Public Health Department Policy & Procedure Manual Example


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One dose of influenza vaccine should be administered annually for persons 9 years of age and older. For children under 9 receiving the vaccine for the first time, a second dose should be administered at least one month after the first.
Influenza-associated pediatric deaths, influenza- associated hospitalizations, and influenza A virus infection, novel subtypes are reportable diseases and conditions by law. Quarterly and annual statistics of reported influenza diseases will be reviewed, analyzed, and provided to the Health and Human Services Committee. If needed, a report can be generated by using the Registry for Effectively Communicating Immunization Needs (RECIN) to determine influenza immunization rates for any age group of Pepin County residents.

  • Epidemiology and Prevention of Vaccine-Preventable Disease, most recent edition.

  • Division of Public Health Immunization Policy Manual

  • ACIP Guidelines for Vaccine Recommendations and Administration

  • Pepin County Health Department Public Health Program Standing Orders

  • Wisconsin Statute 252.04 Immunization Program

  • Wisconsin Statute 252.041 Compulsory vaccination during a state of emergency

  • Wisconsin Statute 252.05 Reports of Cases

  • Wisconsin Statute 140.05 (16)

  • Wisconsin Statute 441

  • Wisconsin Statute 448

POLICY TITLE: Testing vaccine alarm system



AUTHORIZED BY: Heidi Stewart, BSN, Health Officer / Director
To protect the vaccine inventory in the event of an emergency.
Pepin County Health Department will protect the vaccine inventory and minimize potential monetary loss by testing the vaccine alarm system at least every six months.
Pepin County Health Department will test the alarm system of the vaccine refrigerator/freezer at least every six months. If an actual alarm goes off within the six month period; it can be counted as a test. Log the date and time of the test/alarm on the monthly temperature log located on the side of the vaccine refrigerator/freezer.
Back-up Generator:

The vaccine refrigerator/freezer is connected to a back up generator that automatically provides power to the storage unit to maintain the recommended storage temperatures in the event of a power outage.

Sensaphone 400:

A continuous monitoring temperature alarm/notification system is in place to help prevent substantial financial loss if the temperature in the storage unit malfunctions. This system will alert staff during after hour emergencies. If the unit exceeds the recommended temperature ranges, an audible alarm sounds and notices are sent to designated persons as listed:

Sheriff’s Department (715-672-5944)

Health Director/Director (715-495-7630)

On-call nurse (715-495-7631).

For further information, see immunization policy and procedure manual.



POLICY TITLE: Vaccine Receiving and Shipment Unpacking



AUTHORIZED BY: Heidi Stewart, BSN, Health Officer / Director
To assure the vaccine cold chain is maintained.
Pepin County Health Department offers immunizations to children via the Vaccines for Children Program. Vaccine is handled and stored according to Wisconsin DPH and CDC recommendations, ensuring the integrity of the vaccine.

Arrange for vaccine deliveries to be made only during office hours.If the vaccine coordinator or backup person is not on duty, all staff members who accept vaccine deliveries must be aware of the importance of maintaining the cold chain and on the need to immediately notify the vaccine coordinator or backup person of the arrival of the vaccine shipment so that it can be handled and stored appropriately.

Checking the Condition of a Shipment:
Vaccine shipments must be examined immediately upon receipt.

 Examine the shipping container and contents for any signs of physical damage.

 Determine if the shipping time was less than 48 hours. If the interval between shipment from the supplier and arrival of the product at the Health Department’s office was more than 48 hours, the vaccine could have been exposed to excessive heat or cold that might have altered its integrity.

 Crosscheck the contents with the packing slip to be sure they match and then date stamp the packing slip and give to vaccine coordinator.

 Check the vaccine expiration dates to ensure that you have not received any vaccine or diluent that is already expired or that has a short expiration date.

 Check that lyophilized (freeze-dried) vaccine has been shipped with the correct type and quantity of diluent for reconstitution.

 Examine the vaccine and diluent for heat or cold damage:

    • Check the cold chain monitor to see if the vaccine or diluent has been exposed to temperatures outside the recommended range during transport.

    • Check that inactivated vaccines are cold but not frozen. Refrigerated packs should still be cold. Frozen packs can be melted but the package should still be cold. Vaccines should not be in direct contact with refrigerated/frozen packs.

