The Oregon School Nurses Association has worked with school nurses, districts, and health departments across Oregon to offer the following tools as examples/templates for districts to customize to their own policies and protocols and consider incorporating into their own return to school operational blueprints or Comprehensive Communicable Disease Management Plans. Anyone using these free tools does so with the understanding that they should run any final versions of documents made using these templates through their district legal advisor to reduce potential liability, and that OSNA or the specific creators of these tools that are offered free of charge to the public make no specific or implied guarantees of their compliance with applicable laws or guidelines. We sincerely hope that these tools might simply give districts a space to view what other schools are planning to use in their own back to school blueprints or protocols.
Communicable Disease Management Plans
While state guidelines, legislation, and school board policies describe what schools need to do in the school setting to contribute to communicable disease prevention and control, a communicable disease management plan describes how this prevention and control will occur and describes applicable algorithms, procedures, and training to mitigate the risk of infection.
School districts are obliged to have existing communicable disease management plans and exposure control plans in place. For the purposes of COVID-19 control measures, guidance from ODE and OHA have advised that each school update their existing communicable disease management plan.
Some districts have chosen to compile all existing documents into a comprehensive communicable disease control plan with a specific COVID-19 Addendum. Below are some examples of this, using two different models.
- MRSD Comprehensive Communicable Disease Plan
- This is a model that uses district nurses as the communicable disease liaisons between the schools they serve and the local county health department, written by the Molalla River School District.
- If you choose to use content from this source, please cite:
- Olson, J. (2020) Comprehensive Communicable Disease Management Plan. Retrieved from https://www.molallariv.k12.or.us/UserFiles/Servers/Server_110703/File/FINAL MRSD Comprehensive CD Plan.pdf If you request to adapt this plan, please provide credit to the original source.
- If you choose to adapt this plan, please indicate one the cover page that the plan was adapted:
- Adapted with permission from Molalla River School District's Comprehensive Communicable Disease Management plan, authored by Dr. Jan Olson.
- MESD Comprehensive Communicable Disease Plan
- This is a model that uses a dedicated nurse consultant to act as the communicable disease liaison between a group of schools or districts, and the county health departments for those schools. Multnomah Education Service District’s comprehensive plan is adapted [with permission] from the Molalla River School District’s comprehensive plan
EXAMPLES OF ALGORITHMS AND GUIDANCE DOCUMENTS ASSOCIATED WITH COMMUNICABLE DISEASE PLANS
Many districts have chosen to create algorithms and guidance documents to use in addition to existing documents for communicable disease control. Below are some examples of these documents:
- Communicable Disease School Communication Protocol
- An example of the communication protocol to be followed from the time a school has been made aware of a positive disease diagnosis in their school community, through the involvement and communication with the local public health department (LPHD), next steps to be considered for the school itself such as increased sanitation, and provision of contact tracing information to the LPHD.
- Modifications to Health Room
- Considerations for adaptation of existing health rooms in schools, necessary to achieve compliance with existing Oregon law and the ODE/OHA return to school guidance.
- PPE Inventory for Schools
- Spreadsheet to help schools determine possible school purchasing needs to comply with Personal Protective Equipment (PPE) requirements in the return to school guidance, and to comply with existing OSHA laws regarding protection of staff in positions that put them at high risk of exposure to the body fluids of others while at work.
- Supplies Described in ODE Guidance
- Definitions and recommendations on possible quantities to consider when purchasing individual PPE items mentioned in the return to school guidance.
- Exclusion & Quarantine
Cohort Tracking (to facilitate health department contact tracing)
Contact tracing is the responsibility of the Local Public Health Authority (LPHA) for the purposes of population-based communicable disease control. The role of the school district in contact tracing is to provide information in regards to the interaction of cohorts and staff in the school setting. This is achieved by determining how to appropriately maintain student attendance records and contact data that can populate cohort logs to provide to the LPHA. School cohort tracing is accomplished by compiling daily logs of each stable cohort in the school setting, for school-based transportation, or at a school-sponsored activity. This includes school staff logs.
In the event of a positive case of COVID-19 within a school community, cohort lists will be compiled to provide to the LPHA with the names and reliable contact information for the applicable individuals who present in cohorts with whom the positive case interacted with while potentially contagious.
