Policy No. 3:06:00:00
CLEVELAND STATE COMMUNITY COLLEGE Cleveland, Tennessee
SUBJECT: Contagious Diseases
The purposes of this policy are: (l) to prevent the spread of disease by encouraging educational activities to enlighten employees and students; (2) to simplify the coexistence of the healthy and the ill; and (3) to prevent discrimination and persecution of those who have the misfortune to have a serious contagious disease.
Contagious disease is a pathological process, the causative agent of which may be passed on or carried from one person to another directly or indirectly. This includes but is not limited to AIDS, hepatitis, and tuberculosis.
An effort will be made to provide a safe environment for instruction and minimize the risk of infection to students, faculty and staff while respecting individual rights. This policy is based on the State Board of Regents position statement on Acquired Immune Deficiency Syndrome (Attachment E) and the best information currently available from the Atlanta Center for Disease Control, the Tennessee Department of Public Health and the American College Health Association. Mandatory steps to achieve the objective of this policy will include the following:
- Unless a student or employee’s disease has been identified as being contagious in ordinary public association, those persons will be allowed to attend class or to perform job responsibilities as long as they are physically able.
- Persons whose illness or infections are spread only through intimate contact will not routinely be excluded from recreational facilities, food service areas, auditoriums, or other common areas.
- Consideration of the existence of disease will not be a part of the initial admission decision for students or for the hiring of employees.
- Students and employees will not routinely be required to respond to questions about disease, but such information may be a requirement to gain admission to health-related training programs such as Medical Laboratory Technology and Nursing. New employees or students will be encouraged to inform appropriate Cleveland State authorities if they have diseases such as tuberculosis, hepatitis or AIDS so that appropriate medical care and education can be secured.
- Mandatory screening of employees or students will not be conducted to detect disease or antibodies, nor will any attempt be made to identify, screen, or test perceived high-risk groups.
- Cleveland State encourages anyone who suspects that he/she has a high-risk disease to seek prompt medical testing. An ongoing association with local public health officials will be maintained to facilitate prompt, confidential examination and testing.
- Certain diseases, including AIDS, are classified as reportable diseases to the State of Tennessee and involve strict observance of reporting requirements by attendant medical professionals making diagnoses. Confidentiality of all student records at Cleveland State is strictly observed in accordance with the Family Education Rights and Privacy Act of l974.
- Institutional officers must remember that all confidential medical information is protected by statutes and that any unauthorized disclosure may create legal liability. The number of people in the institution who are aware of the existence and/or identity of students or employees who have AIDS, ARC, or a positive HTLV-III antibody test should be kept to an absolute minimum both to protect the confidentiality and privacy of the infected persons and to avoid the generation of unnecessary fear and anxiety among other students and staff. It is recommended that no specific or detailed information concerning complaints or diagnoses be provided to faculty, administrators, or even parents, without the expressed written permission of the patient in each case. This position with respect to health records is supported by amendment to the Family Education Rights and Privacy Act of l974. Certainly, no person, group, agency, insurer, employer, or institution should be provided any medical information without the prior specific written consent of the patient.
- Academic departments offering classes/laboratory experiments involving blood, blood products and body fluids will take necessary steps to ensure the safety of participating individuals. See Attachments A-D.
- When contracts exist between Cleveland State and community health care facilities for the purpose of fieldwork experiences for students, the contracts will provide assurance that the community health care facility is in compliance with Tennessee Public Health Guidelines for the handling of blood, blood products and body fluids. Students will be requested to comply with the employers’ health policy at the institution in which they are trained.
Source: TBR AIDS Statement dated 10/28/87
Revised: December 1, 1992
Academic Department Guidelines
Academic departments offering classes/laboratory experiments involving blood, blood products, or body fluids shall take the following necessary steps to ensure the safety of participating individuals:
- Before such classes, student shall receive special instructions in safety and infection control.
- Students and faculty in such classes shall be required to wear disposable latex gloves. Skin defects on the hands, face, arms and neck shall be covered with an occlusive bandage.
- There shall be no eating, drinking, smoking or application of makeup in classrooms where blood and body fluids are processed.
- Equipment such as lancets and needles utilized in blood specimen collection must be sterile before use and never reused or shared. All efforts must be made to prevent puncture with such used equipment. Any such accident shall be reported immediately to the instructor. After use, lancets and needles must also be placed immediately in puncture-resistant containers and be sterilized before disposal.
