SA-4412 Students Known to be Infected with a Bloodborne Pathogen

1.0        Purpose

The purpose of this policy is to outline the VTCSOM approach to a student who is known to be infected with a bloodborne pathogen (BBP). For the purposes of this policy, the term bloodborne pathogen will refer specifically to HIV (human immunodeficiency virus), HBV (hepatitis B virus), and HCV (hepatitis C virus). Evidence of an active transmissible infection with these pathogens is the detection of a circulating virus by standard clinical laboratory testing. 

It should be noted students who do not perform exposure-prone invasive procedures, as defined in this policy, are unlikely to present a BBP infectious risk to patients under normal conditions, provided that they routinely practice standard universal precautions. 

2.0        Policy

A student who suspects or is aware that he/she is harboring a bloodborne pathogen must report to the Associate Dean for Student Affairs for direction in treatment and work limitations. 

A student who suspects or is aware that he/she is harboring a bloodborne pathogen must also inform Carilion Clinic Employee Health and follow any guidance provided consistent with what is provided for other healthcare workers. Once it has been determined that the student does have a BBP infection, the following procedures will be followed. 

3.0        Procedures

• The student will be given a list of providers who treat these bloodborne pathogen diseases. Seeking treatment and choice of provider is at the discretion of the student. The student will be informed that with successful treatment, the restrictions outlined below may not have to be imposed.
• Students who are determined to have an undetectable viral load will be able to participate in all educational activities.
• During the time the student has a detectable viral load for one or more of these three pathogens, the student will not participate in exposure-prone procedures (as defined by CDC). An exposure-prone invasive procedure, as defined by this policy, is any procedure in which there is the simultaneous presence of the student's digits and a needle or other sharp instrument or object in a poorly visualized or highly confined anatomic site (Centers for Disease Control, MMWR 2012;61: RR-3). Exposure-prone invasive procedures are defined in more detail in this document and include major abdominal, cardiothoracic, and orthopedic surgery, repair of major traumatic injuries, abdominal and vaginal hysterectomy, cesarean section, vaginal deliveries, and major oral or maxillofacial surgery (e.g., fracture reductions), digital palpation of a needle tip in a body cavity, and the simultaneous presence of a health care provider's fingers and a needle or other sharp instrument or object (e.g., bone spicule) in a poorly visualized or highly confined anatomic site.
• The student will monitor his/her disease state and provide status updates every 6 months to the Associate Dean for Student Affairs. 
• Status updates will include a note from the student’s treating physician with a copy of the latest viral load result for the disease being treated. 
• The student will receive training in universal precautions and be tested on that training. 
• The student will be required to practice universal precautions in all settings.   
• If the student is not under successful treatment such that there is a detectible viral load, the student must sign a waiver of confidentiality to the Associate Dean for Student Affairs to inform clerkship directors, faculty, attendings, and senior residents of their medical status and restrictions on the student's activities.   
• The student is to report to the Associate Dean for Student Affairs prior to the start of each clinical rotation to prepare for situations that may occur, the need to disclose, and to report any incidents.   
• The student has the responsibility to disclose and discuss his/her health status related to BBP infection confidentially with clerkship directors and attendings prior to each clerkship.   
• The student has the responsibility to immediately inform attendings and withdraw from procedures when he/she believes the medical situation has changed such that an exposure-prone procedure is occurring.   
• The student is not required to disclose his/her disease status to patients. 
• In consultation with the Associate Dean for Student Affairs, the student who is not under successful treatment such that there is a detectable viral load will know that there may be limitations that his/her disease may put on medical career options. The medical school will advise the student on their career options and limitations and issues related to appropriate practice. 
• All protected medical information, including BBP test results from students, will be kept in strict confidence as stipulated in the Health Insurance Portability and Accountability Act (HIPAA). 

Evidence of non-compliance with the risk reduction strategies mandated in this policy or of subsequent BBP transmission to a patient(s) after risk reduction strategies have been implemented will prompt an immediate review and, in the case of non-compliance, possible disciplinary action. 

4.0        References

• Carilion Clinic Employee Health
• Associate Dean for Student Affairs

5.0        Approval and Revisions

Approved by Student Affairs