No./Title: COM118/Reporting Infections and Other Hazard Exposures	Resp. Office: Medical Education Approval Body: CUME	Effective Date: 05/17/21
Category: COM/UME	Last Review: 10/21/24	Next Review: 10/21/27
Contact: Michael Whitt, Ph.D. Assoc. Dean for Medical Education	 901-448-4634	 mwhitt@uthsc.edu
Related Policy: COM117 Infection Control and Prevention of Exposure to Environmental Hazards RS002 Exposure Control Plan	Program: Medicine (M.D.)

POLICY

It is the policy of the University of Tennessee Health Science Center (UTHSC) College of Medicine (COM) that mechanisms be in place for students to promptly report and receive medical attention for all significant exposures to infectious agents or other environmental hazards. This is essential to protect their own health and safety as well as that of their colleagues and their patients, and applies to prior known infections as well as exposures sustained in the course of medical training.

RATIONALE AND PROCEDURE

1. Students with known blood-borne infections (e.g., Hepatitis B, Hepatitis C, Human Immunodeficiency Virus), are ethically bound to report their infections to the institution .
   1. Students who harbor such pathogens must inform the Medical Director of University Health Services.
   2. The Medical Director evaluates the status of the student according to guidelines set forth by the Centers for Disease Control (CDC) and the Society for Healthcare Epidemiology of America (SHEA), taking into consideration the importance of maintaining patient safety as well as student privacy and medical confidentiality.
   3. The Medical Director will communicate any required restrictions of student activity to the Associate Dean of Medical Education and the Associate Dean of Student Affairs.
   4. Students should not defer seeking clinical care or career advice regarding such conditions due to financial or other concerns. However, students with prior known infections are financially responsible for any associated healthcare or monitoring costs.
   5. In compliance with the American with Disabilities Act Amendments Act of 2008 (ADAAA) students living with blood-borne diseases will not be discriminated against when considering admission and retention at UTHSC COM.
   6. Once it has been determined what, if any, adjustments or restrictions may need to be imposed on an individual student, reasonable accommodations will be developed through the UTHSC Office of Accessibility and Accommodations. All UTHSC COM students must meet the UTHSC COM technical standards.
2. Any significant exposure to potentially infectious materials that may occur in the course of student training is to be treated and reported.
   1. The CDC recommends application of “Standard Precautions” to the care of all patients, regardless of diagnosis or presumed infection status. By these criteria, potential sources of infection include: blood, all other body fluids, secretions and excretions except sweat, as well as contact with non-intact skin or mucous membranes.
   2. The following would be considered significant exposure to such materials:
      1. Percutaneous exposure by needle stick or other sharp instrument, or by human bites that penetrate the skin;
      2. Mucous membrane exposure by a splash to eyes or mouth;
      3. Contamination of a fresh cut (typically less than 2 hours old);
      4. Skin contact involving large volumes or prolonged exposure intervals, particularly if the exposed surface is chapped, abraded or otherwise compromised.
3. Students must not ignore such exposures.
4. If a student sustains an exposure to biological materials considered to be a bloodborne pathogens risk, the student should seek medical consultation and treatment immediately.
   1. First aid response should include the following:
      1. If contact with blood or other potentially infectious material occurs on skin with cuts, rashes, acne or dermatitis, wash the area for 15 minutes with soap and water.
      2. If blood or other potentially infectious material splashes in the eyes or on mucous membranes, flush the area for 15 minutes with water or normal saline.
      3. If there is a cut or puncture with a contaminated object (broken glass, needle, etc.), wash the area for 15 minutes with soap and water.
   2. Following initial first aid immediately inform your supervisor and follow the exposure protocol for the site where the exposure occurred. Contact information for reporting and occupational exposure at each site is provided at the end of this document.
   3. UTHSC campus exposures must be reported within 24 hours to the UT Office of Risk Management using the online incident report form on the UTHSC Campus Safety website: https://www.uthsc.edu/campus-safety/accidents-incidents/index.php.
   4. If the exposure occurred off of the UTHSC campus, after treatment has occurred you must report the exposure within 24 hours to the UT Office of Risk Management using the online incident report form on the Campus Safety website: https://www.uthsc.edu/campus- safety/accidents-incidents/index.php.
   5. Supervisors notified about student exposures must ensure that the student has completed the online incident report form listed above or report the incident themselves.
   6. Visiting students should contact their Campus Liaison for Visiting Students who will complete the incident report form online.
   7. Campus Safety will follow up on injuries and exposures that occur on the Memphis campus to investigate and document if changes can be made to prevent future occurrences. This will include collection of Sharps Injury Log information.
   8. When warranted, students may be excused from all learning activities to address the potential risks or effects of infectious or environmental disease or disability. Students will also meet with the Associate Deans for Medical Education and Student Affairs to discuss the impact on their education and/or graduation date.
5. If the exposure occurs during regular business hours on the Memphis campus, students should report to UHS immediately after notifying their supervisor of the exposure for testing and any necessary treatment. UHS is responsible for arranging for testing of the student and advising the student regarding appropriate care including diagnostic tests and follow-up. Post-exposure prophylaxis should be initiated as soon as possible, if indicated.
6. In the event that it is not possible to be seen at UHS (e.g. weekend or after hours), the student should seek immediate care at the local/nearest emergency department.
7. If the student is located on a regional campus, they should immediately notify both their immediate supervisor (clerkship/course director) and also the local UME dean/coordinator for information about where to obtain treatment/testing. If the exposure occurs after regular business hours or on a weekend, the student should report to the local/nearest emergency department for testing and treatment.
8. Students may also be required to present to the local clinical site’s employee health office for testing and/or documentation of the exposure. If the student receives appropriate testing and treatment from employee health, then it may not be necessary to report to UHS.
9. Regardless of where the student is seen for testing/treatment, the treating provider and/or facility should file all necessary charges with the student’s health insurance. The UTHSC sponsored insurance plan (United HealthCare Student Resources) has the appropriate coverage, and corresponding coverage should be verified if a student is on another plan.
10. If any bills related to an exposure are received after the claims are filed, students should contact the Associate Dean of Student Affairs or the Associate Dean of Medical Education to discuss options for payment. All efforts are made to avoid out of pocket expenses to the student.

