Introduction
During the performance of clinical practice or research activities, students may have contact with patients or research participants with infectious diseases. This contact may place the student at risk for exposure to an infectious agent and/or may result in an infectious disease being transmitted to others. This policy has been established to address The Ohio State University, College of Nursing’s concern for protecting students and clients from the risk of infectious diseases. The policy is in accordance with recommendations of the American Association of Colleges of Nursing (AACN) and recognizes individual rights, voluntary testing, and the confidentiality of test results of all involved. The document is organized in relation to: (1) Prevention, (2) Responsibilities of the student in the care of infected patients, and (3) Post-exposure safety measures.
Prevention
Students can be reasonably protected from the risk of contracting and transmitting an infectious disease in the course of nursing practice with appropriate education, skills training, and immunizations.
Education
Students will receive printed materials and oral instruction on potential infectious hazards, risk behaviors, and preventive measures as part of prerequisite clinical and laboratory preparation. Faculty are responsible for ensuring that the curriculum is in accordance with the current guidelines of the Centers for Disease Control (CDC). In addition, students are expected to have the necessary basic science content (anatomy/physiology of the immune system), pathophysiology, epidemiology, and standard precaution information necessary to provide safe care to patients and protection for themselves.
Adherence to Standard Precautions
Students are expected to understand and strictly adhere to Standard Precaution guidelines and infection control practices as established by the CDC and the Occupational Safety and Health Administration (OSHA) to reduce the risk of contact, droplet and airborne transmission of pathogenic microorganisms.
Vaccinations and Testing
Mandatory Vaccination/Testing
Undergraduate and Graduate students must meet The Ohio State University College of Nursing health requirements prior to contact with a clinical setting. See Undergraduate Student Handbook, “Requirements for Clinical Courses.”
[NOTE: Students who are pregnant or think they are pregnant should document the pregnancy in a written letter and submit the document to Wilce Student Health Center. Some health requirements may be waived for pregnant students or for individual students whose situations may warrant such action. In general, pregnant women should be advised to avoid live vaccines and to avoid becoming pregnant within 28 days of having received one (no harm to the fetus has been reported from the accidental administration of these vaccines during pregnancy) http://www.cdc.gov/vaccines/parents/pregnant.html
Discretionary Vaccination/Testing
MENINGOCCOCAL MENINGITIS: Vaccination with the currently available quadrivalent meningococcal polysaccharide vaccine will decrease the risk for meningococcal disease. Vaccination does not eliminate risk because a) the vaccine confers no protection against serogroup B disease and b) although the vaccine is highly effective against serogroups C, Y, W-135, and A, efficacy is <100%. The risk for meningococcal disease among college students is low; therefore, vaccination of all college students, all freshmen, or only freshmen who live in dormitories or residence halls is not recommended, but is available to students who desire to reduce their risk.
HIV TESTING: Nursing students who are at risk for HIV and who have a desire to be tested can avail themselves of testing and pre and post testing counseling through the Columbus Health Department or The Ohio State University Student Health Services.
SMALLPOX: Routine smallpox vaccination is currently only recommended for persons who are designated by the appropriate federal, state, and local bioterrorism and public health authorities to conduct investigation and follow-up of initial smallpox cases that might necessitate direct patient contact (CDC, 2003). Additionally, vaccination is recommended to persons responsible for administering smallpox vaccine in a pre-event smallpox vaccination program.
Responsibilities of the Student in the Care of Infected Patients
Nurses are front-line providers of health care, and the delivery of nursing care is not without safety hazards. All nursing personnel are professionally and ethically obligated to provide client/patient care with compassion and respect for human dignity and the uniqueness of the persons for whom they care, unrestricted by considerations of social and economic status, personal attributes, or the nature of health problems (ANA, 2001). Students who follow the recommendations developed by the Centers for Disease Control have minimal danger of contracting any infection in the course of their clinical practice/research activities.
Refusal to care for an infected patient is contrary to the ethics of the nursing profession. Students who express apprehension or concern over personal safety and health because of a clinical assignment that brings him/her in contact with individuals who are at risk for or who are infected with an infectious disease will be counseled by his/her clinical instructor and directed to specific information concerning the pathogenic organism and recommended precautions. Students who refuse to care for an infected individual because of the belief that it will place him/her at risk of exposure, when reasonable risk cannot be demonstrated (e.g., the student is not immunosupressed), will be advised that such action is not in accordance with satisfactory clinical performance. Such cases will be handled as individual instances in which students have not met the course requirements. Career counseling may be recommended to determine if the student should continue a career in nursing. Students who are pregnant will be considered on a case to case basis with consideration of CDC and institutional policy.
When caring for persons with infectious diseases, students and faculty are expected to understand and follow current HIPAA rules of privacy and confidentiality.
College of Nursing Guidelines for Reducing the Risk of Transporting Bedbugs
Given the widespread and growing problem of bedbugs in Ohio, the College of Nursing is recommending that individuals follow the recommendations for protection as provided by the Central Ohio Bed Bug Task Force (http://centralohiobedbugs.org/)
In addition, the College of Nursing has taken the following protective measures for students working with vulnerable populations:
- Ziploc bags with supplies will be used in lieu of traditional community bags.
