PROTOCOL FOR SAFE SCHOOL ENVIRONMENT IN LIBERIA

Below is the verbatim protocol arrangement for schools in Liberia as the country plans to reopen schools in in February.

The Ministry of Education has therefore released these protocol to provide guidance to teachers and school managers.

1.     WHAT ARE THESE PROTOCOLS?

  • The Protocols for Safe School Environments in the Ebola Outbreak in Liberia define the minimum requirements that have to be in place in every school to ensure that, from a health and a water, sanitation and hygiene point of view, the school is a safe place to be for all students and school personnel.
  • School administrators are responsible for ensuring that the Protocols are in place and followed.
  • School administrators are recommended to form a School Ebola Safety Committee, including adult volunteers, children and youth, to assist with the safe implementation of the Protocols. Members of this Committee will be trained in infection prevention and control.
  • Active Parent Teacher Associations will also play an important role in the implementation of the Protocols, supported by General Community Health Volunteers.
  • School administrators are recommended to call a meeting of the Parent Teacher Association to share the contents of these Protocols with the community before the reopening of the school.

2.     WHAT NEEDS TO BE IN PLACE BEFORE THE SCHOOL REOPENS?

2.1  Identifying possible Ebola exposure before the school reopens

School administrators have to identify any possible exposure to Ebola by students and school personnel during 21 days before the planned school reopening. Therefore, during registration, the following information will be collected for every student and school personnel:

  • Potential exposure to Ebola during the 21 days before school reopening
  • Contact details of parents/guardians/spouses to be contacted in case a student or school personnel becomes ill at school

A person is considered to have “contact” if, in the last 21 days, they were exposed to a suspected or confirmed Ebola patient through:

  • Direct physical contact
  • Contact with their blood, urine, vomit, feces, sweat, saliva
  • Sleeping in the same household
  • Touching his/her clothes or linens
  • Attending a funeral

A person who is identified as having had “contact”, based on the above criteria, is not allowed to go to school until the status of the suspected Ebola case has been laboratory confirmed:

  • If the suspected case is confirmed as Ebola, the contact has to stay at home for 21 days from the day of last contact (see Section 4 for further details).
  • If the suspected case is found negative (not Ebola), the contact can return to school. It is important that school administrators raise awareness in the (school) community that these individuals do not pose any risk to others.

2.2  Mechanisms and facilities that need to be in place before the school reopens

  • Hand washing facilities must be in place at the school entry point and at the bathrooms (see Section 5.1 for further details)
  • Entry to school must be controlled by measuring temperatures, checking symptoms and washing hands every morning to prevent anyone showing Ebola symptoms from entering the school premises. The School Ebola Safety Committee is responsible for organising this.
  • A referral system with a nearby health facility must be in place before the school reopens. School administrators have to contact the County Health Team to agree on a referral system for their school. County Health Teams will be informed about this requirement by the Ministry of Health.
  • Each school has to identify a small physical space that will be used solely for the temporary isolation of students and school personnel with Ebola symptoms while waiting for the arrival of family/guardians and referral. This space should be easily accessible and easy to clean. Drinking water should be available, and oral rehydration salts if available.
  • The School Ebola Safety Committee should have clear lines of communication with the County Health Team to ensure they are informed of any students or staff currently being traced as potential contacts. Teachers who were doing contact tracing while schools were closed are not allowed to continue doing so once they have resumed their teaching duties.

3.     WHAT NEEDS TO BE DONE ONCE THE SCHOOL REOPENS?

3.1  Monitoring daily access to school

Every school day, at a clearly defined entry point, all students, school personnel, and any other person entering the school premises have to:

  • Get their temperature checked, and
  • Wash their hands in chlorinated water(05% chlorine solution)

A trained Fever Monitoring Team of at least 2 people will measure temperatures of all incoming individuals .While taking the fever, they will ask everybody:

  • If they have had contact with a suspected Ebola case (see Section 2.1), and
  • If they feel sick (see symptoms listed below).

