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Provided by Tom Ulmet, April 5, 2020.

ACAMIS Model Infectious Disease Prevention and Cleaning Procedures 
Created by the ACAMIS Executive Director and the Board of Directors

This document was created by the ACAMIS Executive Office with direct input from the ACAMIS Board of Directors that is comprised of people with vast experience and long service in our region. It is designed for use by schools that were closed during an epidemic or those that remained open as an epidemic began its spread. Following these procedures will not ensure complete elimination of a virus in your environment, but it will go a long way to assure your constituents that you are doing everything possible to protect them.

To make it as useful as possible, input was also sought from other long-serving Heads in China, regional facility consultants, business managers, a major food service provider and governments of two major cities in China. While perhaps not exhaustive, the list is comprehensive. We welcome questions, suggestions or advice that will help to improve the list. Additional suggestions or advice received will be reviewed for appropriateness by a team of original contributors to ensure the information is as reliable as possible. Contact ed.acamis@gmail.com.

Although there has been a corona virus outbreak (SARS, Avian Flu, Swine Flu, MERS) almost every four years since 2003, schools in China or Mongolia did not close during those events and foreigners did not leave the country in such large numbers as now. As many foreigners left China for the Chinese New Year as the outbreak began, now that the virus has been contained, thousands of foreign workers and their families will begin to return to our region from affected areas. https://sampi.co/china-expat-population-statistics/

Therefore, it is important to employ maximum preventive measures to protect the school cluster. We feel the time is right to provide guidance on cleaning and hygiene for international schools in our region and beyond. Please consider these as guidelines, not standards. These recommendations are labour intensive. Some schools may have sufficient support staff to enact all of the recommendations, some may not. Labour shortages for intensified cleaning may be solved by adding part-time cleaning staff as needed to the end of the school year and for the start of the next school year. The Leadership Team must then make the difficult decisions about extent and frequency of cleaning. However, it is vital that each school review them all recommendations to gain an understanding of the magnitude and importance of creating a high- level cleaning routine for special circumstances like this. During the first few weeks of resuming classes, the possibility of accidental infiltration of an illness of some kind into the school cluster is increased. People can be carriers of the virus without showing symptoms for four or five days. There have been past cases where someone entered a school asymptomatic in the morning and developed symptoms during the day. This is why so many detailed cleanings and temperature taking after lunch are necessary.

This document does not specifically address the needs of the youngest children, aged 3-5 in Pre- School, ECE, or Kindergartens, as it is assumed that classes for this group of students will not resume at the same time as other grades/years. Some schools may be governed by a large organization that has its own recommended procedures or you may be subject to government guidelines. While those guidelines must take precedent there is something to be gleaned from the list provided below. There is no such thing as too much in these unusual circumstances.

This information is meant to assist leadership teams to understand the dimension of cleaning needed during disease crises. These points are a powerful deterrent, but not a guarantee to prevent disease from entering your school cluster. If you are uncertain about any of the following items, you should consult a specialized professional cleaning company to obtain an opinion about your circumstances. In general, the list is descriptive to help guide leaders to important considerations. In some places it is prescriptive, to define minimum treatments based on practical, previous experience. Should someone in your school community be found with symptoms of COVID-19 it will need to be reported to local authorities through their procedures as soon as possible. Although the major symptoms of COVID-19 are fatigue, dry cough, fever, shortness of breath, anyone with other cold or flu-like symptoms should be prevented from entering the school.  See Chart at the bottom of this page.

