Purpose:
To protect Students/Personnel from infection.

Equipment:
• Lined waste basket in room.
• Disposable gowns and gloves – one (1) use only.
• Goggles – retained by person using

Found: Area designed by each Department

Procedure:
A. Gown:
1. Remove rings (if they could rip gloves), remove or move watch up arm.
2. Lap gown over at back to cover uniform and tie securely.
3. To remove, untie gown at waist
4. Remove gloves
5. Wash hands. If wearing goggles, remove at this time.
6. Unite gown at neck.
7. Remove gown by grasping either sleeve and pulling away from self. Roll outside to inside, discard in lined waste basket.

B. Goggles
1. Don goggles .
NOTE: Goggles may be reused by washing with soap and water and drying.

C. Gloves
1. Don gloves making sure cuff of gown is covered. To avoid contamination of arm and clothing.
2. Remove gloves by grasping cuff and inverting inside out. Discard in lined waste basket. Remove first.
NOTE: Gloves are put on LAST and removed FIRST.

NOTE: If the person taking care of the patient with an infection comes into direct contact with patient secretions/excretions causing gross contamination of gloves, gloves are to be changed BEFORE touching or contaminating other articles/areas of the room.
Unless there is gross contamination on gloves, gown – may be discarded in regular lined waste basket.

Date: _________ Received From Campus: __________________________

Found by: ___________________ Item(s) Found: _________________________

Did Penetration Occur to Employee? ____No ____Yes
If yes, by whom? _________________________________________________________

Was Treatment Received? ____No ____Yes
If yes, by whom? ________________________________________________________

_______________________________________________________________
What Treatment was Received?
________________________________________________________________

________________________________________________________________
Has Employee Received Hepatitis B Vaccine? ________ Yes ________ No

Any Other Medical Conditions or Considerations?
________________________________________________________________

________________________________________________________________

________________________________________________________________

Employee Signature: ____________________________

Supervisor Signature: _____________________________

Was Item Returned to Facility? ____ Yes _____ No

Date Returned: _________ To Whom?: ______________________________________

Returned By: _____________________________________________________________

This form shall remain on file.

Job tasks will be classified according to risks of exposure to Blood/body fluids, Mucous Membranes, Non-Intact Skin.
Employees engaged in the following activities are MANDATED to follow the minimum protective requirement(s).

Post Exposure Worksheet

Purpose: It is the policy of Hillcrest Educational Centers (HEC) to provide a safe and healthy work environment which includes proper management of exposure to potentially contaminated blood and/or body fluids. These procedures are meant to ensure that appropriate measures are taken to protect those at risk of exposure.

Background: OSHA estimates approximately 5.6 million workers in health care and other facilities are at risk of exposure to bloodborne pathogens such as the human immunodeficiency (HIV), hepatitis B (HBV) virus, hepatitis C (HCV) and other potentially infectious diseases. Those at risk include anyone whose job may require providing first-response medical care in which there is a reasonable expectation of contact with blood or other potentially infectious materials. Common exposure in settings like HEC may occur from human bites. Although they are rarely associated with the transmission of HIV or HBV infection they are associated with a significant risk for serious bacterial infection and require proper medical treatment. Prevention of exposures is critically important. Regular hand washing, appropriate use of gloves and training are steps that contribute to the prevention of complications from these exposures.
Vaccinations and Incident Reporting
HEC has a vaccination program through Occupational Health Services. This program is offered at no cost to all employees upon being hired and again to those who have an occupational exposure to bloodborne pathogens. In the event of employee exposure to bloodborne pathogens, post-exposure evaluation and follow-up will be provided at Occupational Health Services. Following any exposure incident, the affected employee should immediately report to the campus nurse on duty during normal business hours. After hours, employees are instructed to report to the Berkshire Medical Center Emergency Room. An ART form AND Post Exposure Work Sheet should be completed by the nurse, faxed to Employee Health Representative at HR, a copy should be given to the Program Manager and the original sent with the employee for further documentation by the treating physician.

