USF – College of Medicine

GRADUATE MEDICAL EDUCATION POLICY & PROCEDURE

Title: Blood Borne Pathogen Exposure		No.: GME-310
Effective Date: 11-1-01	Revision Date:	Distribution: All
Page: 1 of 2

Policy Statement

Residents are at risk of exposure to and contraction of blood borne pathogens. If infected, a resident serves as a potential source of infection to patients, yet the recognized risk appears to be small. The College of Medicine has a responsibility to protect the confidentiality of the resident while at the same time protecting patients from potential injury. Accordingly, an evidence based protocol, which assures decisions that are consistent with current practice and confidentiality of the resident, will govern the decisions relating to resident participation in invasive clinical activities.

For incoming residents, the technical standards policy (Stated as: The University of South Florida College of Medicine requires that individuals accepted into Graduate Medical Education programs have the necessary physical and mental skills (with reasonable accommodation) to be able to function as a practitioner in the chosen specialty. Vision, hearing and speech capabilities must be adequate for the satisfactory conduct of the chosen field. Upper and lower extremity function must be adequate to accomplish the essential functions of the chosen field. Additional specific physical requirements may exist for some programs and will be provided to interested individuals on request. Individuals must meet the current requirements for licensure within the State of Florida.) will prevail. If a prospective resident is not able to meet the current requirements to be able to practice in the specific specialty of medicine, such resident will not be allowed to begin training in the designated discipline. For residents already in a training program, the Associate Dean for GME or the resident will contact the HSC Health Advisory Committee and notify the committee.

The Associate Dean for GME will ask the HSC Health Advisory Committee to formally initiate the HSC Procedure for Employees Infected with a Bloodborne Pathogen. The Associate Dean will request the Dean of the College of Medicine to appoint individuals to the HSC Health Advisory Committee on a temporary and ad hoc basis to include: the program director of the involved program, the medical directors of the involved hospitals, and at least one representative of the House Staff Association. The HSC Health Advisory Committee will make a recommendation to the Dean regarding the individual protocol for the resident and will serve as the monitoring and oversight body. The Committee will function in a confidential manner and all records will be maintained as individual health care records of the individual. Decisions regarding restriction of invasive clinical activity, notification of patients, and counseling of the resident will be made by the Dean of the College of Medicine.

Title: Blood Borne Pathogen Exposure	No.: GME-310
Page: 2 of 2

Procedure

Responsible Party Action

Resident Notify Associate Dean, GME or HSC Advisory

Committee of exposure.

Associate Dean Activate HSC Advisory Committee.

HSC Advisory Committee Review all pertinent information and formulate

a recommendation for the Dean regarding

restriction of clinical activity and notification

of patients.

Dean, College of Medicine Notify resident of Committee recommendations.

HSC Advisory Committee Monitor health status of resident and

recommend changes in the resident monitoring protocol.

APPROVED:

Associate Dean, Graduate Medical Education

Dean, College of Medicine

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