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Public health guidance for residential institutions

Public Health guidance for planning for human
infections with the Influenza A (H1N1) in residential
educational institutions.

Boarding schools, secondary schools with hostels, summer
colleges, English language colleges, Childcare residential units,
and residential centres for children with learning
difficulties/special needs.

These recommendations are based on current information and are subject to change
based on ongoing surveillance and continuous risk assessment.

Background
Based on new information on circulation of a new Influenza A (H1N1) virus first detected in April, 2009, this document provides interim Public Health guidance for residential educational institutions. This guidance includes recommendations on hygiene measures that should be put in place now in order to prevent the spread of respiratory illness, and planning activities that should occur in preparation for the possibility of cases of Influenza A (H1N1) occurring in residential educational institutions. Educational institutions play a critical role in protecting the health of their students, staff, and the community from contagious diseases such as Influenza A (H1N1). Children and young adults are very susceptible to getting this new virus and residential educational institutions may be locations where spread of this new virus can happen quickly in a community. Educational institutions can help prevent the spread of Influenza A(H1N1) by implementing good health practices now and preparing for activities that need to occur in the event of cases of Influenza A (H1N1) occurring in educational institutions or the community. Guidance

1. Guidance for infection control: Preventing the spread of respiratory illness through
knowledge of Influenza A (H1N1) and practice of good respiratory and hand hygiene.

1. Residential educational institutions and all accommodation used by the institution to house its students should display HSE posters on a. What to do to prevent spread of respiratory illness b. Respiratory Hygiene and Cough Etiquette c. Hand hygiene There are posters suited to different age groups available on 2. Residential educational institutions and all accommodation used by the institution to house its students should have access to HSE information on the symptoms of Influenza A (H1N1), what to do in the event of a person presenting with influenza like symptoms, hand hygiene and respiratory etiquette available to all staff and PH Guidance for residential educational institutions. Education Subgroup, NPHORT, 26/06/09 students (see nal institution should ensure that the information is age appropriate for the students. 3. Educational institutions should not allow children to share wind instruments. 4. Residential educational institutions and all accommodation used by the institution to house its students should promote good hand hygiene and respiratory etiquette to their staff and students. 5. Residential educational institutions and all accommodation used by the institution should provide adequate infection prevention supplies, namely soap, disposable hand towels, tissues and bins. 6. Residential educational institutions and all accommodation used by the institution to house its students should have environmental cleaning procedures to prevent the spread of respiratory illness including: o Ensure that adequate supplies of cleaning materials are readily available (or, if you contract others to provide cleaning services, check that they have contingency plans) o Ensure there are procedures for regular cleaning of hard surfaces o Ensure that hand hygiene facilities are adequate and working properly; if/when updating or repairing facilities, consider installing automatic or foot-operated taps, dryers and waste bins. Ensure that you have stocks of tissues, paper towels and soaps o Consider how you might use alcohol-based hand rub, for example at the entrances to rooms or sites without hand-washing facilities o Check that you have procedures for cleaning rooms used in isolating and
2. Guidance for communications and guardianship arrangements for students

