO – Consider applying to DEEC for emergency waiver on staffing ratios and/or programming (e.g., school closing) at Level 3.

11. PR / MI – Look at our visiting and travel policies and consider differential actions (stop travel/send healthy students home).

12. PR / MI – Consider policies for access to / monitoring of access to program sites by vendors, visitors, etc.

13. PR / MI – Evaluate our supply chain, essential supplies and resources; inventory our current stock and provide sufficient and accessible infection control supplies.
14. identify critical inputs, resources, supplies required to maintain business operations by location and function during a pandemic (e.g. raw materials, suppliers, sub-contractor services/ products, and logistics)
15. E.g., 7 day food supply, heating oil.
16. Note: If flu cases increase, should we increase the amount of cash on hand at all sites? (consistent with disaster conditions)

17. CO – Determine personnel policies regarding flexibility of staff schedules (staggered shifts) and worksites (those who can work from home).

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Level 3 – Emergency conditions
Student threshold:
Greater than 40% of student population in isolation
(e.g., @ 50 students, 40%+ = more than 20 students in isolation)

DC Staff thresholds:
Above 30% of Direct Care staff scheduled to work (by program site, by shift) are absent. (Note: the # scheduled to work is usually above the required staff: student ratio)

Non-DC Staffing:
Non-Direct Care staff absences are monitored by work site and department. Actions in response to absences depends directly on the absent staff’s location, role, function and the depth of backup available for their role / position. .

Level 3 Direct Care Staffing
Condition: Emergency conditions prevail with a combination of high student illness, and staff absences and durations of absences severely affecting program operations. The emergency level of absences barely or does not allow the programs to maintain staff: student ratio utilizing a combination of On-Call staff, over time, and moving as many as possible Asst. Supes into the count.
Mandatory overtime will be implemented by specific program directors as needed.
Absences are monitored daily at the campus + Department level.
Absences are reported daily by campus and by Department to the Senior Management Team and the Nursing Director.
Reports are reviewed for upward trending.

Level 3 Actions

1. PR / MI – Consider instituting limitations on visits to program sites (minimize external entry/contact)

2. MI / CO – Temporarily consolidate teams of healthy / sick students.

3. MI / CO – Temporarily consolidate campuses (maintain sick students at separate campus).

4. MI / CO – Consider sending to visiting resources those well students who have experienced visiting resources and whose behavior would allow visiting.

5. CO – Consider using HA and old ITU building for e.g., storage, isolation units, etc.

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Given the nature of our services, the planful placement of our students, admission procedures, and regulations regarding immunizations and health records decreases the risk of having a serious and wide spread contagious illness or infection among our students is relatively low. However, such an event is possible. Therefore, in addition to having a detailed Infection Control Plan, HEC would utilize the following strategies and actions for managing a serious and wide spread contagious infection among our students and/or staff.

It should be noted that these strategies will be implemented and/or modified as necessary based on factors such as:
• The advice/direction of a physician,
• the specific student health profile,
• the nature of the infection or illness,
• the specific program site,
• available staffing,
• available resources,
• the input of the parent/ legal guardian,
• the input of the custodial agency.

STUDENTS

1) As noted in the Infection Control Manual, there are no Isolation Rooms at HEC. Therefore, any student found to have a serious communicable illness requiring isolation would be referred immediately to an appropriate facility by the HEC Medical Director.

2) If the physician determines that referral for complete isolation is not necessary, and if staffing and resources allow, the student may be maintained and cared for separately in a designated isolation area which would lessen or prevent any spread of the illness.

3) In the event the student cannot be cared for separately from other students but does not require referral for complete isolation and intensive medical care, transport to the home of a parent, legal guardian or responsible family member will be considered.

4) In the event that the number of students affected by a serious contagious illness, and/or the status of staffing and resources, make it impossible to care for ill students at the program site, transport to the home of a parent, legal guardian, responsible family member, or referral to a hospital will be considered.

STAFF

In the event that the availability of staff is negatively affected by a serious and wide spread contagious illness or infection, the following steps will be considered and/or implemented if necessary to maintain adequate care for students and safe conditions for students and staff.

