Big 8 +Health & Safety Coalition

Ohio Guidelines for School Re-entry

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This document represents a collaborative effort from The Big 8 Plus Health and Safety Coalition and was created in response to the need for a unified approach in planning for the return to schools in the midst of the COVID-19 pandemic. The key details to consider and the resulting recommendations have been developed based on current information from ODH, CDC and NASN, as well as other applicable research data. This is a fairly comprehensive list and the recommendations represent the best practice guidelines for the safe return to schools for both students and staff as of today, 6/4/2020. While some guidelines are non-negotiable per ODH directives, it will be up to individual districts as to how they implement these best practice protocols. Please note that this is a fluid document and guidelines may change as prescriptive health orders are updated.

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Health Principles for Education

  • Protect the health and safety of students and staff

  • Assure the ability to meet directives from ODH and the local department of health for social distancing and mitigation of transmission in order for students and staff to return to education in buildings.

  • Schools and districts should have the same requirements and detailed specificity as businesses

  • School health experts such as a School Nurse, School Board Physician or other school health provider is an essential member of the district planning team
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Recommendations and Considerations

Protective Measures

  • Physical Distancing:
    • Create an area and develop guidelines for a supervised space to separate persons with suspected illness from others
    • If 6 feet of social distancing is required, this must apply to all areas and settings including but not limited to:
      • Transportation
      • Classrooms
      • Common areas- halls, entry ways, lunch rooms, restrooms
      • Office areas
      • Playgrounds
      • Gymnasiums and auditoriums
  • Face Masks:
    • Required for all students and staff
    • A medical exemption may apply to some students and staff
    • Employees who can’t wear masks should not work in congregate settings
    • Some employees may need face shields either alone or with masks, see accompanying research
  • Hand hygiene
    • Sanitizer- readily available to students and staff
    • Consider health and fire codes regarding accessibility and storage of hand sanitizer
    • Assure accessibility to sinks, soap and paper towels
    • Hands should be washed
      • Upon entry
      • Before eating
      • Before boarding the bus at end of day
      • After restroom use
      • Any time hands are soiled
      • Do not rely solely on hand sanitizer, use soap and water in between hand sanitizer use
      • Gloves are not recommended unless normally worn for other purposes


  • Personal Protective Equipment (PPE)
    • Follow OSHA standards
    • Employer shall provide PPE
    • Nurses, special ed staff and bus aids will need face shield/goggles
      • Determine what tasks require extra PPE. For example masks for certain student groups during treatment vs. full time wear for educational interventions where distancing is not possible
  • Absenteeism
      • Adopt permissive absenteeism procedures to discourage arriving to school ill
    • Staff- establish medical leave procedures to ease ill time burdens
    • Student- no awards for perfect attendance
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Sanitation

  • Students and staff share responsibility for building cleanliness

  • Provide staff with access to cleaning products and safety data sheets/directions for use

  • Provide appropriate protective gear with training

  • Classrooms

    • Building life-long learners for health practices in our students is important. Encourage and supervise students to

      • Wipe own desks, door handles and learning supplies with supervision


  • Pay special attention to common areas

    • Door handles, high touch points

    • Sinks

    • Water fountains

    • Printers/Copiers/Shared technology and equipment

    • Phones

    • Staff only areas (break rooms, mail room etc)

    • Shared spaces

    • Recommend cleaning at least every two hours

  • Buses

    • Spray disinfectant between routes (check product instructions and dry times)

    • High touch areas- steering wheels, seat backs

  • Supplies- no sharing

  • Lockers and cubbies

    • No sharing

    • Space out locker assignments

    • Stagger locker access

    • Minimize items brought back and forth from school

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Transportation

  • Temperature measurement is not recommended for students or staff (see daily precautions)
  • Bus entry and exit- load back to front/unload front to back
    • Install Plexiglas sneeze guard to protect driver
  • Monitor student movement and maintain 6 feet distance between students
  • Consider limiting transportation to certain grade levels
  • Disinfect between routes
  • Coordinate procedures with other transportation stakeholders such as parochial, public school and daycare transportation staff
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Building Considerations

