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. Students 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 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, students 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, students must receive an annual screening for tuberculosis including:

  • 2-step 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, or chest x-ray if student has had INH treatment.

Chickenpox (Varicella)

Chickenpox is a highly contagious infection that causes significant illness in non immune adults or immunocompromised patients. Knowledge of one’s 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 required.

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. Students are required to have a titer. If serologic data is negative, vaccination is required followed by another titer.

Tetanus, Diptheria, Pertussis

The Tetanus-Diptheria-Pertussis (Tdap) booster is required every 10 years for medical students.

Influenza

The influenza vaccination is required annually in the fall.

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 will require a signed waiver that the immunization was required and that refusal of the immunization places the student at increased risk of infections.

Health, Life & Disability Insurance

Students are required to have health, disability, and life insurance coverage. Comprehensive group plans are available through the School. Because they are group plans, costs are less expensive than if comparable coverage were purchased as an individual. Should students receive comparable health insurance through a spouse or parent at no charge, they are not required to purchase health insurance coverage through the School, provided one properly completes a waiver form and provides proof of coverage. Students are charged for insurance as part of their tuition bill which is sent from the Bursar. Detailed information on students’ health, life and disability benefits are available on the School’s web site. Students are covered both in- and out-of-network. Generally it is less expensive to receive care from an in-network provider.

Health Requirements for Entering Students

Each student must submit a completed health history and physical examination form prior to the first day of medical school. The form should be returned to the Office of Student Affairs/Admissions, 190 White Hall, Wright State University, Dayton, OH 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, and further recommendations might be made for follow-up testing or information.

Drug Impairment

The School's Policy

Success in a medical education environment hinges on maintaining a healthy lifestyle. Substance abuse presents a special concern for the School because of its potentially negative impact on patient care and of medical students' potential access to controlled substances.

The School may consider dismissal or other measures to prevent licensure of students whose problems are incompatible with the responsibilities and ethics of medical practice. Students and physicians should follow the American Medical Association's Principles of Medical Ethics to identify colleagues who cannot practice medicine competently.

In accordance with the policy of Wright State University, the School does not condone violations of federal, state, or local law. The University reserves the right to inform civil authorities should the law be violated. Illegal use, possession, or distribution of drugs also may be cause for suspension or dismissal.

In addition to the University's policy regarding alcohol use, the School does not condone the use of alcohol while students are on duty or on call in a clinical rotation.

Treating Drug Impairment

The School endorses treatment of chemical dependency, addiction, or alcoholism as it does for treating any psychological or physical impairment. Constructive interventions are designed to assure that recovering students can continue their medical education without stigma or penalty.

The student must maintain school standards of performance and behavior. Continuation of medical studies will depend upon successful completion of treatment and an appropriate program of aftercare and monitoring.

How To Report a Possible Drug Problem

Faculty, students, or staff who are concerned about a student's use of drugs or alcohol should contact the Associate Dean for Student Affairs/Admissions. Such reports will be held in confidence unless the information they contain must be used in the course of due process.

The Associate Dean of Student Affairs/Admissions will examine the information and, when necessary, consult with appropriate experts. If further action is warranted, the Associate Dean of Student Affairs/Admissions will recommend to the Dean of Medicine that an ad hoc Committee on Drug Impairment be formed to review the case.

Ad hoc Committee on Drug Impairment

In dealing with possible drug abuse, the Dean will appoint four faculty members and one student from each biennium to the Committee on Drug Impairment. The committee will examine the information to determine if reasonable grounds exist to suspect impairment.

If so, the committee will obtain clinical and performance evaluations as needed to determine the degree of impairment. If impairment is evident, the Committee will:

  • Propose an appropriate intervention or rehabilitation strategy;
  • Propose an appropriate plan to monitor the student's progress in the rehabilitative activities; and
  • Communicate their decisions to the Associate Dean of Student Affairs.

Student Follow-Through

If a student can manage active enrollment and agrees to the recommended treatment and monitoring plan during unscheduled time, he/she may remain enrolled and fulfill all academic requirements.

If a student cannot manage active enrollment but agrees to a recommended treatment and monitoring program that involves inpatient or outpatient treatment and rehabilitation, he/she may take an official leave of absence. In either case, the student is responsible for all treatment costs.

The ad hoc Committee on Drug Impairment will monitor impaired students. Urine surveillance and consultation with a therapist to determine student compliance may be required by the committee.

Graduating students with a history of impairment may have a statement of their performance records, relative to their difficulties and corrective steps, reported to the director of their residency programs. The Committee on Physician Effectiveness and Well-being of the Medical Society in the state in which they will pursue medical training may also be notified.

Treatment Failure or Non-Compliance

The committee may revise its recommendations if a student fails to:

  • Comply with the treatment recommendations of the committee;
  • Complete the treatment recommended by the committee; or
  • Regain and maintain fitness.

Normally, in cases of non-compliance with treatment, the committee will recommend dismissal from the School. A similar sanction will be expected if the student drops out of the recommended treatment or fails to maintain fitness after being reinstated in the School.

Appeal Processes

Students may appeal to the committee for reconsideration of its decisions if new information is available. The final decision for dismissal is made by the Dean of Medicine. A student may appeal the Dean's decision to the President of the university. A written petition must be submitted to the President within seven business days of receiving the Dean's decision. The President's decision is final.

Mental

Administrative Procedures

Students experiencing psychological problems will be treated with compassion, support, dignity, and respect for privacy. The School will offer as much support and assistance as possible within the scope of its primary mission of education.

Counseling faculty members in the Office of Student Affairs/Admissions are available for advice and counseling on personal and academic concerns. In addition, students have access to professional counseling through the Department of Psychiatry. Students may contact the director of Student Mental Health Services by calling 223-8840.

