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IV. HEALTH RESOURCES AND GUIDELINES A.Student Health Clearance B. Student Health Fee C. Student Health Insurance D.Student Health Services Overview E. Student Counseling Services Overview F. N95 Respirator Fitting / Mask FIT Testing G.Blood-Borne Pathogen Exposures/Needle Stick and Injury policy H.Nursing Students with Blood Borne Pathogen Infection I. Substance Abuse Rehabilitation Program

IV. HEALTH RESOURCES AND GUIDELINES

Student Health Clearance

The University of Massachusetts Chan Medical School (UMass Chan) requires all incoming students to complete the Student Health Clearance process prior to matriculation. This policy was developed to decrease risk of transmission of potential infectious agents. It is also required by Massachusetts Law.

It is each student’s professional responsibility to maintain this clearance throughout their educational experience at UMass Chan. All clinical sites within UMass Chan and outside of UMass Chan require documentation of medical clearance prior to starting any clinical educational experience. Student Health Services (SHS) is responsible for periodic tracking of health clearances for all students and will notify students who need updated clearance information via email. The SHS office can help with any questions regarding the clearance paperwork and can assist with resources to help complete the process. Please upload your documentation to the PeopleSoft Portal, you can also use this Portal to correspond with SHS for any questions.

Any student who fails to comply with SHS requests to complete the clearance process will be reported to the Dean of the Tan Chingfen Graduate School of Nursing , the Assistant Dean of Student Affairs & Enrollment Management, and the Registrar’s Office for further action including suspension of registration. Suspension of registration would result in being withheld from classes and all clinical educational experiences.

Student Health Fee

The Student Health Fee is different from the student health insurance plan. This fee is MANDATORY for all students whether or not they have the health insurance plan or their own insurance. About half of the fee goes to student counseling service and the other half goes to SHS. The SHS half pays for physician and nurse services in the SHS, waiver of co-pay in the SHS and administrative support. The other half of the fee covers Student Counseling Services. This portion of the fee allows these visits to be covered at no cost to the student. Please refer to the Student Counseling website for details.

Student Health Insurance

MA law requires all students to carry health insurance. UMass Chan Medical School offers one health insurance plan with BC/BS which is managed by University Health Plans (UHP). Students have the option to enroll in the BC/BS plan through UMass Chan Medical School, purchase Insurance with a company of their choice, or apply for and purchase eligible subsidized coverage through the Commonwealth Connector at: https://www.mahealthconnector.org.

Students may also purchase dependent coverage (spouse, children) for an additional cost after the completion of their enrollment in the Student BC/BC health insurance plan. Students may also purchase optional dental insurance plan with Delta Dental for an additional cost and/or optional vision insurance plan with VSP for an additional cost after the completion of their enrollment in the student BC/BC health insurance plan.

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The Bursar’s Office is responsible for assisting students with the BC/BS student health insurance enrollment. Students complete online enrollment form during annual open enrollment period or request enrollment to the Bursar’s Office during the year when a qualifying event occurs. The Bursar Office can be reached at 508-856- 6641 or 508-856-6612. For plan overview and summary of benefits, students can go UHP website at www.universityhealthplans.com or call UHP toll free at 1-800-437-6448, x112

Student Health Services (SHS)

Student Counseling Services (SCS)

N95 Respirator Fitting/Mask FIT Testing

In-patient clinical sites require all Tan Chingfen Graduate School of Nursing health professional students to follow CDC respiratory infection control recommendations. The CDC recommends healthcare workers to be fit tested for a NIOSH- approved N-95 respirator or a powered air purifying respirator (PAPR) in order to provide protection from certain airborne pathogens such as H1N1 or Tuberculosis. Students may be maskfit at their clinical site, or on-campus.

When a student is assigned to a clinical site that requires MaskFit testing on-campus, they must first be medically cleared by Student Health Services (SHS) and then will be eligible to be fitted by Environmental Health and Safety (EH&S) for either N-95 respirator mask or a PAPR.