- Foot covers, as well as full protective covering will be provided to clinical faculty and made available to students on an ‘as needed’ basis. All gear should be removed in the same
manner as one would remove any contaminated clothing prior to exiting the premise. Protective coverings should be placed in a tightly sealed plastic bag and then discarded into an outside trash container. - All faculty and students are encouraged to avoid sitting or placing any items on upholstered furniture, bedding or carpeted floors.
- Isopropyl alcohol spray can be used to clean equipment that may have come into contact with bed bugs or bed bug larvae.
In general:
- Pay attention to the inside and outside of shoes, lace holes, socks, pant legs and leg area around the hands and arms.
- Any clothing or items taken into the home that cannot be washed or dry cleaned should be placed in a hot dryer for at least 15 minutes.
- Keep a separate pair of shoes and a jacket for use in client homes in a sealed bag.
- Do not redistribute items from one consumer to another.
The ‘guidelines’ as provided on the website listed above provide additional helpful suggestions for maintaining personal protection.
POST -EXPOSURE SAFETY MEASURES
Management of Student Exposed to Pathogenic Microorganisms
Any incident that exposes a student or a patient to the risk of a pathogenic microorganism by needle puncture or contact with secretions/body fluids while in the clinical setting should be reported to the student’s clinical instructor and clinical nursing supervisor (preceptor and/or charge nurse) immediately. Specific agency/institution procedures for such contact should be followed. Immediate actions should include:
- Wash needle sticks and cuts with soap and water
- Flush splashes to the nose, mouth, or skin with water
- Irrigate eyes with clean water, saline, or sterile irrigants
- Immediately seek medical treatment
Treatment areas at the OSU Medical Center include: Employee Health (614-293-8146), Occupational Medicine (614-688-6492), or, after hours and on weekends and holidays, Emergency Department (614-293-8333). Any questions should be directed to the Ohio State University Environmental Health and Safety Office (614-292-1284). Students who are at agencies other than the OSUMC system should follow the guidelines according to the placement agency. Payment for any treatment is the responsibility of the student. The College of Nursing does not reimburse for the costs of blood tests, medical follow-up, and treatment. Students should submit invoices to their personal health insurance providers.
Management of Student who is a Source of Pathogenic Organism
Students who have been diagnosed with infectious diseases should understand that they may pose a risk to patients, particularly highly vulnerable populations like neonates, oncology patients and those immunocompromised from disease or treatment. Students have an ethical duty to be aware of their immunity status or chronic infectious disease (e.g., Hepatitis B, HIV) status to ensure they do not place others at risk of infection. Students who know they are infected are encouraged to voluntarily inform the Associate Dean for Academic Affairs in the college who will refer the students to the Office of Disability Services for modifications or accommodations in clinical education. Such modifications will be made on a case by case basis considering compliance with CDC recommendations and University policy.
It is the desire of the College of Nursing to prevent discrimination against students who may have an infectious disease. Qualified individuals cannot and will not be denied admission to the nursing program solely on the basis of his/her infectious disease status. Screening of potential candidates or inquiry into infectious disease status should not be part of the student application processes.
Incident Policy
ILLNESS
In the event a student becomes ill during clinical study or in the classroom, the instructional staff member shall refer the student to the Wilce Student Health Center or the student’s private physician for treatment. If the student’s condition is one that warrants treatment in an Emergency Department, the instructional staff member, or designee, shall assist the student to the Emergency Department. All medical costs for treatment are the responsibility of the student. If necessary, an incident report shall be filed following the policy of the institution. The student may also need to contact their academic advisor if the illness necessitates a change in the student’s current semester course attendance or future semester enrollment.
NEEDLE STICK OR RELATED INJURY
If a student sustains a “needle stick” or related injury, this incident shall be reported immediately to appropriate agency personnel and to the physician who is responsible for the Preventive Medicine Program at the Wilce Student Health Center. The student should be referred for follow-up to Wilce Student Health Services, Preventive Medicine Department. The instructional staff member and student should complete any incident report forms required by the agency and inform the Office of the Associate Dean for Academic Affairs in the College of Nursing. Any follow-up testing and treatment expenses that are incurred are the responsibility of the student. For more information on blood borne pathogen exposures, please refer to the Wilce Student Health Center web site: http://shs.osu.edu/services/health-professional-student-compliance/blood-and-body-fluid-exposures/
References
American Association of Colleges of Nursing. Web site: www.aacn.nche.edu/Publications/ positions/hivhepb.htm
American Nurses Association (2001). Code of Ethics for Nurses. Washington, D.C.: American Nurses Publishing. Web site: www.nursingworld.org/codeofethics
Centers for Disease Control (CDC) Web site: www.cdc.gov/niosh/topics/bbp/
United States Department of Health and Human Services. Office for Civil Rights. Web site: www.hhs.gov/ocr/hipaa/
Occupational Safety and Health Administration. Web site: https://www.osha.gov/SLTC/bloodbornepathogens/bloodborne_quickref.html
Ohio State University Environmental Health and Safety Office. Web site: http://ehs.osu.edu/
*Note: This policy is based on currently available information. It will be updated as new information is forthcoming from the Centers for Disease Control (CDC). In the absence of new CDC directives, the policy will be reviewed annually in accordance with the University Infection Control guidelines/requirements. Policy review will be initiated by the Assistant Dean and approved by the faculty of the College of Nursing. A copy of the policy will be included in student handbooks given to entering students. It is the responsibility of faculty members and students to familiarize themselves with this policy.
LAST REVIEW/REVISION DATE:
August 1, 2012