7. In the event of Influenza A (H1N1) cases in an educational institution or advice for an educational institution to close on public health grounds it will be essential to have a communications plan which will include: a. Contact details of the institution’s governing body (who should have up to date information on Influenza A (H1N1) and recommended educational institution actions) b. Contact details of the Department of Public Health in the region c. Up to date contact details of the student’s guardian i. The educational institution should ensure that the identified guardian has provided current contact number and emergency contact number ii. Some students may be wards of court where the state is acting in loco parentis in which case the allocated social worker’s current contact number and emergency contact number should be available. d. Boarding schools/Schools with hostels/Summer Colleges/English language
colleges: Check the guardianship arrangements for students who would not be
able to return to their families in the event of closure of the educational
institution; keep these up to date. The guardian may be someone in Ireland
nominated by parents or may be institution itself. The residential educational
institution may wish to clearly indicate to parents and to guardians that in the
PH Guidance for residential educational institutions. Education Subgroup, NPHORT, 26/06/09 event of Influenza A (H1N1) there is a possibility of students being excluded from the residential educational institution and that the parent/guardian must ensure they or their nominated guardian will be available to take care of the child. e. Childcare residential units, residential centres for children with learning
difficulties/special needs: Liaise with placing authorities on the needs of the
children placed with you; agree how you will determine what would be in the
best interests of the student if there is advice to close the residential
educational institution. For children who are wards of court the allocated
social worker must be consulted before any decision is made.
f. Estimate the number of students who will not be able to return home in the event of advice to close the institution. Plan to accommodate these.
3. Guidance for preparing for actions required if the educational institution suspects a
student to have Influenza A (H1N1) or if there is a cluster of students/staff with
influenza like illness in the school.
Residential educational institutions need to be prepared to recognise and respond if a student
develops symptoms consistent with Influenza A (H1N1). This may build on policies already
in place to deal with sick students.
8. All Staff (which depending on type of setting will include teachers, supervisors, bean an ti, carers, social care workers) should be able to recognise symptoms of Influenza A (H1N1). See ost up to date list of symptoms of Influenza A (H1N1). 9. In the event that a staff member thinks a student may have Influenza A (H1N1) there should be a procedure in place that will include isolating the student until their parent/guardian is contacted. The residential educational institution should also have prior permission from parents to enable urgent medical assessment of sick students if parent is uncontactable. If the parent/guardian lives close by he/she should be advised to phone their GP/family doctor regarding advice and assessment prior to attending the surgery. If he/she does not live close by, the educational institution needs to proceed to contact doctor as below. 10. In the event that a student who may have Influenza A (H1N1), is not able to return to their parents or guardians, there should be a procedure in place for contacting the local GP/school doctor by phone for advice and assessment and accommodating and caring for the student in isolation from other students until he/she is assessed by the doctor. 11. In the event that there is an unusual number of children presenting with influenza like illness there should be a policy for notifying the educational institution’s principal/director who should contact the local GP/school doctor by phone for advice and assessment of the situation. 12. Residential educational institutions should have clear policies on exclusion of staff 13. Educational institutions should remind parents and carers that children displaying flu like symptoms while at home (weekends and holidays) should stay at home and not return to the residential educational institution until all flu symptoms have disappeared. PH Guidance for residential educational institutions. Education Subgroup, NPHORT, 26/06/09 4. Guidance for preparing for actions required in the case of a probable/ confirmed
case of Influenza A (H1N1) in a residential educational institution
Residential educational institutions need to have an emergency plan in the event that the
GP/family doctor diagnoses a student or staff member to be a probable or confirmed case of
Influenza A (H1N1).
If the GP/family doctor suspects Influenza A (H1N1) he/she will notify the Department of
Public Health and they will undertake a risk assessment and advise on appropriate actions.
These actions will change based on current information but residential educational
institutions should be prepared to act on advice that may include:
o The person with probable/confirmed Influenza A (H1N1) will be advised to return to o Identification of classmates, other close school contacts and staff who may be offered preventive treatment with an antiviral medication called oseltamivir (tamiflu), self monitoring for flu like symptoms and fever and possibly exclusion from the residential educational institution or cohorting of contacts within the residential educational institution. In a boarding school, it may be easier to plan for close contacts to return home whereas, in a summer school, it may be more appropriate to cohort the contacts. In each case, a risk assessment carried out by local Department of Public Health and they will advise on which option to take. However it is recognised that some students may not be able to return to parents or guardians, so their educational institution might have to continue to accommodate them, even if other students returned to their families and the educational institution suspended most of its activities. The residential educational institution should develop: 14. Plans for dismissal of a portion of students only. 15. Plans for caring for students sick with Influenza A (H1N1),who cannot return home 16. Plans for caring for students who are identified as contacts of a case of Influenza A (H1N1), who cannot return home (see below).
5. Guidance for preparing for educational institution closures
In the event of advice to close an educational institution on public health grounds or because
of staff absenteeism residential institutions will be expected to close. In some residential
educational institutions complete closure may not be possible (for example where a student
lives overseas and is unable to return home immediately). In certain settings (for example
childcare residential settings or residential centres for students with learning
difficulties/special needs) closure may not be in the best interest of the student. Residential
educational institutions must develop plans for partial and total closure.
17. Each residential educational institution should have a governance structure for implementation of educational institution closures. 18. Where advice is to close on public health grounds all students who can return home 19. Plans for caring for students sick with Influenza A (H1N1), who cannot return home PH Guidance for residential educational institutions. Education Subgroup, NPHORT, 26/06/09 20. Plans for caring for students who are identified as contacts of a case of Influenza A (H1N1), who cannot return home (see below) 21. Educational institutions need to have business continuity plans in place to deal with educational institution closures due to public health recommendation or due to teacher absences. These should include a. Staff working arrangements in event of educational institution being closed. b. Communications with students when educational institution is closed. c. Criteria for lifting educational institution closure (in event of closure due to Public Health recommendation Public Health will give advice on criteria for lifting educational institution closure). d. Plans for the partial re-opening of the educational institution as well as full re- 22. Contingency plans for exam classes where needed. 23. Educational institutions must plan for managing staff shortages due to staff being sick or taking leave due to their children being sick.
6. Guidance for caring for a student with Influenza A (H1N1) in the residential
educational institution

