I. Purpose and Policy
The purpose of these guidelines is to reduce the risk of student exposure to blood borne pathogens such as, but not limited to, Hepatitis B Virus (HBV), Hepatitis C Virus (HCV), and the Human Immunodeficiency Virus (HIV).
Standard Precautions is an approach to infection control that requires the application of blood and body fluid precautions for all patients and patient specimens regardless of diagnosis. Standard precautions will be the minimum standard of practice throughout Orvis School of Nursing. Whenever possible Body Substance Isolation will be used. Body Substance Isolation takes Universal Precautions one step further and requires the same barrier precautions for all moist body substances and surfaces, not just those associated with the transmission of HIV and HBV. All human blood and body fluids will be handled as if they are infectious.
II. Prevention of Blood Borne Pathogen Exposure
Education and Training in Standard Precautions and Body Substance Isolation Procedures:
Students will be required to participate yearly in Blood Borne Pathogen Exposure Prevention and Control Class during the first week of level one and level four clinical. The student must also have satisfactorily demonstrated skill in using personal protective equipment and procedures before receiving a patient care assignment. The OSN office will maintain documentation of yearly attendance.
Hepatitis B Vaccine:
Students will be required to have completed the hepatitis B vaccine series, have documentation of titer immunity, or to have signed a declination prior to going to clinical sites. Students may receive the series through Student Health Services, Washoe County Health Department, Orvis Nursing Clinic, or their own private health care provider.
III. Methods of Compliance
Students will become familiar and comply with the Blood Borne Pathogen Exposure Policy of the clinical sites to which they are assigned.
IV. General Screening
The Orvis School of Nursing will not undertake any program of screening faculty or students for antibody to HIV. Any student or faculty wishing to be tested will be referred to his/her private physician, the UNR Student Health Center, or the county health department.
V. Accidental Exposure Incidents
A student in the School of Nursing who has blood or body fluid exposure while in a clinical agency is treated in a similar manner to any type of accident occurring within the agency. The student should immediately notify the clinical faculty who will then immediately notify the supervisor within the health care facility where the accident occurred. As much information as possible about the source patient should be collected (i.e. HBV antigen, HCV and HIV antibody status). The clinical agency will require the completion of an incident/occurrence report and will usually ask for permission from the client to test for blood borne pathogens.
The student should report to a health care provider within two hours to discuss post-exposure prophylaxis treatment. The student should be aware that post-exposure testing and post-exposure prophylaxis treatment is not a covered service at the UNR student health center. While testing and treatment may be initiated at student health services, the student will be required to pay for these services at the time of treatment. In the event of a blood borne pathogen exposure, it is imperative that the student know where and how to seek evaluation and care, as post exposure prophylaxis must be initiated within two hours. Should the student have a private insurance policy (yourself, your employment, or through your parents); it is still necessary for students to determine if exposure to a blood borne pathogen is a “covered service” of their policy.
The University of Nevada Reno is not liable for treatment or medication costs. Each student enrolled in the School of Nursing must carry health insurance and must provide validation of this coverage each semester to the program coordinator or designated staff. The insurance must provide coverage for exposure to infectious/communicable diseases.
The cost of personal health care, including care required as the result of blood borne pathogen exposure in clinical practicum experiences, is not covered by the University, the School of Nursing, or the clinical agencies workman’s compensation policy.
The University of Nevada Reno does have a Student Accident Insurance policy that would cover students for a blood borne pathogen exposure. The policy is limited to $10,000 and only covers the student in off campus locations (i.e. hospitals or non-university clinics). The coverage is only in effect while you are a student.
The exposed student will be encouraged to have testing for HIV at baseline, 6 weeks, 12 weeks and 6 months. The decision to have testing or not, however, is the choice of the individual exposed.
The clinical instructor and student will complete the OSN incident report to document the exposure. The faculty will forward the information to the Director of Orvis School of Nursing for follow up. The school of nursing will keep this documentation on file for a period of not less than ten years following the date of the exposure.
The clinical instructor must notify the Director of the School of Nursing when a student has been accidentally exposed. Notification of the Administration is necessary to assist in the protection of the faculty and College in the event of subsequent liability issues or actions occurring following the incident.
VI. Guidelines for Exempting Students from Clinical Assignment to Clients with Blood Borne Diseases:
The risk of transmission of communicable diseases to pregnant health care workers is not known to be greater than the risk to those not pregnant. However, a pregnant student may not be eligible to receive triple therapy post-exposure prophylaxis in the event of a high-risk exposure due to the teratogenic effects of protease inhibiting medications.
Based on the above information, there is no epidemiological reason to exempt pregnant students from caring for patients with blood borne diseases.
Incompetent Immunological Systems:
Students with diagnosed immunological deficiencies are at an increased risk for developing opportunistic infections that may be present in clients with blood borne diseases as well as other non-infected clients.
The Centers for Disease Control (CDC) and the American Nurses Association do not recommend barring HIV-infected health care workers from practicing their profession, though in some cases, disclosure of the student’s status may be indicated and mandated by law.
Students with HIV infection need not be restricted from clinical experience unless they have some other illness for which any health care worker would be restricted. Symptoms of HIV (i.e. fatigue, paresthesia, vision problems, or dementia) may limit a health care worker’s ability to safely practice.
Any student with an infectious process could further compromise the client with an incompetent immunological system.
All students with exudative or weeping skin lesions should be restricted from direct client care contact.
The decision to exempt a student from clinical experience will be made on a case-by-case basis by the faculty responsible for the clinical course. Decisions about longer exemptions (more than one clinical session) will be made in consultation with the student’s physician and appropriate university faculty/administrators.
VII. Student Acceptance of Clinical Assignment
Students who have received formal classroom instruction in blood borne pathogen exposure control and can satisfactorily demonstrate knowledge and skills requisite to such care are expected to accept clinical assignments in order to meet the course objectives.
The decision to exempt a student from clinical experience will be made on a case-by-case basis by the faculty responsible for the clinical course.
Within the Code of Federal Regulations are statements designed to protect medical information and the privacy of the individual, providing there is no overriding need for the public to know. To mandate that a person infected with HIV be required or requested to notify College authorities is difficult, if not impossible to enforce and legally challengeable.
Individuals involved with health caregiving services that know they are infected with a blood borne disease are ethically and legally obligated to conduct themselves responsibly in accordance with the following protective behaviors.
- Seek medical advice.
- Follow College and/or agency guidelines when involved in direct client care.
- Be knowledgeable about and practice measures to prevent transmission of blood borne diseases.
No specific or detailed information concerning complaints or diagnosis will be provided to faculty, administrators, or even parents, without the express written permission of the individual in each case except as required by law. This position with respect to health records is supported by amendment to the Family Education Rights and Privacy Act of 1974. Health officials and other institutional officers must remember that all confidential medical/health care information is protected by statutes and that any unauthorized disclosures may create legal liability.
Revised April 2006
Approved by Director& OSN Faculty
April 24, 2006