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Old 12-08-2011, 02:33 PM   #1
J'aime Paris
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I'm a Spec. Ed. Aide and need Dis help!

I work at an elem. school in early childhood this year. We have a little guy who has a nurse accompany him to school since he is vent/trach dependant. I dont know much about medical care, but I wonder if the school is failing him and the other kiddos. (THe nurse is hired by mom, not school worker)

What sorts of "protection" should be in place in the classroom? We do not have hazardous waste bags for his diapers. They go in his own garbage, but this garbage is open and on ground level. Other kiddos could gain access.

His secretions are wiped using a cotton hand towel, not disposible. He had blood on a towel the other day, and we had to ask his nurse to change to a new one. His towel is often quite wet, and they use it to wipe his eyes and mouth!

What should the school be enforcing as far as protocol? I want the best protection for this little guy, our students and staff as well. Is there a website I could check? any ino would be greatly appreciated!!!
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Old 12-08-2011, 04:37 PM   #2
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first, thank you for your concern.

The diapers should go in a trash can with a lid and be out of reach of the others. The washrag wiping is pretty common but blood should definately need a new washrag. if you are concerned about her care, contact her case manager at the business she is hired from.
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Old 12-09-2011, 04:38 PM   #3
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Have you shared your concerns with the classroom teacher or the school administration yet?
The child. Should have a medical plan in place (I can't remember the proper name for it) in addition to, or as a part of his IEP.

In EC classrooms it is common for diapers to go in a communal trash can in the restroom or where ever diapers are changed. Most of the schools that I have worked at do double bag the diapers to help control smell, but hazardous waste bags are not used. The school should have a diaper changing procedure such as wearing gloves and disinfecting the changing table. This should cover disposal as well, if you feel that proper procedures are not being used.
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Old 12-09-2011, 05:22 PM   #4
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I work as a special ed aide in a preschool room. We don't have kids with medical problems, but we do have diapers.

Our room is required to have a covered trash can that is used only for diaper disposal. We only put wet diapers in this can, after they are placed in a plastic bag and tied shut. For dirty diapers, we bag them, tie them and take them to an outside garbage can. Otherwise, the smell would kill us all!

The school district provides us with gloves and disposable changing pads to place under the child on the changing table. These are bagged, tied and tossed in the covered garbage can. We wipe down the table with Clorox wipes after changing dirty diapers and before laying out new pads (we usually do wet diapers with the child standing up rather than putting them on the table).

The district also provides our classroom with a hot water heater for hand washing since we change diapers. We were moved to a new campus this year, and they installed a small water heater for us. All preschool classrooms in our district have these, while the elementary classrooms do not.

In terms of the medical waste, it depends on the regulations of your state and/or district. In our district, we are very careful about such things. Anytime a child bleeds on campus, the custodian follows a procedure to clean it up with bleach. We have been told to immediately reach for gloves anytime we deal with blood (cuts, bloody noses, etc.). We are to bag and tie any paper towels or tissues with blood on them right away. If any blood gets on the floor or classroom furniture, we are to isolate our kids from the area and call the custodian. We take it pretty seriously!

Does your school or district have a nurse on staff? If so, I would start with him/her. I would think the nurse has already been involved in any medical cases, but it wouldn't hurt for your teacher to check. The nurse who comes with the child may not be trained in proper techniques to be used in a classroom setting, which might be different from a home or hospital setting.
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Old 12-09-2011, 09:27 PM   #5
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I worked at one time as a School Nurse, as well as a consultant to Day Care Centers, so I second the recommendation to contact the School Nurse with your concerns.
The things that Luv Bunnies mentioned are pretty basic recommendations, that should be in place pretty much anywhere that takes care of children who are diapered. Hot running water is best, but not alwAys available - there re ways to make safe alternatives if you don't have that.
There are other alternatives to bleach for blood and body fluids - bleach is inconvenient because it needs to be mixed up fresh, plus it smells. There are disinfectant wipes available with ability to kill Hepatitis B ( that's the clim that's most important).

This is a good reference from Hennepin County in Minnesota (especially Section 2 and Section 3)

Here's another good one:
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Old 12-10-2011, 12:16 PM   #6
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Thank you for all the suggestions. The childs case manager is unfortunately the worst of his nurses. He has three that rotate at school.

We change diapers on multiple children, but this little guy has his own area. He's had MRSA, infections in his trach, bacterial pneumonia, and who knows about the possibility of hepatitis. He's such a sweetie, but a medically fragile child.

I will try to contact the district nurse. Maybe she'll be helpful. The classroom teacher is awesome, but has no medical knowledge. She's a bit relaxed about the whole germ thing, IMHO.
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Old 12-11-2011, 11:12 PM   #7
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I am mom to two medically fragile kids with trachs, vents and feeding tubes. Good hand washing is the biggest step. All of the other precautions are helpful but can be overdone. Odds are the MRSA is hospital acquired which is different from the skin eating virus we all fear. I think the blood would depend on the amount I saw. My daughter has often punched herself causing a few drops on her spit rag. I doubt that her nurse even thinks about it.

I am sorry that this sounds disjointed but in all honesty, the other kids are probably more dangerous to the medically fragile child than vice- versa. Karen
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Old 12-11-2011, 11:24 PM   #8
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Iam just wondering why the nurses are not hired by the school? If a nurse is required for him to be educated on his IEP, then the nurses should be hired by the school.
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Old 12-11-2011, 11:53 PM   #9
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Originally Posted by blondietink View Post
Iam just wondering why the nurses are not hired by the school? If a nurse is required for him to be educated on his IEP, then the nurses should be hired by the school.

This was my concern as well, his parents could request to have nurse requirement on his IEP if not already there and the school or district should provide the nurse. I know that there are different laws about this depending on the state but its on the IEP its the school/district responsibility.
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Old 12-13-2011, 12:00 PM   #10
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I would also think that if a nurse is hired by the school, then liability would be on the school. If a nurse is hired by the family, then liability would be on the family or agency that the nurse is employed by. Personally I would want the school to carry the risk. Not just risk to the child with a disability, but to the other students and school personnel also. Just MHO.
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Old 01-06-2012, 11:33 PM   #11
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I believe if the nurse was not hired by the parents, the school would probably insist that his FAPE in a LRE would in fact be at home because of his medical concerns.
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