TABLE OF CONTENTS
Student Placement Agreements
All students undertaking a learning placement as a requirement of the course must sign a Student Placement Agreement. These agreements will be discussed with students prior to the placements, usually at the commencement of each year. These are formal written agreements in which the student acknowledges their rights and undertakes to fulfil their responsibilities while on placement including those related to professional conduct, ensuring patient/client safety and minimising the transmission of infectious diseases.
Students not completing and signing a Student Placement Agreement will not be permitted to undertake their placement and may be unable to complete the compulsory requirements.
Students can seek further information about each placement from the Designated Placement Contact Person:
• Yr 1: Ms Alison Miles alison.miles@utas.edu.au or the Unit Coordinator or Administrative Officer.
• Yr 2: Ms Alison Miles alison.miles@utas.edu.au or the Unit Coordinator or Administrative Officer.
• Yr 3: Ms Sarah Downey/Ms Melinda Tarvydas or the Unit/Rotation Coordinator
Further information on the Placement Agreements can be found at:
http://www.utas.edu.au/universitycouncil/policyframework/policies/tlp1.2.pdf
Return to top
Police Checks
There is an increasing requirement for health care workers (HCW) in Australia to undergo police checks. This requirement is in place for all HCW in Commonwealth aged care facilities and in community and child health facilities. It is also a requirement in many jurisdictions within Australia. An example is the NSW Department of Health Policy Directive (PD2005_109) that requires employees and others, including students, to undergo a criminal record check prior to entering NSW Public Health facilities. The Tasmanian Department of Health and Human Services (DHHS) has recently introduced similar requirements for all HCW, students and volunteers. In addition, some individual health care agencies that offer placements also require students to have police checks.
All medical students within the MBBS course at the University of Tasmania are required to undertake placements within Tasmanian public hospitals and other DHHS (and non-DHHS) agencies and so will be required to obtain a National Police Check.
Students should be aware of the following to comply with the requirements:
• A National Police Check must be provided within the first semester of first year in preparation for placements that commence in the second semester of first year. (The National Police check is usually current for three years.)
• If the status of the Police Check changes at any time (eg through new convictions) the student must notify the School immediately
• At the commencement of Year 2 and Year 3, students must sign a compulsory declaration relating to the continued status of the Police Check
• At the commencement of Year 4 at entry to the allocated Clinical School, the student must obtain a current (new) National Police Check, given that the first will be deemed to have ‘expired'.
• At the commencement of Year 5, students must sign a compulsory declaration relating to the continued status of the Police Check
• The requirements for repeating or lateral entry students will be the same as those for other students with the exception that the timing of the police checks will be determined on a case-by-case basis in order to ensure compliance. Such students should contact the School to ensure that they are compliant.
Students will not be permitted to opt out of the requirements for obtaining an appropriate police check as outlined in the School of Medicine Police Check Policy.
Failure to undertake a National Police Check will result in the student being ineligible for core clinical placements/rotations. Such students will not be able complete the course.
Return to top
Professional Conduct
The University is committed to high standards of professional conduct in all its activities and holds expectations about the responsibilities students have as they pursue their studies within different environments.
As a general principle students are expected to be respectful of others at all times. Guidelines outlining expectations regarding professional conduct have been formally developed for students undertaking clinical rotations within the Department of Health and Human Services (DHHS) facilities including all acute care hospitals. See Guidelines for students on clinical placement with the Department of Health and Human Services at:
http://www.medicine.utas.edu.au/policies/pdf/codeconduct07.pdf
The principles outlined in this document relate to the requirements for general behaviour, identification, dress code, confidentiality and communications with the media and members of the public whilst students are within any placement within the DHHS. The Code of Conduct is designed to ensure that students adopt appropriate standards of professional behaviour as is required of all DHHS staff, students and volunteers.
These principles also apply to students undertaking all other placements and clinical rotations outside the DHHS environment.
Before being granted access to patient care areas within the Royal Hobart Hospital, all students are required to sign a declaration that they have read, and agree to abide by, the code of conduct.
Compliance with Agency ICT Policies (if applicable)
Whilst in the workplace learning environment, all students are required to be compliant with the ICT policies of the agency if such policies exist. In 3 rd year prior to commencement of placements within the Royal Hobart Hospital, all students will be required to request access to the RHH network and Digital Medical Record System: in doing so students will be required to agree in writing that they will comply with the Patient Confidentiality Policy of the RHH.
