Standards of Practice for Exclusion from School - Signs & Symptoms

The primary role and consideration for the School Nurse in excluding a child from attendance is the probability of spreading disease among the school students and personnel.

Students with the following signs and symptoms are to be excluded from school attendance until they are symptom-free for 24 hours or they are seen by a physician with written information that the condition is, is currently under treatment, or is no longer contagious and able to return to school.

1. fever with oral equivalent of 100.0
2. persistent vomiting (at least two episodes)
3. diarrhea – 2 or more watery or loose stools, with or without fever
4. skin rashes that are associated with fever or any drainage (with or without being postulant)
5. red eyes that include red conjunctiva with crusting purulent discharge
6. persistent productive cough that produces bloody sputum
7. any open draining lesion
8. jaundice
9. evidence of head lice (pediculosis)

Other signs and symptoms will be assessed individually by the school nurse and may result in exclusion from attending class.

1. nasal discharge that is green or yellow
2. incontinence of feces or urine
3. skin rashes of undetermined origin

The school nurse will make the decision to exclude a student based on the risk of disease spread, risk to the student themselves, medical history of student, or if it is determined the student is too ill to remain at school.

EXCLUSIONS FROM SCHOOL

A student may return to school after being excluded for communicable disease by submitting a physician’s note stating the student does not currently have signs and symptoms of a communicable disease or that the disease in not communicable in a school setting (25 Texas Administrative Code §97>7(d) or by readmission criteria established by the commissioner of health (spelled out below). The criteria for exclusion and re-admission for communicable conditions are listed below and can be found at 25 Texas Administrative Code §97.7(b).

1. Amebiasis – exclude until treatment is initiated
2. Campylobacteriosis – exclude until diarrhea and fever subside
3. Chickenpox (varicella) – exclude until after severe days from onset of rash, except in the case of immunocompromised individuals who should not return until all blisters have crusted over (may take longer than seven days)
4. Common cold (coronavirus) – exclude until fever subsides. THE TEXAS GUIDE TO SCHOOL HEALTH PROGRAMS 469
5. Conjunctivitis, bacterial and /or viral – exclude until written permission and/or permit is issued by a physician or local healthy authority
6. Fever – exclude until fever subsides
7. Fifth disease (erythema infectiosum – exclude until fever subsides
8. Gastroenteritis, viral – exclude until diarrhea subsides 24 hours
9. Giardiasis – exclude until diarrhea subsides 24 hours
10. Head lice (pediculosis) - exclude until one medicated shampoo or lotion treatment has been given
11. Hepatitis, viral, Type A – exclude until one week after onset of illness
12. Impetigo – exclude until treatment has begun
13. Infectious mononucleosis – exclude until physician decides or fever subsides.
14. Influenza – exclude until fever subsides
15. Measles (rubeloa) – exclude until four days after rash onset. In the case of an outbreak, unimmunized children should also be excluded for at least two weeks after last rash onset occurs.
16. Meningitis, bacterial – exclude until written permission and/or permit is issued by a physician or local health authority
17. Meningitis, viral – exclude until fever subsides
18. Mumps – exclude until nine days after onset of swelling
19. Pertussis (whooping cough) – exclude until completion of five days of antibiotic therapy
20. Ringworm of the scalp – exclude until treatment has begun
21. Rubella (German measles) – exclude until seven days after rash onset. In the case of an outbreak, unimmunized children should be excluded for at least three weeks after last rash onset occurs.
22. Salmonellosis – exclude until diarrhea and fever subside
23. Scabies – exclude until treatment has begun.
24. Shigellosis – exclude until diarrhea and fever subside.
25. Streptococcal sore throat and scarlet fever – exclude until 24 hours from time antibiotic treatment was begun and fever subsided.
26. Tuberculosis, pulmonary – exclude until antibiotic treatment has begun and a physician’s certificate or health permit obtained