PRIMARY HEALTH CARE SECTOR

Primary Health Care-Health Affairs Department-Community Health Services Programs Section Schools & Educational institutes Services Unit

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2011

Preface

Clinical guidelines are increasingly becoming a part of current practice and will become more common in the future .Guidelines will improve the quality and the level of the health care services provided to patients. Guidelines can be used by the Health care providers to answer specific questions in day to day practice; and as an information source for continuing professional education. School health care is one of the optimum investments in students’ health promotion in Dubai I hope that developing/ adopting evidence based school health guidelines will assist the health care professionals in schools of Dubai to provide more consistent, as well as more effective care to their beneficiaries at schools facilities,. I would like to thank all those who have contributed in developing School Health Guidelines.

Dr. AHMAD KALBAN Primary Health Care-Chief Executive Officer

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Methodology of developing Guidelines

Under the leadership of DR. AHMAD KALBAN, chief executive officer of primary health care sector (PHC), a school health scientific team was formed in line with the PHC’s strategic goal of introducing evidence-based practice. The scientific group was given the task of developing school health guidelines manual for schools of DUBAI-UAE The group reviewed international guidelines on the topic and chose one of the most comprehensive and recent guidelines as core for the guidelines. The group then looked at other international guidelines and selected some specific guidelines that were better explained in some of them and added those to the core guidelines. The group then adapted the guidelines to suit the population and culture in Dubai. These guidelines will be revised periodically to take account of new evidence in the future. Next review will be undertaken in 2013

Dr. Nahed AbdulKhaleq Monsef PHC Health Affairs Director

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Acknowledgement

Special thanks to: •

The members of the Scientific Group who contributed to the development of these guidelines: × × × × ×

Dr. Hamid Y Hussain, MSc, PhD, Board, Community and family medicine, Team Leader, Head of Schools & Educational Institutes Services Unit - Primary Health Care – DHA Ms. Noora Saeed Ali Al Shehhi, Nurse In Charge, Schools & Educational Institutes Services Unit ,Primary Health Care – DHA Ms. Irene Goc-ong Retuya, Staff Nurse, Community Health Services Programs Section - Primary Health Care – DHA Mrs. Marie Christie Rillera, Senior Staff Nurse, Community Health Services Programs Section - Primary Health Care – DHA Mrs. Ola Mustafa Hilweh, Health Inspector -Community Program Services Section.

•

The members who contributed in the revision of these guidelines × Mrs.Taghrid Mohamed Abdelwahab, Staff Nurse from Schools & Educational Institutes Services Unit - Primary Health Care – DHA × Dr.Mohamed El Disouky, Family Physician - Community Health Services Programs Section - Primary Health Care – DHA

•

Dr. Hanan Obaid, Family Physician - Head of Community Health Services Programs Section - Primary Health Care – DHA, for her supervision.

•

Dr Moulham Ashtar; Family Physician- Head of Clinical Effectiveness Office who revised, and edited the guidelines

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Table of Contents

CONTENTS

PAGE NUMBER

INTRODUCTION

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SCHOOL HEALTH SERVICES VISION, MISSION VALUES AND OBJECTIVES.

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COORDINATED SCHOOL HEALTH PROGRAMS Health Education Physical Education Health Services Nutrition Services Counseling and Psychological Services Healthy School Environment Health Promotion for staff Family / Community Involvement STANDARD REQUIREMENT FOR SCHOOLS I. School Clinic A. School Clinic Room B. Standard Fixtures and Furniture C. Standard Equipment D. Standard Supplies E. Standard Solutions and Medicines F. Standard Linens II. School Clinic Staff III. School Building and Environment A. Classrooms: B. School Compound C. Parking Areas D. Food Facilities E. Drinking Water F. Toilets G. Waste Disposal H. Insect Control I. Health Certificates for the Employees ROLES AND RESPONSIBILITIES OF SCHOOL HEALTH CARE PROVIDERS A. School Medical Officer B. School Health Nurse STANDARDS OF PRACTICE FOR DUBAI COMMUNITY NURSE

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SCOPE OF SERVICE I. SCHOOL HEALTH PROGRAMS A. Immunization 1. Standard Immunization Schedule (table 4) 2. Delayed Immunization Schedule B. Health Promotion C. HEALTH EDUCATION II. SCHOOL HEALTH PROTOCOLS 1. COMMUNICABLE DISEASE AND INFECTION CONTROL School Policy Role of Concerned Parties in Handling Communicable Diseases in Schools: A. Schools Responsibilities B. Student's Responsibilities:

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20 20

CONTENTS Reporting of Notifiable Communicable Diseases: School Health / DHA Standards Notifiable Conditions List Exclusion from school 2. EMERGENCY PROTOCOL 3. CHILD PROTECTION PROTOCOL 3.1. Definitions 3.2. Responding to possible abuse 3.3. Roles and Responsibilities 3.4. Responsibilities of the whole School Staff 3.5. School Procedures 3.6. When to be concerned 3.7. Dealing with a disclosure 4. DISASTER PLAN PROTOCOL III. SCHOOL HEALTH PROCEDURES 1. MEDICATION POLICY AND PROCEDURE 2. DOCUMENTATION FOR SCHOOL NURSES a) Documents and the Role of the School Nurse b) Importance of Health Statistical Reports in School Health Services 3. RECORDS AND REPORTS A. Forms to be filled and submitted by Licensed School Medical Officers: B. Forms to be filled and submitted by Licensed School Health Nurse: C. All the required records and report must be maintained and submitted in the prescribed forms at the specified time as per guidelines which are as follows: SCHOOL VISIT PROCESS 1. supervisory visit 2. nurse visit 3. school facilities inspection visit 4. Dubai licensing department personnel visit ON-GOING PROFESSIONAL DEVELOPMENT FIRST AID FOR COMMON INJURIES & ILLNESSES 1. Abdominal Pain 2. Acute Ear Ache 3. Allergic Reaction (Anaphylaxis) 4. Burn 5. Chemical Burns 6. Electrical Burns 7. Blow to the Eye 8. Large Object Imbedded in the Eye 9. Dirt or Small Particle in the Eye 10. Falls 11. Fever 12. Fractures 13. Joint Injuries A- Dislocation B- Sprain 14. Migraine Headache 15. Nausea and Vomiting 16. Near drowning 17. Nose bleeds 18. Toothache 19. Wounds A-Cuts/Superficial Abrasion: B- Deep/Extensive Laceration: C- Puncture Wound: D- Bleeding

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PAGE NUMBER

37

38 39

CONTENTS 20. Food Poisoning 21. Fainting 22. Poisoning 23. Diabetic Emergencies 24. Bronchial Asthma Attack 25. Seizures 26. Febrile Convulsion EMERGENCY PROCCEDURES FOR INJURY OR ILLNESS PLANNING FOR STUDENTS WITH SPECIAL NEEDS STANDARD PRECAUTIONS: FOR HANDLING BLOOD & BODY FLUIDS IN SCHOOL NURSING PROCEDURES ON ADMINISTRATION OF MEDICATIONS consent for immunization notification for attendance to DHA health center / clinic immunization record schools annual report report on adverse reaction following immunization school details monthly report on first aid administration monthly report on referred students notification for immunization immunization information to parents notification for head lice immunization plan standing order of drugs that can be administered to school children violation letter students health examination report notification for mantoux test SCHOOL HEALTH FORMS REFERENCES

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PAGE NUMBER

53 54 55 57

71 90

INTRODUCTION Schools are unique environments that can reach to a large proportion of children and youth in the country. In United Arab Emirates (UAE), 51.58% of the general population is youth under the age of 25 years. Children and youth of school age (5 to 19 years) contribute to around 18% of the total population in UAE. Students spend around 6 hours at class rooms for almost 13 years of their life. Thus schools have an essential role in improving the health status of young people in the country. SCHOOL HEALTH SERVICES: Vision ,Mission ,Values & Objectives Vision To provide international standard and highest quality of preventive, primitive, curative and rehabilitative services for Dubai Private School pupils & Special needs centers. Mission By application the best technical and administrative methodology concerning heath care services delivery through well trained manpower and advanced equipped materials. School Health Service shall achieve and sustain excellence in quality of care and personal services by exceeding Dubai Private School pupil's expectations while providing an outstanding work environment and professional growth for its staff. Values Staff: Sharing responsibilities, competence, commitment, efficiency, effective communication, continuous learning, teamwork, empowerment, innovation, and enthusiasm, blame free environment and Optimum standardization. Services: Excellence, quality, continuous improvement, flexibility, home environment, safety, and Dubai Private School pupils focused. Objectives All private schools in Dubai are required to establish their own School Health Program with Objectives and Components as follows: • To provide opportunity for every school child to have access to primitive, preventive, curative and rehabilitative health care services in order to maintain their well being. • To establish harmonious interpersonal relations among the Department of Health and Medical Services’ staff, school Administrators, staff of related agencies, students and parents. • To coordinate the activities of school Health Services with Epidemiology Section of DHA for early detection, notification and management of infectious diseases among students.

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• To increase awareness of students on health matters related to their age,

through effective regular health education programs. • To develop and promote awareness of the licensed school doctors/nurses of

• •

• • •

•

their responsibilities in order to enable them to effectively implement the School Health Program in their respective schools. To provide and maintain safe and healthy school’s environment. To monitor the health status, growth and development of every student regularly in order to detect early signs and symptoms of diseases and health problems that will adversely affect the learning process. To provide First Aid and or Emergency Care to the school’s population. To prevent and control communicable diseases in the schools. To plan, implement and evaluate Health Education Programs that will assist every student to develop or enhance healthy lifestyle/practices for the promotion and maintenance of good health. To provide School Dental Services to the students. COORDINATED SCHOOL HEALTH PROGRAMS

Health Education • A planned, sequential Curriculum that addresses the physical, mental,

emotional and social dimensions of health. • The curriculum is designed to motivate and assist the students to maintain

and improve their health, prevent disease, and reduce health related risk behaviors. • It allows students to develop and demonstrate health-related knowledge, attitudes skills and practices. Physical Education • A planned, sequential curriculum that provides cognitive content and learning

experiences in a variety of activity areas such as basic movement skills; physical fitness; rhythms and dance; games; team, dual and individual sports; tumbling and gymnastics; and aquatics. • Quality physical education should promote optimum physical, mental, emotional, and social development, through a variety of planned physical activities. • Ensure that Qualified, trained teachers are supervising physical activities. Health Services • Services provided for students to appraise, protect, and promote health. • These services are designed to ensure access or referral to primary health

care services or both, foster appropriate use of primary health care, prevent and control communicable disease and other health problems, provide emergency care for illness or injury, promote and provide optimum sanitary conditions for a safe school facility and school environment, and provide

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educational and counseling opportunities for promoting and maintaining individual, family, and community health. • Qualified professionals such as physicians, nurses, dentists, health educators, and other allied health personnel provide these services. Nutrition Services • Access to a variety of nutritious and appealing meals that accommodate the

health and nutrition needs of all students. • The school nutrition services offer students a learning laboratory for

classroom nutrition and health education, and serve as a resource for linkages with nutrition-related community services. • Qualified child nutrition professionals provide these services. Counseling and Psychological Services • To improve students’ mental, emotional and social health. • These services include individual and group assessments, interventions, and

referrals. • Organizational assessment and consultation skills of counselors and psychologists contribute not only to the health of students but also to the health of school environment. • Professionals such as certified school counselors, psychologists, and social workers provide these services. Healthy School Environment • The physical and aesthetic surroundings and the psychosocial climate and

culture of the school. • Factors that influence the physical environment include the school building

and the area surrounding it, any biological and chemical agents that are detrimental to health, and physical conditions such as temperature, noise, and lighting. • The psychological environment includes the physical, emotional, and social conditions that affect the well-being of students and staff. Health Promotion for staff • Opportunities for school staff to improve their health status through activities

such as health assessments, health education and health-related fitness activities. • These opportunities encourage school staff to pursue a healthy lifestyle that contributes to their improved health status, improved morale, and a greater personal commitment to the school’s overall coordinated health program. • This personal commitment often transfers in to greater commitment to the health of students and creates positive role modeling. • Health promotion activities have improved productivity, decreased absenteeism and reduced health insurance costs.

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Family / Community Involvement • An integrated school, parent and community approach for enhancing the

health and well-being of students. • School health advisory councils, coalitions, and broadly based constituencies

for school health can build support for school health program efforts. • Schools actively solicit parent involvement and engage community resources

and services to respond more effectively to the health related needs of students. STANDARD REQUIREMENT FOR SCHOOLS For an effective implementation of the School Health Programme, schools in the Emirate of Dubai are urged to provide their schools with the standard equipment and adhere to the policies and procedures as follows: I. School Clinic A. School Clinic Room 1. The school clinic should be of adequate size (14 square meters) to

accommodate standard furniture, fixtures, medical equipment and supplies with sufficient ventilation and lighting. 2. Depending on school population, an additional room for observation of sick students should be made available. 3. School doctor/s as well should be provided with an additional equipped room with computer facility. B. Standard Fixtures and Furniture 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16.

Wash hand basin Liquid soap dispenser with undiluted liquid soap Disposable paper hand towel dispenser or electric hand dryer Office desk and chairs Telephone with external facilities Filling cabinet/ rack for files Cupboard with lock for supplies and instruments Height adjustable examination couch with washable mattress Stainless steel dressing trolley (2layer with castor wheels) Foot operated covered waste disposable bin Refrigerator with ice pack Vaccine carrier/box Thermometers for refrigerator and vaccine carrier Medium size notice board Observation bed (height adjustable) Portable screen (if there is no separate observation room and treatment room)

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17. Wheel chair 18. Foldable Stretcher 19. Computer with internet facility

C. Standard Equipment 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21.

Adult combined height/weight scale (not bathroom scale) ENT Diagnostic Set Sphygmomanometer with Paediatric/Adult Cuff Stethoscope Eye Chart Percussion Hummer Tuning fork Torch with batteries Thermometers (mercy/digital) Tape measure Receiver (big size) Galipot Basin Bandage Scissors Pickup forceps (2 nos.) Oxygen cylinder with regulator and flow meter Nebulizer Glucometer First Aid Kit Sharp Safe box Injection tray with Lid

D. Standard Supplies 1. Disposable wooden spatulas 2. Disposable Hand towels 3. Disposable Medicine cups 4. Sterile cotton buds 5. Sterile Buds 6. Sterile Gauze pieces 7. Disposable Gloves 8. Gauze bandages of different sizes 9. Splints of different sizes 10. Elastic bandages of different sizes 11. Adhesive plasters of different sizes 12. Band aid 13. Hypodermic needles –g.21&g.23 14. Syringes. 15. Alcohol preps 16. Disposable oxygen facial masks 17. Disposable thermometer sleeves/covers 18. Impermeable plastic sheet for covering bed 19. Disposable surgical roll 20. IV Infusion set

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21. IV cannulas /butterflies

E. Standard Solutions and Medicines 1. 2. 3. 4. 5. 6. 7.

Adrenaline -2 ampoules Hydrocortisone -2 vials Spirit 70% Antiseptic solutions Normal saline solution Glucagon IV Solutions : • Dextrose saline • Normal saline

F. Standard Linens 1. 2. 3. 4. 5. 6.

Cotton Bed sheet (12 nos.) preferably white Plastic Sheet (6 nos. ) for giving sponges Pillow cover (12 nos.) preferably white Plastic Pillow covers (6 nos. ) Bath Towel (12 nos) Face Towel (12 nos)

II. School Clinic Staff Required Numbers of Licensed Medical Officer and Licensed School Nurse per Students Ratio are shown in table 1. Table1:

Number of Licensed nurses and doctors in the school

Number of Students

Number of School Nurses

Number of School Medical Officers

0001 to 1,000

One full time Nurse

One part time Doctor

1,000 to 2,000 2,000 and above

Two full time Nurses One full time Doctor For every 1,000 Students Two full time Doctor one School Nurse is required.

Part time Doctor should be available in the School clinic at least two hours/day, twice /week. III. School Building and Environment Building should be situated away from any contamination resource/s and to be concreted & secure with unrestricted access to exits in case of fire or emergency, with proper identification of visitors, corridors that are free of impediments and prompt clean-up of spills.

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A. Classrooms: • • • • • • • •

Lighting and ventilation should be adequate Windows should be secured with metal mesh Floors/roofs/walls should be intact and free of damages Proper spacing of students (one square meter should be allocated for each student) Total students in a class should not be more than 25 The distance between the first line and the black board should not be less than 6 feet. The furniture should be intact and appropriate for the students. Activity hall should be allocated for the students with adequate and appropriate (safe) equipments.

B. School Compound • Main gate should be away from the main road / street. • Barriers should be placed outside main gates, to prevent sudden escape of • • • •

students to streets. Fence with adequate heights should be provided. Playground should be adequately shaded to protect the students from sun and rain. Play facilities provided with safety precautions. Cleanliness should be maintained at all time.

