Reporting of Student Exposures
and Injury-related Incidents

Policy 670.70

Policy Statement

Students are responsible for reporting all exposures and injuries to the following:

  1. Complete Local Procedure(s): If the exposure or injury occurs at the University of Vermont Medical Center, contact Employee Health Service at 847-4277; a related sharps form is located on the UVMMC Intranet home page. If the exposure occurs when the Employee Health Service Office is closed, complete the sharps form, then contact the Administrative Nurse Coordinator (ANC) on pager # 0702. If the exposure occurs outside of UVMMC, including at affiliate sites, contact the equivalent employee health service and follow appropriate procedures for exposures.
    1. If the exposure occurred at another affiliated clinical site, please refer to the information posted on the Clerkship COMET site for instructions specific to that clinical site. Within each of the Clerkship pages on COMET, click on the Student Services button, and then on the Health Care button to find the information.
    2. If the exposure occurred at another site, the student should report to the closest appropriate affiliated employee health service or emergency department.
  2. 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 appropriate post-exposure tests and treatment to be administered 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.
  3. Notify The Robert Larner, M.D. College of Medicine at The University of Vermont Office of Medical Student 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.

Policy Elaboration

Should a student receive a needle stick or other significant blood, body fluid, or body secretion exposure, they should report for evaluation immediately as follows:

  1. When reporting the incident, students should always identify themselves as a UVM medical student at any hospital at which you are rotating.
  2. 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:
    1. It should be determined if the student was injured with a clean or used needle.
    2. 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.
    3. With injuries from used an effort should be made to identify the patient in whom the needle has been used.
    4. If the hepatitis B antibody status of the exposed student is not known, it should be determined.
    5. 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. Booster dose of hepatitis B vaccine in known vaccine responders are not currently recommended by the Centers for Disease Control (CDC).
    6. All puncture wounds and significant exposures should receive vigorous cleansing, and the exposed student should be instructed to seek medical care with their physician at the first sign of bacterial infection. The person’s tetanus immune status should be ascertained. If tetanus immune status is not adequate, a tetanus booster should be administered only if situation involves needle contaminated with soil.
    7. 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.
    8. 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 AIDS or other evidence of HIV infection, declines serologic testing, or has a positive HIV test, immediate consultation with an infectious disease specialist should be obtained to evaluate the need for antiviral prophylaxis. In addition, the medical student should be evaluated serologically for evidence of HIV infection as soon as possible after the exposure and, if sero-negative, retested again after six weeks, 12 weeks, and six months to determine if transmission has occurred. If the source patient is sero-negative and has no other evidence of HIV infection, no further follow-up of the medical student is necessary. If the source patient cannot be identified, decisions regarding appropriate follow up should be based on the type of the exposure and the likelihood that the source patient was infected with HIV.

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 students’ insurance policies. The Larner College of Medicine will cover costs over and above those paid by the students’ 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). 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.

Applicability of the Policy

All Medical Students

Related Larner College of Medicine Policies

Related University of Vermont Policies

Related Liaison Committee on Medical Education (LCME) Standard(s)

12.8 Student Exposure Policies/Procedures

History

  • 5/20/2014 Policy Adopted/Affirmed [Medical Curriculum Committee]
  • 12/20/2016 Policy Revised [Medical Curriculum Committee]
  • 3/21/2017 Policy Revised [Medical Curriculum Committee]
  • 12/19/2017 Policy Revised [Medical Curriculum Committee]
  • 9/18/2018 Policy Revised [Medical Curriculum Committee]
  • 6/18/2019 Policy Revised [Medical Curriculum Committee]
  • 8/20/2019 Gender Neutral Language Edit [Medical Curriculum Committee]
  • 12/17/2019 Reformatted [Medical Curriculum Committee]

Policy Oversight

Associate/Assistant Dean for Students

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