Covid19

.School Based Health Clinics under Level 2.

( This document has been adapted with permission from the CMDHB Youth SBHS Service Provision Covid-19 Alert level 2 for use in non DHB funded school-based health clinics)

 

Under Alert Level 2, it is safe for all schools to open. Safe and sensible practices for hygiene and contact tracing will be the norm, and all students will be able to return, so long as they remain well.

 

Health services should be accessible to all students and staff onsite and may also be offered to other students off site via phone or internet.

Level 2 Directions

  • No staff or students should be at school if unwell

 

  • Students and staff with pre-existing conditions, or identified as vulnerable, can return to school. People at higher-risk of severe illness from COVID-19 (e.g. those with underlying medical conditions, especially if not well-controlled) are encouraged to take additional precautions when leaving home. They may work if they agree with their employer that they can do so safely. Refer to Ministry of Education document: Managing health and safety in schools at Level 2 below

 

  • Additional precautions will be individualised and guided by the persons own medical provider.

 

  • All students/staff who arrive with or develop respiratory symptoms should be sent home (consult the case definition to see if they should attend Community Based Assessment Clinic or a Designated GP Practice [CBAC] for Covid-19 testing)

 

  • When  referring a student or staff member to a designated Practice please remember to contact them via phone/email, unless walk-in is indicated as being acceptable, to ensure the practice has capacity to see them

 

 

  • Schools connected to a confirmed or probable case of COVID-19 must close on an individual or group basis for 72 hours to allow contact tracing and cleaning. They could be closed for a further 14 days, but open for distance learning. Public health units will manage this and the direction to close will come from the Medical Officer of Health.

 

  • No throat swabbing or examining of throats should be undertaken in the Health Clinic – all students/staff who present with sore throats should be referred for Covid19 swabbing.  Students fitting the at-risk category for Rheumatic Fever as per the Heart Foundation Sore Throat Management Algorithm (link below) should be referred to a designated GP Practice or Community Based Assessment Clinic (CBAC) for empirical antibiotic treatment and a Covid19 swab.

https://www.heartfoundation.org.nz/resources/a-guide-for-sore-throat-management-algorithm

  • Consider being available for phone consultations for students who are home.  A phone number/email could be advertised through the school website etc.  This would mostly be providing advice and referrals.  Also phoning students who have known medical conditions to check in to see how they are.

CPR Management

 

According to the New Zealand Resuscitation Council the following modifications should be made to essential life support https://www.nzrc.org.nz/assets/Guidelines/COVID-19/2020-03-27-Temporary-Guideline-in-State-of-EmergencyFINAL.pdf

 

  • Wear PPE

  • Lay a piece of clothing or a towel over the persons mouth (this may prevent droplets/cough spray)

  • Do not listen or feel for breathing by placing your face next to theirs

 

You should still follow DRS ABCD, including opening the persons airway with head tilt/chin lift; provide rescue breaths via face mask and ambi bag (do not insert airway devices); provide chest compressions; use a defibrillator

 

Clinic Provision

 

  • Consideration should be given as to how nurses can manage to staff the clinic safely. This should include how to manage student flow and waiting areas, and whether consultation rooms and other clinic rooms require reconfiguration to ensure appropriate physical distancing and hygiene practices.

  • NO students with respiratory symptoms should turn up to the health centre without the nurse having been advised prior, via phone call or email from student or staff member. Send information to all staff and students, with details on how to contact the health centre staff.

  • See flowcharts below for students presenting with asthma or other respiratory symptoms (These remain unchanged from those suggested at level 3).

  • An isolation room should be provided for students/staff unwell with respiratory symptoms. This room should be as close to the health centre and nurses as practicable. An isolation room should only contain one student/ person in the area at a time. This area should be devoid of beds, bedding, soft chairs, couches etc. Ideally one hard, easy-to-clean chair for student to sit in while waiting to be picked up.  The area should be cleaned after every use.

  • Red tape or similar should be used to indicate where students/staff should STOP and wait when entering the clinic area, and to manage chair spacing within a waiting area to ensure physical distancing is maintained.

 

Personal Protective Equipment

 

  • Please apply the principles in the flowchart (Northern Region Interim Health Professional Home Visit Guideline) below when deciding what level of PPE may be required when needing to have contact with students/staff.  Screen staff and students according to guidelines in this document.

  • If there is an emergency the nurse should attend the incident with full PPE (gown, gloves, goggles, and mask) available. If there are any respiratory symptoms present full PPE should be donned.

  • PPE should be put on and taken off according to the instructions below

  • PPE should be disposed of in a separate bag, sealed and then into general rubbish. You can place your used mask, gown and gloves in a plastic bag and put it in with the waste for disposal. You will need to talk to your manager about how best to do this in your workplace.

  • N95 masks are only for use for aerosol-generating procedures, therefore should not be required in a SBHS.

 

Cleaning

 

Regular cleaning of commonly touched surfaces should be undertaken.

Students should use hand sanitizer on entry to health centre and again before exiting.

Isolation room protocol: Once a suspect case has been transferred from the premises, a general clean of the room can be undertaken. You do not need a stand-down period before you can use the room again. If the patient uses the toilet, the following cleaning procedures also apply.

  • Remove any linen that has been used into linen bags for hot washing.

  • Wipe down hard surfaces with detergent and water, then hospital grade disinfectant.

  • Remove and discard PPE as clinical waste

  • Perform hand hygiene thoroughly to elbows.

Any hospital grade detergent/disinfectant products are suitable for cleaning following a suspected, probable, or confirmed case of Covid-19. Read label of cleaning products and follow recommendations provided on product labels. Labels contain instructions for safe and effective use of the cleaning product, including precautions you should take when applying it. Specific PPE and dwell time (how long the cleaning product should remain wet on the surface before drying) should be included in product instructions. Recommended cleaning product should be a 2-in-1 product (containing both cleaning and disinfectant properties) to increase efficiency.

Keep the windows open for ventilation if possible.

Useful Documents:

Managing students who develop respiratory symptoms at school

Managing students who develop asthma symptoms at school

CDC Donning and Doffing PPE

Support Agencies and useful numbers

Covid19 Health Professionals Home Visiting Guide (guide to use of PPE can be applied to school setting)

Designated Community Covid19 Swabbing Practices

Community Based Assessment Clinics

Managing health and safety in schools at level 2

The artwork on this website has been used with the permission of the Mangere College Art Department.