Procedures after bite exposure (Student to Student or Student to Staff)
• Immediately wash the site for 5 minutes with soap and water or flush eyes with normal
saline or tap water for 15 minutes (remove and discard contact lenses) Mild bleeding should be allowed to continue
• If there is blood in the biter’s mouth it should be rinsed and spit with tap water several times
• Report the injury to a supervisor
• Contact or go to campus Nursing Department who will make an assessment and refer to pediatrician, Occupational Health Services or Emergency Department as necessary
• Initial assessment includes skin integrity (is the skin broken), documentation of the incident and those involved, and initial wound care
• If after hours, go to the Emergency Room for evaluation of a bite that has broken the skin
• Complete incident report form, ART Form and Post Exposure Work Sheet. Enter a progress note in the appropriate system.
• Obtain a medical history on the source patient (biter) and have blood specimens drawn within the first 8-10 hours after exposure (consent must be obtained): Rapid HIV and Hepatitis panel. (Previously drawn labs are acceptable if dated in the past 60 days)
• Employees referred to Occupational Health or ER will receive an assessment and treatment which may include but is not limited to tetanus update, antibiotics, and several blood tests as needed. Treatment options will be discussed on an individual basis.
• Report the results of blood testing of the source (biter) to Occupational Health as soon as available (within 24 hours if rapid HIV done). The status of the Employee should be reported to the campus at this time. If there are positive reports at any time, The Medical Directors of both HEC and Occupational Health will be notified immediately. Referral for appropriate counseling and treatment will be made.
• If exposure occurs when there is no nurse available to draw blood, a call should be placed to the campus Head Nurse to decide the course of action.

Procedures after body fluid exposure (Student to Student or Student to Staff)
In the event of an accidental exposure to blood or body fluids (e.g., needlestick, blood or body
fluid contamination to a cut or scrape, mucous membrane exposure)

• Immediately wash the area for 10 minutes with soap and water or flush eyes with normal
saline or tap water for 15 minutes (remove and discard contact lenses)or rinse mouth for several minutes
• Report the injury to a supervisor
• Contact or go to campus Nursing Department who will make an assessment and refer to pediatrician or Occupational Health Services as necessary
• Initial assessment includes skin integrity (is the skin broken), documentation of those involved, and initial wound care
• If after hours, go to the Emergency Room for evaluation
• Complete incident report form, ART Form and Post Exposure Work Sheet. Enter nursing note in appropriate system.
• Obtain a medical history on the source patient and have blood specimens drawn within the first 8-10 hours after exposure (consent must be obtained): Rapid HIV and Hepatitis panel. (Previously drawn labs are acceptable if dated in the past 60 days)
• Employees referred to Occupational Health or ER will receive an assessment and treatment based on the individual circumstances.
• Report the results of blood testing of the source to Occupational Health as soon as available (within 24 hours if rapid HIV done). The status of the Employee should be reported to the campus at this time. If there are positive reports at any time, The Medical Directors of both HEC and Occupational Health will be notified immediately. Referral for appropriate counseling and treatment will be made.
• If exposure occurs when there is no nurse available to draw blood, a call should be placed to the campus Head Nurse to decide the course of action.

Standard:
In order to provide for the safety of Employees and Students alike, Hilcrest provides these Infection Control Guidelines. ALL Employees will be responsible for having a working knowledge of the principles of infection control, modes of transmission of disease, and their role as Employee in the prevention of the spread of disease.

Introduction:
The concept of Universal Precautions focuses on the isolation of body substances such as Blood, Urine, Feces, Wound and Oral Secretions, Sputum, Semen, Vomitus, etc. In this way, the individual diagnosis of the student is not the determining factor in the handling of blood/body fluids.
CDC, OSHA, and the Massachusetts Department of Public Health state that we should consider all blood/body fluids as potentially infectious. By not relying on diagnosis for Universal Precautions we are better able to protect students and staff alike.
The most important parts of this concept are:
• INCREASED AND PROPER HAND WASHING BY STUDENTS AND STAFF
• THE USE OF GLOVES.

