Student Exposure to Infectious and Environmental Hazards Policy

Formerly known as Universal Precautions or Body Substance Isolation.

• Consider blood, body fluids and tissue from ALL PATIENTS to be potentially infectious.
• Perform hand hygiene before/after all patient contacts.
• Wear gloves when exposure to blood and body fluids may occur, e.g., during phlebotomy. Change your gloves and perform hand hygiene after each procedure and before contact with another patient.
• Wear a gown, mask and goggles when blood or body fluids splashes may occur, e.g., during surgery, placing nasogastric tubes, etc.
• Report immediately all incidents of blood and body fluid exposure of the following types:
  • Parenteral: needle stick, puncture or cut.
  • Mucous membrane: splash to eyes, nose, mouth.
  • Cutaneous: contact with blood and body fluids on ungloved hands or other skin surfaces that may be cut, chapped, abraded, or affected by active dermatitis.

• Needle stick, especially hollow-bore needles and/or deep injury
• Other percutaneous injuries such as cuts
• Source patient with known untreated or poorly controlled infection with HIV/HBV/HCV

• Mucous membrane splash
• Non-intact skin splash
• Human bite  

Possible Hepatitis B, Hepatitis C, HIV exposure.

• Clean wounds or punctures with soap and water
• Flush mucous membranes or skin copiously with water or saline
• DO NOT “force bleed” the wound
• DO NOT apply caustics (eg, bleach, organic solvents, hard surface disinfectants, etc.)

• Prompt medical evaluation is important to ensure adequate treatment.
• Inform the supervising house officer or attending physician of any exposures and report, as soon as possible, to the Emergency Department or Employee Health Service at the institution where the exposure occurred. If the student is at a facility without either of the above, report to the UB Student Health Center on the Main Street Campus or the emergency department of an affiliated hospital.
• When HIV post–exposure prophylaxis (PEP) is indicated, early treatment (within hours) is recommended.
• Carefully note the type of exposure, type of fluid/tissue involved and appropriate information about the source patient (risk factors, lab data)

• On the EXPOSED health care worker:
  • Hepatitis B & C antibody tests
  • HIV test (4^th generation)
  • If HIV PEP will be used: CBC, electrolytes, BUN/creat, LFTs, pregnancy test
• On the SOURCE patient:
  • Hepatitis B surface antigen
  • Hepatitis C RNA test
  • HIV test (4^th generation)

• Tetanus toxoid (if needed)
• No specific treatment if HCV (+) source

• Hepatitis B vaccine (if not immune)
• Hepatitis B Immune Globulin (HBIG) if not immune and known Hepatitis B surface antigen (+) source

• May be indicated – prescribed according to CDC guidelines based on severity of injury & risk of source patient (see More Information)

• Students MUST be seen in follow up at Student Health Center

• National Clinicians’ Consultation Center PEPline
  UCSF Clinician Consultation Center
  (800) 933-3413
  Providers only!
• Updated US Public Health Service guidelines
• Sharps Safety
  
• Bloodborne Infectious Diseases Risk Factors
• Injection Safety Resources for Providers

Students will be excused from all learning activities to address the potential risks or effects of infectious or environmental disease or disability. Students will also meet with the Senior Associate Dean for Student and Academic Affairs to discuss the impact on their education and/or graduation date.

A medical school has policies in place that effectively address medical student exposure to infectious and environmental hazards, including the following:

• The education of medical students about methods of prevention
• The procedures for care and treatment after exposure, including a definition of financial responsibility
• The effects of infectious and environmental disease or disability on medical student learning activities

Reviewed by Curriculum Committee: 11/30/18
Passed by Curriculum Committee: 12/21/18
Policy Implementation: Course/Clerkship Directors, Senior Associate Dean for Student and Academic Affairs
Policy Contact: Senior Associate Dean for Student and Academic Affairs