Procedure: Infectious diseases screening and immunisation for students undertaking clinical placements

Purpose

To advise students undertaking clinical placements in clinical placement facilities of the procedures they must follow regarding screening and immunisation for specified infectious diseases and blood-borne virus testing.

Definitions

Exposure Prone Procedure (EPP) is a procedure where there is a risk of injury to the healthcare worker resulting in exposure of the patient’s open tissues to the blood of the worker. These procedures include those where the worker’s hands (whether gloved or not) may be in contact with sharp instruments, needle tips or sharp tissues (spicules of bone or teeth) inside a patient’s open body cavity, wound or confined anatomical space where the hands or fingertips may not be completely visible at all times.

Procedure

Provision and timing of information

1. Students are provided with relevant information, and University Policies and Procedures, at the time the University offers a place in a program with a placement component, including the immunisations required.
2. Students electing to undertake a course requiring clinical placement, where clinical placement is not a compulsory requirement of their program, are informed of the infectious diseases screening and immunisation requirements at the earliest possible time after they have been accepted to enrol in the course.
3. Students who have a clinical placement component in their program meet the requirements of the relevant clinical placement facility.
4. Students provide evidence to the University of protection against vaccine preventable diseases; where required by the agreement between the Parties, the University provides that evidence to the clinical placement facility through an agreed process. For the ACT and NSW this is outlined in the following documents:

1. Occupational Assessment, Screening and Vaccination Procedure (Canberra Health Services)
2. Healthcare Workers Living with Blood Borne Viruses or Performing Exposure Prone Procedures and at Risk of Exposure to Blood Borne Viruses Procedure (Canberra Health Services)
3. Occupational Assessment, Screening and Vaccination Against Specified Infectious Diseases Policy Directive (NSW Health)
4. Mangement of Healthcare Workers with a Blood Borne Virus and Those Doing Exposure Prone Procedures Policy Directive (NSW Health)

5. Students with a medical contraindication to an immunisation provide evidence of their circumstances to the University and contact the clinical placement facility before any clinical placement, where the clinical placement facility allows a clinical placement to continue under such circumstances, to manage the risk of infection from the infectious diseases against which they are not protected and the consequences of infection and management in the event of an occupational risk exposure.
6. Students with temporary medical contraindications for immunisation present for re-assessment after the conclusion of the contraindication to determine appropriate management strategies.
7. Some clinical placement facilities will not allow a clinical placement to proceed where a student has a medical contraindication.
8. Students notify the University of the nature and reasons of any restriction or qualification made to a student's activities in a clinical placement facility, including non-acceptance by a facility.
9. Students take all reasonable steps to minimise the risk of transmitting infectious diseases to other people. Where a student is infected with a blood-borne virus, they exclude themselves from the placement and contact the clinical placement facility to discuss further steps. Students infected with a blood borne virus (HIV, hepatitis C and/or hepatitis B) do not perform Exposure Prone Procedures without review and permission by the clinical placement facility.
10. Students are skilled and compliant with clinical placement facility procedures aimed to reduce the risk of infection transmission from patients, including standard and transmission-based precautions.
11. The University provides assistance to the student in accordance with its Policy: Disability.
12. The University discloses to a clinical placement facility its knowledge of any blood-borne virus or any screening and immunisation requirements not met.
13. The University understands the private nature of the information that may be disclosed by a student and acts in accordance with the Privacy Act 1988 (Cth).
14. The University will not disclose a student’s health information to any person outside the University, without specific written consent, except as contemplated by this policy, as required to meet legislative requirements, or unless the University considers that disclosure of the information is required to prevent or lessen a serious or imminent threat to the life, health or safety of the student concerned, or another person.
15. Students who undertake a period of study overseas seek advice from an appropriate travel medicine facility to ensure they are aware of any specific health risks, obtain any relevant chemoprophylaxis and arrange payment of required and/or recommended immunisations.

Completion of policy requirements

16. Students undertaking a clinical placement as a mandatory component of their program meet the requirements set out in this policy by the date specified by the University, which is no later than Census Date of their first semester of enrolment in the program and ensure throughout the duration of their program that all screening and vaccination requirements are current for each clinical placement as outlined by the relevant health authorities.
17. Students electing to undertake a placement as a non-mandatory part of their program meet the requirements set out in this policy at least one full semester prior to their placement commencing.
18. The University co-ordinates the collation of required evidence and identifies students who do not meet requirements, for further assessment by the clinical placement facility.

