HIV/HBV POLICY

The Centers for Disease Control and Prevention has developed guidelines on measures to be taken by the health care community to avoid the transmission of human immunodeficiency virus (HIV) or hepatitis B virus (HBV) from infected health care workers to patients. Although the guidelines suggest that infected health care workers not engage in “exposure-prone invasive procedures,” those procedures have not been specified. Rather, many health care institutions, including hospitals and clinics associated with the medical school, have adopted policies to specify that health care workers who perform surgical or obstetrical procedures that involve entry into tissues, cavities, or organs—or dental procedures involving manipulation, cutting, or removal of oral or perioral tissues, including teeth structure—know their HIV (and HBV) status and, if positive, seek counsel from an expert review panel before performing these procedures. Technique, skill, experience and infection control compliance are among the factors to be considered when evaluating the worker. Although these measures were developed primarily to protect patients from the transmission of the HBV virus, the greater transmissibility of HIV suggests their application to HIV-infected health care workers as well.

Section I: Admission. HIV or HBV serostatus will not be a consideration in the determination of acceptance for the Honors Program, MD program, or transfer admission to the School of Medicine, provided that the adoption of state or federal legislation or the establishment of policies by the McGaw Medical Center institutions does not restrict the clinical activities of an infected student to the extent that completion of medical degree requirements is not possible.

Potential visiting students must submit evidence when applying to the School of Medicine that 1) they have completed the three-stage HBV immunization series, 2) they are determined to be immune or chronic carriers of HBV, and 3) they have undergone training in the universal precautions for avoiding exposure to blood and other body fluids.

Section II: Testing. Neither applicants, entrants, re-entrants, current students, nor visiting students will be required to undergo HIV testing. The individual medical student who suspects that he or she may be at risk for HIV or HBV infection is responsible for ascertaining his or her serostatus.

Section III: Infected Students and Continuation in School. A medical student found to be infected with HIV or HBV may continue in the MD program as long as he or she is able to carry out the physical and intellectual activities expected of all students.

Unless directly notified by the student, those involved in his or her education will have no knowledge of his or her serostatus. However, the HIV+ or HBV+ student is urged to notify his or her physician and thereby obtain appropriate medical and emotional support. He or she also is urged to notify the director of the Chicago Campus Student Health Service or the chief of the Division of Infectious Diseases of the Department of Medicine, who will, among other actions:

• ascertain whether the student is receiving medical and emotional support to that student’s satisfaction, and, if not, suggest alternative sources by which such care could be obtained;
• ensure that the student is aware of any particular precautions to be taken in patient care activities, career specialty selection, and lifestyle to avoid the transmission of the infection to any other person;
• ensure that the student is aware of possible signs of disease progression that would suggest interference with his or her physical or emotional ability to fulfill patient care or other educational requirements of the MD program;
• discuss with the student whether he or she may already have participated in patient care activity in which an injury to that student by a sharp instrument would have led to contamination of the patient with the student’s blood;
• if the circumstances in the immediately preceding point indeed have occurred, notify the student of the legal obligation by the State of Illinois and moral obligation of the school to notify the patient involved; ensure that this information, including the identity of the student, is made known to the hospital or clinic in which the incident occurred; and offer the assistance of the School of Medicine in making these notifications;
• report to the Medical Student HIV/HBV Review Panel (Section IV) that these communications have been made to a student and the nature of any follow-up actions that have taken place, without in any way suggesting the student’s identity to the panel; and
• seek from the Medical Student HIV/HBV Review Panel advice or assistance in further counseling or assisting the student with particular needs.

An HIV- or HBV-infected student may consult the Associate Dean for Student Programs and Professional Development, anonymously if desired, for further interpretation of any part of this policy, referral to an appropriate member of the School of Medicine HIV/HBV Review Panel, or other support with related educational or personal concerns.

Section IV: Medical Student HIV/HBV Review Panel. The Medical Student HIV/HBV Review Panel shall consist of the Director of the Chicago Campus Student Health Service, the Chief of the Division of Infectious Diseases in the Department of Medicine, the Surgery Clerkship Director and the Obstetrics and Gynecology Clerkship Director.