There should be an insulating barrier between the vaccine and the refrigerated/frozen packs, such as crumpled brown packing paper, bubble wrap or some other barrier.

    • Check that varicella vaccine is frozen and that dry ice is present in the shipping container. Dry ice must be handled carefully. Leave dry ice in the shipping container to evaporate. This should be left in a well ventilated area away from children.

    • Check that the diluent is cool or at room temperature. Diluent should not be in direct contact with refrigerated/frozen packs. There should be an insulating barrier between the diluent and the refrigerated/frozen packs, such as crumpled brown packing paper, bubble wrap or some other barrier. The diluent for varicella vaccine may be shipped with its vaccine but should not be placed in the container with the dry ice.

If there are any discrepancies with the packing slip or concerns about the shipment, immediately notify the primary vaccine coordinator (or the backup person), mark the vaccine and diluent as “DO NOT USE”, and store them in proper conditions apart from other vaccine supplies until the integrity of the vaccine and diluent is determined. Contact the vaccine manufacturer and the State Immunization Program (608-266-1506) for further guidance.

Once vaccine shipment has been checked according to the procedures described above, immediately store the vaccine and diluent at the recommended temperatures (varicella gets placed in the freezer and all other vaccines get placed in the refrigerator). Do not leave the shipment unattended. The vaccines inside might warm to inappropriate temperatures and become unusable. All staff who may accept packages must be aware that vaccine shipments require immediate attention. Staff who do not routinely handle vaccines but who accept vaccine shipments should alert the primary vaccine coordinator (or the designated backup person) as soon as vaccine shipments arrive so that they may be stored properly.

For further information, see immunization policy and procedure manual.

  • Wisconsin Department of Health Services

  • Centers for Disease Control

POLICY TITLE: Client Transfers and Referrals



AUTHORIZED BY: Heidi Stewart, BSN, Health Officer / Director
To assure the needs of clients are being met and appropriate care is being provided.


The Pepin County Health Department may transfer clients or make referrals to other agencies for the following reasons: continuing care through the health department is not appropriate; there is a change in the medical/treatment program, the client moves out of the country.

1. Clients having needs that the health department cannot meet shall be referred to another agency, social service organization, or governmental unit that is appropriate for the unmet needs of the client. This includes referrals to meet the needs of clients for services needed at times before and after normal business hours at the health department. Permission will be obtained from the client prior to making the referral.

2. Clients whose needs change significantly and who require care that cannot be provided by the health department are given immediate notice and assistance in selecting another health care agency to meet their needs.

3. The registered nurse will:

a) inform the client and family of the need for the transfer/referral;

b) involve the client and family in the decision making process regarding the arrangements;

c) serve as a liaison between the client, family, and physician relative to the transfer/referral arrangements

d) verbally confirm the client transfer arrangements with and give information to the receiving

health care provider;

e) obtain the client’s signature on the release of information form;

f) document reasons for the transfer/referral in the client’s health care record


POLICY TITLE: Emergency Administration of Epinephrine

EFFECTIVE DATE: 07/01/2007


AUTHORIZED BY: Jen Rombalski, Health Officer
To provide the necessary information and guidelines to educate and train BCDHHS Public Health Nurses and Registered Nurses in the specific use and administration of Epinephrine 1:1000 solely for the emergency management of a person suffering from an anaphylactic reaction.
Public Health Nurse

Registered Nurse


  1. Conduct scene safety to assure that patient, workers, and bystanders are separated from the allergen.

  2. Patients with an anaphylactic reaction may initially present with airway/respiratory compromise or airway/respiratory compromise may develop as the allergic reaction progresses. Not all signs and symptoms are present in every case. When signs and symptoms of allergic reaction include respiratory distress or shock, assume that it is anaphylaxis. CALL 911 IMMEDIATELY and LIE PATIENT FLAT WITH FEET ELEVATED!

  3. ASSESSMENT of anaphylactic/allergic reaction:

  1. Perform initial assessment

    • Perform airway, breathing, and circulation procedures as necessary
    • Determine patient transport priority

  1. History-interview individual, family and/or bystanders

    • Has this happened before?

    • When did it start?

    • What happened before reaction started?

    • Did patient eat anything?

    • Did anyone smell anything?

    • Did patient feel anything?

    • Did patient take anything?

