7
Management
Responsibilities of Healthcare Organizations
Academic Institutions and Professional Schools
Professional schools should provide the following for trainees and students:
➤ Counseling students and trainees who will be participating in
exposure-prone procedures to inform them that they have an ethical
obligation: (1) to know their HBV, HCV, and HIV infection statuses; (2)
to be vaccinated with HBV vaccine if they are working in a healthcare
institution; (3) to seek appropriate treatment for HBV, HCV, and HIV
if found to be infected; and (4) to inform the appropriate supervising
individual according to institutional procedures (e.g., at a minimum, the
occupational medicine program, in order to facilitate the establishment
of an oversight panel).
➤ Detailed training and education about the bi-directional risks for
exposure to, and infection with, bloodborne pathogens, including meeting
the Occupational Safety and Health Administration's requirement for
annual bloodborne pathogen education for healthcare workers.
➤ Access to and education about the efficacy of HBV immunization.
➤ Annual testing for serological signs of HBV infection for HCP who
conduct exposure-prone procedures who elect not to be immunized or
for HBV vaccine non-responders. The Canadian guidelines
1
and the UK
guidelines
2
recommend annual and post-exposure testing.
➤ Comprehensive exposure management and follow-up protocols,
including post-exposure immuno- and chemoprophylaxis, when
appropriate, for exposed staff, students, and trainees.
➤ Career counseling to those planning to conduct exposure-prone
procedures who are identified as living with a bloodborne pathogen(s)
about the advances in the suppressive treatment or cure of these
infections. Trainees and students have an obligation to provide notice
of active infections to their institutions if they are planning to conduct
exposure-prone procedures, and to participate in ongoing follow-up for
these infections according to the standard of care.
➤ Career counseling for students, trainees, and faculty whose viral loads
cannot be consistently suppressed concerning their ability to conduct
exposure-prone procedures and potential effects on their subsequent
careers.
➤ Mechanisms and processes for oversight of HCP living with a bloodborne
pathogen who perform exposure-prone procedures. Oversight can
be provided by a state expert review panel, an institutional expert
review panel, or a more informal oversight team that includes, at a
minimum, the clinician providing care for the HCP and an independent
occupational medicine physician who is not directly involved in the care
of the HCP (discussed in detail in the following section).
