Health Requirements

Prevention

Maintaining good physical health is critical in your role as a medical care provider. To help assure your educational success, we have designed specific and firm health guidelines. You have the complete support of faculty and staff in managing good health and accessing any medical resources you may need.

One of the most effective defenses against infectious disease is understanding the causes and modes of transmission. This leads to behavioral changes that reduce the spread of infection. The School of Medicine will continually emphasize prevention and new knowledge regarding HIV and other communicable diseases where appropriate.

Student Health Services works to help you avoid medical problems that are preventable, correct medical problems that can be treated, and assist in managing medical problems that are not correctable. Several requirements and procedures help Student Health Services meet these goals.

Required Vaccinations

By virtue of working in a clinical setting, you may be at risk of acquiring infectious diseases and/or spreading infectious diseases to patients and other health care workers. Many of these infections are preventable by immunization or standard infection control. For these reasons, we've established mandatory procedures and immunizations that must be met by all of our students before they may participate in any clinical program or activity.

Tuberculosis

Although tuberculosis generally is prevented by proper infection control, transmission in health care settings can occur. Therefore, you must receive an annual screening for tuberculosis including:

• PPD (Mantoux) skin test if previous skin tests have been negative,
  
• chest x-ray if PPD skin test is positive, or
  
• chest x-ray if a student has received BCG and PPD is positive.

Chickenpox (Varicella)

Chickenpox is a highly contagious infection that causes significant illness in non immune adults or immunocompromised patients. Knowledge of your immune status could help decrease the risk of infection and the potential for spreading the disease. Students are required to have a varicella titer. If serologic data is negative, vaccination is recommended.

Rubella

Medical students can acquire rubella from patients. The infection has devastating effects on the fetus. Infected medical students could spread the infection to pregnant patients and other health care workers. Each student must provide a written statement of laboratory evidence showing significant antibody titer to rubella or written evidence of having received rubella vaccine (MMR). Titers are the best indicators.

Rubeola

Individuals born before 1957 are most likely immune to rubeola. Those people born after 1957 are considered to be immune if laboratory evidence of antibodies to the rubeola virus exists or if that person has been adequately immunized. Adequate immunization can be defined as follows:

• two doses of rubeola vaccine (MMR) — the initial dose given at 12 months or after and the subsequent dose at five years or later; or
  
• serum antibody titer indicating immunity to rubeola (measles).

Documentation that the MMR vaccine was given is adequate proof for rubeola immunization.

Poliomyelitis Vaccine

Although poliomyelitis is uncommon in the United States, documentation of adequate immunization is required. Adequate immunization is defined as a single dose of each of the following: Type I, Type II and Type III; or four doses of trivalent oral polio vaccine given at appropriate intervals.

Hepatitis B Vaccine

The transmission rate of hepatitis B with an accidental percutaneous exposure is high, and consequences of infection may be severe. In addition to the serious health risks, non-immune students put career goals in jeopardy if they become chronic hepatitis B carriers. That is why hepatitis B vaccine is recommended for all health care workers who are exposed to blood or blood products and those who handle needles or instruments that could have been contaminated with a patient's blood or serum. This vaccine is proven to be safe and effective. The School of Medicine provides the vaccine to all entering Year 1 students.

Recommended Immunizations

Here are other immunizations Student Health Services strongly recommends but does not require:

• Influenza (flu) - annually in the fall, and
  
• Tetanus and Diphtheria Booster - every 10 years.

Pregnant Students

All pregnant students should consult their obstetrician before receiving HBIG, hepatitis B vaccine or any viral vaccine.

Refusal of Immunizations

If a student refuses the hepatitis immunization series, the School of Medicine will require a signed waiver that the immunization was recommended and that refusal of the immunization places the student at increased risk of infections.

Health, Life & Disability Insurance

You are required to have health, disability, and life insurance coverage. Comprehensive group plans are available through the School of Medicine. Because they are group plans, costs are less expensive than if comparable coverage were purchased as an individual. Should you receive comparable health insurance through a spouse or parent at no charge, you are not required to purchase health insurance coverage through the school, provided you properly complete a waiver form and provide proof of coverage. You are charged for insurance as part of your tuition bill, which is sent from the Bursar. A brochure that explains your health benefits and health insurance claim forms are available in the Office of Student Affairs. Students are covered both in- and out-of-network. Generally it is less expensive to receive care from an in-network provider. A directory of providers is available for your review in the Office of Student Affairs. Complete information about the program including how to file claims is available on the web at: www.med.wright.edu/students/insurance/.

