Infection Control and Exposure Response

The safety of all students, staff, faculty, and patients is of primary concern. Therefore, during orientations for both didactic and clinical education phases, PA students are presented with information on personal security and fire safety, in addition to infection control, HIPAA, and OSHA. Furthermore, PA students will be required to complete any clinical site-specific safety or security training requirements in preparation for supervised clinical practice experiences. Students must be aware that risk exists for exposure to infection and environmental disease during the didactic and clinical phases of the Program. PA students, staff, and faculty must adhere to all established Emory & Henry College safety protocols.

• Didactic-phase students must notify their course director and/or MLFC preceptor as soon as possible of any exposure to bodily fluids, chemical hazards, or potentially serious infectious diseases.
• Clinical-phase students must notify their SCPE preceptor and the Director of Clinical Education as soon as possible of any exposure to bodily fluids, chemical hazards, or potentially serious infectious diseases.
• All faculty, staff and students will utilize Standard Precautions (Methods of Prevention as outlined in the MPAS Program Student Handbooks) during all activities that present a risk of exposure to blood/body fluids or chemical hazards. Failure to do so will be grounds for disciplinary action.
• Students must follow the exposure response plan detailed below in the case of any exposure to blood/body fluids, chemical hazards, or potentially serious infectious diseases.
• Compliance with all safety practices is a not just good procedure, it is also a mark of professionalism. Failure to observe and practice Standard Precautions may result in adverse/disciplinary action for unprofessional behavior and referral to the Student Progression Committee.

Methods of Prevention

Standard precautions (Methods of Prevention) are the minimum safety and infection prevention practices that apply to all patient care and laboratory or technical skills training experiences in any setting where healthcare or healthcare training is delivered. These practices are designed to protect healthcare professionals (HCP) and prevent HCP from spreading infections to others.

Methods of Prevention

Hand Hygiene

• Good hand hygiene is critical to reduce the risk of spreading infection.

• Current CDC guidelines recommend use of alcohol-based hand rub for hand hygiene except when hands are visibly soiled (e.g. dirt, blood, body fluids), or after caring for patients with known or suspected infectious diarrhea, in which cases soap and water should be used. Key situations where hand hygiene should be performed include:

  • Before touching a patient, even if gloves will be worn.

  • Before exiting the patient’s care area after touching the patient or the patient’s immediate environment.

  • After contact with blood, body fluids or excretions, or wound dressings.

  • Prior to performing an aseptic task (e.g. placing an IV, preparing an injection).

  • If hands will be moving from a contaminated-body site to a clean-body site during patient care.

  • After glove removal.

Use of personal protective equipment (PPE)

Exam gloves will be worn when there is risk of contact with or when handling blood or body fluids or when there is a potential for contact with mucous membranes, non-intact skin or body orifice areas, or contaminated equipment. Facial masks, protective eyewear and/or gowns (as well as gloves) will be worn when performing/assisting procedures with a risk of body fluid or other hazardous material splashes or sprays.

Safe injection practices:

• No recapping of needles unless required by the specific procedure being performed.

• Use of self-sheathing needles and/or needleless systems when available.

• All needles and other disposable sharps will be placed in designated puncture resistant containers as soon as possible after their use.

Safe handling of potentially contaminated surfaces or equipment:

• Environmental cleaning: Areas in which patient care activities are performed will be routinely cleaned and disinfected at the conclusion of the activity.

• Medical equipment safety: Reusable medical equipment must be cleaned and disinfected (or sterilized) according to the manufacturer’s instructions. If the manufacturer does not provide guidelines for this process the device may not be suitable for multi-patient use.

Respiratory hygiene/Cough etiquette:

• Cover mouth/nose when coughing or sneezing.

• Use and dispose of tissues.

• Perform hand hygiene after hands have been in contact with respiratory secretions.

• Consider using a mask to prevent aerosol spread.

• Sit as far away from others as possible.

