UNSOM Students: Student Life: Student Health & Wellness: Fluid Exposure
Medical Student Fluid Exposure Procedures
As a medical student, and later as a physician, you will be exposed to patients with all varieties of infectious disease. It is your responsibility to know the mode of transmission and prevention of these diseases. You will be expected to avoid physical contact with all bodily fluids and take appropriate preventive measures to protect yourself from patients with infectious disease. Also, you will be expected to protect your patients from exposure to you if/when you have a contagious disease.
All medical students will be educated and trained to prevent or reduce exposure to blood borne pathogens. ONLINE TRAINING IS AVAILABLE. Safety of medical students in the pursuit of their clinical training is of the utmost importance. Because of their inexperience, students have traditionally represented a large group reporting exposures to blood in hospital and clinical settings. For this reason, procedures have been developed to inform students of potential risk and teach them techniques and procedures designed to decrease or avoid exposure. In addition, follow-up, diagnostic and treatment regimens have been implemented to deal with exposures after they occur.
Scroll down for specific procedures for the Reno and Las Vegas campuses.
Protocol for Student Exposure to Blood Borne Pathogens
All exposures must be reported to the Student Health Center in Reno.
Students are responsible for seeking both immediate and follow up treatment for exposures. Treatment includes laboratory evaluation for HIV, hepatitis and other infectious diseases. Students who desire counseling should contact the Office of Admissions and Student Affairs.
Students' medical information, including laboratory evaluations, will remain strictly confidential and will be maintained separately from student files.
General Guidelines for Exposures and Treatment:
- An incident report is completed at the time of the exposure, regardless of the facility in which the student is working.
- Initial laboratory work should be obtained within three days following the exposure in the case of non-priority exposures (see description above) or immediately following the exposure in the case of priority exposures (see description above).
- Follow up laboratory studies must be done six weeks following exposure, and again six months following exposure. Copies of the test results must be forwarded to the Student Health Center (Reno).
- The Student Health Center will maintain exposure information in a confidential file that is separate from the students' medical record. These exposure files will be kept in a secure location with restricted access.
- Students who have failed to send the proper documentation of laboratory or other follow up treatment will receive a reminder card. If there is no response to the reminder card, after two attempts, a certified letter will be sent to the student reminding his/her of the importance of follow up. If there is no response to the certified letter, no further attempts will be made to contact the student. The student will then be responsible for any further care.
Fluid Exposure Protocol for the Reno Campus
and all medical school outpatient facilities statewide:
Priority Exposure: Require IMMEDIATE medical attention and laboratory work. These exposures Include percutaneous injury with:
- Large bore hollow needles
- Deep puncture wounds
- Visible blood on needle or device used in patient's artery or vein
- Any exposure with an HIV positive patient should be considered a high priority.
Non Priority Exposure: Do not require immediate medical attention and laboratory work. These exposures include:
- Solid needle (suture needle) percutaneous injury
- Superficial injury
- Blood or fluid splash to mucous membranes or skin
For Non-priority Exposures (see description above):
- Report the exposure immediately to your attending physician and/or resident. If the exposure is non-priority, it is not necessary to obtain laboratory work in the emergency room of the facility.
- Complete the UNSOM incident form.
- Do not allow the hospital or clinic to file a worker's compensation report. Students are not eligible for worker's compensation and the filing of a report will delay processing of insurance claims.
- Contact the Student Health Center (775-784-6598) to schedule an appointment for follow up treatment within three days of the exposure.
For Priority Exposures (see description above):
- Report the exposure immediately to your attending physician and/or resident. If the exposure is non-priority, it is not necessary to obtain laboratory work in the emergency room of the facility.
- Complete the UNSOM incident form.
- Obtain laboratory work as soon as possible following the exposure. If necessary, in the emergency department of the facility.
- Do not allow the hospital or clinic to file a worker's compensation report. Students are not eligible for worker's compensation and the filing of a report will delay processing of insurance claims.
- Contact the Student Health Center (775-784-6598) to report the exposure and schedule follow up treatment.
Fluid Exposure Protocol for the Las Vegas Campus:
University Medical Center Procedure:
Who do I inform if I have an exposure?
Medical students report the exposure to the On Duty Administrator and fill out a C-1 exposure form. The attending physician, resident or nurse should know who this On Duty Administrator is and how to contact them.
- Monday-Friday, 8 – 5 p.m., (regular working hours): A member of the Exposure Evaluation Team will meet with the student as soon as possible to provide counseling, risk assessment and reach a decision with the student about the need for post-exposure prophylaxis.
- Night, weekend, holiday: A member of the Exposure Evaluation Team will be on-call and respond by beeper/phone to the talk with the medical student.
Should I go to the emergency room?
Emergency room visits will only be required if the injury requires emergency care. The Employee Health Nurse Practitioner will meet with the student within 72 hours of the exposure to review lab results.
Does my insurance pay for the care I receive?
Medical students are considered Health Care Workers by University Medical Center (UMC). UMC will provide, at NO COST to all Health Care Workers, all necessary blood tests, initial counseling and early evaluation, and, if appropriate, a 28-day HIV post-exposure prophylaxis, as outlined in the Fluid Exposure Protocol. All Health Care Workers will be evaluated and counseled within two hours by the UMC Exposure Evaluation Team.
What types of exposures does this protocol cover?
This protocol is designed to evaluate post-exposure treatment for HIV and Hepatitis B.
Should I get any follow-up care?
The protocol at UMC is designed to provide care/medications (if required). Students should follow up with the primary care clinics in Las Vegas.
Where can I read the complete protocol?
The complete UMC Fluid Exposure Protocol is available for review by students in the Office of Recruitment and Student Affairs, as well as the Department of Surgery and the Department of Obstetrics/Gynecology.
Do all exposures put me equally at risk?
Students who experience percutaneous injuries are the most at risk for exposures. Students who experience mucous membrane or non-intact skin exposures are less at risk. Complete information on procedures for the different exposure types are available in the Fluid Exposure Protocol at the locations lists above.
What if I get told to do something different?
This is a new policy and procedure adopted at the end of June 06 at UMC. It may take time for the information to get distributed to everyone. You can contact the Office of Recruitment and Student Affairs or your Clerkship Coordinator if you have questions.
Follow up Care:
As a professional, it is your responsibility to follow up on your own laboratory work and obtain necessary treatment. If laboratory work and other treatment is obtained at a facility other than the Student Health Center (Reno) or the Fire Mesa Family Medicine Clinic (Las Vegas), please send a copy of your laboratory results to either Michelle Smythe, Student Health Center, Reno.
If you have been immunized, and are Hepatitis B antibody negative (by lab test) and you are exposed to a Hepatitis B positive patient, you should get HBIG and Hep B vaccine boosters.