 

Disease Prevention at School 
Leaders and Teachers:

  • Create an Infectious Disease Prevention Plan with the leadership team and involve your Board/Owner
  • Review the plan to make sure it is feasible and can be carried out regularly
  • Share the plan with teachers and support staff
  • Review with cleaning vendors and cleaning staff new kinds of equipment to optimize cleaning efficiency and frequency
  • Create a communications plan to inform the school constituents of the procedures in place
  • Determine how many students may return when classes resume and consider closing off some classrooms or unneeded areas of the school to reduce cleaning and best utilize cleaning staff
  • Estimate and acquire a sufficient amount of needed materials including sanitizers, hand wipes, tissues, cleaning equipment and personal protective equipment for cleaners (gloves, goggles, shoes, coveralls, etc)
  • Prepare all leaders to observe, monitor and correct any deficiencies noticed in the delivery of the plan
  • Encourage all children and staff to wash their hands frequently and thoroughly during the day with soap for twenty seconds, particularly before and after breaks and lunch and after using the toilet
  • Provide lessons and activities for students to educate them on the importance of health and hygiene
  • Place signage appropriately to remind people to wash hands
  • Encourage students to remind other students to wash hands
  • Establish isolated Health corner away from Nurse station to accommodate those showing symptoms
  • Establish disposal bins for masks and other materials
  • Sanitation materials (hand wipes, hand sanitizer) should be provided for all staff to keep at their desks
  • Consider providing parents with weekly temperature recording forms with daily entries each night and each morning
  • Avoid holding student assemblies

Training:

  • Provide training for teachers so they have an understanding of the overall plan, their role in observing students and of reporting anything that appears to be deficient
  • Provide training for supporting division to ensure understanding of the need and the responsibility they have to keep everyone safe, including themselves
  • Provide training for Cleaning Staff so they understand the proper equipment, materials and thoroughness needed to perform their vital role
  • Train the school Doctor/Nurse and health staff to work with teachers to monitor symptoms and comments from students and make rounds of classes twice daily to check for any teacher observations. If any student shows symptoms of any illness, do temperature check and isolate the student until parents can take the child home. In such an event, the classroom should be disinfected
  • School guards should be informed of the overall plan and trained to perform the important role of assisting visitors without letting them enter and any additional duties you determine are needed. An English speaker at the gate is vital during school hours.

 

PEOPLE 
Teachers:

  • Take temperatures of all family members before bedtime and first thing in the morning
  • If any teacher or teacher’s family members family member shows signs of illness such as coughing, headache or fever before they leave home, they should remain at home in isolation. They should immediately inform their Supervisor. Consult school leadership as soon as possible. With fever, seek medical assistance immediately
  • Make thorough explanations to students of the sanitization plan and the reasons for it as a necessity for them to feel and be safe in their school
  • Instruct students on the proper way to wash hands with soap for a minimum of 20 seconds. Hand washing video clips are available on YouTube
  • Observe students throughout the day for signs of flu-like symptoms
  • Any student making a joke or false comment about (COVID-19) should be counseled
  • Avoid telling stories of their own experiences or quarantine, but provide time for students to share theirs
  • Avoid bringing large groups of students together for assemblies
  • If the number of returning students is lower than before the outbreak, space them more widely in the classroom
  • Wipe school laptop keyboards in classrooms after each class. Students wipe their own electronic equipment

Teaching Assistants (If you have no teaching assistants see Support Staff):

  • Take temperatures of all family members before bedtime and first thing in the morning
  • If any teaching assistant’s family member shows signs of illness such as coughing,
  • headache or fever before they leave home, they should remain at home in isolation. They should immediately inform their Supervisor and with fever, seek medical assistance immediately
  • As appropriate, school toys, play equipment and musical instruments are cleaned daily unless an incident occurs that warrants immediate cleaning
  • Classroom furnishings are disinfected twice daily
  • Wash daily with disinfectant all marble surfaces, floors, walls, and window interiors

Support Staff:

  • Take temperatures of all family members before bedtime and first thing in the morning
  • If any support staff family member shows signs of illness such as coughing, headache or fever before they leave home, they should remain at home in isolation. They should immediately inform their Supervisor and if fever, seek medical assistance immediately
  • As appropriate, school toys, play equipment and musical instruments are cleaned daily
  • unless an incident occurs that warrants immediate cleaning
  • Classroom furnishings are disinfected twice daily
  • Wash daily with disinfectant all marble surfaces, floors, walls, and window interiors daily with disinfectant
  • General office cleaning – 2 times per day
  • Common area* cleaning – 6 times per day (Recommended every 90 minutes between 9:00 am and 6:00 pm)
  • Replenish hand sanitizers in pantries, meeting rooms, entrance ways to property and rooms specially setup to accommodate visitors

* Common areas are defined as meeting rooms, copy rooms, corridors, pantries, cafeteria, visitor areas, kitchen areas, elevator lobbies, parent rooms, medical room, quiet room, shower rooms and reception.

