COM Student Handbook 

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Student Health

Exposure to Infectious Diseases

Students will be instructed in the fundamentals of the spread of infectious diseases and isolation techniques during Freshman orientation.

Prior to the start of their junior year, the students will receive orientation from the Infection Control Office at the USA Hospitals and Clinics where at least the following topics will be covered:

    • Types of isolation procedures.
    • The student's right to the availability of protective equipment (gowns, gloves, face masks, etc.).
    • Protocols for students who sustain needle sticks.
    • The availability of personnel of the Infection Control Office and Employee Health to provide information regarding infectious disease exposure.

 

Policy Statement on AIDS and Other Infectious Diseases

Acquired Immune Deficiency Syndrome (AIDS) has confronted the health professions with numerous issues of an ethical and moral nature related to the care and treatment of patients infected with the Human Immunodeficiency Virus (HIV) and other infectious diseases.

AIDS and HIV-related disorders have focused attention on the basic obligations of health professions and the responsibilities of practitioners to patients. In this context, it is recognized that AIDS patients and HIV-infected individuals are entitled to competent medical service that reflects compassion and respect for their human dignity, as well as concern for safeguarding their confidence within the constraints of the law.

One of the objectives of the College of Medicine is the development of professional men and women aspiring to practice medicine. These future practitioners should be prepared for a lifetime of service to the ill, which demands adherence to the highest standards of professional conduct and behavior. AIDS has brought attention to these objectives. In this regard:

Faculty, medical students, graduate medical students, and practitioners within the College of Medicine have a fundamental responsibility to provide care to patients, regardless of the patient's diagnosis. Failure to accept such responsibility is contrary to the ethics inherent in the philosophies of the medical professions.

Faculty members have a special responsibility to set an example for the standards of ethical behavior and attitudes of the practice of medicine.

Faculty, students, and practitioners within the College of Medicine who pose a risk of transmitting an infectious agent should consult with knowledgeable physicians to determine whether continuing to provide professional services represents any material risk to the patient and, if so, should not engage in any professional activity that would create a risk of transmission of the disease to others.

It is necessary that faculty, students, and other personnel of the College of Medicine help and be helped to address any fears and prejudices about treating HIV-infected patients. Thus, the responsibilities of the College of Medicine include the following:

    1. Providing accurate information to applicants to the College of Medicine of the personal risks involved in the practice of their selected profession.

    2. Providing up-to-date information on the modes of acquiring and transmitting HIV and other infectious agents in the clinical activities of the College.

    3. Providing training in the accepted measures to prevent exposure to or transmission of HIV or other infectious agents in the healthcare setting.

    4. Ensuring that policies exist to monitor adherence to institutional guidelines for prevention and infection control.

    5. Ensuring that procedures are established in the event of accidental exposure or violations of guidelines.

    6. Providing appropriate equipment and supplies to minimize the risk of infection with HIV or other infectious agents.

    7. Providing education and counseling to those individuals who are apprehensive or reluctant to participate in educational programs or patient care activities involving HIV- infected individuals or individuals with other infectious diseases.

Approved by USAMC Hospital Board and COM Executive Council, August, 1990.

(This policy statement was adapted from a policy statement developed by the Association of Academic Health Centers Board of Directors Statement on Professional Responsibility in Treating AIDS Patients, April, 1988. Also used as reference was the American Association of Medical Colleges Statement on Professional Responsibility in Treating AIDS Patients, February 25, 1988).

Infectious Disease Reporting

Alabama's Infected Health Care Worker Management Act was signed into law in August, 1993. The law provides for mandatory reporting of HIV and Hepatitis B infection in healthcare workers, including medical students, and defines how the reported information is to be used. The State Board of Health has approved rules related to implementation of this Act. A copy of the rules is on file in the Office of Student Affairs and copies may be requested from that office or from the Alabama Department of Public Health, 434 Monroe Street, Montgomery, Alabama, 36130-3017. In addition, if there are specific questions with regard to such Act, you may contact Dr. John VandeWaa at 471-7895. A summary of the requirements that would be placed on medical students that relate to reporting include:

  • Any infected medical student shall notify the State Health Officer by sending a letter marked "Personal and Confidential" to the Director of the Division of Infection Control within 30 days of the time he or she is aware of his or her infection. The letter shall include at a minimum the infected healthcare worker's name and diagnosis and information as to how he or she can be contacted. The infected healthcare worker shall subsequently make available to the Department all requested documents or records three years old or less and shall cooperate fully with the Department in the investigation.
  • Any physician providing care to any infected healthcare worker shall notify the State Health Officer of the infected status of his patient within seven (7) days of the time he or she diagnoses or provides such care. Such notification shall be on forms as designated by the Department and sent to the designee of the State Health Officer by marking the envelope "Personal and Confidential" and sending it to the Director of the Division of Infection Control. Further, the physician shall make available to the Department all requested documents or records three years old or less and shall cooperate fully with the Department in the investigation.
  • After reporting to the State Health Officer, no infected healthcare worker shall perform or assist in performance of an invasive procedure until after an internal Department review by Department staff and written notification regarding conditions of practice from the State Health Officer.