C. Parking Areas Adequate safe parking areas for school buses & other vehicles should be provided within the school premises D. Food Facilities The School canteen should meet all standard requirements (healthy food) and the food providing companies should be licensed. Canteen workers should be medically fit and certified by health authority. Canteen crew should abide to infection control policies Lunch and snacks should include the following: • • • •

Fruits and vegetables Dairy products Starch (carbohydrates) Meat and substitutes

Examples of snack • 1 fruit or 30 to 50g of dried fruits • Sticks of some vegetables (carrot, cucumber, celery, pepper) + dip made

with cheese • 1 juice (100% natural) or fresh juice (no sugar added)

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• • • • • •

1 fruit yogurt 1 toast with a piece of cheese 1 small bag of pretzel 4 cookies (such as soda or crackers) + cheese 1 oat and raisin or oat and date cookie (6 cm of circumference) If prepared at school: 1 smoothie (1/2 cup of milk with 1 fruit with iced cubes)

Examples of Lunch • • • • •

1 cheese/labnee sandwich + vegetables 1 Zaatar + 1 yogurt (plain) or cheese + vegetables 1 meat sandwich (chicken, turkey or tuna) + vegetables 1 pita or Arabic bread (small)+ 1/2 cup of cooked beans +vegetables Mini pizza with cheese

Hot meals • 1 cup of pasta+ tomato sauce + meat (60-90g) or meat + cheese • 3/4 cooked rice + 1/2 cup of sauce (vegetables) + meat (60-90g) • 3/4 of cooked mashed potato+ meat (60-90) + vegetables (1/2 cup of

green beans) • 1 cup of corn + tomato sauce + meat (chicken or minced meat) Mexican

style • 1 fajitas + tomato sauce + chicken or meat + vegetables (Mexican style) • 3/4 of cooked rice or bulgur + tomato sauce with vegetables (1/2 cup) +

1/2 cup of beans • 3/4 noodles+ vegetables+ tofu or meat (chicken) Chinese style

Desert: • • • • • • • • • • • • •

1 fruit salad 1 fruit compote 1 fruit yogurt 1 piece of spongy cake 1 fruit mousse 1 scope of sherbet 1 scope of iced yogurt 1 scope of sorbet 3 dates 1 piece of fruit cake 2 raisin and oat cookie (small size) 1 fruit jello 1 desert made with milk (such as mohalabia)

Notes: • Frying should be limited, breading should be avoided. • If soups served, they should be clear not creamy ones • Cooking: stir fried, poached, steamed, and grilled is encouraged

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E. Drinking Water • Safe drinking water sources should be available • Water tanks should be kept clean and closed tightly & water purified

periodically. • Cartridge of the water filters should be changed as recommended. • Cleaning and maintaining reports should be obtained after periodical

cleaning. F. Toilets • Adequate toilet facilities should be provided with proper lighting /

ventilation. • One washbasin with soap and paper towel dispenser or electric hand dryer should be made available for every 25 students. • Water supply should be adequately available at all times. • Floors and walls (not less than 2 meters high) should be covered with ceramic and free of any damage and always kept clean and disinfected. • Floor should not be slippery. • Proper drainage system should be provided. • Separate room should be provided to store the domestic items safely and out of reach of children. • Relevant Health educations materials (hygiene posters) should be visible. Note: at least 5 hand sanitizers should be available all the time at the main places of school facilities for easy access G. Waste Disposal • Adequate waste disposal bins with lid and plastic disposal bags should be

provided. • Clinical and non-clinical wastes should be collected separately and

disposed properly as per policy. • Cleaners should abide to infection control policies

H. Insect Control • School environment should be kept free of insects and rodents. • A contract with specialized company for insect control should be available

in the school & control measures should be applied at least 4 times per year. I. Health Certificates for the Employees The following categories of employees should possess valid health certificates issued by the authorized Health Care Organization: • KG teachers and assistants • Physical education teachers • Nurses • Bus supervisors • Domestic staff

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ROLES AND RESPONSIBILITIES OF SCHOOL HEALTH CARE PROVIDERS A. School Medical Officer: 1) Qualifications:

Medical practitioner preferably with Pediatric and Public Experience, and licensed by the Dubai Health Authority 2) Professional Accountability: To the Head of School Health Services of Dubai Health Authority 3) Duties / Responsibilities / Activities: as described in the below table 2 Table 2: Duties / Responsibilities Maintenance of Health school Environment

Health

School Medical Officer Duties / Responsibilities/ Activities Activities In coordination with the Licensed school Health Nurse, regularly checks the school's environment to ensure of its cleanliness and safety in line with the Dubai Municipality Local Order No. 76 of 1992. Implementing all school health protocols and guidelines Plans and conducts comprehensive medical examination on students as per school Health Record at school entry, grade5, grade9, and school leaving. Screening the student for all body system.

Physical/Medical examination of students

Records all finding in the school Health Record, specifying any defect or abnormality. Refers and follows up students with abnormal finding to the Health Center/Clinics of DHA or to their family physicians for further investigation and health care. Informs parent on "Parents Notification form".

First Aid Care/ Emergency Care

Prevention and Control of Communicable Diseases

Health Education Maintenance of Records and Reports ICD Coding Professional update

Attends promptly to students with injuries or other conditions requiring immediate attention. Writes standing order of drugs/treatments, which can be administered to the student by the licensed school Health Nurse in the absence of the Medical Officer. Share in planning ,assessing and attending immunization session, which will be conducted in the school to be available for any untoward reaction including anaphylaxis due to immunization. School doctor has to contact epidemiology section of PHC to get necessary information and access to e-notification system of DHA (website) and to inform SHS in charge also Advises the parents to keep the student at home during the communicable period of that particular disease Maintain effective relationship with parents, families and local community. Participates in planning and conducting health education activities in the school Acts as a counselor in guiding the school administrators, teachers and parents to discuss any health problem of a student, whenever needed. Filling, maintaining and sending records and reports as prescribed in the guideline. Affixes ICD codes where required according to ICD booklet provided by DHA. To Updates knowledge, skills and practice related to school Health requirements

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B. School Health Nurse: 1. Qualification Preferred to be Graduate of Bachelor of Science in nursing Licensed by the DHA 2. Professional Accountability To the School Medical Officer and obliged to coordinate with the Nurse In charge of School Health Services of DHA with regards to his/her nursing responsibilities and functions. 3. Responsibilities / functions/ Activities: as described in the below table 3 The school nurse should wear uniform during working hours. Table 3

School Health Nurse Responsibilities / functions / Activities

Responsibilities / Functions

Activities Ensures that all medical supplies and equipment needed for first aid and emergency care are available and in working condition in the school clinic (as listed in the standard requirement).

In the absence of the School Medical Officer, provides first aid/ emergency care to sick or injured students.

Assists School Medical Officer in conducting medical examination to the students.

Assesses needs of students (examines/ observes/ measures vital signs) who require first aid care. Administers the first aid care appropriate to his/her condition or needs. Refers to the School Medical Officer for advice when needed. Informs parent, through the school authorities, about the student's condition. Transfers the student to the Accident/Emergency of the nearest hospital as per the standard procedure. Ensure and prepares all the needed supplies/ equipments for the medical examination of the students. Provides privacy to the student during medical examination. Checks that all finding and recommendations are recorded in the student's School Health Record. Monitors student who are frequently absent from school due to health related problems.

Assesses student, to detect early signs and symptoms of health problems

Monitors and maintains growth and development of students.

Coordinates with classroom teachers to: ƒ Observe and report student with unhealthy practices. ƒ Refer promptly student who are showing signs of visual, hearing and learning difficulties. ƒ Refer student with fever, rashes or unusual behavior. ƒ Report presence of potential hazards in the classroom. ƒ Motivate student to enhance healthy practices. ƒ Maintain sanitary and safe environment in the classroom. Measures height and weight of students and calculates BMI at the start of academic year. For those students with deviations from normal measurements, repeat the measurements regularly. Refers to the School Medical Officer, Students whose growth and development measurement show deviations from normal.

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Monitors record/graph of the measurement of every student in the School Health Record. Administers medicines, treatment as per the written standing order of the School Medical Officer. (Review and implement the attached copy of the Nursing Procedure Manual of DHA on Administration of Medications) Administers nursing care appropriate to the identified nursing needs of the student.

Administers independent nursing measures (e.g. cold sponge) appropriate to the identified needs of the sick student. Gives re-assurance to the sick student. Monitors the student's condition in the school clinic before sending the student home or back to the classroom. Informs parent to render sick off certificate to be kept in School Health Record. Assesses learning needs of students Prepares health education teaching plans to meet the identified learning needs of the students.

Plans, implements and evaluates health education programmes for students.

Presents health education materials/aid that will help to enhance health practices of students. Plan and conducts health education sessions for parents of students with chronic illness to assist them to understand their child's disease and needs. Conducts health –teaching sessions to meet the learning needs of students (e.g. topics on: personal hygiene, proper nutrition, accident prevention etc.)

Plans, implement, evaluate and deliver immunization programs for all students in the school under the supervision of School Health Services Staff of DHA (including vaccine administration). Monitors and maintains safe and healthy school environment, in cooperation with the School Medical Officer. Maintains and submit the required records and reports as per guidelines. Professional update.

Plans the immunization schedule of every student as per guidelines in immunization. Administers vaccine under the supervision of staff nurses, School Health Services, DHA. Documents all the vaccine Administered to the student in the prescribed form, fills and submits all required report to School Health Services of DHA. Checks to implement the standard requirements for school Building and Environment as per the Dubai Municipality Local order No.76 of 1992. Reports and suggests to school authorities, corrective measures of any finding that needs attention. Fills the prescribed form and submits as per specified date and frequency. To Updates knowledge, skills and practice related to school Health requirements

Note: school nurse should be able to deal with special needs students according to their requirements

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STANDARDS OF PRACTICE FOR DUBAI COMMUNITY NURSE Practice standards describe the knowledge, skills and attitudes needed to practice nursing safely as well as providing clarity on levels of professional performance expected by both the profession and the community. Practice standards can also be used to measure actual performance of the community health nurse. While it is recognized that community nurses may be involved with specialist and generalist practice functions, these standards describe the nursing process, which includes components of assessment, diagnosis, outcome identification, planning, implementation and evaluation. These standards are based on the generic Scope of Practice (SOP) and competencies for the Registered Nurse in Dubai. The Dubai Health Regulatory Agency (DHRA) is responsible for regulating nursing practice in the Emirate of Dubai, United Arab Emirates. Standards for Community Nurse Practice in Dubai: 1. Facilitating access and equity 2. Promoting health 3. Building individual and community capacity 4. Building relationships 5. Demonstrating professional responsibility and accountability SCOPE OF SERVICE I. SCHOOL HEALTH PROGRAMS The Primary Health Care of the Dubai Health Authority (DHA), in cooperation with different government agencies, shall provide an overall supervision in the implementation and evaluation of the School Health Program of Schools in the Emirate of Dubai. A. Immunization Immunization is a proven tool for controlling and eliminating life-threatening infectious diseases and is one of the most cost-effective health investments. Standard Immunization Schedule is shown in (table 4) Table 4 Vaccines

Age/years

Interval

Dose

Remarks

DPT/OPV 2nd booster

5-6

2 ½ years interval from the first booster

0.5 ML

Only for children not vaccinated in child health services.

5-6

4 Years

Single

If 2nd MMR was not given along with 2nd booster keep 5 years intervals.

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5 Years from 2nd booster

0.5 ML

Td 4th booster

15

5 Years interval

0.5 ML

HBV 1st dose HBV 2nd dose HBV 3rd dose

5-12 5-12 5-12

1-2 months 4 month

0.5 ML 0.5 ML 0.5 ML

MMR 2nd dose Td /OPV 3rd booster

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Td if not given at 15 years it can be given up to 18 years. No OPV should be given after 15 years. HBV if not given in SHS.

Delayed Immunization Schedule shall be implemented when the Standard Immunization Schedule is not followed or interrupted and or when a child is not vaccinated at all (table 5). • If the child was never vaccinated at all from birth, the delayed immunization

schedule can be followed after the age of 5 years as follows: Table 5 Interval First After 3 days After 6 Weeks After 6 Weeks After 6 Months After one year interval After 4 years interval After 4 years interval

Mantoux Test and Vaccine/s to give Mantoux test to be done Mantoux reading, If reading is Negative: To give BCG and 1st dose of OPV, DPT & MMR 2nd dose of OPV, DPT, & 1st dose of HBV 3rd dose OPV, DPT & 2nd dose HBV From 1st dose of HBV give the 3rd dose of HBV 1st booster of OPV & DPT 2nd booster of OPV & Td 3rd booster of OPV & Td.

Example: Child is 6 years old, never vaccinated at all from birth. Give as follow: Mantoux test to be done After 3 days do Mantoux reading, If Mantoux Test reading is Negative: Give BCG, and 1st dose OPV, DPT & MMR After 6 Weeks, give 2nd dose OPV, DPT, & 1st dose of HBV After 6 Weeks, 3rd dose of OPV, DPT & 2nd dose HBV After 6 Months from 1st dose of HBV give, the 3rd dose of HBV After one year interval from the 3rd dose of OPV & DPT give the 1st booster dose of OPV & DPT. After 4 years interval from the 1st booster of OPV & DPT give the 2nd booster of OPV & Td. After 4 years interval from the 2nd booster of OPV & Td give the 3rd booster of OPV & Td. • Delayed schedule for School Health Services with children who had discontinued or interrupted immunization:

There is no re-initiation of primary doses so that whatever OPV and DPT received before school age is/are considered primary doses (table 6). Table 6 Interval

Mantoux Test and Vaccine/s to give

3rd dose OPV, Td 1st booster OPV, DPT After 1 year interval 2nd booster OPV, DPT After 2 ½ years interval 3rd booster OPV , Td After 5 years interval 4th booster Td Only After 5 years interval nd If 2 dose was not taken you have to plan for it

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Example: Child is 10 Years old and received only 2 doses of OPV and DPT. There is no re-initiation of primary doses so that whatever OPV, DPT received before school age is considered primary doses. Give as follow: Give the 3rd dose of OPV and Td After 1 year interval from 3rd dose of OPV & Td give 1st booster OPV and Td After 2 ½ years interval from the 1st booster of OPV & Td give 2nd booster OPV and Td After 5 years interval from 2nd booster of OPV and Td give 3rd booster of Td NOTES: • If the child was never vaccinated (up to 15 years) give Mantoux test. • If Mantoux Reading is Negative give BCG and one dose of MMR , Td & OPV • Td & MMR can be given up to 18 years of age • NO OPV after 15 years of age • NO DPT After 6 years of age • NO DPT for children with epilepsy or febrile convulsion. DT can be given. • 3 doses of HBV should be finished before 12 years of age • NO Vaccination shall be planned utilizing photocopy of vaccination records. The original vaccination card should be available or a letter signed by parent stating the original vaccination card was lost. • Mantoux test shall be done only for children who did not receive BCG since birth. • If the child was born before the year 2000, and he was vaccinated up to five years of age consider that 2nd dose MMR was not given so you have to give it with the 3rd booster. B. Health Promotion 1. Medical or preventive This approach is aimed at reducing premature deaths (mortality) and avoidable diseases (morbidity). Actions are targeted at whole populations (e.g. immunization) or so called high risk groups. This approach seeks to increase the use of medical interventions to promote health. 2. Behaviour change This approach aims to encourage individuals to adopt “healthy” behaviours that are regarded as key to improving health. 3. Educational Seeks to provide knowledge and information, and to develop the necessary skills so that people can make informed decisions about their behaviour 4. Empowerment The idea is on helping people or communities to identify their own health concerns, gain the skills and make changes to their lives accordingly. 5. Social change To enhance social performance and among students population

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C. Health Education Steps in Planning a Health Education Curriculum: 1. Assess and identify the learning needs of students; what they need to know, their values, beliefs, health practices etc. 2. Formulate the learning objectives. Learning objectives shall be clearly written, specific, measurable, achievable, realistic and time bound. 3. Outline the topic and list the essential education materials required. 4. Choose teaching methodologies which are appropriate; (demonstration, discussion, role play etc.). 5. Select instructional strategies and audio visual aids which : a. Culturally relevant, developmentally appropriate and meet the different learning needs of students served. b. Actively engage parents and other caregivers in promoting healthy values and beliefs that support healthy behaviors and discourage risky behaviors. 6. Identify and arrange for the provision of all resources needed to conduct the health education session. 7. Arrange the venue, date and time to conduct the health education session. 8. Implement the health education plan. 9. Evaluate the health education session. to determine if the expected outcomes have been achieved. Provide a timely, personalized and descriptive feedback to the student/s and record achievements. II. SCHOOL HEALTH PROTOCOLS 1. COMMUNICABLE DISEASE AND INFECTION CONTROL School Policy: Certain communicable diseases are designated as “notifiable” so that public health measures can be taken to prevent large outbreaks among children and others. Because of the danger to student and employee health, school boards are required by law to safeguard the health of any student or employee who has contracted or been exposed to a communicable disease Role of Concerned Parties in Handling Communicable Diseases in Schools: Schools Responsibilities: The schools should have policies/procedures for: • Providing orientation, In-service education and resource materials for school personnel regarding management of communicable diseases • Education of parents to keep children home when there are signs of disease and to secure appropriate treatment • Record-keeping and retrieval procedures regarding non-immunized children.

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•

• •

Exclusion and follow-up of children who are not immunized against vaccine preventable diseases or who have contracted a communicable disease or infestation Designating the school nurse (or other school official) for the reporting of “notifiable” communicable diseases. School nurses can aid parents by referring them to public health nurses if there is need. In some schools, the school nurse or school physician may be delegated to take on more direct responsibility for nursing or medical assistance to the child.

. Student's Responsibilities: • • • • •

Remain home when ill. Report to the teacher when they feel sick at school; Avoid close contact with other children who have respiratory or communicable diseases; Practice good habits of cleanliness Dress appropriately for the weather.