In response to the current LPHA request, and in order to align with the current guidance from the Oregon Department of Education (ODE) and Oregon Health Authority (OHA), each individual school must be able to compile these lists in a timely manner for the LPHA. These lists must populate a full report (most often an Excel spreadsheet) that includes all close contacts (individuals who were within 6 feet of the infected individual for longer than 15 minutes) and must include:
- Name and contact information
- Arrival and Departure time
- Parent contact information, as applicable.
- This information must be collected for all cohorts who may have had contact with an infected student or staff Classroom cohorts
- Intervention and student support cohorts (SLP groups)
- Lunchtime cohorts
- Transportation attendance rosters
- List of all students accessing the health room, with time, duration, and date
- Staff and Itinerant staff who had contact with the infected individual
There are a variety of methods in which cohort tracing/tracking data may be collected. Most schools already have systems in place that contain much of the needed data. For example, Synergy contains reports that can populate
- Attendance records
- Bus route lists (could become bus attendance logs)
- Parent and Emergency contact info
- Some electronic school record systems may be able to combine these reports into a single log
Either by combining existing data or by developing new tracking tools, each school must establish a reliable method of tracking student attendance, itinerant staff activity, and any overlap of cohorts. Here is a handy checklist detailing cohort considerations when positive cases of COVID-19 are identified at school. Cohort tracking for each school may be accomplished via spreadsheets, Google Forms, student data systems, or sign-in rosters, respectively. Below are some examples of documents that can be used to collect cohort data and an example of a spreadsheet that can be populated from this data.
Key reminders: designated persons must be established to review and maintain logs and to compile the appropriate log information or populate necessary reports in the event of an exposure. For electronic logs, this person should be an owner of the content and have editing rights. This should ideally be the designated liaison to the LPHA or someone reporting to the liaison to the LPHA.
- Shared Spreadsheets: Google spreadsheets are a good choice when individuals with access to editing are limited. They allow for documents to be shared between individuals for real-time information. Spreadsheets can be completed by a designated person, if resources allow, or by individuals as they enter and exit a space, for example.
- Directions on how to create a Google Sheet
Google Spreadsheets may be used to track activity in the building for a variety of purposes, such as office sign in or sign in within a particular classroom. Google spreadsheet information is accessible to all of those with editing and viewing privileges, so this must be kept in mind
STUDENT DATA SYSTEMS
- Itinerant Staff Tracking Form: Google Forms can be developed to track specific cohorts. This form is an example of tracking the itinerant staff activity among cohorts. The advantage of Google Forms is that other individuals' entries are not visible to users. This makes sense with tracking staff activity. Google Form Data can be exported to Excel Spreadsheets for cohort tracing.
- Directions on how to make a Google Form for schools that might not want to have an editable spreadsheet available to several employees at once. A Google form can be used to populate a spreadsheet of the compiled data, maintaining confidentiality, and reducing accidental corruption of the data.
- Synergy Reports- Districts that use Synergy to track student data my populate the required information from specific reports.
- Please note Synergy tools are evolving and report specific to cohort logs are being developed. and this section will be updated as these reports become available.
- Please note also that Synergy tools are different by district, so you will need to determine (until cohort logs are finalized) which reports fulfill the necessary information. Below are examples of reports that exist in some Synergy systems that can produce the required information
- STU-001 Student List with Contact
- U-STU 002 Emergency Contacts
To determine any students who may have not been present in the cohort during a potential exposure, student attendance records can be reviewed to determine which students may be eliminated from the above student lists. The below report is an example of reports in some Synergy systems, this may look different in your system set up.
- Student Attendance
- ATD-406 Daily Student List by Attendance
- Hard Copy Sign in Sheets or Logs: These forms may be resorted to for schools that do not have electronic data systems and that do not have access to Google Forms.
- Consideration with hard copy records should be given to organization and maintenance of records as well as potential accessibility in the event of exposure.
