A Guide for School Nurses to Implement Testing, Tracking & Tracing: COVID-19
By, Kyle Tretina, Ph.D., Dan Miller and Rebecca Love, Registered Nurse, MSN, FIEL
April 8, 2021 – School Nurse
Opening all K-12 schools in Fall 2021 is central to being able to reopen our society, and support children, families and our economy. In agreement with the US Dept of Education’s recent “National Safe School Reopening Summit”, we believe that with a “layered mitigation plan”, schools can and will reopen safely.
Building on the lessons learned by schools and educators in 2020 that were able to put in protocols and processes that allowed them to keep their doors open, this is great news for the upcoming semester, but will rely heavily on school nurses to plan and implement.
We would summarize CDC recommendations for reopening schools as having five essential layers, each of which works with the others to build safe spaces for educating the next generation:
- Universal and correct mask wearing is perhaps the most important mitigation method. In addition to educating and enforcing proper mask usage in classrooms, proper engagement with parents will be needed to reinforce this messaging at home and ensure greater levels of compliance and therefore safety.
- Physical and social distancing measures must remain in place in schools, despite the difficulties of ensuring that these policies are followed by students. In a demonstration of the ability to respond to new discoveries in scientific research, the CDC recently changed its recommendations from 6 feet to 3 feet of physical distancing between students in elementary school classrooms where everyone wears a mask. Guidelines for distancing during extracurricular activities were recently published, but further research is needed to provide more specifics regarding the safest way for students to return to sports in a pandemic.
- Proper hand washing should be practiced whether or not there is a pandemic, so this practice should be viewed as a measure that not only slows the spread of COVID-19, but provides support for the wellbeing of students in their standard hygiene practices.
- Ensuring the thorough and safe cleaning of surfaces, consistently in all schools is one way to ensure transmission of COVID-19 on surfaces, although this mode of transmission is thought to be rare.
- Diagnostic testing and contact tracing with isolation and quarantine will continue to be an essential part of reopening schools. These practices are difficult without the consultation of experts or the assistance of software to help keep track of test results, foot traffic, etc., but are necessary. Even with vaccinations now being prioritized for educators, knowing that those vaccines are working will require testing. Diagnosing COVID-19 as opposed to the flu or other diseases will require testing. Assessing the progress of our fight against the pandemic will require testing. Most importantly, effectively preventing the next pandemic will require a testing infrastructure greater than we have at this time.
Since most K-12 students will not be able to access a vaccine, this population will be at risk of COVID-19 and school nurses are going to be on the front lines to keep students and staff safe.
However, it means there has to be an operational plan clearly outlined to support school nurses to create an effective plan. To help with these efforts, here is our 3 phase checklist to help K-12 School Nurses open their doors open in Fall 2021.
- Testing Partner: Find the right partner to be able to provide COVID-19 testing. This partner should be able to provide these following services:
a. Tests: Yes, any partner you have, should have access to far more tests than you need.
b. Labs: Beyond tests, any partner needs to have access to labs to be able to process the tests. The more access the better. The turnaround time of processing tests can vary greatly between labs, or for the same lab during a surge in demand.
c. Shipping: You partner should provide you with an easy shipping program — and provide you with all such labels and packaging.
d. HIPAA Compliance should be easy in terms of:
i. Consents to testing
ii. Process Results
iii. Clinician Review iv. Safely share results with friends and family, if you wish.
e. Processes & Protocols: to help provide the best of practice guidelines for being able to deliver an effective and efficient testing plan.
f. Clinical Expertise/Team: Any partner should have a strong clinical team, including Physicians and Nurses, who can be engaged to answer questions, deal with complicated cases, and parter to support you in protocols and processes that need adaptation and deal with the unknowns; a clinical team also will keep you in good standing with regulations and compliance at the local, State and Federal level.
g. Public Health Reporting: Look to a provider that can support you with public health reporting, as each positive test needs to be reported to the public health department, alongside the name of the clinician overseeing the testing.
2. School Team: As a School Nurse, ultimately you will be a responsible party to operate and oversee the testing, but you will need a team to help. When you find the right testing partner, next you will need to build the team who can help you operate a testing program — who you need:
a. Operational Team: 4–5 people:
b. To help register students/parent consents ii. Collect the specimens iii. Send off the specimens iv. Check Results: likely this will be the responsibility of the nurse to review each day.
3. Tracking and Tracing
a. Positive Results should be followed up by:
b. Informing students/family and providing guidance to quarantine guidelines. ii. Tracking and tracing those students/staff who were in contact with that individual so they can be tested and guidance to quarantine guidelines
In addition, we want to provide you with a list of other articles that can help guide you as well. These are some of the best we have found:
- Early Insights and Recommendations for Implementing a Covid-19 Antigen Testing Program in K-12 Schools: Lessons Learned from Six Pilot Sites
- Reopening K-12 Schools During the COVID-19 Pandemic: Prioritizing Health, Equity, and Communities
- Risk Assessment and Testing Protocols for Reducing SARS-CoV-2 Transmission in K-12 Schools
- Information for School Nurses and Other Healthcare Personnel (HCP) Working in Schools and Child Care Settings
- Centers for Disease Control Schools & Childcare Programs Guidance web page for their latest resources and information in response to the COVID-19 pandemic.
- Interim Guidance: Role of the School Nurse in COVID-19 Testing in Schools by the National Association of School Nurses.
And more references from the CDC: