Abstract

The Infectious and Environmental Hazards: Guidelines to Prevent and Respond to Exposures establishes the school’s mechanisms for educating medical students about ways to reduce exposure to infectious agents and environmental hazards. The guidelines outline recommended actions following an exposure. For medical students with infectious and environmental disease or disability, it describes their impact on student’s participation in learning activities.

Reason for Policy

This policy ensures faculty oversight of the undergraduate medical curriculum and that the medical school meets the requirements set forth by the Liaison Committee for Medical Education (LCME) accreditation requirements as follows:

12.8   Student Exposure Policies/Procedures. “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.”

Scope

This policy applies to all medical students enrolled in the UAB Heersink School of Medicine and to visiting students participating in coursework on any of the School’s campuses.

Policy

The UAB Heersink School of Medicine ensures that all medical students have rapid access to evaluation, testing, and any needed prophylactic treatment for exposure to infectious or environmental hazards, regardless of the training site. The Medical School provides education to students about prevention of infectious and environmental hazards and the procedures for handling exposures when they occur. Students with infectious and environmental disease or disability are provided guidance for clinical participation and reporting.

General Procedure

1. Education about methods to prevent infectious and environmental exposures.

Students are introduced to the concept of infection control including universal precautions during their first year of medical school. They also receive basic instruction in responding to infectious and environmental exposures. Students receive a placard to clip to their identification badge for ready access to instructions for responding to exposures.

During orientation to the clerkships, students receive further training in infection control and protocols for responding to infectious and hazardous environmental exposures. This includes campus-specific instructions. Students receive a placard to clip to their identification badge for ready access to instructions for responding to exposures.

Topics covered in trainings include

• Definitions of infectious and hazardous environmental exposures
• Handwashing
• Barrier protection (gloves, gowns and/or plastic aprons, facial barriers including masks, glasses/goggles and face shields, hair covers, shoe covers, and boots)
• Sharps management: Sharps management refers to safe use of sharp agents such as needles, scalpel blades, etc. and their appropriate disposal in designated, rigid, impervious containers
• Patient isolation
• Procedures for care and treatment after exposure to blood or body fluid
• Procedures after exposure to environmental hazards

Prior to beginning clinical coursework at the Heersink School of Medicine, visiting students must provide evidence of training in infection control from their home institution. Students are provided with Heersink School of Medicine-specific protocols for responding to infectious and hazardous environmental exposures prior to engaging in coursework at any clinical site. Students receive a placard to clip to their identification badge for ready access to instructions for responding to exposures.

2. Procedure for handling blood/body fluid exposures. 

A blood/body fluid exposure is defined as percutaneous injury (e.g., a needle-stick or cut with a sharp object) or contact of a mucous membrane(s) or non-intact skin with blood, tissue, or body fluids, whether or not there is visible blood.

Students may be exposed to blood/body fluids in the course of their clinical duties at the Heersink School of Medicine facilities or at non-Heersink School of Medicine facilities where a student is involved in a practical experience for credit. As all blood and body fluids are considered infectious, regardless of the perceived status of the source individual, all students must follow Occupational Safety and Health Administration (OSHA) guidelines for universal precautions to prevent contact with blood or body fluids. Universal precautions are intended to prevent parenteral, mucous membrane, and non-intact skin exposures of health care workers to blood-borne pathogens.

In case of any blood/body fluid exposure as defined above, immediately take appropriate measures as follows:

• Step 1—Clean the exposed area
  • Remove and properly dispose of all contaminated personal protective equipment.  
  • Wash the exposed area thoroughly with soap and running water. Use antibacterial soap if possible.
  • If blood/body fluid was splashed in the eye(s) or mucous membrane, flush the affected area with running water for 15 minutes. Remove and dispose of contact lenses if worn.
• Step 2—Report the Exposure. See campus specific reporting details below. Medical Student Services always has someone on call. If a student experiences an exposure and needs help knowing what to do, they can call 205-934-3411 and ask for the Medical Student Services team member on call. The person on call will guide the student through reporting steps.

Birmingham and affiliated hospitals and clinics

• • Report the exposure to a preceptor or clinical supervisor and the course director immediately.
  • Report the exposure to UAB Employee Health immediately. Contact UAB Employee Health, Monday-Friday 6:30a.m.-5p.m. at 205-934-3675. After hours, on weekends, holidays and in case the department is closed due to inclement weather, call Hospital Paging at 205-934-3411 and ask for the Needlestick Team Member on call. You may be required to complete an incident report. UAB Employee Health will assist you with this.
  • Gather source patient information: The preceptor/clinical supervisor will collect the HIV, Hepatitis B and Hepatitis C status of the source patient. If a source patient’s statuses are unknown, the preceptor/clinical supervisor should contact the source patient’s attending physician and request that the physician obtain a specimen for STAT testing. The preceptor/clinical supervisor should report the results to UAB Employee Health immediately upon receipt.
  • If testing cannot be obtained on the source patient, contact UAB Employee Health for further instructions.

Huntsville and affiliated hospitals and clinics

• • Report the exposure to a preceptor or clinical supervisor and the course director immediately.
  • Request that an incident report be filed. Be sure to send an incident report to the UAB Huntsville Medical Student Services office. They will forward this to UAB Student Health Services/UAB Employee Health.
  • Contact the appropriate office (described below) for evaluation and further medical care. Be sure to present your health insurance card for services, including for follow-up lab work.
  • For exposures occurring at Huntsville Hospital, report exposure to the nursing supervisor and attending physician. Students should call the 4HELP desk (256-265-HELP) and begin preventative measures as and when deemed appropriate. Any follow-up will be scheduled by the Family Medicine (FM) Clinic Manager.
  • For exposures occurring at UAB Huntsville Clinics, report to your attending or the supervising nurse. You will be directed to contact the FM Clinic Manager for further instructions.
  • For exposures occurring at a non-UAB hospital or clinic, contact the nursing supervisor or the facility’s Employee Health office. Be sure to present your health insurance card for services. If the hosting facility provides initial treatment, but refuses to provide long-term follow-up care, gather all serologic results post-exposure, including the patient’s lab work, and notify the UAB Huntsville Office of Medical Education and Student Services.  They will contact UAB Employee Health or UAB Huntsville FM for further follow-up.  Always seek treatment as directed which may include going to a local emergency room.  Retain copies of any bills related to treatment for later use.

Montgomery and affiliated hospitals and clinics

• • Report the exposure to a preceptor or clinical supervisor and the course director immediately.
  • Request that an incident report be filed. 
  • Contact the appropriate office (described below) for evaluation and further medical care.
  • Always seek treatment as directed which may include going to a local emergency room.
  • For exposure occurring at Baptist South Hospital contact: 334-286-2739.
  • For exposure occurring at Baptist East Hospital contact: 334-244-8299.
  • For exposure occurring at a non-Baptist Hospital facility contact:  The nursing supervisor or the facility’s Employee Health office.
  • Be sure to present your health insurance card for services.
  • If the student or the treatment facility has questions about exposure procedures, they may call the Montgomery Student Services Office.

Tuscaloosa and affiliated hospitals and clinics

• • Report the exposure to a preceptor or clinical supervisor and the course director immediately.
  • Request that an incident report be filed. 
  • For exposures at Druid City Hospital (DCH), contact the charge nurse then report to DCH employee health. If after hours: report to DCH emergency department.
  • For exposures at University Medical Center (UMC), contact the clinic charge nurse; report to Faculty/Staff clinic.
  • Offsite exposure: Contact preceptor and the facility’s Employee Health office.
  • If you have questions, call Medical Student Affairs: 205-348-1384.

Exposures occurring while on visiting electives

• • The host institution should review their exposure policy with you prior to initiation of any coursework.
  • Report the exposure to a preceptor or clinical supervisor and the course director immediately.
  • Report the exposure to Medical Student Services
  • Report the Exposure to UAB Employee Health (205-934-3675).
  • If the host institution or physician’s office offers to provide medical care and recommended testing, have an initial evaluation and follow-up performed there in accordance with the host institution’s policy. 
  • If the host institution is unable to provide medical care and recommended testing, notify UAB Employee Health at (205-934-3675) immediately for further instructions. You may be required to report to a local emergency room for initial treatment and/or medical treatment in case of injury.
  • If the hosting facility provides initial treatment but is unable to provide long-term follow-up care, gather all completed documentation, serologic results from post-exposure testing and notify UAB Employee Health. UAB Employee Health will provide the long-term follow-up care at no charge.
  • Continue to communicate with Employee Health regarding all follow-up care.

• Step 3-Follow up as directed to ensure continued monitoring and care.  Students will be provided with individualized follow up plans based on type of exposure and specific student needs.  

3.  Procedures for Environmental exposure (chemical)

• Step 1

If in eyes

• • Immediately wash eyes-hold eye open and continue washing for 15 minutes
  • Remove contact lenses if present after 5 minutes and keep washing
  • Wash only with water
  • Seek medical attention if needed

On skin or clothing

• • Remove all contaminated clothing and PPE
  • Wash the area with copious amounts of water at least for 15 minutes
  • Seek medical attention if needed

Inhaled

• • Move to fresh air
  • Seek medical attention

• Step 2 - Report the exposure to a preceptor or clinical supervisor and the course director immediately. Seek medical attention at closest emergency facility.