Policy and Guidelines for Preventing Transmission of Human Immunodeficiency Virus (HIV) and Hepatitis B Virus (HBV) by Medical Students to Individuals During Exposure Prone Invasive Procedures and Otherwise

The policy statements outlined herein are based upon the updated CDC recommendations for the management of Hepatitis B-infected healthcare providers and students dated July 6, 2012:

  • Infected healthcare workers who adhere to standard (formerly universal) Precautions and who do not perform "exposure prone procedures" (Category I per CDC) are deemed to pose no risk of transmitting HIV or HBV to patients. Students do not ordinarily perform such procedures.
  • All students shall be vaccinated against Hepatitis B (series of standard three vaccinations followed by a titer).
  • All students are responsible for knowing their Hepatitis B/HIV status and must report seroconversions to the College of Medicine Office of Student Affairs or to Student Health or to one of the Employee Health Nurses at USA Health University Hospital or Children's & Women's Hospital.
  • Depending on the circumstances, an Expert Panel (CDC-defined) may be convened and HPV/HIV viral loads may be required.

The University of South Alabama Hospitals and Clinics comply with standard Precautions and recommendations for disinfection and sterilization of medical devices. These precautions will be appropriately monitored in all healthcare settings. Established procedures are provided for the monitoring of compliance with infection control policies.

Health Insurance

Health Insurance

Students who matriculate to the University Of South Alabama College Of Medicine are required to be covered by health insurance throughout medical school. Acceptable coverage can be in the form of a spouse’s plan, a parent’s plan, an individual plan, or a group plan. Group coverage is available through Student Health. Students are considered to be adults and are expected to be able to assess appropriate parameters for health insurance keeping in mind that unexpected hospital expenses can easily delay or terminate a student’s academic career.

Documentation of Coverage

The following procedure is used to ensure proper health insurance coverage for all students with the least amount of follow-up. Prior to registering for any semester of coursework in the College of Medicine, each student shall present proof of coverage to the Office of Student Records. Proof of coverage is strictly limited to a copy of the student’s current health insurance card. No other documentation is acceptable. Any student failing to submit the proper documentation of current health insurance coverage will not be allowed to register. Any student who allows their health insurance coverage to lapse may not participate in patient care and will be placed on administrative leave until proof of current coverage is provided. This administrative leave shall be noted on the student’s academic transcript.

Any student who knowingly submits false documentation will be brought before the SPEC.

Disability Insurance

The USA COM Student Assembly voted that disability insurance be mandatory for all medical students. The annual fee for this coverage is collected with fall quarter registration. The coverage is provided through the AMA Insurance Agency, Inc. A complete description of all coverage provisions is available in the Office of Student Affairs on the main campus and at Mastin.

Required Immunizations and Physical Examinations Immunizations for Communicable Diseases

Medical students are frequently exposed to infectious diseases during their clinical experience. They are, therefore, at risk of contracting several illnesses that are easily preventable by immunization. The students are also potential carriers of these illnesses and may infect other patients who may be immune-compromised.  To protect both the students and patients, all students in the USA COM must present proof of immunity to the following diseases and are strongly urged to receive an annual influenza vaccine during the two clinical years.

  • Measles (Rubeola): All students born after 1956 are required to provide documentation that they have received two doses of live measles vaccine prior to their matriculation. The first dose of the vaccine should have been administered after 15 months of age. If documentation cannot be provided then the student is required to receive immunization for measles from his/her personal physician or the Board of Health or provide evidence of a protective titer. Pregnancy is a contraindication to this vaccine. If necessary, pregnant students should be vaccinated in the post-partum period.
  • Mumps and Rubella: All students born after 1956 will be required to provide documentation that they  have received  one  dose  of  live  Mumps/Rubella  vaccine after 15 months of age or produce the results of serologic  studies  showing  a protective titer of Mumps and Rubella antibodies. Without this documentation the student is required to receive immunization for Rubella/Mumps prior to matriculation from a personal physician or the Board of Health. Pregnancy is a contraindication to this vaccine. If necessary, pregnant students should be immunized in the post-partum period.
  • Tetanus – Diphtheria – Pertussis: All students are required to document that they have received the primary series and a booster dose of adult Tetanus-Diphtheria-Pertussis (Tdap) vaccine within ten years of the beginning of the academic year. Without this documentation the student is required to receive the Td vaccine from his/her personal physician or the Board of Health.
  • Polio: All students are required to document that they have received the primary series of Polio vaccine. If documentation cannot be produced the student will be required to receive the primary series of inactivated polio vaccine from their personal physician or the Board of Health or provide serologic evidence of immunity.
  • Varicella: All students must certify that they have had varicella or they must have a varicella titer determined. If the titer is undetectable, they must receive two doses of varicella vaccine 4-8 weeks apart.
  • Hepatitis B: All students must be immunized against infection from hepatitis B virus. A Hepatitis B titer must be submitted following the series to assure immunity.
  • Influenza: All students are required to receive an annual influenza vaccine during the fall of each academic year. Failure to provide proof of a flu vaccine will result in a hold being placed against the student’s spring registration until proper documentation is submitted.