Disciplinary Action
Disciplinary action may be taken in the case of breaches under the General Misconduct provisions of the University's Ordinance of Student Discipline (Ordinance 58). In extreme cases penalties could include suspension or exclusion from the MBBS course.
Return to top
Use of Personal Internet Sites
(Facebook, MySpace, personal websites/pages)
In order to ensure privacy and confidentiality for patients/clients and to meet the requirements of placement agencies, including the DHHS, students are advised that they are not permitted to place on an internet site any material pertaining to their experiences whilst on placement. This includes photographic material, any case material, all material that could be relevant to patient care or contact and diarising or discussing student experiences.
Occupational Health and Safety (OH&S) in the Workplace Environment
Medical students are required to learn within the University environment and in healthcare environments whilst on learning/clinical placements.
When learning in the University environment: follow UTAS policy
The University is committed to providing a safe and secure teaching and learning environment. Students are expected to ensure their own safety as well as the safety of others within the University environment through familiarising themselves with and complying with the UTAS OH&S policies and practises (including the UTAS Infectious Disease Policy). Whilst at UTAS facilities, please refer to: http://www.admin.utas.edu.au/hr/ohs/pol_proc/ohs.pdf
Figure 1
When learning in a workplace environment: follow Agency policy
Students undertaking learning activities within a WORKPLACE LEARNING PLACEMENT (e.g. within the DHHS on clinical rotation, in private hospital placements, General Practice placements, Community Health Care Agency placements and other community placements) will be required to familiarise themselves and comply with the Placement Agency OH&S Policy where such a policy exists and also will be required to comply with the Faculty of Health Science Infectious Disease Policy.
The School of Medicine will strive to identify any Workplace Agency that does not have an OH&S Policy (potentially unaccredited General Practices) and negotiate to provide a ‘Tool Box' of procedures to be undertaken in the event of exposure to blood and/or body fluids (needlestick injuries). This is summarized in Figure 2.
In the event of exposure to blood/body fluids including needlestick injuries, whilst learning within the placement agency, students will be required (Figure 3)
• to IMMEDIATELY comply with Agency Procedures for Occupational Exposure to Blood/Body Fluids & Needlestick injuries so that the incident may be reported and appropriately investigated & managed within the Placement Agency AND ALSO
• notify the UTAS responsible Officer (Unit or Rotation Coordinator) so that the incident is reported and follow up for the student is ensured .
FIG. 2: OH&S whilst within a workplace learning environment
FIG. 3: OH&S whilst within a workplace learning environment
Blood/body fluid exposure (including needle stick injury)
Return to top
Prevention of Transmission of Infectious Diseases
The University and individual students are required to comply with Commonwealth and State legislation and regulations and, in addition, the University has a legal duty to ensure the safety of students and patients. As part of this, the University and individual students have a duty of care towards both students and patients to minimise the risk of spreading or contracting infectious or blood-borne diseases.
Healthcare Acquired Infections (HCAI's)
Healthcare acquired infections (nosocomial infections) are infections acquired directly or indirectly in a healthcare setting. The probability of a microorganism causing infection in a host is dependent upon the dose (number of microorganisms), a receptive host site of contact with the organism, time of contact (sufficient for multiplication or not) and the virulence of the organism.
The source (s) of infecting agents may be patients, staff, students or visitors including;
• Persons with acute diseases,
• Persons in the incubating or window period of a disease,
• Persons who are colonised or chronic carriers of the infecting agent,
• The person's own endogenous flora, or
• Inanimate objects including equipment and medications.
Susceptible Host : Resistance to infection varies depending upon underlying medical
conditions and other factors that may compromise a person's immune status. Trauma, surgical procedures, anaesthesia, invasive indwelling devices, and therapeutic and diagnostic procedures render a person more susceptible to infection.
Immunocompromised patients are at increased risk of infection from both their own flora (endogenous) as well as other sources (exogenous). Susceptibility to infection depends on the severity and duration of immunosuppression. If considerable immunosuppression or neutropenia is present the Additional Precaution of single room accommodation is desirable.
Routes of Transmission:
• Direct contact transmission involves direct physical transfer of microorganisms from an infected or colonised person to a susceptible host. Indirect contact transmission involves the contact of a susceptible host with a contaminated inanimate object, such as contaminated instruments or equipment.
• Droplets are generated during coughing, sneezing, talking, and during certain procedures such as suctioning and bronchoscopy. Transmission occurs when droplets containing microorganisms come in contact with the conjunctiva, nasal mucosa or mouth of a susceptible person. Droplet distribution involves close association, usually 1 metre or less.