  • Designated entry and exit doors
  • Bathrooms
    • Post directions on correct hand-washing procedure
    • Maintain ample supplies
    • Use Plexiglas between sinks
    • Limit/stagger student access
  • Fire/Tornado drills

    • Tornado drills may not be safe due to distancing challenges

    • Legislative backing to change requirements (perform drills according to ability to adapt for social distancing)

  • First Aid and emergency medical procedure

    • Emergency procedures without PPE are at the risk and discretion of the employee and are not required

    • Some procedures may not be able to be performed until EMS arrives

    • Senior student requirement for First Aid and CPR should be waived or limited to didactic content

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Class Transition


  • Adapt schedules to limit class size
  • Move teachers instead of students when changing classrooms
  • Stagger class changes

  • One-way hallways
  • Limit permissions for students leaving class (education of teachers on first aid that could be handled in class)

  • Plan bathroom privileges

  • No book bags

  • No lockers

  • Adapt water fountains to prevent contamination, for example, retrofit fountains to promote no-touch water bottle fillers
  • Provide alternate activities for recess to encourage physical distancing


Unified Arts

  • Provide outdoor physical education when possible

  • Limit class size

  • Equipment and instrument sanitation between use
  • Music/Theater, choir and band- no ensemble performances or practice
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Food/Eating

  • In blended online/in-person learning models, consider federal lunch program waiver in order to provide access to food on non-attendance days

  • Provide meals in classroom as an alternative to lunch room gatherings

  • Contracted services/personnel coming into buildings other than school staff should follow all health and safety measures
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Health Assessments


    • Health assessments
    • Implement a symptom check and surveillance form
      • Temperatures - not recommended as a screening tool for well students/staff
        • Evidence does not support fever alone as a good indicator of COVID-19
        • Asymptomatic people can spread disease
        • Risk of exposure to those measuring temperature
        • Inaccuracy of temperature in uncontrolled setting (device used, environmental temperature fluctuation.
      • Employees shall self-assess for symptoms before entering buildings
      • Parents/Guardians should assess students at home and not send to school with symptoms


    • Students and staff who exhibit illness symptoms during the day
      • Students/staff with COVID-19 symptoms must go home
      • Check temperature at school when exhibiting signs of illness
      • Mask and isolate students under supervision to avoid exposing others
      • Parents/guardians must pick up ill students within 30 minutes of being notified
      • Identify a space to separate those exhibiting symptoms from others (see guidance document)
      • Students/staff excluded for virus symptoms will follow state and local health department guidelines and may be out for 10 days or more
      • Use surveillance form to keep a record of ill students and staff and to determine when they may return to work or school
      • Check with local health department regarding procedures for reporting COVID-19 illness
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    COVID-19 Tracking and Reporting

    • Recommend parents report diagnosis to school or district
    • Local health department must notify schools of students and staff testing positive for COVID-19 (Category A)
    • Local health department performs contact tracing
    • Collaborate with local health department for surveillance tracking (surveillance form available- contact OASN.org)
    • Returning to school/work after above
    • Follow CDC/ODH Local Health Department guidance for system based, test-based and time based re-entry
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    Medication Administration

      • Physical distancing procedures to mitigate transmission

        • Stagger medication administration times

        • Limit volume of students- one student at a time in the health office

        • Routine procedures should be performed in the well area of the health office (sick children should be in a separate space)

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    High Risk Students and Staff

    • Procedures that aerosolize the virus cannot be performed safely in schools

      • Nebulizers

      • Suctioning- oral and tracheal

      • High flow oxygen

    • Specialized PPE is required for procedures that require less than 6 foot distance e.g.