    • Did anyone, including patient, give Epinephrine dose already?

    • Does patient have history of cardiac problems?

  1. Perform focused assessment. Observe for signs and symptoms of anaphylactic reaction:

    • Dyspnea

    • Altered level of consciousness

    • Altered speech or inability to speak

    • Restlessness

    • Signs of upper respiratory distress in anaphylaxis

    • Hoarseness

    • Stridor

    • Pharyngeal edema

    • Patient report of tight chest or throat

    • Cough

  1. Signs of lower respiratory distress in anaphylaxis

  • Tachypnea

  • Hypoventilation

  • Labored accessory muscle use

  • Abnormal retractions

  • Prolonged expirations

  • Wheezes (audible with stethoscope)

  • Diminished lung sounds

  1. Skin Changes in anaphylaxis

  • Redness

  • Rashes

  • Edema

  • Moisture

  • Itching

  • Uticaria

  • Pallor

  • Cyanosis

  1. Cardiovascular/Vitals in anaphylaxis

  • Tachycardia

  • Hypotension

  1. Gastrointestinal in anaphylaxis

  • Abdominal cramping

  • Nausea/vomiting

  • Diarrhea

Note: Be certain the signs and symptoms are those of anaphylaxis and not of a stage of heart disease (congestive heart failure), psychosis, hypertension history, COPD, glaucoma, pulmonary edema, hyperthyroidism, or pregnancy.

  1. Identify need for medication based on patient history and presenting signs and symptoms. Inquire as to whether anyone, including the patient, has administered Epinephrine already. If not, gather supplies as follows:

SUPPLIES: (will be found in “kits” in 3 locations in the clinic lab)

  • Aqueous epinephrine 1:1000 dilution, in ampules

  • Filter needle

  • Syringes: 1cc, 22-25 g, 1” and 1 ½” needles for epinephrine

  • Pediatric and adult airways (small, medium and large)

  • Sphygmomanometer (child, adult & extra large cuffs) and stethoscope

  • Pediatric and adult size pocket mask with one-way valve

  • Alcohol swabs

  • Tongue depressors

  • Flashlight with extra batteries (for examination of mouth and throat)

  • Wrist watch

  • Tourniquet

  • Cell phone or access to land line


CAUTION: Avoid possible inadvertent intravascular administration. DO NOT INJECT INTO BUTTOCK. DO NOT INJECT INTRAVENOUSLY. Large doses or accidental intravenous injection of epinephrine may result in cerebral hemorrhage due to sharp rise in blood pressure. Rapidly acting vasodilators can counteract the marked pressor effects of epinephrine.

ADMINISTER Epinephrine 1:1000 as follows:

  1. Be conscientious of blood borne pathogen precautions.

  2. Check to see that the Epinephrine is not expired or discolored.

  3. Place filter needle on a 1 cc syringe. Tap the solution within the ampule out of neck; break open ampule by covering with paper towel and snapping neck of ampule by pulling top of ampule toward you while pushing neck of ampule away from you.

  4. Draw correct dose into syringe. See table below:


Weight in kg

Weight in lbs

Epinephrine Dose

1mg/mL injectable (1:1000 dilution) IM

1-6 mos

4-7 kg

9-15 lbs

0.05mg (0.05 mL)

7-18 mos

7-11 kg

15-24 lbs

0.1mg (0.1 mL)

19-36 mos

11-14 kg

24-31 lbs

0.15 mg (0.15 mL)

37-48 mos

14-17 kg

31-37 lbs

0.15 mg (0.15 mL)

49-59 mos

17-19 kg

37-42 lbs

0.2 mg (0.2 mL)

5-7 yrs

19-23 kg

42-51 lbs

0.2 mg (0.2 mL)

8-10 yrs

23-35 kg

51-77 lbs

0.3 mg (0.3 mL)

11-12 yrs

35-45 kg

77-99 lbs

0.4 mg (0.4 mL)

13 yrs & older

45 + kg

99 + lbs

0.5 mg (0.5 mL)

  1. Remove filter needle and discard in sharps container.

  2. Place 1” or 1 ½” (depending on size of patient), 22-25 gauge needle on syringe

  3. Cleanse patient muscle (deltoid for adults or children; vastus lateralis for infants) with alcohol pad

  4. Inject needle intramuscularly (IM).

  5. Apply a band-aid to the injection site.

  6. Do not recap needle.

  7. Place needle and syringe in sharps container.

  8. Reassess patient. After 10 minutes, if no signs of improvement, administer an additional dose, for up to 3 doses max!!

