Student Health Procedures

North Harris Montgomery Community College District recognizes its responsibility to protect the rights and privileges of students, employees, clients, and the general public against the contact and spread of infectious diseases. NHMCCD is also sensitive to the needs and rights of any of its employees or students who have contracted diseases that might be infectious. In recognition of Human Immune deficiency Virus (HIV), Tuberculosis (TB), and Hepatitis B Virus (HBV) as serious public health threats, NHMCCD has adopted the following procedures.

The faculty of the Health Occupations Programs also believes that with proper education, skills, and immunizations, students in health careers can be reasonably protected from risks of infection while performing clinical activities.

The following procedures relate to:

1. admission of students who have infectious diseases
2. student immunization
3. tuberculosis policies and procedures
4. prevention of exposure to blood and body fluids
5. exposure to blood or body fluids
6. pregnancy/temporary disability/mobility assisted devices
7. impaired students in clinical practice, and
8. invasive campus laboratory activities for EMS students

Revised: August 2006

Purpose:

Preventing discrimination against students with HIV or other infectious diseases.

No prospective student will be refused admission based solely on a positive diagnosis of an infectious disease. Further, NHMCCD will not require preadmission screening for infectious diseases as a condition of admission. Once admitted, students with infectious diseases, including HIV positive will not be denied access to usual and normal student activities.

Procedure:

Students will not be required to give information regarding having infectious diseases including HIV or HBV prior to admission into the health occupations programs.

Purpose:

To meet the requirements of the Texas Department of State Health Services, and to protect the student and others from the spread of infectious diseases.

Upon admission to the Health Occupations Program, students will be required to have current immunizations as required by the Texas Department of State Health Services. In addition, the hepatitis vaccine series is required to be completed before starting the program. See Appendix C: Documentation of Required Immunizations. A PPD skin test for tuberculosis is required upon admission to the Health Occupations Program and yearly thereafter (see tuberculosis policy).

Procedure:

Students enrolled in health career courses that have or will have direct client contact must show proof of immunizations using the attached form, or they may submit copies of the original immunization record. Students who show serological documentation that they are immune to the Hepatitis B virus are not required to be immunized upon the submission of appropriate medical documentation. These records may be submitted to the division secretary, the clinical instructor, and/or the clinical facility, as requested. Students will be responsible for keeping their own records and maintaining currency of immunization status.

Students who are not current on immunizations may not be allowed to attend clinical, depending on the discretion of the clinical instructor and/or clinical facility. Without valid documentation, students will receive an absence for each day excluded from clinical due to immunization status.

Policy:

All students, excluding those with a history of Bacillus of Calmette and Guerin (BCG) vaccination, must receive a PPD tuberculin skin test (a tine test is NOT acceptable) and proof of results prior to their first day of clinical, unless a previously positive reaction can be documented, or completion of adequate preventive therapy or adequate therapy for active disease can be documented.

Initial and follow-up tuberculin skin tests should be obtained and interpreted according to current CDC guidelines.

Students with a documented history of a positive tuberculin test or adequate treatment for disease or preventive therapy for infection should obtain a chest x-ray and review the symptoms of TB. They should be exempt from future screening unless they develop symptoms suggestive of tuberculosis. Each year, prior to start of clinical, submit the Respiratory Screen form in Appendix C to clinical instructor and Nursing Office.

PPD negative students must have PPDs done according to CDC guidelines. Currently, students must have yearly PPDs, however, CDC guidelines may change. Students whose TB status is not current, as evidenced by documentation, will not be allowed in the clinical agency for the clinical experience of the class.

Procedures:

Students are responsible for maintaining current status. It is their responsibility to show documentation to the clinical instructor as well as turn it in to the designated division staff assistant and/or clinical facility. Students who are unable to attend clinical due to incomplete immunizations will receive a clinical absence and no alternative clinical will be provided for make-up.

Purpose:

Students should be evaluated if they have been exposed to a potentially infectious tuberculosis client for whom infection control procedures have not been taken.

Persons with previously known positive skin test reactions who have been exposed to an infectious client do not require a repeat skin test or a chest radiograph unless they have symptoms suggestive of tuberculosis.

Procedure:

Unless a negative skin test has been documented within the preceding 3 months, each exposed individual (except those already known to be positive reactors) should receive a PPD tuberculin skin test as soon as possible after exposure and should be managed in the same way as their contacts. If the initial skin test is negative, the test should be repeated 12 weeks after the exposure ended. Exposed persons with skin test reactions of 5mm or with symptoms suggestive of tuberculosis should receive chest radiographs. All diagnostic and treatment related expenses are the sole responsibility of the student.