• Airborne transmission occurs by dissemination in the air of either droplet nuclei or dust particles containing the infectious agent. Microorganisms carried in this manner can be widely dispersed via air currents and can remain airborne for long periods before being inhaled by the susceptible host.
• Vehicle transmission applies to microorganisms transmitted by contaminated food, water, drugs, blood or body fluids.
• Vectorborne transmission occurs when mosquitoes, flies, rats or other vermin transmit microorganisms.
Compliance with the Infectious Disease Policy
The School of Medicine has developed an infectious diseases policy for medical students that provide recommendations to protect students from acquiring infectious diseases in their course of study and to protect patients from infected students. The Policy outlines the responsibilities of the School of Medicine and the responsibilities of individual students. It is broadly divided into requirements related to 3 areas:
• screening for blood-borne virus infections,
• immunisations and
• tuberculosis screening.
The Infectious Disease Policy, implemented from January 2 2008, can be found at;
http://fcms.its.utas.edu.au/files/policies/FHSIDpolicy08.pdf
In accordance with the Infectious Disease Policy, students must
- Provide a written declaration that they have read, understood, accept and agree to comply with the Infectious Disease Policy
- Be aware of their infective status for blood-borne viruses (HIV, Hepatitis B and C viruses) and, if infected, to comply with their responsibilities and not perform exposure-prone procedures
- Document their compliance with the immunisation program and provide that documentation to the School of Medicine
- Students who have complied fully with the immunization guidelines should be aware of the requirement for annual influenza vaccinations .
- In addition, students who have significant exposure to tuberculosis should undertake repeat screening for tuberculosis (Mantoux test).
Students have the choice to opt out of the immunisation program on medical or conscientious grounds with the written approval of the Head of School. Opting out is not grounds for exclusion from the medical course. However, students who opt out may be ineligible for clinical placements/rotations depending on the requirements of the placement agencies. This is a rapidly changing area and students should seek advice about current legislative and occupational health and safety protocols that apply within the placement agencies and consider their ability to complete the course should opting out make them ineligible for clinical placements/rotations.
Preventing Infections in the Healthcare Environment
In addition to complying with the screening and immunisation requirements of the Infectious Disease Policy and so that each student can fulfil their duty of care to prevent or minimise the risk of transmission of infectious diseases to patients, students must understand and practice infection control practices , including standard and additional precautions at all times when in contact with patients and in clinical placements and rotations.
Student Responsibilities
All students have a responsibility to:
• Know what healthcare acquired infections (HCAIs) are and understand the routes of transmission of infection.
• Comply with best practice infection control techniques, including standard and additional precautions.
• Practice recommended hand washing to prevent transmission of infection.
• Understand and practice the principles of asepsis in performing procedures and know what to do in the event that aseptic technique is compromised.
• Know how to report and seek assistance in the event of exposure to blood and/or body fluids (needle stick injuries).
• Understand and practice appropriate waste disposal including the disposal of sharps to minimise the risk of transmission of infectious diseases in health care settings.
Students are expected to access, read and adhere to occupational health and safety guidelines including guidelines for management of exposure to blood/body fluids (needle stick injuries) at each health care agency where they undertake a clinical placement. Refer to Figures 2 and 3.
In the event of exposure during that placement, students are required to comply with the policies of the health care agency in the first instance and also to report the incident to the School of Medicine.
Standard Precautions
These are work practices required for the basic level of infection control to minimize the transmission of healthcare associated infection and are recommended for the treatment and care of all patients. Standard Precautions, which should be implemented at all times include:
• Hand washing,
• Use of personal protective equipment (PPE),
• Aseptic technique,
• Appropriate reprocessing of instruments and equipment following use,
• Safe handling and disposal of potentially infectious material, and
• Environmental controls.
Standard Precautions are designed to reduce the risk of transmission of microorganisms from both recognised and unrecognised sources of infection to a susceptible patient.
Hand Hygiene
Hand washing is the most important hygiene measure in preventing the spread of infection.
Hands carry two different types of microbial flora: resident and transient.
Resident Flora : These organisms live and multiply on the skin (mainly on superficial layers, but 10-20% inhabit deep layers) and can be repeatedly cultured, even after routine hand washing. Although these organisms are generally harmless, they are of special concern if staff are performing invasive procedures. In these circumstances they need to be reduced and inhibited using an antimicrobial preparation, to prevent cross-infection.