Exposure Response

Wounds and skin sites that have been in contact with blood or body fluids should be washed with soap and water; mucous membranes should be flushed with water. There is no evidence that the use of antiseptics for wound care or expressing fluid by squeezing the wound further reduces the risk for HIV transmission. However, the use of antiseptics is not contraindicated. Use of caustic agents, e.g., bleach, is not recommended.

Incident/Injury Form

• The student must notify her/his supervisor immediately and complete notice of incident forms in use by the clinical site as well as the Student Incident/Injury Form which is posted EValue.

Medical Evaluation: It is very important that medical evaluation take place immediately because treatment decisions must be made within 2 hours of exposure. HIV prophylaxis for high-risk exposure appears most effective if started within 2–4 hours. It is also extremely important to evaluate the donor’s risk status immediately.

• The student should report IMMEDIATELY to his or her Clinical Preceptor and also contact the Director of Clinical Education within 24 hours of exposure.
• If the exposure occurs at an off-campus clinical site, the student should follow the Infection Control policy of that facility. Outside of these hours, the student should go IMMEDIATELY to the nearest urgent care or emergency room.  
  • Note: If the incident occurs at a hospital or large medical facility, that facility’s Employee Health Clinic may be able to do the initial clinical evaluation.

Program Participation: Continued participation in the activities of the PA program will not be affected by any injury or illness that occurs while enrolled provided the student continues to meet all Technical Standards and fulfill all defined requirements for program progression and is not directly infectious by way of routine contact. Note: This only applies to serious, potentially life-threatening infections.

Financial Responsibility: Students are mandated to have health insurance throughout their participation in the Program. Students will be financially responsible for all costs incurred during compliance with this policy.

Laboratory Testing/Treatment: To determine whether treatment of the student is necessary, blood may need to be drawn from the patient (i.e. source of contamination) to evaluate Hepatitis B, C, and HIV status. In a hospital setting the Infection Control Nurse or Nurse Supervisor is often authorized to order these tests on the patient/donor. The Infection Control Nurse or Nurse Supervisor should also review the medical record, question the patient/donor about risk factors, and obtain the patient’s/donor’s consent to do the tests necessary to evaluate their health status. If the exposure occurs in an outpatient setting (and these tests cannot be done), the patient /donor may need to accompany the exposed student for evaluation.

Student Safety During Supervised Clinical Practice Experiences (SCPEs)

The MPAS Program will provide appropriate training to students regarding Occupational Safety and Health Administration (OSHA) standards prior to beginning SCPEs. The facility at which the SCPE takes place shall provide to students access to the facility’s rules, regulations, policies and procedures with which the students are expected to comply, including the Facility’s OSHA, personal and workplace security and personal safety policies and procedures and shall address all appropriate safety measures for all students on site. It will be the clinical preceptor’s responsibility to take reasonable steps to ensure personal safety and security of students during the SCPE. This is clearly communicated to preceptors and agreed upon in a signed Preceptor Agreement obtained prior to the SCPEs.

For all incidents/injuries, students are required to complete the Student Incident/Injury Report Form as included in the MPAS Program Student Handbook within 24 hours of the incident or injury, unless discussed with the Director of Clinical Education for extenuating circumstances.

Specific to Supervised Clinical Practice Experiences (SCPEs), newly developed sites are evaluated for safety on a minimum of three occasions: (a) by program faculty prior to establishing clinical rotations, via the SCPES Site Visit Evaluation Report form Facility Safety Checklist; (b) by students, via the mid- and end-of-rotation Student Evaluation of Clinical Rotation Site form SCPE Rotation Site Safety evaluation; (c) by program faculty when performing site visits with students via the SCPE Site Visit with Student Evaluation Report form Facility Safety Checklist. For established sites, a minimum of one site visit per year is required to assure appropriateness and safety of the site. Students will not be placed or permitted to continue experiences at sites having any identified safety concerns until those issues have been rectified.

