The practice of school nursing concerning the prevention and control of communicable disease is regulated by the State of Texas under Texas Administrative Code (TAC) Chapter 97.
Symptoms requiring exclusion from school
The major criterion for exclusion from school is the probability of spread of infection from person to person. A child may have a non-excludable illness that makes it difficult for the child to learn and/or requires the child be cared for at home or in a hospital. The school nurse is qualified to assess a student's symptoms and to determine when parent or guardian needs to be notified regarding the student's symptoms based inability to adequately engage in learning.
The first step in the control of communicable diseases is assessment of presenting signs and symptoms. A student exhibiting any of the following symptoms will be excluded from school:
§ Temperature of 100.0° F or higher. According to the TAC, students must be excluded from school for a minimum of 24 hours until symptom-free and/or fever-free without the use of fever suppressing medications.
§ Two or more episodes of diarrhea within 24 hours or any diarrheal illness. The student may be excluded from school until diarrhea free for 24 hours without the use of diarrhea suppressing medications.
§ Blood in stools not explained by dietary change, medication, or hard stools.
§ Nausea and/or vomiting accompanied by a fever above 100.0 degrees Fahrenheit, or abdominal pain/tenderness upon palpation that lasts longer than 2 hours.
§ Two or more episodes of vomiting within 24 hours.
§ The definition of vomit being "ejection of matter from the stomach and out through the mouth "
§ Red eye with purulent discharge or crusting.
§ Scaly patches on scalp (possible ringworm).
§ Open, purulent draining lesions.
§ Signs of jaundice.
§ Undetermined rash on torso or face with behavior change or fever, open wound and drainage, bruising without cause, joint pain, inability to participate, or increasing tenderness and redness at the site.
The 24 hour rule refers to and includes full school days, i.e. students excluded at 8:40 a.m. one day may not return to class the following day at 8:40 a.m.
Exclusion criteria
Established by the Texas Department of State Health Services (DSHS) and located in the Texas Administrative Code, is mirrored in MISD Regulation FFAD and used to identify notifiable conditions and to determine readmission requirements for communicable diseases. The campus administrator shall exclude from attendance any child having or suspected of having a communicable disease designated by the Commissioner of Health as cause for exclusion until one of the criteria listed is fulfilled:
§ Amebiasis-Exclude until treatment is initiated.
§ Campylobacteriosis-Exclude until after diarrhea free without the use of antimotility medications and fever free without the use of fever suppressing medications.
§ Chickenpox (Varicella)-Exclude until lesions are dry or if lesions are not vesicular, until 24 hours have passed with no new lesions occurring.
§ Common Cold-Exclude until fever free for 24 hours without the use of fever suppressing medications.
§ Conjunctivitis, viral or bacterial-Exclude until written permission and/or permit is issued by a physician or local health authority, or until symptom free.
§ Diphtheria-Doctor’s release
§ Fever-Exclude until fever free for 24 hours without the use of fever suppressing medications.
§ Fifth’s Disease-Exclude until fever free for 24 hours without the use of fever suppressing medications.
§ Gastroenteritis-Exclude until diarrhea free for 24 hours without the use of diarrhea suppressing medications.
§ Giardiasis-Exclude until diarrhea free for 24 hours without the use of diarrhea suppressing medications.
§ Hepatitis A-Exclude until one week after onset of illness
§ Infections-Includes wounds, skin, and soft tissue. Exclude until drainage from wounds or skin and soft tissue infections is contained and maintained in a clean dry bandage; restrict from situations that could result in the infected area becoming exposed, wet, soiled, or otherwise compromised.
§ Infectious mononucleosis-Exclude until physician decides or fever free for 24 hours without the use of fever suppressing medication.
§ Influenza-Exclude until fever free for 24 hours without the use of fever suppressing medications.
§ Measles (Rubeola)-Exclude until four days after rash onset or in the case of an outbreak, unimmunized children should also be excluded until at least two weeks (14 days) after the onset of the last rash.
§ Measles (Rubella)-Exclude until seven days after rash onset or in the case of an outbreak, unimmunized children should be excluded for at least three weeks (21 days) after the onset of the last rash.
§ Meningitis, bacterial-Exclude until 24 hours after start of effective treatment and approval by healthcare provider.
§ Meningitis, viral-Exclude until fever free for 24 hours without the use of fever suppressing medications.
§ Mumps-Exclude until five days after the onset of swelling.
§ Pertussis (Whooping cough)-Exclude until completion of five days of antibiotic therapy.
§ Ringworm-If the site can be completely covered by clothing or a bandage, the child is not excluded from school. Otherwise, exclude until treatment begins.
§ Salmonella-Exclude until after diarrhea free for 24 hours without the use of diarrhea suppressing medications and fever free for 24 hours without the use of fever suppressing medications.
§ Scabies-Exclude until treatment has begun.
§ Shigellosis-Exclude until after diarrhea free for 24 hours without the use of diarrhea suppressing medications and fever free for 24 hours without the use of fever suppressing medications.
§ Streptococcal sore throat/Scarlet fever-Exclude until 24 hours from the time antibiotic treatment has begun and fever free for 24 hours without the use of fever suppressing medication.
§ Tuberculosis (Pulmonary)-Exclude until antibiotic treatment has begun and a physician’s certificate or health permit obtained.