1) Increased use on-call and part time staff.
2) Voluntary overtime.
3) Imposition of mandatory overtime.
4) Deployment of administrative and support staff to direct care functions.
5) Temporary consolidation of teams, units and/or program sites.
6) The temporary reduction of student census (e.g., sending students on approved and planed visits)

Outpatient Services
Due to the transient nature of outpatient clients, the potential for increased numbers of infectious individuals may occur during some seasonal times. The following guidelines will be followed during that time;

1. When a client calls to cancel appointmnet due to illness, cancel the scheduled appointment despite regard of timeframe and reschedule as soon as possible

2. When a client arrives with obvious signs of active illness (listless, feverish, cough, sneezing etc.) they should be sent home/ referred to private physician. Another appointment should be scheduled

3. When staff are ill, they should notify the receptioist as soon as possible. Cancel appointments and reschedule when available.

4. During high illness or flu season, staff should be prepared to be flexible regarding scheduling and covering other practitioners where possible. If the schedule cannot be maintained by the remaining staff then the office will be closed. This decision will be made by the available Administrators who will be updated by the IC Coordinator.

5. There should be resources such as tissues, hand sanitizer and rest room facitities available to all clients.

Purpose:
To affirm the importance of student placement practices and to safely admit students and prevent unecessary exposure of current population.

Applicability:
Admitting, nursing, physician and staff working with that student.

General Statement:
A Free From Communicable Disease Form signed by an M.D., is requested for EVERY student prior to admission.
A. Since there are NO Isolation Rooms at HEC, any student found to have a communicable disease requiring isolation would be referred IMMEDIATELY to an appropriate facility by the School Physician.
B. Nursing assessments are done within 24 hours of Admission by an R.N.
C. Physicals are done within 30 days of an admission.

Controlling Infection

A. Admitting personnel will cooperate with nursing and the medical staff, when placing students who are immunosuppressed, at increased risk for infection, or suspected of/diagnosed with a communicable disease.
B. The physician will assess each student upon admission according to guidelines, and alert staff as to signs and symptoms, initial diagnosis, and type of precautions needed.
C. The ICC is to be notified AS SOON AS POSSIBLE of ANY student admitted who has a suspected or confirmed communicable disease.
D. Personnel potentially exposed to a student with tuberculosis, who was diagnosed after the admission process, will be .referred to Occupational Health.
E. If a student is admitted with a communicable disease such as: chicken pox, measles, etc., ALL personnel should be aware of their status. Staff members who have NO RECORD of having had the disease, report to the Charge Nurse. Other staff assignment may have to be made. ALL Pregnant staff, should be aware of communicable diseases they have had. This includes: Housekeeping, Dietary, etc. The ICC (or Designee) should be notified for evaluation.
F. If student currently in placement, develops a communicable disease that is deemed by the Medical Director not to require hospitalization or isolation, levels of bedrest will be initiated. See standing orders in Policies and Procedures for specifics on levels of bedrest. These levels provide for limited activity and decreased exposure to other students and staff as much as is possible in a residential setting.

Responsibilities

A. Training Coordinator

1. Document and maintain records of adequate education of ALL personnel, in infection control practice.
2. Assure compliance with Infection Control Polices and Procedures.
3. Assure compliance with Employee Health Program Policies.
4. Review and revise, as necessary, the Infection Control Policies and Procedures.
5. Submit ALL Policies and Procedures that may relate to infection control to the ICC for review, prior to adoption.
6. Report potential infection control hazards to the ICC and EOC Committee.
7. Make available to ALL Department personnel, ICC Policies, Procedures, and if applicable, Surveillance.

B. Infection Control Coordinator:

1. Available as a resource
2. Prepare, review and revise, Infection Control Policies and Procedures
3. Assist in preparing and presenting relevant educational infection control programs.
4. Periodically observe Departmental adherence to infection control practices.
5. Conduct additional investigations, as necessary.
6. Provide any surveillance or investigation data to Departments as indicated, by the EOC Committee.
 
C. EOC / IOP Committees

1. Review ALL Infection Control Policies.
2. Available as a Consultant.
3. Review ANY data and make recommendations concerning Departmental infection control practices.

Personnel:

A. UNIVERSAL PRECAUTIONS will be used by ALL personnel.
B. ALL staff will be screened for communicable diseases as stated in: Hillcrest Employee Health Policy.
C. ALL staff will participate in education programs at the time of hire, (BEFORE beginning job duties), and at least annually thereafter to review practices related to the prevention of infection.

