Learner Exposure/Blood Borne Pathogen Occupational Exposure

SOP #:
12.8.2
Version #:
2
Implementation Date:
December 8, 2021
Last Reviewed/Update Date
March 26, 2024
Approval by ECC
April 10, 2024

Rationale

Training for care of patients and delivery of patient care necessitates encounters with patients who have communicable diseases. Brody School of Medicine (BSOM) should educate learners to be as protected as possible against the transmission of blood borne pathogens (BBP) and other highly contagious diseases (i.e., Tuberculosis, COVID), and identify the steps learners should follow in the event of a potential exposure.

Scope

Brody School of Medicine Courses and Clinical Experiences

This Standard Operating Procedure (SOP) applies to all BSOM learners and applies to blood borne pathogen and other highly contagious diseases both inside and outside of BSOM Clinics and the spaces of our clinical partner, ECU Health. Learners at other sites are expected to follow the exposure procedures at those sites.

Responsibilities

ECU Prospective Health

Provide mandatory training sessions for each Brody learner via yearly orientation sessions, which are required prior to student entry into any educational space. The purpose of each session is to educate learners on access to resources, the effects of infections and environmental diseases, methods of prevention, and protocols in the event of a BBP or other highly contagious disease exposure.

BSOM Learners

Complete and document training annually.

Learner should refer to this procedure to document the time and location of their potential exposure and to determine who their first point of contact should be.

Depending on the timing and location of the exposure, learners should contact either an ECU attending physician or head nurse, the nursing coordinator, Occupational Health at ECU Health, or ECU Prospective Health. The steps are outlined in this SOP and a brief summary provided in a Student Exposure Card included as an appendix to this SOP.

The learner has financial responsibility for care and treatment which is covered by the required student health insurance. In addition to the student health insurance, costs for the care and treatment are covered by Student Health and Prospective Health as outlined in the SOP.

BSOM Office of Student Affairs (OSA)

Assist ECU Prospective Health in their annual collection of confidential M1 BBP information and document vaccination data as each new cohort of learners enter into BSOM, as well as facilitate student understanding of the current policy if requested. OSA is also responsible for the annual tracking of student compliance, ensuring the attendance at annual training prior to entry into educational setting.

Procedures for Implementation and Review

Learner exposures can broadly be classified as 1) blood borne pathogen exposures and 2) exposures to other highly contagious diseases.

Required training

All learners must complete the blood borne pathogen safety and exposure training annually. The training is organized by the Office of Student Affairs and provided by the Office of Prospective Health. Records verifying completion are maintained in the Office of Student Affairs.

Additional training includes completion of a Blood Borne Pathogen module, a module on respiratory diseases, and N-95 mask fit testing during M1 and M3 orientation.

Steps to be taken following exposure

If learners have been in contact with blood, infectious body fluid, serum, or unfixed tissue, including contact that occurs via sharps stick, cut or splash onto mucous membrane or nonintact skin, a blood borne pathogen exposure has occurred.

Exposure occurred during regular work hours (7:45am-4:45pm):

  1. Exposure occurred at ECU Health:
    1. Contact Occupational Health at ECU Health for source patient workup (847- 0095).
    2. Contact ECU Prospective Health (744-2070).
    3. Have surveillance or treatment as needed, including HIV prophylaxis as soon as possible if indicated.
    4. Follow in conjunction with ID if post exposure prophylaxis (PEP) given x1 month surveillance x 6 months.
  2. Exposure did not occur at ECU Health:
    1. Contact ECU Prospective Health (744-2070).
    2. Have surveillance or treatment as needed, including HIV prophylaxis as soon as possible if indicated.
    3. Follow in conjunction with Infectious Diseases (ID) if PEP is given x1 month surveillance x 6 months.

Exposure occurred outside of regular work hours:

  1. Exposure occurred at ECU Health:
    1. Contact nursing coordinator for risk assessment for HIV risk.
    2. If no HIV risk, contact Prospective Health during work hours for followup/surveillance.
    3. If HIV risk exists, medical learner may be referred to the Emergency Department (ED) for post exposure prophylaxis as soon as possible.
    4. Phone consult with Infectious Diseases regarding need for PEP.
    5. If PEP is needed, have metabolic panel, CBC and diff, as well as pregnancy test in ED.
    6. ED obtains consent and sends PEP prescription to pharmacy if indicated.
    7. Schedule follow-up at ECU Prospective Health (744-2070) during work hours for followup/surveillance.
    8. Have surveillance or treatment as needed.
    9. Follow in conjunction with ID if PEP given x1 month surveillance x 6 months.
  2. Exposure did not occur at ECU Health:
    1. ECU attending physician or head nurse reviews patient chart and completes risk assessment per appendix “D” ECU Infection Control Policy.
    2. If the source has a history of HIV or risk factors, the medical learner should be referred to ED for post exposure prophylaxis.
    3. Phone consult with Infectious Diseases regarding need for post exposure prophylaxis (PEP).
    4. If PEP is needed, have metabolic panel, CBC and diff, as well as pregnancy test in ED.
    5. ED obtains consent and sends post exposure prophylaxis prescription to pharmacy if indicated.
    6. Schedule follow-up at ECU Prospective Health (744-2070) during work hours for followup/surveillance.
    7. Have surveillance or treatment as needed.
    8. Follow in conjunction with ID if PEP given x1 month surveillance x 6 months.

Responsibility for costs of treatment for Blood-Borne Pathogen and other Highly Contagious Disease Exposure

Learners are ultimately responsible for all medical costs related to blood-borne pathogen and other highly contagious disease exposures. Costs related to testing and diagnosis are covered by the required student health insurance, supplemented by the services of the Office of Prospective Health and by Student Health.

Return to Educational Activities after Exposure

Learners should notify the Office of Student Affairs immediately regarding an exposure or illness. Student Affairs will work with the learner to notify course and clerkship directors that the absence is excused. Absences for testing and treatment are absences for healthcare appointments/personal illness, governed by the BSOM Student Attendance Policy. Learner return to educational activities following an exposure or illness will be based on current professional (CDC) guidelines.

It is a code of conduct violation for students to attend any in person class or campus event while they are in isolation or quarantine. The ECU Student Health Services can help determine when the criteria for ending quarantine and resuming regular activities has been met.

Related Policies

BSOM Student Attendance Policy

Applicable Laws, Regulations & Standards

LCME Element 12.8