UPDATE of HIV/AIDS Policy Statement (revised 4/18/03)

To be available for all at the Headmaster/Principal/Health offices.

 

HIV/AIDS AND BLOODBORNE PATHOGENS POLICY STATEMENT

The following is the complete text of the Pinkerton Academy policy on HIV/AIDS adopted by the Pinkerton Academy Board of Trustees on April 9, 1992, and revised on April 10, 1997.

       Pinkerton Academy recognizes that employees with a life-threatening illness such as AIDS may wish to continue their employment and, in fact, that continued employment may be therapeutically important.

       There shall be no discrimination in employment based solely on HIV/AIDS infection. No employee shall be terminated, transferred or subjected to adverse action based solely on the fact of infection or perceived infection. Employees who are unable to safely perform their duties due to illness (including, but not limited to HIV/AIDS) shall retain eligibility for all benefits provided for other school employees who are likewise unable to perform their duties, and who suffer from any illness, long-term disease or disabling condition. In determining an HIV/AIDS infected employee's ability to continue in employment, the Academy will consider making reasonable accommodations to the employee's condition, consistent with applicable federal, state and local laws.

      Barring special circumstances, such as untreated tuberculosis or a significant health problem that will restrict that individual's ability to work safely, employees who are infected or perceived to be infected with HIV/AIDS shall continue with the job to which they would have been assigned had they not been infected. They are entitled to the same rights, privileges and services accorded to other employees.

       Pinkerton Academy has established a program of ongoing education for HIV/AIDS for all employees. This program includes information about the nature of HIV/AIDS infection, how it is and is not transmitted according to current information available, procedures for infection control and prevention, and resources available to obtain further information, testing, etc. It is essential that employees understand that they will not always know which students or employees are infected with HIV/AIDS. The infected persons do not always know that they have become infected. Employees should always consider every exposure as potentially hazardous and use standard (formerly universal) precautions when there is a possibility of exposure to blood and/or bodily fluids (see Bloodborne Pathogens Exposure Plan).

       The Head Nurse has been appointed as the contact person for HIV/AIDS at Pinkerton Academy. If you have any concerns or questions, please contact the Head Nurse.

 

BLOODBORNE PATHOGENS EXPOSURE PLAN

        Pinkerton Academy has established a comprehensive Bloodborne Pathogens Exposure Control Plan in accordance with OSHA standards. The plan is intended to institute guidelines to prevent transmission of communicable diseases, particularly HIV/AIDS and Hepatitis, via contaminated blood and/or bodily fluids. All exposures are to be considered infectious regardless of perceived status of the individual (see also HIV/AIDS and Bloodborne Pathogens Policy Statement).

Primary preventive actions include:

§         Hepatitis B prophylaxis for employees whose job classification may result in exposure to blood or other potentially infectious materials, ex. nursing staff, athletic trainers/coaches, custodians, and teacher aides who are required to provide toilet assistance, etc.

§         prevent/minimize direct contact

§         use of standard (formerly universal) precautions whenever a potential for exposure exists:

-         use of immediate and thorough hand washing after an exposure, and the completion of appropriate forms at the Health Office for follow-up of the exposure incident

-         use of disposable gloves (latex, rubber, plastic) to provide a barrier; additional gloves may be obtained from the Health Office

-         use of Personal Protective Equipment when such exposure can be anticipated


Post-Exposure Evaluation and Follow-up:

§         All exposures must be reported to the Health Office.

§         A written report of exposure (as defined by CDC/OSHA) incident will be completed.

§         The exposed individual(s) will be provided with post-exposure evaluation and follow-up and offered post-exposure prophylaxis, according to current CDC recommendations, at no cost to the employee.

 

AIDS (Acquired Immune Deficiency Syndrome) is caused by a virus known as HIV  (human immunodeficiency virus). This virus damages the body's ability to fight disease, making it susceptible to a variety of illnesses including certain serious conditions referred to as opportunistic infections. These include such conditions known as Kaposi's Sarcoma, pneumocystis carinii pneumonia, tuberculosis, etc. The occurrence of one of these opportunistic infections or AIDS associated dementia provides a basis for the diagnosis of AIDS. From the time an individual becomes infected with HIV, before any symptoms develop—before most tests for HIV would be positive (usually 1-3 months, but possibly 6 months or more after becoming infected)—they may infect others with the virus. HIV can be transmitted through sexual contact, sharing contaminated needles/syringes, transfusions of infected blood/components, transplantation of infected tissues/organs, and via infected body fluids.

