ARC-PA 5th ed Standard A3.08

Enrollment in physician assistant and medical educational programs often yields unintentional exposure to diseases such as viruses that are unavoidable. The student’s responsibility is to pursue healthcare and treatment advice, including timeframe for safe return to class or SCPE site, from their medical provider, should the need arise.

It is the policy of the GWU Department of Physician Assistant Studies to follow the guidelines made by the Centers for Disease Control (CDC) and the Occupational Safety and Health Administration (OSHA) regarding the use of Standard Precautions to prevent the spread of infection and reduce occupational exposure to blood and body fluid pathogens. (Standard A3.08)

Usually before matriculation, but always before patient care or laboratory experiences, including on-campus learning activities, students MUST undergo training focused on potential hazards, standard precautions, and safety procedures related to chemical and bloodborne pathogens exposure. NOTE: As part of the supervised clinical practice experience, students may be required to complete additional site-specific safety or security training.

When hazardous exposure to chemical agents or blood or body fluids occurs, the incident must be immediately reported. After initial first aid and safety procedures (limiting exposure and risk) have been completed – e.g., thorough hand washing, flushing of mucous membranes, etc.:

  • Events that occur on campus are reported to the Director of Didactic Education and an Incident Report completed within 48 hours of the incident.

In all exposure instances, medical evaluation, treatment of injuries, and evaluation focused on risk limits should be conducted immediately at:

  • GWU Health Services
  • Any local occupational medicine clinic, urgent care clinic, or if warranted, the emergency room;
  • If an emergency, call 911 for rapid treatment and transport to the nearest emergency room; and,
  • Note: neither the clinical agency nor GWU is responsible for the cost of the care involved in the treatment, maintenance, or surveillance of exposure to blood or body fluids. See Student Health Policy.

Accidental Exposure to Infectious Diseases Incident Reporting

The procedures for care and treatment after exposure to infectious or potentially infectious blood and/or body fluid remain the financial responsibility of the student (Standard A3.08).

GWU PA students exposed to blood or body fluids (e.g., from a needle stick or scalpel injury or splashing of body fluids in the eye, the mucous membranes of the mouth and nose, or on non-intact skin) must adhere to the following exposure protocol for proper workup, counseling, and follow-up.

In the event of accidental exposure (needle stick, splash, TB exposure, etc.), students should follow these basic principles:

  • Remove or dilute the infectious material and institute first aid measures as appropriate.
  • Remove soiled clothing.
  • Thoroughly wash skin and mucosa by washing with copious amounts of water and soap. Contamination of the eyes requires immediate flushing with water or ophthalmic saline irrigation solution for 15 minutes (remove contacts first if you are a contact wearer).
  • The student will notify the immediate faculty and the Director of Didactic Education or Associate Program Director (during 16 months of on-campus training).
  • THE STUDENT MUST BE EVALUATED IMMEDIATELY BY A MEDICAL PROVIDER for treatment and evaluation for prophylaxis.
  • The student should utilize a local hospital Emergency Department for 24-hour accessibility or an Urgent Care with extended hours, depending on the time of exposure and the geography of the clinical rotation assignment. If the facility in which the student is assigned has a protocol in place for testing students, the PA Studies Program encourages the student to utilize those services.
  • Along with the medical provider in the facility above, a student should assess the infection risk, including an evaluation of the type and amount of infectious material, the mode of transmission, the portal of entry, and the general and specific conditions of the host. The student should obtain the name and medical record number of the patient source. For accidents with microorganisms for which serological tests are available, a base-line serum sample should be obtained at the time of occurrence.
  • The student must submit an Incident Report Form within 48 hours.

NOTE: All expenses incurred related to an exposure are the sole responsibility of the PA student. Clinical sites and Gardner-Webb University and GWU Department of PA Studies are not liable for the cost of exposure testing.

Students should follow the guidance of their evaluating clinician based upon established guidelines and have appropriate
interval follow-ups.

OSHA standards 1910-1030 require the record of the exposed student is kept for the duration of the status as a student plus 30 years. These copies reside with the student and the healthcare provider.

Effects of Infectious/Environmental Disease or Disability: Students who contract infectious/environmental disease or disability will be reviewed individually based on the status of their individual cases. Students whose disease/disability necessitates an extended leave will require a medical deceleration granted by the APC and Executive Committees.

