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Guidelines on Students Infected with HIV/Hepatitis B/Hepatitis C

Emory University School of Medicine requires any student who is infected with Human Immune Deficiency Virus (HIV), Hepatitis B virus “e” antigen positive, or Hepatitis C virus to notify the Executive Associate Dean for Medical Education and Student Affairs of his/her positive status so that the School may help to define any limitations necessary on clinical rotations and make such accommodations as may be reasonable to permit the student’s continued matriculation.  

The Executive Associate Dean for Medical Education and Student Affairs, or his/her designee, will make recommendations on a case-by-case basis, utilizing the best currently available scientific knowledge and any established recommendations from the U.S. Centers for Disease Control and Prevention and other applicable governmental guidelines regarding what, if any, limitations need to be applied to clinical activity.  In conducting this evaluation and making such recommendations, the Executive Associate Dean will consult with the student, the student’s personal physician and others, including faculty of the School of Medicine, as determined appropriate to assist in this individualized judgment.  Within the parameters of existing law the student’s confidentiality will be maintained during this process.  

Reasonable efforts to assist the student in completing the requirements for an M.D. degree will be made by the School of Medicine.  In addition, the student will be offered counseling concerning the options for the future selection of a career pathway in the profession of medicine.  

More Specific Guidelines on Students Infected with Blood-Borne Pathogens

  1. Students should be allowed to complete the M.D. degree if at all possible with an effort by all to maintain confidentiality to the degree that it is possible.

  2. In such instances, the clinical Department Chairs need not be notified of the name of an individual student involved or the type of blood-borne pathogen involved.  However, the Clerkship Director for the Departments of Surgery, Obstetrics/Gynecology, Emergency Medicine and any other Clerkship Directors (if indicated) will be informed of the name of the individual student so that any special assignments can be made if indicated.  If the student is Hepatitis B “e”-antigen positive, the Clerkship Director will be given that data.

  3. Students will be carefully counseled concerning their potential risk to patients and their risk to themselves.  They will be instructed to be punctilious in the use of universal precautions and up-to-date hospital infection control techniques.  They will be referred to appropriate physician caregivers for optimal follow-up and therapy.

  4. The student will also be counseled carefully about future career plans based on current medical and legal data.

  5. Invasive procedures considered as potential risks for Health Care Workers-to-Patient transmission by the Centers for Disease Control and Prevention will be strictly avoided by students who are Hepatitis B “e”- antigen positive.  Students with other known blood-borne pathogens will be advised on a case-by-case basis.  In general, because of their lack of experience, students with HIV or HCV infections will be advised like HBV-infected students.  Recommended practices include double gloving and not performing any procedures that have been previously identified as associated with a risk of provider-to-patient HBV transmission.

  6. The student will be allowed to withdraw without penalty from any clinical setting that the student feels might present a risk for infectivity.

  7. HIV-positive students should undergo screening for Tuberculosis every six to twelve months and receive pneumococcal vaccine, annual influenza vaccine, and other appropriate preventive immunizations.

  8. The student’s condition will be re-evaluated at least annually by the Dean to determine if any additional limitations are indicated.  The student’s viral load, CD4 count and clinical status as well as the regimen of anti-retroviral therapy that is being employed can be useful in assisting in any decision making by the medical school if the student will allow the Executive Associate Dean to discuss the results with his/her health care provider.

Students who fail to show a response to Hepatitis B vaccination by serologic means will be counseled to see a physician to determine their Hepatitis B antigen status and to see if they are Hepatitis B “e”-antigen positive.  If they are “e”-antigen positive, they will be encouraged to report this finding to the Office of the Executive Associate Dean, Medical Education & Student Affairs and then to be followed as per protocol.