The virus has been found in varying amounts in blood, semen, saliva, tears, sweat, breast milk, and vaginal secretions. Dried body fluids reduce the amounts of live virus by 90-99% within several hours. Toothbrushes, razors, and other personal care items that could potentially become contaminated with blood should not be shared. Tattooing and body piercing place people at increased risk of HIV transmission. Human bites also increase the risk of transmission. Contact with saliva, tears, and sweat have not been shown to result in transmission of HIV. There has been one documented case of HIV transmission through acupuncture (CDC).

Some symptoms include (a) persistent cough, fever, shortness of breath, multiple purplish blotches, bumps on the skin, night sweats, weight loss, memory loss, partial paralysis, persistent generalized swollen glands, changes in mental status or behavior, etc. Diagnosis of AIDS, however, may not be made for 1-15 years (the average, being 11 years) after the initial infection. This might result in infection of others because the infected individual may not feel sick and probably will not have testing unless they recognize that they have been exposed to HIV through risky or promiscuous sexual behavior, drug usage, blood or other bodily fluids. Prevention involves elimination of risk factors and/or risky behaviors, careful adherence to proper standard (formerly universal) precautions, and strictly monogamous sexual relationships, or abstinence. AIDS is usually the end stage of HIV infection.

AIDS is a communicable disease. As with all diseases where contagion is a concern, precautions to prevent transmission need to be outlined. Because of the emotional issues involved and the seriousness of this disease, these are being specifically outlined. Since HIV is not spread through casual social contact or behaviors that are acceptable or permitted at school, it should not be necessary to share the identity of a student or employee who has HIV/AIDS. Any decision to disclose the identity of an infected individual should be based solely on their medical/ educational needs and should be done only with the knowledge and written consent of that individual or parent/guardian. As in most states, patients in New Hampshire have a statutory right of confidentiality with respect to their medical records and medical information (N.H. RSA 329:26).

            In the absence of legal process, except for a variety of narrow exceptions, medical practitioners have a duty to release a patient's privileged information only to the patient, the patient’s authorized representative, the attending physician, and other practitioners with a legitimate interest in the patient's case. One individual, (preferably the Head Nurse and an alternate designee, as appropriate) should be appointed and identified as the contact person for HIV/AIDS at Pinkerton Academy. It is very important that any student (parent/guardian) or employee with HIV/AIDS be notified if there are reported illnesses in the school that may pose a threat to the infected individual, whose immune system has already been compromised. 

Because immunizations may cause illness in those with immune deficiencies, the school nurse may learn that a student is infected with HIV/AIDS when asked to approve an immunization waiver. The waiver shall state that the student is "Medically Excused" from the immunization requirements. In order to protect health, life, and confidentiality, it is essential that the infected individual contact the designee(s). Normal activities should be continued whenever possible, and any changes to work schedules and other activities, including participation in sports will be made on an individual basis. Contact sports will require a physician's approval. The designee(s), along with the infected individual, their personal physician, and parent/guardian shall determine if further action is medically or educationally warranted.

An Advisory HIV/AIDS Team will be available for consultation with the Pinkerton designee(s) to review and assist with making recommendations for any student/faculty member identified with HIV/AIDS. The team may include as many of the following as indicated by the individual case: the Pinkerton Academy designee(s), who will chair the team meeting and provide the information needed for the decision‑making process; an administrative representative; the school physician; school nurse(s); a guidance counselor or Special Education representative; representatives of the State Department of Education and Communicable Disease Control; the parent/guardian; student or employee, (and immediate supervisor, if appropriate); the individual's physician; and any other appropriately involved professionals. Changes in the educational program or work assignment will be made on a case‑by‑case basis: utilizing the best available medical and scientific evidence and advice, while considering the condition of the infected individual. 

We must keep in mind the importance of providing adequate protection and notification to the infected individual to prevent exposure to infection that may pose additional threats to health and life, with an emphasis on recommendations being "reasonable." This policy is intended to ensure the treatment of the infected individual in a confidential and compassionate manner. Discussion and decisions of the team can usually be carried out effectively without disclosing the name of the individual involved. The infected individual may opt to meet with the designee(s), and their physician prior to a team meeting. An individual may choose to have their concerns presented by the designee to the team, instead of attending the team meeting, particularly, if the decision to disclose their identity has not yet been made. The infected individual may then review the recommendations made, request clarification, etc. as needed. The designee(s) shall request periodic reevaluation by the team as needed. Decisions of the team may be appealed to the Headmaster.