ACT and NSW Government requirements

19. Students undertaking clinical placements in facilities operated by ACT Health and the NSW Department of Health, are required to know their immunisation and/or infectious status throughout the period of their clinical placement.
20. Current NSW government requirements are available from https://www1.health.nsw.gov.au/pds/ActivePDSDocuments/PD2022_030.pdf
21. Current ACT Health requirements are available from http://www.health.act.gov.au/professionals/occupational-medicine-unit
22. These policies also recommend students undertaking clinical placements be vaccinated in accordance with the recommendations of the National Health and Medical Research Council (NHMRC) as documented in The Australian Immunisation Handbook https://immunisationhandbook.health.gov.au
23. Students protect their patients, their colleagues and themselves from infection. Students undertaking placements in clinical placement facilities, particularly those conducting Exposure Prone Procedures, are inevitably exposed to infectious diseases in the course of their training. Students infected with blood-borne viruses pose a risk to patients. Many of the diseases are preventable through immunisation or by the adoption of safe-working practices.

Results of testing

24. ACT Health, NSW Health or the clinical placement facility operator make the decision and outcome on immunity or infectious disease status. The University does not make decisions on immunity or infectious disease status.
25. Students note that their clinical placement provider and ANU will not allow a placement at the clinical placement facility if they choose not to consent to the requirements outlined in this procedure or related policy and the policies governing the clinical placement facility and this may affect a student's ability to complete the requirements of their program.
26. Students not able to complete required clinical placements during their enrolment at the University as a result of their infectious disease status will be excluded from courses requiring placements in clinical placement facilities.
27. The University provides students with advice to determine their eligibility to transfer to other University programs or other course enrolment, if required.

Appeals

28. Students appeal against a decision resulting from the outcome of their infectious disease status to the relevant Health Department.
29. Students appeal to the Associate Dean (Education) of the relevant College if they were not informed of the requirements on infectious disease status to complete their program, where the clinical placement is compulsory under their program requirements.
30. The Associate Dean (Education) provides an outcome in writing for the student’s appeal within 20 business days of the College receiving the appeal, including grounds for the decision made.
31. The Associate Dean (Education) takes into account:

1. The effect of the lapse in procedure on the student’s program;
2. The student’s potential to complete the program despite the lapse in procedure; and
3. Reasonable mitigation for the student, where the effect on the student has been detrimental to the student’s progress in the program; or
4. Alternative program options where a student cannot complete the program.

32. Students appeal to the Deputy Vice-Chancellor on procedural grounds only against a decision made by the Associate Dean (Education) under clause 30.

Specified infectious diseases

33. Students provide evidence of immunisation and/or immunity for the following infectious diseases, as required by ACT and NSW Health:

1. Measles
2. Mumps
3. Rubella
4. Varicella-zoster (chickenpox/shingles)
5. Tetanus
6. Diphtheria
7. Pertussis (whooping cough)
8. Hepatitis B
9. Influenza (annually and seasonal)
10. SARS-CoV-2 (COVID-19)

34. Screening and assessment +/- clinical review for infection with tuberculosis is also provided.
35. Students provide evidence (e.g. immunisation records and/or blood test demonstrating antibodies) according to the applicable Health Departments policy/procedure to the University prior to clinical placement.

Exposure Prone Procedures and blood borne viruses

36. Students performing Exposure Prone Procedures are tested for infection of the following viruses, as required by ACT Health:

1. Human immunodeficiency virus (HIV)
2. Hepatitis C virus
3. Hepatitis B virus

37. Students with chronic infection with these viruses may require further testing (e.g. hepatitis C PCR) and assessment by the relevant Health Department to determine whether they are able to participate in Exposure Prone Procedures.
38. Students with chronic infection follow the Blood Borne Virus management procedures outlined in the relevant Health Department policy documents.

Chronic infection may limit the ability of students to complete university training requirements and exclude health care workers from specific career options as documented in The CDNA National Guidelines for Healthcare Workers on Managing Blood-Borne Viruses https://www.health.gov.au/resources/collections/cdna-national-guidelines-for-healthcare-workers-on-managing-bloodborne-viruses?utm_source=health.gov.au&utm_medium=callout-auto-custom&utm_campaign=digital_transformation

Additional immunisations in special circumstances

39. Students undertaking clinical or elective placements in locations with specific risks for acquisition of other infectious diseases, where immunisation is a requirement of the placement or a general recommendation for the health of the student, seek medical advice and are responsible for arrangement and payment of required/recommended immunisations (e.g. laboratory placements (meningococcus), placements in Northern Australia indigenous communities (hepatitis A) and overseas placements (hepatitis A, typhoid, Japanese Encephalitis)).