Deer Valley High School

Deer Valley Unified School District HEALTH AND SAFETY REQUIREMENTS

HEALTH AND SAFETY REQUIREMENTS

1. MMR (Measles/Rubeola, Mumps, & Rubella)

MMR is a combined vaccine that protects against three separate illnesses – measles, mumps and rubella (German measles) – in a single injection. Measles, mumps, and rubella are highly infectious diseases that can have serious, and potentially fatal, complications. The full series of MMR vaccination requires two doses.

If you had all three illnesses OR you have received the vaccinations but have no documented proof, you can have an IgG MMR titer drawn, which provides evidence of immunity to each disease. If the titer results are POSITIVE, showing immunity to each disease, submit a copy of the lab results.

Options to meet this requirement:

1. Submit documentation of two MMR vaccinations on separate dates at least 4 weeks apart.

      OR

2. Lab documentation of POSITIVE titer results for each disease (measles, mumps and rubella).
3. NEGATIVE or EQUIVOCAL titer results for measles, mumps or rubella shows lack of immunity, meaning you must Submit documentation of one MMR booster (vaccination) dated after negative or equivocal titer.

2. Varicella (Chickenpox)

Chickenpox is a highly contagious disease caused by the varicella-zoster virus (VZV). Infection with chickenpox also makes people susceptible to develop herpes zoster (shingles) later in life. The best means of preventing chickenpox is to get the varicella vaccine.

Varicella vaccination is required for all healthcare workers who do not meet evidence of immunity by having met any of the following criteria: a). Documentation of receiving 2 doses of varicella vaccine, separated by at least 4 weeks or b). Laboratory evidence of immunity or laboratory confirmation of disease. If you haven't had the varicella vaccine or if you don't have a blood test that shows you are immune to varicella (i.e., no serologic evidence of immunity or prior vaccination) get 2 doses of varicella vaccine, 4 weeks apart.

Options to meet this requirement:

1. Documentation of two varicella vaccines, including dates of administration.

OR

2. Submit a copy of proof of a POSITIVE IgG titer for varicella. If the titer is NEGATIVE or EQUIVOCAL. Submit documentation of one varicella (vaccination) booster dated after negative or equivocal titer.

3. Tetanus/Diphtheria/Pertussis (Tdap):

Tetanus, diphtheria, and pertussis are serious bacterial illnesses which can lead to illness and death. Tdap vaccination can protect against these diseases and is recommended for healthcare personnel with direct patient contact who have not previously received Tdap. Tdap vaccination can protect healthcare personnel against pertussis and help prevent them from spreading it to their patients.

The Td vaccine protects against tetanus and diphtheria, but not pertussis. Following administration of Tdap, a Td booster should be given if 10 years or more since the Tdap. Tdap may be given as one of these boosters if you have never gotten Tdap before. Tdap can be administered regardless of interval since the previous Td dose.

To meet this requirement:

Provide documentation of a Tdap vaccination administered after the age of 11 and then a Td vaccination every 10 years thereafter.

4. Tuberculosis (TB)

Tuberculosis (TB) is caused by a bacterium called Mycobacterium tuberculosis which usually infects the lungs, but can attack any part of the body such as the kidney, spine, and brain. Not everyone infected with TB bacteria develops tuberculosis. As a result, two TB-related conditions exist: latent TB infection (LTBI) and TB disease. If not treated properly, TB disease can be fatal.

All students entering a DVUSD program are required to submit documentation showing negative TB disease status. Documentation may include a negative 2-step Tuberculosis Skin Test (TBST) or negative blood test (QuantiFERON or T-Spot) performed within the previous six (6) months. The TBST or negative blood test must remain current throughout the semester of enrollment.

To maintain compliance with annual TB testing requirements, students who initially submitted a 2-step TBST may submit a current 1-step TBST for subsequent annual testing. A TBST is considered current if no more than 365 days have elapsed since the date of administration of the second of the 2-step TBST. Most recent skin testing or blood test must have been completed within the previous six (6) months.

If you have ever had a positive TBST, you must provide documentation of a negative blood test or negative chest X-ray. You will also need to complete a TB Symptom Screening Questionnaire annually.

To meet this requirement:

1. Proof of a negative 2-step TBST completed within the previous 6 months, including date given, date read, result, and name and signature of the healthcare provider. A 2-step TBST consists of an initial TBST and a boosted TBST 1-3 weeks apart.

OR

2. Submit documentation of a negative blood test (QuantiFERON or T-Spot) performed within the last six months.

OR

3. Submit documentation of a negative chest X-ray if TBST or Blood Testing is positive.
4. POSITIVE RESULTS: If you have a positive TBST, provide documentation of negative chest X-ray or negative blood test

5. Hepatitis B

DVUSD Nursing students may be exposed to potentially infectious materials which can increase their risk of acquiring hepatitis B virus infection, a serious disease that can cause acute or chronic liver disease which can lead to a serious, lifelong illness. DVUSD Nursing recommends that all students receive the hepatitis B 3-vaccine series administered over a 6 month period. Obtain the first vaccination; the second is given 1 - 2 months after the first dose and the third injection is 4 - 6 months after the first dose.