Transient Flora : These organisms are present in the hospital microenvironment and
contaminate the hands of hospital staff during normal work activities. They can be readily passed on to another person during contact and will survive on the hands for up to 24 hours, if not removed by hand washing. (Occasionally, despite routine hand washing, a transient organism may take up "temporary residence" for a period of several weeks.) Contamination with transient flora may occur in the absence of visible soiling. Routine hand washing is performed to remove transient microbial flora derived from touching one's skin, another person's skin, or some object in the environment.
When:5 Moments for Hand Hygiene
The highest priority area to reduce the risk of healthcare associated infections (HCAIs) nominated by the Australian Commission on Safety and Quality in Health Care is improved healthcare worker hand hygiene. A National Hand Hygiene Initiative has been launched to be completed by 2011. The Initiative recommends the use of hand hygiene at 5 key moments: See Figure 4.
Hand hygiene should be practised before significant contact with any patient. Significant contact activities include:
• Examination of a patient, or similar prolonged contact
• Performing a procedure on a patient.
• Inspection of a wound or intravascular cannula site.
• Emptying a catheter or drainage reservoir.
• Undertaking a venepuncture or a dressing.
• Changing an IV flask or manipulating any similar ‘closed' sterile system.
• Delivery of IM or IV injections.
Hand hygiene should be practised after activities likely to cause significant contamination. Activities known to cause significant contamination include:
• Examination of a patient, or similar prolonged contact or
• Contact with the patient's surroundings
• Performing a procedure on a patient
• Handling objects or materials soiled with body secretions or excretions.
• Direct contact with body secretions or excretions.
• Direct contact with mucous membranes, wounds, tracheostomy.
• Personal hygiene after toileting.
Figure 4. Five Moments for Hand Hygiene
How:Handwashing Techniques
The Infection Control Guidelines published by the Australian Government Department of Health and Aging recommend the following handwashing techniques:
Figure 6: Handwashing Techniques.
Hand Hygiene: Use of skin disinfectants (antiseptics)
Hygienic gels and handwash/scrub products are formulated to reduce transient bacteria on the hands and should demonstrate residual as well as immediate activity. Antiseptic products formulated for use without water such as alcohol gels are increasingly available in all healthcare settings. They should be used when there is insufficient time and/or facilities for handwashing. They should be used between all patient contacts if handwashing is not performed.
Hand Hygiene: Hand Care
Hand care is important because intact skin (with no cuts or abrasions) is a natural defense against infections. Any breaks or lesions of the skin are possible sources of entry for pathogens.
Rings should not be worn, nails should be short and clean and artificial nails should not be worn.
Repeated handwashing and wearing of gloves can cause irritation or sensitivity, leading to dermatitis or allergic reactions. This can be minimized by early intervention, including assessment of handwashing technique and the use of suitable individual-use hand creams.
Gloves and other Personal Protective Equipment
Personal Protective Equipment (PPE) provides a barrier between the source and the operator. Its use does not negate the need for safe work practices or hand washing. In many situations the risk of exposure to blood and body fluids can be determined in advance, so the appropriate PPE should be worn prior to performing the procedure or task. PPE may include: gloves, gowns and aprons, eye and/or facial protection (glasses, goggles, face shields), masks and adequate footwear.
Gloves
Gloves should be used as an adjunct to hand washing when
• contamination of hands with blood or body fluids is anticipated or whenever there is a risk of direct contact with:
• Blood,
• Body fluids,
• Mucous membranes,
• Non-intact skin or
• Contaminated equipment or surfaces.
• Specimens should be collected with gloved hands, placed in a correctly labeled leak proof container, enclosed in a sealed bag for transport with the request form in the outer sleeve pocket of the plastic bag to prevent contamination.
Types of gloves worn should be appropriate to the task:
• Sterile gloves for procedures involving normally sterile areas of the body,
• Non sterile examination gloves to be used for all other contacts,
• General-purpose utility gloves to be used for cleaning and during manual decontamination of used instruments and equipment.
All healthcare workers including students should wash their hands before and after using gloves. They should change their gloves and wash their hands after each patient procedure and also during multiple procedures on the same patient if there is a risk of cross-contamination.
Allergy or sensitivity may develop to glove powder or contact with latex proteins. Powder free latex gloves or alternatives to latex are available and should be used by those who develop sensitivity.
Gowns
Gowns are worn to protect the wearer's clothing and skin from contamination with blood and body substances . Impermeable gowns/plastic aprons are essential in situations where contamination with large amounts of blood or body fluid is anticipated. A plastic apron can be worn beneath a sterile gown to give added protection for added protection during surgical procedures.