MRSA:
Management of Community-Associated Staphylococcus Aureus (CA-MRSA) Infections

Purpose: To prevent the spread of MRSA infection from person to person ensuring the health and well-being of all students and staff.
Background: MRSA infections are skin infections that appear as pustules or boils which often are red, swollen, painful or have pus or other drainage. MRSA is typically transmitted by DIRECT skin to skin contact OR contact with shared items or surfaces (e.g. used towels, bandages, shared sports equipment, etc.). It is estimated that 30-50% of the population are carriers of the staphylococcus bacteria on his/her skin or in the nose passages and it can be easily transmitted from one person to another. According to the Centers for Disease Control and Prevention, almost all MRSA infections can be successfully treated with or without antibiotics.
Prevention is the best defense and students and staff should be reminded about the importance of simple hand washing and practicing good personal hygiene overall. All cuts and open draining wounds MUST be covered with a secure bandage.
Actions when a student is infected with MRSA:
1) Staff should notify nursing if a student has any signs of infected skin. (Pustule, redness, swelling, drainage)
2) Nursing staff will assess and treat the area. Cultures of any drainage will be obtained and sent to the lab. Other treatment may include obtaining vital signs, warm packs, application of antibiotic ointment and coverage of any draining area.
3) The nursing department will observe for worsening symptoms and call the physician’s office as necessary. If the culture report is positive for MRSA, physician should be notified. Antibiotic treatment may be instituted.
4) The student should come to the nursing department for dressing changes at least 2-3 times per day or as instructed. Any contaminated dressings should be disposed of properly and the area of examination cleaned with antibacterial wipes.
5) All staff should use universal precautions and barriers when exposed to any drainage. Towels, sheets and clothing coming in contact with the drainage should be washed and dried in the dryer. Students may need assistance with this task.
6) No sharing of personal items
7) Student should be reminded to leave the dressing intact and wash their hands frequently.

Actions when a staff is infected with MRSA:
1) If staff have any type of skin infection which is warm, red, swollen, painful or draining they should seek medical attention from their primary care physician.
2) The draining wound should be covered with a clean, dry bandage that contains the drainage.
3) If the drainage cannot be contained or you have fever greater than 101, you should not be at work.
4) The dressing should remain intact; skin to skin contact should be avoided.
5) Staff should engage in frequent hand washing or sanitizing
6) Report any infection and treatment to HR representative.

Precautions:
• Frequent hand washing is the single most important preventive measure to avoid infection with MRSA. Keep your hands clean by washing thoroughly with soap and water or using an alcohol-based hand sanitizer.
• Keep cuts and scrapes clean and covered with a bandage until healed.
• Avoid contact with other people’s wounds or bandages.
• Avoid sharing personal items such as towels or razors.
• Avoid unnecessary use of antibiotics.
• Additional material on MRSA can be found at the CDC web site: http://www.cdc.gov/Features/MRSAinSchools/

PURPOSE & GOAL: The program is designed, implemented, and evaluated to prevent or reduce the incidence of infection among students and staff at HEC.

1. Responsibility
A. The Infection Control Coordinator is responsible for the activities associated with surveillance, prevention, and control of infections among students and staff. The Coordinator is also available for consultation to the EOC Committee regarding any infection related discussions.

B. The EOC Committee will be comprised of the following members, as appropriate:
Chairperson
Workers Compensation Coordinator/EOC Coordinator
Nursing Department Representatives
Maintenance Representatives
Housekeeping Representatives
Direct Care Representatives

In addition, Representatives from other areas are invited to meetings for discussion of issues specific to each of these departments. The EOC Committee meets bi-monthly at each site with the exception of the Intensive Treatment Unit where the EOC Committee meets bi-monthly.