Effective immunization status can be proven by a titer confirming the presence of anti-Hbs or HepBSab antibodies in the blood. This titer is recommended but not mandatory.

Students may choose to decline the hepatitis B vaccine; however, lack of immunity to hepatitis B means that students remain at risk of acquiring the disease.

Options to meet this requirement:

1. Submit a copy of laboratory documentation of a positive HbsAb titer.

OR

2. Submit a copy of your immunization record, showing completion of the three Hepatitis B injections. If the series is in progress, submit a copy of the immunizations received to date. You must remain on schedule for the remaining immunizations and provide the additional documentation. One to two months after your last immunization, it is recommended that you have an HbsAb titer drawn.

OR

3. Submit a copy of your signed Hepatitis B declination noting that by declining the vaccine you continue to be at risk of acquiring hepatitis B, a serious disease.

6. Influenza (Flu Vaccine)

Influenza is a serious contagious respiratory disease which can result in mild to severe illness. Susceptible individuals are at high risk for serious flu complications which may lead to hospitalization or death.

The single best way to protect against the flu is annual vaccination. A flu vaccine is needed every season because: 1). The body's immune response from vaccination declines over time, so an annual vaccine is needed for optimal protection; 2). because flu viruses are constantly changing, the formulation of the flu vaccine is reviewed each year and sometimes updated to keep up with changing flu viruses. The seasonal flu vaccine protects against the influenza viruses that research indicates will be most common during the upcoming season.

Students are required to be vaccinated every flu season and to submit documentation proving annual vaccinations.

To meet this requirement:

Submit a copy of proof of flu vaccine proving annual vaccination.

7. CPR (Basic Life Support) Certification

CPR is a procedure performed on persons in cardiac arrest in an effort to maintain blood circulation and to preserve brain function. DVUSD Nursing students are required to learn CPR by completing an acceptable Basic Life Support course. CPR certification must include infant, child, and adult, 1-and 2-man rescuer, and evidence of a hands-on skills component.

CPR courses are offered at numerous locations throughout the greater Phoenix area. The American Heart Association provides in-person courses and an online course. Students who complete online courses must complete the hands-on skills training and testing. CPR training without the hands-on skills training and testing component will not be accepted.

Students are required to maintain current CPR certification throughout enrollment in the nursing program.

To meet this requirement:

Submit a copy of the signed CPR card (front and back) or CPR certificate.

8. Health Care Provider Signature Form

Must be completed and signed by a licensed healthcare provider (M.D., D.O., N.P., P.A.) within the past six (6) months.

1. Submit a copy of DVUSD athletic clearance for

OR

2. Submit a copy of DVUSD Introduction to Nursing (CAN) Medical Clearance form

To meet this requirement:

Submit a copy of the signed Health Care Provider Signature form completed within the past six (6) months.

9. Proof of Health Care Insurance

Proof of health care insurance. Students are required to maintain current health care insurance throughout enrollment of the nursing program.

To meet this requirement:

Submit a copy of health care insurance card.  

10. Entrance Math/English Exam

All students admitted to DVUSD Nursing are required to show a "Pass" result on the DVUSD Entrance Math/English Exam completed through Canvas. You will need to self-enroll at: https://dvusd.instructure.com/enroll/KPLYR8

To meet this requirement:

Complete the DVUSD Entrance Math/English Exam

11. Background Clearance Document

All students admitted to DVUSD Nursing are required to show a "Pass" result on the DVUSD -required supplemental background screening completed within the first week of class. Information regarding the background clearance is obtained from DVUSD Nursing following your acceptance into the nursing program.

To meet this requirement:

Submit a completed DVUSD background information sheet

IMPORTANT:

• Healthcare students have a responsibility to protect themselves and their patients and families from preventable diseases.

• Students are responsible for maintaining all health and safety requirements and to submit documentation by due date. Failure to maintain program health and safety requirements will result in inability to continue clinical experiences and may result in withdrawal from the nursing program.

• All immunization records must include student name and the signature of healthcare provider.

• Health and safety requirements are subject to change depending on clinical agency requirements.

Health and Safety Requirements Student Worksheet

Use this worksheet as a guide to ensure that you have documentation of each requirement. DO NOT submit this document. Only supporting documents (lab results, immunization records, signed healthcare provider form, etc.) for each requirement should be submitted.

