Environmental Hazards Exposure Policy

At Noorda-COM we promote the health, safety, and well-being of medical students and residents. All students and residents will be educated and trained to prevent or reduce exposure to respiratory, bodily fluid, or blood borne pathogens. Procedures have been developed to inform students and residents of potential risk and teach them techniques and procedures designed to decrease or avoid exposure. In addition, follow-up, diagnostic and treatment regimens are available to address exposures after they occur.

Standard Precautions

Standard Precautions is the name of the isolation system used within clinical sites, and is used for every patient, regardless of diagnosis. The aim is to minimize the risk of exposure to blood or body fluids. To accomplish this, personal protective equipment (PPE) (i.e., gloves, gowns, masks, and goggles) is used for potential contact with body fluids from any patient.

Standard Precautions include these principles:

  • Hand Hygiene: Wash hands with soap and water or sanitize with an alcohol-based hand rub before and after each patient contact, and after removing gloves. See Hand Hygiene Policy.
  • Gloves: Use when touching any body fluids or non-intact skin.
  • Gowns: Wear if splashing or splattering of clothing is likely.
  • Masks and goggles: Wear if aerosolization or splattering is likely.
  • Needles: Activate sharps safety devices if applicable, then discard uncapped needle/syringe and other sharps in containers provided for this purpose. Use safety products provided.
  • Patient Specimens: Consider all specimens, including blood, as biohazardous.
  • Blood Spills: Clean up with disposable materials (i.e., paper towels or spill kit), clean and disinfect the area. Notify Housekeeping for thorough cleaning.

Droplet Precautions

Droplet Precautions are used when patients have a disease process that is spread by contact with respiratory secretions.

These include:

  • Respiratory infections (RSV, Human Metapneumovirus, Parainfluenza, Influenza)
  • Neisseria meningitides (meningitis or sepsis)
  • Invasive Hemophilus Influenza Type B (meningitis, sepsis, epiglottises)
  • Diphtheria
  • Pneumonic Plague
  • Mumps
  • Parvovirus B19
  • Rubella
  • SARS-CoV-2

Contact Precautions

Patients may be in contact isolation when they have a disease that is spread by contact with wounds or body fluids.

These include:

  • Diarrhea (Rotavirus, Clostridium difficile, E. Coli 0157:H7, Shigella, Salmonella, Hepatitis A, Campylobacter, Yersinia.)
  • Open draining wounds, infection or colonization with multi-drug resistant organisms (MDROs)

Airborne Precautions 

Airborne precautions are used when the infection is spread through the air. Examples of diseases requiring airborne precautions are:

  • TB (tuberculosis)
  • Measles
  • Chickenpox

Personal Protective Equipment (PPE)

Students and residents will wear personal protective equipment (PPE) when there is potential for handling or coming in contact with bodily secretions or fluids. Medical students and residents PPE are included in supply planning for PPE at each clinical site. Provision for PPE for medical students and residents has been incorporated into clinical site agreements. If availability of PPE is not adequate to fully meet a student or residents PPE needs, students and residents should not be involved in any direct in-person patient care activities for which their roles require PPE, whether in the context of curricular direct patient contact activities or as volunteers to help meet critical health care workforce (HCW) needs. In such a circumstance, students and residents are to contact Clinical Education or GME Office to coordinate with the clinical site to facilitate PPE on the student and residents behalf.  Noorda-COM requires students and residents to be evaluated and monitored by clinical preceptors regarding proper PPE use.

Needle Stick Policy/Exposure to Blood and Body Fluids Policy/Procedure 

If a Noorda-COM medical student and resident are exposed to bloodborne pathogens either by direct contact with blood or other body fluids via the eyes, mucous membranes, human bite, or sharps (e.g., needle stick, lancet stick, scalpel cut, etc.) while on clerkship or rotation, it is to be handled as an EMERGENCY SITUATION.

Instructions 

  • Remove all soiled clothing
  • Wash the exposed area:
    • Wash needlesticks and cuts with soap and water (15 minutes)
    • Flush splashes to the nose, mouth, or skin with water (15 minutes)
    • Irrigate eyes with clean water, saline, or sterile irrigants (15 minutes)
  • Notify the Preceptor/Program Director IMMEDIATELY!!
    • Ask for and write down the following patient information:
      • Name
      • Date of birth (DOB)
      • Medical record number (MRN)
      • Address
      • Phone number
      • Prior testing for HIV, Hepatitis B, Hepatitis C, RPR, or other risk factors
    • If patient is known HIV positive
      • Obtain CD4 count
      • History or current opportunistic infections
      • Prior or current regimen or resistance
    • Seek URGENT care from your primary care physician, urgent care, or emergency room
      • Depending on the exposure steps may include but not limited to:
        • Risk assessment for exposure
        • Baseline laboratory work for the student and patient (HIV, Hep B, Hep C)
        • Evaluation of “source” patient
        • If the patient is HIV positive or HIV status is unknown, begin post-exposure prophylaxis (PEP) with a multidrug regimen within a few hours of exposure
      • Notify your Noorda-COM Clinical Coordinator or Program Director about the exposure
      • Fill out the exposure incident report through Exxat (REQUIRED)
      • The student health nurse will follow-up post-exposure
      • Additional questions can be directed to

This policy was reviewed and revised in March 2024. For assistance with policies and procedures, please contact Alexa Levine (adlevine@noordacom.org).