CM-25 - LSUHSC Policy on AIDS (HIV) and Hepatitis Virus (HBV)

May 15, 2002

Individuals Infected with Human Immunodeficiency Virus (HIV)/Hepatitis B Virus (HBV)/Hepatitis C Virus (HCV)

It is a policy of LSUHSC to encourage preventive and early care for faculty, staff, employees and trainees with HIV/HBV/HCV. These individuals are encouraged to seek regular health care in keeping with current standards from their private health care provider, or, if unavailable, to access these services through Student Health, Comprehensive Health Clinics or the Employee Assistance Program for initial evaluation and referral.

LSUHSC will not discriminate against blood-borne infected persons in employment, education, and the use of public facilities. Discrimination against persons with disabilities is prohibited in accordance with Section 504 of the 1973 Vocational Rehabilitation Act, and the 1990 Americans with Disabilities Act.

Individuals have access to intra-institutional channels through the Office of Human Resource Management to appeal and obtain redress of allegedly discriminatory policies, procedures, or administrative actions.

Objective

The objectives of the LSUHSC bloodborne diseases policy are as follows:

To provide guidelines for a safe patient care environment;
To protect the personal rights of HIV/HBV/HCV infected individuals, including the right to freedom from unwarranted disparate treatment and improper handling of private information;
To provide information, education, and counseling that promotes the personal and professional well being of students, trainees, faculty and employees;
To provide for the implementation of laws and regulations pertaining to public health and welfare, and employment practices.

This policy has been developed with guidance from various national organizations and academic health care institutions. Portions of the following documents have been incorporated into this policy: AAMC Policy Guidelines for Addressing HIV Infection in the Academic Medical Community (AAMC 1988), Morbidity and Mortality Weekly Report (MMWR, Vol.50, No.RR-11, June 29, 2001), and the Consensus Statement by the Workgroup on HIV/HBV Transmission in the Health Care Setting (Louisiana Department of Health and Hospitals, September 12, 1991).

It should be considered flexible and subject to updates as new and additional knowledge is acquired.

Definitions

Healthcare Workers (HCWs) - students of the Health Sciences Center and faculty/staff of LSUHSC.
LSUHSC- Louisiana State University Health Sciences Center in New Orleans and Shreveport.
Blood-borne Disease - infections known to be transmitted by blood, including such organisms as Hepatitis B Virus (HBV), Hepatitis C Virus (HCV) and Human Immunodeficiency Virus (HIV).
Invasive Procedures - as defined by the American Medical Association, Association of American Medical Colleges, American Dental Association, Association of American Dental Schools, American Nursing Association, and the Center for Disease Control as they relate to the specific discipline.
Exposure-prone Procedure - certain invasive surgical or dental procedures already implicated in the transmission of blooborne infections from infected HCW's to patients. Examples include certain oral, cardiothoracic, colorectal and obstetric/gynecologic procedures. Characteristics of exposure-prone procedures include digital palpation of a needle tip in a body cavity or the simultaneous presence of the HCW's fingers and a needle or other sharp instrument or object in a poorly visualized or highly confined anatomic site. Performance of exposure-prone procedures presents a recognized risk of percutaneous injury to the HCW and if such an injury occurs, the HCW's blood is likely to contaminate the patient's body cavity, subcutaneous tissues and/or mucous membranes, and/or nonintact skin.
Standard Precautions - recommended guidelines written by LSUHSC in the LSUHSC Standard Precautions Policy for bloodborne trasmissible diseases.
Documented Occupational Exposures - where either the HCW has contact with a patient's blood/body fluids or where the patient had contact with HCW's blood/body fluids. The incident is documented by completing a "First Report of Injury" form.

Signed: Perry G. Rigby, M.D., Chancellor

Appendix

LSUHSC-NO Procedure on Bloodborne Diseases

Preamble

Faculty, staff, and students who are HIV/HBV/HCV infected, and who perform exposure prone procedures are encouraged to self-identify to the Chancellor (or designee) of LSU Health Sciences Center, to their immediate supervisor, who would then report to the Chancellor (or designee) of LSU Health Sciences Center, or directly to the Expert Review Panel (ERP). In reporting their status to the Health Sciences Center, HIV/HBV/HCV infected individuals are assured that every effort will be made by the LSUHSC Administration to maintain confidentiality, as determined by the Expert Review Panel (ERP), and that a mechanism is in place, through the HIV/HBV Policy/Procedure and Expert Review Panel (ERP), to maintain balance between the individual's job-related responsibilities and the institution's responsibilities to faculty, staff, students, patients and the community. There is a need to protect the HIV/HBV infected individuals, faculty, staff, and patients. The Expert Review Panel (ERP) in conjunction with the Administration is working to assure a system is in place to fulfill this need.