C. The Infection Control Coordinator is responsible for the annual review of the Plan for Surveillance including:
1) Data collection method(s), quality control measures, reporting mechanisms.
2) Effectiveness of program and actions taken for the previous year(s), including data and trends
3) Effectiveness of control measures and actions taken by the EOC Committee
4) New or revised Local, State, and Federal Regulations
5) CDC Guidelines for infection control issues/programs
6) Information regarding Infection control in professional publications or as distributed by Local, State, and/or Federal Departments of Health
7) Review available HEC data presented annually, identify trends, recognize opportunities for improvement, propose actions, assign responsibility, implement and evaluate the effectiveness of actions taken.
8) Annual review and approval of infection control policies and procedures

D. Statement of Authority: Infection Control Coordinator
In the event of a threat to the public health of HEC students and personnel the ICC has the authority to take any steps deemed necessary to control the identified threat. The Medical Director will be contacted and informed of the potential health risk, prior to action being taken in such a situation. However, if the Medical Director can not be reached to make a timely decision the ICC may take definitive action. These actions may include, but are not limited to:
ordering lab work
restricting visitors
requiring the use of personal protective equipment
restricting entry into specific areas
ordering surveillance
further precautions as deemed appropriate by the ICC.

E. Infection Prevention: The Infection Control Coordinator (ICC) has the authority to institute any surveillance activities, control measures, or procedures to prevent infection or its spread among students, visitors, and staff. The ICC will consult appropriately with the EOC Committee and its Chairperson(s).
The Infection Control Coordinator is consulted by Department Heads on issues regarding Infection control, including the following:
1). The purchase of equipment associated with Sterilization, Disinfection, and/or Cleaning
2). Revision of Policies or Procedures relevant to infection control practices
3). The purchase of personal protection equipment and barriers
4). Infectious disease(s) in Staff or Students.

2. Scope of Care

The objective of the Infection Control program is to recognize the occurrence of preventable infections among students and staff along with understanding the prevention of these infectious diseases. The scope of care also includes those practices related to disinfection and cleaning of equipment as well as the necessary supplies. The areas/services which are included in the Scope of the program are:
Residential and Academic Buildings
Offices
Outpatient Services provided by Hillcrest Psychological Services
Food Services
Environmental Services:
Maintenance Services
Housekeeping Services

In addition, contract services are reviewed for appropriate infection control practices.

3. Important Aspects of Care:

A. Surveillance is focused on:
• Total agency surveillance including outpatient services for identification and investigation of preventable infections
• The incidence of blood/body fluid(s) exposure
• The identification of outbreaks of infectious diseases and the institution of appropriate precautions to prevent further spread
• Identification and reporting of those diseases, Reportable by Law to Local and/or State Departments of Health.

B. Review of the policies and procedures as they relate to infection control and/or environmental control issues, particularly those which address prevention and containment of infectious diseases.
4. Indicators

A. Criteria used to identify preventable infections:
• Signs, symptoms, and laboratory findings, that were present and/or incubating at the time of admission.
• For an unknown incubation period, an infection is considered from external sources if it develops 72 hours or more after admission or returning from LOA.
• Infection present at the time of admission, will be referred to the Physician and treated as indicated.
• Self report disclosed by outpatient clients

 
Flu recommendations and procedures

In view of the recent information regarding the swine influenza A (H1N1) the following procedures will be available for all HEC campuses. The best way to prevent the spread of flu illness should be noted and encouraged at every opportunity. These steps include:

• Cover your cough or sneezes into a tissue or inside of arm, not your hands, dispose of the tissue
• Avoid touching your eyes, nose and mouth
• Wash your hands frequently with soap and water or hand sanitizer
• Stay home if you are sick with fever over 100.4F
• Clean surfaces such as desks, tables, counters, and door knobs with antibacterial solutions

On the occasion that the flu reaches our students these procedures should be followed:

• All students will be observed for the following symptoms: fever above 100.4 F, cough, sore throat, body aches, headache, chills and fatigue
• When these symptoms occur, every effort will be made to isolate the student in their room or a designated infirmary area on campus (to be determined by PD and Head Nurse)
• Saff who are assigned to be with ill students will be provided with N95 masks, gloves and disinfectant wipes
• Observation of symptoms will continue. If the BMC diagnostic criteria for testing is fulfilled then a nasopharyngeal swab will be obtained and sent to BMC Lab
• BMC lab will test the swab for Influenza A virus (results available within 24 hours), if present, a repeat specimen will be obtained and submitted to the State lab for subtyping
• Dr. Dempsey will be notified at which time anti-viral treatment may be initiated according to his orders
• If the testing does not reveal type A flu, isolation is not necessary. However, bedrest may be indicated depending on current symptoms assessed by the nurse on duty.
• Symptomatic treatment by staff and nursing will continue throughout the illness. This may include: tylenol/ ibuprofen, fluids and rest.
• Documentation of information will be completed by nursing on the Student Isolation Log. This information will be used to follow isolation and testing processes. (see attached)
• Staff will use the Student Monitoring Sheet to record pertinent information for each student in the isolation room. (see attached)
• The Head Nurses at each campus will make daily decisions on the students entering and leaving the isolation infirmary area.
• Updates on available information will be relayed to staff in Community Meetings
• Decisions on limiting travel or visitation on and off campus will be made by the SMT