Certain Employees are at a higher risk of exposure to infectious materials than others. There are 3 categories of decreasing risk as shown below:

Category I: Tasks that involve exposure to blood/body fluids or tissue.
These are ALL procedures that involve an inherent potential for mucus membrane or skin contact with blood/body fluids or body substances. PROTECTIVE BARRIERS APPROPRIATE FOR THE TASK MUST BE WORN.

Category II: Tasks that involve no exposure to blood/body fluids or body substances, but may require performing unplanned Category I tasks.
These are procedures that during routine work, skin and mucus membrane contact with blood, body fluids or body substances doesn’t normally occur. However, the potential for exposure may occur. Appropriate barrier protection must be worn.

Category III: Tasks that involve no exposure to Blood, Body Fluids, or Body Substances.
These are tasks that during normal work routine, there is no exposure or potential for exposure to blood, body fluids, or body substances.

In order of decreasing intensity and/or potential for exposure, the following Employees are at risk:
Nurses
YDP’s
Teachers
Teachers Adies
Supervisors and Assistant Supervisors
Houskeeping
Maintenance
Food Service/Dietary
Administrative Personnel
Administrative/Campus Secretaries
Business Office

In-service training is provided at least yearly for ALL employees, and to ALL new employees, at time of hire. At least the following topics are covered:
Infection Control Policies and Procedures
Employee Health Practices
Risk of exposure to blood/body fluids or tissue(s)
Employee responsibility for reducing risk
Universal Precautions

Equipment is provided to safeguard Employee/Student contacts. Each Employee should know where to obtain supplies. These include:
Gloves – Vinyl or Latex of appropriate size.
Gowns – as necessary
Masks/Eye Protection – (Gobbles, or Glasses with Side Pieces)
Resuscitation Equipment
Plastic Bags – Plain or RED, as needed
Sharps Disposal Units – Appropriately placed
Cleaning Products – as needed.

Individual judgement is necessary in determining which type of barrier equipment will be needed. Some of the reasons for barrier use are listed below:
• Wear gloves when it is likely that hands will be in contact with: Body fluids such as Blood, Urine, Semen, Feces, Wound and Oral Secretions, Sputum, or Vomitus.
• Protect clothing ,a gown ,when: It is likely clothing will be soiled.
• Wear eye protection when: Eyes or mucous membranes may be splashed such as blood draws, irrigating wounds, etc.
• Follow Written Policy for handling of linens, trash, contaminated equipment.
• Used Needles, Syringes, Sharps are to be discharged in puncture proof containers which are provided. Do NOT recap needled after use.

• Wash hands often and carefully. ALWAYS wash hands after contact with: Blood, Body Fluids, Tissue(s), and after removing gloves.
• Mouth-to-Mouth resuscitation should be done with the use of a one-way mask which is provided.

In order to safely handle Blood, Body Fluids or Tissue(s) and ensure good care and treatment, the following Guidelines should be used:

Specimens:
All specimens of Blood/body fluids or Tissue are to be treated the same, and are to be considered potentially infectious. ALL persons handling specimens should take care in obtaining specimens or handling the container to prevent contamination of the container or self. If a container becomes soiled with Blood/body fluids or Tissue(s), while being obtained, cleanse the outside of the container with 70% alcohol (wear gloves), or place in a plastic bag for transport to the laboratory.

Wound Dressing:
ALL wound dressings are to be handled so as to confine and contain Blood/body fluids. The Inverted Glove technique may be used for small dressings. Gloves are to be worn when removing dressings. Care should be taken when removing large dressings, so as not to spill on self or patient. Place ALL dressings in an impervious bag, as soon as removed. Bags/gloves may be placed in regular trash for disposal.
EXCEPTION: Heavily soiled dressings are to be red-bagged, secured tightly, for removal and disposal.

Trash:
Trash is to be placed in appropriate plastic bags, secured tightly, for removal and disposal.

Sharps:
All sharps are to be placed in puncture-proof containers as provided. When containers are full, close securely, and arrange for pick-up as per Policy for Disposal. Keep container in Nurses Station until pick-up.

Linens:
Linens are to be handled in the following manner:
• Regular Linen – Placed into linen bag at site of use. Laundry is done by Students with Supervision or by Laundry personnel. Some laundry is done by direct care staff.
• Linen visibly soiled with Blood/body fluids – is to be placed into a plastic bag using gloves. Laundry will be done by Staff, Supervising the Student, or by a Laundry person.

