Employee Health

Services

Guidelines for

Students

in

Patient Care Areas

(Information on immunizations, communicable illness and exposures)

Revised March 2009

Employee Health Services

To:Affiliated Schools

From:Employee Health Services

Date:March 25, 2009

Subject:TGH Immunizations, Exposures and Illness Requirements for Students assigned to Patient Care Areas

Tampa GeneralHospital is pleased to have your students at our facilities. To provide a safe environment and to prevent exposures to communicable diseases, we must ask that you comply with TGH policies and procedures on immunizations and communicable illness. These guidelines also review the procedure you need to follow if your students are exposed to a bloodborne pathogen (i.e. needlestick) or other infectious disease (i.e. meningitis, tuberculosis).

All affiliated schools are responsible for ensuring that their students in patient care areas have completed the required immunizations and screenings. TGH does not review documentation for students. Each school must maintain documentation of all required immunizations/screenings for their students.

Employee Health Services is located on the fourth floor of the East Pavilion. Take the elevators by McDonalds to the fourth floor and follow the signs. Our hours of operation are: 7:00 a.m. to 4:30 p.m. Monday – Friday.

Thank you for helping us keep our hospital safe for all healthcare workers, patients, and visitors. We appreciate your cooperation. Please call JoAnn Shea, Director, Employee Health at 813-844-7692 if you have any questions.

Employee Health Services

Tampa GeneralHospital

P.O. Box 1289

Tampa, FL 33601-1289

Phone: 813-844-7649

FAX: 813-844-4034

Immunization Requirements

All students must complete the following requirements prior to patient contact at Tampa GeneralHospital.

1.Tuberculosis

  1. Documentation of a negative TB skin test (TST or QFT) within 1 year of starting clinicals/patient contact at Tampa GeneralHospital.
  1. Documentation of a negative CXR (within previous 1 year) for all persons with a history of a positive TB skin test. Students must be aware of signs/symptoms of tuberculosis.
  1. A yearly TB skin test or QFT blood test is required for all students in patient contact areas.

2.Rubella (German Measles)

  1. All students must have documentation of rubella immunity (titer) or documentation of receipt of ONE live rubella or MMR vaccine after 12 months of age.

3.Rubeola (Measles)

  1. All persons must have documentation of rubeola immunity (titer) or documentation of TWO live measles, MMR or MR vaccines after 12 months of age.

4.Mumps

a.All persons must have documentation of mumps immunity (titer) or documentation of TWO live mumps or MMR vaccines after 12 months of age.

5.Chickenpox (Varicella)

  1. It is recommended but not required that students or agency/contract employees with a negative history of chickenpox have a varicella titer drawn by their personal healthcare provider.
  1. Students with a negative history of chickenpox or a negative varicella titer must not have contact with patients diagnosed with chickenpox or herpes zoster (shingles).
  1. The varicella vaccine (Varivax) is strongly recommended for all students with a negative varicella titer.

6.Hepatitis B

  1. The Hepatitis B vaccine is strongly recommended for all students who may be potentially exposed to blood or infectious body fluids. Tampa General Healthcare does not provide the Hepatitis B vaccine to students, but recommends the Hepatitis B vaccine series be completed prior to patient contact.

7.Tdap (Tetanus, Diptheria, Pertussis)

a.It is strongly recommended that students who have not had a Tetanus/Diptheria booster in the prior 5 years receive Tdap (Adacel) prior to patient contact. Students who will have contact with patients 12 months of age or younger should receive the Tdap vaccine if it has been at least two years since the last Tetanus/Diptheria booster. The Tdap vaccine includes a vaccination against Pertussis.

8.Influenza Vaccine

a.CDC and Joint Commission recommend that all healthcare workers, including students, be immunized annually with the influenza (flu) vaccine.

NOTE:TGH does not review immunization records on students. Each school is responsible for complying with and maintaining immunization documentation.
Guidelines for Exposures to
Bloodborne Pathogens

TGH Employee Health Services will evaluate students and agency/contract employees who report an exposure to blood or infectious body fluids while training or working at Tampa GeneralHospital. Exposures to blood or infectious body fluids by needlesticks, sharps, mucous membrane or skin exposures should be reported to Employee Health Services during office hours or to the TGH nursing supervisor after hours.

Please review the TGH Exposure Control Plan and TGH policies, “Management of Healthcare Workers Exposed to Blood and Body Fluids,” and “Post-Exposure Prophylaxis After Occupational Exposure to HIV” for specific post-exposure management information.

After an exposure to blood or body fluids, you should:

1.Report the exposure to your instructor, supervisor or to the department supervisor where your exposure occurred. Fill out the employee section of Tampa General Healthcare Employee Workers’ Compensation Accident Report. Have your instructor or supervisor fill out the supervisor section of the form.

2.During office hours (Monday-Friday from 7am to 4:30pm) report exposures to Employee Health Services immediately. Your exposure will be evaluated and blood tests will be done to determine your baseline HIV, HBsAb and HCV status. Employee Health will order HIV, Hepatitis B and Hepatitis C testing on the source patient. Post-exposure prophylaxis (PEP) therapy may be recommended if you were exposed to an HIV positive patient or a patient at risk for HIV infection. PEP therapy is most effective if started within two hours of your exposure.