Students with current pulmonary or laryngeal tuberculosis pose a risk to clients and other students and staff while they are infectious; therefore, restrictions for these persons are necessary.

Procedure:

Students with current pulmonary or laryngeal tuberculosis should be excluded from the classroom until adequate treatment is instituted, cough is resolved, and sputum is free of bacilli on three consecutive smears. Individuals who discontinue treatment before the recommended course of therapy has been completed should not be allowed to attend class until treatment is resumed, an adequate response to therapy is documented, and they have negative sputum spears on three consecutive days.

Students who are otherwise healthy and receiving preventive treatment for tuberculosis infection should be allowed to continue usual class activities.

Procedure:

Individuals who cannot take or do not accept or complete a full course of preventive therapy should have their attendance in the classroom/clinical setting evaluated. Restrictions may not be necessary for otherwise healthy persons who do not accept or complete preventive therapy. These persons should be counseled about the risk of contracting disease and should be instructed to seek evaluation promptly if symptoms develop that may be due to tuberculosis, especially if they have contact with high risk clients (i.e., clients at high risk for severe consequences if they become infected).

CONSULTATION

Consultation on tuberculosis surveillance, screening, and other methods to reduce tuberculosis transmission should be available from state health department tuberculosis control programs and infection control employee health affiliates of clinical facilities.

Procedure:

Faculty and students will consult the policies and procedures at the clinical facilities where they have clinical activities. Policies and procedures will be followed for both the facility and the college whichever is more restrictive.

Purpose:

To protect the student’s health in the event of an exposure to blood and body fluids.

In the event that a student becomes exposed to blood or body fluids, the student must follow the procedures outlined by the college.

Procedure:

1. Student must report exposure to clinical instructor, authorities in health care agency and his/her program director at North Harris Montgomery Community College District.
2. The student, instructor and facility representative will collaborate to assess the clinical status of the source client who exposed the student.
3. The clinical facility will test the client for evidence of HIV or Hepatitis B as soon as possible after the exposure. The students will seek out the health care institution’s related policies for additional information and guidance.
4. Current CDC guidelines for exposure to blood and body fluids should be consulted at www.cdc.gov.
5. The student must be re-tested if negative following current CDC guidelines.
6. The student must seek counseling, or be referred to the college counseling service throughout the experience.
7. In order to ensure the confidentiality of student and client medical records, information is shared only on a strict “need to know” basis. Any breaches of confidentiality will be grounds for disciplinary action.
8. Confidential screening for various communicable diseases can be obtained through the local health department.
9. All expenses incurred are the sole responsibility of the student.

Purpose:

To establish guidance on a student’s continued performance of published clinical objectives during pregnancy or during any other period when a student is temporarily disabled.

Students who are temporarily disabled shall be entitled to the same rights given other students until such time as their performance is documented to be impeded.

Procedure:

1. A student is not required to disclose the fact of pregnancy. For safety for the student and her fetus, it is recommended that the student inform the clinical instructor.
2. A student shall be allowed to continue to perform all program objectives during pregnancy until the student or her doctor communicate that it is no longer safe to do so, or when the student’s performance is documented to be substandard, as described below.

Purpose:

To protect client health and safety from students whose performance is impaired by suspected chemical dependency and/or mental illness.

Students whose performance is impaired by mental illness and/or chemical dependency will not be allowed to participate in clinical settings. Students in recovery may participate in all aspects of clinical experience and nursing students will be advised to contact the Board of Nurse Examiners to facilitate eventual licensure and compliance with proposed restrictions, such as TPAPN (Texas Peer Assistance Program for Nurses) participation.

Procedure:

The student whose performance is impaired by suspected chemical dependency and/or mental illness and would therefore endanger client health and safety will be prohibited by the instructor from participating in the clinical experience.

1. The on-site instructor will determine whether in his/her judgment, student performance presents a danger to the client’s health and safety.
2. The student restricted from practice will be required to call a support person/friend to accompany him/her to home or to a treatment provider.
3. The student will be advised to seek treatment and referred to counseling services at the college.
4. The instructor will document the specific behavioral observations that required removing the student from the clinical area.
5. Impaired behavior negatively affecting performance will result in dismissal from the course and failure.
6. Student confidentiality will be maintained at all times, with the exception of informing those who need to know.
7. Faculty will comply with Sec.301.404 of the Nursing Practice Act which states “ A professional nursing education program that has reasonable cause to suspect that the ability of a professional nursing student to perform the services of the nursing profession would be, or would reasonably be expected to be, impaired by chemical dependency shall file with the Board a written, signed report that includes the identity of the student and any additional information the Board requires.”

Refer to Chemical Abuse Policy in Appendix B for further information.