PERSONAL CLOTHES:
Student’s personal clothing, soiled with blood/body fluids is placed into a plastic bag. Most clothing may be washed in a regular washing machine with detergent and bleach.

MOUTH-TO-MOUTH RESUSCITATION:
Disposable mouth-to-mouth resuscitation equipment is provided for use, when needed.

COMMUNICABLE DISEASE EXPOSURE:
Employees exposed within or outside the school, and susceptible to a communicable disease should notify the ICC, so approprate policy may be followed to prevent exposure to other Students and co-workers.

BLOOD/BODY FLUID SPILLS:
Large blood/body fluid Spills are to be treated carefully to avoid contamination of the Environment, Students, and Personnel. The blood or body fluids should be carefully wiped up with disposable paper towels, which should then be discarded into red plastic bags, and secured tightly. The contaminated area should then be wiped with a solution of 1:10 Bleach or other suitable sanitizer. Following this, Housekeeping will santize the area.

FOOD/DRINK:
Food or drink shall NOT be stored in Refrigerators, Freezers, Cabinets where Blood/body fluids are stored.

DISHES:
Dishes have not been found to transmit infections. Therefore, regular trays and dishes may be used for ALL staff and students.

BLOOD SPILLS AND CLEAN UP

Purpose:
To safely clean up and dispose of Blood/Body Fluid spills.

Equipment:
• Blood/Body Fluid Spill Kit ( Gloves, Goggles)
• Double Plastic Bags
• Disposable Paper Towels/Cloths for Clean-Up
• Dustpan and Brush
• Bleach Solution 1:10 Dilution or virex (Made Up as needed)
• Detergent/Germicide

Definition:
Blood/Body Fluid Spill – A spill will be defined as a large amount of blood spilled. If body fluids (as Gastric fluids, Fecal material, Urine) are obviously Blood tinged/contaminated, they will also be treated as a blood Spill. Drops of blood/body fluids may be wiped up with an alcohol wipe, or gauze, wearing gloves.

Procedures:
1. Mark/close off area of spill.
2. Obtain supplies needed and dress appropriately.
3. Prepare solution of detergent/germicide and a solution of bleach 1:10 or virex to decontaminate the area, after the spill is cleaned with the detergent.
4. Using care, clean up any broken glass using a dustpan and brush.
5. Using disposable paper towels/cloths, wipe up the Blood/Body spill. Place into red bag, secure tightly.
6. After Blood/body fluids have been wiped up, using a Clean paper towel/cloth, wipe area with bleach solution 1:10 or detergent/germicide.
7. Place used paper towels/cloths into red plastic bag, along with barrier gear, secure tightly, for disposal.
8. Arrange for transport and disposal.
9. Dustpan and brush are to be soaked in the 1:10 bleach solution or virex, rinsed and replaced.
10. Notify Housekeeping to sanitize the area.

Training: Blood Borne Pathogens Movie/ Training is done at new staff orientation and annually thereafter.

Information: This Infection Control Manual is available at all sites.
Record Keeping: Record keeping is done consistent with OSHA standards and regulations.

Method of Compliance: Policies and procedures are consistent with OSHA standrads and regulations.

Review of Plan: Annually on Date of Inception

Approved: This Plan is approved by the Infection Control Coordinator and the Leadership of Hillcrest Educational Centers, Inc.

O.S.H.A.

This standard is written to address OSHA recommended policies/procedures to be used by Hillcrest for the care and safety of students and employees. In order to accomplish this goal, Departments where exposure to blood/body fluids is a possible part of their work experience will have written policies/procedures addressing these issues.
Body Fluids include: blood, semen, vaginal secretions, other blood contaminated body fluids, saliva in dental procedure.
Also, Hillcrest has a standard appropriate Employee Health Policy for pre-employment screening for: Hepatitis B Vaccines, Follow-Up Blood/Body Exposures, as well as Exposures to Communicable Disease.

