Policies and Procedures for Infection Control/Prevention and Exposure Response

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, nursing students are presented with information on personal security and fire safety, in addition to infection control, HIPAA, and OSHA. Furthermore, nursing 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. Nursing students, staff, and faculty must adhere to all established Emory and Henry College safety protocols.

• Didactic-phase students must notify their course faculty 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 Nursing 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 not just good procedure; it is also a mark of your 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.

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 any notice of incident forms in use by the clinical site, as well as the Student Incident/Injury Form which can be found on Moodle>Student Forms/Documents-SON https://moodle.ehc.edu/course/view.php?id=22021

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/Course Faculty and also contact the Program Director or Dean within 24 hours of exposure.
• If the exposure occurs at an off-campus clinical unit, the student should follow the Infection Control Policy of that facility. Outside of clinical 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 Nursing 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 Nursing Program will provide appropriate training to students regarding Occupational Safety and Health Administration (OSHA) standards prior to beginning the program. The facility at which the clinical experience takes place shall provide 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 faculty’s responsibility to take reasonable steps to ensure personal safety and security of students during clinical experiences.

For all incidents/injuries, students are required to complete the Student Incident/Injury Report Form as included on Moodle>Student Forms/Documents – SON https://moodle.ehc.edu/course/view.php?id=22021 within 24 hours of the incident or injury.

Inherent Risk Assumed

Choosing the healthcare profession 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 safety while performing their duties, responsibilities, and training in this role of caring for other human beings. By enrolling in this Nursing Program the EHC Nursing 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 Precautions

Students are required to review the material on personal safety and security in the School of Nursing’s Student Handbook in addition to the Safety and Security information posted in the Emory and Henry College Academic Catalog>Student Handbook EHC Safety and Security. Importantly, in addition to the E&H College and School of Nursing safety policies and procedures, nursing students are required to follow all clinical site-specific safety policies and procedures.

Evaluation Guidelines

Evaluation of Student Clinical Performance

1. During clinical experience, the course faculty will collaborate with the mentor/preceptor assigned to the student to receive feedback.
2. Course faculty will collaborate with the mentor/preceptor to assist the student in achieving clinical objectives.
3. Course faculty will discuss evaluations with the student during clinical experiences.
4. In the event of an unsatisfactory performance or critical incident, the mentor/preceptor will contact the course faculty immediately. The course faculty and mentor/preceptor will discuss and determine the appropriate plan of action and counseling of the student.
5. At the end of clinical experiences, the course faculty and student will meet for the final evaluation.
6. Students are required to receive a satisfactory grade on the final clinical evaluation to successfully complete the course.
7. Course faculty are responsible for all grading and evaluations with input from the mentor/preceptor.

Student Evaluation of Mentor/Preceptor and Clinical Facility Site

Each student will complete an evaluation of the mentor/preceptor and the clinical facility at the end of the clinical experience(s). The evaluation will be submitted as designated by the course faculty.

Mentor/Preceptor Evaluation of Clinical Practice Experience

The mentor/preceptor will complete an evaluation of the clinical experience at the end of the semester.

Student Drug and Alcohol Policy

It is the policy of Emory and Henry College School of Nursing to maintain a safe and healthy environment for its students and employees. Emory and Henry College prohibits being under the influence of, or the unlawful use, manufacture, possession, distribution or dispensing of drugs, “controlled substances” as defined in the Controlled Substance Act, 21, U.S.C. 812 Section 812  and alcohol on college property or during college activities.

Violation of this policy is grounds for disciplinary action, up to and including permanent dismissal of a student. Federal and state laws provide additional penalties including fines and imprisonment. Local and College ordinances and policies may provide penalties for drug and alcohol violators, which may include referral for local prosecution or requiring the individuals to participate satisfactorily in an approved drug or alcohol abuse assistance or rehabilitation program.

To maintain a safe and drug free environment, EHC expects its campuses and institutes to establish procedures for performing screenings for controlled substances and alcohol within areas or positions that affect safety or where such screenings are required by federal regulations. In addition, screenings are permissible where there is a reasonable suspicion of drug or alcohol use.

At EHC, the college bears the additional responsibility of assuring that students entering clinical settings are ready for providing clinical care and must pay particular attention to issues that could affect patient safety or student access. To this end, the campus has an established a number of guidelines and procedures relating to drug and alcohol monitoring.

