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Clinical Requirements Guide Name:____________________________________________________ Date:___________________ College:______________________________ Program: ____________________________________ This Clinical Requirements Guide is meant to be used as an informational guide for students to further understand the University of Washington and Community Partners agreed upon, requirements before participating in any patient care or clinical experiences. Students, faculty, staff, and community partner’s all have a shared responsibility to protect ourselves and our patients by taking reasonable precautions. All requirements will be verified by a private vender, Certified Background (www.certifiedbackground). Please use this guide to gather the required documentation before logging on to your Certified Background account. It is your professional responsibility to know and keep current with your immunizations and health requirements. Failure to comply with these requirements will result in a hold on your registrations, and may delay your graduation. If you have a circumstances that is outside of these guidelines, please contact us at: [email protected] and include a brief explanation. Immunization Requirements HEPATITUS B Hepatitis B is an infectious disease caused by the Hepatitis B virus (HPV) which can cause both acute and chronic infections of the liver. Health care workers with a risk of exposure to body fluids such as blood must be prove that they are effectively immunized by submitting a lab report confirming positive antibodies (anti-HBs or HepB Sab) are present in the blood. To be vaccinated sufficiently, UWB requires a 3 shot vaccination series (0, 1, 6 months), and then confirmation of positive titer 6-8 weeks later. If the titer does not show sufficient immunization (negative titer), you must repeat a 3 part vaccination series again (shots 4-6), followed by confirmation of immunization by positive titer 6-8 weeks later. A booster vaccination is not equivalent to repeating the vaccination series #4-6, and will not be accepted. Immunity confirmed by positive titer (anti-HBs or HepB Sab) lab report Date: _________ OR Vaccination #1 - 3 Dates: _____________, _____________, ______________ Immunity confirmed by positive titer lab report Date: ____________ If negative titer after vaccination, then repeat vaccination series. Booster is not acceptable. Vaccines #4 - 6 Dates: ____________, _____________, ______________ Immunity confirmed by positive titer lab report Date: ____________ If you have a circumstances that is outside of these guidelines, please contact us at [email protected] and include a brief explanation. UW1-211 Box 358532 18115 Campus Way NE Bothell, WA 98011-8246 phone: 425.352.5376 fax: 425.352.3237 email: [email protected] website: www.uwb.edu/nhs Revised June 9, 2015 MMR (Measles, Mumps, Rubella) Measles, Mumps, and Rubella (MMR) are three separate highly contagious infectious diseases. The MMR vaccine is a mixture of live attenuated viruses of these diseases, generally administered to children around the age of one year, with a second dose before starting school (i.e. age 4 or 5). UWB requires you provided proof of vaccination of 2 doses at appropriate intervals OR positive lab reports showing positive antibody titer for all 3 diseases. Vaccination Dates: ____________, _____________ OR Immunity confirmed by positive titer lab reports: o Measles Date: ____________ o Mumps Date: ____________ o Rubella Date: ____________ VARICELLA (Chicken Pox) Varicella is a highly contagious disease caused by the initial infection with Varicella zoster virus (VZV). The virus may be spread 1 to 2 days before a rash appears, and is easily spread through coughs, sneezes, and contact with the blisters. The varicella vaccine is recommended, with a second dose administered 5 years after initial immunization. If you have a history of Chicken pox, you must verify you are sufficiently immunized (measured by positive titer). Student are required to upload documentation of vaccinations or lab reports confirming positive titer. Vaccination Dates: ____________, _____________ OR Immunity confirmed by positive titer lab report Date: ____________ TETANUS, DIPHTHERIA & PERTUSSIS (Tdap) TDap and Tdap are both combined vaccines against diphtheria, tetanus, and pertussis (whooping cough), three highly contagious diseases. (Note that the names are easy to confuse. The difference is in the dosage, with the upper case letters meaning higher quantity.) The usual course of childhood immunization in the USA is five doses between 2 months and 15 years. For adults, separate combination (booster) vaccines are used that adjust the relative concentrations of their components. Students are required to submit documentation that they received a TDap booster within the last 10 years. After 10, years you are only required to obtain a booster for tetanus and diphtheria (Td). Tdap vaccination Td booster vaccination Date: ____________ Date: ____________ Revised June 9, 2015 TUBERCULOSIS (TB) Tuberculosis, TB (short for tubercle bacillus), is a widespread, and in many cases fatal, infectious disease caused by various strains of mycobacteria, usually Mycobacterium tuberculosis. In many parts of the world, newborns are vaccinated with the Bacillus Calmette–Guérin (BCG) vaccine. The US however has never used mass immunization of BCG, relying instead on the detection and treatment of TB. For UWB student, you must submit either a Tuberculing skin test (TST) or a QuantiFERON-TB blood test (QFT) to assess if you have a latent tuberculosis infection. TST: Two skin tests are required the first time you are screened for TB. Once the first skin test is administered you must return within 48-72 hours, to have your skin reaction assessed. If the first skin test is negative, then you will receive the second skin test within 1-3 week. If the first skin test is positive, a chest x-ray is required and an annual symptom checker must be completed within 12 months. QFT: Single blood test that can be assessed after a single patient visit. If results are positive, you must then complete a TB Questionnaire. Note that because TST and QFT do not measure the same components of the immunologic