Download Infectious Diseases Procedures and General Health

Information for RCSI Students
Infectious Diseases Procedures and General Health
Background
Students and practitioners in the health care professions have always faced the
possibility of exposure to infectious diseases such as Hepatitis B and TB. Equally,
both have had a responsibility to protect their patients from infections which they
might introduce. While the risks are small, the increasing efficiency of preventive
measures such as vaccination has highlighted the importance of these diseases and
measures to deal with them. RCSI has introduced procedures to offer both students
and patients protection against Hepatitis B, Tuberculosis and several other common
diseases.
By law, medical, nursing and physiotherapy students (but not pharmacy) are classified
as Category A Healthcare Workers and must be screened for and protected against the
following diseases:
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Hepatitis B
Hepatitis C
TB
Varicella/zoster
Measles
Mumps
Rubella
Meningitis C
Influenza, incl H1N1
Apart from this document, it is also important to read the RCSI Blood Borne Virus
Policy.
By participating in this vaccination programme, students are agreeing to the
following:
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appropriate tests and clinical follow-up for Hepatitis B and Hepatitis C
vaccination for Hepatitis B and follow-up testing, if deemed necessary
screening for Tuberculosis if necessary
screening for immunity to measles, mumps, rubella and chicken-pox and to
subsequent vaccination for these if necessary
positively participation in other health screening measures as deemed
appropriate by RCSI, eg anti-influenza vaccination in clinical years or MRSA
screening prior to certain clinical placements
RCSI providing evidence of compliance with these procedures to affiliated
clinical partners when requested
This is complex work involving individual assessment, gathering formal
documentation of previous vaccinations, blood tests to confirm current immune status
for different diseases, administration of a vaccination programme (unique to each
individual), and appropriate follow up. This work is carried out by the RCSI Student
health service based in Mercer’s Medical Centre.
Prior to their first attendance at Mercer’s, all students must complete and submit a
questionnaire (here). This should be filled out completely and emailed to Mercer’s
before your initial attendance.
Please note: we will only be using your mobile number or RCSI email address to
contact you (not gmail or other). If you change your phone number, it is your
responsibility to inform us by calling 01-4022 300 or dropping the information into
Mercer’s Medical Centre.
As this Programme continues over several years, it is vital that students inform
Mercer’s if they have:
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New contact details (address or mobile number)
Change in their health status (eg new diagnosis)
It is also important that students attend for appointments when requested. There are
approximately three thousand attendances required per year to run this Programme,
and we cannot offer individual appointments. All RCSI staff are aware of this
Programme and understand that you may have to miss some lectures to attend. Failure
to attend because of a lecture is not a valid excuse.
The most time-consuming element here is vaccination against Hepatitis B – this
comprises 3 shots over a six month period with a follow up blood test two months
later to confirm seroconversion. Up to 10% of students will be negative at this point
and will need to have the entire course again. This obviously has implications for
starting clinical attachments, doing electives etc, and is another reason to start the
programme as early as possible. Many elective hospitals and prospective employers
seek confirmation of your immunisation status. If this is not completed and supplied
to them, then there will be no elective or job.
Pregnancy
Most of these vaccines are contra-indicated in pregnancy. It is extremely important
that you do not proceed with vaccinations if you are, or may become, pregnant over
the course of the immunisations. You should discuss this with the clinical staff in
Mercer’s Medical Centre.
The bulk of this work should be done in first year. Subsequent clinical years will need
much less done for them but will still require some attention (eg rechecking Hep C
prior to IC3, annual influenza vaccinations, screening for MRSA).
The average first year will need to be seen on five occasions (although some may
need up to ten attendances, eg if their initial Hep B course is unsuccessful), while in
later years a single annual attendance is likely to be sufficient for most students.
Costs
A) First years, including Pre-Med and Pre-Physio:
(ie: all new RCSI students, except Pharmacy)
€250 Health Screening Package to cover the first year screening, and vaccination
programme (Hepatitis B; Hepatitis C; Measles; Mumps; Rubella; Varicella;
Tuberculosis).
This cost is to be paid when you check in for your first visit, using cash,
cheque or credit/laser card. This is a standard capitation fee, payable by all
students, irrespective of past vaccination history or number of attendances
required. The vaccination programme will not commence until this fee is
paid.
There will be an additional charge if Varicella vaccination is needed.
N.B. If you do not complete this first year vaccination programme by the end of
September in your second year, you will be liable for additional costs as set out
below.
B) Other years:
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There will be a €30 consultation fee which will cover:
 Elective form signing
 Copies of blood test results
 Official certification of immunisation and blood results
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If other blood tests are required, there will be a €30 consultation fee and a €30
charge for the tests.
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If vaccinations are required there will be an initial consultation fee of €30 and
a charge for vaccines (see list below) unless provided free to Mercer’s by the
HSE.