APPROVAL HISTORY

Effective: 05/17/21

Revised: 10/21/24

Contact information for incident reporting at UTHSC and affiliate sites

Affiliate Site Daytime* After Hours*

UTHSC – Memphis	University Health Services (901) 448-5630	UHS Medical Provider: (901) 541-5654
BAPTIST HOSPITAL (East)	Employee Health (8am-4pm) (901) 226-5000	Emergency Room (901) 226-5000
EAST TENNESSEE CHILDREN’S HOSPITAL	Operator: (865) 541-8000	Operator: (865) 541-8000
ERLANGER HOSPITAL	Head nurse in the area where it occurred or Erlanger House Supervisor (423) 778-6168. If there is no answer, please call the Erlanger Operator at 423.778.7000 and ask the operator to the House Supervisor.	Head nurse in the area where it occurred or Erlanger House Supervisor (423) 778- 6168. If there is no answer, please call the Erlanger Operator at 423.778.7000 and ask the operator to the House Supervisor.
LEBONHEUR HOSPITAL	Associate Health (8am-4pm) (901) 287-5437	Emergency Room (866) 870-5570
JACKSON-MADISON COUNTY HOSPITAL	Operator: (731) 541-5000	Operator: (731) 541-5000
MEMPHIS MENTAL HEALTH INSTITUTE (MMHI)	Operator: (901) 577-1800	Operator: (901) 577-1800
METHODIST UNIVERSITY HOSPITAL	Associate Health (7am-4pm) (901) 516-9195	Emergency Room (901) 516-8193
MOCCASIN BEND MENTAL HEALTH INSTITUTE	Operator: (423) 265-2271	Operator: (423) 265-2271
REGIONAL ONE HEALTH (ROH – THE MED)	Occupational Health (7am-5pm) (901) 545-7166	Emergency Room (901) 545-7100
ST. FRANCIS HOSPITAL	(901) 820-7716	Emergency Room (901) 765-2180
ST. JUDE CHILDREN’S RESEARCH HOSPITAL	Occupational Health (901) 595-3300	Operator: (901) 595-3300
ASCENSION ST. THOMAS HOSPITAL – RUTHERFORD	Rutherford Occupational Health (615) 396-5990	Operator: (615) 396-4100

ASCENSION ST. THOMAS HOSPITAL – WEST	West Occupational Health (615) 222-2160	Operator: (615) 396-4100
ASCENSION ST. THOMAS HOSPITAL – MIDTOWN	Midtown Occupational Health (615) 284-6565	Operator: (615) 284-5555
UT MEDICAL CENTER (KNOXVILLE)	Occupational Health: 865.305.8831	Operator: (865) 305-9401 Occupational Health: 865.305.8831
VA HOSPITAL	Employee Health (8am-5pm) (901) 523-8990	Emergency Room (901) 523-8990