If an individual answers “yes” to either one of these questions, they will not be permitted to enter the school premises. In that case, the Fever Monitoring Team will follow the steps outlined in Section 3.2.

Once in the classroom, before starting the first class of the day, the teacher will repeat the questions about potential contact and symptoms. School administrators and members of the Fever Monitoring Team measure each other’s temperatures before they start working.

Access to school is prohibited to any student, school personnel, or any other person who:

  • Has a fever of 38° Celsius (or 100.4° Fahrenheit)or higher
  • Has two or more symptoms of Ebola:
  • Headache
  • Red eyes
  • Joint and muscle pain
  • Diarrhoea
  • Vomiting
  • Abnormal bleeding
  • Weakness
  • Had contact with an Ebola patient or a person who died of Ebola during the past 21 days
  • Does not respect the preventive measures put in place for everyone’s protection

To avoid delays, school administrators may ask students and school personnel to come to school earlier, or may stagger the start of classes for different age groups.

3.2  When fever or other Ebola symptoms are detected at school

Anybody displaying Ebola symptoms at school has to be managed carefully, following the steps outlined below, depending on when the symptoms are detected. Touching the person with Ebola symptoms must be avoided, and a distance of 1 meter (3 feet) must be kept to mitigate the risk of being infected, however, it is also very important to remember to treat the person with care, affection and respect.

Detection at the school entrance:

  • When a person is detected with a fever of 38°C (100.4°F)or higher and/or any of the other symptoms listed above, the Fever Monitoring Team alerts other members of the team, and accompanies the person to the pre-identified isolation location while keeping a distance of 1 meter (3 feet).
  • School administrators inform his/her family/guardians that he/she must follow the referral system agreed with the County Health Team. Somebody from the School Ebola Safety Committee steps in as long as family/guardians are not available.
  • The health centre keeps school administrators and family/guardians informed of the health condition of the individual.
  • If Ebola is confirmed by a laboratory:
    • School administrators record it in a register (both school personnel and students).
    • The County Health Team must make a list of possible contacts with school administrators.
  • If the case is laboratory confirmed, school administrators immediately inform the district education authorities, who report to the county education authorities.

Detection during school hours:

  • When a teacher detects a possible Ebola case in the classroom, based on the symptoms listed above:
    • The teacher immediately informs school administrators, who inform the parents/guardians that he/she must follow the referral pathway agreed with the County Health Team.
    • Somebody from the School Ebola Safety Committee accompanies the student to the pre-identified isolation location in the school premises, keeping a distance of 1 meter (3 feet).
  • If a teacher or any other school personnel feels unwell:
    • The teacher/other school personnel immediately notifies school administrators, goes to the pre-identified isolation location in the school premises, and follows the referral pathway agreed with the County Health Team.
    • School administrators contact his/her family.
  • The health centre keeps school administrators and family/guardians informed of the health condition of the individual.
  • If Ebola is laboratory confirmed:
    • School administrators record it in a register (both school personnel and students).
    • The County Health Team must make a list of possible contacts with school administrators.

 

  • If the case is laboratory confirmed at the health facility, school administrators immediately inform the district education authorities, who report to the county education authorities.

 

4.     QUARANTINE PERIOD

When, after contact with an Ebola case, a person is quarantined by the County Health Team, this person is not allowed to go to school during 21 days, while the County Health Team monitors his/her health condition:

  • When a contact is quarantined, if he/she does not display symptoms after 21 days, he/she can return to school on day 22, after consulting the County Health Team. School administrators should raise awareness in the (school) community that these individuals do not pose anyrisk toothers.
  • If the person starts to display symptoms during their quarantine period:
    • The family should immediately contact the County Health Team.
    • Family members will not be allowed to enter the school premises until the laboratory test proves negative for Ebola.
    • Tracing of other possible contacts has to be organised by the County Health Team.

During the quarantine period, the school should provide ongoing support:

  • School administrators are encouraged to provide quarantined students with learning materials and activities, in collaboration with parents/guardians.
  • The salary of teachers and other school personnel is not to be ceased or reduced for being absent from school because of quarantine.