Standard Precautions per CDC Guidelines

Standard precautions are the minimum infection prevention practices that apply to all patient care and laboratory or technical skills training experiences, regardless of suspected or confirmed infection status of the patient or colleague, in any setting where health care is delivered. These practices are designed to protect healthcare professionals (HCP) and prevent HCP from spreading infections to others. Standard precautions include:

  1. Hand hygiene.
  2. Use of personal protective equipment (e.g., gloves, masks, eyewear)
  3. Respiratory hygiene/cough etiquette.
  4. Sharps safety.
  5. Safe injection practices (i.e., aseptic technique for parenteral medications)
  6. Sterile instruments and devices.
  7. Clean and disinfected environmental surfaces.

Hand Hygiene

Hand Hygiene means cleaning your hands by using either handwashing (washing hands with soap and water), antiseptic hand wash, antiseptic hand rub (e.g., alcohol-based hand sanitizer including foam or gel), or surgical hand antisepsis.

Cleaning your hands reduces:

  • The spread of potentially deadly germs to patients
  • The risk of healthcare provider colonization or infection caused by germs acquired from the patient

Two methods for hand hygiene:

  • Alcohol-based hand sanitizers are the most effective products for reducing the number of germs on healthcare providers’ hands.
  • Alcohol-based hand sanitizers are the preferred method for cleaning your hands in most clinical situations.
  • Wash hands with soap and water whenever they are visibly dirty, before eating, and after using the restroom.
Use an Alcohol-Based Hand SanitizerWash with Soap and Water
• Immediately before touching a patient
• Before performing an aseptic task (e.g., placing an indwelling device) or handling invasive medical devices
• Before moving from work on a soiled body site to a clean body site on the same patient
• After touching a patient or the patient’s immediate environment
• After contact with blood, body fluids, or contaminated surfaces
• Immediately after glove removal
• When hands are visibly soiled
• After caring for a person with known or suspected infectious diarrhea
• After known or suspected exposure to spores (e.g., B. anthracis, C difficile outbreaks)

 

 

 

Refer to the CDC Website for information regarding when/how to perform hand hygiene, glove use, hand hygiene
for surgery, skin, and nail care.

Personal Protective Equipment (PPE)

PPE includes non-sterile gloves, facial masks (N95 or higher respirator), protective eyewear (face shield or goggles), and isolation gowns. It should be worn whenever the risk of exposure to infectious diseases, blood, or body fluids are present. According to the CDC, PPE should be used by the following:

  • Patients with confirmed or possible SARS-CoV-2 infection should wear a facemask when being evaluated medically.
  • Healthcare personnel should adhere to Standard and Transmission-based Precautions when caring for patients with SARS-CoV-2 infection. Recommended PPE is described in the Infection Control Guidance.

At a minimum, PPE includes:

  • Exam gloves:
    • Handling blood or body fluids;
    • Touching mucous membranes, non-intact skin, or a body orifice; and,
    • Touching contaminated equipment;
  • PLUS facial masks, protective eyewear, and gowns:
    • Performing or assisting procedures with a risk of body fluid or other hazardous material exposure (splashes or sprays). This includes but is not limited to debridement, excision, and irrigation type procedures in any healthcare setting and operating room surgical treatment.
  • Donning PPE Gear must follow the CDC Guidelines, which can be found on the CDC website.

Safe Injection Practices

  • NEVER recap needles
  • Use self-sheathing needles or needleless systems when available.
  • All needles and other disposable sharps will be placed in designated puncture-resistant containers as soon as possible after use.
  • As often as possible, use single-dose vials.

Safe handling of potentially contaminated surfaces or equipment

  • Environmental cleaning
    • Areas in which patient care is performed will be cleaned and disinfected after every 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 cleaning a device, it may not be suitable for multi-patient use. In this instance, always check with the course director or clinical supervisor on how to proceed.

Respiratory hygiene/cough etiquette

The following measures to contain respiratory secretions are recommended for all individuals with signs and symptoms of a respiratory infection.

  • Cover your mouth and nose with a tissue when coughing or sneezing;
  • Use in the nearest waste receptacle to dispose of the tissue after use;
  • Perform hand hygiene after having contact with respiratory secretions and contaminated objects/materials.
  • Use a mask to prevent aerosol spread.
  • Social distance from others as much as possible.
  • Advise healthcare personnel to observe Droplet Precautions (i.e., wearing a surgical or procedure mask for close contact), in addition to Standard Precautions, when examining a patient with symptoms of a respiratory infection, particularly if fever is present. These precautions should be maintained until it is determined that the cause of symptoms is not an infectious agent that requires Droplet Precautions.

Compliance with all safety practices is not just proper procedure but is also a mark of professionalism. Failure to observe and practice Standard Precautions will result in adverse/disciplinary action for unprofessional behavior.