  • Tuberculosis: In light of the significant incidence of multiple drug-resistant tuberculosis and the need for effective infection control measures, pre-matriculation and annual testing for tuberculosis is required for all students in the College. Failure to provide proof of current PPD will result in a hold being placed against the student’s spring registration until proper documentation is submitted.

    Sophomore, junior and senior students must provide proof of tuberculosis testing (PPD) prior to November of each year. Students Health Services will administer these tests for students for a nominal fee. Each student is responsible for having the tuberculosis test placed and read, then providing the results to the Student Health Services no later than the first of November. That office will provide a list of students in non-compliance and a “hold” will be placed on those students’ registration until the test is completed.

    Any student who is positive due to a childhood or other exposure must provide a statement from his/her physician that the student is not contagious. The statement should also include that the student has a clear chest x-ray on file and whether they have been counseled about INH treatment. These students may additionally be required to meet with the Infectious Disease faculty at the University of South Alabama Medical Center.

  • Exceptions:  In the event  that  a  student has  a problem that  he/she believes would be a contraindication to  a specific vaccination,  the  pertinent  information  should  be provided to the Associate Dean of Student Affairs. The student may be required to sign a Release of Liability holding the College of Medicine harmless.

Implementation of Student Immunization Policy

In order to facilitate the collection and processing of immunization information for students entering the College of Medicine, the following protocol will be followed:

  • The Health Data Record form and AAMC Standard Immunization form will be sent to each entering freshman in the early summer prior to matriculation.
  • The forms will be returned to the Student Health Center no later than the assigned date prior to orientation.
  • The Student Health Center will review the Health Data Records to assure that all immunization requirements have been met.
  • Any entering student who has not completed all requirements for immunizations by matriculation will meet with the Associate Dean of  Student Affairs to discuss the need for documentation or possibility for an exemption.
  • Any student who has not provided all necessary documentation by October 1 will be placed on a Leave of Absence until the College requirement has been met.
  • If a student has started, but not completed, a series of required vaccinations by the beginning of the academic year, he/she will be given an appropriate amount of time to complete the series. Failure to provide all necessary documentation by the deadline will result in placement of the student on a Leave of Absence until the College requirement has been met.
Physical Examination

The College requires students to undergo a complete history and physical examination after admission to school, but prior to matriculation. The completed Health Data forms are reviewed for completeness and placed in the students’ files if complete. If not complete, the Associate Dean of Student Affairs will follow policy to assure that the form and immunizations are completed. The required Physical Examination/Health Data form must be submitted NO LATER THAN THE FIRST WEEK OF AUGUST.

The College requires documentation that visiting students meet the AAMC Standard Immunization requirements. Records pertaining to visiting students are handled through the Student Affairs office in the USA Medical Center Mastin office.

Policy on Healthcare Providers

No provider of healthcare, psychiatric, and/or psychological services to a medical student may be involved in the academic assessment of that student or in decisions about the promotion of that student.

Post Exposure Prophylaxis (PEP) Program

Safety is a priority for the University of South Alabama College of Medicine medical students. All medical students undergo initial training on post-exposure prophylaxis during orientation for their M1 year with a subsequent refresher module during their M3 orientation. During this training, procedural guidelines are discussed with emphasis on the reporting mechanisms, timeliness of testing, and treatment. Each student is provided a card to carry at all times with these guidelines and phone numbers to facilitate the testing and reporting process. Additionally, these post-exposure prophylaxis guidelines are published on the College of Medicine website under the Current Students policies and forms.

The cost for any laboratory clinical services associated with post-exposure testing should be billed to the student’s health insurance company. After payment from the insurance company, any remaining billed expenses should be presented to the Associate Dean of Student Affairs. As long as the student has filed in a timely manner with their insurance, the remaining balance will be paid by the Dean’s office in the College of Medicine. In order to ensure payment from the College of Medicine, the student should present all pertinent paperwork including that which documents the amount reconciled by their insurance carrier.

If the filing on the student’s insurance and the presentation of the remaining billed services are not handled in a timely fashion, the College of Medicine will not pay the difference and the student will be responsible for the balance.