Parents:

  • Take temperatures of all family members before bedtime and first thing in the morning
  • If any family member shows signs of illness such as coughing, headache or fever, they should remain at home in isolation. Do not send the children to school with any kind of illness, cold or flu. With fever, seek medical assistance immediately
  • Anyone who prepares special snacks and lunches must send them with the child as deliveries will not be accepted. Children should not exchange food or snacks under any circumstances

Visitors:

  • Visitors of any kind should not be allowed to enter the campus
  • Deliveries should be dropped at the gate
  • Parents dropping off children should drop them at a designated entrance and should maintain social distancing when waiting outside the gates after school to collect them
  • Many schools have different campus designs where parents can gather in shelter inside the gate, but parents should not enter the classroom areas
  • For meetings with parents, a special room near the gate should be set aside and sanitized after each meeting
  • Sanitation materials (hand wipes, hand sanitizer) should be provided and used in the meeting room by all parties who are meeting before and after a meeting
  • Visitors for admission should be met outside or in a space near the gate, but not allowed inside the building

Arrivals at School Gates:

  • All arrivals at school gates should have their temperature checked
  • Visitors should not be allowed into the school buildings
  • Explanations of the school’s sanitization requirements should be provided in writing at the gate
  • Mats soaked in a chlorine base should be placed at the gates or entrances for everyone to wipe shoes when entering

 

PLACES
Food Service:

  • Food services will be informed by local government of sanitizing requirements and food safety in preparation and serving areas
  • These requirements may fall short in terms of keeping tables and chairs sanitized
  • Therefore, staff need to be trained to immediately sanitize tables and chairs after each use and be uniformly cleaned after the break or lunch
  • After an extended shutdown of school, have the food service check expiration dates of all packaged foods and dispose of any whose dates have expired as local inspectors will likely appear soon after reopening
  • Ensure the students have more space between them at tables than usual; this may mean changing the lunch schedule to have fewer students in the cafeteria at the same time or arranging lunches to be delivered to classrooms

School Transportation:

  • Bus or vans to be thoroughly sanitized before departing on their runs, morning and afternoon
  • Bus assistants take temperatures of all students before they board the bus
  • Windows on each side of the driver should be open for air circulation
  • Wet and dry towels and sanitized wipes should be carried on each vehicle in case of student illness
  • Additionally, buses are sprayed 2 times daily with disinfectant aerosol, before morning pickup and after the last drop-off
  • If a student shows signs of illness of any kind, the entire group should be checked outside the gate/building on arrival and the incident recorded for further monitoring
  • The student who became ill should be kept in isolation until parents can come to collect

Classrooms:

  • Surfaces, including floors, of every classroom should be disinfected twice daily with a recommended disinfectant, preferably at lunch time and after school
  • Desk bottoms should also be wiped at least once a day
  • Classrooms with UV lighting should be turned on each night instead of once per week
  • UV lighting may not be suitable for every room, but is best installed in primary classrooms

Ventilation:

  • With Air quality control systems installed, check filters every week and disinfect or change as needed
  • With no air quality control system installed, open classroom windows for an hour at 07.00 and leave them open slightly during the day for airflow and cross ventilation
  • With classroom air purifiers, monitor filters weekly and change as needed. Air filters can trap and recycle virus
  • Air Quality filtration systems are ideal in normal conditions, but if someone enter with the virus the air quality system fans can spread the virus to other areas. If a case is detected, that system should be shut down immediately. See *Engineering Controls below.