Gowns/aprons are also worn by personnel during the care of patients infected or colonised with epidemiologically important microorganisms to reduce the opportunity for transmission of pathogens from patients or items in their environment to other susceptible patients.
Protective Eyewear
Protective Eyewear such as goggles, glasses or face shields must be worn during procedures likely to cause splattering, splashing or spraying of blood or body fluids. Eyewear should be shielded at the side and close fitting, and should be cleaned after use in detergent and water if contaminated.
Masks
Surgical masks are fluid-repellant paper filter masks. They are worn to protect the mucous membranes of the mouth and nose during procedures likely to cause splattering, splashing or spraying of blood or body fluids.
Particulate filter masks with filtration to 1 micron must be used for care of patients known or suspected to be infected with pathogens spread by the airborne route. To provide protection against airborne pathogens masks must provide a snug fit and be changed when they become moist or visibly soiled during use.
Safe handling & disposal of potentially infectious material
Waste Disposal
Standard Precautions must be employed when handling all waste. Waste is segregated at the point of generation into general, medical, cytotoxic, radioactive and hazardous streams. There is a legal obligation to classify waste appropriately .
Standard Precautions must be employed when handling all waste. Waste is segregated at the point of generation into general, medical, cytotoxic, radioactive and hazardous streams. There is a legal obligation to classify waste appropriately.
Disposal of Sharps
The person generating the sharp is responsible for its safe disposal. Sharps should never be passed by hand between health care workers. Disposal should occur immediately following its use and at the point of use into designated puncture resistant containers that conform to Australian Standard AS4031. Discard sharps containers when 2 / 3 full, seal appropriately and place in the medical waste stream. Never recap used needles unless an approved recapping device is used.
Environmental Controls
A neutral detergent is the cleaning solution of choice for environmental surfaces. Extra cleaning may be necessary in the presence of some micro-organisms. Blood and body substances must be dealt with by wiping the area immediately with a paper towel and then cleaning the area with detergent and water if the spill is small. Large spills should be contained and in addition to cleaning with detergent and water, chlorine-generating disinfectants may be used.
Soiled linen : is discarded into linen bags which when 2/3 – 3/4 full must be securely tied for transport. Any linen bags likely to leak blood or body fluid must be contained by a clear plastic bag and secured prior to transport. Alternatively waterproof linen bags should be used. All linen is considered contaminated therefore minimal handling is recommended.
Additional Precautions
Additional Precautions are implemented when Standard Precautions may be insufficient to prevent transmission of infection. (However, Additional Precautions when required are always used in addition to Standard Precautions.)
Additional Precautions are recommended for specified patients known or suspected to be infected or colonised with epidemiologically important or highly transmissible pathogens that can cause infection, including by
• Airborne transmission of respiratory secretions (eg TB, measles, chickenpox).
• Droplet transmission of respiratory secretions (eg, rubella, pertussis, influenza).
• Contact with patients who may be disseminators of infectious agents of special concern (eg MRSA, VRE, Clostridium difficile ).
• Any combination of the above routes.
The Additional Precautions implemented are based on disease transmission and are specific to the situation and may include one or any combination of the following:
• Allocation of a single room with en suite facilities.
• Cohorting (room sharing by persons with the same infectious agent).
• Additional use of PPE
• Dedicated patient equipment
• Special ventilation requirements (a negative pressure room).
Additional Precautions are not required for patients with blood-borne viruses such as HIV, Hepatitis B virus or Hepatitis C virus, unless there are complicating infections, such as pulmonary tuberculosis.
Critical Incidents
Students who witness or experience distressing or traumatic events, including events encountered during non-core activities such as ambulance duty and community placements, are required to report them to the Deputy Head of School or to the Associate Head of the Clinical School at which the student is enrolled.
Further Information
Students can access information on health risks and appropriate precautions from the Australian Government Department of Health and Aging website at:
http://www.health.gov.au/internet/wcms/publishing.nsf/Content/icg-guidelines-index.htm
Recommendations on action to be taken in the event of exposure to blood-borne viruses can be found at the University Occupational Health and Safety Website at:
http://www.admin.utas.edu.au/hr/ohs/pol_proc/exposure.pdf ).
Students can also access the Victorian Governments The Blue Book: Guidelines for the control of infectious disease , which provides detailed guidelines for specific diseases at: http://www.health.vic.gov.au/ideas/bluebook
Return to top
|