Supplies to have on hand:
Anti-bacterial wipes
N 95 Masks
Gloves
Tissues
Nasopharyngeal swabs
Ibuprofen/Tylenol
Ginger ale
Sports drink/ other clear fluids

Flu in outpatient areas:
Appointments may be cancelled if client reports active flu illlness
Appointments may be cancelled if the clinicain experiences active flu symptoms 
Indicators for outbreaks of infection are defined by the Infection Control Coordinator and/or EOC Committee

The ICC will monitor the occurrence of pathogens, drug resistance, and report concerns regarding these to the EOC Committee, and will authorize surveillance as appropriate.

Indicators for Employee Health:

a) Incidence of Measles, Rubella, or Chicken Pox and post-exposure follow-up
b) Blood/body fluid exposures and follow up per OSHA’s Bloodborne Pathogen Standard.

Indicators for Environmental Controls

Housekeeping – Cleaning Procedures: Prior to any change in products used or in manner of use, the Dept. Manager will submit to the EOC Committee ALL available written literature substantiating the efficacy of the change relative to infection control. (See, Housekeeping Department, Policies for Infection Control).

Maintenance: The importance of effective infection control including the Maintenance of the Facility(ies) is recognized and reflected in Dept. policies (See, Maintenance Department, Policies for Infection Control).

The Manager of the Maintenance Department will consult with the ICC relative to appropriate infection control measures put in place prior to, and during all, construction, reconstruction, or major renovation (constituting entering into walls and/or ceilings) to the facility(ies).

Indicators for Policies and Procedures

Review and Revision:

1) ALL infection control policy and procedures are reviewed and revised to reflect current standards at least every 2 years.
2) New policy and procedures are added as required by Local, State, or Federal Laws or Regulations
3) Each Department Manager will consult with the ICC prior to effecting any revisions of Department Policy or Procedure relative to infection control.

REPORTABLE DISEASES

REPORT IMMEDIATELY BY PHONE
This includes both suspected and confirmed cases.
All cases should be reported to your local health department.
If unavailable, call the Massachusetts Department of Health
Telephone (617) 983-6800 Confidential Fax (617) 983-6813

Any Case of an unusual illness thought to have public health implications.

Any Cluster/Outbreak of Illness (Including, but not limited to foodborne Illness)

• Anthrax
• Botulism
• Brucellosis
• Diphtheria
• Encephalitis, any case
• Haemophilus influenzae, invasive
• Hemoêytic uremic syndrome (also report dWectty.to MDPH: 617-983-6800).
• Hepatitis A (lgM+ only)
• Meningitis, baterial community acquired
• Meningococcal disease, invasive
• (N. meningitidis)
• Plague
• Polio
• Q Fever
• Rabies in humans
• Rubella
• Smallpox
• Tetanus
• Tularemia
• Viral hemorrhagic fevers

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REPORT PROMPTLY (WITHIN 1-2 BUSINESS DAYS)
This includes both suspected and confirmed cases.
All cases should be reported to your local health department.
If unavailable, call the Massachusetts Department of Health
Telephone (617) 983-6800 Confidential Fax (617) 983-6813

• Ehrlichiosis
• Creutzfekit-Jakob disease
• Food poisoning and toxicity (includes poisoning by
ciguatera, scombrotoxln, mushroom toxin, tetrodotoxin,
paralytic shellfish and amnesic shellfish)
• Guillain Barré syndrome
• Hansen’s disease (leprosy)
• Hantavirus infection HBsAg+ pregnant women
• Leptospirosis
• Lyme disease
• Meningitis, viral (aseptic), and other infectious (non-bacterial)
• Pertussis (Whooping Cough)
• Psattacosis
• Reye syndrome
• Rheumatic fever
• Rlckettsialpox
• Rocky Mountain spotted fever
• Toxic shock syndrome
• Trichinosis
• Varicella (chickenpox)