Reporting of Notifiable Communicable Diseases: Schools are required to report of communicable diseases and the number of individuals affected. Vaccine-preventable diseases should be reported immediately and appropriate action taken to ensure the protection of other children and adults in the school setting. School Health / DHA Standards 1. School doctor and school nurse are the only entitled persons in the school authorized to deal with the case from technical and administrative point of view. 2. School principle should not address any sort of letter to the parents unless to be advised by the doctor or nurse and after contacting school health services at Dubai Health Authority 3. Upon identification of any notifiable diseases at any school, an official notification (e-notification) through DHA website should be done. 4. E-notification of communicable diseases should be based on the rules and regulations whether immediate notification or flexible like for example meningococcal meningitis notification should be extremely urgent. Notification should be based on the nature of the disease 5. Any sort of advises for parents and family regarding taking vaccine or attending doctors should be only done after negotiation with school health at DHA if the case is still suspected and not yet confirmed. 6. Any health education material concerning notifiable diseases should be obtained from reputable scientific reference like World Health Organization (WHO), Centers for Disease Control and Prevention (CDC) etc. 7. On any suspicion of notifiable diseases the case should be isolated and sent home and advised to be handled by specialized doctor. 8. Contacts should be put under close observation and tracing system.

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9. Public health precautions and measures have to be applied. 10. Reference case can not be back to school unless the clearance certificate approved by doctor. 11. All cases should be away from school for all periods of communicability and according to the table of communicable diseases. 12. School doctor has the right to allow the student to be back to school after doing case assessment and referring to the ongoing rules and regulations 13. Upon case identification, an awareness session has to be delivered to all classmates and some health education materials provided accordingly. 14. The doctors and nurses at school are the only adviser for the school management for any further action after making necessary communications with school health services / DHA 15. Attached to this guideline is the list of common communicable diseases and the recommended duration of isolations and fitness for back to schools. Notifiable Conditions List Reportable immediately by telephone on the day of recognition or strong suspicion of disease: • • • • • •

• • • • • •

Chickenpox (Varicella) Diphtheria Hepatitis (viral, acute) Measles (rubella) Meningococcal disease Outbreaks o Food borne (involving 2 or more persons) o waterborne; and o Respiratory ƒ Institutional ƒ Unusual disease or illness Pertussis Poliomyelitis Rabies (human and animal) Rubella (including congenital) Staphylococcus aureus disease, reduced or resistant susceptibility to vancomycin Tuberculosis

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Exclusion from school: Look to (Tables 7a, 7b, 7c) Table 7a Disease Or Condition

Incubation Period From two to three weeks; usually 13-17 days

SCHOOL EXCLUSION TABLE Exclusion of Cases Exclusion of Contacts Not excluded

Chicken pox

Exclude from school until vesicles become dry, or 10 days from appearance of rash.

Not excluded

Conjunctivitis

Until discharge from eyes has ceased Usually two to five days

Until cultures are negative, until receipt of a medical certificate of recovery from infection.

Domiciliary contacts excluded until investigated by medial officer and shown to be clear of infection.

Usually one to three weeks or longer; or average seven to ten days Usually fifteen to fifty days; the average twenty eight to thirty days

Until diarrhea ceases

Not excluded

Exclude from school or work for one week after the onset of illness or jaundice. Until receipt of a medical certificate of recovery from infection or on subsidence of symptoms.

Not excluded

Usually sixty to ninety days; the range is forty five to one hundred eighty days

Until recovered from acute attack

Not excluded

Until sores have fully healed. The child may be allowed to return earlier provided that appropriate treatment has commenced, and that sores on exposed surfaces (such as scalp, face, hands or legs) are properly covered with occlusive dressings.

Not excluded

Diphtheria

Giardiasis (diarrhoea)

Hepatitis A

Hepatitis B

Impetigo (School sores)

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Table 7b Disease Or Condition

Measles (Rubeolla)

Meningococcal Infection

Meningitis (Viral, Aseptic)

Mumps

Incubation Period Approximately ten days, but varies from seven to ten days and may be as long as fourteen days until the rash appears

Until at least five days from the appearance of rash, or until receipt of medical certificate of recovery from infection.

Non-immunized contacts must be excluded for thirteen days from the first day of appearance of rash in the last case unless immunized within 72 hours of contact.

Until receipt of a medical certificate of recovery from infection.

Household contacts must be excluded from school or child care until they have received appropriate chemotherapy for at least 48 hours.

Exclusion from school, child care or workplace until nine days after the onset of swelling. Until fully recovered.

Not excluded

Until appropriate treatment has commenced.

Not excluded

It is commonly seven to ten days; rarely more than fourteen days.

Until two weeks after the onset of illness and until receipt of a medical certificate of recovery from infection

Usually seven to fourteen days; the range is three to thirty five days for paralytic cases

Exclude from schools and children’s settings until at least fourteen days after onset of illness and until receipt of a medical certificate of recovery from infection.

Household contacts must be excluded from attending a children’s services centre for twenty one days after last exposure to infection if the contacts have not previously had whooping cough or immunization against whooping cough. Not excluded

Commonly three to four days, but can vary from two to ten days

Varies with specific agent Usually twelve to twenty five days; commonly eighteen days

Pediculosis (Headlice)

Pertussis (Whooping cough)

SCHOOL EXCLUSION TABLE Exclusion of Cases Exclusion of Contacts

Poliomyelitis / Acute Flaccid Paralysis (AFP)

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Table 7c Disease Or Condition Rubella (German Measles)

Scabies

Shigellosis (Diarrhoea)

Incubation Period Usually sixteen to eighteen days

Exclude from school for at least five days after onset of the rash

Not excluded

Until appropriate treatment has commenced.

Not excluded

Until diarrhoea ceases

Not excluded

Exclude from schools and children’s settings until a medical certificate of recovery from infection has been obtained.

Not excluded

Until appropriate treatment has commenced.

Not excluded

From infection to the primary lesion or significant tuberculin reaction; about four to twelve weeks.

Until receipt of a medical certificate from a health officer of the Department that child is not considered to be infectious.

Not excluded

Usually one to three weeks (depending on the infective dose from three days to three months) Usually one to ten days

Until receipt of a medical certificate of recovery from infection.

Not excluded unless the medical officer of a health of the Department considers exclusion to be necessary.

Usually two to six weeks before itching occurs in a person not previously infected If a person is reexposed it is one to four days. From twelve hours to four days 9usually one to three days); up to one week Shigella dysenteriae Usually one to three days

Streptococcal infection including Scarlet Fever

Trachoma

Tuberculosis

Typhoid Fevers

Paratyphoid Fevers

SCHOOL EXCLUSION TABLE Exclusion of Cases Exclusion of Contacts

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2. EMERGENCY PROTOCOL • Schools should have an emergency plan which includes policies and

procedures that is appropriate to the school to provide immediate care during emergency (figure 1) • A team of school nurse, school doctor, teacher, supervisor and administrator should be developed. • The policies should be reviewed on a regular basis and kept updated. Figure 1: Emergency Protocol Flow Chart

3. CHILD PROTECTION PROTOCOL 3.1. Definitions Neglect The persistent or severe neglect of a child which results in impairment of health or development Physical Abuse: Actual or likely physical injury to a child, or failure to prevent physical injury or suffering Sexual Abuse Actual or likely exploitation of a child by involvement in sexual activities without informed consent or understanding, or that violate social taboos or family roles Emotional Actual or likely severe adverse effects on the emotional and behavioral development of a child by persistent or severe emotional ill-treatment, inappropriacy, or rejection 29

Potential abuse Situations where children may not have been abused but where social and medical assessments indicate a high degree of risk that they might be abused in the future, including situations where another child in the household has been abused, or where there is a known abuser 3.2. Responding to possible abuse A guide for considering information giving rise to doubts about a child’s safety or welfare • Decision Making:

You must record the grounds for your concern, either in the patient’s records or in another appropriate way. You should raise questions with the family and be open about your concerns, unless to do so would put the child at risk of harm. You may wish to organize further contact by other members of your practice team or by suggesting a further appointment. You may wish to consult with colleagues. This may give you fuller information and help you decide on your best course of action. You may wish to discuss your concerns with the Social Services team on a ‘what if…’ basis. You may wish to discuss your concerns with the designated nurse or doctor for child protection. • Taking Action:

You may decide, after consultation or independently, to make contact with Social Services. This could mean contacting them for a discussion or making a direct referral. You should have clear in your mind What information, allegation or observation leads me to be concerned at this moment? What other information or observations might support this concern, drawing upon previous experience with the child or their family? Is the situation urgent? What are your expectations of making the referral? 3.3. Roles and Responsibilities • Class Teachers

Class teachers will, in most cases, be the first person that a concern is raised by. They will collate detailed/accurate/secure written records of concerns and liaise with the designated child protection staff.

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• The School Nurse

Their role is to ensure that relevant information obtained in the course of their duties is communicated to the Designated Teacher. Types of injuries, attendance and frequency are recorded. 3.4. Responsibilities of the whole School Staff • All school staff has a responsibility to identify and report suspected abuse

and to ensure the safety and well being of the pupils in their school. In doing so they should seek advice and support as necessary from the Principal/Designated Teacher. • Staff is expected to provide a safe and caring environment in which children can develop the confidence to voice ideas, feelings and opinions. Children should be treated with respect within a framework of agreed and understood behavior. • All school staff is expected to: ƒ Be aware of signs and symptoms of abuse. ƒ Report concerns to the Designated Teachers as appropriate. ƒ Keep clear, dated, factual and confidential records of child protection concerns. 3.5. School Procedures • Any member of staff concerned about a child must inform a Designated

Teacher immediately. • The member of staff must record information regarding the concerns on

•

•

• •

the same day. The recording must be a clear, precise, factual account of the observations. The designated teacher will consult the Principal who will decide whether the concerns should be referred to the Child Protection Officer. If it is decided to make a referral to the Child Protection Officer, this will be done, if necessary, without prior discussion with the parents. If a referral is made to the Child Protection Officer, the Designated Teacher will ensure that a written report of the concerns is sent to them within 48 hours. Particular attention will be paid to the attendance and development of any child who has been identified as at risk. If a pupil who has been identified as at risk changes school, the Principal will inform the Child Protection Officer and consider the transfer of appropriate records to the receiving school.

3.6. When to be concerned Staff should be concerned if a pupil: • Has any injury which is not typical of the bumps and scrapes normally associated with children’s activities? • Regularly has unexplained injuries. • Frequently have injuries, even when apparently reasonable explanations are given.

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• Offers confused or conflicting explanations about on how injuries were

sustained. • Exhibits significant changes in behavior, performance or attitude. • Indulges in sexual behavior which is unusually explicit and/or inappropriate

to his or her age. • Discloses an experience in which he or she may have been significantly harmed. 3.7. Dealing with a disclosure If a pupil discloses that he or she has been abused in some way, the member of staff should: • Listen to what is being said without displaying shock or disbelief; • Accept what is being said; • Allow the child to talk freely; • Reassure the child, but not make promises which it might not be possible to keep; • Not promise confidentially, as it might be necessary to refer the case to the Child Protection Officer • Reassure the pupil that what has happened is not their fault; • Stress that it was the right thing to tell; • Listen, rather than ask direct questions; • Ask open questions rather than leading questions; • Not criticize the perpetrator; • Explain what has to be done next and who has to be told. 4. DISASTER PLAN PROTOCOL A team of selected members need to be well trained in specific skills to carry out their specific tasks efficiently during a disaster. Fire safety plan should be developed. Schools serving less privileged children should have specially trained staff and special equipments accordingly. III. SCHOOL HEALTH PROCEDURES 1. MEDICATION POLICY AND PROCEDURE • Only minimum amount of medicines to be stored if school has a part time

doctor. • If there is a full time doctor, medication policy should be developed under

his/ her responsibility. • School doctor’s instructions should be followed on the storage and delivery

procedure of medication regarding expiry date, temperature control, and other pharmaceutical issues

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2. DOCUMENTATION FOR SCHOOL NURSES a) Documents and the Role of the School Nurse A school nurse spends a lot of time around documenting; nurse's notes, immunization records, medications administered, first aid notes, referral notes, etc. Legal and ethical considerations require school nurses to document care and keep every student's personal information confidential and secure. From a legal perspective in the health care setting it shall be remembered that "if it was not documented it was not done." Purposes of Maintaining School Health Records: • To facilitate communication among care providers • To provide continuity and evaluation of care • For medico-legal purposes • To provide statistical data • For research and education Maintenance and Storage of School Health Records: • Only health practitioners in the school clinic directly involved in a student’s care must have access to that student's health records and related information. • Handwritten or hard copy of health records and information must be stored in a locked cabinet or cupboard and in a safe monitorable location and only school health practitioners must have access to these storage facilities. • Records in the school nurses' office, whether they are paper or electronic need to be secured when not in use. • Only Official School forms, which have been approved for use, will be filed with other school health records. • Password to computers should not be shared • Check and ensure that every student have their duly filled up school health record. • Document all attendance of the student to the school clinic • For those students who do not avail immunization in the school, open their school health record just the same. Attach the copy of their immunization record in the page provided for, in the school health record. Errors in Documentation: • References to school problems (e.g. staffing shortage), should never be included in student record. • Terms suggestive of an error should not be used (e.g. accidentally, or by mistake), state only the facts of what occurred. • When an error is made, one single line should be drawn through the error; the word "error" and the nurse's signature should be written directly above it. The correct entry should follow. Words should never be erased, scratched or whited out.

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• When an entry is made in the wrong student's record, the entry should

be marked "mistake in entry" and a line drawn through the mistaken entry as above. • Late entries should be avoided when necessary, a late entry maybe added, but in the correct date and time sequence. For example, write today's date and time when entering a note of care provided yesterday and mark it "late entry." School health record: Fill the first page with the personal data of the student taking into consideration of the following: • If both parents are employed write both their telephone numbers. • Under the column “Others”, write distinguishing information related to child’s heath, e.g. chronic illness, on regular treatment, or with orthopedic aid, like brace/crutches, etc. • Write the name of the school any time during the students stay in the same school. If the student transfers to another school, then write the name of the other school in the next line. Fill the 2nd page school Medical Examination with the age of the student at the time of examination properly written on the space provided. Ensure that the Medical Officer who conducts the medical examination signed on the form. Immunization record: • Fill up the 1st page with student’s name, health card number, and the • •

•

• • •

name of the school. Fill up the 2nd page with the birth date of the student. During the planning of immunization, write in pencil the planned date of immunization (date when the vaccine is supposed to be administered) on the column provided for. The nurse, who gave the vaccine, erases the planned date which was written in pencil, and stamp the date of vaccination. Also, sign over the date stamp. Record only in the Immunization Record (DOH/PHC/SHS-02) or records of vaccines administered outside DOHMS facility. Attach the Immunization Record (DOH/PHC/SHS-02) or records of vaccines administered outside DOHMS facility. Always attach the Immunization Record (DOH/PHC/SHS-02) to the student’s School Health Record. If and when the student leaves the school permanently, Immunization Record should be given to parents.

Transferring School Health Record • When a student is transferred to another school, send the student’s

school health record tot the school clinic of that school. • When a student leaves Dubai permanently, hand over the school health record to parents.

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b) Importance of Health Statistical Reports in School Health Services Systematically collecting, analyzing, interpreting, disseminating, and using health data is essential: • To understanding the health status of a population • To assessing progress of school programmes and other related activities • To planning effective prevention programs, data are the foundation of setting objectives • To identify emerging health issues and trends • For epidemiological research. Nurses’ Responsibilities in Health Statistics: • Record data accurately • Analyze data to understand its significance • Know the implications of the data to the needs of school population served • Maintain the confidentiality of the health data • Submit reports promptly. 3. RECORDS AND REPORTS A. Forms to be filled and submitted by Licensed School Medical Officers: (Look table 8) Table 8 Name of Forms

Forms to be filled and submitted by Licensed School Medical Officers Frequency of submission or Submitted To Due Date

School Health Record of Individual School Child (DOH/PHC-109)

Medical Officer Incharge or Nurse Incharge of school Health Service

When required

Students' Health Examination Report (DOH]/PHC/SHS-03)

Medical Officer Incharge of school Health Service

Monthly –Every 1st Week of the month

To be sent student's parents

When needed

Medical Officer Incharge of School Health Service

Whenever a students develops adverse reaction to vaccine

Original copy to be given to the school nurse, and duplicate copy will be sent to Medical Officer, School Health Service, DOHMS

When necessary

Notification for students' attendance to the DOHMS Health Centre/Clinic (DOH]/PHC/SHS-04) Report of Adverse Reaction Following Immunization (DOH]/PHC/SHS-05) Standing Order of Drugs that can be administered to the school children. (DOH]/PHC/SHS-15)

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B. Forms to be filled and submitted by Licensed School Health Nurse: (Look table 9) Table 9

Forms to be filled and submitted by Licensed School Health Nurse Frequency of submission Name of Forms Submitted To or Due Date Nurse Incharge of school Yearly School Details Health Service Every 1st week of October (DOH]/PHC/SHS-06) Monthly Report on First Aid Nurse Incharge of school Monthly - Every 1st week of Administration next month Health Service (DOH]/PHC/SHS-07) Monthly Report on Referred Nurse Incharge of school Monthly - Every 1st week of Students next month Health Service (DOH]/PHC/SHS-08) Nurse Incharge of school 10 days before every Immunization Plan Health Service Immunization Program (DOH]/PHC/SHS-14) Nurse Incharge of school Immunization Register Yearly Health Service Book School Annual Report (DOH]/PHC/SHS-01)

Nurse Incharge of school Health Service

Yearly - every 2nd week of June

Consent for Immunization (DOH]/PHC/SHS-12)

To be sent to parents to be filled up by them and then to be returned back to the licensed nurse

Yearly

Immunization Record of Individual Student (DOH]/PHC/SHS-02) Notification for Immunization (DOH]/PHC/SHS-10) Notification for Head Lice (DOH]/PHC/SHS-11) Immunization Information to parents (DOH]/PHC/SHS-12) Notification for Mantoux Test (DOH]/PHC/SHS-13)

Every after Immunization To be sent to parents

Whenever a student receives a vaccine

To be sent to parents

Whenever a student is found to have Head Lice

To be sent to parents and to be attached in the School Health Record

Whenever a student is due for a vaccine

To be sent to parents

Whenever Mantoux Test is done

C. All the required records and report must be maintained and submitted in the prescribed forms at the specified time as per guidelines which are as follows: 1. 2. 3. 4.