These standards are addressed in the following policies and documents:

Infection Control Manual
Infection Control Procedures
Universal Precautions/Procedures
Employee Health

I. Employees considered at risk of Blood Borne Pathogen Exposure include the following:

A. ALL Nursing Staff
Youth Development Professionals (YDP’s)
Teachers
Teacher’s Aides
Assistant Supervisors
Supervisors

B. Environment of Care Services
Housekeeping
Maintenance

EXCEPTIONS:
Training/Staff Development
Campus/Administrative Secretary
Administrative Office Workers

II. Universal Precautions:
A. Barriers/Handwashing
B. Specimen Handling
C. Wound Dressings
D. Trash (Medical Waste Handling)
E. Sharps
F. Linen Handling
G. Exposures to Communicable Diseases
H. Exposures to Blood-Borne Pathogens
I. Blood/Body Fluid Spills
J. Safe-Work Practices

III. Barriers:
When a specific barrier is indicated ALL persons performing the task will wear specific barrier-appropriate barriers for use as identified/listed for procedures:
a. Protective Clothing – Needs to prevent blood/infectious materials from passing through and contaminating personal clothing or skin. This clothing need not be impervious.
b. Gloves – Work where there is a chance of contact with ANY blood/body fluids that may transmit a blood/borne pathogen.
c. Hands – Washed using CDC recommended methods whenever gloves are removed.
d. Eye Protection – Provided to ALL persons where there is a chance of blood/body fluid splashing.
e. One-Way Resuscitation: Masks provided for resuscitation.

(ALL persons involved in care involving blood/body fluid exposure are to be aware of where to find barriers, how to use them, when to use them, and how to dispose of them).

IV. Housekeeping
ALL persons involved in health care are responsible for keeping his/her area clean and safe to work in. Food and/or drink is NOT kept or eaten where contamination can/could occur. Spills are cleaned up as they occur, to ensure no cross-contamination or exposure to others.
The Housekeeping Department is responsible for ALL general cleaning. The Department has written Policies/Procedures, schedules, and appropriates products for maintaining cleanliness, safety of the campus.

V. Linen Handling:
Students may be responsible for their own laundry, or are assisted by direct care staff.
Hillcrest campuses may employ full-time Laundry personnel.
Gloves are to be used, if there is any possibility of body fluid contamination
OR
Linen grossly contaminated with blood, potential infectious material(s).

VI. Regulated (Medical) Waste:
Heavily soiled waste (where environment could become contaminated by leakage) is placed in a red biohazard bag and transported by housekeeping for disposal.
ALL sharps are placed into rigid containers which are provided to the campuses, and are conveniently placed for easy use. Containers are NOT to be overfilled, closed securely at site, .
Needles are NOT recapped, or broken, prior to discarding.
Slightly soiled bandages, bandaids, alcohol wipes, sanitary napkins are NOT considered to be regulated (Medical) waste. These may be placed in regular trash receptacles.

VII. Employee Health
There is a written plan for Employee Health. This Plan includes:
• Pre-Employment Evaluation/Physical
• Essential functioning testing
• Vaccines – HBV

Follow-Up Exposures to:

o Hepatitis B
o HIV/AIDS
o TB
o Communicable Disease(s)

All employees are required to report any signs and/or symptoms of communicable disease to a campus nurse. Signs and symptoms include but are not limited to:
Fever, vomiting, diarrhea, rash, fatigue, sore throat, and/or skin lesions.
The nurse will then take action consistent with policy on suspected or confirmed communicable disease.

VIII. Education:

There is an ongoing education program for all employees. All mandated programs are available and are to be attended on a Yearly Basis.

IX. Medical Records:
ALL Medical Records, Vaccine Records, Exposure Follow-Up, are located in the Employee Health Record.

X. Copies of OSHA Blood Borne Pathogen Standard –
are available in the following campus areas:
Human Resources Department
Infection Control Manuals
Nurses Stations

Epidemiological studies show that AIDS is transmitted primarily via sexual contact or blood-to-blood contact. Researchers state that casual transmission of the virus has not occurred in close family environments, and opportunistic infections associated with AIDS do not present an appreciable risk to healthy individuals. Since there is no evidence of casual transmission by sitting near, living in the household, or caring for an individual with AIDS, the following policy and procedures are intended to insure the privacy and protect the rights of all students and employees of Hillcrest Educational Centers.