As previously stated above, Pinkerton Academy shall establish a program of ongoing education for HIV/AIDS for all employees and students. This program shall include information about the nature of HIV/AIDS infection, how it is and is not transmitted according to current information available, procedures for infection control and prevention, and resources available to obtain further information, testing, etc. AIDS education will be presented in a professional manner provided as part of the Health Curriculum, which is required for all students. It may also be addressed in other academic areas as appropriate. The policy of the Academy in dealing with HIV/AIDS-infected students and employees will be included in all appropriate publications. Review of standard (formerly universal) procedures shall be provided annually for individuals whose responsibilities are primarily maintenance and/or custodial. By the nature of its makeup, this document will also serve as an educational tool.

There is no evidence that HIV is transmitted through contact with vomitus, nasal discharge, saliva, urine, or feces. These bodily fluids, however, might transmit Hepatitis A and B, colds, influenza, and other viruses, making it common sense to use precautions when handling all bodily fluids of all persons. Proper hand-washing is the most important means of interrupting transmission. Employees should always use non-latex gloves. Contaminated items should then be bagged and disposed. Disinfection of exposed surfaces such as floors and furniture is essential. 

Blood is the most important source of HIV (and Hepatitis B and C) transmission in the workplace. Employees who may occasionally render First Aid should avoid coming in contact with blood, etc. by using a barrier. It is best to treat all bodily fluids as though they were infectious. A solution of 1 part bleach to 10 parts water, freshly diluted, (or other approved solution), is the simplest way to decontaminate blood spills. Soiled cleaning equipment should also be decontaminated.

Any individual who may experience inadvertent exposure to blood or other bodily fluids without the benefit of gloves, or other appropriate barrier, should thoroughly wash their hands with soap and water as soon as possible after exposure. Such exposure should then be reported to the nursing staff so that any follow-up procedures may be initiated. HIV Protocol for follow‑up of persons exposed to another person's blood shall comply with the recommendations of the N.H. Dept. of Communicable Disease Control.

In its 1987 decision, the Supreme Court determined that a person with a communicable disease may be considered handicapped under Section 504 of the Rehabilitation Act of 1973. In September 1988, the U.S. Dept. of Justice issued a statement that people with HIV/AIDS are covered under Section 504. HIV/AIDS infection cannot be the basis of exclusion from school, work, sports teams, etc., if the individual is otherwise qualified, unless it can be determined that the individual poses a direct health threat to others.

In the case of a student who is already participating in a special program under I.D.E.A. (P.L. 94‑142), only a Special Education Team may alter the student's program. The Advisory HIV/AIDS Team may make recommendations but changes remain the responsibility of the Special Education Team. If there is no risk to the school community or to the student's well‑being, the Special Education Team need not consider the case. If a change is required, the Special Education Team must consider the student's needs while ensuring that confidentiality is not violated in the process.

Students who become infected with HIV/AIDS, who were not considered disabled before their infection, may eventually need changes in their school program because of deteriorating health. However, unnecessarily segregating a student may be considered a violation of the student's rights. Students with HIV/AIDS may occasionally need to alter their schedule due to illness.  They should be treated like all other students who have occasional illnesses, unless the parents request otherwise or it is felt that health problems are significantly interfering with the student's academic achievement. In this instance, the student may be referred to the appropriate district for coding as "Other Health Impaired" and become eligible to receive services provided under I.D.E.A. (PL94‑142).

If a parent informs an employee about confidential information related to their child's health or safety, the employee is put in an awkward position. As employees are required to report communicable diseases to the Health Services staff, the employee should explain the policy and urge the parent to contact the appropriate person, in the case of HIV/AIDS infection, the designee(s) (Head Nurse). If the employee reports information in good faith to the appropriate individual, the employee shall not be held legally liable for divulging the information. Employees are cautioned that it is never appropriate to share confidential information with persons who do not have the "need to know."

It is important to stress that HIV is transmitted by risky behavior, not by "risk groups." Anyone can be infected if they engage in activities that expose them to HIV.

Further information may be obtained from the Health Office or by calling the N.H. AIDS Hotline 1‑800‑752‑AIDS or the State of N.H. Communicable Disease Control AIDS Program at 1‑603‑271‑4576.  Internet information is updated regularly by CDC at www.cdc.gov. CDC National AIDS Hotline 1-800-342-AIDS (for Spanish 1-800-344-SIDA).