Health Requirements for Entering Students

Each student will receive a health history and physical examination form, which is to be completed by a physician and submitted prior to the first week of medical school. The form should be returned to the Medical Director of Student Health Services, room 118 of the Frederick A. White Center, Wright State University, Dayton, Ohio 45435. It is extremely important that the immunization history — with dates, as well as the history of current screening for tuberculosis — be completed. Serologic tests may be substituted in lieu of an immunization history. Each history will be reviewed by the medical director, and further recommendations might be made for follow-up testing or information.

Occupational Exposure to Bloodborne Pathogens

Since a bloodborne pathogen exposure places an individual at risk for hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV) infection, and/or syphilis infection, it is important that one seeks medical attention as soon as possible after an exposure occurs. Any medical student who sustains an exposure to blood or body fluids should be managed according to currently recommended guidelines from the Centers for Disease Control and Prevention (CDC) and according to the policies and procedures of the institution. Proper steps must be taken to insure that both evaluations and preventive measures are instituted in a timely manner. The steps noted below should be followed when an exposure occurs in a medical student.

• The exposure site should be cleansed thoroughly immediately following the exposure. Irrigate eye with water keeping the affected eye lower than the unaffected eye during irrigation.
  
• Note the patient's name, the location where the exposure occurred, the date and time of the exposure, the rotation, the names of witnesses, and, in the case of a needlestick, the type (hollow bore or solid).
  
• Notify the employee health office in the hospital or the safety officer in a private setting during regular working hours. Report to the emergency department during evenings, night and on weekends. A list of employee health office contacts is attached.
  
• Call University Med/Peds at 443-0354 and identify yourself as a medical student with an exposure and, if necessary, leave a phone number where you can be contacted. An ID physician will call you and discuss the exposure, arrange for blood tests, if needed, and any follow-up tests or visits.
  
• If appropriate, after assessments are performed and based on current guidelines, the student may be offered antiviral prophylaxis against HIV. After discussion of the risks and benefits of antiviral prophylaxis, a student should be dispensed a 96-hour supply of the antiviral medications. All exposed individuals must be counseled on the importance of follow-up evaluations. Each must have a follow-up evaluation within 96 hours of the exposure. The following should be done:
  1. Notification must be made with the employee health service of the institution and the Associate Dean for Student Affairs/Admissions, WSU SOM, as soon as possible but not later than 96 hours following the initial evaluation. (Please see list of contact addresses and telephone/FAX numbers at the end of this policy.)
     
  2. Insure that copies of all records are confidentially forwarded as soon as possible but not later than 96 hours following the initial evaluation to the employee health service of the institution. Medical student records should be forwarded to the Office of Student Affairs/Admissions, WSU SOM. The Office of Student Affairs/Admissions will report the incident to the WSU Department of Environmental Health and Safety and the State of Ohio.
     
  3. The medical student must be instructed on the requirement for follow-up evaluations within a 96-hour period. Appropriate educational and medical support will be provided through University Med/Peds or the Office of Student Affairs.
• Financial charges incurred during the evaluation should be forwarded to the Office of the Associate Dean for Student Affairs/Admissions, WSU SOM.

Minimizing Risks

• All students must follow policies and procedures according to the most current published CDC guidelines regarding use of precautionary measures to minimize the risk of HBV, HCV, and HIV transmission. Students must practice these precautions:
  
• Routinely use appropriate barrier precautions to prevent skin and mucous membrane exposure when contact with blood or other body fluids of any patient is anticipated. Examples of protective barriers include gloves, gowns, masks, and protective eyewear.
  
• Gloves should be worn for touching blood and body fluids, mucous membranes or non-intact skin of all patients; for handling items or surfaces soiled with blood or body fluids; and for performing venipuncture and other vascular access procedures. Gloves should be changed after contact with each patient.
  
• Wear masks and protective eyewear or face shields during procedures that are likely to generate droplets or splashes of blood or other body fluids, to prevent exposure of mucous membranes of the mouth, nose, and eyes. Fluid-resistant gowns or aprons should be worn during procedures that are likely to generate splashes of blood or other body fluids.
  
• Wash hands before and after contact with patients, and immediately after protective gloves are removed. Hands and other skin surfaces should be washed immediately and thoroughly if contaminated with blood or other body fluids.
  