Respirator Fitness Form – Students who need to be MaskFit tested must download, complete and send the attached Respirator Fitness form to Student Health Services. • Step 1 - Forms needed to be completed and sent to Student Health via email (StudentHealth@umassmemorial.org) to obtain Mask Fit clearance. • Step 2- Once cleared, students should make an appointment as soon as possible with Environmental Health and Safety team to be Mask Fit: • Students can book their MaskFit appointment here once cleared by SHS: https://outlook.office365.com/owa/calendar/FitTesting1@umassmed.edu/bookings/

Blood-Borne Pathogen Exposure/Needlestick/Injury

For students who experience an exposure to blood, visibly bloody fluid, body fluid, e.g. cerebrospinal, synovial, peritoneal, pleural, amniotic, semen, secretions from a needlestick/cut or splash to eyes, mouth, nose or open cut, animal bite/lab injury. For what to do: https://umassmed.edu/studenthealth/blood-borne-pathogen-exposure/

Nursing Students with Blood Borne Pathogen Infection

Last updated June 7, 2013

The University of Massachusetts Chan Medical School (UMass Chan) recognizes its duty to minimize the risk of transmission of blood-borne pathogens by individuals studying at the University. UMass Chan also recognizes its duty to provide a study and work environment which is free from discrimination. The policy which follows has been developed to ensure that UMass Chan acts in a manner consistent with these two duties.

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This policy is based on currently available evidence from the medical literature and position papers from discipline-specific organizations. Revision of this policy may occur from time to time in light of new scientific evidence.

The intent of this policy is to limit the possibility of transmission of blood-borne pathogens by infected students within both the educational and clinical setting. UMass Chan recognizes, however, that it is not possible to eliminate the risk of infection.

This policy applies to all students enrolled in University of Massachusetts Chan Medical School Tan Chingfen Graduate School of Nursing sponsored educational programs, including both University of Massachusetts Chan Medical School Tan Chingfen Graduate School of Nursing students as well as visiting students.

1. General Considerations

To decrease their risk of acquiring or transmitting blood-borne pathogens, all Tan Chingfen Graduate School of Nursing students involved in patient care will receive training in the principles of Standard Precautions. They will be expected to adhere to those principles at all times within educational and clinical settings. Any students who believe that they may have exposed others to their blood or bodily fluids in a clinical situation have a professional responsibility to notify the attending physician and supervising faculty member. All students must comply with the applicable reporting, follow-up policies and protocols of the clinical site where the incident occurred. As professionals concerned with the health of others, it is strongly recommended that students involved in such incidents consent to undergoing diagnostic testing for blood-borne pathogens as defined below.

2. Admission to UMASS Medical School Tan Chingfen Graduate School of Nursing

An applicant’s HBV, HCV, or HIV serologic status will have no impact on consideration for admission to University of Massachusetts Chan Medical School Tan Chingfen Graduate School of Nursing.

3. Immunization

Tan Chingfen Graduate School of Nursing students are expected to undergo HBV immunization as a condition of admission unless they are (a) already known to be seropositive or (b) can provide proof of prior effective immunization with adequate HBV surface antibody titers. If a student has undergone immunization prior to or on admission to the Tan Chingfen Graduate School of Nursing and remains seronegative, the student will be expected to receive a single booster dose of HBV vaccine and will be retested no sooner than six weeks after that immunization. If still seronegative, the two additional doses of the HBV vaccine will be administered. Should the subsequent HBV surface antibody titer measurement remain negative, then testing for HBV surface antigen will be performed. Students who are found to be HBV surface antigen positive, will be advised to follow up with the Student Health Service (see 6. UMass Chan Student Health Service responsibilities

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4. Visiting Students

In the event that the Tan Chingfen Graduate School of Nursing has a visiting student the UMass Chan Medical School policy on Visiting Students will be enacted.