Since psychological problems do not necessarily imply unacceptable student performance, the school does not impose administrative actions solely because of a student's psychological condition. However, the school cannot relax those performance and behavior standards that are essential to medical education. Administrative intervention could be required when psychological problems cause unacceptable performance or behavior.

Students or faculty who suspect that a student is psychologically impaired should contact the Associate Dean for Student Affairs/Admissions. If further action appears necessary, the Associate Dean will pursue one of the following alternatives:

  • If performance or behavior factors are not involved, the Associate Dean for Student Affairs/Admissions will fully respect the right and responsibility of the student to determine further actions, if any, including leave of absence and professional treatment. The student will be offered all reasonable assistance. Any treatment will be confidential and at the student's expense.
  • If performance or behavior factors are involved, the Associate Dean for Student Affairs/Admissions may intervene. This would include instances such as:
    • threats to life, limb or property of self or others;
    • functioning incompetently in a medical education setting;
    • inappropriate professional behavior;
    • behavior which disrupts academic or clinical activities;
    • recurrent need for excessive support which interferes with the responsibilities of faculty, staff, or fellow students;
    • violation of local, state, or federal laws;
    • violation of policies of the school, the university, or affiliated hospitals; or
    • violation of professional ethics.

Under these circumstances, the Associate Dean for Student Affairs/Admissions may take action required to fulfill the responsibilities of the school. This could include:

  • continuation with no further action,
  • continuation after leave of absence for a specified period,
  • continuation contingent on a supporting clinical opinion,
  • review by the Student Promotions Committee or Honor Code Council, or
  • review by an ad hoc committee.

The student may be encouraged to pursue professional help, but the school normally will honor the student's right and responsibility to manage his/her personal issues.

Ad Hoc Student Mental Health Committee

If serious or recurrent behavior problems and/or questions of professional competence exist, the Associate Dean for Student Affairs/Admissions, Student Promotions Committee (SPC), or Honor Code Council may appoint an ad hoc Student Mental Health Committee to review the circumstances and recommend actions. The Committee will consist of four faculty members plus one faculty or staff member selected by the student. The Committee's recommendations could include, but are not limited to, the following:

  • any of the actions described previously;
  • indefinite leave of absence with specified conditions;
  • required clinical evaluation;
  • alteration of the student's academic program; or
  • dismissal.

Required Clinical Evaluation

A required clinical evaluation will be imposed with discretion and under the following terms, which will be made clear to the student and to the clinician:

  • The student may select a clinician from a list provided by the Office of Student Affairs/Admissions.
  • The clinician is serving as an agent of the School, to assist with education planning, and must be knowledgeable of the medical education process. The School will pay for the evaluation.
  • The evaluation report will be forwarded to the Associate Dean for Student Affairs/Admissions. Information will be limited to that which is necessary to clarify the student's ability to function as a medical student, including any related treatment requirements.
  • An ad hoc Student Mental Health Committee convened by the Associate Dean, SPC or ESC and recommending a required evaluation will review the evaluation and make recommendations for action back to the initiating person or committee.

Appeal Processes

Students wishing to appeal a decision requiring a clinical evaluation, treatment, or leave of absence mandated by the SPC or ESC should follow the guidelines for appeal included in the Assessment and Promotions or Ethical Standards policies. Students wishing to appeal a decision by the Associate Dean for Student Affairs requiring a clinical evaluation, treatment, or leave of absence may appeal to the Dean of Medicine in writing within seven business days of receiving the decision regarding their status. After reviewing the relevant documents, the Dean will notify the student, by letter, of his/her decision.

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.

Protocol to Follow When Exposure Occurs

Needlestick Information

Follow institutional protocol for post-exposure care (washing, irrigating, etc.)

Notify safety officer to get patient tested (unless already known to be positive):  Hepatitis  B & C & a RAPID HIV.  If patient tests negative, student will not need to be tested.

Contact  ID doctor on-call:

  • Days:  937-208-2873
  • Nights  937-208-8000 to page ID doctor

Email: Erin Nash about incident: erin.nash@wright.edu

Help? Contact your clerkship director or coordinator

WSU Post-Exposure Prophylaxis Protocol

After An Exposure

Immediately

  • Wash needle stick area and cuts with soap and water
  • Flush splashes to the nose, mouth or skin with water
  • Irrigate eyes with clean water, saline, or sterile irrigants

Next

  • Notify designated safety officer at your training institution
  • Confirm exposure
  • Have the source patient tested
    • Rapid HIV test (unless already known to be positive)
    • Hepatitis C antibody (unless already known to be positive)
    • Hepatitis B surface antigen (unless already known to be positive)

NOTE: Consider an HIV viral load on a patient who has an HIV screen that is negative, but is high risk for HIV infection.

Attention: If the source patient tests are negative, DO NOT do lab tests on the student

  • It is the student’s responsibility to notify the WSU Boonshoft School of Medicine (BSOM) of all needle stick exposures:
    • Record the details of the exposure (see Box 1 below)
    • Call Gwen Sloas, EDD at (937) 775-2934
    • Complete all required post-exposure paperwork.

On the Next Regular Business Day (Monday-Friday)

  • Go to the WSU Department of Medicine at Miami Valley Hospital.
  • Talk to an Infectious Disease (ID) specialist about the circumstances of the exposure
  • If indicated, obtain a lab testing slip before you leave
  • Start antiretroviral therapy (if indicated after ID consultation)

If the Exposure Occurs on Nights, Weekends, or Holidays

  • Call and discuss the incident with the on-call WSU ID specialist
  • Pick up a lab testing slip on the next regular business day. No lab tests are urgently needed during off hours.
  • The ID specialist will instruct you to begin antiretroviral therapy if it is indicated.

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 needle stick 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 blood borne 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.