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These costs do not apply for MRSA screening or anti-influenza vaccination in
clinical years or for Hepatitis C retesting in IC3
Vaccine
Yellow Fever
Typhoid
Rabies 1.0 IM
Hepatitis B Adult
Hepatitis A Adult
Hepatyrix (Hep A & Typhoid)
Twinrix Adult (Hep A & B)
Revaxix (Tetanus/Diptheria/Polio)
Meningitis ACWY
Japanese B Encephalitis
Tick Borne Encephalitis
Cholera
Varicella
Blood Tests
Hepatitis A, B, C,
Measles, Mumps, Rubella, Varicella
Dose
1
1
3
3 + Blood test
1
1
3 + Blood test
1
1
2
3
2
2
Cost
€ 40.00
€ 35.00
€ 60.00
€ 35.00
€ 45.00
€ 85.00
€ 50.00
€ 40.00
€ 45.00
€ 80.00
€ 70.00
€30.00
€60.00
Price
€30.00
Hepatitis B
1. First year students must attend for blood tests (Hepatitis B Surface Antigen,
Hepatitis B Core Antibody, and Hepatitis B antibody if you have already had
Hep B vaccinations) taken by the RCSI Student Health Service .
2. Non-immune students are required to be vaccinated against Hepatitis B
through the programme carried out by the RCSI Student Health Service.
Follow-up serology for evidence of immunity must be taken by the RCSI
Student Health Service.
3. Students who show evidence of Hepatitis B or other serious infectivity are
referred to the RCSI document Standard Operating Procedures/Policy on
Blood Borne Viruses.
4. www.patient.co.uk/health/Hepatitis-B-Immunisation.htm
Hepatitis C
1. All students will be screened for Hepatitis C in first year and again prior to
their clinical attachments.
2. http://www.patient.co.uk/health/Hepatitis-C.htm
Measles, Mumps and Rubella
1. Students must provide evidence of having received two doses of MMR.
2. Students who cannot provide evidence of having received both doses of MMR
will receive a booster dose of MMR carried out by the RCSI Student Health
Service.
3. Student without any prior vaccination should receive both doses of MMR,
given at least one month apart, unless otherwise contra-indicated.
4. http://www.patient.co.uk/health/MMR-Immunisation.htm
Chicken pox
1. Students without a definite history of chickenpox or vaccination will be
considered non immune, and will be tested for the presence of immunity to
Varicella Zoster virus.
2. Non-immune students may need vaccination against VZV through the
programme carried out by the RCSI Student Health Service. Vaccination via
Student Health will incur an additional cost to the Healthcare Screening
Package fee.
3. www.patient.co.uk/health.Chickenpox-in-Adults-and-Teenagers.htm
Tuberculosis
1. Students should have documented proof of prior BCG vaccination or on
examination show a BCG vaccination scar.
2. If neither of the above is present then base line Mantoux testing should be
performed in line with the procedure outlined in the National Immunisation
Guidelines for Ireland.
3. You will also be asked to complete a simple symptom questionnaire.
4. http://www.patient.co.uk/health/Tuberculosis.htm
Meningitis C
1. Students should provide evidence of receiving one dose of Meningitis C
vaccine.
2. Otherwise, students will be offered vaccination (a single shot).
3. http://www.patient.co.uk/health/Meningococcal-Group-C-Immunisation.htm
HIV
The policy for screening for HIV infection is under review at present.
http://www.patient.co.uk/health/HIV-and-AIDS.htm
MRSA
Some of the clinical locations for RCSI student attachments have now requested that
students demonstrate that they are not carriers of MRSA (methicillin-resistant
Staphylococcus aureus). This is a bacterial infection which is usually harmless to the
healthy but can cause severe problems for vulnerable patients. More information is
available here: http://www.patient.co.uk/health/MRSA.htm
Students doing one of these attachments must therefore attend Mercer’s Medical
Centre to have a nasal swab taken to confirm the absence of MRSA before they start
their clinical attachment.
The RCSI Clinical Co-Ordinator (Dr.Claire Condron) will inform you of a dedicated
clinic time allocated to do this work and it is important that you attend at that time.
Given the number of students involved, Mercer’s cannot offer individual
appointments and if you miss the dedicated clinic, then your attachment will not
proceed.
The results are usually available after one week and will be emailed to you. If you
have not received your results within ten working days, please contact Mercer’s at 01
– 4022 300. The result may also be forwarded to the relevant clinical attachment, as
evidence of RCSI compliance with the requested procedure.
The vast majority of such screens (>99%) are negative and for those individuals, that
is the end of the process. However, if your swab comes back as positive for MRSA,
you will need to undergo:
 further swabbing (nose/groin/any areas of broken skin)
 treatment – usually just an ointment or other topical treatment in the first
instance
 three sets of follow-up swabs to ensure clearance
 redeployment until clear.
In the very unlikely event of a student being permanently colonised, then this will
require careful assessment and occupational health advice.
