THE UNIVERSITY OF NORTH CAROLINA AT CHAPEL HILL

Policy on HIV-Infected and HBV-Infected Employees* and Students
Who are Engaged in University Patient-Care Activities

1. Introduction and Purpose
2. Employee and Student Rights
3. Employee and Student Responsibilities
4. Reporting Requirements
5. Obligations of Confidentiality and Limitations on Disclosure
6. Notification to Patients
7. Exposure-Prone Procedures
8. Universal Precautions in Treatment
9. Expert Panel Membership
10. Expert Panel Responsibilities
11. Department Chair, Dean, and Division Chief Responsibilities
12. Alternative Patient-Care and Career Opportunities
13. Applications for Enrollment
14. Effective Date

THE UNIVERSITY OF NORTH CAROLINA AT CHAPEL HILL

Policy on HIV-Infected and HBV-Infected Employees* and Students
Who are Engaged in University Patient-Care Activities

1. Introduction and Purpose

The medical, scientific, and legal understanding of AIDS, HIV infection, and HBV infection is still evolving. In order to respond to the challenges of both HIV and HBV infection with safety, sensitivity, and flexibility, based on the best currently available medical, scientific, and legal information, it is the policy of The University of North Carolina at Chapel Hill to review, evaluate, and respond on an individual case-by-case basis to any instances of HIV and HBV infection among University employees or students engaged in patient-care activities, according to the guidelines provided herein.

This Policy supplements the Policy on AIDS issued by the Chancellor in February, 1986. This supplemental Policy is intended specifically to address issues relating to employment and enrollment of employees and students of The University of North Carolina at Chapel Hill engaged in patient-care activities. When University employees or students are engaged in patient-care activities at facilities other than those of The University of North Carolina at Chapel Hill (for example, at The University of North Carolina Health Care System), the policies of those institutions must also be observed insofar as they are applicable.

2. Employee and Student Rights

University employees and students who are seropositive for the human immunodeficiency virus, or who have AIDS, or who are infected with Hepatitis B virus will not be excluded from participating in University patient-care activities, or restricted in their access to University patient-care services or facilities, because of their health status, unless medically-based judgments in individual cases establish that exclusion or restriction is appropriate for the welfare of patients, the welfare of other members of the patient-care community, or the welfare of the infected individual.

3. Employee and Student Responsibilities

University employees and students engaged in patient-care activities are encouraged to know their HIV and HBV status. Any student or employee engaged in patient-care activities who knows, or has reasonable basis for believing, that she or he is infected with HIV or HBV is expected to seek expert advice about his or her health circumstances and is obligated, ethically and legally, to conduct himself or herself responsibly, in accordance with such knowledge, for the protection of patients and other members of the community.

1. Any employee who knows, or has reasonable basis for believing, that he or she is infected with HIV-1 or HBV, and who may perform, in connection with his or her employment, patient-care procedures that may have the characteristics of exposure-prone procedures, is required to share that information, on a confidential basis as provided within this Policy in Section 4, so that the University can act to protect the welfare of patients and other members of the University community and can respond appropriately to the employee's health and employment needs. An employee who does not share that information as provided in this Policy may be subject to disciplinary action, up to and including dismissal.
2. Any student who knows, or has reasonable basis for believing, that he or she is infected with HIV-1 or HBV, and whose curriculum may require that he or she perform patient-care procedures that may have the characteristics of exposure-prone procedures, is required to share that information, on a confidential basis as provided within this Policy in Section 4, so that the University can act to protect the welfare of patients and other members of the University community and can respond appropriately to the student's health and educational needs.

4. Reporting Requirements

Upon learning or forming a reasonable belief that he or she is infected with HIV or HBV, or at a high risk of developing an HIV or HBV infection, an employee or student who performs, or may have occasion to perform, procedures that have the characteristics of exposure-prone procedures described herein must desist immediately from performing such procedures and must comply with (a) – (c), below:

5. Obligations of Confidentiality and Limitations on Disclosure

The University recognizes the importance of protecting, to the greatest extent possible and within the bounds provided by law, the confidentiality and privacy of any employee or student found to have HIV or HBV infection. Accordingly, such information will be handled by University employees who come into possession of this information with the same degree of care and sensitivity accorded to other types of highly confidential medical information. However, because the University also has the responsibility to protect patients, employees, and students from the harmful acts or conditions of its employees and students, there cannot be a guarantee of complete confidentiality that may interfere with this responsibility. Accordingly, it is a condition of employment and enrollment that employees and students subject to this Policy agree to the disclosure of information regarding their HIV or HBV infection as provided hereafter and for the purposes set forth herein.