- Laboratory equipment such as slides, dropper pipettes, and test tubes that may be grossly contaminated with blood or body fluids when used should be disposable and not washed and reused.
- Blood specimens and body fluids and materials contaminated with them (including gloves) shall be placed in biohazard bags and be autoclaved to sterilize them before disposal.
- Student shall be required to remove their gloves and wash their hands before leaving such classroom sessions.
- After such classes, the laboratory counter surfaces and specimen racks shall be cleaned with a detergent solution followed by a cleaning with 0.5% sodium hypochlorite (1:10 dilution of household bleach or acceptable substitute).
- Specimen spills shall be reported to the instructor immediately so that the area can be properly decontaminated.
All persons responsible for college instruction of CPR shall be provided the attached information and shall follow the CDC recommendations for safety and infection control.
SAFETY IN TRAINING FOR AND PROVIDING CPR
Safety in CPR training from the students’ and instructors’ perspective has gained increased attention. Adherence to the following recommendations should minimize any possible complications for instructors and students (which are directly quoted from the Centers for Disease Control) when mannequins are used in CPR training.
- Purchasers of training mannequins should thoroughly examine the manufacturers’ recommendations and provisions for sanitary practices.
- Students should be told in advance that the training sessions will involve “close physical contact” with their fellow students.
- Students or instructors should not actively participate in training sessions (hands-on training with mannequins) if they have dermatological lesions on hands or in oral or circumoral areas, if they are known to be seropositive for hepatitis B surface antigen (HBsAg), if they have upper-respiratory tract infections, if they have acquired immunodeficiency syndrome (AIDS), or if the student or instructor has reason to believe that he or she has been exposed to or is in the active stage of any infectious process.
- If more than one CPR mannequin is used in a particular training class, students should be assigned in pairs, with each pair having contact with only one mannequin. This would lessen the possible contamination of several mannequins by one individual and therefore limit possible exposures of other class members.
- All persons responsible for CPR training should be thoroughly familiar with hygienic concepts (e.g., thorough hand washing prior to mannequin contact, not eating during class to avoid contamination of mannequins with food particles, etc.) as well as the procedures for cleaning and maintaining mannequins and accessories (e.g., face shields). Mannequins should be inspected routinely for signs of physical deterioration, such as cracks or tears in plastic surface, which make thorough cleaning difficult or impossible. The clothes and hair of mannequins should be washed periodically, e.g., monthly, or whenever visibly soiled.
- During the training of two-rescuer CPR, there is no opportunity to disinfect the mannequin between students when the “switching procedure” is practiced. In order to limit the potential for disease transmission during this exercise, the second student taking over ventilation on the mannequin should simulate ventilation instead of blowing into the mannequin. This recommendation is consistent with the current training recommendations of the American Red Cross and the American Heart Association.
- Training of the “obstructed airway procedure” involves the student using his or her finger to sweep foreign matter out of the mannequin’s mouth. The action could contaminate the student’s finger with exhaled moisture and salvia from previous students in the same class and/or contaminate the mannequin with material form the student’s finger. When practicing this procedure, the finger sweep should either be simulated or done on a mannequin whose airway was decontaminated before the procedure and will be decontaminated after the procedure.
At the end of each class, the procedures listed below should be followed as soon as possible to avoid drying of contamination on mannequin surface.
- As indicated, thoroughly wash all external surfaces.
- Rinse all surfaces with fresh water.
- Wet all surfaces with a sodium hypochlorite solution having at least 500 ppm free available chlorine (1/4 cup liquid household bleach per gallon of tap water) for 10 minutes. This solution must be made fresh and discarded after use.
- Rinse with fresh water and immediately dry all external surfaces; this drying will prevent the survival and growth of bacterial of fungal pathogens if the mannequins are stored for periods longer than the day of cleaning. Each student is issued a facemask, name attached, and a sealable bag for individual use.
- Each time a different student uses the mannequin in a training class, the individual protective face shield, if used, should be changed. Between students or after the instructor demonstrates a procedure such as clearing any obstruction from the airway, the mannequin face and inside the mouth should be wiped vigorously with clean absorbent material (e.g. 4” by 4” gauze pad) with the hypochlorite solution described in recommendation No. 8c above. The surfaces should remain wet for at least 30 seconds before they are wiped dry with a second piece of clean absorbent material.