Inherent Risk Assumed

Choosing the path of medicine is a noble and self-sacrificing calling. Students should accept responsibility for the decision they have made to enter into a profession, and professional training program, that has inherent risk to their personal health and safety while performing their duties, responsibilities, and training in this role of caring for other human beings. By enrolling in this PA Program the EHC PA student accepts this risk.

Universal Precautions

Students are responsible for following OSHA Guidelines for universal precautions at the clinical rotation site, including the use of gloves, care of sharp objects, use of eyewear, protective clothing, and other precautionary measures.

Latex Allergies

Any documented allergies to latex products should be reported to the preceptor and Director of Clinical Education. Each student is responsible to supply the latex free products they may need if not readily available.

Safety Procedures

Students are required to review the material on personal safety and security in the MPAS Program’s Student Handbook in addition to the material posted on the website of Emory & Henry College under Campus Safety Policies (https://www.ehc.edu/student-life/campus-safety/). Importantly, in addition to the E&H College and MPAS Program safety policies and procedures, SCPE students are required to follow all SCPE site-specific safety policies and procedures.

While on clinical rotations, it is the responsibility of students to inform the Director of Clinical Education (or representative) of any safety or security concerns. In the case of an emergent safety or security concern, the student either dial 911, if appropriate or notify their site supervisor and/or facility security.

Transportation Policies

Specifically for student safety and security, and unless in an emergency or critical situation, faculty (e.g., principal faculty and instructional faculty, clinical preceptors and/or clinical site staff) are not permitted to transport students.

Exposure, Accident Reporting and Medical Care

The Director of Clinical Education, Preceptor and facility employee health (if available) must be notified of any exposure/possible exposure or accident within 24 hours of the incident. If a student believes they have been exposed to an infectious disease or has been involved in an accident, they should consult their primary medical provider as soon as possible for guidance and assistance, as well as appropriate treatment and care. Ultimately, the student is responsible for initiating care after exposure to possible pathogens. All costs related to medical care are the student’s sole responsibility. Please refer to the absence policy for any and all time missed from SCPEs.

All injuries and exposures must be reported to the Director of Clinical Education via the Student Incident/Injury Report Form as included in the MPAS Program Student Handbook. For additional information, see the MPAS Program student handbook.

Anatomy Lab Safety and Conduct Policy and Procedure

Students will be expected to purchase and wear scrubs and a long white jacket to be worn only during their anatomy laboratory experiences and discarded after the course is completed.

Most of the cadavers are embalmed with a fluid containing formaldehyde, phenol, alcohol, and glycerol. These substances kill bacteria and inactivate most viruses. The level of formaldehyde is controlled by Environmental Health and Safety to ensure that our exposures are below levels set by OSHA and NIOSH.

Personal Protection:

• Eye protection must be worn when dissecting and moving cadavers.
• Non-latex gloves must be worn throughout the dissection period.
• Students must wear course-specific white lab coats over navy blue scrubs whenever in the laboratory.
  • Students are expected to dispose of scrubs and lab coats at the end of the course.
• No sandals, perforated shoes, or bare feet are permissible in the anatomy lab.
• Students with long hair will be expected to pull their hair back from their face.
• Wearers of soft contact lenses are cautioned that they may experience eye discomfort when wearing these lenses and it may be prudent to wear eye glasses during laboratory time.

Conduct:

• Care of cadavers is the students’ responsibility.
  • The cadaver must be kept clean, properly covered and moistened to prevent deterioration. When not in use, the cadaver should be wrapped and moistened as directed by the anatomist.
• Treat anatomical specimens with the respect that is always due to the deceased. Keep in mind that the cadaver plays an important role in your learning.
  • Cadavers will receive absolute respect at all times.
  • Any student who exhibits disrespectful behavior towards a cadaver in the lab will be considered to have violated the student code of conduct and professionalism and is subject to applicable consequences up to an including course failure and dismissal from the program.
• The cadavers are the property of the Anatomical Board of the State of Virginia.
  • It is a violation of Virginia law to remove any part of the cadaver from the dissecting laboratory.
  • Any student who removes any part of a cadaver from the lab will be considered to have violated the student code of conduct and professionalism and is subject to applicable consequents up to an including course failure and dismissal from the program.
• No eating, drinking, or smoking in the laboratory.
• Discarding of materials:
  • Cadaver organs are to be discarded in labeled receptacles. These materials returned for cremation with the body of origin.
  • Unless otherwise instructed by the Anatomist and Anatomy Faculty, gloves and paper towels are to be discarded in proper trash receptacles, NOT in the red bag receptacles.
  • All sharp objects are to be placed in the red “SHARPS” container. No other objects (i.e., foil scalpel blade covers, paper towels, etc.) or waste of any type is to be placed in the sharps container. Violation of this policy will result in one full letter grade deduction from the final course grade (e.g., an A will become a B).
• No marking of bones or models with pencils or pen is permitted at any time.
• Unless permitted by course director(s), audio-visual devices of any kind are not allowed in the lab at any time. This includes cameras on cell-phones.
  • Unless with prior approval, any student who brings an audiovisual device (e.g., camera or cell phone) into the will be considered to have violated the student code of conduct and professionalism and is subject to applicable consequences up to an including course failure and dismissal from the program.

Security:

• Anatomical Board regulations state that no guests or outside visitors are allowed in the dissection lab at any time.
  • Only students enrolled in the MPAS Program and designated faculty, instructors, and tutors are permitted to enter the lab.
  • Any student who provides access to the lab for any person other than a student enrolled in the MPAS Program will be considered to have violated the student code of conduct and professionalism and is subject to applicable consequences up to an including course failure and dismissal from the program.
• No open doors.
  • Doors to the anatomy lab must remain closed at all times.
• Use of the dissecting lab outside of normally scheduled lab times is permitted for MPAS Program students only.
  • Students may not enter or work in the dissecting lab alone. There must be a minimum of two students in the lab at all times.

Accidents:

• Spills and injuries should be immediately reported to the instructors.
• If injury requires treatment an injury report must be completed.
• Students with injuries requiring medical attention will be sent to the emergency room.

Spills:

• Wipe up spills immediately.
• Use eyewash and showers if necessary.

Safe Use of Equipment:

• Insert scalpel blades with forceps.
• Dispose of blades only in sharps containers.
• Never attempt to catch a dropped scalpel.
• Scalpel blades are the number one cause of injury in the dissecting lab. Please use caution.
• Use autopsy saw ONLY under supervision of an instructor.
• All dissecting instruments, gloves, models, bones, and text materials should be kept clean and free of tissue at all times.
• Keep the dissecting tables clean. At the end of each lab, any loose tissue should be placed in the receptacle which corresponds numerically with your individual cadaver. In addition, the outside of the cadaver tank should be kept clean.
• All tissue removed from the body must be collected and placed in the designated receptacle which corresponds numerically with your individual cadaver.
• Buckets under the table are for collection of tissue fluids and should be emptied into the shower drain and washed when significant fluid or tissue can accumulate.
• At the end of each dissecting period, clean and dry your personal instruments, remove them from the dissection table, and store in appropriate designated areas.
• Clean and return mallets, chisels, and saws to equipment cabinets when you are finished.
• Be sure that exhaust tubes are appropriately attached to the HVAC system at all times and that the table vent is an open position.

Hazardous Chemicals:

Material Safety Data Sheets (MSDS) for chemicals used in the lab are available upon request.

OSHA

The Occupational Safety and Health Administration (OSHA) was created by Congress to “assure the safe and healthful working conditions for working men and women by setting and enforcing standards and by providing training, outreach, education and assistance”. https://www.osha.gov/about.html

All students are expected to review the following OSHA Safety and Health Topics

• Healthcare website: https://www.osha.gov/SLTC/healthcarefacilities/
• All modules of the OSHA Worker Safety in Hospitals web site: https://www.osha.gov/dsg/hospitals/index.html

All students are required to successful complete HIPAA and OSHA trainings during their boot camp orientation.