Information concerning the health status of an employee or student with HIV or HBV infection must not be disclosed by University employees who come into possession of this information unless:

(e) This disclosure is required to protect the public health.

The number of persons within or outside of the University to be advised of the existence and, if necessary, the identity of an employee or student with HIV or HBV infection will be kept to an absolute minimum. Information should be shared only to the degree necessary to permit the expert panel of the Chancellor's Task Force on AIDS and the University administration (as hereinafter provided) to respond as provided by this Policy. Determining who does or does not have a legitimate and significant need to know about a particular case of HIV or HBV infection is a difficult question that, in case of doubt, is ultimately resolved by the Chancellor or his delegate, the Chair of the Chancellor's Task Force on AIDS. That Task Force is available to assist any member of the University community needing guidance on such matters.

6. Notification to Patients

The public health benefit of notification of patients who have had exposure-prone procedures performed by employees or students found thereafter to be infected with HIV or positive for HBeAg shall be considered on a case-by-case basis, taking into consideration an assessment of specific risks, confidentiality issues, and legal responsibilities. Carefully designed and implemented follow-up studies may be necessary to determine more precisely the risk of transmission that may have existed during such procedures. Decisions regarding notification and follow-up studies will be made by the University administration in consultation with State and local public health officials and the expert panel of the Chancellor’s Task Force on AIDS.

7. Exposure-Prone Procedures

All employees and students who perform procedures that have the characteristics of exposure-prone procedures described herein in this Section should know their HIV and HBV status. Employees or students who perform procedures that have the characteristics of exposure-prone procedures described herein and who do not have serologic evidence of immunity to Hepatitis B from vaccination or from previous infection should know their HBsAg status, and if that is positive, they should also know their HBeAg status.

Designation and definition of exposure-prone procedures will be provided in connection with consideration of individual employees and students pursuant to this Policy by the appropriate medical/surgical/dental services on a case-by-case basis. Characteristics of exposure-prone procedures may include, but need not be limited to, digital palpation of a needle tip in a body cavity or the simultaneous presence of the employee's or student's fingers and a needle or other sharp instrument or object in a highly confined anatomic site or a site where visibility is poor. Performance of exposure-prone procedures may present a recognized risk of percutaneous injury to the employee or student, and -- if such an injury occurs -- the employee's or student's blood is likely to contact the patient's body cavity, subcutaneous tissues, and/or mucous membranes. However, the presence of any of the characteristics listed does not necessarily require the characterization of a particular procedure as exposure-prone. Such characterization shall be on a case-by-case basis as provided in Section 10.

8. Universal Precautions in Treatment

All employees and students engaged in patient-care activities must adhere at all times to relevant Universal Precautions, as outlined by the Centers for Disease Control, including the appropriate use of hand washing, protective barriers, and care in the use and disposal of needles and other sharp instruments. All employees and students who have exudative lesions or weeping dermatitis must refrain from all direct patient care and from handling patient-care equipment and devices used in performing invasive procedures until the condition resolves. Such individuals must be reassigned to other appropriate activities until such time as such condition resolves. All employees and students must also comply at all times with current guidelines for disinfection and sterilization of reusable devices used in invasive procedures. Employees may seek additional advice from the University's Environment, Health and Safety Office. Students may seek additional advice from the Office of Student Services in their respective schools.

Deans, Department Chairs, Directors, and Division Chiefs are charged with the responsibility for seeing that the guidelines and policies referred to in this Section are widely disseminated and enforced. Each employee and student, however, must assume responsibility for the protection of patients and his or her own protection by properly following recommended infection control practices.

9. Expert Panel Membership

The expert panel of the Chancellor’s Task Force on AIDS shall be comprised of, but need not be limited to, the following: the employee's or student's personal physician(s); a representative of the Student Health Service (in the case of a student whose personal physician is other than an employee of the Student Health Service); an infectious disease specialist with expertise in the epidemiology of HIV and HBV transmission; a specialist in infection control; an ethicist; the Dean of the School or his or her delegate; and a representative of The University of North Carolina Health Care System. The University Vice Chancellor and General Counsel will advise the Panel. If the individual's personal physician is unavailable, then the Chair of the Task Force will appoint a physician from the Department of Medicine (in the case of an employee) or from the Student Health Service (in the case of a student) .