105 CMR 300000 Reportable Diseases and Isolation and Quarantine Requirements February 2003, Page 1 of 2
 
REPORT DIRECTLY TO THE MASSACHUSETTS DPH
DEPARTMENT OF PUBLIC HEALTH

HIV infection and AIDS (617) 983-6560

Sexually Transmitted Diseases (617) 983-6940

Chanchrold Ophthalmia neonatorum:
Chalamydial infections (genital) a. Gonoccocal
Genital Warts b. Other agents
Gonorrhea Pelvic Inflammatory disease
Granuloma inguinale a. Gonococcal
Herpes, neonatal (onset within 30 days b. Other agents
after birth)
Lymphogranuloma venereum Syphilis

Tuberculosis suspect and confirmed cases: Report within 24 hours to (617) 983-6989 or
Toll Free (1-888) MASS-MTB (627-7682) or
Confidential Fax (617) 983-6990

Latent tuberculosis infection: Confidential Fax (617) 983-6990 or
Mall report to:
Massachusetts Department of Public Health
Division of Tuberculosis Prevention and Control
305 South Street, Jamaica Plain, MA 02130

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REPORTABLE DISEASES PRIMARILY ASCERTAINED THROUGH LABORATORY REPORTING OF EVIDENCE OF INFECTION

Please work with the laboratories you utilize for diagnostic testing to assure complete reporting.

Amebiasis
Babesiosis
Calicvirus infection
Campylobacteriosis
Cholera
Cryptococcosis
Cryptosporidiosis
Cyclosporlasis
Dengue fever virus
Eastern equine encephahtis virus
E. coil 0157:H7
Enteroviruses (from CSF)
Giardiasis
Group A streptococcus, invasive infection
Group B streptococcus, invasive infection
Hepatitis B
Hepatitis C
Hepatitis – infectious, not otherwise specified
Evidence of human prion disease
Influenza
Legionellosis
Listeriosis
Malaria
Salmonellosis
Shiga toxin-producing organisms
Shigellosis
Streptococcus pneumoniae, invasive
infection /
Toxoplasmosis
West Nile virus
Yellow fever virus
Yersiniosis

105 CMR 300000 Reportable Diseases and Isolation and Quarantine Requirements February 2003, Page 2 of 2

COLLECTING AND ORGANIZING DATA

Data is collected, organized, and presented annually by the ICC and includes:

Incidence of all specific types of infections as well as anaylsis of campus location.

Indicators of environmental controls affecting this data are collected by the EOC Committee, who then notify the ICC of variances.

Communicable diseases are reported to the appropriate Department of Health, by the Medical Director, and reviewed by the ICC when appropriate, such as when further surveillance or action is necessary.

EVALUATION OF CARE

Data is trended and reviewed by the ICC and presented to the EOC Committee annually.

Analysis of data is done for the following reasons:
a) To identify problems
b) To determine the necessity for further data collection or further investigation
c) To quantify the problem and determine causes
d) To compare data to current issues in the professional infection control literature, with national or local data, or other appropriate benchmarks in order to evaluate efficacy of the infection control program
e) To review new CDC Guidelines, OSHA Regulations, state and local Laws to assure compliance
f) To coordinate efforts with Occupational Health to protect employees
g) To provide data to health care providers when appropriate, so that action can be taken to reduce known risks
h) To identify cases of significant epidemiological variation, in order to institute further investigation
 
ACTION TAKEN TO IMPROVE PROGRAM

The ICC and EOC Committee will take action to solve problems or reduce risk of infection, including the following:

1. Use of Knowledge:
a) Present annual infection control programs to all staff, to reinforce and broaden their knowledge base.
b) Orient new employees to accepted infection control procedures.
c) Integrate new procedures or practice recommendations into ongoing programs.
d) Present special programs to staff, relative to new practices, as this information becomes available.
e) Distribute information or current infection control issues at meetings and/or in writing.

2. Assessment of Behaviors
a) The ICC or EOC Committee may institute appropriate measures to modify staff practices necessary to assure compliance with current standards.
b) New policy and procedures as developed, and/or revised, should incorporate the following strategies:
i) Scientifically valid and pertinent information including CDC Guidelines and OSHA Regulations.
ii) Employee Health policies as they relate to infectious disease, prevention, and treatment.
iii) Methods used to reduce the risk of cross-infection between staff/staff, staff/student, and student/student. This may include review of universal precautions, as well as policies on disinfection and handwashing.

