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Guidelines on Supporting Students Who Require Interventions or Supports that Cannot be Delivered from a Distance

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Acknowledgement

The Inclusion Support Branch of Manitoba Education appreciates the support of a team coordinated by the Infection Prevention and Control Consultant of Manitoba Health, Seniors and Active Living.

 

Purpose

This document was prepared to assist school divisions and funded independent schools in keeping students and staff safe in situations where students require interventions or supports that cannot be provided from a distance of two metres.

Assumptions

All facilities providing schooling or school-related activities must continue to follow applicable health and safety legislation to ensure the safety, health, and well-being of students and staff.

Guidelines in this document are based on the underlying assumption that attending students have already screened negative for COVID-19 by parents or by the protocol established by the school or school division.

Schools and school divisions are following the most recent public health guidelines, such as those found in the following documents:

Before implementation, it is recommended that this content be reviewed by the Workplace Safety and Health Committee of the school division or school.

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Special Considerations

When working with students who need extra supports, additional considerations are beneficial to both students and staff members.

  • In order to avoid stigma or unintended consequences, it is important that routine practices are followed universally.
  • Consider how the environment can be engineered to support students who have difficulty following recommended protocols (e.g., students who are impulsive, students who are working to improve self-management, students for whom self-management is not yet possible).
    • Suggestions: Use tape on the floor, hoops, mats, or other items that can mark off personal space; organize activities with a visual cue about how many students should be in that area (e.g., two chairs next to an activity).
  • Review student-specific plans to determine whether interventions that require close physical proximity for longer periods of time are necessary (e.g., physically directing a student).
  • Student-specific plans may be required to address particular situations (e.g., students with ‘tics’ such as touching their face; students with mental health needs and who are upset or do not understand the need to physically distance; students who communicate in ASL and who may need to touch their face to express themselves).
  • School clinicians will review additional protocols identified by their regulatory body.
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Following Routine Practices

Avoid touching your eyes, nose, and mouth with unclean hands.

Ensure students and staff obey the following hand hygiene guidelines. At the following times, engage in frequent hand hygiene with soap and water for at least 15 to 20 seconds, or use alcohol-based sanitizer:

  • at the start of the day and before going home
  • before and after completing any support/procedure that does not allow physical distancing (both students and staff)
  • before and after putting on (donning) and removing (doffing) personal protective equipment (PPE) such as gloves, masks, and eye shields, as outlined later in this document
  • after going to the washroom, wiping nose or handling dirty tissues, coughing, sneezing, or blowing nose
  • after getting hands dirty or if they have become contaminated
  • after completing cleaning tasks (staff)
  • before and after food preparation or contact with food
  • before and after snacks or meals

Note: The hand hygiene procedure takes longer than 15 to 20 seconds, as you need to turn the water on, get your hands wet, perform the lathering and mechanical actions, and then rinse them off and dry. The time spent just lathering and performing the mechanical actions is what requires 15 to 20 seconds.

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Provide Accessible Information and Direct Instruction

Encourage hand hygiene and make alcohol-based hand sanitizer available at all building access points.

Post signs in common areas, such as entrances, classrooms, restrooms, life skills area, physiotherapy area, and vocational area.

Provide clear, direct instructions about how to perform hand hygiene and cough etiquette.

  • Use plain language, as spoken in the community
  • Keep messages short, explaining simple steps they can take
  • Use large fonts and graphics
  • Make sure instructions are accessible (e.g., Braille, pictorial)
  • Use social stories

Please feel free to print/utilize the posters that have been created by the Manitoba government to define/explain hand hygiene and cough etiquette:

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Non-medical Masks

Wearing a non-medical mask has not been proven to protect the person wearing it from contracting COVID-19. However, good hand hygiene and cough etiquette will provide significant protection from viral respiratory illnesses.

Evolving evidence with regard to COVID-19 transmission suggests that infected people may spread the virus without experiencing symptoms or before symptoms begin. Choosing to wear a non-medical mask is one way to protect those around you. If you choose to wear a non-medical mask, be sure to carefully perform hand hygiene before the mask is put on and after it is taken off. Also, avoid touching your face as much as possible. This will further reduce the risk of spreading COVID-19.