- People responsible for the use and maintenance of CPR mannequins should be encouraged not to reply totally on the mere presence of a disinfectant to protect them and their students from cross-infection during training programs. Emphasis should be placed on the necessity of thorough physical cleaning (scrubbing, wiping) as the first step in an effective decontamination protocol. Microbial contamination is easily removed from smooth, nonporous surface by using disposable cleaning cloths moistened with a detergent solution, and there is no evidence that a soaking procedure alone in a liquid is as effective as the same procedure accompanied by vigorous scrubbing.
- With specific regard to concerns about potential for hepatitis B and AIDS transmission in CPR training, it has recently been shown that the hepatitis B virus is not as resistant to disinfectant chemicals as it was once thought to be. Current recommendations for strategies dealing with AIDS contamination are the same as those for viral hepatitis B.
MLT STUDENT POLICES AND PROCEDURES FOR LABORATORY SESSIONS
Laboratory classes are provided to enable the student to grasp certain concepts through the use of controlled experiments. Correct experimental results and laboratory safety are dependent on good laboratory technique. The following is a list of policies and safety procedures which, when incorporated in the laboratory sessions, will give the student the basis for good laboratory technique and a safe environment.
- Students should wear gloves and be dressed in a laboratory coat, gown, or uniform when handling and processing specimens. This will minimize the risk of contamination to exposed body parts or street clothing.
- Specimens needing centrifugation should first be placed into capped tubes that in turn should be placed into a centrifuge carriage with a sealed dome. These anti-aerosol devices provide an almost absolute containment of any infectious material.
- Care should be used when operating all laboratory equipment. If the student is unsure or undecided in the operation of some equipment, ask the instructor for assistance.
- There will be no pipetting by mouth unless approved by the instructor. Suction bulbs are provided in the laboratory so there is no need for pipetting by mouth. The bulbs prevent accidental aspiration of chemicals and harmful biological materials.
- There will be no smoking in the laboratory. Volatile chemicals and reagents are used in the laboratory and smoking would create a fire hazard.
- Eating and drinking will not be allowed in the laboratory. Contamination of chemicals or reagents might occur, and the food or drink might become contaminated with hazardous materials or biological organisms.
- Notify the instructor immediately of all injuries no matter how minor they may seem.
- The student will become familiar with the location and use of available safety equipment. Should an accident occur, the first movements are critical to prevent further damage or injury. Knowledge of accessible safety equipment and its use will save valuable time in an emergency situation.
- Broken glassware should be handled carefully to avoid physical injury. The student should also be aware of any solution which might have been contained in the broken flask or bottle and act accordingly.
The student will exercise care in the preparation, use, and transportation of chemicals and biological materials.
- If acid is accidentally spilled, it is to be cleaned up immediately after neutralization with a mild base.
- If a base solution is accidentally spilled, it is to be cleaned up immediately after dilution with water.
- Accidental spillage of a specimen should be promptly cleaned up with sodium hypochlorite (1:10 dilution of household bleach). This solution should be freshly prepared and kept in its diluted form no longer than one week. Spillage should be left standing with disinfecting solution for 10 minutes.
- If accidental contamination occurs to an exposed area of skin, wash first with a good liquid antimicrobial detergent soap (i.e., Hibiclens). Rinse well with water, then apply 50% isopropyl alcohol. Leave preparation on skin surface for at least one minute before final washing with liquid soap and water.
- Bulk Blood, suctioned fluids, excretions, and secretions may be carefully poured down a drain connected to a sanitary sewer.
- All laboratory specimens and disposables should be discarded in biohazard bags, then autoclaved prior to final disposition by either incineration or sanitary carting. Materials that are to be autoclaved should be disposed of immediately and not left lying around.
- Disposable syringes with needles, scalpel blades, broken glassware and other sharp items capable of causing injury should be placed intact into puncture-resistant containers located as close to the area in which they were used as is practical. To prevent needle-stick injuries, needles should not be recapped, purposely bent, broken, or otherwise manipulated by hand.
Close of Laboratory Period
- The student will implement all shutdown procedures and clean his/her area and the equipment he/she is using at the end of each laboratory session. General clean-up will be assigned by the instructor on a rotating basis.
- All workbench areas should be cleaned and sanitized with an appropriate germicidal agent at the end of each laboratory period. (0.5%) sodium hpochlorite).
- Centrifuge carriages should be sanitized daily with a germicide and after days use centrifuge interiors should be sprayed with Lysol.
