CNA Handbook: Blood Borne Pathogen Exposure and Respiratory Policy

Insurance

All students must have health insurance upon entering and throughout their enrollment. It is the student’s responsibility to obtain and pay for this insurance, as well as to understand the benefits and limitations of any insurance policy they maintain or is maintained on their behalf.

HIV Screening

Truckee Meadows Community College will not undertake any program of screening faculty or students for antibody to HIV. Any student or faculty wishing to be tested will be referred to his/her private physician.

Accidental Exposure Incidents

A student who has exposure to blood or body fluid or other potentially infectious material to non-intact skin or mucous membranes from a needle stick, sharps injury or other cause must immediately:

• Wash needle stick and/or cuts with soap and water.
• Flush splashes to the nose, mouth, or skin with copious amounts of water.
• Irrigate eyes with clean water, saline, or sterile irrigants.
• Remove soiled personal protective equipment and/or clothing as soon as possible.

After washing, flushing and/or irrigating the exposed area, the student must immediately:

• Notify the appropriate registered nurse at the clinical facility AND
• Notify clinical faculty who will then implement the process below.
• If there is a witness to the incident, several steps can be taken simultaneously.

Clinical Facility and student must:

• Complete an incident report at the clinical facility, if required; and be aware of and follow any reporting and follow-up requirements of the clinical facility.
• Complete the appropriate TMCC Exposure/Incident/Injury report form(s) with the clinical instructor.

The Clinical Faculty will be responsible for coordinating the procedures needed to get appropriate care for the student.

The Clinical Facility will:

• Identify the source of the exposure.
• Obtain stat physician’s order for needle stick exposure panel, if a needle stick.
• Obtain consent from source client, if not in chart.
• Determine who will be the health care provider for the student for counseling and treatment, if needed.
• Obtain phone number and name of student and the health care provider, and provide this information to the contacts listed below. Check the phone #s
• Normally the labs will be run STAT and will be reported to the student's physician.
• Provide the student with contact information to obtain source testing results (normally Employee Health, IC nurse, or staff development coordinator [SDC]).
• Send the student to their health care provider to obtain medical evaluation and post-exposure follow-up within 1 to 2 hours of the exposure (except as noted above for the VAMC). Medical evaluation may be at the healthcare facility of the clinical agency; the University of Nevada, Reno Student Health Center; with a private healthcare provider; at an urgent care facility; or at an emergency room.
  • Student should bring a copy of the documents with as much completed information as possible to the health care provider. They should also have the contact number for source information (normally the Employee Health Office) so that the health care provider may obtain results.
• The National HIV/AIDS Center provides a PEPline, a Clinicians’ Post-Exposure Prophylaxis Hotline which offers up-to- the minute advice on managing occupational exposures (needle sticks, etc.) to HIV, hepatitis and other blood borne pathogens. It is offered 24 hours a day, 7 days a week at 1-888-448-4911. The number for HIV Peri-natal Hotline for pregnant women is 1-888-448-8765.
• There is also a Clinician’s Consultation Center that is free of charge. This Warmline is staffed by physicians, clinical pharmacists and nurse practitioners Monday through Friday from 5 a.m. to 5 p.m., Pacific Time, at 1-800-933-3413.

Additional responsibilities

• The clinical instructor must notify the CNA Coordinator of the incident as quickly as possible.
• It is the student’s responsibility to make his/her healthcare provider aware of the results of any blood panel drawn as a result of an exposure.
• It is the student’s responsibility to follow-up with any counseling recommended by his/her healthcare provider as a result of an exposure.
• It is the student’s responsibility to follow-up with any treatment recommended by his/her healthcare provider as a result of an exposure.
• The student has financial responsibility for any cost associated with evaluation, treatment and/or counseling that results from an exposure.

Source information

• The clinical facility will collect as much information as possible from the source patient following an exposure. While the College will make every effort to maintain confidentiality, the College cannot be held responsible for acts and omissions of the clinical agency.

Guidelines for Exempting Students from Clinical Assignment to Clients with Blood Borne Diseases

Confirmed Pregnancy

The risk of transmission of HIV infection to pregnant health care workers is not known to be greater than the risk to those not pregnant.

The risk of transmission of other pathogens, such as cytomegalovirus from patients with AIDS to pregnant health care workers, is unknown but is thought to be low to nonexistent.

Based on the above information, there is no epidemiological reason to exempt pregnant students from caring for patients with blood borne disease.

Incompetent Immunological System

Students with diagnosed immunological deficiencies are at an increased risk for developing opportunistic infections that may be present in clients with blood borne diseases, as well as, other non-infected clients.

The Centers for Disease Control (CDC) (http://www.cdc.gov/mmwr/preview/mmwrhtml/00023587.htm accessed 10/12/04) does not recommend barring HIV-infected health care workers from practicing their profession. There is no evidence that infected nurses have ever infected a client with HIV in the process of providing nursing care. Although there is evidence that one dentist infected six clients with HIV, the mechanism of transmission has not been established. Looking back on studies a number of HIV-infected dentists and surgeons have not discovered any transmission to any of their patients.

Based on this information, students with HIV infection need not be restricted from clinical experience, unless they have some other illness for which any health care worker would be restricted. Symptoms of HIV (i.e. fatigue, paresthesia, vision problems, or dementia) may limit a health care worker’s ability to safely practice.

Infections

Any student with an infectious process could further compromise the client with an incompetent immunological system.

All students with exudative or weeping skin lesions should be restricted from direct client care contact.

The decision to exempt a student from clinical experience will be made on a case-by-case basis by the faculty responsible for the clinical course. Decisions about longer exemptions (more than one clinical session) will be made in consultation with the student’s physician and appropriate college faculty/administrators.

Record Keeping/Confidentiality

Records from testing, vaccination and training will be maintained by the TMCC Sciences Division.

Within the Code of Federal Regulations are statements designed to protect medical information and the privacy of the individual, providing there is no overriding need for the public to know. To mandate that a person infected with HIV be required or requested to notify Truckee Meadows Community College authorities is difficult, if not impossible to enforce and legally challengeable.

Individuals involved with health care-giving services who know they are infected with blood borne or other pathogens are ethically and legally obligated to conduct themselves responsibly in accordance with the following protective behaviors:

• Seek medical advice
• Follow College and/or agency guidelines when involved in direct client care
• Be knowledgeable about and practice measures to prevent transmission of blood borne or other diseases

No specific or detailed information concerning complaints or diagnosis will be provided to faculty, administrators, or even parents, without the express written permission of the individual in each case. This position with respect to health records is supported by amendment to the Family Education Rights and Privacy Act of 1974.

Health officials and other institutional officers must remember that all confidential medical/health care information is protected by statutes and that any unauthorized disclosures may create legal liability.

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