Consent for Immunization (DHA]/PHC/SHS-10) Immunization Record (DHA]/PHC/SHS-02) Student's Health Examination Report (DHA/PHC/SHS-03) Notification for Students' Attendance to the DHA Health Centre/Clinic (DHA/PHC/SHS-04) 5. Report of Adverse Reaction Following Immunization (DHA/PHC/SHS-05) 6. School Details (DHA/PHC/SHS-06) 7. Monthly Report on First Aid Administration (DHA/PHC/SHS-07) 8. Monthly Report on Referred Students (DHA /PHC/SHS-08) 9. School Annual Report (DHA/PHC/SHS-09) 10. Notification for Immunization (DHA/PHC/SHS-10) 36

11. Notification for Head Lice (DHA/PHC/SHS-11) 12. Immunization Information to Parents (DHA /PHC/SHS-12) 13. Notification for Mantoux test (DHA /PHC/SHS-13) 14. Immunization Plan (DHA /PHC/SHS-14) 15. Standing Order of Drugs that can be administered to the school children (DHA /PHC/SHS-15) 16. School Health Record of Individual School Child (DHA /PHC-109) 17. Immunization Register Book 18. School Accident / Emergency Report Form SCHOOL VISIT PROCESS 1. SUPERVISORY VISIT Supervisory visit shall be carried out for a minimum of twice per academic year for each private school by DHA School Health Doctor In-charge and DHA School Health Nurse In-charge. Each one will use a specific checklist. Visit objectives: • To monitor the implementation of School Health Program in every school as per guidelines. • To provide assistance / advice to the private School Doctors and Nurses in carrying out their roles and responsibilities. Then, they will report to Community Programs Service Section and Director of Public Health Affairs of Dubai Health Authority. N.B. Dubai Municipality representative may join the team during the visit. 2. NURSE VISIT Nurse visit shall be carried out on a daily basis by DHA School Health Nurses who covers specific and certain number of private schools. Each staff nurse is responsible to visit their assigned private schools regularly. The private schools are divided into 2 groups according to their location: one group for all schools located in Bur Dubai and another group for all schools located in Deira. Hence, the DHA School Health staff nurses are also grouped into 2 depending on the location of the school assigned to them. Each group has its own Team Leader. They will provide assistance and advice to private school nurses in carrying out their expected activities especially in the implementation of Immunization Program in the school. They also ensure the implementation of school health programs at school environment. Finally, they will report to their Nurse In-charge at DHA School Health Services. 3. SCHOOL FACILITIES INSPECTION VISIT School facilities inspection visit shall be carried out by DHA School Health Inspector or Administrator within the supervisory visit schedule. It aims to audit all school facilities according to the standard checklist. Finally, School Health Inspector will report to the Head of School Health Services.

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4. DUBAI LINCENSING DEPARTMENT PERSONNEL VISIT Regular and frequent visits to school clinics shall be carried out by Dubai health Authority Licensing Personnel to monitor and check license status of nurses and doctors working at school clinics. Fine system will be imposed on any violations. ON-GOING EDUCATIONAL DEVELOPMENT To support the aim of delivering the best quality in service, school health care providers must undertake mandatory competency that should provide them with the necessary skills to remain safe, updated in knowledge and skills needed to make competent judgments and decisions in practice. The following are the mandatory competencies that school health care providers must comply to: 1. Basic Life Support • Current valid certification in BLS for Healthcare Providers Program and renew as recommended. 2. First Aid • Current valid certification in First Aid Training. 3. Fire and Safety • Current valid certification in Fire and Safety Training. 4. Health Education / Promotion • Must demonstrate competency in giving health education / promotion. • Able to provide evidence-based, culturally appropriate information to the children, family and significant others to promote, improve and restore health.

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FIRST AID FOR COMMON INJURIES & ILLNESSES 1. Abdominal Pain Abdominal pain results from illness ranging from minor conditions to serious medical emergencies such as: trauma, appendicitis, hernia, constipation etc. Urgent medical care is needed for any severe abdominal pain. Do These: 2. Observe and record; blood pressure, pulse and breathing 3. Offer reassurance and comfort 4. Help to a position that assists in relief of pain 5. Call 999 or for an ambulance − If pain is very severe − Individual is lying still with rigid and distended abdomen − Any signs of bleeding either from mouth or anus − Individual is feeling faint or losing consciousness 2. Acute Ear Ache Ear ache can be an agonizing pain, caused by any of the following: − Freshly pierced ear lobe or the discomfort of a tight earring − Trauma from vigorous use of cotton swab while cleaning the ear − Pressure in the ear canal due to an acute viral infection such as a cold, sinus congestion or from a respiratory allergy − A plug of ear wax − Presence of a foreign body - like a pea, bean, or flying insect. Do These: 1. Check ear for: − History of trauma or injury − Presence of foreign object − Discharge or bleeding − Swelling 2. Calm and help individual into sitting or lying position for comfort 3. Give analgesic as prescribed 4. Observe and record; blood pressure, pulse and temperature 5. If discharge is present, wipe from outer ear only 6. Call 999 or for an ambulance − If pain is caused by trauma − Foreign object is seen − Dizziness, ringing in the ears − Discharge or blood from the ear − Loss of hearing Do not: − Block any drainage coming from the ear. − Try to clean or wash inside of the ear canal. 39

− Attempt to remove the object by probing with a cotton swab, pin, or any other tool. − To do so will risk pushing the object farther into the ear and damaging the middle ear. − Reach inside the ear canal with tweezers. 3. Allergic Reaction (Anaphylaxis) Anaphylaxis occurs after exposure to allergen to which an individual is extremely sensitive such as; − Food (peanuts, shellfish, eggs, strawberry etc.) − Medicines (penicillin, sulfa) − Insect stings and bites (bees, or wasps) Anaphylactic reaction is a severe, and sudden generalized reaction that is potentially life threatening. Do These: − If individual is carrying an Epinephrine pen (EpiPen®) help individual use it or administer it at once − Call 999 or for an ambulance − Help individual in sitting or lying position that assists in breathing − Observe and record; blood pressure, pulse and breathing. Be alert for breathing and pulse being slower or faster than usual − If conscious offer reassurance and comfort, if necessary cover with blanket to keep warm − If unconscious check for signs of life and prepare to give CPR if necessary. 4. Burn Do These: 1. Remove individual from the Burn / Danger area − If clothing is on fire: STOP, DROP and ROLL − PULL individual to the ground − Wrap in blanket − Roll long ground until flames are extinguished 2. If the burned area is small, cool the burned area with room temperature water. If possible hold the burned area under cold running water up to 20 minutes 3. If the burned area is large cover with wet cloth or gauze for at least 10 minutes 4. Remove clothing and jewelry or any other constricting item before the area swells 5. Protect the burn from friction or pressure while cleaning. 6. If burn is large or deep, manage for shock. 7. Call or send someone to phone 999, or for an ambulance if − There is fire − Individual has large burn Do Not: − Do not apply lotions, ointment or fat/ butter on a burn

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− Do not use icy or cold water on a burn, because even though it may relieve pain, the cold can actually cause additional damage to skin. − Do not touch injured areas or burst any blisters − Do not remove anything sticking to the burn 5. Chemical Burns Chemical burns take place at work, home or in school. It can be the result of an accident or as the result of an assault. Most chemical burns occur when the skin is in contact with strong acids or bases. i Sometimes the burn develops slowly and in some cases the individual may not be aware of the burn for up to 24 hours. The extent of damage depends on how long the skin is exposed to the chemical. The chemical will continue to 'eat' its way through the skin and into deeper layer until it is washed away. Some Chemicals that cause burns are: − Bleach, boric acid, paint thinner, Sulphuric acid − Some chemicals in the laboratory when incorrectly mixed together − Swimming pool chlorinators, battery acids, drain or toilet bowl cleaners etc. Do These: Treatment will vary with the nature of the chemical and extent of the burn. − Ensure area is safe. − Wear Personal Protective Equipment to avoid contact with substance yourself − With a dry chemical or powder, first brush it off the skin. − With spilled liquid giving off fumes, move the individual out or ventilate the area. − Wash off the area as quickly as possible with running water for 20 to 30 minutes. Use a sink or water hose or even a shower to flush the entire area of contact. − If available follow directions on chemical container − Remove clothing and jewelry from the burn area − Put a dressing over the burn − Call or send someone to phone 999, or for an ambulance for any chemical burn. − If available, send chemical container with the individual 6. Electrical Burns Electrical burns are often accompanied by respiratory or cardiac arrest. Electrical burns may cause massive internal injuries even when the external burn may look minor. Electrical burns may include: − External burns caused by the heat of electricity − Electrical injuries caused by electricity flowing through the body − Lightning burns may be more serious than initial appearance. The entrance wound may be small, but electricity continues to burn as it penetrates deeper

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Do These: − Call or send someone to phone 999, for an ambulance. − Never go near an individual who may have been injured by electricity. Do not touch until you know the area is safe. Unplug or turn off power − Do not attempt to remove individual from the source of electricity − Wear personal protective equipment − Cover burned area with a dry non-stick sterile dressing − Look for a second burned area where the electricity left the body − Treat for shock 7. Blow to the Eye − If the eye is bleeding or leaking fluid, call 999 or get the individual to the emergency room immediately − Put a cold pack over the eye for 15 minutes to ease pain and reduce swelling, but do not put pressure on the eye. − Do not remove contact lens if individual is wearing a contact lens. − Ask individual to lie still and also cover the uninjured eye. Movement of the uninjured eye causes movement of the injured eye too. − Call or send someone to phone 999, or for an ambulance, if pain persists or vision is affected in any way. 8. Large Object Imbedded in the Eye − Do not remove the object. − Stabilize object in place, use thick cloth or dressing and cut a hole for affected eye

− Position a paper cup over injured eye and impaled object. − Do not touch eye or imbedded object.

− Secure cup in place with bandage or scarf that covers BOTH eyes, because movement of the uninjured eye causes movement of the injured eye.

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− Keep individual still, and observe for shock. − Call or send someone to phone 999, for an ambulance or get individual to the emergency room immediately. 9. Dirt or Small Particle in the Eye − Do not let individual rub his / her eye − Gently pull the upper eyelid out and down over the lower eyelid to try and remove the foreign body.

− Gently flush the eye with water from a medicine dropper or water glass. Have individual hold head with the affected eye lower than the other so that water does not flow into unaffected eye. − If particle remains and is visible, carefully try to brush it out with a sterile dressing. Lift the upper eyelid and swab its underside if you see the particle.

− If particle remains or individual has any vision problems or pain, cover the eye with sterile dressing and the uninjured eye − Call or send someone to phone 999, for an ambulance or get individual to the emergency room immediately. 10. Falls When you observe a Minor Fall Do These: − If it is safe to move the individual pick him/her up and comfort him/her − Apply an ice pack on bruised area − Treat any cuts or scrapes − Have the him/her rest − Inform parents / guardian − Instruct parent / guardian to observe for the next 24 hours and assess for any change such as; unsteady walking, blurred vision, slurred speech or losing consciousness. A Major Fall is if you observe: − It involves the head, neck and spine or hipbones − If the individual loses consciousness even if just for a moment

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− If there is clear liquid coming from the nose, ear or mouth − If the individual is having difficulty breathing Do These: − Call or send someone to phone 999, for an ambulance − Do not move the individual − Try to keep the individual still with the neck and spine straight − If you have to move the individual use two people to keep back and neck straight − While waiting for help reassure the individual, check breathing and pulse − Stop any bleeding − Look for signs of shock. (Pale and sweaty clammy skin, rapid or uneven breathing, unconsciousness). − Do not try to straight out any twisted limbs − Do not try and push any bones that might have broken through the surface of the skin back under the skin − Elevate the feet of the individual about 12in. − Do not elevate the feet if you expect spinal or back injury or if doing so causes the individual any discomfort Call or send someone to phone 999, for an ambulance immediately if: − Individual has trouble staying awake or is overly sleepy − Is vomiting − Cannot walk normally − Has slurred speech − Cannot stop crying − Has trouble focusing or paying attention − Complains of neck or back pain − Has increased pain 11. Fever Fever is an abnormal body temperature elevation. Normal range of temperature for children is 36.4°C to 37.0°C. In children any temperature of 38°C or above is considered high and is classed as a fever. A child’s temperature can vary depending on activity, emotional stress; the type of clothing child is wearing, environmental temperature, and disease processes such as; − Flu − Ear infections − Respiratory tract infections − Tonsillitis − Urinary infections − Any of the common childhood diseases such as measles, mumps, chickenpox Do These: − Remove excess clothing − Administer antipyretic as prescribed by school physician

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− − − −

Provide adequate fluid intake as tolerated and as prescribed Place a cool sponge on the child’s forehead Recheck temperature 20 to 30 minutes after administration of antipyretic. Call or send someone to phone 999, for an ambulance immediately if individual develops: 9 change in level of consciousness 9 convulsions or fits 9 difficulty of breathing

Do not give Aspirin (acetylsalicylic acid) because of the risk of Reye’s syndrome. Sponging children is No longer recommended to lower temperature because it can lead to extreme chilling and shock to an immune nervous system and has little advantage over the use of oral antipyretics. (Purssell, 2000). 12. Fractures A fracture is a break in the continuity or structure of the bone as a result of trauma, twisting or bone decalcification. Do These: − Put on personal protective equipment − Have individual rest and immobilize the injured body part, reassure individual − Check for signs of shock, cover and keep warm − Call or send someone to phone 999, for an ambulance immediately − With an open fracture, cover the wound with a clean dressing. − Apply ice pack on the injured area with a towel between the ice bag and the skin for up to 20 minutes − Raise the injured body part if it does not cause individual more pain − Elevate a splinted arm − Monitor individual’s vital signs while waiting for an ambulance − Remove clothing and jewelry if they may cut off circulation as swelling occurs. Do not: • Do not try to align the ends of a broken bone • Do not give individual anything to eat or drink. 13. Joint Injuries A- Dislocation Dislocation is when one or more bones have been moved out of the normal position in a joint.

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Signs and Symptoms: − The joint is deformed as compared to the other side of the body − Pain over involved area − Swelling − Inability to use injured body part Do These: − Have individual rest and immobilize the area in the position in which you find it, reassure individual − Check for signs of shock, cover and keep warm − Call or send someone to phone 999, for an ambulance immediately − Apply ice pack on the injured area with a towel between the ice bag and the skin for up to 20 minutes − Use a splint to immobilize the area − Monitor individual’s vital signs while waiting for an ambulance − Remove clothing and jewelry if they may cut off circulation as swelling occurs. Do not: − Do not try to put the displaced bone back in place. − Do not give individual anything to eat or drink. B- Sprain Sprain is an injury which occurs due to excessive stretching of a ligament from its normal position. It is caused by a twisting motion, such as a fall or step in uneven surface.

Do These: − Have individual rest and immobilize the area in the position in which you find it, reassure individual − Apply ice pack on the injured and wrap joint with a compression bandage − Use a soft splint(blanket or pillow) to immobilize and support the joint − Elevate a sprained hand or ankle above the level of the heart − Call or send someone to phone 999, for an ambulance − Remove clothing and jewelry if they may cut off circulation as swelling occurs.