- Before leaving the laboratory, all protective clothing*should be removed.
- In addition hands and arms should be washed with Hibiclens.
*Use a plastic bag for transportation home. Chlorox should be used in laundering of laboratory coats, gowns, and uniforms.
Guidelines for Nursing Clinical Experience
The nursing department believes that nursing professionals have a fundamental responsibility to provide care to all patients assigned to them, and that refusal to care for selected patients is contrary to the ethics of the nursing profession.
To prevent the accidental transmission of contagious diseases in health care settings, the following measures recommended by the Communicable Disease Center have been adopted.
- Use of appropriate barrier precautions to prevent exposure to skin and mucous membrane when contact with blood or other body fluids is anticipated.
- Gloves should be worn when in contact with blood, body fluids and mucous membranes and for handling items or surface soiled with blood or other body fluids, or for performing venipuncture and other vascular access procedures.
- Gloves should be changed after caring for each patient.
- Masks and protective eyewear or face shields should be worn during procedures that are likely to generate air-born droplets of blood or other body fluids to protect exposure of mucous membranes of the mouth, nose and eyes.
- Gowns should be worn during procedures that are likely to generate splashes of blood or other body fluids.
- Use caution to prevent injuries caused by needles, scalpels and other sharp instruments. To prevent needle sticks, needles should not be recapped, purposely bent or broken. After use, sharps should be placed in puncture resistant containers for appropriate disposal.
- Hands should be washed prior to and immediately after patient contact.
- Blood spills should be cleaned up promptly with a disinfectant such as 1:10 dilution of bleach.
Board of Regents Position Statement On Acquired Immune Deficiency Syndrome
The emergence since 1981 of the Acquired Immune Deficiency Syndrome (AIDS) in the American population has raised profound questions for multiple professional disciplines, including those of medicine, law, and education. While medical research continues on the fundamental nature of the disease, public policy must be formulated on the basis of the best available medical knowledge. Educational institutions nationwide are currently faced with the task of promulgating policies designed to protect the rights of victims of AIDS while recognizing legitimate concerns of unafflicted individuals who will necessarily be thrust into varying degrees of close contact with victims.
It is the general position of the SBR to permit students who have been diagnosed as having AIDS to participate fully in classes and activities to the degree that they are physically capable. Similarly, employees diagnosed as having AIDS will, as a general rule, be permitted to continue their employment to the degree they are physically capable. This statement is based upon information published by the U.S. Public Health Service, Department of Health and Human Services, which indicates that the causative virus of AIDS is transmitted primarily through intimate, sexual contact or through shared intravenous needles. However, precautions should be taken when an individual may have a high risk of being exposed to bites or human bodily fluids.
In recognition of the concerns of unafflicted members of the campus community regarding possible disease transmission, an institution or school shall reserve the right to review the individual circumstances of AIDS victims who are students and employees. These circumstances would include, but not necessarily be limited to, such areas as roommates or suitemates in campus housing; classes involving close personal contact such as those providing training in mouth-to-mouth resuscitation; and work or training experiences in certain areas such as health care, campus security, laboratory research, day care centers for young children, and food preparation. In the event an AIDS victim develops open skin lesions, uncontrolled diarrhea, or other evidence of clinical deterioration of his or her disease to the extent that the possibility of transmission of the disease might be increased, institution or school officials will review the individual circumstances in consultation with medical authorities. The advice and opinions of medical personnel will be weighed heavily in decisions regarding individuals diagnosed as having AIDS. Appropriate action in such cases will be taken when necessary to protect the public health, as is currently done in the event of the occurrence of other infectious diseases on the campus. The likelihood of preventative protective action being taken to protect other students, employees or members of the pubic from infection will understandably increase as the likelihood of exposure of those persons to the bodily fluids of an AIDS victim increases.
Each institution and school shall establish procedures by which appropriate officials on each campus will provide to health care workers, security officers, lab workers, day care workers, student housing residents, and others having increased likelihood of exposure to the bodily fluids of an AIDS victim such information as is available and necessary, possibly include the identify of the victim, for the purpose of enabling those individuals to avoid or take protective measures against the possibility of infection. Because of the communicable nature of AIDS, those persons who have tested positive to the virus must be reported to the local public health authorities. However, each institution and school shall exercise reasonable effort to ensure protection of the privacy rights of those persons reported but only to the extent such can be done without endangering the health of others.