General Policies & Procedures: Blood-Borne Diseases Policy

Policy for Medical Students and Residents with Blood-Borne Diseases

This policy relates to medical students and residents who are infected with one or more of the following blood-borne diseases: Hepatitis C Virus and who are antibody positive, (HCV); Hepatitis B Virus and who are surface antigen positive, (HBV); or Human Immunodeficiency Virus (HIV).  It is premised on the understanding that the medical, scientific and legal principles of blood-borne infections are still evolving, and that the University of Minnesota Medical School will respond to the challenges presented by these infections with sensitivity, flexibility, and the best current medical, scientific, and legal information available.

Protocol for Exposure to Blood-Borne Pathogens During Educational Experiences

1. Perform basic first aid and wash exposed area.
   
   Clean the wound, skin or mucous membrane immediately with soap and running water.  Allow blood to flow freely from the wound.  Do not attempt to squeeze or “milk” blood from the wound.
   
   If exposure is to the eyes, flush eyes with water or normal saline solution for several minutes.
   
2. Report the needlestick to your supervising preceptor or designated person and proceed to the recommended facility for an assessment of the exposure.
   
3. Secure information about the source patient with the help of your preceptor and/or the recommended facility.
   
4. Use the institution’s standard procedures to assess the source patient.
   
5. If assessments indicate a high risk of infectious disease, seek prophylactic medication treatment within two hours of exposure.  Your immediate supervisor will suggest a site for initial treatment.
   
6. Whatever the risk assessment, every resident or fellow with a needlestick must complete a follow-up exam within 72 hours of exposure.
   
7. Contact your training program coordinator to file a worker’s compensation claim.
   
8. If infected with HCV, HBV, or HIV, you must report this infection to the Blood-Borne Infectious Disease Review Panel by contacting the Associate Dean for Graduate Medical Education at 612-626-4009.  This report is not only a professional responsibility; in cases of HIV and HBV, it is also required by state law.

Status, Accommodations and Testing
No student or resident shall be denied acceptance into the medical school or residency programs on the basis of HIV, HBV, or HCV serostatus.  Evaluation for admission and continuation in the programs will focus on whether the individual in his or her current state of health, with reasonable accommodations, will be able to successfully complete the essential elements of the educational program.

The Medical School will work with the infected student or resident and the University’s Office of Disability Services to provide reasonable accommodations where needed.  An accommodation is not considered reasonable if it alters the fundamental nature or requirements of the educational program, imposes an undue hardship, or fails to eliminate or substantially reduce a direct threat to the health or safety of others.

No student or resident will be required to undergo HIV testing.  It is the responsibility of the individual medical student or resident who suspects that he or she may be at risk for HIV, HBV, or HCV infection to ascertain his or her serostatus.  Depending on the requirements of clinical sites, medical students and residents may be required to be immunized against HBV.

Prevention of Tuberculosis During Educational Rotations
In accordance with OSHA regulations for health care workers, AHC students will be required to complete mask fit testing.  Students will carry documentation of testing and the mask requirements during rotations.

Reporting and Confidentiality
Medical students or residents infected with HCV, HBV, or HIV have a professional responsibility to report their serostatus to a member of the Blood-Borne Infectious Disease Review Panel (“Review Panel”) in the Medical School. Consistent with the self-reporting requirements imposed on physicians and other regulated healthcare workers under Minnesota law, Minn. Stat. ß 214, this reporting obligation shall be mandatory for students and residents infected with HIV or HBV.  Failure to self-report is basis for disciplinary action by the Medical School.

The clinical sites where students and residents train also may have reporting requirements depending on the procedures and activities to be performed by the medical student or resident.  Students and residents who wish to perform exposure-prone invasive proceduresat a clinical site as part of their education and training must comply with all review, disclosure and infection control requirements at that site.  Another potential option that may preserve greater confidentiality for the student or resident is to restructure the clinical experience to avoid participation in any exposure-prone procedures.  As outlined below, the Medical School Review Panel will work with the affected student or resident and the clinical site(s) to help shape the appropriate educational experience.

Confidentiality of all information about HIV, HBV, or HCV status will be maintained pursuant to state and federal laws.  The individuals who will be informed of the student’s or resident’s serostatus are members of the Review Panel, designated representative(s) of the clinical site to the extent required by the site’s policies, and the Office of Disability Services if the student or resident requests accommodations.  Faculty who are providing modifications in the student’s or resident’s educational program will be informed that the individual has a blood-borne infectious disease, but will not be notified of the particular disease.

Review Panel
The members and the chair of the Review Panel will be appointed by the Dean of the Medical School for staggered terms of three years.  There is no limit on the number of terms that may be served. The Review Panel will include two members of the full-time University faculty with expertise in infectious disease (ID members) and two members of the full-time University faculty who perform surgical or obstetrical procedures that involve surgical entry into tissues, cavities, or organs (EPP members).  The Chair, also a member of the full-time University faculty, may be drawn from any discipline.

Each individual case will be managed by a sub-committee of the Panel selected by the chair that includes an ID and EPP Review Panel member, as well as the Associate Dean for Student Affairs in cases affecting medical students or the appropriate residency program director in cases involving residents.  The Associate Dean for Student Affairs will assure that any modifications to the curriculum for an infected medical student have the written approval of the Senior Associate Dean for Education.  The Senior Associate Dean for Education will report the modifications to the Committee on Scholastic Standing.  In cases involving residents, the residency program director will assure that the head of the training program approves any modifications to the resident’s training experience.

Once a member of the Review Panel has been notified, a sub-committee will be chosen by the Panel’s Chair.

The ongoing responsibilities of the Panel are to:

1. Support the student or resident in receiving satisfactory medical and emotional care and in following treatment recommendations.
   
2. Ensure that the student or resident is aware of any necessary precautions to be taken in patient care activities to avoid the transmission of the infection to any other person and recommend any modifications in the educational program needed for this purpose.
   
3. Serve as a liaison with the clinical site(s) to help shape the student’s or resident’s educational experience.
   
4. Offer career counseling and specialty selection assistance.
   
5.  Inform the student or resident of possible signs of progress of the disease that might interfere with his or her physical or emotional ability to fulfill patient care or other educational requirements of the MD or residency program.
   
6.  Discuss with the student or resident whether he or she may have participated in patient care activities in which an injury to that student or resident would have led to contamination of a patient with the student’s or resident’s blood.

All modifications must be approved by the Review Panel as a whole.

The Medical School recognizes that it is possible for an individual infected with HCV, HBV, and/or HIV to practice medicine, and to practice many specialties unimpeded by disease specific restrictions.  Therefore, the school will provide assistance to any student or resident infected with these diseases to complete their MD or residency program requirements subject to considerations that it deems in its best judgment are appropriate to the circumstances of each individual case.