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RICE: This acronym is an easy way to remember how to treat all bone, joint, and muscle injuries (table 8): Table 10 RICE ACRONYM Rest: Any movement of a musculoskeletal injury can cause further injury, pain and swelling. Rest R is important for healing. Have individual rest until medical help arrives to the scene. ICE. Cold reduces swelling, lessens pain and minimizes bruising. Apply ice pack or cold pack on I the injury (except in open fractures) as soon as possible. Wrap the ice pack or cold pack in cloth to prevent direct skin contact because it may be very cold to freeze the skin COMPRESSION: Compression helps prevent internal bleeding and swelling. Compression C should be done with an elastic roller bandage. Wrap the bandage over the injured area. Check fingers or toes frequently to make sure circulation is not cut off. ELEVATION: Elevating an injured arm or leg also helps prevent swelling and control internal or E external bleeding. Splint a fracture first and elevate it only if moving the limb does not cause pain

14. Migraine Headache Signs and Symptoms: − Pain in the temples or behind one eye or ear or any part of the head − Nausea and vomiting − Sensitivity to light and sound − Seeing spots or flashlights Do These: − Check vital signs − Apply cold compress to the area of pain − Have individual rest in bed with pillows comfortably supporting head or neck. − Reduce light and noise in the room − Administer analgesic as prescribed by school physician. 15. Nausea and Vomiting Signs and Symptoms: − Weakness − Dizziness or faintness − Perspiration − Skin pallor − Rapid pulse − Headache Do These: − Assist individual into sitting position, lean head forward over emesis basin − Ask to take deep breaths slowly − Apply a cool compress over individual’s forehead − Limit movement and activities − Limit intake of food and fluid until nauseous feeling subsides − Observe what is the vomitus and amount of vomitus − Call or send someone to phone 999, for an ambulance if vomiting persists with signs of dehydration

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− Limit client’s intake of food and fluid temporarily until signs of nausea subside. 16. Near drowning Do These: − Call or send someone to phone 999, for an ambulance immediately for transfer to emergency department − Remove wet clothes if possible and keep individual warm − Check vital signs − If breathing spontaneously: 9 place in recovery position, ideally with head low down so that water drains from the mouth 9 Supplemental Oxygen may be given by mask to aid ventilation. 17. Nose bleeds Do These: − Put on personal protective equipment − Have individual sit and tilt head forward and ask to keep his/her mouth open − Loosen any tight clothing around the neck − Press both sides of the nostrils just below the bridge of the nose continuously for 10 to 15 minutes − Ask individual to breathe through his/her mouth and not to speak, swallow, cough, blow or sniff − If bleeding continues press harder − Check vital signs − After 10 or 15 minutes, release pressure slowly. Pinch the nostrils again for another 10 to 15 minutes if bleeding continues − Call or send someone to phone 999, for an ambulance immediately if 9 Bleeding continues after 2 attempts to control bleeding and is heavy such as gushing blood 9 You suspect there is injury 9 Individual has difficulty breathing or high blood pressure. Do not: − Do not ask individual to lean his head backward − Do not use ice pack on the nose or forehead − Do not press on the bridge of the nose between the eyes (upper bony part of the nose). − If there is a foreign objects: 9 Do not attempt to remove object 9 Call parent and recommend medical check-up 18. Toothache Signs and Symptoms: − Individual’s jaw is sore and tender to touch

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− − − −

Bleeding or swelling around the tooth or gums Throbbing pain in the head, jaw and ear Eating or drinking difficult Tooth is sensitive to hot/cold food and drink

Do These: − Give warm water mouthwash − Give analgesic as per school physician’s /dentist’s standing order − Apply warm compress on the check over affected tooth /teeth − Have individual see dentist immediately if pain is throbbing in nature and accompanied with fever. Do These for Tooth Knocked Out: − Have individual sit with head tilted forward to let blood drain out − Wear personal protective clothing − Fold a roll of gauze into a pad and place over the tooth socket. − Instruct individual bite down to put pressure on the area for 20 to 30 minutes. − Save tooth which maybe reimplanted. Touch only the tooth’s crown, rinse it if dirty. Put in a container of milk or cool water. − Get individual and the tooth to a dentist immediately. 19. Wounds The treatment of wounds depends on the mechanism of injury and the type of wound caused, like laceration, puncture etc. Wound care involves cleaning and dressing to prevent infection (especially Tetanus) and protect the wound so that healing can occur. The control of any bleeding is the priority of care. A- Cuts/Superficial Abrasion: Do These: − Determine cause of injury − Wear personal protective equipment − Gently wash the wound with soap and water to remove dirt − Cover the wound with dry, sterile dressing and bandage − Determine individual's Tetanus immunization status B- Deep/Extensive Laceration: Do These: − Determine cause of injury − Wear personal protective equipment − Call or send someone to phone 999, for an ambulance − Control bleeding by covering with sterile gauze dressing and apply direct pressure − Gently wash the wound with soap and water to remove dirt − Cover the wound with dry, sterile dressing and bandage − Determine individual's Tetanus immunization status

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C- Puncture Wound: Do These: − Determine cause of injury − Wear personal protective equipment − Call or send someone to phone 999, for an ambulance − Control bleeding by covering with sterile gauze dressing and apply direct pressure − Gently wash the wound with soap and water − Cover the wound with dry, sterile dressing and bandage − Determine individual's Tetanus immunization status D- Bleeding: Many injuries cause external or internal bleeding; bleeding may be minor or life threatening. Bleeding is one of the most frightening emergencies. Remember: − Remain calm − You can stop most bleeding with pressure − Bleeding often looks a lot worse than it is Do These: − Wear personal protective equipment − Remove clothing to expose the wound − If individual is able, ask to apply pressure over the wound with a large sterile dressing while you put on gloves and eye protection. − Apply firm pressure on the dressing over the bleeding area with the flat part of your fingers or the palm of your hand. − A small amount of pressure is needed to control bleeding from a scrape. Press harder to stop severe bleeding − If bleeding does not stop, add a second dressing and press harder. − Do not remove the first dressing because it might pull off some blood clots and cause the wound to bleed more. − Check for signs of shock − Elevate the wound, raise the injured part of the body above the level of the heart to slow down blood flow to the wound − Ask individual to lie down, with the legs raised if you think that shock may develop − Monitor vital signs. Keep individual warm. 20. Food Poisoning Do These: − Have individual rest in bed − Give fluids if not vomiting − Call or send someone to phone 999, for an ambulance and transfer to emergency department immediately

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21. Fainting Do These: − Check the individual's ABC's and provide BLS if required − Lay the individual down and raise the legs about 12 inches above the level of the heart − Loosen constricting clothing − Check for possible injuries caused by falling − Reassure individual as he / she recovers − Send someone to phone 999, for an ambulance and transfer to emergency department immediately 22. Poisoning Do not try to induce vomiting Do These: − Determine what was swallowed, when and how much − Monitor vital signs, level of consciousness − Send container of substance (medicine/s etc.) to the hospital − For a responsive individual: 9 Call or send someone to phone 999, for an ambulance and transfer to emergency department immediately 9 If individual’s mouth or lips are burned by corrosive chemical, rinse the mouth with cold water (without swallowing) − For an unresponsive individual: 9 Put in recovery position and be prepared for vomiting 9 Call or send someone to phone 999, for an ambulance and transfer to emergency department immediately 23. Diabetic Emergencies People with diabetes sometimes have problems maintaining a balance of blood sugar and insulin in the body. They can go into hyperglycemia or hypoglycemia. Many factors can cause either of this condition. The immediate effects of low blood sugar can be more serious than that of high blood sugar. Individuals quickly progress to a medical emergency if the not treated promptly Signs and symptoms of hypoglycemia (low blood sugar): − Sudden dizziness − Shakiness − Mood change or aggressiveness, anger − Headache − Confused or having difficulty paying attention − Pale skin − Sweating − Hunger − Jerky movements

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Do These: − Ask and confirm if individual has diabetes; look for a medical alert ID − Give sugar: 9 2 - 4 glucose tablets or 9 6 – 8 ounces 100% orange juice or other juice 9 1 or 2 sugar packets or 5 or 6 pieces of hard candy (unless choking is a risk) − If still feels ill or has signs and symptoms after 15 minutes, give sugar every 15 minutes until individual recovers or EMS arrives. − If individual is unable to sit up or swallow, Call or send someone to phone 999, for an ambulance. − If individual is having seizure, follow steps for management of seizure. − If individual is not having seizure and you do not suspect head, neck or spine injury, roll him / her to recovery position to help keep airway open. Do not give foods that contain little or no sugar such as: 9 Diet soda 9 Chocolate 9 Artificial sweetener 24. Bronchial Asthma Attack During an Asthma attack the airway becomes narrow and the individual has difficulty breathing. Many asthma individuals know they have the condition and carry medication for emergency situations. Untreated a severe asthma attack can become fatal. Do These: − Help individual rest and sit in a position for easiest breathing − Assist individual to use his/her medication (usually an inhaler) 9 Follow prescribed dose for children or adults 9 Use a spacer if available − Reassure individual and Assess vital signs − Administer Oxygen inhalation as per your school physicians’ standing order − Call or send someone to phone 999, for an ambulance immediately if: 9 Individual does not know he / she has asthma (first attack) 9 Breathing difficulty persists after using the inhaler. 25. Seizures Seizures or convulsions result from a brain disturbance caused by different conditions such as; epilepsy, high fever in children certain injuries etc. Do These: − Check for signs of life − Prevent injury during seizure; move away dangerous objects, put something flat and soft under the head

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− Loosen clothing around neck to ease breathing − Gently turn individual to one side to help keep the airway clear if vomiting occurs − Call or send someone to phone 999, for an ambulance immediately if: 9 Seizures continues more than 5 minutes, recovers very slowly 9 Has difficulty breathing or another seizure quickly follows 9 Individual is not known to have epilepsy 9 Individual has a history of diabetes, or is pregnant or is injured − If individual is injured manage injuries resulting from the seizure 26. Febrile Convulsion − For individual with febrile convulsions follow the steps; 9 for reducing fever 9 for managing seizures − Do Not 9 Do not try to stop a convulsing individual’s movements 9 Do not place any object in the individual’s mouth EMERGENCY PROCCEDURES FOR INJURY OR ILLNESS Follow the following recommendations: − Remain calm and communicate a calm, supportive attitude to the ill or injured individual. − Never leave an ill or injured individual unattended. Have someone else call emergency assistance and the parent. − Do not move an injured individual or allow the person to walk (bring help and supplies to the individual). Other school staff or responsible adults should be enlisted to help clear the area of students who may congregate following an injury or other emergency situation. − If trained and if necessary, institute CPR. − Do not use treatment methods beyond your skill level or your scope of practice. All persons working with students are encouraged to obtain training in CPR/First Aid training through DHA PHC. − Call emergency assistance immediately for: 9 9 9 9 9 9 9 9 9 9 9

Anaphylactic reaction Amputation Bleeding (severe) Breathing difficulty (persistent) Broken bone Burns (chemical, electrical, third degree) Chest pain (severe) Choking Electrical shock Frostbite Head, neck, or back injury (severe)

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9 9 9 9 9 9

Heat stroke Poisoning Seizure (if no history of seizures) Shock Unconsciousness Wound (deep/extensive)

How to call EMS (Emergency Medical System): When you call 999 be ready to give the following information: 1. Your name and the phone number you are using 2. The location and number of individuals 3. What happened to the individual/s and any special circumstances or conditions that may require special rescue or medical equipment 4. The individual’s condition: is individual responsive, breathing, or bleeding? 5. Individual’s appropriate age and sex 6. What is being done for the individual/s? Every school should have a procedure for contacting the individual's parent/guardian/named contact individual in an emergency as soon as possible. It is a good practice to practice to report all serious and significant incidents to individual's parents/guardian by sending a letter home or by telephoning them. PLANNING FOR STUDENTS WITH SPECIAL NEEDS Some students in your school may have special emergency care needs due to health conditions, physical abilities or communication challenges. Include caring for these students' special needs in emergency. In the event of an emergency situation, refer to the student's emergency care plan. 1. Health conditions The School nurse, physician and other school health professional, along with student's parent or legal guardian should develop individual emergency care plan for students when they are enrolled. Plans should be made available to appropriate staff at all times for students with these conditions: − − − − −

Seizures Diabetes Asthma or other breathing difficulties Life-threatening or severe allergic reactions Technology dependent or medically fragile conditions.

2. Physical Abilities Other students in your school may have special emergency needs due to their physical abilities. These students will need special arrangements in the event of a school-wide emergency. A plan should be developed and a responsible

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person should be designated to assists these students. All staff should be aware of the plan for students who are: − In wheelchair − Temporarily on crutches / walking casts − Unable or have difficulty walking up or down stairs 3. Communication challenges Other students in your school may have sensory impairments or have difficulty understanding special instructions during an emergency. These students may need special communication considerations in the event of a school- wide emergency. All staff should be aware of the plan to communicate information for students who have: − Visual impairment − Hearing impairment − Processing disorder − Limited language (English, Arabic) proficiency − Behavior or developmental disorder − Emotional or mental health issues STANDARD PRECAUTIONS: FOR HANDLING BLOOD & BODY FLUIDS IN SCHOOL Anticipating potential contact with infectious materials in routine and emergency situations is the most important step in preventing exposure to and transmission of infections. Use Standard Precautions and infection control techniques in all situations that may present the hazard of infection. Precautions should be observed and appropriate protection used when caring for bleeding injuries or handling other body fluids in emergency situations. Body fluids include blood, drainage from cuts, scabs, skin lesions, urine, feces, vomitus, nasal discharge, and saliva. The body fluids of all persons should be considered to be potentially hazardous. Avoid direct contact with body fluids. Use Personal Protective Equipment (PPE) including: − Gloves to protect your hands from blood and other body fluids − Eye protection, if the individual is bleeding, to protect your eyes from blood and other body fluids − Mask to protect you when you give breaths If unanticipated skin contact occurs, hands and all other affected skin should be washed with soap and running water as soon as possible. The local procedures for blood and body fluid exposure should be followed. Diligent and proper hand washing, the use of barriers (e.g., gloves), appropriate disposal of waste products and needles, and proper care of spills are essential techniques of infection control.

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If it is necessary to perform CPR, a one-way mask or other infection control barrier should be used. However, CPR should not be delayed while such a device is located. HAND WASHING PROCEDURE − Wash hands vigorously with soap under a stream of warm running water for at least 20 seconds. − Wash all surfaces including backs of hands, wrists, between fingers, and under nails. − Rinse hands well with running water and thoroughly dry with paper towels. − If soap and water are unavailable, an alcohol-based hand rub may be used. GLOVES − Gloves must be worn when direct care may involve contact with any type of body fluid. − Disposable, single-use, waterproof gloves (e.g., latex or vinyl) should be used. (Vinyl gloves should be used by individuals who have latex allergy or a high potential for developing a latex allergy, e.g., individuals with spinal bifida.) − Discard gloves in the appropriate container after each use. − Hands should be washed immediately after glove removal. DISPOSAL OF INFECTIOUS WASTE − All used or contaminated supplies (e.g., gloves and other barriers, sanitary napkins, bandages) except syringes, needles, and other sharp implements should be placed into a plastic bag and sealed. This bag can be thrown into the garbage out of reach of children or animals. − Needles, syringes, and other sharp objects should be placed immediately after use in a puncture proof container that is leak proof on the bottom and sides. To reduce the risk of a cut or accidental puncture by a needle, needles should not be recapped, bent, or removed from the syringe before disposal. Once the container is full, it should be sealed, bagged, and kept out of the reach of children or animals until it can be disposed of properly. − Body waste (e.g., urine, vomitus, feces) should be disposed of in the toilet. If body fluids (e.g., urine, vomitus) are spilled, the body fluids should be covered with an absorbent sanitary material, gently swept up, and discarded in plastic bags. CLEAN-UP: Spills of blood and body fluids − Spills of blood and body fluids should be cleaned up immediately with an approved disinfectant cleaner. − Wear gloves. − Mop up spill with absorbent material.

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− Wash the area well, using the disinfectant cleaner supplied in the clinic or a 1:10 water/bleach solution. (Mix 1 part household bleach in 10 parts of water. Replace solution daily.) − Dispose of gloves, soiled towels, and other waste in sealed plastic bags and place in garbage, as already indicated. CLEAN-UP: Routine environmental clean-up − When clinics and bathrooms become contaminated with blood or body fluids, use the procedures outlined above. − Regular cleaning of non-contaminated surfaces, (e.g., toilet seats, tabletops) can be done with standard cleaning solutions or the 1:10 water/bleach solution described above. Regular cleaning of obvious soil is more effective than extraordinary attempts to disinfect or sterilize surfaces. − Brooms and dustpans must be rinsed with disinfectant. Mops must be soaked in disinfectant, washed, and thoroughly rinsed. The disinfectant solution should be disposed of promptly down the drain.

NURSING PROCEDURES ON ADMINISTRATION OF MEDICATIONS Drug administration and handling is and entire responsibility of the authorized nursing personnel only (Staff nurses and above). Under no circumstances should this responsibility be delegated to any other nursing personnel such as Assistant nurses, Nursing Aides and unauthorized Student Nurse Trainees. A-Purpose: − − − −

To aid the body to overcome an illness. To relive symptoms of illness. To promote health and prevent disease. To aid in diagnosis.

B-General instructions: 1. Insure that there is complete written order.(Emergency situation are exempted) 2. Be familiar with the related hospital policy. 3. Observe the five (7) rights of preparing and administrating drugs: 9 Right drug. 9 Right dosage. 9 Right route. 9 Right time. 9 Right patient. 9 Right to educate. 9 Right to refuse.

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4. Be aware of the patient diagnosis, plan of care, physical characteristic and

properties of drug; expect results of drug therapy, drugs' common average dosage, desired action, undesirable side effect, symptoms of toxicity, drug interactions and the common route of administration. 5. Do not use a drug that defers from normal colour, odour or consistency. (Consult the pharmacist when in doubt). 6. Do not leave the medicine cabinet unlocked or medications unattended. 7. Do not give medicine from an unlabelled container or from one on which the label is illegible. Such containers should be returned to the pharmacy. 8. Check expiry date of drugs before administering. 9. Double check all mathematical calculation for preparing medication. 10. Check the label of the drug container three (3) times. a) When reaching the medication. b) Immediately prior to the preparation of the drug. c) When returning the container to its storage place. 11. Administer only those medications that you have prepared personally. 12. Allow no interruptions while preparing and administering medications. 13. If narcotics are to be administered, follow the related current policy. 14. Report immediately : a) Errors in administering drugs. b) If the patient shows any symptoms suggesting an undesirable reaction to the drug. c) In advertently omitted drugs. d) If patient refuses the drug. e) Any drug the patient is allergic to and records it in the medication chart. 15. Don’t transfer medicines from one container to another. 16. Check patient's written and verbal history for past allergic reaction. Do not rely solely on patients' chart. C-Administration of oral medication Specific Instructions: − Do not administer oral medications to comatose patient. − Administer irritating drugs with meals or snacks to minimize irritation to the gastric mucosa. − Consult the pharmacist if there is a need for the tablet to be crushed. − Unless tablet is scored, it should not be broken to adjust the dosage. − Pour liquids from the side of the bottle opposite the label. − Do not mix two (2) liquid medicines together. − Hold the medicine glass at eye level to pour medication .The meniscus (lower curve of the liquid) should be at the calibration line indicating the proper dosage. − Do not return an unused dose of medicine to a stock bottle. − Withhold the medication and report if the patient is vomiting or scheduled for diagnostic procedures wherein drug administration is contraindicated. − Store drugs as recommended: e.g. tablets should be kept dry and protected from light; solutions should be stored at recommended temperature.