  9. If additional dosage is needed, draw up using new filter needle and new syringe.

  10. Repeat steps d through k above.

  1. Record all vital signs (taken every 5-10 minutes until stable) and the injection in Progress Notes (PHN0015). Include information regarding date, time, medication administered, dose administered, route and location (anatomical) administered, name of person who administered the medication, and any patient physiological responses to the medication.

  2. Route an ICF to Supervisor with Progress Notes to open/close a case regarding the incident.

  3. If the anaphylaxis occurred following an immunization, the event must be reported to VAERS (1.800.822.7967) or

  4. ADVERSE REACTIONS TO EPINEPHRINE can occur, as follows:

  • Ventricular arrhythmias

  • Precipitation of angina or myocardial infarction

  • Tachycardia

  • Anxiety

  • Hypertension

  • Headache

  • Pallor

  • Dizziness

  • Nausea

  • Vomiting

  1. If patient is having an ALLERGIC REACTION: Patient has contact with a substance that causes an allergic reaction without signs of respiratory distress or shock (hypoperfusion).

  • Continue with focused assessment. Patients who are wheezing without signs of respiratory compromise or hypotension should not receive Epinephrine.

  • Perform non-pharmacological interventions (i.e.: treat for shock including positioning with head flat and feet raised and cover with a warm blanket).

  1. Record assessment findings and reassess in two minutes. Use Progress Notes (PHN0015) to document situation. Initiate Initial Contact Form (ICF) (PHN0157) and route to Supervisor to open as a case.

  2. For anaphylactic reactions, notify the patient’s primary care physician.


General Recommendations on Immunization: Recommendations of the ACIP, MMWR,

December 1, 2006, Vol. 55, No. RR-15.

POLICY TITLE: Pepin County Health Department Facebook Page



AUTHORIZED BY: Heidi Stewart, BSN, Health Officer / Director

To inform the community of health related topics: including, but not limited to: health tips, newly published research, product recalls, health department and other applicable events, and health department activities.

The Pepin County Health Department will maintain an up to date Facebook page to inform the community of health related topics.

The Pepin County Health Department Facebook Page will provide information about the Pepin County Health Department. This information will include: mission statement, locations, phone numbers, hours, and website URL. Staff will attempt to update the Facebook page at least once a day during the work week.
Information provided in daily updates may include:

  • Health tips

  • Recall information

  • Immunization information

  • Upcoming events for the health department and other related events

  • Health related video links

  • Other applicable information


All page updates are visible at and can be viewed at any time. Posts can be deleted at any time if needed


POLICY TITLE: Media Communications



AUTHORIZED BY: Heidi Stewart, BSN, Health Officer / Director
To assure accurate appropriate and timely information is communicated to appropriate audiences and to facilitate consistent messaging among public health system partners.


Pepin County Health Department is committed to providing accurate and timely information to the public, policy makers, partner agencies, and other appropriate audiences. At the same time, it is important to coordinate messaging with public health system partners who may be communicating with others on a public health related topic. This policy and procedure is intended to guide health department staff in making decisions about communications that will be released outside the agency.
Emergency Communications:

The Pepin County Public Information Officer is responsible for coordinating communication efforts during an emergency and will work in tandem with the Health Officer in developing statements for release. Final approval for releases during a public health emergency will come from the Health Officer. Because the media often work on tight deadlines, it is important that any Health Department staff member who is contacted by the media get the request to the Health Officer as soon as possible. See the Public Health Emergency Plan (PHEP) for more details.

General Day-to-Day Inquiries:

During non-emergency situations, the Health Officer will serve as Public Information Officer.

  1. Requests for interviews in response to a submitted press release should go to the primary contact on the press release.

  2. Cold calls from the media should be directed to the Health Officer. If the Health Officer determines a member of the staff as a particular expertise in an area of the inquiry, he/she should direct the call to that staff member and properly notify the staff member of the request to speak to the press.

  3. Follow-up calls on a story recently reported may go to the staff member who was interviewed for the story.
  4. If at any time a staff member feels unprepared or uncomfortable with the nature of the reporter’s questions, he/she should stop the interview and direct the reported to a member of the management team.