Guidelines and Procedures:

1. Clinical sites may require drug testing, (at the student’s expense) as a condition of clinical placement and students may be responsible for payment of such testing. In addition, agencies may require random drug and/or alcohol testing of a student while in or on the clinical site’s premises. Students participating in patient care in such settings as a part of their education must conform to that site’s policies and requirements.
2. Students taking over-the-counter or prescribed medication are responsible for understanding the effect that the medication may have on their performance or personal behavior and possibility that usage of these medications might lead to an adverse finding on a drug screen. Students in such circumstances are strongly advised to report the use of such substances to their Program Director and/or Director of Clinical Education (DCE), if they suspect that their performance may be impaired and/or if their behavior has caused college officials to require them to provide blood, urine, or breath analysis.
3. A college official may require a student to undergo drug testing, (at the student’s expense) for an immediate blood, alcohol, urine or breath analysis under any of, but not limited to, the following circumstances and conditions:
   1. When there is reasonable suspicion that the individual is under the influence of alcohol, narcotics, stimulants, sedatives, hallucinogens, marijuana or other chemical substances;
   2. Following a work-related injury;
   3. Observation of poor judgement or careless acts, that caused or had the potential to cause patient injury, or that had, or had the potential to jeopardize the safety of others, or that had resulted in damage to property and/or equipment;
   4. Suspected diversion of controlled substances (e.g. use of possession of a prescription drug without a prescription, sale or distribution of a prescription drug, or theft of a prescription drug) including but not limited to, anti-anxiety agents or psychostimulants (such as Adderall, Dexedrine, Ritalin).
4. Until proven otherwise, an individual with a preliminary positive drug or alcohol screen is presumed to be under the influence of drugs or alcohol and subject to intervention or sanction by his/her college. This type of intervention or sanction will be dependent on the setting in which the incident occurred, the degree of impairment observed and the actual level of banned substance detected. Additional confirmatory testing or monitoring would likely be required to determine the need for additional sanctions/treatment beyond temporary removal from the setting in which a change in, and/or abnormal behavior was observed.
5. Individuals with a history of drug or alcohol use, including those who were required by the college to seek treatment as a condition of continued enrollment, may be required to have periodic testing for drugs or alcohol at the student’s expense.
6. Individuals who refuse to undergo an immediate drug and alcohol screen may be subject to immediate disciplinary actions, up to and including dismissal.

School of Nursing students are also bound by the Emory & Henry College Code of Student Conduct. https://catalog.ehc.edu/ehc-student-handbook/code-of-student-conduct

Intervention Process for Cases of Chronic Substances Use/Abuse/Dependence

In the absence of a defined college process, the following general guidelines should be followed when a college determines that a student is unduly affected by substance use/abuse/dependence.

1. Students that have been exhibiting evidence of substance use/abuse/dependence should be referred for assistance through the Paul Adrian Powell, III Student Success Center and the SON Committee (SONC) for voluntary evaluation and care. Counseling services are provided through the Paul Adrian Powell, III Student Success Center. Services are available to all enrolled students. Depending on a student’s needs, students may meet individually with a counselor or participate in workshops and groups that focus on various topics such as stress management, assertiveness, appropriate expressions of anger, grief, trauma, consultation, adjustment to changes, substance abuse, and relationships. When necessary, the Counseling Office refers students for services that are not available through the college. Information about counseling services can be found at: https://www.ehc.edu/office-student-success/counseling-services/ Counseling staff provide services on the Marion campus as well as the Emory Campus.
2. If his/her conduct and performance in a clinical setting warrants such action, the student may be subject to immediate corrective action by the clinical faculty. Such actions could involve immediate removal from the clinical setting, requirement for immediate testing for alcohol or controlled substances at the student’s expense, referral of the student for behavioral screening, or other actions deemed necessary by the clinical faculty.
3. A student may be required to take a leave of absence (normally for a period not to exceed 12 months) for evaluation and care by treating clinical professionals who will be permitted to confirm compliance with recommended treatments and to confirm readiness of the student to return.
4. Any student who fails to complete recommended care and treatment and/or whose readiness to resume his/her academic program is not confirmed by his/her health care provider will be subject to dismissal.
5. Any student on leave to address substance use/abuse/dependence will not be allowed to resume active enrollment without a written positive recommendation from his/her treating healthcare provider(s).
6. In the case of substance use/abuse/dependence:
   1. The student must provide evidence of successful completion of the treatment program and sustained active recovery/sobriety.
   2. The student must present documentation that they are substance free, presently involved in an after-care program and fit to resume their education without restrictions.
   3. The student must sign a statement that they are willing (or be willing) to provide periodic unannounced urine screens during the remainder of their educational experience.
7. Students should be aware that academic programs may be required to divulge information related to prior drug or alcohol treatment for hospital and/or professional credentialing.