If the Ebola case was laboratory confirmed, once the person has been treated for Ebola and released from the hospitals/he can return to school after consultation with the County Health Team. The person is cured of Ebola and can no longer transmit Ebola. It is important that school administrators raise awareness in the (school) community that these individuals are cured of Ebola and pose no risk to others.

 

5.     SAFE HEALTH AND HYGIENE PRACTICES

While the enforcement of hygiene rules and practices at school is the school administrator’s responsibility, also students, families and communities have an important role to play in ensuring compliance.

5.1  Hand washing

It is the school administrators’ responsibility to ensure that hand washing facilities are available. Hand washing with 0.05% chlorine solution, alcohol-based hand sanitizer, or soap and running water can be used to help prevent infection of Ebola.

At the absolute minimum, the following 2 locations in the school have to have hand washing facilities:

  • The school entry point, for hand washing with chlorinated water (05% chlorine solution)
  • The bathrooms, for hand washing with water and soap

Any additional hand washing stations on the school premises should use water and soap.

School administrators are requested to put up posters illustrating how to wash hands correctly at all hand washing stations, and to organise practice sessions when schools reopen where trained school personnel teach all students and school personnel how to wash hands correctly:

  • Rub hands together for 40-60 seconds
  • Rinse well
  • Dry hands without using a towel, by shaking hands in the air

Anyone who enters the school must wash their hands:

  • At the school entrance
  • After using the bathroom
  • After physical education activities, a play session or recess
  • Before and after eating
  • After coming in contact with their own or other people’s bodily fluids(tears, nasal secretions, saliva, blood, sweat, urine, vomit, etc.), even if wearing gloves

In addition to the above, education personnel must wash their hands:

  • Before preparing food, eating, or helping student seat
  • After helping a student use the bathroom
  • After helping a student blow his/her nose

If a school does not have a reliable water supply, school administrators are responsible for organising the provision of water from a source in the community. The minimum requirements, including for drinking and hand washing, are:

  • 3 litres of water per student per day for day students
  • 20 litres of water per student per day for boarding school students

5.2  Cleaning schools

It is the school administrators’ responsibility to ensure that the school environment is clean. If there is a spill of bodily fluid (blood, vomit, stool or urine) the area should be cleaned with a 0.5% chlorine solution.

  • People who clean spills of bodily fluids (blood, vomit, stool or urine) have to be trained and provided with protective equipment:
    • At least heavy duty reusable gloves and rubber boots
    • If available, aprons and face shields or masks.
  • Protective equipment (like reusable gloves and rubber boots) that has been soaked in a 0.5% chlorine solution for 30 minutes can be reused.
  • If cleaning spills (blood stains, vomit, stool or urine), follow these steps:
    1. Put on available protective equipment and wear for entire process of cleaning and disinfecting
    2. Clean visible waste:
      1. Pour or spray strong (0.5%) chlorine on a towel
      2. Place the towel on top of the spill and use the towel to remove all visible waste
  • Place the soiled towel in a bucket and cover with 0.5% chlorine solution
  1. Disinfect:
    1. Pour 0.5% chlorine solution on the floor, covering the whole area, be careful not to splash
    2. Let the chlorine sit for 15 minutes while it disinfects
  • Place the soiled towel in a bucket and cover with 0.5% chlorine solution. After one hour, the towels may be washed with soap and reused once they are dry.
  1. Let the cleaned and disinfected surface air dry
  2. Remove protective equipment and wash hands

Who cleans the spills?

  • In principle, trained personnel should be paid to clean the school.
  • Where this is not possible, school administrators, in collaboration with Parent Teacher Associations, should agree on a different arrangement.
  • Students should not be cleaning spills (blood, vomit, stool or urine).