Stairways and Hallways:

  • Places in the building that are most touched by people such as staircase railings in every part of the building need to be wiped with sanitizer after every class change
  • Lifts/Elevators are particularly dangerous due to droplets being trapped inside and buttons should be sanitized after every class change. Students should not be allowed to use them
  • Hallways should be cleaned with disinfectant two times per day and cleaned additionally as needed depending on use or events
  • Any entrance carpets should be sprayed with disinfectant at the start of each day

Toilets:

  • Toilet areas need to be cleaned with disinfectant after every class period; more depending on scheduled events
  • Restroom cleaning – 6-8 times per day (every hour between 9:00 am and 6:00 pm)
  • Signs should be placed encouraging proper disposal of hand wipes and paper towels as well as to remind users to wash hands for at least 20 seconds. Hand wipes should not be disposed of in toilets

Face Masks
This is a controversial issue and requires careful consideration. Certainly, in public areas with numbers of unknown people, it may be advisable to wear a face mask. However, unless mandated by local government, wearing a face mask in schools may not be advisable at this time, particularly in schools that have Air Quality Systems installed, provided the system brings in, circulates and filters sufficient fresh air and all persons demonstrating symptoms of any illness are restricted from entry.

Notably, “Data on individuals aged 18 years old and under suggest that there is a relatively low attack rate in this age group (2.4% of all reported cases).” With ages 1-9, the percentage is even lower. See Page 11. Therefore, while children are not as directly affected by the virus as other age groups, they can a carrier without symptoms. https://www.who.int/docs/default-source/coronaviruse/who-china-joint-mission-on-covid-19- final-report.pdf

The primary benefit of covering your nose and mouth with a mask is that you protect others. If you cough or sneeze, the mask can catch those respiratory droplets so they don't land on other people or surfaces. Most masks have a short period of effectiveness and may be impractical and unhygienic for students to manage throughout the day. Masks are not designed to prevent children from touching the mask constantly and adjusting it, which can transfer bacteria faster to children from hand to eyes and mouth. Additionally, disposal of masks potentially creates another major health problem. https://www.npr.org/sections/goatsandsoda/2020/04/03/826996154/coronavirus-faqs-is-a- homemade-mask-effective-and-whats-the-best-way-to-wear-one

Generally, masks are designed to prevent your own spreading of bacteria or virus to others. Removing it during eating times defeats the purpose of a mask. Anyone in need of a face mask to prevent the spread of something should be sent home. If face masks are used, those who use them should wash their face with soap as frequently as their hands. Masks are not a replacement for all the other steps we need to take right now to protect ourselves from the coronavirus — especially social distancing and good hand hygiene. In practice, people touch or adjust a mask many times in one hour and contaminate their hands, which means they should wash their hands each time they touch their mask. This is impossible in a school setting (realistically, impossible anywhere).

Finally, although the CDC recently revised its advisory for people in the highly infectious areas of the USA to suggest wearing face masks in public areas when around many people, the WHO continues to advise against wearing face masks. “Only wear a mask if you are ill with COVID-19 symptoms (especially coughing) or looking after someone who may have COVID-19. A disposable face mask can only be used once. If you are not ill or looking after someone who is ill then you are wasting a mask. There is a world-wide shortage of masks, so WHO urges people to use masks wisely. WHO advises rational use of medical masks to avoid unnecessary wastage of precious resources and mis-use of masks. (see Advice on the use of masks).“ The advice on applying the mask properly is quite cumbersome and time consuming. “The most effective ways to protect yourself and others against COVID-19 are to frequently clean your hands, cover your cough with the bend of elbow or tissue and maintain a distance of at least 1 meter (3 feet) from people who are coughing or sneezing.” https://www.who.int/news-room/q-a-detail/q-a- coronaviruses

With proper screening before entering the school and with stringent sanitization procedures in place, your school should be among the safest anywhere. Nonetheless, be prepared for some people to insist that they or their child wear masks. Teaching and interactions will certainly be more effective without masks.

Outside the school, mixing with the public, it is perfectly reasonable to wear a mask. With the intense hygiene measures in place and ill children and staff prevented from entering, classes will be more productive without masks.