5. Other Serologic Testing

Tan Chingfen Graduate School of Nursing or visiting students are not required to undergo serologic testing for HIV or HCV. However, it is the professional responsibility of the student who may be at risk for HIV or HCV infection to ascertain their own serostatus for these infections.

6. UMass Chan Student Health Services Responsibilities

University of Massachusetts Chan Medical School Tan Chingfen Graduate School of Nursing students infected with a BBP may come to the attention of UMass Chan Student Health Services (SHS). It is the responsibility of the SHS: a) To confirm that the infected student is receiving adequate medical and psychological care, either at the SHS or with the student’s personal physician. b) To assist with providing, arranging, and coordinating such care if necessary. c) To advise the student of precautions to be taken to prevent transmission of their BBP infection, both in terms of patient care activities as well as general lifestyle considerations. d) To advise the student of signs of possible progression of their disease that would interfere with their physical or emotional ability to fulfill educational requirements. e) To review the UMass Chan policy regarding students with blood-borne pathogen infection including explaining the expectation that the student self-identify to the ADA Student Coordinator. f) To explain that, as a medical provider involved with the student’s health care, the SHS adheres to HIPAA guidelines and will not discuss the student’s medical condition without the student’s permission.

In addition, the SHS, or the student’s personal physician, may be expected to perform semiannual follow-up evaluations of infected students. This will provide the UMass Chan BPP Review Panel (see section 10 below) with clinical updates on any changes in the student’s degree of infectivity (e.g., viral load, etc.). It also allows for a written statement of medical clearance ensuring that the student’s BBP disease has not progressed to the point of limiting the student’s educational capabilities as described in the Tan Chingfen Graduate School of Nursing Technical Standards.

7. Notification

Nursing students who are infected with HBV, HCV, or HIV have a professional responsibility to self-identify their serologic status to the ADA Student Coordinator (school official designated to oversee the educational program of students who with BBP infection). Such notification should occur upon enrollment. If a student is diagnosed with a BBP infection after starting graduate school, the student should notify the ADA Student Coordinator promptly. Failure to self-report is basis for disciplinary action, up to and including dismissal from the Tan Chingfen Graduate School of Nursing.

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8. Career Guidance and Educational Monitoring

Upon notification, the ADA Student Coordinator will begin ongoing meetings with the infected student to: a) Review the UMass Chan Medical School Tan Chingfen Graduate School of Nursing policy on students with BBP infection b) Confirm and monitor that the student is receiving appropriate medical care c) Assist the student with applying for ADA status d) Discuss with the student if there is a possibility that s/he may have already participated in patient care activities in which injury to the student may have led to exposure of patients to the student’s blood e) Provide ongoing intensive career guidance regarding track selection f) Review and approve all planned elective clinical rotations.

The ADA Student Coordinator will also convene a meeting of the UMass Chan BBP Review Panel to discuss potential modifications in the educational program for the infected student. In the case of a need for an urgent determination, temporary restrictions may be issued by the ADA Student Coordinator, pending a meeting of the full UMass Chan BBP Review Panel.

9. UMass Chan BBP Review Panel

An ad hoc panel, known as the UMass Chan Blood Borne Pathogen Review Panel, will be convened to review each infected student’s clinical status. This BBP Review Panel will consist of the following membership: at least two physicians with expertise in infectious disease, two members of the clinical clerkship faculty who perform surgical or obstetrical procedures, two faculty members from the Tan Chingfen Graduate School of Nursing , the UMass Chan ADA Student Coordinator, and the Assistant Dean of Student Advising (chair). With the student’s permission, their personal physician will be invited (but not required) to attend the review panel meeting(s).

