MD Program Policy: Universal Precautions

To protect students from acquiring infectious diseases through patient contact in their day-to-day role as medical students.

Definitions

Bodily fluids: Any natural bodily liquid or secretion, including but not limited to blood and semen.

Barrier: Anything that serves to block or prevent transmission of pathogens.

Source Patient: The patient who is the source of the body fluid or the source of the exposure.

Prophylaxis: An action taken to preserve health and prevent the spread of disease.

Universal precautions: The approach to treat all human blood and certain body fluids as if they were known to be infectious for HIV, Hepatitis B and other blood borne pathogens.

Exposure: An exposure incident means a specific eye, mucous membrane, non-intact skin, or parenteral contact with blood or other potentially infectious materials.

Infections material: Blood, semen, vaginal secretions, cerebrospinal fluid, synovial fluid, pleural fluid, pericardial fluid, amniotic fluid, saliva in dental procedures, any bodily fluid visibly contaminated with blood, mixtures of fluids where you can’t differentiate between body fluids, unfixed human tissue or organs (other than intact skin), and certain cell, tissue or organ cultures and mediums.

Policy Details

Blood and Bodily Fluid Precautions
1. Blood and body fluid precautions should be used for all patients, regardless of known HIV status.
2. Universal precautions apply to blood and other body fluids containing visible blood, semen, and vaginal secretions.
3. Universal precautions also apply to tissues and to the following fluids: cerebrospinal, synovial, pleural, peritoneal, pericardial, and amniotic fluids.
4. Universal precautions do not apply to feces, nasal secretions, sputum, sweat, tears, urine, and vomitus unless they contain visible blood.
5. Universal precautions do not apply to saliva except when visibly contaminated with blood or in the dental setting where blood contamination of saliva is predictable.
6. While universal precautions do not apply to human breast milk, health care workers may wear gloves in situations in which exposures to breast milk might be frequent (e.g., breast milk banking).
Barrier Techniques
1. Students must use appropriate barrier techniques to prevent skin and mucous membrane exposure when contact with the blood or other body fluid of any patient is anticipated.
2. Students must wear gloves when touching blood, body fluids, mucous membranes, or non-intact skin. Students must change gloves after contact with each patient.
3. Students must use gloves when:
  1. performing phlebotomy
  2. performing finger or heel sticks on infants and children
  3. dressing changes
  4. suturing
  5. examination of denuded or disrupted skin
  6. administration of immunizations or injections
  7. any surgical procedure
  8. pelvic gynecologic exam
4. Students must use masks and protective eyewear or face shields during procedures likely to generate droplets of blood or other body fluids to prevent exposure of mucous membranes of the mouth, nose, and eyes. An annual N95 mask fit test is a program requirement for all students.
5. Students must wear gowns or aprons during procedures likely to generate splashes of blood or other body fluids.
6. Students must immediately wash their skin when contaminated with blood or other body fluids. Students should wash their hands immediately after gloves are removed or as soon as possible after contamination.
7. Students must take care in disposing of needles, scalpels, and other sharp instruments. Students should place such sharps in a puncture-resistant container.
8. Students should use available mouthpieces and resuscitation bags to minimize the need for or risk of mouth-to-mouth resuscitation.
9. Students who have exudative lesions or weeping dermatitis should refrain from direct patient contact and from handling patient care equipment, until the condition is resolved.
Management of Blood Borne Pathogen Post Exposure
The following information contains guidelines for students regarding the management of bloodborne pathogen exposures. Although needle stick and other sharps injuries are the most common means of exposure for health care workers, bloodborne pathogens also can be transmitted through contact with mucous membranes and non-intact skin. Hospitals and clinics must evaluate and manage exposure incidents that occur to their employees and provide the same services to students on clinical rotation at their facility.
1. Detailed procedures for each clinical site are listed in OASIS Notices under ”What to Do in Case of Blood/Fluid Exposure”. injury. At UW Hospital and Clinics, go to Employee Health Services during daytime hours and to the Emergency Room after hours. Instructions for care at statewide campus sites is available on the ”Statewide Campus Sites” page of the Center Canvas site.
2. At some sites, students may be offered baseline testing; however, this is no longer recommended for exposed persons and does not need to be done routinely.
3. Students must notify the facility’s coordinator for employee health and/or infection control issues immediately. The coordinator will:
  1. Assess exposure to determine if it is significant. This must be done by someone other than the exposed/injured person.
  2. Arrange for testing of the source patient, if necessary. This is the responsibility of the site.
  3. At UW Hospital and Clinics, contact Employee Health Services (days) or the ER (nights).
4. Notify your preceptor or clinical instructor as soon as practical.
5. Contact the Office of Student Services ASAP at 608-263-4920.
6. Contact UHS for advice, consultation, or follow-up as needed:

1. - (608) 262-6720;
  - (608) 265-7000, #4555;
  - Appointments/info: (608) 265-5600, 8:30 am - 5 pm weekdays;
  - A clinician is available on call after hours from 5 pm - 9 pm weekdays, and 12 pm - 9 pm weekends.
  - Employee health staff in most facilities are very experienced in the management of exposures and the issues that surround them. For follow up care, students should use UHS. If it is not practical to come to UHS for care, the cost of services incurred is the responsibility of the student and/or their insurance.

Needle Stick Injuries
1. Students must avoid the following activities that studies indicate are often associated with needle stick injuries:
  1. recapping needles
  2. transferring a body fluid between containers
  3. failing to properly dispose of used needles in sharps containers
2. Students must use only approved devices, not recap needles, and dispose of needles promptly in sharps containers (e.g., not laying them on trays, bed sheets).
3. Students must immediately report all needle stick and sharps-related injuries promptly to ensure that they receive appropriate follow-up care.
Other Common Exposure Procedures
1. Care of the Injury or Exposed Area
  An important step in preventing bloodborne infection is prompt and thorough cleaning of the blood spill or splash or of the injury. Potentially exposed students may require a tetanus booster.
2. Reporting the Incident
  1. Staff at the clinical site will assess the exposure incident and assist in collecting the information that is needed to manage the exposure and care for the student.
  2. The definition of significant exposure considers the type of body fluid, the integrity of the skin surfaces, and the mechanism of the injury.
3. Evaluation of the Source Patient
  1. The source patient may be evaluated for the HIV antibody, hepatitis B surface antigen or panel, and hepatitis C antibody.
  2. Students should receive from the facility source patient test results.
  3. Evaluation should not rely on medical or social history to assess the risk of bloodborne pathogens. The standard practice is to test every source patient. This usually requires the patient’s consent for testing. Health care staff at the clinical site will obtain this consent, not the affected medical student.
  4. Testing the source patient should be done as soon as possible. Time is of the essence, especially with short hospital stays, or exposures in outpatient settings.
  5. Since exposures may take place in surgical or delivery room areas, the source patient’s ability to give consent for testing may be delayed.
4. Evaluation of the Exposed Person
  1. Routine baseline testing is not necessary for the exposed person.
  2. Post-exposure prophylaxis: Chemoprophylaxis with immune globulin or antiviral medications may be recommended in some situations, or if the source patient is positive for a given infection.
5. Follow-Up
  1. The Infection Control Office, after consideration of the risk exposure and source patient’s test results, determines the need for follow-up testing in exposed students.
  2. Testing may still be done if desired for personal reasons. Students should contact UHS to schedule an appointment to pursue testing.
Cleaning of Surfaces and Linens
1. Environmental surfaces should be cleaned when contaminated.
2. Scrubbing is as important as the cleansing agent in the physical removal of microorganisms.
3. Soiled linen should be properly bagged and washed in water of 160.0 F (710 C) with detergent for 30 minutes or with suitable chemicals at lower temperatures.
Procedures
1. Reporting
  1. Students must immediately report any needle stick or exposure to bloodborne pathogens as detailed above.
  2. Students having any difficulty with this reporting should immediately contact Student Services at 608-263-4920.
2. Follow-up
  1. Students should fully comply with all recommended follow-up.
  2. For follow-up care, students should use UHS or their primary care provider. If it is not practical to use either UHS or a PCP for care, the cost of services incurred is the responsibility of the student and/or their insurance.