5.3  Eating and drinking practices in school

School administrators, with the help of Parent Teacher Associations and other community members, should mitigate the risk for students and school personnel to be infected by Ebola when they eat or drink on the school premises during school hours, by respecting the following rules:

  • Clean drinking water must be available for all students and school personnel.
  • When food is soldinside the school compound:
    • It should only be sold by vendors authorised by school administrators and the Parent Teacher Association.
    • School administrators are responsible for ensuring that the area where food is sold is clean at all times.
    • Food vendors must follow the same procedures for school entry (temperature check, answering questions about other symptoms and contact, hand washing) when entering school premises
    • The sale of bush meat should be prohibited on school premises.
  • Students should not:
    • Eat food that has touched the ground.
    • Share the same cup or utensils for eating or drinking.
    • Leave the school yard to buy food if food is available at school.
  • If the school provides utensils and supports communal eating:
    • Purchase additional cups, bowls and utensils, or
    • Ask parents/guardians to provide students with their own cup, bowl and utensils to take to school

5.4  “No Touch Policies” at school

One of the biggest challenges in the Ebola outbreak is to minimise physical contact to mitigate the risks of contracting the Ebola virus. If screening for ill students and staff is effective, a “No Touch Policy” is not necessary. However, if a person at the school shows fever or symptoms of Ebola, touching the person must be avoided, and a distance of 1 meter (3 feet) must be kept.

5.5  Additional safety precautions at school

  • Every school should be equipped with a first aid kit and at least one school staff member should be trained in first aid, in collaboration with the County Health Team.
  • Gloves should be worn whenever contact with blood is anticipated, like when dressing a cut or helping a student with a nosebleed.
  • Immediately rinse cuts and scrapes with soap and water, cover all cuts and abrasions with dressings.
  • If contact with blood occurs, do not panic, and wash with soap and water.
  • Every school should develop a catch up campaign for missed school health activities (like for example immunisation catch up campaigns, deworming, and micronutrient supplementation).

6.     PROVIDING PSYCHOSOCIAL SUPPORT AND REDUCING STIGMA

The majority of students respond to routine, friendly communication, regular classroom activities, and activities with elements of psychosocial support. The Ebola outbreak has created different sets of vulnerabilities for stigma though, including child survivors of Ebola, orphans, and children who have lost family members or siblings.

School administrators are responsible to ensure that students who need it receive psychosocial support. When required, in a confidential manner, students should be referred to the teacher-counsellor, and if necessary, to child protection services.

7.     COMMUNICATING WITH FAMILIES

Communicating with families and communities, and involving them in efforts to prevent Ebola is critical, to ensure that they become strong advocates and allies in implementing the Protocols.
At home, families and communities should act as good role models by exercising good hygiene rules, such as:

  • Ensuring children wash hands with water and soap before eating, after using the bathroom, and before leaving for school;
  • Ensuring that children are clean and wear unsoiled clothes to go to school, keeping children’s clothes away from urine, vomit and blood;
  • Reminding children before leaving for school in the morning that they should not share food, drinking cups and bottles with their classmates;
  • Not sending sick children to school;
  • Encouraging children to tell teachers immediately when they themselves, or a classmate, feel sick (headache, nausea, diarrhoea, vomiting ), and praising them when they do so.

8.     UNTIL WHEN?

Liberia can be declared “Ebola-free” after passing two consecutive quarantine periods of 21 days without having any Ebola cases in the country. That is, 42 days consecutive must pass after the last Ebola patient in the country is cured. When this occurs, the Liberian government, in coordination with the World Health Organisation (WHO) and the Centres for Disease Control and Prevention (CDC), can declare the country “Ebola-free”.

Until then, everyone in the school community should continue to be vigilant and work together to implement the Protocols for Safe School Environments in the Ebola Outbreak in Liberiato stop the transmission of Ebola. When Liberia is declared Ebola-free, and the risk of reintroduction from the region is reduced, these protocols will be revised to ensure preparedness to respond to a potential new outbreak, as well as to uphold good hygiene practices in schools and communities.

9.     COMPLIANCE

<The Ministry of Education proposed to add this section, for the Ministry to include.>

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