      • School Nurse assessment of ill and injured students

      • CPI holds

      • Hand over hand instruction

      • Diapering and toileting

      • Medical procedure- catheterizations, tube feed, ostomy care, diabetes care

      • PT/OT/Speech/Adaptive PE

    • Vulnerable student populations: foster care, homeless, mental illness, ACES, Special Education, Medically complex and medically fragile, chronic disease

    • Staff with chronic illness or age- contributing health factors

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    Training and Education

    Staff
    • Symptoms of COVID-19
    • Preventing cross contamination
    • When to stay home
    • Social distancing
    • PPE use
      • Cloth masks (how to use/clean and care /minimize cross contamination)
      • Glove use
      • Other
    • Safety protocols
    • Procedures for reporting illness
    • Building specific mitigation processes
    • Social Emotional Health for self and for students: assistance and resources
    Students
    • Symptoms of COVID-19
    • Preventing cross contamination
    • When to stay home
    • Social distancing
    • PPE use
      • Cloth masks (how to use/clean and care /minimize cross contamination
      • Disposable masks
    • Safety protocols
    • Building specific mitigation processes
    • Social Emotional Health for self: assistance and resources
    Parents
    • Symptoms of COVID-19
    • School Processes and Procedures
    • When to keep your child home
      • Fever
      • COVID-19 symptoms
    • What to do when your child is sick at school
    • Reporting illnesses
    • Mask use, cleaning and care
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    Legislative Support and Special Ed Considerations

    ODH consider waivers for

    • Immunization report deadlines
    • CPR/AED requirements for students-suspend hands on requirement
    • Health Screening deadlines
      • Suspend/Extend October deadline for Kindergarten and “New to District Students”
      • Suspend/Extend routine screening of other grade levels
      • Allow Nursing discretion for screening priorities
    • Special Education/504 considerations
      • ETR-schedule individual appointments for health screening if schools are closed
      • Re-evaluation-consider referral to health care provider for health evaluation
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    Authors

    Dawn Abbott, MEd, BSN, RN, NCSN, LSN; Director of Health Services, Dayton Public Schools

    Deb Aloshen, MEd, BSN, RN, LSN; Director, Health and Nursing Services, Cleveland Metropolitan School District

    Ann Cipriani, MEd, BA, RN, LSN, NCSN ; Health Services Coordinator, Toledo Public Schools

    Cynthia Eghbalnia, MPH, CIH, CSP: Environmental Health and Safety/WC Administrator, Cincinnati Public Schools

    Camilla Giallourakis, MSN, APRN, CNP – AC/PC: Nurse Practitioner, Akron Children's Hospital

    Amy Hotler, DNP, RN, LSN; Supervisor Health, Family and Community Services, Columbus City Schools

    Joan Hlinomaz, MS, BSN, RN, NCSN: Licensed School Nurse, Kettering City School District, Past President OASN

    Megan Hussar: School Health Liaison, Canton City Schools

    Rhea Jagodzinski, M.Ed., BSN, RN, LSN: ASP Licensed School Nurse, ESC of Lake Erie West, Toledo

    Kate King, DNP, RN, LSN: Director, Health, Family and Community Services, Columbus City Schools

    Rachel Klaiber, School Nurse, South East OASN Regional President

    Angie Lewis, BSN, RN, LSN, NCSN: School Nurse, South East OASN Regional Rep, Rock Hill School

    Rhonda McCloskey, MSN, RN, LSN: Schoool Health Liaison, Canton City Schools

    Carol Pennington, MSN, RN, LSN: Manager of Nursing and Health Services, Cleveland Metropolitan School District

    Susan Ross:Health Services Outreach Coordinator, Canton City Schools

    Mary Schatz, MSN, RN, LSN: Nurse Manager School Health Services of Akron Children's Hospital

    Kimberly Stanislo, DNP, APRN-CNP, CPNP-PC, LSN: Clinical Assistant Professor, Ashland University

    Deborah L. Strouse, MEd, MSN, CNP, NCSN, FNP-C: Emergency Prepareness Nurse Training Coordinator, Columbus City Schools

    Michele Wilmoth, MSN, RN, LSN, NCSN: Director, School Health Services, Akron Children's Hospital

    Kelly Wagner, MEd, BSN, RN, NCSN: School Nurse, President Ohio Association of School Nurses, Delaware City Schools