The panel will serve as a resource for students infected with HIV or HBV, either directly, if the student so wishes, or indirectly via individual members who will counsel an infected student confidentially. The panel will not have access to an infected student’s identity unless notified directly by the student. When notified of the existence of an HIV+ or HBV+ student, the panel will ensure that the student receives the counsel and support described in Section III. Its discussions and other activities will be confidential, although the panel will notify the Dean of the Feinberg School of Medicine and the Chair of the University AIDS Advisory Committee of the existence of each HIV+ medical student (in the case of an HBV+ student, only the Dean of the School of Medicine) and that it has determined that the provisions of Section III (above) have been fulfilled.

Section V: Immunization. All Northwestern University medical students must undergo HBV immunization as a condition of entrance to the School of Medicine, except those who present evidence of current HBV+ status. HBV- students who have never undergone HBV immunization must complete the three-stage immunization series and undergo follow-up determination of antibody titer as a condition of promotion to the second-year curriculum. These students also will be encouraged to obtain a “booster” vaccination if titer is below 10 IU/L. The Feinberg School of Medicine will subsidize the cost of the third-stage immunization and follow-up antibody titers. Potential visiting students from other institutions who cannot show evidence of HBV immunization when applying will be denied acceptance.

Section VI: Infected Patients. Before engaging in any clinical care activities, medical school and visiting students first must have received training in the universal precautions for the handling of sharp instruments and body fluids to minimize the risk of infection from their clinical interaction with HIV+ and HBV+ patients. In addition, all medical school students will be provided instruction on psychological aspects of interacting with HIV+ and HBV+ patients as a component of their preclinical education. All students are expected to participate in the care of all patients to whom they are assigned, regardless of the infectious status of the patient.

A student who is apprehensive about providing care to any patient should discuss this apprehension in advance with the clerkship director and/or Associate Dean for Student Programs and Professional Development. A student who suspects that he or she is being subjected to patient care or laboratory conditions in which not all universal precautions are being enforced should immediately consult the Infection Control Officer of that institution and/or the Associate Dean for Student Programs and Professional Development.

Section VII: Possible Contamination. A student subjected to possible contamination from the tissue or body fluids of any patient, regardless of suspected HIV or HBV status, through needlestick, cut, or other injury that breaks the skin or splashes fluids onto open sores or mucosal surfaces (mouth, eyes), should follow the instructions outlined in the Needlestick Section. Any testing or treatment will be performed only at the student’s request, and any test result will be confidential to the student.

Section VIII: Treatment Cost. The cost of testing and treatment requested by a Northwestern student who has been exposed to possible HIV or HBV contamination during assigned medical educational activities will be borne by the University. Although these services also will be offered to visiting students, the costs will be the responsibility of the student or his or her home school.

Section IX: Compatibility with Related University Policy. The Northwestern University “Policies and Procedures—AIDS” was adopted in 1986. Essential items of that policy that relate to medical students and the medical school authority responsible for fulfilling requirements therein are as follows:

• Northwestern Univerity shall follow the guidelines recommended by the Centers for Disease Control and Prevention and the American College Health Association.
• Students with AIDS-related complex (ARC)/AIDS may continue their studies at the University so long as they are able to meet the requirements of their academic programs.
• Students who test HIV+ are expected to arrange periodic follow-up examinations.
• Known cases of ARC or AIDS shall be reviewed by a University AIDS Advisory Committee. (The activities of the Medical Student HIV/HBV Review Panel will be equivalent to those of the University AIDS Advisory Committee).
• The University shall conduct educational programs on AIDS awareness (School of Medicine oversight responsibility: Curriculum Committee).
• Medical students are required to learn “universal precautions” as taught by the School of Medicine (School of Medicine oversight responsibility: Curriculum Committee and the Introduction to the Clinical Clerkships Committee).
• Universal precautions must be carried out in all research and educational laboratories of the University (School of Medicine oversight responsibility: School of Medicine Safety Committee).

Section X: Conclusion. The School of Medicine recognizes that it is possible for an otherwise healthy HIV+ physician to practice medicine and for an HBV+ physician to practice many specialties, unimpeded by disease-specific restrictions. Therefore, the school will assist students infected with these diseases to complete their medical degree requirements, subject to considerations that it feels, in its best judgment, are appropriate to the circumstances of each individual case.