Exposure to Infectious and Environmental Hazards

UNR Med Student Handbook: Student Health

Medical students and physicians are potentially exposed to patients with infectious disease. All medical students will be educated and trained to prevent or reduce exposure to blood borne pathogens. 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 address exposures after they occur.

Education

HIPAA Training

All medical students are required to complete training for the Health Insurance Portability and Accountability Act (HIPAA). The training, which addresses the School's specific privacy policies and procedures, is held annually. In addition, you may be asked to complete HIPAA training at individual clinical sites, including the partner hospitals of the University of Nevada, Reno School of Medicine. Information regarding training and compliance can be found through the HIPAA/Security.

OSHA Training

Students are introduced to the concept of infection control and work-related exposure during their first year of medical school during a mandatory online training. Education and training regarding exposures will be updated annually throughout medical school, including the transition course. Students must attend sessions each year and be certified to continue patient care activities. Students are expected to understand and comply with the following procedures:

  • Universal precautions
  • Needle/sharp safety
  • Use of protective equipment
  • Isolation guidelines

Protocol for Student Exposure to Blood Borne Pathogens

All exposures must be reported to the Student Health Center in Reno, regardless of where the exposure occurred. Appropriate follow-up treatment will be provided by the UNR Student Health Center (SHC) in Reno, and the University Medical Center (UMC) in Las Vegas - (702)383-2408; select '2' for ODA.

The University of Nevada, Reno Student Health Center is a designated facility for fluid exposure evaluation and the designated facility for maintenance of records of all student exposures.

The University of Nevada, Las Vegas (UNLV) Student Health Center in Las Vegas, the primary provider for medical students enrolled in the school's health insurance policy, is the provider for students who have non-priority exposure while in Las Vegas. The University of Nevada, Las Vegas (UNLV) Student Health Centershares reports of all exposures with the Student Health Center to protect the health of students. Students can contact the Center at: (702)362-6373.

Students' medical information, including laboratory evaluations, will remain strictly confidential and will be maintained separately from student files. Students who experience a fluid exposure while out of state will be required to submit documentation of follow up treatment to the Student Health Center as soon after the exposure as possible. Once back on the University of Nevada, Reno School of Medicine campus, the student should contact the Student Health Center to schedule a follow up consultation.

PLEASE NOTE THERE ARE TWO TYPES OF EXPOSURES:

Priority Exposures

Require IMMEDIATE attention and laboratory assessment. 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

Non-Priority Exposures

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

Students beginning their third year clerkships will be provided a laminated card that outlines the University of Nevada, Reno School of Medicine protocol for exposures. The care provides contact information for each campus, identification of key personnel at the school, and guidelines for treatment. Students are expected to carry the cards with them at all times while in a clinical setting.

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 (6) weeks following exposure, and again six (6) months following exposure. Copies of the test results must be forwarded to either the Student Health Center (Reno) or the University of Nevada, Las Vegas (UNLV) Student Health Center (Las Vegas).
  • The Student Health Center will maintain exposure information in a confidential file that is separate from the student's 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, a certified letter will be sent to the student reminding him/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

Non-priority Exposures

  1. 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.
  2. Complete the University of Nevada, Reno School of Medicine incident form.
  3. 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.
  4. Come in to the Student Health Center as a walk-in for follow-up treatment within three days of exposure.

Priority Exposures

  1. Report the exposure immediately to your attending physician and/or resident.
  2. Complete the the University of Nevada, Reno School of Medicine incident form.
  3. Obtain laboratory work as soon as possible following the exposure. If necessary, go to the emergency department of the facility.
  4. 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.
  5. Contact the Student Health Center (775)784-6598 within 24 hours to report the exposure and schedule follow-up treatment.

Fluid Exposure Protocol for the Las Vegas Campus

Procedure

Who do I inform if I have an exposure?

Medical students report the exposure to the On Duty Administrator at the University Medical Center and fill out UMC's C-1 exposure form. The attending physician, resident or nurse should know who this On Duty Administrator is and contact information.

  • (702)383-2408 - select '2' for On Duty Administrator.
  • Monday-Friday, 8 - 5 p.m., (regular working hours): A member of the UMC's 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, and holiday: A member of the UMC's 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 as determined by the UMC's Exposure Evaluation Team. 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 - UNR Family Medicine (702) 992-6888; and, the University of Nevada, Las Vegas (UNLV) Student Health Center.
Where can I read the complete protocol?
The complete UMC Fluid Exposure Protocol is available for review by students in the University of Nevada, Reno School of Medicine 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 is defined within the Fluid Exposure Protocol.
What if I am told to do something different?
You can contact the Office of Admissions and Student Affairs or your Clerkship Director if you have questions.

Student Transmissible Disease Policy

Transmissible Disease Expert Panel Protocol

  1. The University of Nevada, Reno School of Medicine Transmissible Disease Expert Panel shall meet on a regular academic semester basis, in addition to a case-by-case basis to assess, reassess and, where appropriate, to modify its original recommendations as circumstances warrant.
  2. Upon notification as outlined in Section 6.2 - Notification and Reporting Requirements, the Associate Dean of ASA presents to the UNIVERSITY OF NEVADA, RENO SCHOOL OF MEDICINE Transmissible Disease Expert Panel any and all reports received for discussion.
    • The University of Nevada, Reno School of Medicine Transmissible Disease Expert Panel will review the report and, if necessary, formulate a recommended action plan.
    • The University of Nevada, Reno School of Medicine Transmissible Disease Expert Panel will issue recommendation(s) within a reasonable time frame.
    • Recommendations of the University of Nevada, Reno School of Medicine Transmissible Disease Expert Panel may include, but are not limited to: postponement of, modification of, or discontinuation of a student's educational process.
    • The Associate Dean of ASA shall notify the student and all appropriate parties in writing of his/her determination. Said notification shall include a copy of the University of Nevada, Reno School of Medicine Transmissible Disease Expert Panel's recommendations.
  3. The student must comply with the recommendations of the University of Nevada, Reno School of Medicine Transmissible Disease Expert Panel. Failure to do so may result in the discontinuation and/or restriction of the student's activities related to the educational process; or, dismissal from medical school.