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Considerations Regarding Staff Assignments

It is important to identify which staff members can safely work with students who are considered low, medium, or high risk, based on the staff members’ individual circumstances. Staff would then be assigned accordingly and/or necessary accommodations would need to be put into place.

Vulnerable populations are described by Public Health as outlined below. These vulnerabilities need to be considered as they relate to both students and staff.

Anyone who is

  • at risk due to underlying medical conditions (e.g., heart disease, hypertension, diabetes, chronic respiratory diseases, cancer)
  • at risk due to a compromised immune system from a medical condition or treatment (e.g., chemotherapy)
  • An older adult

Anyone who has

  • difficulty reading, speaking, understanding, or communicating
  • difficulty doing preventive activities like frequent hand washing and covering coughs and sneezes
  • ongoing specialized medical care or who requires specific medical supplies
  • ongoing supervision needs or support for maintaining independence
  • difficulty accessing medical care or health advice
  • difficulty accessing transportation
  • economic barriers
  • unstable employment or inflexible working conditions
  • social or geographic isolation, like in remote and isolated communities
  • insecure, inadequate, or non-existent housing conditions
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Students Who Require Supports that Cannot be Delivered at a Distance

Students may require specific interventions or supports that cannot be delivered from a distance. Examples of these interventions or supports include

  • Catheterization
  • Gastrostomy and Ostomy feeding/care
  • Blood-glucose monitoring
  • Pre-set oxygen
  • Suctioning
  • Diapering
  • Assistance in using the washroom
  • Assistance with feeding
  • Assistance with mobility
  • Assistance with communication device or other teaching tools
  • administration of emergency medication by school staff (e.g., epinephrine auto-injector or “epi-pen”, asthma medication, rescue medication for seizures)
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Level of Risk

Precautions related to these types of supports will vary depending on the level of risk.

Low Risk

A student is considered low risk if they

  • have screened negative
  • can communicate sufficiently to follow basic directions
  • are able to perform preventative activities like frequent hand hygiene and cough etiquette
  • are generally cooperative during all types of procedures

When the risk is low, following routine practices and providing accessible information and direct instruction are considered sufficient. See the information outlined previously in this document.

  • Disposable gloves need only be worn to perform close personal care that results in potential for contact with bodily fluids. Perform hand hygiene before AND after removing gloves.

Medium Risk

A student is considered medium risk if they

  • have screened negative
  • have difficulty communicating sufficiently to follow basic directions
  • have difficulty performing preventative activities like frequent hand hygiene and cough etiquette
  • are generally cooperative during all types of procedures
  • demonstrates symptoms such as running nose, coughing, sneezing, gagging, drooling, but do so normally

Medium-risk situations call for routine practices (as outlined previously in this document) to be followed at all times. Providing accessible information and direct instruction is also useful. In addition, the following precautions are recommended:

Disposable gloves need only be worn to perform close personal care that results in potential for contact with bodily fluids. Perform hand hygiene before AND after removing gloves.

Procedural/surgical masks must be worn by staff members when they are unable to practise physical distancing of two metres.

Utilize the following teaching experiences that help students learn about hand hygiene and not touching their eyes, nose, and mouth with unclean hands.

  • Break down into smaller steps to increase understanding
  • Use timers to help ensure adequate time. See how many 15- to 20-second songs students can identify. Be creative. Engage the students in coming up with games and other ways to encourage everyone to wash their hands for 15 to 20 seconds. Older students may watch videos of procedures or science experiments to learn techniques.
  • Note: The hand hygiene procedure takes longer than 15 to 20 seconds, as you need to turn the water on, get your hands wet, perform the lathering and mechanical actions, and then rinse them off and dry. The time spent just lathering and performing the mechanical actions is what requires 15 to 20 seconds.

High Risk

A student is considered high risk if they

  • have screened negative
  • have difficulty communicating sufficiently to follow basic directions
  • have difficulty performing preventative activities like frequent hand hygiene and cough etiquette
  • are uncooperative during most/all types of procedures
  • have vulnerabilities that include expected behaviours that increase the chance of spreading infection (e.g., spitting, biting)

High risk situations call for routine practices, as outlined previously in this document, to be followed at all times. Providing accessible information and direct instruction is also useful. In addition, the following precautions are recommended:

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Additional Notes

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