A. Legal Effect of This Policy Statement
This instrument is an expression of policy. It is not intended to and does not want to modify contractual or other legal rights held by the Hillcrest Educational Centers’ students or employees. This statement is not intended to and does not create or modify Hillcrest Educational Centers’ legal duty of care to students or employees.

B. Definitions:
“HEC” means the Hillcrest Educational Centers, Inc.
“Student” means a student, who has been admitted to, enrolled in, and is residing at the agency, and who has not graduated, transferred, or discharged from HEC, or who has been otherwise removed from active status for any reason.
“Employee” means a person, including an administrator, who receives wages or a salary from HEC.
“HIV” means the Human Immunodeficiency Virus, sometimes referred to as the Human T-Lymphotropic Virus, Type III (HLTV-III) or the Human T-Lymphotropic Virus, Type III/Lymphaadenopathy Associated Virus (HLTV-III/LAV)
“HIV test” means a properly performed test licensed by the U.S. Food and Drug Administration to detect the presence of HIV antibodies or antigens in a person’s blood.
“AIDS” means Acquired Immune Deficiency Syndrome caused by HIV, as well as the condition sometimes referred to as AIDS-Related Complex (ARC).
“Person with HIV infection” means a person who is infected with HIV, whether the person has AIDS or some symptoms of AIDS or is asymptomatic.
“Person believed to have HIV infection” means a person believed to have HIV infection
“Person believed to be at risk of HIV infection” means a person believed to be at risk of contracting the HIV infection by a student of employee of HEC.

C. General Policy
1) HEC will not discriminate against students or employees with HIV infection, students or employees believed to have the HIV infection, or students or employees believed to be at risk of the HIV infection on the basis of their perceived risk.
2) HEC will conform its policies regarding persons with HIV infection to the law, the best available scientific and medical evidence and the imperatives of human dignity, including privacy.
3) HEC will treat students and employees with HIV with respect and will, where necessary, accommodate such students and employees accordingly.
4) Since HIV is not known to be transmitted by food or air, according to the latest available scientific and medical evidence, HEC’s students and employees will follow standard sanitary procedures related to preparing food and cleaning eating-ware, regardless of the presence at HEC of a person with HIV infection or believed to have HIV infection.
5) Since HIV is not transmitted through sharing bathroom facilities, and standard sanitary procedures will prevent the growth of fungi and bacteria that may potentially cause illness to immuno-compromised people, HEC’s students and employees will follow standard sanitary procedures in sharing and cleaning bathroom facilities, regardless of the presence at HEC of a person with HIV infection or believed to have HIV infection. Toothbrushes and razors should not be shared under any circumstances but in particular because of HIV status.
6) Since HIV is transmitted through blood, semen and vaginal secretions, as are other pathogens, and since according to the latest scientific and medical evidence HIV is not transmitted by sweat, feces, urine, vomit, tears, saliva, sputum or nasal mucous, unless these fluids contain blood, HEC’s students and employees will follow the Universal Precautions issued by the Center for Disease Control to clean up all bodily fluids, in handling materials, such as clothing and sanitary napkins, that have come in contact with bodily fluids, regardless of whether those bodily fluids are from a person with HIV infection or believed to have HIV infection and regardless of whether or not the body fluid is considered to contain blood.
7) HEC will educate students and employees about HIV infection/AIDS so that they will understand that they need not feel threatened by the simple presence at HEC of persons with HIV infection, persons believed to have HIV infection, or persons believed to be at risk of HIV infection.
8) HEC will not tolerate, and will strive to prevent and eliminate, any possible discrimination or harassment by students or employees directed at persons with HIV infection, persons believe to have HIV infection, or persons believed to be at risk of HIV infection.