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Equipment: − Drug chart − Medicine trolley containing prescribed medicines − Medicines, graduated medicine glasses and spoons − Facial tissues − Small tray − Receiver − Container with water for used medicine glasses − Paper bag − Additional 9 Sphygmomanometer and stethoscope. 9 Feeding cup / straw /dropper / syringe 9 Milk or juice 9 Water jug with water Preparation of equipment: Wash hands and make sure that the medicine trolley contains the prescribed medication and necessary equipment. Preparation of patient and environment: − Evaluate the patient's knowledge on the medication to be given and provide with the necessary information accordingly. − Check vital signs if necessary. Implementation of the procedure: 1. Identify the patient carefully by: 9 Checking the drug chart. 9 Looking at the identification hand. 9 Asking the patient to state his name. 2. Check the medicine container against the drug chart. 3. Remove prescribed dose from the container after rechecking the label. Capsules or tablets should be put in to the medicine glass using the cap of the bottle or tea spoon. Liquid drugs can be poured in to the graduated medicine glasses. (Shack the bottle well if necessary). 4. Wipe the rim of the bottle with tissue paper after pouring liquid medication. 5. Return the medicine container into its proper place. 6. Position the patient if necessary. 7. Administer medicine and remain with the patient until you are sure that he / she has swallowed the drug. 9 Medicines with unpalatable taste maybe mixed with milk or juice. 9 NB: Medications should not be mixed with milk for children. 9 Use an individual dropper or syringe to give liquid medication to infant or small children while holding them in sitting or semi sitting position. Place the medication between the gum and the cheek to prevent possible aspiration.

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9 Don’t tilt the head forward when the patient has difficulty in swallowing liquid medication. Tilting the head forward or very far backward is likely to cause aspiration. After care of patient: Following the administration of medication, observe the patient and report any signs of unfavorable reaction. 1. Check vital signs if necessary. After care of equipment: Wash used items thoroughly. Report on drug chart and nurses' notes: 1. Drug chart –Date, time, dosage and nurse’s signature. 2. Nurses' notes – Special observation and remarks, if any. D-Administration of Injections Indications: To administer medication through parenteral route: 1. When other routes of administration are contraindicated. 2. To insure adequate absorption and more predictable result with greater accuracy. 3. When the drug is not available in any other form. Special Instructions: 1. Nurse should know : a) That the size and type of syringe to be used is determined by: • Type of medication. • Amount of medication. • Method of dispensing medication. b) That the size of the needle to be used is determined by : • The route of administration. • Medication to be administered. • Size of the patient. c) The most commonly used sizes of needles for various routes: Intradermal 27G. 3/8" (0.94cm) 27G. 1/2" (1.25cm) 26G. 1/2" (1.25cm) 25G. 5/8" (1.6cm) Subcutaneous All the above sizes and 23G. 3/4" (1.88 cm) Intramuscular 23G. 1" (2.5 cm) 22G. 1" (2.5 cm) 22G. 1 1/2" (3.8cm) 21G. 1" (2.5cm) 21G. 2" (5 cm) 20G. 1 1/2" (3.8cm) 20G. 2" (5 cm)

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d) The parts of the syringe and needles that must be kept sterile during the procedure of preparing and administering injection such as : • Inside of the barrel. • The part of the plunger that enters the barrel. • The tip of the barrel. • The needle except for the needle hilt. e) The common sites used. Refer to Diagram No. 1 for the comparison of angles of insertion for intramuscular (90 degrees), subcutaneous (45 degrees), and intradermal (15 degrees) injections. f) Common complications which can occur if care is not taken such as: • Abscess • Necrosis • Nerve injuries • Lingering pain • Periostitis • Blood borne disease 2. Rotate the site if the patient is to receive frequent injections. 3. Do not inject more than 0.01 ml – 0.1 ml of solution for intradermal route, more than 1-2 ml for subcutaneous route and more than 4-5 ml for intramuscular route. 4. Evaluate condition of administration site for presence of lesions, rash, inflammation, lipid dystrophy, and ecchymosis or tissue damage from previous injections. 5. Check label on medication bottle to determine if medication can be administered via route ordered. 6. Allow the patient who is fearful of injection to talk about his fears. 7. Inject the medicine in to relaxed muscles. 8. Inject the solution slowly so that it is dispersed more easily in to the surrounding tissue. 9. Do not move the needle while injecting medication. 10. Write the date and time on the multivial after opening. 11. Follow the instructions of the manufacturer regarding, reconstitution, storage and duration of usage of multidose vials. Equipment: 1. Tray containing: a) Required sizes of syringe and needles. b) Prescribed medication. c) Receiver. d) Sprit swab. 2. Drug chart / injection card. 3. Small tray with cover. Additional Items: a) Stethoscope. b) Sphygmomanometer. c) Sterile distilled water. d) Ampoule file.

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e) Band –Aid. Preparation of Equipment (Preparation of injection): 1. Wash hands. 2. Check the label with patient's drug chart. 3. Open packs and assemble the syringe and needle observing aseptic technique and place it in the small tray. 4. Cleanse the top of the vial with sprit swab or break top of ampoule at colored line protecting fingers. File slightly if difficult to break. Tap stem of ampoule with finger nails before breaking. 5. Remove the needle guard and place it in the small tray. 6. Reconstitute the drug, if needed. 7. If drug is suspension mix well by rolling vial between palms. 8. Inject air in to vial an amount equal to the solution to be withdrawn. Do not inject air in to ampoule as it causes displacement and possible loss of medication through leakage. 9. Extract desired amount of medicine, expel air in to the vial, remove needle from vial and secure the needle well with the needle guard in place. 10. Double check drug and dosage against medication sheet and vial or ampoule. 11. Place syringe, vial or ampoule and spirit swab in the tray. 12. Take the prepared tray and the medication chart / injection card to patient's side. Preparation of Patient and Environment: 1. Explain the medications action and procedures for administration when required. Give honest explanation if certain medication is known to cause more pain. 2. Provide privacy and adequate lighting. 3. Assess patient's parameters if needed. 4. Place patient as per his condition and comfort. 5. Expose the area. Implementation: 1. Identify the patient carefully by : a) Checking the medication chart. b) Checking the identification band. c) Asking the patient against the drug chart. 2. Check the vial / ampoule against the drug chart. Intradermal Injection: 1. Select the site on the inner aspect of the forearm about a hand's breath above the patient's wrist. 2. Cleanse the area with a spirit swab using circular motion and moving outward from the injection site. 3. Allow the skin to dry. 4. Grasp patient's forearm from underneath and gently pull the skin taut. 5. Insert the needle at 10- 15ºangle with the bevel of the needle facing up (Figure 1).

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6. 7. 8. 9.

Inject the medicine slowly to form a wheal at the site. Withdraw needle at the same angle as the needle was inserted. Do not massage the area after removing the needle. Observe the area for signs of reaction at order intervals.

Figure 1:Comparison of angles of insertion for intramuscular (90 degrees), subcutaneous (45 degrees), and intradermal (15 degrees) injections

Subcutaneous Injections: 1. Select the site. (Refer to figure 2) a) Outer part of upper arm. b) Anterior lateral aspects of thigh. c) Anterior abdominal wall. d) Back. 2. Cleanse the area with a spirit using circular motion and moving outward from the injection site. 3. Allow the skin to dry. 4. Hold the skin taut over the injection site or grasp the area surrounding the injection site and hold it in a cushion manner. 5. Inject the needle quickly at an angle 45º to 90º depending on the condition of the tissue after the needle is in place. 6. Release the grasp on the tissue after the needle is in place. 7. Pull back the plunger gently to determine if the needle is in a blood vessel. If blood appears, withdraw needle, apply pressure on the bleeding site and select anew site. (Except in administration of Heparin). 8. Inject the medicine slowly. 9. Withdraw the needle gently at the same angle it was inserted while applying pressure against the injection site 10. Massage the area gently with spirit swab (Except after administration of Heparin). NOTE: For other drugs refer to manufacture's instructions.

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Figure 2: Common Sites For Subcutaneous Injections

Intramuscular Injections: 1. Position patient according to the site to be used. 2. Cleanse the area with alcohol swab using circle motion and using outwards from the injection site. 3. Draw 0.2 to 0.5 ml of air into the syringe. 4. Using the thumb and first two fingers, hold the skin taut. 5. Holding the needle vertically and quickly thrust the needle in to tissues at a 90º angel firmly and steadily. * Do not insert the complete length of the needle. 6. Aspirate by slowly pulling back on the plunger to determine wither the needle is in blood vessels. If blood is aspirated, withdraw the needle, apply pressure replace with another sterile one and select anew site. 7. Inject the medicine slowly. 8. Remove the needle quickly while applying pressure against the injection site. 9. Massage the area, as long as two minutes unless label on the medication recommends otherwise.

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Sites used for IM injections (Refer to figure 3) Dorsogluteal site i) Position patient on his abdomen exposing the site well and toes pointing in ward. This helps muscles to relax and makes the injection less painful. ii) a) Draw an imaginary diagonal line from the greater trochanter of the femur to the posterior superior iliac spine. Site of injection is above and outside of the diagonal line. b) Locate the site by dividing the buttock into quadrants. • Draw an imaginary rectangle having the iliac crest, anterior iliac spine, inferior gluteal fold and the division between the buttocks as boundaries. • The site of injection is in the upper outer quadrant of rectangle DO NOT USE THIS SITE FOR CHILDREN UNDER THE AGE OF TWO. Ventrogluteal site i) Place patient in lateral or prone position. ii) Palpate for the greater trochanter at the head of the femur, the anteriorsuperior iliac spine and the iliac crest. iii) Place palm on the greater trochanter and index finger on the anteriorsuperior iliac spine. iv) Move middle fingers away from index finger as far as possible along the iliac crest v) The site of injection is in the center of the triangle formed by the index and middle fingers. Vastus lateralis i) Place patient in supine or sitting position. ii) Draw the following imaginary lines on the thigh. • One on the mid-anterior thigh on the front of the leg. • One on the mid-lateral thigh on the site of the leg. • One, a hand's breadth below the greater trochanter of the femur. • One, a hand's breadth above the knee. iii) The site is in the middle of the rectangle formed. Rectus Femoris Site i) ii) iii) iv)

Place patient in supine or setting position. Draw an imaginary rectangle in the middle third of the front of the thigh. Grasp the rectus femoris muscle in order to avoid striking at the femur. The site is at the center of the rectangle.

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Deltoid muscle i) Place patient in supine or sitting position with elbow flexed. ii) The site for injection is two to three finger breadths down from the acromion process on the outer aspect of the arm. Figure 3:Sites for Intramuscular Injections

A - Ventrogluteal site / B - Vastus lateralis site / C - Deltoid Muscle / D - Dorsogluteal site

After Care of Patient: a. b. c. d.

Readjust patient's clothing. Reposition patient as per his condition and comfort. Observe patient and report any signs of unfavorable reaction. Check patients' parameters as indicated.

After Care of Equipment: a. Discard used needles and other sharp items into the sharp safe box. (Needle should not be recapped). b. Clean and replace other used items.

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Report On Nurses Notes: Any special observations and remarks Drug Chart: Date, Time, Dosage and Nurse's Signature E-Intradermal Administration of BCG Vaccine Definition: BCG stands for Bacillus Calmette-Guerin. This vaccine contains a live attenuated, bovine type of tubercle bacilli. BCG vaccination is the introduction of BCG vaccine intradermally. Purpose: To produce acquired stimulation of the immunological system thus producing antibodies mainly against miliary TB and TB meningitis. General Instructions The nurse should: a. Know the guidelines on immunization. b. Follow aseptic technique. c. Administer accurate dosage as prescribed. d. Know that the BCG vaccine is administered at birth and then after a negative mantoux test result only. e. Ensure that the preferable site for administrating BCG vaccine is on the left deltoid region. f. Be aware of the contraindication for administering BCG vaccine such as HIV positive, Immuno deficiencies, mantoux positive result and fever. g. Ensure that BCG is given on the other arm, if other vaccines are to be given at the same time. h. Know once the vaccine is re constituted: i. It should be stored at temperature between +2 ºC to +8 ºC away from light. ii. It should be used within 2 to 4 hours/ according to manufacturer's instructions. Equipment A tray with the following: 1. Vaccine and solvent. 2. BCG/ Tuberculin syringes. 3. 2 ml syringes 4. Needles G-20 and G-25 5. Cotton ball swab 6. Normal saline solution 7. Vaccine carrier with ice pack and thermometer Preparation of Equipment and Vaccine 1. Wash hands. 2. Check the batch number and expiry date of the vaccine.

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3. Reconstitute the vaccine. Preparation of the Client and Environment Explain to the client / relative regarding the BCG immunization. a. Reasons for vaccination. b. Expected reaction following BCG vaccination. Implementation of the Procedure 1. Clean the site (halfway down the lateral aspect of the left arm over the deltoid region) with normal saline solution and allow it to dry. 2. Withdraw the vaccine into the BCG / tuberculin syringe as per the following prescribed dosages: a. For children below 1 year - 0.05 ml b. For one year and above - 0.1 ml 3. Hold the syringe with the bevel of the needle facing upward. 4. Bring the syringe close and parallel to the left arm. Grasp the arm and slightly stretch the skin. 5. Insert the tip of the needle in to the skin until the bevel disappears then push gently the piston of the syringe to introduce the vaccine intradermally. NB: When the vaccine is injected, resistance should be felt and a white blob appears. If both do not happen stop the vaccination as there is a danger of giving subcutaneous injection. 6. Withdraw the needle gently, do not massage the site. After Care of the Client and Environment 1. Leave the area exposed for awhile to dry. 2. Keep the area clean free from any irritation. 3. Observe the site for any reaction. 4. Ensure follow up appointment is give After Care of Equipment 1. Clean and replace re-usable items. 2. Discard unused/ remaining reconstituted vaccine after 4 hours. Report On Nurse's Notes Record the following: a. Batch/ Lot. No. of the vaccine, manufacturer, expiry date b. Site c. Dose d. Date e. Name and signature of the vaccinator f. Report any immediate reaction g. Whatever health instructions given F-Tuberculin Skin Test Purpose To determine the need for BCG vaccine and to aid in diagnosing Mycobacterium Tuberculosis

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General Instructions Nurse should know: a. That the Tuberculin test is given intradermally. b. The preferred site for injection is on the anterior aspect of the left forearm and site should be free of excess hair or blemishes. c. Whether the patient has been vaccinated earlier with the Bacillus Calmette Guerin (BCG) or not, had recent viral disease, suffering from immuno suppressive disease or on immuno suppressive drugs. d. That vaccination with MMR and polio within the past 4-6 weeks may suppress the skin reaction. e. No other vaccinations should be given on the same day. f. That reading of the test is done after 48-72 hours. g. The Purified Protein Derivative (PPD) solution should be stored at a temperature between + 2ºC to + 8 ºC. Equipment PPD at prescribed strength 1. Tuberculin syringe 2. Needle, gauge No. 26 or 27 3. Cotton wool 4. Normal saline, Alcohol swab, as per policy 5. Small plastic tray with cover Preparation of the Medication 1. Wash hands. 2. Check the drug order. 3. Check the PPD ampoule against the drug chart, its expiry date, number and strength. 4. Open packs and assemble syringe, needle, observing aseptic technique and place it in the small tray. 5. Tap stem of the ampoule and break it. 6. Remove needle guard and break it. 7. Reconstitute the drug as per manufacturer's instruction. 8. Withdraw 0.1ml of tuberculin solution into the tuberculin syringe. 9. Place the syringe, ampoule and saline/ alcohol swab in the tray. Preparation of the Patient and Environment Provide privacy and adequate lighting. 1. Explain the procedure to the patient/ relative as to; 1. Purpose of the test. 2. Expected reaction of the test. Measuring the Reaction 1. Have adequate lighting. 2. Flex the arm slightly at the elbow. 3. Inspect the presence of indurations from side view against the light. 4. Lightly palpate the site with a finger across the injection site from the area of normal skin to the area of induration.

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5. Outline the diameter of indurations (not erythema) by marking the beginning and end point of the induration using a pen. 6. Measure the transverse diameter of the indurations in millimeter with a flexible ruler. Record on Nurse’s Notes 1. Name, strength and lot number of PPD. 2. Date, time and site the test is done. 3. Date and time of the reading. 4. Test result.