  5. A staff member shall notify his/her supervisor immediately (via voicemail, e-mail, or personal contact) when a media interview has been done.

  6. Whenever an interview is done, the staff member shall document with whom he/she spoke and what media outlet the reporter represents as well as the topic area. This may be done in Nightengale Notes.

  7. If the media inquiry affects other public health system partners, notify them as soon as possible about the nature of the inquiry and the information provided to the media to help assure a consistent message among partner organizations. If time permits, it is preferable to get input from affected partners as to the content of the message relayed to the media.

  8. If a member of the public, health care provider or a member of the governing body requests a statement or information regarding a specific health department program or service, the inquiry will be sent directly to the Health Officer.

Press Releases:

  1. A written press release is a good method to share information about emerging and/or urgent health topics, new programs, follow-up to recently covered issue, or to get a message out in general.

  2. Prior to distribution, all written press releases will be reviewed by the Health Offier.

  3. All press releases must include the primary staff person’s contact information, including a telephone number, as well as a date.

  4. A current media contact list can be found in the Public Health Emergency Plan (PHEP).

  5. If the press release is related to the work of other public health system partners, develop the release collaboratively to assure a consistent message is being delivered by partner organization/agencies and share the final release with all appropriate partners.

Media Interview Tips:
    • Educate the reporter. Don’t assume he/she has all the facts. Prepare a written fact sheet to reduce the likelihood of reporting errors.

    • Consider who the audience for the information will be and what your main message is. Stay on message and try to connect it to the overall mission of the health department.

    • Plan your “sound bite”. This is the one sentence that is most important for you to communicate (7-9 seconds).

    • Use common, easy to understand language that is passionate and paints a clear picture.

    • Remember that the best messages tell us why the issue/program/policy/case is important. What is the point you want everyone to remember? Why do you want to get across the audience no matter what?

    • Don’t wait to be asked your message. Volunteer it, repeat it several times, and always come back to it.

    • Anticipate questions and prepare answers to those questions.

    • Use proper grammar and speak in an easy to understand language with no jargon or acronyms.

    • Remember that the camera/microphone is always on and nothing is “off the record”.

    • Never lie, speculate, or guess

    • If you don’t know, say so

    • Don’t get defensive or angry

Media Release Tips:

  • Identify that the article is a News Release at the very top of the printed document

  • Provide a caption (or headline) to identify the subject of the announcement

  • Provide contact information for the primary staff person who can answer follow-up media inquiries

  • Indicate the date of the release

  • Number all pages

  • Put (MORE) at the bottom of a page when the content of a news release will extend onto an additional page

  • Mark the end of the release with a symbol noting the end of the document – usually ### or XXX or -30- or END

  • Double check all facts and be sure to use good grammar. Do not use any acronyms or jargon.

All work with the media and advocacy efforts are tracked by the management team as part of the Health Department Strategic Planning process to determine whether media goals outlined in the strategic plan are met.


POLICY TITLE: Social Media



AUTHORIZED BY: Heidi Stewart, BSN, Health Officer /Director
This policy governs the publication of and commentary on social media by employees of the Pepin County Health Department (PCHD). For the purposes of this policy, social media means any online publication and commentary, including without information blogs, wiki’s, social networking sites such as Facebook, LinkedIn, Twitter, Flickr, and YouTube. This policy is in addition to and complements any existing or future policies regarding the use of technology, computers, e-mail and the internet.


Pepin County Health Department (PCHD) may utilize social media and social network sites to further enhance communications with various stakeholder organizations in support of agency goals and objectives. This includes the use of social networking to communicate and engage with the general public and partners on upcoming flu clinics and other events, educating the community on various public health topics, notifying the community and partners on recalls, and so forth. In addition, social media can be used to keep the community and partners informed real-time of public health emergencies such as acts of bioterrorism, large scale disease outbreaks, and other public health emergencies. A 2010 study conducted by the National Chapter of the American Red Cross concluded that social media could be an effective tool in emergency response. The ARC found that if individuals needed help and couldn’t reach 9-1-1, one in five would try to contact responders through a digital means such as e-mail, websites or social media. If web users knew of someone else who needed help, 44 percent would ask other people in their social network to contact authorities, 35 percent would post a request for help directly on a response agency’s Facebook page and 28 percent would send a direct Twitter message to responders.