response, they are not interchangeable. If you have received the BCG vaccine, you must take the QFT. If your test results show you are positive for latent TB infection, you must complete a chest Xray, submit an annual symptom check from your health care provider, and complete a TB health questionnaire. Submitted Once Tuberculing skin testing (TST) 1) Skin test #1 Date:________ Result: Neg____Pos_____mm____ 2) Skin test #1 Date:________ Result: Neg____Pos_____mm____ OR QuantiFERON (QFT) Date:________ Result:___________ OR If history of BCG vaccine must receive QFT. If result is negative requirement has been met. If positive, must provide clear chest X-ray & TB questionnaire (administered within last 12 months) Exam Date: ________ X-ray Date: _________ TUBERCULOSIS (TB) - Yearly Annual TB testing is required for all healthcare professionals (either a TST or QFT). For TST this typically requires a single test, however, if it has been more that 12 months (i.e. your TST has lapsed) you will need to repeat the whole TST two step sequence again. Remember it is your professional responsibility to know and keep current with your immunizations. Revised June 9, 2015 Submitted Every Year Annual TST Date:________ Result: Neg____Pos_____mm____ Date:________ Result: Neg____Pos_____mm____ Date:________ Result: Neg____Pos_____mm____ OR Annual QuantiFERON (QFT) Date:________ Result:___________ Date:________ Result:___________ Date:________ Result:___________ If previously documented positive TST result and clear chest x-ray. If positive, must provide clear chest X-ray & TB questionnaire (administered within last 12 months) Exam Date________ X-ray Date_________ INFLUENZA (flu shot) Three types of influenza affect people. Symptoms can be mild to severe. Usually, the virus is spread through the air from coughs or sneezes. Due to the high mutation rate of the virus, a particular influenza vaccine usually confers protection for no more than a few years. Students are required to be vaccinated during the current flu season, and upload documentation proving annual vaccinations every 12 months thereafter. Vaccination Dates: ____________, _____________, ____________, _____________ If your history with this or other diseases are outside of these guidelines, please contact us at : [email protected] and include a brief explanation of your circumstances. Training and Professional Requirements: PROFESSIONAL RN LICENSE All students will need to provide documentation of a current RN license from Washington State. Typically students can access their RN license online and submit a screenshot of their license. The screen shot must include expiration date. To access your RN license go to https://fortress.wa.gov/doh/providercredentialsearch/SearchCriteria.aspx WA State Nursing License Number: _________________________ & Expiration Date: ___________ BACKGROUND CHECKS (including Disclosure Statement) A National Criminal Background Check and Washington State Patrol Background Check (WATCH) is required for all students. These checks will include all counties of residence, all Washington State counties per RCW 43.43.830 and OIG and GSA screens. Excluded provider search on OIG http://exclusions.oig.hhs.gov/. A Washington State Patrol Background Check (WATCH) will be required. Students whose background check reports a criminal offense, may be required to submit a letter of explanation to the School of Nursing and Health Studies to review. Revised June 9, 2015 National Criminal Background Check including Excluded Provider Search on OIG and GSA Date __________ AND Washington State Patrol Check (WATCH) annually. Dates ________,________,________,________,________,________ CPR (Cardiopulmonary resuscitation) CPR an emergency procedure performed in an effort to manually preserve intact brain function until further measures are taken to restore spontaneous blood circulation and breathing in a person who is in cardiac arrest. Basic Life Support (BLS) training for healthcare providers, will teach students the importance of early CPR and defibrillation, basic steps of performing CPR, relieving choking, and using an AED; and the role of each link in the Chain of Survival. The American Heart Association (AHA) has created a BLS training program that can be administered by a number of independent contractors. Some courses allow students to first complete online lessons, and then meet with an AHA instructor for skills practice and testing. Many independent trainers offer CPR courses for other professionals. Because of the variability of training programs, it is very important to note that only the below CPR certificate will be accepted. Students are required to submit a scanned copy (front & back) of their CPR card. American Heart Association BLS Healthcare Provider Certificate. Date __________ HIPPA Training HIPAA stands for the Health Insurance Portability and Accountability Act of 1996, which governs the privacy of an individual's medical records. Employees of businesses that may come into contact with records covered by HIPAA are required to undergo training on how to handle those records, and they can be held accountable for violations of the act. All students must complete the on-line HIPPA Training program on Certified Background website. HIPPA Training Date: _________ Social Networking Policy Guidelines It is important for all students to maintain the privacy of an individual’s history, especially on social networking sites. Because of this UWB School of Nursing & Health Studies has developed their own policy guidelines. Students are required to review this policy, and upload a signed copy of the agreement. Signed form acknowledging you have read and understand the policy Date: _________ Blood Borne Pathogen Form The UWB School of Nursing & Health Studies had developed a policy on infection control procedures for health care providers infected with HBV/HIV/HCV and other blood borne pathogens. This policy also explains the Universities and community partner’s procedures if a student has experienced an injury or been exposed to Blood Borne Pathogens (BBP). Students are required to review this policy, and upload a signed copy of the agreement. Signed form acknowledging you have read and understand the policy Date: _________ Revised June 9, 2015