Bloodborne Viruses and Medical Students
This advice is to help clinical teachers plan the learning and teaching for students who are not cleared for Exposure Prone Procedures (EPPs).
The University’s Occupational Health Unit (OHU) performs all relevant ‘standard health checks’ on all students on their entry to Medical School. There is a professional expectation that all students will attend for screening and failure to complete this screening is likely to result in failure to progress to subsequent years training. Being positive for BBV does not preclude training for medicine but does affect the career options of graduates.
Students are reminded that they should self-report to OHU if they have think they have been exposed to circumstances or sexual incidents where they may have contracted a BBV immediately on their return in order that they can be re-screened urgently.
The following direct extract from the UK government guidance for Health Clearance for medical students is detailed here:
32. Medical students should be subject to standard health checks when they commence their course. However, the practical skills required of medical students to obtain provisional General Medical Council (GMC) registration or of Foundation Practitioners to obtain full GMC registration do not include EPPs. Fitness for EPPs is therefore not an absolute requirement for those wishing to train as doctors. This recognises that many career paths are available to doctors which do not require the performance of EPPs.
33. However, some commonly undertaken components of the undergraduate medical curriculum may involve students in EPPs. Additional health clearance is required for those students who will be involved in EPPs. Students found to be infectious carriers of BBVs will need to comply with occupational health supervision and guidance from the responsible Head of Course to ensure they do not perform EPPs. While the appropriate Medical School is responsible for medical students during their training, NHS Boards accepting student placements should check that this guidance is being followed. Further guidance on health clearance and management of infected medical students is being prepared jointly by the Council of Heads of Medical Schools, the Association of UK University Hospitals and the Higher Education Occupational Physicians group.
In the Health Clearance Guidance, medical students are described as ‘new health care workers’ where they come into ‘direct clinical contact’ with patients.
Care and support for BBV-infected medical students: students who are positive for BBV must remain under the care of specialist physicians and must attend OHU.
Definition of EPP: these are invasive procedures where there is risk of injury that could expose the patient’s tissues and the healthcare worker’s blood.
Non-EPP: procedures that are not exposure prone involve the worker’s gloved hands and fingers being visible outside of the body at all times. The usual risk reduction and infection control procedures must be followed at all times. Internal examinations such as rectal and vaginal examinations where there is no risk from sharp instruments are also not exposure prone. Other non-EPP are venepuncture, micro-lancet use, IV cannulation, and surface suturing.
Guidance for Years 1 and 2 students: in Years 1 and 2 of the course students practise suturing and venepuncture. These and other skills employ simulated materials. The usual risk reduction procedures must be followed. In laboratory/FRS sessions students may be required to take blood from each other using needles or micro-lancets. These are not exposure prone procedures and providing standard infection control procedures are followed no other precautions need to be taken. The procedures include safe sharps disposal and protocols for managing needle-stick injury.
Guidance for Years 3, 4 and 5 students - ‘the clinical years’: senior medical students spend most of their learning time in clinical situations. They should not be carrying out EPP but may observe operative procedures. In some cases students may ‘scrub-up’ and assist in operations. Because there is a low risk of BBV transmission during EPPs, healthcare workers (including medical students) who are infectious for HIV, hepatitis B or hepatitis C must not be allowed to carry out EPPs, as injury to the worker could result in their blood contaminating their patient’s open tissues. However, students who are successfully treated for BBV infection and, for HIV and HBV are appropriately monitored, will normally become eligible to perform EPPs. The guidance recently published by the Medical Schools Council on health clearance for medical and dental students provides full details.
In the course of their learning, senior medical students may be offered the opportunity to assist in procedures that are exposure prone. The students, the educational supervisors and other staff should be aware of the extant guidance quoted above. Students who are not cleared for EPP must be confident in asserting their wish not to be involved without it compromising their formative or summative assessments.
Responsibilities: the responsibilities of all parties are outlined here. All professional groups and authorities identified in this section must understand that whilst discharging their respective responsibilities, healthcare workers, including students, have a right to expect that their confidentiality will be respected and protected. Any unauthorised disclosure about the BBV status of a student, employee or patient constitutes a breach of confidence and may lead to disciplinary action.
If you have any further enquiries, please contact Professor John Paul Leach, Head of the Undergraduate Medical School: John.Leach@glasgow.ac.uk