• Take precautions to prevent injuries caused by needles, scalpels, and other sharp instruments or devices during procedures; take these same precautions when cleaning used instruments, when disposing used needles, and when handling sharp instruments after procedures. To prevent needlestick injuries, needles should NEVER be recapped, purposely bent or broken by hand, removed from disposable syringes or otherwise manipulated by hand. Used, disposable syringes and needles, scalpel blades and other sharp items should be placed in puncture resistant containers for disposal. Large-bore, reusable needles should be placed in puncture-resistant containers for transport to the reprocessing area.
  
• Use mouthpieces, resuscitation bags or other ventilation devices whenever possible for emergency mouth-to-mouth resuscitation.
  
• Refrain from all direct patient care and from handling patient-care equipment if you have exudative lesions or weeping dermatitis, until the condition resolves or the areas are adequately protected.
  
• Students who are pregnant should be especially familiar with and strictly adhere to precautions to minimize the risk of transmitting bloodborne pathogens to themselves and their fetus.

Managing Chronic HBV, HCV, and HIV for Infected Students

• Any student who believes or has reason to believe that he or she is infected with HIV or HBV shall report that fact to the Associate Dean for Student Affairs/Admissions prior to performing an invasive procedure where there is a risk of contact between the blood or body fluids of the student and the blood or body fluids of the patient. The Associate Dean will require confirmation from a qualified physician as to the student's diagnosis, state of health and symptoms.
  
• Having identified a student with HBV, HCV and//or HIV, the Associate Dean for Student Affairs/Admissions will coordinate an ad hoc committee including the student's physician, an infectious disease specialist or credentialed HIV specialist and a dean-appointed faculty member familiar with the clinical curriculum. The ad hoc committee will evaluate the student's course work and patient contact to determine appropriate clinical curricular changes based on guidelines from the Ohio Department of Health (ODH) and the Center for Disease Control (CDC). The committee shall report any recommendations to the Associate Dean for Student Affairs/Admissions who in turn will notify the student and clerkship directors, as needed, of any requirements and/or limitations placed on the student's clinical activity.
  
• A student who fails to comply with the requirements and/or limitations will be subject to discipline.
  
• All information regarding the HBV, HCV and/or HIV status of a student shall be held in strict confidence. Wright State University Boonshoft School of Medicine.

Protocol Following Exposure to Blood/Body Fluids

Post-Exposure Contacts per Hospital

Children's Medical Center
One Children's Plaza
Dayton, OH 45404
Rebecca Mann, RN
Employee Health Coordinator
937-641-4570
Fax: 937-641-3473
E-mail: mannrj@childrensdayton.org

Good Samaritan Hospital
2222 Philadelphia Drive
Dayton, OH 45406
Lisa Shores, RN, or Michelle Dillhoff, RN
937-278-2612, x3200
Fax: 937-2767622
E-mail: lshores@shp-dayton.org or mdillhof@shp-dayton.org

Greene Memorial Hospital
1151 North Monroe Drive
Xenia, OH 45385
Pat Pickarski
Employee Health Specialist
937-352-2491
Fax: 937-352-3101
Pager: 220-7218
E-mail: ppickarski@greenehealth.org

Kettering and Sycamore Hospitals
3535 Southern Boulevard
Kettering, OH 45429
Mary Shock, RN
Employee Health Nurse
937-395-5284
Fax: 937-395-8351
E-mail: mary.shock@kmcnetwork.org

Miami Valley Hospital
One Wyoming Street
Dayton, OH 45401
Carol Ondercin, RN
Employee Health Nurse Manager
937-208-4803
Fax: 937-208-4640
E-mail: crondercin@mvh.org

Veterans Affairs Medical Center
4100 West Third Street
Dayton, OH 45428
Patti Hoffman, RN
Infection Control
937-268-6511, x1470
Fax: 937-262-5978
E-mail: patti.hoffman@med.va.gov

Wright-Patterson Medical Center
88th Medical Group
4881 Sugar Maple Drive
Wright-Patterson AFB, OH 45433
Danna Lilly, RN
Employee Health Nurse
937-257-6855
E-mail: danna.lilly@wpafb.af.mil

Wright State University
Boonshoft School of Medicine
210 Medical Science Building
Dayton, OH 45401-1751
Stephen Peterson, Ph.D.
937-775-2934
Fax: 937-775-3322
E-mail: stephen.peterson@wright.ed

Medical Liability Coverage

Wright State University provides you with medical liability when providing medical services as a part of approved educational activities. You are not covered while participating in unapproved activities or rotations. Generally, in the third and fourth years, you are not covered for an activity unless it is officially listed on your schedule. To assure that you are covered for a specific activity, inquire in the Office of Student Affairs. When rotating outside the School of Medicine, you may be requested to provide a letter from the school showing proof of coverage.