67070 - Medical Student Handbook | College of Medicine

Reporting of Student Exposures
and Injury-Related Incidents

Policy 670.70

Policy Statement

Students are responsible for reporting all exposure- or injury-related incidents that occur during their enrollment at the Larner College of Medicine.

The following constitute significant exposure to blood or other potentially infectious material (OPIM)*.

Percutaneous (through the skin) exposure by needle-stick or other sharp instrument;
Contamination of a fresh cut (less than two hours old) with blood or other body secretions;
Mucous membrane exposure via splash in mouth or eye;
Human bites that penetrate the skin;
Cutaneous exposure involving large amounts of blood or prolonged contact with blood, especially when the exposed skin is chapped or abraded or affected by dermatitis.

*OPIM includes: semen, vaginal secretions, cerebrospinal fluid, synovial fluid, pleural fluid, peritoneal fluid, pericardial fluid, amniotic fluid, saliva in dental procedures, and any other body fluid that is visibly contaminated with blood.

Policy Elaboration

Students are expected to do the following:

Complete Local Procedure(s):

If the exposure or injury occurs at the University of Vermont Medical Center (UVMMC) students should complete the “sharps form” located on the UVMMC Intranet home page and contact Employee Health Service at 847-4277. If the exposure or injury occurs when the Employee Health Service Office is closed, complete the sharps form and contact the Administrative Nurse Coordinator (ANC) on pager # 0702.
If the exposure occurs at a non-UVMMC partner organization, hospital, or clinic outside the network, contact the equivalent employee health service or emergency department and follow their procedures for exposures or injuries.
Students on the Connecticut campus should report to Nuvance Employee Health Service within one hour, or, if Employee Health Service is not open at the time of the exposure or injury, they should present to the ED and follow up with Employee Health Services the following business day. Students should complete the Employee Injury Report (tool? form?) located on the Nuvance Health Intranet home page.

Notify the UVM Risk Management and Safety Office: Download and complete an incident report form, which must include confirmation that there is a plan for administration of appropriate post-exposure testing and treatment and the signature of the site supervisor or course director. If a signature from a site supervisor or course director cannot be obtained, the campus Associate/Assistant Dean for Students can sign the form. Email the completed form to UVM Office of Risk Management.
Notify The LCOM Office of Medical Education: Email Medical Student Services with the subject line "Reporting of Exposure -- private and confidential." In the body of the email, include your name, contact number, a brief report of the incident, and confirmation you’ve submitted a completed incident form to the UVM Office of Risk Management.

If a student receives a needle or sharp injury, or other significant blood, body fluid, or body secretion exposure, they should report for evaluation immediately as follows:

When reporting the incident, students should always identify themselves as a UVM medical student at any hospital at which they are rotating.
The affiliated health care organization should follow its blood-borne pathogen exposure procedures. If no such procedures exist or if the affiliated health care organization elects, the CDC Blood-borne Infections Diseases: HIV/AIDS, Hepatitis B, Hepatitis C guidelines should be used.
The following procedures shall be used for any exposure which occurs while receiving education at the Larner College of Medicine:

All puncture wounds and significant exposures should be vigorously cleansed, and the exposed student should be instructed to seek medical care with their physician at the first sign of bacterial infection.
It should be determined if the student was injured with a clean or used needle/sharp.
Puncture injuries from needles that have not been used on patients or their blood or body secretions do not normally require any special care aside from cleansing the wound and possibly tetanus prophylaxis. The person's tetanus immune status should be determined and if not adequate, a tetanus booster should be administered if clinically indicated.
With injuries from used needles, an effort should be made to identify the patient in whom the needle was used.
If a medical student has significant exposure to blood or other potentially infectious material at The University of Vermont Medical Center, Employee Health will inform the source patient of the incident and request consent for testing for evidence of HIV, hepatitis B and hepatitis C infections. If the exposure occurs at another site, the appropriate employee health office or other responsible party will inform the source patient and request consent for testing. If the source patient has HIV infection, declines serologic testing, or has a reactive HIV test, consult with an infectious disease specialist regarding next steps.
If the hepatitis B antibody status of the exposed student is not known, it should be determined by blood testing.
If the source patient is known to be hepatitis B surface antigen positive and the exposed student is a known hepatitis B vaccine non-responder, then HBIG should be given as soon as possible after exposure and repeated after one month. At the University of Vermont Medical Center, HBIG will be administered by the Emergency Department and billed to the student’s health insurance. A booster dose of hepatitis B vaccine in known vaccine responders is not currently recommended by the Centers for Disease Control (CDC).
For documented needle stick exposures to other potentially transmissible disease, such as acute malaria or syphilis, the need for prophylaxis should be determined on an individual basis in consultation with an infectious disease specialist and the hospital epidemiologist. It is probably unnecessary to provide antibacterial prophylaxis for puncture wounds from needles used on patients with bacterial sepsis.

When exposure occurs at a The University of Vermont Medical Center facility, the Employee Health Service at The University of Vermont Medical Center is responsible for receiving the student’s report of exposure, for arranging for the testing of identified source patients, and for advising the student regarding appropriate care, including diagnostic tests and follow-up. The service will consult closely with the infectious disease specialists as indicated. When the exposure occurs outside of the regular hours of the Employee Health Service, the Administrative Nurse Coordinator will advise the student regarding the appropriate care including diagnostic tests and follow-up, and will consult with infectious disease specialists as indicated. Costs for care related to needle-stick injuries or other exposures incurred in clinical education settings will be billed to the student's insurance policies. The Larner College of Medicine will cover costs over and above those paid by the student's insurance policies. Students should submit any outstanding charges not covered by their insurance to Medical Student Services for reimbursement.

Alternatively, students may use the anonymous HIV testing services available through the Health Department of the State of Vermont (800-882-2437) or in Connecticut at State of Connecticut anonymous HIV testing sites. The Employee Health Service will provide the student with written recommendations regarding appropriate follow-up to be implemented in the primary care setting. The infectious disease specialists are available for consultation with students’ physicians providing follow-up care (please see the University of Vermont Medical Center Infectious Disease and Travel Clinic informational web page for a list of physicians and specialists).

When exposure occurs at another health care facility, the student should seek similar immediate evaluative services and source patient testing through the Employee Health Service or the emergency department, with follow-up care to be sought as directed by the Employee Health Service or from the student’s physician.