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SCHOOL HEALTH FORMS CONSENT FOR IMMUNIZATION Child Name: ----------------------------------------------------------------------------------------------Date of Birth: ---------------------------------------------------------------------------------------------School Name: --------------------------------------------------------------------------------------------Class/Grade: ---------------------------------------------------------------------------------------------Please Tick (√) I give the consent for the immunization of my child I don’t agree for immunization of my child. Name & Signature: -------------------------------------------------------------------------------------Parents/ Guardian P.O.Box:---------------------------------------------------------------------------------------------------Telephone Number: ------------------------------------------------------------------------------------Dear Parents Please provide the following information to update your child school health record and send his/her ORIGINAL IMMUNIZATION CARD Child History of illness: Please tick (√) appropriately, if yes, Specify Month/Year of illness Infectious Disease

YES

NO

Diphtheria Dysentery Infective Hepatitis Measles Mumps Poliomyelitis Rubella

Non-Infectious Disease

YES

NO

Accidents Allergies Bronchial Asthma Congenital Heart Disease Diabetes Mellitus Epilepsy G6PD (Glucose6-Phospate Dehydrogenase deficiency) Rheumatic Fever Surgical Operation Thalassemia

Scarlet Fever Tuberculosis Whooping Cough Chicken Pox

If yes, write the year of illness History of: Yes, Frequency: -----------------Blood Transfusion No Hospitalization No Yes, Reason: --------------------------Date: family History: Diabetes- Hypertension- Mental Disorder- Stroke- TuberculosisOther, Specify------------------------------------------------------------------------Licensed School Nurse Signature: -----------------------------------------------------

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NOTIFICATION FOR ATTENDANCE TO DHA HEALTH CENTER / CLINIC Date: --------------------------------------------Dear Parents/ Guardian Please be inform that your child -------------------------------------------------------------------Was seen in -----------------------------------------------------------School and was found to have ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------Recommendation: You are requested to bring him/her to --------------------------clinic/ Health Center where he/ she is registered for further medical checkup on -------------------------at -------------am/pm It is important you should bring the child’s health card issued by Dubai Health Authority. ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------Name & Signature: ------------------------------------------------------Licensed School Doctor/ Licensed School Nurse IMMUNIZATION RECORD

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SCHOOLS ANNUAL REPORT 1. MEDICAL EXAMINATION

Grade

Sex

School Entry Grade 5 Grade 9 School Leaving

M F M F M F M F M F M F

Others Total

Number of Finding No Abnormality Abnormality Detected Detected

Total Examination

Number of referred cases

2. NOTIFIED COMMUNICABLE DISEASES Communicable Disease Code Grade

Sex

Total

M Early Years F M KS1 F M KS2 F M KS3 F M KS4 F Total

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3. IMMUNIZATION Mantoux

Total

Other

HBV

Rubella

MMR

T.T

DEF

Booster

PRI

DEF

OPV

Booster

PRI

Td

DEF

Total Given

DEF

NEG

BGC

AD

REF

POS

Total Given

Sex

Grade

Highly POS

M F M F M F M F M F M

Total

F Grand Total

Note: POS: Positive\ REF: Referred \AD: Abnormality Detected\ NEG: Negative\ DEF: Defaulters\ PRI: Primary Dose \Td: Tetanus Diphtheria\ T.T: Tetanus Toxoid

4. FIRST AID ADMINISTRATION

Grade

Sex

Code & Number of First Aid Administered

Total

Referred Number

M F M F M F

5. NUMBER OF REFERRALS Grade

OTHERS

Sex M F M F M F M F

School Health Unit

Health Centers Clinic

Accident Emergency

74

Private Clinic

Others

Total

6. HEALTH EDUCATION

Topic

Attendance Number

Number of Sessions

Group Teaching/ Discussion/ Lecture

Demonstration & Return Demonstration

Incidental Teaching

Meeting with Parents Meeting with School Staff Other Specify Total

7. SUPERVISION OF GENERAL HYGIENE OF SCHOOL Areas of Supervision School Compound

Number of Visits

Observation

Class Rooms Drinking Water Toilet Facilities Waste Disposals Canteen/Pantry Swimming Pool

8. GENERAL REMARKS & RECOMMENDATIONS

Name & Signature of Licensed School Nurse: Name & Signature of Licensed Medical Officer:

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Action Taken

REPORT ON ADVERSE REACTION FOLLOWING IMMUNIZATION Patients Personal Details: ID Number: -----------------------------------------------------------------------------------------------Patient name: -----------------------------------------------------Date of Birth: ---------------------Address: ---------------------------------------------------------------------------------------------------Sex: ---------------------------------------Telephone Number: --------------------------------------Vaccine Information: Name of Vaccine: -----------------------------------Batch Number: -------------------------------Manufacturer: -----------------------------------------Expiry Date: ----------------------------------Route: ------------------------Site: -------------------------------------- Dose: -----------------------Date of Immunization: -----------------------------------------------------------------------------Number of Prior dose (if any): --------Administered by: ------------------------------------Designation: ----------------------------------Clinic/Center/School: -----------------------------------------------------------------------------------Nature of Reaction: (Sign & Symptoms on back page) ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------Action Taken: 1. Medical Management: ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------2. Referral (if any): ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------Date: --------------------------------Name & Signature: ----------------------------------------------

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Signs & Symptoms of the Immunization Reaction 1. Fever: Temperature > (37.8 C) a. Felt Hot, but temperature not measured b. Highest measured temperature. 2. Local Reaction: Site a. Pain, Swelling, Increased warmth. b. Induration or lump without abscess. c. Abscess formation- required drainage or drained spontaneously. 3. Rash: other than at injection site 4. Adenopathy: a. Local (injection site area) b. Generalized 5. allergic event a. hives b. angioneurotic edema c. wheezing/ asthma d. anaphylaxis: if “yes” interval from vaccination to onset: • 30 min • 30 min- 6 hrs • > 6 hrs Was blood pressure measured? If “yes Lowest B.P” 6. Arthralgia/ Arthritis (Pain in joints/ inflammation of joints) 7. Convulsion: If “yes” how many episodes following Immunization? 8. Encephalitis &/ encephalopathy a. Signs of increased intra cranial pressure b. Focal Neurologic Signs c. Coma or Marked Alteration in level of Consciousness 9. Guillain – Bare Syndrome 10. Reye’s Syndrome 11. polio 12. Paralysis other than GBS/ Reye’s Syndrome & Diagnosis (Specify) 13. Miscellaneous: a. Hypotonic, Hypo responsive Episode b. Idiopathic Thrombocytopenic Purpura- if “yes” Lowest Platelet count c. Pancreatitis d. Parotitis.

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SCHOOL DETAILS School Name: ---------------------------------------------School Year: -----------------------------Address & P.O.Box: ------------------------------------------------------------------------------------Location: --------------------------------------------------------------------------------------------------Telephone No: -------------------------------------------------------------------------------------------E mail: ----------------------------------------------------- Fax No: ------------------------------------Principle Name: -----------------------------------------------------------------------------------------Stages: KG Primary Elem Secondary Total Number of Students: -------------- Boys: -------------- Girls: ------------------------------Medium of Instruction: ---------------------------------------------------------------------------------School Hours: From: -------------------------- To: ---------------------------------------------------Weekly off days: -----------------------------------------------------------------------------------------Summer Vacation: Form: ---------------------------------- To: ------------------------------------Winter Vacation: Form: ---------------------------------- To: ------------------------------------Other Vacation: Form: -----------------------------------To: ------------------------------------School Medical Officer: No 1

No 2

No 1

No 2

Name Licensed No. & Validity P.O.Box Emirate Tel. No. Clinic Residence Work Timing Licensed School Nurse No 3

Name Licensed No. & Validity Telephone No Work Timing Submitted By: --------------------------------------------------------------------------------------------Name: ------------------------------------------------ Signature: --------------------------------------Designation: ---------------------------------------- Date: ----------------------------------------------

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MONTHLY REPORT ON FIRST AID ADMINISTRATION Month of: --------------------------S.N Student Name

Sex

Age

School Year: ---------------------Class Date

First Aid Case

Action Taken

Name & Signature of Licensed School Nurse: --------------------------------------------------Name & Signature of Licensed Medical officer: --------------------------------------------------

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MONTHLY REPORT ON REFERRED STUDENTS Month of: -----------------------------------S.N

Name of Students

Sex

Age

class

School Year: ---------------------------

Date of Referral

Reason for referral

Referred to

Remarks

Name & Signature of Licensed School Nurse: --------------------------------------------------Name & Signature of Licensed Medical officer: --------------------------------------------------

80

‫إﻋﻼن ﻋﻦ اﻟﺘﻄﻌﻴﻢ‬ ‫اﻟﺴﺎدة\ أوﻟﻴﺎء اﻷﻣﻮر‪:‬‬ ‫ﺗﻢ اﻟﻴﻮم ﺗﻄﻌﻴﻢ ﻃﻔﻠﻜﻢ\ ﻃﻔﻠﺘﻜﻢ‪ ------------------------------------‬ﺑﺎﻟﻄﻌﻢ \ اﻟﺘﻄﻌﻴﻤﺎت اﻟﻤﺸﺎر إﻟﻴﻬﺎ‪:‬‬ ‫… ﺷﻠﻞ اﻷﻃﻔﺎل‬ ‫… اﻟﻤﺼﻞ اﻟﺜﻨﺎﺋﻲ‬ ‫… ﻧﻜﺎف‪ -‬ﺣﺼﺒﺔ‪ -‬ﺣﺼﺒﺔ اﻟﻤﺎﻧﻲ‬ ‫… ﻣﻀﺎد اﻟﺘﺪرن‬ ‫… اﻟﻤﺼﻞ اﻟﺜﻼﺛﻲ‬ ‫… اﻟﻜﺰاز و اﻟﺴﻌﺎل اﻟﺪﻳﻜﻲ‬ ‫… اﻟﺘﻬﺎب اﻟﻜﺒﺪ اﻟﻮﺑﺎﺋﻲ)ﺟﺮﻋﺔ أوﻟﻰ(‬ ‫… اﻟﺘﻬﺎب اﻟﻜﺒﺪ اﻟﻮﺑﺎﺋﻲ)ﺟﺮﻋﺔ ﺛﺎﻧﻴﻪ(‬ ‫… اﻟﺘﻬﺎب اﻟﻜﺒﺪ اﻟﻮﺑﺎﺋﻲ )ﺟﺮﻋﺔ ﺛﺎﻟﺜﻪ(‬ ‫ﻓﻲ ﺣﺎل ارﺗﻔﺎع ﺣﺮارة ﻃﻔﻠﻜﻢ\ ﻃﻔﻠﺘﻜﻢ ﺑﺈﻣﻜﺎﻧﻜﻢ إﻋﻄﺎء ﺟﺮﻋﺔ ﻣﻦ اﻟﺒﺎراﺳﻴﺘﺎﻣﻮل )ﻣﺜﻞ ﺑﺎﻧﺎدول او آﺎﻟﺒﻮل او ادول(‬ ‫ﻟﺘﺨﻔﻴﺾ اﻟﺤﺮارة وذﻟﻚ ﻋﻠﻰ اﻟﻨﺤﻮ اﻟﺘﺎﻟﻲ‪:‬‬ ‫‪ 6‬ﺳﻨﻮات إﻟﻰ ‪ 12‬ﺳﻨﻪ )‪ 10‬ﻣﻠﻞ( )ﻣﻠﻌﻘﺘﻴﻦ ﺻﻐﻴﺮﺗﻴﻦ( أو ﻧﺼﻒ ﺣﺒﻪ‬ ‫ﻓﻮق ‪ 12‬ﺳﻨﻪ )ﺣﺒﻪ واﺣﺪﻩ ﻓﻘﻂ(‬ ‫ﺑﺈﻣﻜﺎﻧﻜﻢ إﻋﻄﺎء هﺬﻩ اﻟﺠﺮﻋﺔ أرﺑﻊ ﻣﺮات ﻓﻲ اﻟﻴﻮم آﺤﺪ أﻗﺼﻰ ﻋﻨﺪ اﻟﻠﺰوم‪ ,‬ﻓﻲ ﺣﺎﻟﺔ اﺳﺘﻤﺮار ارﺗﻔﺎع درﺟﺔ اﻟﺤﺮارة ﻳﺠﺐ‬ ‫ﻣﺮاﺟﻌﺔ اﻟﻤﺮآﺰ أو اﻟﻌﻴﺎدة اﻟﺘﺎﺑﻌﻴﻦ ﻟﻬﺎ‪.‬‬ ‫‪NOTIFICATION FOR IMMUNIZATION‬‬ ‫‪Dear Parents,‬‬ ‫‪This is to inform you that your child: ---------------------------------------------------------------‬‬‫‪----‬‬‫‪Received today the vaccine/s which is/ are ticked below:‬‬ ‫‪… Oral polio‬‬ ‫‪… DT‬‬ ‫‪… MMR‬‬ ‫‪… BCG‬‬ ‫‪… DPT‬‬ ‫‪… Td‬‬ ‫)‪… Hepatitis- B(1st dose‬‬ ‫)‪… Hepatitis- B(2nd dose‬‬ ‫)‪… Hepatitis- B(3rd dose‬‬ ‫‪If the child develops fever you may give him/her paracetamol (e.g. PANADOL,‬‬ ‫‪Calpol, Adol) as follows:‬‬ ‫‪Children 6-12 years (10 ml) ( 2 tea spoons) of syrup or ½ tablets‬‬ ‫)‪Children above 12 years (one tablet‬‬ ‫‪This may be given maximum up to 4 times a day if necessary, but if fever persists‬‬ ‫‪bring child to the nearest Health Center/ clinic.‬‬ ‫‪Name & Signature of Licensed School Nurse: --------------------------------------------------‬‬‫‪Name & Signature of Licensed Medical officer: --------------------------------------------------‬‬

‫‪81‬‬

‫إﺧﻄﺎر أوﻟﻴﺎء اﻷﻣﻮر ﺑﺎﻟﺘﻄﻌﻴﻢ)اﻟﺘﺤﺼﻴﻦ(‬ ‫ﻣﻦ )اﺳﻢ اﻟﻤﺪرﺳﺔ(‪-----------------------------------------------------------------------------------------:‬‬ ‫اﻟﻌﻨﻮان‪--------------------------------------------------------------------------------------------------- :‬‬ ‫اﻟﺴﻴﺪ وﻟﻲ اﻷﻣﺮ‪,‬‬ ‫ﻧﻮد إﺧﻄﺎرآﻢ ﺑﺎن اﺑﻨﺘﻜﻢ \ اﺑﻨﺘﻜﻢ‪------------------------------------------------ :‬ﻓﻲ اﻟﺼﻒ‪ --------------------:‬ﻗﺪ‬ ‫ﺣﺎن ﻣﻮﻋﺪ إﻋﻄﺎﺋﻪ\ إﻋﻄﺎﺋﻬﺎ ﺟﺮﻋﺔ ﻣﻦ ﻣﺼﻞ‪---------------------------------------------------------- :‬‬ ‫اﻟﺮﺟﺎء اﻹﺟﺎﺑﺔ ﻋﻠﻰ اﻷﺳﺌﻠﺔ أدﻧﺎﻩ ﻣﻊ إرﺟﺎع هﺬا اﻟﻄﻠﺐ ﻓﻲ ﻏﻀﻮن ﻳﻮﻣﻴﻦ ﺑﻌﺪ اﺳﺘﻼﻣﻪ و آﺘﺎﺑﺔ ﻣﺎ ﻓﻴﻪ ﻣﻦ ﺑﻴﺎﻧﺎت‪ .‬و ﻓﻲ‬ ‫ﺣﺎل ﻋﺪم اﺳﺘﻼﻣﻨﺎ ﻟﻬﺬا اﻟﻄﻠﺐ ﻣﻨﻜﻢ ﻓﻲ وﻗﺘﻪ ﻓﺎن اﺑﻨﻜﻢ\ اﺑﻨﺘﻜﻢ ﻟﻦ ﻳﺘﻢ إﻋﻄﺎؤﻩ\إﻋﻄﺎؤهﺎ اﻟﻄﻌﻢ اﻟﻤﺬآﻮر‪.‬‬ ‫‪-------------------------‬‬‫ﻣﺪﻳﺮ اﻟﻤﺪرﺳﺔ‬