3.After hours, report your exposure to the nursing supervisor immediately. Your exposure will be evaluated for PEP therapy after consultation with an Infectious Disease physician. Any exposure reported after hours must be reported to Employee Health on the next working day. ONLY Employee Health is authorized to order HIV and Hepatitis testing on healthcare workers and source patients!!

4.Please bring the following information on the source patient when you report to Employee Health: source patient name, medical record number, patient ID number, diagnosis, unit, and room number.

5.TGH will not charge you for post-exposure visits, including HIV, HBV and HCV testing or for the costs of PEP medications. If you are seen in the TGH ER, any costs incurred through the Emergency Room physician group will be your responsibility.

6.Please call and Employee Health nurse practitioner at 844-4525/4526/4527 if you have any questions concerning an exposure to blood or body fluids.

Exposures to Infectious Diseases

Procedures students and agency/contract personnel should follow after an exposure to one of the following infectious diseases:

1.Tuberculosis

  1. Confirm exposure with your instructor, supervisor or TGH department manager where the exposure occurred.
  1. Report to TGH Employee Health Services for an evaluation if you do not have a history of a positive tuberculin skin test (TST) or QFT.
  1. Employee Health will give you a baseline TST or QFT if you have not had a TB skin test in the past three months.
  1. Employee Health will give you a second TST or QFT ten weeks after the tuberculosis exposure to determine if you acquired a tuberculosis infection due to this exposure. There will be no charge for the tuberculin skin tests.
  1. If you post-exposure TST is positive, you will be advised to report to your personal healthcare provider for an evaluation and prophylaxis therapy.

2.Meningitis

  1. Confirm exposure with your instructor or supervisor and fill out a Tampa General Hospital Employee Workers’ Compensation Accident Report.
  1. Report to TGH Employee Health Services for an evaluation of this exposure as soon as possible (preferably within 48 hours). Prophylaxis medication may be prescribed (Rifampin or Cipro).

3.Chickenpox (Varicella)

  1. Persons with a negative history of chickenpox or a negative varicella titer who were exposed to chickenpox or shingles must report to Employee Health for an evaluation.
  1. Employee Health will draw a varicella (chickenpox) titer on exposed persons (no charge). Person with a negative varicella titer will not be allowed in patient contact areas from the 10th to 21st day post-exposure.

4.Other Infectious Diseases

  1. Students or agency/contract personnel concerned about exposures to other infectious diseases (i.e., pertussis, measles, rubella, viruses, etc.) at Tampa GeneralHospital should call Employee Health Services at 844-7649.
NOTE:Following OSHA standards, all students and agency/contract personnel must complete a
qualitative fit test and be properly trained in the use, limitations and application of the Tecnol PFR 95 respirator for Tuberculosis Protection prior entering the room of a patient on airborne isolation (Tuberculosis). Each school, agency and contract individual is responsible for ensuring the Respiratory Fit testing is completed prior to patient contact.

Communicable Illnesses

Students and agency/contract personnel with an illness or medical condition that may be communicable to patients, visitors and/or staff should not work in patient contact areas until the condition is resolved. Please refer to TGH policy IC-23, “Work Restrictions Relating to Communicable Illness/Conditions in Healthcare Workers” for specific restrictions.

General guidelines include:

  1. Conjunctivitis or Pink Eye: Persons cannot work in patient contact areas until the eye drainage has ceased.
  1. Draining or infected skin lesions: Persons cannot work in patient contact areas until the infection has resolved and/or the wound is no longer draining.
  1. Oral herpes with draining lesions: Persons cannot work in patient contact areas until the herpes lesion is dry, without drainage.
  1. Group A streptocococcal disease (strep throat): Person cannot work in patient contact areas until 24 hours of antibiotic treatment is received.
  1. Scabies/Lice: Person cannot work until cleared by a physician or TGH Employee Health Services.
  1. Diarrhea: Person with diarrhea lasting over three days or accompanied by fever or bloody stools (or diagnosed with Salmonella, Shigella or Giardia) cannot work in patient contact areas until cleared by a physician or TGH Employee Health Services.
  1. Chickenpox, Measles, Mumps, Rubella, Shingles, Hepatitis A, or undiagnosed rashes: Report measles, mumps, chickenpox, rubella or Hepatitis A cases to Employee Health immediately. Person cannot return to patient contact areas until cleared by a physician or TGH Employee Health Services.
  1. HIV+, HbsAg+, or HCV+: Persons working in patient care areas who are positive for Hepatitis C, HIV or Hepatitis B surface antigen may be restricted from specific exposure prone procedures. Consultation with TGH Employee Health Services prior to patient contact is required. Strict confidentiality will be maintained.
  1. Active Tuberculosis: Report active tuberculosis to Employee Health immediately. Persons diagnosed with active tuberculosis will be excluded from patient care until two weeks of appropriate therapy is completed and there are three negative sputum smears for acid fast bacilli.
We encourage you to consult with TGH Employee Health Services at 844-7649 for any potential communicable condition. We will investigate any potential transmission to staff and patients.

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