 

Sample Corporate Sanitation Policy for Suspected Contamination
The following recommendations were provided by the representative of a global property management company, which due to concerns related to liability has asked not to be referenced. If you do have an infection, or suspected infection, at school, you should notify your local authorities. In this event, below are some suggestions for how to proceed, but you should still defer to your local health authority’s policy in the event they have their own procedures and they do not want your school to address the matter directly.

Cleaning of Areas – For A Confirmed or Suspected Novel Coronavirus

  • All personnel engaged in cleaning areas suspected of contamination must be equipped with sufficient personal protective equipment, including, goggles, mask, protective clothing, overshoes and gloves. Gloves or other reusable PPE items shall be soaked in 1:49 bleach solution for 30 minutes before use again.
  • Should a case be detected, inform relevant Building Engineers to adjust the air conditioning system to prevention circulation of the indoor air to other areas. Replace the localized AHU and PAU filter immediately.
  • Use 1:49 bleach solution to clean the immediate area, including workstations, desk phones laptops and other property/office furniture. Use 1:99 bleach solution or 70% alcohol to clean the property/office area general surfaces.
  • Soft furnishings i.e. curtain and sofa cushion in a property/office use 70-80oC hot water with normal cleansing agent to wash.
  • Designated protected cleaners must conduct “Fogging” treatment with the use of “Quat” (quaternary ammonia) based disinfectant on localised office or classroom floors. http://www.quats.org/what-are-quats/how-quats-work/
  • Pour 1:99 bleach solution into the u-channel and floor drains on all floors.
  • For carpet cleaning use a high efficiency vacuum cleaner with filter media e.g. HEPA, to clean. If carpet is obviously contaminated, use 70% alcohol to soak the contaminated area and further clean by steam cleaner.

Engineering Controls
Do NOT assume that because you have a central air quality control system that your school is protected. The CDC recommends that essential parts such as fans and filters need to be cleaned regularly. If you discover a potential or actual case, the air system should be shut down immediately and that specific room must be closed for 24 hours with windows open before disinfecting is attempted along with isolating any persons in that class. CDC recommendations do not provide the detail needed for schools, but they do include some guidance for larger system equipment. https://www.cdc.gov/coronavirus/2019- ncov/community/organizations/cleaning-disinfection.html

  • Confirm the last cleaning and replacement of air conditioning and filtration.
  • In office areas of confirmed or suspected cases replace the localized AHU and PAU filter.
  • Conduct general inspection to ensure fixed and portable extraction fans, kitchen extraction fans are clean and in good repair.
  • Ensure you have contact details for engineering vendors and keep informed of your contractor’s capability and charges to undertake additional filter cleaning.

Summary
The front line of defense is the family and in the home. We rely on parents to monitor their children and all family members before they leave home and when they return from school or work. However, some parents may want their child to make up the time missed so badly that they think it is appropriate to send a child to school even with mild symptoms such as runny nose, cold or mild flu. Communication with your constituents is vital in ensuring understanding of what you are doing to make the school environment safe. Emphasize in your communications that children should not be sent to school if they are visibly unwell and are coughing, sneezing, have a runny nose or a fever or with a cold or flu. Attempting to attend with these symptoms complicates the monitoring process and can lead to counterproductive rumours about individuals.

When you create your cleaning and prevention protocol, be sure to communicate it among your school constituents. Elevated hygiene practices reduce fear and emotions and build confidence. Most incidents within a school circulate quickly as rumours. If false, they are difficult to correct. Once started, you can assume it will soon be posted somewhere on social media. In general, it is not recommended to respond on social media directly, but to identify who posted it. Unless the information is confidential, clarify the rumour directly with that person.
The measures shown above indicate you are making every effort to be as vigilant as possible and carry on as normally as possible. But remember, these are not normal times and one case can result in follow up by health authorities that may have a lasting negative effect on the school.

Symptoms for exclusion from the campus, except for sneezing or coughing related to allergies.

Enjoy a Safe, Clean School Environment
Because of the temperature and health screening procedures and the sanitization measures being taken, the school should be among the safest and healthiest environments for children and allow them to return to some semblance of normal during these abnormal times.

 

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