‫‪----------------------‬‬‫ﻣﻤﺮﺿﺔ اﻟﻤﺪرﺳﺔ‬

‫‪ .1‬ﻣﺘﻰ أﻋﻄﻲ اﺑﻨﻜﻢ\ اﺑﻨﺘﻜﻢ ﺁﺧﺮ ﺟﺮﻋﺔ ﻣﻦ اﻟﺘﺤﺼﻴﻨﺎت؟‬ ‫ﺷﻬﺮ‪ --------------------------- :‬ﺳﻨﺔ‪------------------------------ :‬‬ ‫________________________________________________________________‬ ‫‪ .2‬هﻞ ﻋﺎﻧﻰ اﺑﻨﻜﻢ\ اﺑﻨﺘﻜﻢ ﻣﻦ أي ﻣﺮض ﻣﻌﺪي ﻣﻨﺬ أﺧﺬﻩ ﻵﺧﺮ ﺗﺤﺼﻴﻦ؟‬ ‫ﻻ‪O‬‬ ‫ﻧﻌﻢ ‪O‬‬ ‫إذا آﺎﻧﺖ اﻹﺟﺎﺑﺔ" ﻧﻌﻢ" اﻟﺮﺟﺎء ﺗﺤﺪﻳﺪ اﻟﻤﺮض ‪------------------------------------ :‬‬ ‫________________________________________________________________‬ ‫‪ .3‬هﻞ ﻳﻌﺎﻧﻲ اﺑﻨﻜﻢ\ اﺑﻨﺘﻜﻢ ﻣﻦ ﺣﺴﺎﺳﻴﺔ ﻣﻦ اﻟﺒﻴﺾ؟‬ ‫ﻻ‪O‬‬ ‫ﻧﻌﻢ ‪O‬‬ ‫إذا آﺎﻧﺖ اﻹﺟﺎﺑﺔ" ﻧﻌﻢ" ﻓﻤﺎ هﻲ ﻋﻼﻣﺎت اﻟﺤﺴﺎﺳﻴﺔ اﻟﻤﻼﺣﻈﺔ‪----------------------------- :‬‬ ‫________________________________________________________________‬ ‫‪ .4‬هﻞ ﻳﻌﺎﻧﻰ اﺑﻨﻜﻢ\ اﺑﻨﺘﻜﻢ ﻣﻦ أي ﻣﺮض؟‬ ‫ﻻ‪O‬‬ ‫ﻧﻌﻢ ‪O‬‬ ‫إذا آﺎﻧﺖ اﻹﺟﺎﺑﺔ" ﻧﻌﻢ" ﻓﻤﺎ هﻮ اﻟﻤﺮض اﻟﺬي ﻳﻌﺎﻧﻲ ﻣﻨﻪ؟ ‪-------------------------------‬‬ ‫________________________________________________________________‬ ‫‪ .5‬هﻞ ﻳﺄﺧﺬ اﺑﻨﻜﻢ\ اﺑﻨﺘﻜﻢ أي دواء ﺑﺎﻧﺘﻈﺎم أو ﻋﻼج ﻣﺜﻞ‪:‬‬ ‫ﻻ‪O‬‬ ‫اﻟﻜﻮرﺗﻴﺰون‪ :‬ﻧﻌﻢ ‪O‬‬ ‫إذا آﺎﻧﺖ اﻹﺟﺎﺑﺔ" ﻧﻌﻢ" ﻓﻤﺘﻰ آﺎﻧﺖ أﺧﺮ ﺟﺮﻋﻪ ﻣﻦ اﻟﻜﻮرﺗﻴﺰون‪------------------------ :‬‬ ‫ﻻ‪O‬‬ ‫ﻧﻘﻞ دم‪ :‬ﻧﻌﻢ ‪O‬‬ ‫إذا آﺎﻧﺖ اﻹﺟﺎﺑﺔ" ﻧﻌﻢ" ﻓﻤﺘﻰ آﺎن أﺧﺮ ﺗﺎرﻳﺦ ﺁﺧﺮ دم أﻋﻄﻲ ﻟﻪ‪------------------- :‬‬ ‫________________________________________________________________‬ ‫‪ .6‬هﻞ ﻟﺪﻳﻜﻢ اﻋﺘﺮاض أن ﻳﺄﺧﺬ ﻃﻔﻠﻜﻢ \ ﻃﻔﻠﺘﻜﻢ اﻟﺘﺤﺼﻴﻦ ﻓﻲ اﻟﻤﺪرﺳﺔ؟‬ ‫ﻻ‪O‬‬ ‫ﻧﻌﻢ ‪O‬‬ ‫إذا آﺎن ﻧﻌﻢ ﻓﻤﺎ هﻲ اﻷﺳﺒﺎب‪------------------------------------------------------------ :‬‬ ‫________________________________________________________________‬ ‫اﺷﻬﺪ ﺑﺎن اﻟﺒﻴﺎﻧﺎت أﻋﻼﻩ ﺻﺤﻴﺤﺔ‪.‬‬ ‫اﺳﻢ وﻟﻲ اﻷﻣﺮ‪ ------------------------------------------------- :‬اﻟﺘﻮﻗﻴﻊ‪---------------------------------- :‬‬ ‫هﺎﺗﻒ اﻟﻤﻨﺰل‪ ---------------------------- :‬اﻟﻤﻜﺘﺐ‪ ----------------------- :‬اﻟﻨﻘﺎل‪-------------------------- :‬‬ ‫ﺗﺎرﻳﺦ اﻟﺘﻮﻗﻴﻊ‪---------------------------- :‬‬

‫‪82‬‬

IMMUNIZATION INFORMATION TO PARENTS From :( Name of School) ------------------------------------------------------------------------------(Address)--------------------------------------------------------------------------------------------------Dear parent, This is to inform you that your child: ---------------------------------------------------------------Grade ----------------------is due for dose of --------------------------------------------------------Please answer the questions and return this form within 2 days after you receive this letter. If we will not receive this form on time, your child will not be given the vaccine as mentioned above. Thank you. --------------------------------------------------------------------------School Nurse School Principal ___________________________________________________________________ 1. When did your child receive the last vaccination? Month: --------------------Year: ------------------------_____________________________________________________________________________________________________

2. Has your child suffered from any infectious disease since the last vaccination? {Yes {No If yes, specify what disease: ----------------------------------------------_____________________________________________________________________________________________________

3. Is your child allergic to egg? {Yes {No If yes, what sign of allergy you observed? ----------------------------------------------_____________________________________________________________________________________________________

4. Is your child suffering from any illness? {Yes {No If yes, what illness? ----------------------------------------------------------_____________________________________________________________________________________________________

5. Is your child on regular medication / treatment like: a. Steroid: {Yes {No If yes, when was the last dose taken: ------------------------------------------------------b. Blood Transfusion

{Yes

{No

If yes, when was the last blood transfusion received: ---------------------------------_____________________________________________________________________________________________________

6. Do you have any objection of your child receiving due dose of vaccine in school? {Yes {No If yes, reason: -------------------------------------------------------_____________________________________________________________________________________________________

I certify that the information given above is correct to the best of my knowledge. Name of the parent: --------------------------Signature: ------------------------------Telephone No: Residence: ---------------------------- Office: ------------------------Mobile: -----------------Date Signed: ------------------------

83

‫اﻟﺘﺒﻠﻴﻎ ﻋﻦ اﻹﺻﺎﺑﺔ ﺑﺎﻟﻘﻤﻞ‬ ‫أﻋﺰاﺋﻲ أوﻟﻴﺎء اﻷﻣﻮر‬ .‫ﺣﺸﺮﻩ ﻗﻤﻞ اﻟﺮأس‬----------------------------‫ﻳﺆﺳﻔﻨﺎ أن ﻧﺨﺒﺮآﻢ ﺑﺄﻧﻪ وﺟﺪ ﻓﻲ ﺷﻌﺮ رأس اﺑﻨﻜﻢ \اﺑﻨﺘﻜﻢ‬ ‫ ﻓﺎﻟﺮﺟﺎء ﻣﻌﺎﻟﺠﺔ اﺑﻨﻜﻢ\اﺑﻨﺘﻜﻢ ﺑﺄﺳﺮع‬,‫ﻗﺪ ﺗﻨﺘﺸﺮ اﻟﻌﺪوى ﺑﺤﺸﺮﻩ ﻗﻤﻞ اﻟﺮأس ﺑﻴﻦ اﻟﻄﻼب ﻓﻲ اﻟﻤﺪرﺳﺔ أو ﺑﻴﻦ أﻓﺮاد اﻷﺳﺮة‬ .‫وﻗﺖ ﻣﻤﻜﻦ وذﻟﻚ ﻣﻦ ﺧﻼل ﻏﺴﻞ اﻟﺸﻌﺮ ﺑﺸﺎﻣﺒﻮ أو آﺮﻳﻤﺎت ﻟﻤﻌﺎﻟﺠﺔ ﻗﻤﻞ اﻟﺮأس‬ .‫ﻳﺮﺟﻰ ﻣﺮاﺟﻌﺔ اﻟﻄﺒﻴﺐ ﻟﻠﻌﻼج اﻟﻔﻮري و ﻷﺧﺬ اﻟﻨﺼﺎﺋﺢ‬ ------------------------------:‫اﻻﺳﻢ واﻟﺘﻮﻗﻴﻊ‬ ‫ﻣﻤﺮﺿﺔ اﻟﻤﺪرﺳﺔ‬/‫ﻃﺒﻴﺐ اﻟﻤﺪر ﺳﻪ‬

NOTIFICATION FOR HEAD LICE Dear Parent / Guardian: Your child------------------------------------------------has been found to have “head lice” Infestation. Head lice Infestation can spread to other children in school or other members of your family. It is essential that your child and other family members with head lice receive treatment with Anti Lice shampoo / lotion / cream. Please visit your doctor for treatment and additional advice. ----------------------------------------------Name & Signature Licensed School Medical Officer / Licensed School Nurse

84

IMMUNIZATION PLAN Name of School: ------------------------------------------------------------------------------------Month of ----------------------------------------

S.N.

Name of the Child

Age

Class

Year: ------------------------------------------

Immunization Due OPV

DPT

Td

D.T.

MMR

HBV

PPD

Grand Total Prepared By: -----------------------------------------Licensed school nurse Signature-----------------------------Date: ------------------------------------

Received By: ----------------------------------------------DHA staff nurse Signature---------------------------------Date: ---------------------------------------

85

BCG

STANDING ORDER OF DRUGS THAT CAN BE ADMINISTERED TO SCHOOL CHILDREN

Name of School: -----------------------------------------------Academic Year: -----------------------------------This is to authorize you to administer drugs to school children, when indicated as follows: Name of Drug

Age

Dose

Indication

Remarks

----------------------------------------------------

-----------------------------------------------

Name of School Medical Officer in print

Licensed No. and Validity

----------------------------------------------------

-----------------------------------------------

School Medical Officer Signature

Date Signed

86

VIOLATION LETTER

Date: ----------------------------------------Ref: ----------------------------------------------------Principal------------------------------------Dubai---------------------------------------------------Fax: --------------------------------------Dear Sir/ Madam: Based on inspection report submitted by our inspection team on------------------, we would like to inform you that the following violations were discovered on the establishment: • Illegal appointment of Mr. / Ms. ------------------------------------------------as School Nurse without obtaining DHA License. • Licensed nurse was not available in the school and not replaced by nurse with DHA license. •No available doctor in the school. Consequently, and based on Administration Decision No. (39) The following actions were imposed on --------------------------------------------------------------School: •Five Thousand Dirham (5,000 Dhs) as fine on establishment •All transactions of ----------------------------------- are stopped till we receive written satisfactory report about corrective action taken. • Nurses without DHA License are stopped from working. This for your kind information and necessary action Thanks. Acting Director, Specification and Licensing Department

87

STUDENTS HEALTH EXAMINATION REPORT School Name: ---------------------------Month: ---------------------------A. Total Students Examined: (total number:--------------------) Number of Nationals:-------------

Year: ------------------------

Number of Non Nationals:----------

Total NAD:-----------

Total AFD:--------------

Total NAD:-----------

Total AFD:---------

M

M

M

M

F

F

F

F

Keys: M: male/ F: Female/ NAD: No Abnormality Detected /AFD: Abnormality Finding Detected

B. Deviation from Normal (abnormal finding) Abnormal Finding

Nationals M F

No

1.

General: • Pallor ( anemia) • Lymph nodes • others 2. Built: • Weight < 10 percentile • Weight < 90 percentile • Height > 10 percentile • Height > 90 percentile 3. Skin: • Pit. Alba • Dermatitis/ Eczema • Others (specify) 4. Eyes: • Defective vision. • Others (specify) 5. ENT: • Defective Hearing • Waxed ears • Enlarged Tonsils/ Adenoid • Others (Specify) 6. Respiratory System : • Chronic Bronchitis • Bronchial Asthma • Others (Specify) 7. Cardiovascular System: • Cardiac Murmur • Others (Specify) 8. Abdomen/ Pelvis • Hepato- Splenomegaly • Hernias • Others (specify) 9. Genito-Urinary System • Testes • Others (Specify) 10. Central Nervous System: • Epilepsy • Others (Specify) 11. Endocrine System: • Diabetes Mellitus • Thyroid • Others (specify) 12. Musculoskeletal System : • Scoliosis • Knock Knees • Bow Legs • Others (Specify ) Other abnormal Finding: (not included above) School Medical Officer Name & signature:

88

Non National M F

No

Total

‫إﻋﻼم ﻋـــــﻦ إﺟﺮاء اﺧﺘﺒﺎر اﻟﺘﺪرن‬

،‫اﻟﺴﺎدة أوﻟﻴﺎء اﻷﻣﻮر‬ ---------------------------- ‫ ﻃﻔﻠﺘﻜﻢ‬/‫ إﺟﺮاء اﺧﺘﺒﺎر اﻟﺘﺪرن ﻟﻄﻔﻠﻜﻢ‬------------------------------ ‫ﺗﻢ ﺑﺘﺎرﻳﺦ اﻟﻴﻮم‬ .‫وﺳﻴﺘﻢ اﻟﻜﺸﻒ ﻋﻦ ﻧﺘﻴﺠﺔ اﻻﺧﺘﺒﺎر ﺑﻌﺪ ﺛﻼﺛﺔ أﻳﺎم ﻓﻲ اﻟﻤﺪرﺳﺔ‬ ‫ﻓﺈذا آﺎﻧﺖ اﻟﻤﺪرﺳﺔ ﻣﻐﻠﻘﺔ أو ﺗﻐﻴﺐ ﻃﻔﻠﻚ أو ﻃﻔﻠﺘﻜﻢ ﻓﻲ اﻟﻴﻮم اﻟﻤﻌﺘﻤﺪ ﻟﻠﻜﺸﻒ ﻋﻠﻰ ﻧﺘﻴﺠﺔ اﺧﺘﺒﺎر اﻟﺘﺪرن ﻳﺮﺟﻰ إﺣﻀﺎر‬ .‫ﻃﻔﻠﻜﻢ أو ﻃﻔﻠﺘﻜﻢ إﻟﻰ اﻟﻤﺮآﺰ اﻟﺼﺤﻲ أو اﻟﻌﻴﺎدة اﻟﺘﺎﺑﻌﻴﻦ ﻟﻬﺎ‬ :‫ﺗﻌﻠﻴـﻤﺎت‬ ‫ﻃﻔﻠﺘﻜﻢ اﻻﺳﺘﺤﻤﺎم ﺧﻼل هﺬﻩ اﻟﻔﺘﺮة اﻟﺰﻣﻨﻴﺔ إﻧﻤﺎ ﻳﻔﻀﻞ ﻋﺪم اﺳﺘﺨﺪام اﻟﺼﺎﺑﻮن ﻋﻠﻰ ﻣﻨﻄﻘﺔ اﻻﺧﺘﺒﺎر ﻓﻲ‬/‫ ﺑﺈﻣﻜﺎن ﻃﻔﻠﻜﻢ‬.1 .‫اﻟﻴﺪ اﻟﺘﻲ اﺟﺮي ﻋﻠﻴﻬﺎ اﻻﺧﺘﺒﺎر هﻲ ﻋﺎدة ﻓﻲ أﺳﻔﻞ آﻮع اﻟﻴﺪ اﻟﻴﺴﺮى ﻣﻦ اﻷﻣﺎم‬ .‫ ﻳﺠﺐ ﻋﺪم وﺿﻊ اﻟﺰﻳﻮت أو اﻟﺒﻮدرة أو اﻟﻤﻌﻘﻤﺎت أو اﻟﻜﺮﻳﻤﺎت ﻋﻠﻰ ﻣﻨﻄﻘﺔ اﻻﺧﺘﺒﺎر‬.2 .‫ ﻳﺠﺐ ﻋﺪم ﺗﻐﻄﻴﺔ أو ﺣﻚ ﻣﻨﻄﻘﺔ اﻻﺧﺘﺒﺎر‬.3 ..‫وﺷﻜﺮًا ﻟﺘﻌﺎوﻧﻜﻢ‬ --------------------------------------‫اﺳﻢ و ﺗﻮﻗﻴﻊ اﻟﻤﻤﺮﺿﺔ‬ -----------------------------:‫اﻟﺘﺎرﻳﺦ‬

NOTIFICATION FOR MANTOUX TEST

Dear Parent, Your child: ----------------------------------------------has been given a Monteux Test on --------------------------------------and the reading should be done after three days on --------------------------------------in the school. In case the school is closed or the child is absent on the day of reading the Monteux test please bring the child to the nearest health center clinic. Instruction: Child may take bath during this three days but don't apply soap on the test area (the tested area will be usually on the inner side of the left lower arm). Don't apply oil, lotion, powder, alcohol, cream, or anything to the tested area. Don't scratch or cover with plaster or band aid strip the tested area. Thank you Name & signature of license school nurse: --------------------------------------------------Date: ----------------------------

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REFERENCES

1. American school health association & School Health > What is School Health ? http://www.ashaweb.org/i4a/pages/index.cfm?pageid=3278, 2. School Health Guidelines & Strategies. CDC, http://www.cdc.gov/HealthyYouth/publications/guidelines.htm 3. Nursing Policies and Procedures, North Carolina School Nurse Manual, http://www.nrms.k12.nc.us/departments/student_health/nurse_policy_procedure. asp 4. Jane Thompson, RN, C, school nurse supervisor (UCPS) Union county public schools. School Health Protocols, http://tss.ucps.k12.nc.us/health/protocols.php 5. Injection site: 2005, Lippincott Williams & Wilkins Instructor’s Resource CD-ROM to Accompany Fundamentals of Nursing: the Art and Science of Nursing Care, Fifth

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