The UMass Chan BBP Review Panel will review relevant medical information regarding the infected student and propose any necessary specific modifications in the student’s educational program. Each infected student’s situation will be assessed individually on a case-by-case basis. The BBP Review Panel will not be informed of the identity of the student. The BBP Review Panel will take into account such factors as type of BBP infection, degree of infectivity (e.g., based on viral load, etc.), basic health of the student, any associated co-morbidities, as well as the particular requirements and locations of upcoming clinical clerkships or other educational experiences, etc. The BBP Review Panel will then make specific recommendations to the ADA student coordinator to help shape the appropriate accommodations to the student’s upcoming educational experiences.

Trainees typically have limited experience with performing procedures and are lacking in technical expertise. As such, they are more likely to make errors in procedural technique that could lead to an exposure. In addition, it is reasonable to assume that patients undergoing an exposure prone procedure would be very unlikely to consent to the non-essential participation of an infected student if there is a risk of BBP transmission. For these reasons, the Review Panel may stipulate broader restrictions on an infected student’s participation than what is

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recommended in guidelines concerning experienced infected health care workers with BBP infection.

10. Confidentiality

Confidentiality of all information about HIV, HBV, or HCV serostatus will be maintained pursuant to state and Federal laws. The Review Panel will consider the details of the student’s serostatus and relevant medical history but will not know any particulars of the student’s identity.

On a need-to-know basis, only those faculty, who will be providing modifications in the student’s educational program will be informed that the student has a blood borne pathogen infection without identifying the specific type of pathogen. It may also be necessary to notify other rotation site supervisors that the student is “sharps restricted.” These individuals will not be informed about the student’s particular disease. The individual clinical sites where students train also may have additional reporting requirements depending upon procedures and activities to be performed by nursing students at that site.

11. Accommodations

In compliance with the American with Disabilities Act (ADA) of 1990 and the ADA Amendments Act of 2008 (ADAAA), students living with blood-borne diseases are to be treated like anyone else having a “disability” for the purposes of admission and retention at University of Massachusetts Chan Medical School Tan Chingfen Graduate School of Nursing. University of Massachusetts Chan Medical School Tan Chingfen Graduate School of Nursing is committed to non-discrimination of disabled individuals and makes reasonable accommodations to enable them to complete their medical education. Reasonable accommodations may be made in the Nursing degree program for infected students so that they will not necessarily be prevented by their bloodborne pathogen disease status from completing a degree. Accommodations should be designed such that the infected student has every reasonable opportunity to excel.

The UMass Chan BPP Review Panel will work with the UMass Chan ADA Student Coordinator to provide the student with reasonable accommodations where needed. An accommodation is not considered reasonable if it alters the fundamental nature or requirements of an educational program, imposes an undue hardship, or fails to eliminate or substantially reduce a direct threat to the health or safety of others. Infected students, like all students, must meet the University of Massachusetts Chan Medical School Tan Chingfen Graduate School of Nursing technical standards.

Prior to starting a rotation that the UMass Chan BPP Review Panel considers as a potential risk for exposure, the infected student must meet with the program director or faculty so that restrictions on the student’s participation can be clearly defined.

12. General Principles Governing Clinical Activities of Infected Students

Each student with BBP infection will have an individualized educational program designed by the UMass Chan BBP Review Panel. There are, however, some general guidelines that apply to all infected students. In addition to practicing Standard Precautions, students with BBP infection should:

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a) Always double glove any time gloves are to be worn. b) If at risk of transmitting infection, not participate in exposure-prone procedures, which at a minimum include the following: i. digital palpation of a needle in body cavity ii. simultaneous presence of the student’s fingers and a needle, other sharp instrument, or sharp tissues (e.g., teeth, spicules of bone, etc.) in a poorly visualized or highly confined anatomic space iii. see appendix for detailed list of specific exposure prone procedures c) In the clinical setting, if an infected student is asked to assume a role in a procedure which may put a patient at risk, s/he should decline participation and indicate that s/he is