At the request of the Dean of the School where the employee or student is employed or enrolled, and with the approval of the Vice Chancellor for Medical Affairs, the Chair of the Chancellor’s Task Force on AIDS shall modify the composition of the expert panel for employees or students whose patient-care activities are performed wholly or in part at The University of North Carolina Health Care System to achieve a review panel comparable to or identical to, as the Dean may request, any similar panel of The University of North Carolina Health Care System.

10. Expert Panel Responsibilities

The purposes of the expert panel are to:

The expert panel, upon completing its analysis, will submit its recommendations in writing to the Dean with a copy to the infected individual.

The panel recommendations are advisory and, thus, not binding on the Dean. The Dean, acting in accordance with all applicable University procedures and in consultation with the appropriate Vice Chancellor, is responsible for determining to what extent, if at all, the panel recommendations are to be accepted and implemented; provided, however, that the Dean's decision shall specify the circumstances under which, if any, the employee or student may perform or may resume performing exposure-prone procedures. Such circumstances could include notifying prospective patients of the employee's or student's seropositivity before the patients undergo such procedures. The Dean's decision may also provide that the employee or student must maintain a "log" which describes with particularity the actual circumstances (i.e., patient name, date, protocol) of any procedures performed.

The Dean, within ten working days of receipt of the panel recommendations, shall notify the infected employee or student of his or her determination in writing, which should include a copy of the panel recommendations.

The expert panel should meet on a regular or as-needed basis to reassess and, where appropriate, to modify its original recommendations as circumstances warrant. In the case of a student, these meetings may take place as curriculum or courses vary within a particular year, if necessary.

The University shall modify, restrict, or discontinue the employment and/or academic activities of an HIV-infected employee or student only in accordance with applicable University procedures, and only if the University through the procedures herein has determined that no reasonable accommodation exists that would enable the infected individual to perform his or her employment and/or academic activities without posing an unacceptable risk to patients or to himself or herself or others.

The University shall implement a decision to modify, restrict, or discontinue the employment and/or academic activities of an HIV-infected or HBV-infected individual as discreetly and confidentially as possible, with as little impact as possible to the person, his or her career, and his or her standing in the community.

11. Department Chair, Director, and Division Chief Responsibilities

Department Chairs, Directors, and Division Chiefs are expected to counsel HIV-infected and HBV-infected employees and students who perform invasive procedures that are not defined on a case-by-case basis as exposure-prone regarding proper infection control procedures (e.g., Universal Precautions and current recommendations on disinfection/sterilization). These individuals also are charged with the responsibility for seeing that proper infection control procedures are followed by employees and students. Employees or students infected with HIV or HBV who perform invasive procedures not identified on a case-by-case basis as exposure-prone will be able to perform such routine invasive procedures, provided the infected individual complies with established infection control guidelines (e.g., Universal Precautions and the like).

12. Alternative Patient-Care and Career Opportunities

Employees or students whose practices are modified because of their HIV or HBV infection status should, whenever possible, be provided opportunities to continue appropriate patient-care activities. Career counseling and job retraining are encouraged, to the extent resources permit, to promote the continued use of the individual's talents, knowledge, and skills. Employees and students whose practices are modified because of HBV infection should be reevaluated periodically to determine whether their HBeAg status changes are due to resolution of infection or as a result of treatment.

13. Applications for Enrollment

HIV-infected or HBV-infected applicants for enrollment in the schools of Medicine, Dentistry, Nursing, and certain other fields involved in patient care may wish to evaluate their career goals. First, they may wish to consider the implications of electing a prolonged period of medical, dental, nursing, or other education, with the significant possibility that they will become disabled during training or early in their career. Second, they may wish to consider various career choices because of the hazards of their exposure to infection in certain portions of medical, dental, nursing or other patient-care fields of education and practice. Third, they may wish to evaluate career choices after recognizing that barriers to certain exposure-prone procedures and fields of specialization within medicine, dentistry, nursing, or other patient-care fields may be imposed because of possible risks of infection to patients. Fourth, they may wish to consider the financial costs of such education in light of the personal health and career uncertainties that confront them. Students may seek additional advice through the Office of Student Services of the School in question.

14. Effective Date

This Policy is effective April 18, 1991, revised July 1, 2002.