MMR (Measles/Rubeola, Mumps and Rubella) To meet requirement:

1. MMR vaccination: Dates: #1__________ #2__________

OR

2. Date & titer results:

Booster: ___________

Measles: ___________ _____________

Mumps: ___________ _____________

Rubella: ___________ _____________

Varicella (Chickenpox) To meet requirement:

1. Varicella vaccination dates: #1__________ #2__________

OR

2. Date & results of varicella IgG titer: Date: ___________ Result: ______________, Booster: ___________

Tetanus/Diphtheria/Pertussis (Tdap) To meet requirement:

Tdap vaccine: Date: ___________

Td booster: Date: ___________

Tuberculosis To meet requirement:

1. Negative 2-step TB Skin Test (TBST), including date of administration, date read, result, and name and signature of healthcare provider.

Initial Test (#1) Date: __________ Date Read: __________ Results: Negative or Positive

Boosted Test (#2) Date: __________ Date Read: __________ Results: Negative or Positive

2. Annual 1-step TBST (accepted only from continuing students who have submitted initial 2-step TBST)

 Date: __________ Date Read: __________ Results: Negative or Positive

OR

3. Negative blood test (Either QuantiFERON or TSpot)

QuantiFERON Date: __________

T-Spot Date:_________

OR

4. Negative chest X-ray

OR

1. Documentation of a negative chest X-ray (x-ray report) or negative QuantiFERON result.

Date: __________

Hepatitis B To meet requirement:

1. Positive HbsAb titer Date: __________ Result: _____

OR

2. Proof of 3 Hepatitis B vaccinations

Hepatitis B vaccine/dates: #1__________ #2__________ #3__________

        OR

3. Hepatitis B declination- students who choose to decline Hepatitis B vaccine series must submit a HBV Vaccination Declination form.

Flu Vaccine To meet requirement:

Documentation of current annual flu vaccine Date: __________

CPR Card (Healthcare Provider level) To meet requirement:

CPR card or certificate showing date card issued: __________ Expiration date: __________

Background Clearance Document To meet requirement:

DVUSD Background check form filled out, signed and dated

Health Care Provider Signature Form To meet requirement:

Healthcare Provider Signature Form signed and dated by healthcare provider. Date of exam: __________

Proof of Health Care Insurance To meet requirement:

Coverage dates: __________

Background Clearance Document

Full Legal Name

First ________________________________ Middle ____________________ Last _________________________

Social Security Number

_________-_____-_________

All students admitted to DVUSD Nursing are required to show a "Pass" result on the DVUSD -required supplemental background screening completed within the first week of class. Information regarding the background clearance is obtained from DVUSD Nursing following your acceptance into the nursing program.

I (student name) ___________________________ understand and allow DVUSD nursing to run a background check. I understand my background check must show “Pass” to be allowed to participate in DVUSD Nursing program.

Student Print Name                                                                        Student Signature

___________________________________________      ____________________________________ Date____________

Parent / Legal Guardian Print Name                                         Parent / Legal Guardian Signature

___________________________________________      ____________________________________ Date____________

Instructions for Completion of Healthcare Provider Signature Form

A healthcare provider must sign the Healthcare Provider Signature Form within six (6) months of program admission and indicate whether the applicant will be able to function as a nursing student. Health care providers who qualify to sign this declaration include a licensed physician (M.D., D.O.), a nurse practitioner (N.P.), or physician’s assistant (P.A.).

(Please Print)

Applicant Name: _____________________________________ Student ID Number: _______________________

It is essential that nursing students be able to perform a number of physical activities in the clinical portion of the program. At a minimum, students will be required to lift patients, stand for several hours at a time and perform bending activities. Students who have a chronic illness or condition must be maintained on current treatment and be able to implement direct patient care. The clinical nursing experience also places students under considerable mental and emotional stress as they undertake responsibilities and duties impacting patients’ lives. Students must be able to demonstrate rational and appropriate behavior under stressful conditions. Individuals should give careful consideration to the mental and physical demands of the program prior to making application.

I have reviewed the DVUSD Essential Skills and Functional Abilities. I believe the applicant:

______ WILL ______WILL NOT be able to function as a nursing student as described above.

If not, explain:

___________________________________________________________________________________________

___________________________________________________________________________________________

___________________________________________________________________________________________

___________________________________________________________________________________________

___________________________________________________________________________________________

Licensed Healthcare Examiner (M.D., D.O., N.P., P.A.):

Print Name: _____________________________________________ Title: ________________________

Signature: _______________________________________________ Date: ________________________

Address: ______________________________________________________________________________

City: _____________________________ State: _______________ Zip Code: __________________

Phone: _____________________________

Essential Skills and Functional Abilities for Nursing Students

Individuals enrolled in DVUSD Nursing must be able to perform essential skills. If a student believes that he or she cannot meet one or more of the standards without accommodations, the nursing program must determine, on an individual basis, whether a reasonable accommodation can be made. The ultimate determination regarding reasonable accommodations will be based upon the preservation of patient safety.