Students performing in the clinical facilities must understand that they may be exposed to environmental hazards and infectious diseases including, but not limited to Tuberculosis, Hepatitis B, and HIV (AIDS). Hillsborough Community College recommends that all Health Science program students obtain the Hepatitis B vaccine prior to entering the clinical experience portion of the program. Students understand and assume the risks involved in the clinical portion of Health Science Programs at Hillsborough Community College, especially the risk of contracting Hepatitis B through human blood spills, Tuberculosis, HIV (AIDS) and other related infectious diseases while participating in the required clinical experiences.
INDIVIDUALS WITH BLOOD BORNE INFECTIOUS DISEASES
Applicants for Admission to the Program
Students enrolled in the Dental Hygiene Program may be exposed to bloodborne pathogens via blood and body fluids. Although there are no documented cases of occupational spread of HIV to dental workers, students enrolled in the Dental Hygiene Program must recognize that the potential does exist for transmission of bloodborne and other infectious diseases during patient care activities. The risk of HIV disease transmission from dental patients to members of the dental team is extremely low, however, there is a small potential. The Americans with Disabilities Act (ADA) and other anti-discrimination laws prohibit discrimination against patients with disabilities including those with HIV; therefore, students are required to treat all patients assigned, regardless of whether the patient has a blood borne infectious disease recognizing that students will utilize current infection control recommendations and information on the diseases. Refusal to treat any patient may affect the student’s academic success.
No students will be allowed to render care to patients in any setting until he/she has been instructed in infection control following OSHA guidelines. Students must demonstrate competence using standard precautions in a laboratory setting, prior to any patient care. Faculty supervision will be provided throughout the laboratory and clinical phases of education to continually monitor the safety of students and use of standard precautions for both students and patients.
As noted above, applicants are notified of the program’s policy on Blood Borne Infectious Diseases during the admissions process. Once accepted into the Dental Hygiene program, each student must complete a Medical History form and undergo a physical, requiring their doctor to authorize the student’s participation in the program. If the student has an infectious disease, the Dental Hygiene Department Chair would learn this from review of the student’s medical release forms. Students with a positive finding are counseled about possible risks they pose to the patient and they are asked to discuss the risks with their healthcare provider. The decision to notify a patient of their status rests with the student, based on confidentiality procedures for Health Care Workers. Students learn standard precautions and are expected to follow them to protect themselves and their patients. Infection control is evaluated daily in the clinical and laboratory settings. If a student has an open wound or weeping lesion on his/her skin, he/she may be asked to reschedule the patient and not treat patients until the lesion has healed or he/she is deemed safe to treat patients. As noted above, students may not refuse to treat a patient based on the patients’ disease status.
Patients upon arrival to the clinic are required to complete thorough medical histories that are reviewed by the students, dentist and program faculty. Assuming they are truthful, and know their status, the clinic will know of any patients with Blood Borne Infectious Diseases. Patient Confidentiality rules apply. Standard precautions will be taken for all patients so no changes should be needed. Faculty and the consulting dentist will decide if the clinic is equipped well enough to treat the patient safely. If a patient is deemed to be immunocompromised or at risk the patient may be referred to an appropriate setting, such as a hospital dentistry clinic for their safety. In addition, health care workers in Florida are not required to notify patients of their status. If the students, faculty or staff choose to disclose their status to patients, then the patient may decide whether to be treated by the health care worker.
Faculty and Staff
In the Dental Hygiene Clinic, all faculty and staff are expected to follow the infection control guidelines presented to students during DES 1800 and DES 1800L (pre-clinic). In addition, faculty members are expected to maintain annual OSHA updates, offered by the college. If a faculty member has an open skin lesion, such as herpetic whitlow, the faculty will not be allowed to work in clinic until the lesion has healed or the safety of the patient can be assured. Chapter 64B5-25 of the Florida Administrative Code addresses sterilization and disinfection procedures, which all faculty and students are expected to follow.