4.   Costs for care and treatment after blood/body fluid or environmental exposure.

If you incur costs for treatment, please contact the Associate Dean for Students or the Student Affairs Director on the campus where the exposure occurred. The school will reimburse you for these costs.

5.  Procedures for exclusions or restriction from clinical actvities for students who are infected

Students who are infected or at risk of having been infected with a potentially transmissible disease are not excluded from participating in patient-care activities or restricted in their access to patient-care services because of their health status, unless medically-based judgments in individual cases establish that exclusion or restriction is appropriate for the welfare of patients, the welfare of other members of the patient-care community, or the welfare of the student.

Students with the following conditions are not permitted to administer patient care.

• Skin infections (open draining wounds or paronychias of any kind).
• Respiratory tract infections with fever.
• Symptoms of COVID or documented COVID infection. 
• Active exanthems (chickenpox, measles, rubella, monkeypox, etc.).
• Enteric infections (hepatitis A, salmonellosis, shigellosis, amebiasis, vomiting and/or diarrhea of unknown etiology).
• Contagious viral conjunctivitis. 

Clinical students with infectious illnesses, transmissable through routine patient care activities, are excused from clinical coursework until the condition is considered no longer transmissable. Such students remain subject to course attendance policies and are responsible for successful completion of all course requirements to the satisfaction of the course director (see Attendance Policy for Clinical Rotations). Students excused for illness will work with clinical course directors and the assistant dean for clinical education to develop a plan to meet clinical requirements. Students unable to complete course requirements by the course’s end date will receive a temporary notation on their transcript of Incomplete. The temporary designation of Incomplete will be replaced by a final grade once the student completes coursework (see Medical Student Grading). In cases of prolonged illness, a student may go on leave of absence. In such cases, students will receive a grade of withdrawal for the course (see Medical Student Grading) and will be required to retake the whole course.

Students excused for illness will work with the Associate Dean for Students to determine timing of return. Decisions for return prioritize the student’s health and require sufficient recovery to allow for effective participation in coursework and to reduce likelihood of transmission of infection to others. Written clearance from the student’s healthcare provider documenting readiness for return is required. Documention should be directed to the associate dean for students or their designee. The associate dean for students will communicate with the assistant dean for clinical education and the clinical course director regarding excused absences and the date when the student may return to coursework. For students on leave of absence for health reasons, requirements for return to coursework are outlined in the Leave of Absence Policy.

6. Infected Health Care Worker Management Act.

The UAB Heersink School of Medicine complies with all state laws. Alabama’s Infected Health Care Worker Management Act (IHCWMA) requires that students with Human Immunodeficiency Virus, students who are known carriers of Hepatitis B (those with HBeAG for 6 months or longer) or students with Hepatitis C and who are involved in invasive procedures are to notify the State Health Officer in accordance with the Infected Health Care Worker Management Act (IHCWMA). Instructions for reporting can be found here. When a student is impacted by this law, the associate dean for students will work directly with the student to ensure confidentiality and protection of personal health information and to ensure that the student’s clinical experience is equitable and allows them to meet all graduation requirements. No restrictions on clinical activities are expected for students on therapy for HIV or Hepatitis B or who have received or are receiving treatment for Hepatitis C.

7. Environmental health and safety procedures. 

Environmental exposures are rare but can occur in the clinical and research settings.

If you have questions or concerns about an environmental exposure

• During office hours: contact EHS at 205-934-2487
• After hours & holidays: contact the EHS Director on Call, 205—917-4766, or call University Police, 205-934-3535.
• If you have an emergency related to an exposure, contact the UAB Police by dialing 911 from a UAB phone.  
• If you're calling from a non-UAB phone, call Campus Police at 205-934-3535. 

In the event of an emergency involving a radiation source:

• During office hours: contact the Radiation Safety Program at 205-934-4751
• After hours & holidays: call UAB Paging (205-934-3411) & ask for either the Health Physicist On-Call, the Radiation Safety Officer, or the Assistant Radiation Safety Officer 

History

Policy Created: Aug. 20, 2013
Approved: Nov. 14, 2022, by UA Systems Office
Revised: Oct. 27, 2022

The University of Alabama at Birmingham Marnix E. Heersink School of Medicine policies, guidance, and statements shall be reviewed periodically to determine whether revisions are appropriate to address the needs of the medical school community.