I. HIV/HBV Risk Event

Employee of LSUHSC-NO: When an employee has an accident which is considered an "at risk" incident (i.e., needle stick, puncture, mucous membrane or skin exposure, or cut from a potentially contaminated source), the employee must immediately report the incident to his/her immediate supervisor.

The supervisor is responsible for reporting the incident and following procedures to insure proper testing and medical treatment are provided. The employee is entitled to seek his/her medical care of choice under Worker's Compensation. Medical care will be made available, if requested by the employee, at the LSUHSC-NO Comprehensive Medicine Clinic , the Worker's Compensation Physician under contract , or the employee’s personal physician. The current physician contract is with Concentra Medical Center with two (2) locations at 318 Baronne Street, New Orleans and 3640 Houma Blvd., Metairie. Before being treated by the contracted physician group, treatment must be authorized by the supervisor or designee.

The supervisor or designee will fill out an Employee’s Report of Injury Form which the employee carries to the clinic. The Employee’s Report of Injury Form may be obtained from Human Resources Management (room 603). In cases where the supervisor is unavailable and the employee is taken to any of the clinics, the clinic will telephone the Human Resource Management Office and request authorization for treatment. Injured employees may also seek treatment from their personal physician. When possible, injured employees should contact the Human Resource Management Office before going to their personal physician.

The LSUHSC-NO Comprehensive Medicine Clinic or , the Worker's Compensation Clinic, or the employee’s personal physician must be notified that the employee has had an "at risk " incident and that proper testing must be performed. Based on the initial testing, additional testing or treatment may be warranted and must be recommended by the examining physician at the time of treatment in order to be considered for eligibility under Worker's Compensation.

The Employee Report of Injury Form must be promptly completed and forwarded to the Office of Human Resource Management within 30 days. The Supervisor's Accident Investigation Report must also be completed. The itemized billing from the health care provider must be submitted to the Office of Human Resource Management within 90 days after services were rendered for eligibility under Worker's Compensation.

The Environmental Health and Safety Office will forward the Supervisor's Accident Investigation Report Form to the supervisor when the First Report of Injury Form has been received and logged by Human Resource Management. Supervisors are required to investigate each accident and to implement corrective action to prevent recurrence.

Counseling for LSUHSC-NO employees is available through the Employee Assistance Program (568-3931) at no cost for initial counseling. Contact the Office of Human Resource Management for more information. The Employee Assistance Program can also provide access to the Expert Review Panel (ERP) on behalf of LSUHSC-NO employees.

Summary of steps to be taken when an "at risk" incident occurs:

Report incident to supervisor
Provide immediate health care, and testing , and prophylaxis, if indicated
File the required paperwork
Seek counseling and access to ERP, if necessary.

Residents: Residents employed through the Health Sciences Center are treated as employees.

Students: When a student has an accident which is considered an "at risk" incident (i.e., needle stick, puncture or cut from a potentially contaminated source) the student must immediately report the incident to his/her immediate supervisor as determined by each school/department.

The supervisor is responsible for reporting the incident and following procedures to ensure proper testing and health care are provided. If the incident occurs at an off-campus location, the student should be referred to the institutional infection control office (usually, their employee health service). For on-site occurrences, the student should be referred to Student Health at 2020 Gravier, 7th floor. The CDC and OSHA guidelines for risk exposure will be followed and appropriate reporting provided. Follow up lab studies for all students should be handled through LSUHSC Student Health. . During hours when the Student Health Clinic is not open, students should seek emergency care at the Fast Track emergency room at the Medical Center of Louisiana, Charity Campus.