D. Students
1) Students or prospective students, or their parents or guardians who know that the students or prospective students have HIV infection must disclose this information to the Coordinator of Nursing Services in order to facilitate appropriate medical treatment and counseling. Students with AIDS or with clinical evidence of HIV, who are too ill to receive treatment in a residential facility should have an alternative treatment in an appropriate medical or hospital setting.
2) It is assumed that HIV infected students can be served in residential facilities and that their diagnosis does not pose any special consideration in terms of physical facility requirements. In some unusual circumstances, however, a student may exhibit exceptional behavior that poses a theoretical risk to other students or employees. Such behavior would consist of engaging in sexual activity with other students, using parenteral drugs, frequent incontinence and public defecation. Those students whose behavior is determined to be unmanageable should be transferred to an appropriate setting.
3) HEC will not require prospective students to undergo HIV tests as a condition of admission. However, HIV testing may be done after admission in the following circumstances:
a. If the authorization for Diagnostic Testing has been signed by the legal guardian during the pre-placement process and that student has exposed peers or staff to his/her own body fluids.
b. If testing for HIV is requested by a student and the guardian consents and , an HEC physician orders testing. In this case, results would be available to HEC staff as outlined in section D, # 10 of this policy. If the student is 18 years old or older, and competent, guardian consent would not be needed.
c. Anonymous testing may be arranged, if requested by a student, for any student 13 years old or older, at the Neighborhood Health Clinic with no guardian consent, in this case results will not be made available to HEC or any HEC staff.
4) HEC will not deny admission to prospective students with HIV infection, believed to have HIV infection, or believed to be at risk of HIV infection, on the basis that they have HIV infection, are believed to have HIV infection, or are believed to be at risk of HIV infection. HIV infection is not considered a communicable infectious disease for the purpose of the provision elsewhere in this policy. HEC will not admit a student without verification that the student is free from communicable / infectious disease.
5) The person with HIV infection and /or AIDS has a somewhat greater risk of encountering infections in a residential program. In the event of an outbreak at HEC of a communicable disease, nursing will immediately notify the Medical Director of any students with HIV/AIDS infection and follow the directives given, including if necessary transfer and/ or quarantine within HEC, if possible, or at another facility.
6) HEC will not deny students with HIV infection, believed to have HIV infection, or believed to be at risk of HIV infection, any rights, privileges, benefits, or status as students on the basis that they have HIV infection, are believed to have HIV infection, or are believed to be at risk of HIV infection.
7) HEC will not require or request students undergo HIV testing as a condition for obtaining, or retaining rights, privileges, or benefits as a student,
8) If a Program Director has a reasonable belief that a student has HIV infection, the Program Director may request that the school physician refer the student to an appropriate medical setting for an HIV test and, if necessary, treatment. At an appropriate medical setting, the student will be administered an HIV test only after the student or the student’s parent or guardian voluntarily signs an informed consent form consistent with section D, #5 above.
9) A student’s HIV test results, whether positive or negative, will be placed in a sealed envelope labeled “Confidential Medical Information.” HEC will determine whether to maintain any such sealed envelopes in individual students’ medical records or in a separate file with restricted access. Release of test results shall be in accordance with Section D, # 10 below.
10) Testing for HIV antibody is not recommended for any purpose other than early intervention and treatment. HEC will restrict information regarding a student’s HIV status to as few employees as is possible, and will strive to maintain maximum feasible confidentiality. Only employees with an absolute need to know should have medical knowledge of a particular student. In individual situations this might include one or more of the following:
a) student
b) parent or guardian
c) administrators
d) direct care staff, if deemed appropriate by HEC’s community based healthcare provider for employees (e.g., Occupational Health) after an exposure.
e) nursing/medical staff
f) clinical staff
11) If the Medical Director determines that he/she should release a student’s HIV test results in circumstances not mandated by law to anyone other than an employee of HEC, the managing physician, or the student’s parent or guardian, HEC must first obtain the voluntary consent, in accordance with Section D, #3 above, of the student or the student’s parent or guardian.

Employees

1) HEC will not dismiss, refuse to hire, refuse to advance in employment, or otherwise discriminate against persons with HIV infection, believed to have HIV infection, or persons believed to be at risk of HIV infection.
2) HEC will not require that employee or prospective employees disclose their HIV status.
3) HEC will not require that employees or prospective employees undergo HIV testing as a condition of application or employment.
4) Information voluntarily provided by an HEC employee of their HIV status shall be kept confidential and contained in a separate medical file.
5) If requested to do so, HEC will make every effort to accommodate an employee diagnosed with HIV, AIDS , or any other infectious disease.