In Florida, Hepatitis B Infected Licensees are discussed in Chapter 64B5-25.004 of the Florida Administrative Code. Highlights of this rule are summarized as follows:
- Licensees bear the ultimate responsibility for the safety of their patients when the licensee or personnel employed by the licensee represent a health risk through direct or indirect contact with patients. This rule assures the ability of infected licensees to practice so long as adequate safeguards are maintained.
- Any practicing licensee in Florida infected with Hepatitis B virus is required to notify the Board of Dentistry of such in writing no later than 14 days after learning of his or her infection with the Hepatitis B virus.
- Infected licensees will be monitored on a random basis at least once a year by Board approved consultants for the purpose of verifying compliance with sterilization, disinfection and barrier techniques. The random monitoring will be performed in addition to any check conducted by any county health department.
- Infected licensees shall notify the patient, Board’s Executive Director and the local county health department at any time a barrier technique has been or may have been broken.
A complete copy of The Florida Administrative Code can be found at: https://www.flrules.org/default.asp
The Hillsborough Community College Dental Hygiene Program follows the rules established by the state of Florida. According to the Florida Guidelines on Health Care Workers Infected with HIV and or HVB from the Florida Department of Health and Rehabilitative Services, faculty and staff are not required to notify the Department Head of any communicable diseases unless they choose to provide notice. If the information is disclosed, the Department Head will keep all disclosed information confidential and discuss any potential issues with the faculty or staff member. The faculty or staff member will also be encouraged to notify the State Health Director if he/she has yet to do so. Other than the State Health Director, it will be left to the faculty or staff member to decide if the information will be disclosed and to whom, to include patients.
Hillsborough Community College Dental Clinic has the right and the obligation to adopt policies, which are designed to protect the health of the students, faculty, staff and patients. It has been well established that a medical history is not reliable for the detection of infectious diseases. To maintain maximum levels of protection, the following guidelines emphasize adherence to standard precautions that require that blood, saliva from dental procedures and other specified body fluids of ALL patients be handled as if they contained blood-borne pathogens. The clinic expects that appropriate professional judgment shall be used by the faculty in all matters related to infection control procedures in preclinical and clinical settings. The primary goal of the “Updated CDC Recommendations for the Management of Hepatitis B Virus-Infected Health-Care Providers and Students” is to promote patient safety while providing risk management and practice guidance to HBV-infected health-care providers and students, particularly those performing exposure-prone procedures such as certain types of surgery. Because percutaneous injuries sustained by health-care personnel during certain surgical, obstetrical, and dental procedures provide a potential route of HBV transmission to patients as well as providers, the report emphasizes prevention of operator injuries and blood exposures during exposure-prone surgical, obstetrical, and dental procedures.
“ These updated recommendations reaffirm the 1991 CDC recommendation that HBV infection alone should not disqualify infected persons from the practice or study of surgery, dentistry, medicine, or allied health fields. The previous recommendations have been updated to include the following changes: no prenotification of patients of a health-care provider’s or student’s HBV status; use of HBV DNA serum levels rather than hepatitis B e-antigen status to monitor infectivity; and, for those health-care professionals requiring oversight, specific suggestions for composition of expert review panels and threshold value of serum, HBV DNA considered “safe” for practice (<1,000 IU.ml). These recommendations also explicitly address the issue of medical and dental students who are discovered to have chronic HBV infection. For most chronically HBV-infected providers and students who conform to current standards for infection control. HBV infection status alone does not require any curtailing of their practices or supervised learning experiences. These updated recommendations outline the criteria for safe clinical practice of HBV-infected providers and students that can be used by the appropriate occupational or student health authorities to develop their own institutional policies. These recommendations also can be used by an institutional expert panel that monitors providers who perform exposure-prone procedures.” "Updated CDC Recommendations for the Management of, Hepatitis B Virus-Infected Health-Care Providers and Students", MMWR July 6, 2012, Vol. 61, No. 3, 1-12