The student is entitled to seek his/her health care of choice. Health care will be made available if requested by the student at either the LSUHSC-NO Student Health Clinic, or if contracted to another facility or location, from that satellite location following their policy for "at risk" incidents. Injured students may also seek treatment from their personal health care provider. In all cases, the First Report of Injury and Supervisor's Accident Investigation Report must be filed with the Louisiana Office of Risk Management for eligibility under Student Health Needlestick Insurance.

The health care provider treating the student must be notified that the student has had an "at risk" incident for HIV/HBV/HCV and that proper testing must be performed. Based on the initial testing, additional testing or treatment may be warranted and must be recommended by the examining health care provider at time of treatment.

A form entitled First Report of Injury must be promptly completed and forwarded to the Office of Human Resource Management within 30 days. The Supervisor's Accident Investigation Report must also be completed. All students have a limited amount of insurance to cover costs of labwork that may be necessary as a result of exposure. Specifics about this insurance may be obtained directly from the Student Health Office.

Counseling for LSUHSC-NO students is available through the LSUHSC-NO Student Health Mental Health Counselors or the Campus Assistance Program. The Student Health Clinic can also provide access to the Expert Review Panel (ERP) on behalf of students.

Summary of steps to be taken when and "at risk" incident occurs:

Report incident to supervisor
Provide immediate attention, testing
File required paperwork
Seek counseling and access to ERP, if necessary.

II. HIV/HBV/HCV Infected Individuals

Standing HIV/HBV/HCV Policy and Procedure Committee

The Chancellor or designee will designate the Standing Bloodborne Pathogen Policy and Procedure Committee at LSUHSC-NO. This committee, with representatives from each school, will review and update the LSUHSC-NO policy and procedures periodically. The members are charged with the duty of reviewing new and current information and revising the existing policy and procedure to reflect such changes. The members shall determine the qualifications necessary for additional training, and by whom provided, in the specific area of HIV/HBV/HCV for counselors, supervisors, instructors, physicians, and laboratory personnel providing treatment or testing on behalf of LSUHSC-NO.

Standing Expert Review Panel (ERP)

The Chancellor or designee is authorized to convene the ERP at any time that he/she feels input from the panel is necessary. The Chancellor or designee will convene the Expert Review Panel (ERP) when requested by students, residents, faculty, employees or counselors, as necessary, to deal with individual cases involving LSUHSC-NO personnel. Requests to convene the Expert Review Panel (ERP) shall be addressed directly to the Chancellor or designee in order to retain the individual's confidentiality within the school or department.

Expert Review Panel Membership

Three members will be appointed to the Expert Review Panel (ERP) as follows:

An Internist with experience in HIV/HBV/HCV disease.
A psychiatrist with experience in HIV/HBV/HCV disease.
The chairman of the LSUHSC-NO standing HIV/HBV/HCV Committee.
The Chairmanship will rotate among these three members.

Ad hoc committee members - to be appointed by the three appointed panel members:

A health professional with expertise in the procedures and duties to be performed by the individual.
For faculty, staff and residents, the Chairman of the department or a designee. For students, the Chairman of the Curriculum Committee of the respective school or a designee.

Ex Officio panel members - these persons will be selected at the individual's discretion (i.e., they are not required):

The individual's physician
An advocate selected by the individual.

When a request is received, the chairman of the panel will meet with the individual and the ex officio panel members chosen by the individual. At this meeting, the Chairman will explain the purposes of the panel and how the deliberations will take place. Additionally, the individual may wish to meet with other members of the panel prior to the full panel meeting.

Expert Review Panel

The purpose of the Expert Review Panel (ERP), will be to:

provide advice to HIV/HBV/HCV infected students, faculty, and employees, at their request, or by way of referral from an instructor, supervisor, department head, or dean.
certify extent and limitation on an individual's involvement with exposure prone procedures;
recommend modification of training curriculum and/or job re-assignment, where appropriate;
provide review of cases where competence is of concern to an instructor, supervisor, department head, or dean.
provide advice and make recommendations to the Chancellor on matters involving HIV/HBV/HCV infected individuals (e.g. disclosure of information, public announcements, limitation of practice, etc.).

Documentation of the Expert Review Panel's Action

The panel Chairman will prepare a report of the recommendations of the panel. This will be reviewed by the individual involved and signed in the presence of witnesses, by both the individual and the chairman of the panel. This report will be kept in the locked confidential file of the ERP.