“sharps restricted.” d) If a glove or any other body part of an infected student is entered or nicked by a needle or sharp instrument, that instrument will be discarded or removed and cleaned, and the student will retire from the procedure. e) If an infected student sustains an injury that may have exposed a patient to the infected student’s blood or bodily fluid, the student shall immediately notify the patient’s attending physician or the responsible faculty member about the incident, and also comply with the applicable reporting and follow-up policies and protocols of the clinical site where the incident occurred. The attending physician should then communicate with the appropriate institutional officials (i.e., risk management, etc.), to initiate a full disclosure process. f) On a case-by-case basis, infected students may be required to provide the UMass Chan

Blood-Borne Pathogen Review Panel with updated information from their health care provider. Such reports will be requested at intervals not to exceed 6 months and may include the following: i. A current statement from the student’s medical provider confirming that the student’s overall condition is sufficiently healthy so as to be able to perform expected duties on clinical rotations as described in the Technical Standards found in the University of Massachusetts Chan Medical School Tan Chingfen Graduate School of Nursing Student Handbook. ii. Appropriate recent laboratory tests confirming that the student’s potential infectivity has not changed since the Review Panel issued their recommendations.

13. General Principles Governing Educational Programs of Infected Students

For the required clinical rotations and other required clinical experiences considered higher risk for potentially exposing patients to blood borne pathogens, infected students will preferentially be assigned to rotation sites where the content and structure of their educational experience can be most closely supervised.

To ensure that appropriate restrictions and accommodations are put in place for all clinical situations where patients or others are potentially at risk, the infected student is required to seek authorization from the ADA Student Coordinator for all elective clinical rotations. The Assistant Dean for Student Advising must also be notified of any changes in the student’s schedule of clinical experiences. Infected students who are at risk for transmitting a blood borne pathogen may not be permitted to do elective rotations in specialty areas involving exposure prone

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procedures. If the student disagrees with such a determination, s/he may appeal to the UMass Chan Blood Borne Pathogen Review Panel.

Infected University of Massachusetts Chan Medical School Tan Chingfen Graduate School of Nursing students wishing to do an elective rotation away will need to follow the Blood Borne Pathogen Policy of the host institution.

Appendix 1: Resources: CDC Current guidelines regarding exposure prone procedures for infected health care workers

From: Centers for Disease Control and Prevention; Updated CDC Recommendations for the Management of Hepatitis B Virus-Infected Health-Care Providers and Students; MMWR Recomm Rep; 2012; July 6;61 (RR03); 1-12.

CDC classification of exposure-prone patient care procedures

Category I. Procedures known or likely to pose an increased risk of percutaneous injury to a health-care provider that have resulted in provider-to-patient transmission of hepatitis B virus (HBV)

These procedures are limited to major abdominal, cardiothoracic, and orthopedic surgery, repair of major traumatic injuries, abdominal and vaginal hysterectomy, caesarean section, vaginal deliveries, and major oral or maxillofacial surgery (e.g., fracture reductions). Techniques that have been demonstrated to increase the risk for health-care provider percutaneous injury and providerto-patient blood exposure include • digital palpation of a needle tip in a body cavity and/or • the simultaneous presence of a health care provider's fingers and a needle or other sharp instrument or object (e.g., bone spicule) in a poorly visualized or highly confined anatomic site.

Category I procedures, especially those that have been implicated in HBV transmission, are not ordinarily performed by students fulfilling the essential functions of a medical or dental school education.

Category II. All other invasive and noninvasive procedures

These and similar procedures are not included in Category I as they pose low or no risk for percutaneous injury to a health-care provider or, if a percutaneous injury occurs, it usually happens outside a patient's body and generally does not pose a risk for provider-to-patient blood exposure. These include • surgical and obstetrical/gynecologic procedures that do not involve the techniques listed for Category I; • the use of needles or other sharp devices when the health-care provider's hands are outside a body cavity (e.g., phlebotomy, placing and maintaining peripheral and central intravascular lines, administering medication by injection, performing needle biopsies, or lumbar puncture);

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