  1. All PCHD social media sites shall be (1) approved by the Director; (2) published using approved social networking platform and tools.

  2. PCHD staff shall not use personal profiles in participating in any social networking site as representatives of the PCHD. Instead, PCHD employees must set up a PCHD profile using their PCHD email. The PCHD will keep a log of PCHD staff that are approved to participate or facilitate on social networking sites, the name of the site, the purpose of the site, and applicable usernames and passwords.

  3. The PCHD has the right to audit at any time any social networking site that PCHD employees are involved with.

  4. All PCHD social networking sites shall adhere to applicable state, federal and local laws, regulations and policies including all applicable County policies.

  5. Freedom of Information Act and e-discovery laws and policies apply to social media content and therefore content must be able to be managed, stored and retrieved to comply with these laws.

  6. Publication and commentary on social media carries similar obligations to any other kind of publication or commentary.

  7. All uses of social media must follow the same ethical standards that PCHD employees must otherwise follow.

  8. PCHD social networking sites are subject to public records laws.

  9. All social network sites and entries shall clearly indicate that any articles and any other content posted or submitted for posting are subject to public disclosure.

  10. The PCHD reserves the right to restrict or remove any content that is deemed in violation of this policy or any applicable law.

  11. Where possible, social networking sites should link back to the official PCHD website.
  12. PCHD social networking content and comments containing any of the following forms of content shall not be allowed for posting on either any PCHD facilitated / owned social networking site or any other social networking site that the PCHD participates in:

  • Comments not topically related to the particular site or blog article being commented upon

  • Political views, including lobbying

  • Profane language or content

  • Content that promotes, fosters, or perpetuates discrimination on the basis of race, creed, color, age, religion, gender, marital status, status with regard to public assistance, national origin, physical or mental disability or sexual orientation;

  • Sexual content or links to sexual content

  • Solicitations of commerce

  • Conduct or encouragement of illegal activity

  • Information that may tend to compromise the safety or security of the public or public systems

  1. In the event that any of the above content or comments are posted to a PCHD facilitated and / or owned social network site, the PCHD will promptly delete such comments, and if applicable, block or remove the individual from the social network site.

  2. Where appropriate, County IT security policies shall apply to all social networking sites and articles.

  3. Employees representing the PCHD or the County government via social media outlets must conduct themselves at all times as a representative of the PCHD and in accordance with all human resource policies.

  4. PCHD employees may not present themselves as PCHD employees in neither social networking sites not approved per this policy nor social networking sites that are deemed non-work related and are of the personal nature.

  5. The PCHD will be responsible for providing annual training to all PCHD employees on the use of social media and social networking tools.
  6. Employees found in violation of this policy may be subject to disciplinary action, up to and including termination of employment.



POLICY TITLE: Fluoride Rinse Program



AUTHORIZED BY: Heidi Stewart, BSN, Health Officer / Director
To improve the oral health of children in Pepin County by providing fluoride rinse to children.
Pepin County Health Department receives funding from the Wisconsin Division of Public Health to purchase fluoride rinse supplies for the Durand and Pepin School Districts. Supplies are then distributed to classrooms by health department staff located in each school district.

All children in grades K-8 are eligible to participate in the weekly fluoride rinse program. A parent or guardian signature is required.

Rinsing Process:

  1. When all children have their filled cups of fluoride rinse (Kindergarten is 5 ml, grades 1-8 is 10 ml) and their napkins in their hands, the teacher/aid will remind them not to swallow the solution.

  2. All children will be asked to slowly empty the contents of the cup into their mouths and will rinse for one minute. The teacher/aid will tell them when to start and stop.

  3. After one minute, the children will be directed to expectorate the solution back into their cups, blot their lips with the napkin, and slowly stuff the napkin into the paper cup to absorb the liquid. The cups will then be discarded into a plastic lined garbage can or a plastic bag.
  4. The children are then instructed not to eat or drink for 30 minutes after the fluoride rinse process is completed.

Correct Rinsing:

To rinse correctly with maximum results, the solution should be swished all around the teeth, and strained back and forth through the spaces between the front and back teeth. The cheeks and lips should puff rhythmically. Some children may just shake their heads back and forth, but this will not accomplish a good rinse

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