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Policy and guidelines for addressing HIV and HBV infection

The following is directed to the reduction of the possibility of exposure to Human Immunodeficiency Virus (HIV) and Hepatitis B Virus (HBV) of student nurses, faculty, staff and patients of the School of Nursing. It is based on the 1992 position statement of the American Association of Colleges of Nursing and the 1991 Recommendations for preventing transmission of human immunodeficiency virus and hepatitis B virus to patients during exposure-prone invasive procedures and the 1998 MMWR Management of Health Care Worker exposures to HIV and recommendations for post exposure prophylaxis from the Center for Disease Control, U.S. Department of Health.

Hepatitis B virus vaccination

  • Students admitted to the clinical nursing major must present documentation of a completed series of HBV vaccination as per the Occupational Safety and Health Administration 1991 safety standards for health care workers exposure to blood-borne pathogens.
  • Students who are immune or medically at risk from the vaccine must present a statement from a physician stating the reason for exemption from this requirement. 
  • Documentation of immunization or the physician's statement exempting immunization will become a part of the student's permanent file in the School of Nursing.

Human Immunodeficiency Virus and HBV Guidelines

General policy guidelines

The policy will be reviewed annually to ensure that it reflects sound and current thinking on the transmission of HIV and HBV.

  • The policy generally applies to students, faculty and staff of the MU Sinclair School of Nursing.
  • Inquiry into HIV status will not be a part of the student, faculty or staff application process.
  • The School of Nursing will inform students of potential infectious hazards inherent in the nursing education program, including those that might pose additional risks to the personal health of HIV-positive persons.
  • Qualified persons will not be denied admission to the programs in nursing or employment as faculty on the basis of HIV status unless this disease is a handicap that poses a "direct threat" to others as defined by the Americans with Disabilities Act of 1990.

Guidelines for testing

  • Nursing students, faculty, or staff who believe they may be at risk for or have been exposed to HIV infection, HBeAg, or HBsAg have an obligation to know their status. Testing will be voluntary; confidentiality will be maintained.
  • Pre-and post-testing counseling will be available at the office of the Associate Dean and will be confidential. The cost of testing will be the responsibility of the individual involved, but may be done at the Department of Health at no charge.
  • Testing records will be kept by the provider administering the test separate from academic or employment files, and will be available only with the individual's written consent.

    Education and management

    • Students will receive written and verbal information and instructions on universal precautions for blood and body infections prior to exposure to patients. Faculty have the responsibility to provide the most recent recommendations for universal precautions and post exposure prophylaxis published by the Centers for Disease Control and Prevention.
    • Students will receive appropriate information regarding personal health habits, HIV and HBV prevention, and risk behaviors prior to clinical experience.
    • These instructions will be continually reinforced and clinical supervision will be managed to ensure compliance in all undergraduate and graduate clinical learning experiences. Faculty will serve as competent role-models in the care of HIV and HBV infected patients.
    • All faculty and students are professionally and ethically obligated to provide patient care with compassion and respect for human dignity. No faculty member or student may ethically refuse to care for a patient solely because the patient is at risk of contracting, or has, an infectious disease such as HBV, HIV or AIDS. Faculty and students will understand and follow rules of confidentiality.

    HIV/HBV positive students, faculty and staff

    • Students who are HIV positive or who have AIDS do not pose a health risk to ther students in an academic or residential setting, but in a clinical setting, the CDC guidelines and universal precautions should be followed.
    • Clinical settings that pose additional risk to the personal health of HIV positive students and faculty will be identified, and such persons will be advised of these risks and urged to consult their health care provider to assess the significance of the risks to their own health.
    • Students, faculty, and staff who know they are infected should inform the Associate Dean, the designated official of the School of Nursing, who will provide information and referral on health care and counseling, and will assess the need for necessary modification/accommodations in clinical education or job functions.
    • Any modification of clinical activity of HIVor HBV infected students or faculty will consider the clinical activity, the technical expertise of the infected person, the risks posed by HIV or HBV carriers, functional disabilities, and the transmissibility of simultaneously carried infectious agents.

    HIV post-exposure report and procedures

    • Immediate antiseptic procedures should be followed after possible exposure.
    • A student has an ethical duty to report to the faculty member in charge any accident that exposes him/herself or a patient to a risk of transmission of a blood-borne disease. Particularly because post-exposure prophylaxis is most likely to be effective if implemented as soon after exposure as possible.
    • If an accidental exposure occurs, faculty, students, and staff will follow the CDC guidelines for occupational exposure.
    • Notification of patients who have had exposure-prone procedures performed by students or faculty who are HIV positive or have AIDS will be based on policy established by the agency or institution providing the setting for clinical experiences.
    • The CDC recommends that this be considered on a case-by-case basis with consideration of specific risks, confidentiality, and available resources.

    Definition of a significant occupational exposure

    A significant occupational exposure is defined as:

    • A needle stick or cut caused by a needle or sharp that was actually or potentially contaminated with blood or body fluids.
    • A mucous membrane (i.e., splash to the eye or mouth) exposure to blood or body fluids.
    • A cutaneous exposure involving large amounts of blood or prolonged contact with blood -especially when the exposed skin was chapped, abraded, or afflicted with dermatitis.
    • If a significant occupational exposure occurs to a known HIV-positive patient, the instructor or supervisor should be notified immediately so that post-exposure prophylaxis can be considered. Post-exposure prophylaxis should be initiated as soon as possible following CDC recommendation.