9.01 General Information
Personal Responsibility: The learning and practice of medicine involves exposure to infectious agents. Personal risk can be minimized by intelligent attention to immunization, Standard Precautions, and other preventive measures. The following sections outline these measures.
Professional Responsibility: Harvard Medical School subscribes to the AAMC’s statement of professional responsibility in treating patients with HIV, adopted by the Executive Council of the AAMC on February 25, 1988:
Medical students, residents, and faculty have a fundamental responsibility to provide care to all patients assigned to them, regardless of diagnosis. A failure to accept this responsibility violates a basic tenet of the medical profession—to place the patient’s interest and welfare first.
Immunization: Under Commonwealth of Massachusetts legislation, students must present evidence of vaccination against measles, mumps, rubella, tetanus, diphtheria, pertussis and hepatitis B in order to matriculate at Harvard Medical School. Students should have received one dose of Tdap (Tetanus, Diphtheria, acellular Pertussis) booster vaccine. In addition, Harvard Medical School and the Harvard School of Dental Medicine require students to have blood tests to verify serologic immunity to measles, mumps, rubella and hepatitis B (see below for more about hepatitis B) and either vaccination or serologic immunity to varicella (chicken pox).
The Centers for Disease Control and Prevention (CDC) and the Association of American Medical Colleges (AAMC) urge that all students present proof of immunity to polio. Having a record of other immunizations you may have received would be helpful for Harvard University Health Services.
All medical and dental students are required to have a tuberculin skin test during the six months before matriculation and every year thereafter. The test must be read by a physician or a nurse practitioner and documented in writing. Students known to be skin-test positive should consult a physician at the Medical Area Health Service (MAHS), as should those exposed to patients with active tuberculosis.
Students who have not been tested for serologic immunity or who have not followed the recommended tuberculosis testing schedule will not be allowed to register for clinical clerkships. Vaccinations, serologic testing and tuberculosis skin testing are available to medical and dental students through the Medical Area Health Service. Charges for vaccinations may apply.
N.B.: A history of having had measles, mumps, rubella (German measles), or hepatitis B does not meet the respective requirement. Only documentation of a blood test for antibodies to the disease agent is acceptable.
The only circumstances under which you may be exempted from the Massachusetts Immunization Law and the requirements of Harvard Medical School and the Harvard School of Dental Medicine for serologies are as follow:
- You have certification, in writing, by a physician who has personally examined you and is of the opinion that your physical condition is such that your health would be endangered by one or more of the required immunizations; or
- You state in writing that such immunizations as required would conflict with your religious beliefs.
Infection Control: Students exposed to or with infectious or communicable illnesses, including diarrheal illness; pertussis (whooping cough); shingles; tuberculosis (TB); methicillin resistant Staph. aureus (MRSA) infection; Group A strep. infection; or draining lesions on the hands, must consult with Harvard University Health Services/Medical Area Health Service. In addition, a student in such circumstances should consult with the infection control office in the institution wherein the exposure occurred or where the student is doing a clerkship about the advisability of working with patients and to be sure he/she is following the local regulations. When caring for patients with certain respiratory infectious diseases, students must adhere to local regulations regarding precautions, including wearing appropriate masks. All students must be mask-fit tested prior to starting their first clinical clerkship (see 9.09).
Hepatitis B: Harvard Medical School adheres to recommendations by the Centers for Disease Control and Prevention (CDC) for management of hepatitis B-infected health-care providers and students (http://www.cdc.gov/mmwr/PDF/rr/rr6103.pdf or www.cdc.gov/mmwr/preview/mmwrhtml/rr6103a1.htm) and complies with nondiscrimination obligations under the Americans with Disabilities Act, Section 504 of the Rehabilitation Act, and Title VI of the Civil Rights Act. CDC recommendations focus on HBV-infected health care providers and students who perform “exposure-prone procedures” that pose an increased risk of provider-to-patient transmission of hepatitis B (See CDC Recommendations above, Table 2: BOX. CDC classification of exposure-prone patient care procedures, Category I). Such procedures include, for example, major abdominal, cardiothoracic, and orthopedic surgery; repair of major traumatic injuries; vaginal deliveries; and major oral or maxillofacial surgery. According to the CDC, “Category I procedures, especially those that have been implicated in HBV transmission, are not ordinarily performed by students fulfilling the essential functions of a medical or dental school education.” No oversight by an expert panel is required for the kinds of procedures ordinarily performed by medical students, e.g., phlebotomy, placing of intravenous lines, medication injections, needle biopsies, lumbar puncture, insertion of tubes (nasogastric, endotracheal, rectal, urinary catheters), endoscopic/bronchoscopic procedures, etc.
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