- In settings where electronic data systems exist, consideration should be paid to duplicating data entry. For example, if attendance is already being taken electronically, there is already a record of arrival and departure of students)
Communication Resources for the School Community
ODE/OHA’s Ready Schools, Safe Learners guidance requires schools to “Develop a letter or communication to staff to be shared at the start of on-site instruction and at periodic intervals explaining infection control measures that are being implemented to prevent spread of disease.“ (section 1b) and to “Communicate any information related to reentry for the 2020-21 school year to multilingual families in a language they can understand about any program, service, or activity that is called to the attention of parents who are proficient in English.” (section 6b) . Many districts will choose to accomplish this over multiple communications.
The examples below can support these communications to parents, students, and staff, reinforcing COVID-19 prevention messages:
- 10 Things You Can Do to Prepare for School Reopening - Spanish and English
- Example one page pamphlet for school communities on school-specific methods of preventing the spread of COVID-19, created by the Molalla River School District.
- OHA How to Protect Yourself and Others - Spanish and English
- Two-page document with details on how to prevent the spread of COVID-19
- Parent Stay Home Letter with Icons - English, Arabic, Chinese, Russian, Spanish and Vietnamese (Translations are out of date. Updated version will be posted as soon as released by ODE.)
- Example letter template to be provided to parents, detailing symptoms of illness to keep their children home for, and when to report to the school if their child is ill (pulled from ODE/OHA School Exclusion Guidelines and OHA resources).
Health Promotion is an important aspect of communication and prevention. Below are some example materials that promote COVID-19 disease prevention strategies.
Return to School State Documents
Ready Schools, safe Learners guidance requires schools to “Train all staff on updated protocols, policies, and guidelines to adhere to physical distancing requirements and recommendations outlined in this guidance and the Operational Blueprint for Reentry.” (section 8b). The below example can be modified with specific examples adapted for a particular district.
Ready Schools, Safe Learners guidance requires schools to “Record and monitor the students and staff being isolated or sent home.” (Section 1i) In order to stay informed of illness trends and possible outbreaks, schools should track 1) students absent because of specific symptoms, and 2) track students or staff present – and then sent home - with specific symptoms noted. Existing systems such as confidential health room logs may be modified for this purpose, to include tracking of parent phone calls to the front office explaining absence due to illness. Regardless of the reason for visiting the health room, a log should be maintained of individuals who spent time in the health room or isolation space each school day, to be included with the other cohort tracking logs used to inform the health department for contact-tracing needs.
Note that information needed for COVID-19 response can also support school nurse data collections in line with NASN recommendations. For example, the required school record could note specific symptoms, as well as who saw the student (nurse, UAP, etc), and could include what happened next (send back to class, sent home, 911 call).
- Parent Daily Symptom Check Algorithm
- Example "Can My Child Attend School" algorithm for parents, to be checked every morning and used as the initial step in a school’s multi-level screening protocol
- "Cant I Attend Work" Algorithm For Staff
- Example "Can I Attend Work" algorithm for staff, to be checked every morning and used as the initial step in a school's multi-level screening protocol
- Instructions for Daily Visual Symptom Screening Upon Entry
- Example of daily visual screening to be done on entry to bus or school, as the second step in a school’s multi-level screening protocol
- Health Room Symptom Screening Algorithm
- Example screening algorithm to be used in the health room when a nurse is not available
- Symptom Surveillance Log
- Example spreadsheet to be shared between front office staff receiving illness/absence phone calls from parents, and health room staff, to monitor symptoms that are subject to exclusion and to track the appropriate date of return to school
- ODE/OHA School Exclusion Guidelines (Updated October 1, 2020)
- Be sure to update the draft tools with the appropriate changes when customizing to suit individual practice.
- All staff and parents should be made aware of these general exclusion guidelines; when to stay home or keep a student home due to symptoms and diagnoses of illness. School staff also use these guidelines to provide passive symptom screening throughout the school day to determine when to send a student to the health room for further screening and possible isolation.
- Symptom Screening Tool
- General guidance document on screening of students in the school setting specific to COVID-19
- Full Screening Process
- General guidance document on the full screening process in the school setting specific to COVID-19
Frequently Asked Questions
Oregon school-based nurses posed the following questions during OSNA online discussions. OSNA leaders, the OHA State School Nurse Consultant, and ODE’s School Health Specialist reviewed responses provided during a state-wide online OSNA Q&A session. Answers aligned with current guidance are provided here. Answers not addressed in guidance were sent up to OHA or ODE.