Outbreak Situations
1. In the event of an outbreak of any infectious illness on campus, in clinical
locations or in the wide local community, students are required to adhere to all
infection control measures recommended during that outbreak.
2. Students who contract an infectious illness should adhere strictly to the
minimum period of isolation recommended and must not return to the clinical
environment until that period has elapsed and they have recovered from their
illness.
3. Students should avail of any other appropriate immunisation as and when
recommended during an outbreak situation. This may include obtaining
boosters to previously completed primary immunisation courses.
Students who show evidence of active infection at any stage of their medical career
will be required to withdraw from patient contact, undertake treatment and
demonstrate non-infectivity before re-admission.
ADVICE TO DOCTORS WITH SERIOUS CONTAGIOUS/INFECTIOUS
DISEASES
It is unethical for doctors who believe that they might be infected with a serious
contagious disease (e.g. Hepatitis, HIV etc.) not to seek and accept advice from
professional colleagues as to how far it is necessary for them to limit their practice in
order to protect their patients. Colleagues who are consulted have a dual role. They
must counsel and support the doctor concerned, but they must ensure that the doctor
does not pose a risk to patients and others. If such a risk exists, the Fitness to Practice
Committee must be informed as soon as possible.
A Guide to Ethical Conduct and Behaviour, 1998
The Medical Council
It is the College’s opinion that the above Medical Council advice applies equally to
clinical students. Students have a responsibility to protect the interests of the public
and their colleagues and to inform the College if any form of physical, mental or
other ill-health appears to seriously affect competence and responsibility to patients.
Summary of Process
1. All new students are invited to an Orientation Day, where you will be
given initial information on this screening and vaccination programme.
2. You will then receive an email with detailed information.
3. It is important that you then read the two key documents available online
(Infectious Diseases Procedures and General Health and Blood Borne
Virus Policy).
4. Please then complete the RCS Student Vaccination/Screening
Programme Form and submit online.
5. You should receive an email confirmation that this Form has been
successfully received.
6. Mercer’s Medical Centre will then contact you by email with the date and
time of your first appointment. It is most important that you attend at the
scheduled time. We cannot offer alternative appointments. All RCSI staff
are aware of this Programme and understand that you may have to miss
some lectures to attend for this. Failure to attend because of a lecture is
not a valid excuse.
7. If you have supporting documentation about previous vaccinations or
illnesses, please bring it with you to the first appointment.
8. At the end of that initial meeting, you will be given a follow-up
appointment.
Frequently Asked Questions
Where can I get a copy of the Vaccination/Screening Programme Form?
Click here
Who must complete the Vaccination/Screening Programme Form?
All incoming male and female students, regardless of age, must complete the Form.
What should I do if my physician doesn’t speak English?
You will need to have the information needed for the form and all your relevant
records translated into English.
Can I scan my immunization records and send them attached to an e-mail?
No. Email isn’t a secure way of sending documents, and we take the confidentiality of
your medical information very seriously.
Do I have to pay for my screening required immunisations, or are they covered
by RCSI?
Yes, you must pay for them. The immunisations and tests are not covered by the
RCSI.
What immunizations are necessary?
Please refer to the main document above for a complete list and instructions. You’ll
find specific requirements for measles, mumps, rubella, tetanus, diphtheria, hepatitis
B, and meningococcal disease, as well as a recommendation for varicella (chicken
pox).
What should I do if my immunization records are lost or unavailable?
You could have special blood tests called IgG titers to show immunity to measles,
mumps, and rubella, a tetanus/diphtheria/pertussis (Tdap) booster, a Mantoux TB test
for tuberculosis, and a hepatitis B vaccine.
Why do I need to have two mumps vaccines?
In response to an outbreak of mumps on several college campuses in previous years, it
is strongly recommended that students entering college have proof of two doses of a
mumps vaccine or MMR (measles, mumps, and rubella) or proof of immunity through
blood testing. This is also recommended this as a way to decrease the risk of mumps
among the students and others in the community in which they reside.
In my country, a rubella immunization is required for females only.
Rubella immunity is required for all male and female students. Regardless of your
sex, you must have a rubella immunization or a blood titer that proves immunity.
Will you accept my mother’s word that I was immunized for measles, mumps,
and rubella?
While your parents may be a reliable source of knowledge about your childhood
health, we do require medically documented proof of immunity. Blood titres can also
be used to prove immunity.
What does “documented proof” of immunity mean?
Documented proof is a written record of your immunization dates provided by school,
university, college, or physician’s office, and/or results of laboratory blood testing.
My blood titre was equivocal or borderline. Do I need another immunization?
Yes, because we cannot accept borderline immunity. You will need another
immunization to boost your immunity.
Do I need the hepatitis B immunization if I’m married?
Yes. The hepatitis B immunization is required by law for all newly entering students,
regardless of age, gender, or marital status.
How many shots are there for the hepatitis B immunization?
Three. The second injection must be administered at least 28 to 60 days after the first
injection. The third injection must be administered six months after the first injection.