Assess Actions

Data Collection and Evaluation
A. The ICC will assess the effectiveness of actions taken by collecting and comparing data and noting any further trends.
B. If improvement is acceptable to ICC, no further action is taken unless specifically requested by the Medical Director.
C. In the event that further action is needed, as determined by Assessment or Request, there will be further data collection and evaluation by the ICC, who will then report this, as appropriate to the Medical Director.

Communicate Relevant Actions Taken

Surveillance Reports
A. The ICC will present pertinent infection control information at IOP Meetings.
B. The ICC will present pertinent infection control information to the EOC Committee quarterly.
C. The Annual Report will include a summary of surveillance data, trends, and actions taken.

 

Hillcrest Educational Centers, (HEC) is committed to providing a safe environment for students and staff. All preventative health care measures are consistently monitored to decrease the risk of exposure to communicable disease.
Upon review of the types of reasonably anticipated exposures occurring in residential settings, this manual was developed to describe the procedures currently employed by our agency to address potential risk(s).

BROOKSIDE ALARM
Main Bldg.: V5-0629
School: V5-0658
Dorm 1: A1-0831
Dorm 2: A1-0832
Gym: A1-0854

HILLCREST CENTER
Tetro Academic Center: A1-0870
Dellea Left: A1-0446
Dellea Right: A1-0445
Miller Hall: A1-0554
Gym: A1-0648

HIGHPOINT
Fernbrook: V5-1585

Main Bldg. A1-0621
Chyla Hall: A1-0505
School: V2-0069
Gym: A1-0855
West pump station: V2-0261
East pump station: V2-0260

HILLCREST ACADEMY
Fire: V5-1503
Security: A2-10000
AO 788 South St.: V5-0689

• If an alarm sounds while you are working in the maintenance shop, stay calm, turn off any running equipment and evacuate the building.

• Find a supervisor to determine if it is a false alarm.

• Provide any necessary assistance to the supervisor with evacuation of students or determination of source of alarm.

• NEVER re-enter any building without a supervisor knowing your whereabouts.

• Be available at a central location to aid the Fire Dept. as needed.

• If it is determined that there was a false alarm, and if you are needed to re-set the alarm, follow up with the supervisor as to your actions. Make sure everyone knows when and if the alarm has been restored, including a call to Berkshire Communicators.

• Berkshire Communicators: 413-499-3650

When a fire alarm goes off at a program or work site the monitoring company, Berkshire Communicators, performs the following actions in the following order:

1) Dispatches the fire department to the program/work site.
2) Calls the program/work site for more information. (See NOTE 1 below)
3) Calls the HEC maintenance department cell phone, which is carried by the on-call maintenance manager.
4) If #3 is not successful, calls through the call list of designated Maintenance staff until 1 is reached.
5) If the monitoring company cannot reach a designated Maintenance staff, they will try to reach (in this order) the Program Director, the Executive Vice President or the President/CEO.

NOTE 1:
The monitoring company will try to reach the program or work site to acquire more information to be sure that no other help is needed, such as an ambulance, police, etc.

If a Supervisor has definitely ascertained and verified that there is a false alarm (i.e., a student was seen by a staff member pulling the fire alarm), the Supervisor may directly call the Fire Department — not Berkshire Communicators — to alert them that the alarm is a verified false alarm.

All other alarms should be treated as unknown, and normal building evacuation should take place.

The following procedure pertains to the gasoline powered generators, and the steps described are a general guideline. Each campus has a more detailed instruction manual specific for that site.

• Notify Supervisor of testing

• Check oil and fuel level; add if necessary.

• Start generator.

• Move Gen-Tran switches from “LINE” to “GEN”.

• Walk through building and observe that all circuits are operating, record findings. Allow generator to run for thirty minutes.

• Return switches from “GEN” to “LINE”.

• Turn off generator, wait 10 minutes to cool.

• Close generator housing.

• Notify Supervisor that testing is complete.

The Highpoint and Center campuses have a winter and summer schedule for the operation of the generators.

Due to extreme cold temperatures, the generators are kept in the heated garage at the Center campus during the winter months, generally from December through March. If they are needed, a supervisor will contact the Maintenance Dept. person on call who will come in to plug in the generators and supply back up power.