If a student in the educational institution has Influenza A (H1N1), they should if possible return home, or if unable to do so, remain isolated from other students until all symptoms have disappeared or for the period of time advised by the Department of Public Health, whichever is longer. a. If possible they should return home for seven days or until symptoms b. If unable to return home, the educational institution should identify appropriate accommodation for caring for a student with Influenza A (H1N1). This ideally should be a single room, ideally en suite. c. Sick students should not take part in any communal activities for the duration d. Consistent with the welfare of the student, visitor access should be kept to a a. The educational institution should identify which member of staff will care for b. The number of staff who have close contact with the student during their c. Staff looking after affected students should not work with well students. d. Staff at risk of complications if infected (pregnant women or those with an underlying condition with increased risk of influenza-related complications) should NOT care for symptomatic students (see‘Guidance on caring for persons at home with Influenza A (H1N1)’ at PH Guidance for residential educational institutions. Education Subgroup, NPHORT, 26/06/09 e. Sick staff should be excluded from school. f. Staff should clean their hands thoroughly with soap and water on alcohol hand rub before and after any contact with symptomatic students or staff and their environment. g. Staff should use a surgical facemask on entering the room of a sick student or h. Staff and students should be encouraged to avoid touching their eyes, nose and i. Further guidance on caring for a persons with Influenza A (H1N1) can be found at ‘Guidance on caring for persons at home with Influenza A (H1N1)’ at j. If a nurse is available to look after a student with Influenza A (H1N1) they should follow ‘Infection Prevention and Control Precautions for use when caring for patients with suspected or confirmed Influenza A(H1N1)’ () and Appendix 1. 26. Cleaning of symptomatic student’s environment and belongings should be consistent with ‘Guidance on caring for persons at home with Influenza A (H1N1)’ at 27. Consideration should be given to asking symptomatic students to wear a surgical mask if this can be tolerated if they have to leave their room. 7. Guidance on caring for students who are identified as contacts of a case of Influenza
A (H1N1)

When a student is identified as having Influenza A (H1N1), the local Department of Public Health will undertake a risk assessment to identify students and staff who are considered close contacts. They will advise on actions required for these staff and students. This may involve preventive treatment with an antiviral medicine called oseltamivir (Tamiflu), monitoring for fever and flu like symptoms, cohorting and/or exclusion from the residential educational institution. In a boarding school, it may be easier to plan for close contacts to return home whereas, in a summer school, it may be more appropriate to cohort the contacts. In each case, a risk assessment carried out by local Public Health professionals will make a decision on which option to take. In the event that cohorting of contacts at the residential educational institution is recommended the institution should develop plans to care for contacts, which should include: 28. The educational institution should identify rooms/buildings that can be used to cohort student contacts. If the design of the institution and the numbers of pupils involved permits, it is better to cohort the contacts into separate wings or separate houses from the rest of the students. This includes separate areas for sleeping, eating, schooling and socialising. If it is not possible to have separate areas for all activities (eg dining room), arrangements should be made to have the contacts in those areas at a different time to the other students. PH Guidance for residential educational institutions. Education Subgroup, NPHORT, 26/06/09 29. Staff should be identified to provide care for these students, dispense their medication and monitor them for symptoms. Appendix 1.
Specific guidance for caring for cases in different residential educational institutions
Note: Cases should be sent home if possible. However, if this is not possible, the
following guidance should be followed

Boarding schools with a school nurse and sick bay
1. Student should be isolated in a single room with separate bathroom and toilet. 2. Nurse should provide care for student. 3. Nurse should follow ‘Infection Prevention and Control Precautions for use when caring for patients with suspected or confirmed Influenza A(H1N1)’ at
Residential Summer Schools- i.e. adult/adolescent educational colleges for sports or the
arts etc.
These institutions may have challenges with large numbers of overseas students who cannot
go home (e.g overseas students)
1. The organisation must designate accommodation suitable for caring for an ill student who cannot go home or for during the period while the ill student is waiting to go home. 2. Persons caring for ill students should follow the ‘Guidance on caring for persons at home with Influenza A (H1N1)’ at http://www.hpsc.ie.
Gaeltacht (where students are placed with Irish families/Bean an Ti) or Summer
Schools for Foreign Students (where students are placed with Irish families)
Accomodation in Gaeltacht areas and for Summer Schools will generally be family homes
and isolating a case into a single ensuite room may be difficult. The emphasis should be on
sending the case home for isolation as soon as possible. However the educational institution
must plan for when this is not possible.
1. The organisation should consider designating one house that will accommodate sick 2. If it is not possible to designate an entire house, at a minimum, rooms with ensuite facilities should be identified, where sick students can be placed. This may necessitate moving students into other houses. 3. One designated student, or the Bean an Ti/ homeowner should care for the sick students and should follow the ‘Guidance on caring for persons at home with Influenza A (H1N1)’ at http://www.hpsc.ie 4. If facilities are not available for isolation, the organisation must ensure that plans are in place to send sick students home without delay. PH Guidance for residential educational institutions. Education Subgroup, NPHORT, 26/06/09

Source: http://www.corkvec.ie/news/documents/public_health_guidance_for_planning_for_residential.pdf

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