Purpose:

To screen all Students for Tuberculosis in order to ensure their safety and control cross infection of students and staff on campus, as recommended by the Centers for Disease Control.

Applies to:

ALL Hillcrest Educational Centers, Inc., Students and Employees.
Components:

1. Routine T.B. Screening
a. ALL new employees, except those known to be skin test positive, shall be given a skin test by Occupational Health using 5 t.u. (.1 ml) of

PPD.
b. ALL students are required to present documentation of PPD screening within 60 days of admission. For past positive reactors, a chest X-ray or TB Clinic Report, prior to acceptance, is required in lieu of testing. Such situations will be reviewed by the medical director on admission and follow up will be done as ordered.
d. ALL students in residence will be given a TB screening every year and a TB test planted if indicated. Positive reactors who have completed adequate preventative treatment do not need repeat chest films, unless they have pulmonary symptoms, which may be due to TB.

2. Testing After Potential Exposure:
a. Immediately following significant exposure to an employee, or student having suspected tuberculosis, all PPD negative persons at risk, will be skin tested. If the test is negative, it will be repeated 12-weeks after exposure, in accordance with CDC Guidelines.
b. Positive reactors do not require a skin test or chest film following exposure, unless they have symptoms suggestive to Tuberculosis.

3. Follow-Up:
a. Employees or Students with a positive skin test, will be required to have a chest X-ray. Those who convert from negative to positive, or have suspicious chest X-rays, will be referred to the Tuberculosis Clinic, or to a private Physician.

4. PPD Skin Test Interpretation
a positive skin test will be defined as follows:
a. 10 mm. induration is considered positive in:
1) Persons having recent close contact with an individual with active T.B.

2) Individuals with a chest X-ray and History consistent with, prior untreated T.B.
b. 15 mm. induration will be considered positive for ALL others.

5. Responsibilities of the Nursing Department
a. Administer TB screenings and TB skin tests if indicated, refer for follow-up, as indicated.
b. Keep appropriate records of each Student.
c. With post-exposure TB testing:

1. Notify exposed personnel, and arrange for skin tests. It is the responsibility of the exposed person to be tested within 5 days of notification.

2. ANY exposed person, who does not have documentation of negative results, cannot return to work, as recommended by the CDC.

3. Notify ALL exposed Personnel and arrange for skin tests to be repeated in 12 weeks.

4. Refer ALL appropriate personnel to a private physician or the Tuberculosis Clinic.

5. Inform the positive (PPD or chest X-ray) personnel to return to work with documented proof of follow-up care, prior to returning to work, as per CDC Guidelines.
d. Notify the Board of Health in accordance with MGL C71, S555A.
e. NO facilities for isolation are available at Hillcrest Educational Centers. If a student who is previously negative is found to have active TB, IMMEDIATE transfer to a health care facility where isolation is available must be arranged.

Policy:
It is the Policy of HEC to have an effective TB Control Program, which includes early detection, and treatment of persons with active TB.

Purpose:
To reduce the risk of TB transmission in the residential setting.

Program:

I. The ICC is responsible for the design, implementation, and maintenance of the TB Infection Control Program.
II. Policies are developed, implemented, and enforced to ensure early detection of Students and staff who may have infectious TB.
III. Prompt triage and appropriate management of Students and staff who may have TB infection, are done in the Outpatient Setting.
IV. Prompt diagnostic evaluation, and treatment for persons who may have infectious TB
V. Education and training of staff about TB and the effective methods for prevention of TB transmission
VI. Prompt evaluation of possible episodes of transmission of TB on the campus, including health care workers Purified Protein Derivative (PPD) skin test conversions, clusters of cases in health care workers or students, and contacts of TB patients who were not promptly detected and isolated.
VII. Coordination of activities with Local Public Health Department, emphasizing reporting, adequate discharge follow-up, ensuring continuation, and completion of therapy.