The panel should take into consideration that, as of June 10, 1992 the Centers for Disease Control (CDC) still maintains that notification of patients treated by an infected healthcare worker (HCW) and follow-up studies should be considered on a case-by-case basis, taking into consideration an assessment of specific risks, confidentiality issues and available resources.

III. Additional Requirements and Procedures

Exposure Determination

Each school/department shall perform an exposure risk determination analysis to identify all students, faculty and employees who are directly exposed or have a likelihood of exposure to blood or other potentially infectious materials without regard to the use of personal protective equipment.

Education and Standard Precautions

All students and employees who, in the course of their responsibilities, come in contact with blood and/or body fluids of patients/clients should receive a current copy of CDC Standard Precautions. Each School/Department is responsible for developing and conducting early, comprehensive education regarding CDC "Standard Precautions" and work practice procedures for those personnel and students who potentially may come in contact with blood or body fluids of patients/clients. Students and employees are responsible for familiarizing themselves with the elements of "Standard Precautions" and work practice procedures and for adhering to these procedures whenever they are involved in patient/client care. Faculty will facilitate and monitor student compliance with these procedures.

Protective equipment (gloves, masks) should be provided at the work site. Each individual should provide protective eyewear for personal use.

Wherever possible, engineering controls should be instituted to eliminate or minimize exposure. Examples of such controls include sharp containers, mechanical pipetting, and splash guards.

All personnel having experience in another agency, must be familiar with and adhere to the infection control policies of that agency.

Individuals employed by LSUHSC will receive the CDC's publication “Exposure to Blood: What Health-Care Workers Need to Know” as well as recommendations for preventing transmission of bloodborne pathogens to patients (MMWR Vol. 50 June 29, 2001). They will also receive information during orientation, about management of personnel with blood-borne diseases. Their supervisor or instructor will be responsible for making this information available.

Medical/Infectious Waste Disposal

Medical /infectious waste will be labeled and disposed of according to the most recent guidance policy contained in the LSUHSC-New Orleans Environmental Health & Safety Manual.

Housekeeping and Laundry Practices

Each school/department providing housekeeping and/or laundry services should prepare a procedure to be followed which includes proper handling of potentially infectious materials, laundry and equipment. The procedure should include protective equipment to be utilized, frequency of disinfection and type or concentration of disinfectant utilized.

Record Keeping

All records relating to a reported Aat risk" incident will be kept by the Office of Human Resource Management.

Prevention

Information regarding risks and benefits of prophylactic treatment will be made available to persons involved in “at risk” events, as described. In accordance with current CDC guidelines (MMWR Vol. 50 June, 29, 2001) access to HIV/HBV/HCV testing, hepatitis B immune globulin, and antiretroviral medications will be made available to individuals as soon as possible within 24 hours of the reported incident. If such access is not available at the institution of event, individuals may seek these services through Student Health, Comprehensive Medicine, at the Employee Assistance Program, or at the Emergency Room at the Medical Center of Louisiana, as described in this policy.

The HBV vaccination will be made available to all employees whose exposure determination identifies a risk of directly contacting blood or other potentially infectious materials.

The LSUHSC-NO Faculty Clinic located at 2020 Gravier will administer the vaccination. The cost of the vaccination will be borne by the employee's department or school.

Counseling and Related Service

Employees: The LSUHSC-NO Campus Assistance Program (CAP) provides the following services for LSUHSC employees, faculty, staff , residents, and students.

24 hour crisis line
problem assessment
referral

On behalf of LSUHSC, the Campus Assistance Program (CAP) will also provide the following services, if needed for persons with HIV/HBV/HCV:

Confidential HIV/HBV/HCV testing;
Pre/Post test counseling for those unable to obtain such services through other means;
Crisis and short term emotional counseling;
Career counseling regarding options for employees and trainees;
Information and referral to medical, psychiatric, social, and support services in the Greater New Orleans Community;
Access to the Expert Review Panel (ERP);
Additional medical back up as needed.

Disclosure of Information

Information concerning LSUHSC-NO employees or students who have tested positive or are receiving treatment for HIV/HBV/HCV is confidential.

Inquiries from external sources regarding such information shall be referred to the LSUHSC-NO Director of Informational Services.