A Kirkland special-education student, who needs extensive help during the day with personal care, returned to class despite protests by aides who say her contagious C. diff infection creates an unsafe workplace.

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A special-education student diagnosed with a C. difficile gut infection has returned to Robert Frost Elementary School in Kirkland over the protests of support staff who say the girl poses a “biohazard” risk and creates an unsafe work environment for those who fear they’ll catch the highly contagious bacterial disease.

Union officials representing paraeducators and bus drivers had demanded last month that the child be kept out of school until officials with the Lake Washington School District proved the classroom environment and cleaning protocols were safe.

District officials and the girl’s parents said the student had recovered sufficiently to return and doctors said the infection likely posed little danger.

Paraeducators, or classroom aides, however, said they were at high risk for infection because they must change the child’s diapers multiple times a day and the Clostridium difficile, or C. diff, bacteria are spread by contact with fecal material.

The case highlights the challenges that come with making sure children with disabilities are accommodated in a public-school setting, union officials said.

C. diff germs cause nasty, drug-resistant infections that can lead to devastating diarrhea and potentially deadly complications, especially among the elderly and the sick, according to the Centers for Disease Control and Prevention (CDC). The illnesses are often triggered by antibiotic use that kills “good” bacteria in the gut, allowing C. diff to flourish.

The CDC reported Feb. 26 that C. diff now infects nearly half a million people a year in the U.S. and causes 15,000 deaths.

“A public-school classroom is not the appropriate setting, nor are the Para Educators the appropriate people to provide daily medical care to a patient infected with a serious, communicable disease,” wrote Liz Brown, business agent for the Teamsters Local 763, in a Feb. 18 letter to the school district. The union represents about 200 paraeducators and 100 bus drivers in the Lake Washington district.

The district has a duty under Washington law to provide a workplace free from recognized dangers and to warn employees of “biohazards,” including agents transmitted by handling waste, the letter said. People older than 65 are among those most vulnerable to C. diff, and several of the paraeducators are in their 60s, Brown added.

But the district also has a duty under federal law to provide disabled students with access to education, school officials noted.

Special precautions in place

The child, who has limited communication skills and uses a wheelchair, was first diagnosed with C. diff last fall, according to Wynn Spaulding, the district’s associate director of special education, who oversees Frost Elementary. The child’s parents granted permission for district officials to discuss her case.

The girl remained home for months, without education services. In late January, doctors told district officials she was healthy enough to return to school, although, for now, she continues to test positive for C. diff bacteria. State guidelines allow students and staff with C. diff to return to the classroom after they’ve been free of diarrhea for 48 hours.

The girl returned to class Feb. 24. Upon her return, district officials launched new protocols that call for gloves, gowns and face masks when helping the child with toileting.

In addition, staff are required to undress the child when she arrives at school, dress her in clean clothes and then wash her clothing with hot water and detergent on site. All surfaces are sterilized with chlorine-bleach wipes, including her wheelchair from home, which is cleaned and bagged for the day. She uses another wheelchair while at school.

Officials said precautions and protocols were put in place to prevent spreading C. diff to staff or fellow students.

“The District expects that strict compliance with these procedures will allow the Frost staff to continue safely supporting all of our students in the continued access to their public school education,” Paul Vine, the district’s special-services director, wrote in a letter responding to the union.

If such protocols are followed, potential infections should be halted, said Dr. Jeffrey Duchin, interim health officer for Public Health — Seattle & King County.

“The guidelines, I think, are important,” he said. “I don’t think it presents a high level of risk to the staff.”

Duchin and other infection-control experts emphasized that such care must be “meticulous” to succeed.

“They would have to function the way nursing staff does in a hospital,” said Dr. William Schaffner, an infectious-disease expert at Vanderbilt University in Nashville.

C. diff common, officials say

Union officials said the aides and bus drivers received training that allows them to care for the students in the special-education classroom at Robert Frost, including three medically vulnerable students. That includes instruction in handling blood-borne pathogens and specialized duties depending on the student.

But they are not health-care workers, Brown said. “They have not been trained to develop the habits by which doctors, nurses and other health-care professionals reduce their exposure to bacteria and other pathogens,” she wrote.

At least three staffers at the school, including one paraeducator, have contracted C. diff infections in the past three years, Brown said. One paraeducator asked to be transferred to another classroom because she was taking antibiotics, which make people more susceptible, Brown added.

However, Duchin noted the infections are increasingly common and that staff members could have become infected in places other than the classroom.

Because of health-privacy rules, district officials haven’t informed other staffers or the parents of children in the class about the child’s C. diff infection. The paraeducators have “grave concerns” that the student will expose other students to the potentially dangerous germ, the union letter said.

Most C. diff infections, nearly two-thirds, are associated with health care, but the infection is increasingly transmitted in community settings, the CDC study reported.

Duchin and other health officials noted that despite worries, C. diff is not a condition that must be reported to the state health department, and many people are colonized with the bacteria, meaning they can harbor the germs in their bowels without being sick themselves. It’s not known, for instance, how many children in any classroom at any school are colonized with C. diff and able to transmit infections, Duchin said.

Paraeducators “do God’s work”

Concern over C. diff in a school setting was apparent earlier this year when officials in Perth Amboy, N.J., closed a middle school for a week to disinfect the campus after a staff member was diagnosed with C. diff.

The move drew criticism from some medical experts who said officials overreacted.

Dr. L. Clifford McDonald, the CDC’s C. diff expert, said he has been consulted on only two or three school-related cases in the past 11 years, despite a spike in the infections nationwide. Research shows there may be a small increased risk in those who care for diapered children or for household members with C. diff, he noted.

“Overall, these routes of transmission appear, right now at least, to be very small contributors to the overall burden of disease and C. difficile is found, at low levels, to be widespread in the environment,” McDonald said in an email.

If concerns about C. diff infection persist, Brown said she’d file a complaint with the state Department of Labor and Industries. A spokeswoman said the agency frequently investigates complaints that infectious diseases pose workplace hazards.

Neither Brown nor district officials said they thought the conflict would affect student care in the classroom.

“All of our staff are very professional,” said Spaulding.

“My paraeducators, they do God’s work,” added Brown.