Policy Statement
All Keck School of Medicine students must comply with appropriate strategies to reduce their personal risk of acquiring infections or transmitting infectious diseases such as Hepatitis B, C, and/or HIV in the health care setting.
Policy Requirements
- All medical students are required to obtain the vaccinations mandated by the Keck School of Medicine before beginning medical school, and to update their vaccinations as required to protect themselves, patients, and other health care personnel from preventable diseases.
- All medical students infected with any chronic transmissable infection are required to discuss their situation with a physician at USC Student Health.
- Acceptable alternate educational experiences will be developed whenever possible to provide sufficient educational benefit to students who have significant HBV, HCV, or HIV infections; however, there may be some instances where a comparable experience will not be possible. In all cases, the student will be responsible for meeting all graduation requirements of the Keck School of Medicine.
- Students are encouraged, but not required, to meet with faculty advisors regarding the potential impact that a possibly transmissable disease may or may not have on their future career and specialty choice.
Procedures
- To comply with KSOM policies, all medical students infected with any chronic transmissible infection are required to discuss their situation with a physician at USC Student Health. This discussion includes an evaluation of their current health status (or review of data previously collected elsewhere), and consideration of the impact their infection or status may have on patients seen during their training. Given the advances in recent years in the treatment of chronic transmissible infections students are encouraged to seek optimal medical management, including treatment with anti-viral medications when appropriate. To the extent possible, this process will respect and maintain the confidentiality of all involved parties; however, the USC Student Health physician will have permission to share pertinent information with an expert review panel. The expert review panel will track and monitor all cases described above. Test results are to be submitted to the expert review panel every six months while the student is on any surgery or obstetric/gynecology clinical rotations. The expert panel will be assembled according to the Society for Healthcare Epidemiology of America (SHEA) 2022 whitepaper and may include the USC student health clinical epidemiologist, , USC Student Health physician(s), a representative from KSOM, USC legal counsel, and/or the student’s treating medical provider with expertise in the management of chronic Hepatitis B. The health status of any affected student will not routinely be released to other members of the health care team, staff, faculty, or patients. The expert review panel will review the student’s infection status information and make recommendations regarding the clinical activities in which the student can appropriately participate.
Hepatitis B:
- Students who do not have a positive HBsAb after completion of two lifetime FDA approved Hepatitis B vaccine series (preferably with at least one series of the 2-dose CpG-adjuvanted recombinant vaccine) must provide serological evidence of not being previously or currently infected with Hepatitis B virus (negative Hepatitis B surface antigen and negative Hepatitis B core antibody).
- Students who are deemed “non-converters” after completion of approved Hepatitis B vaccine series and negative serological tests for Hepatitis B infection will be required to have annual screening while on clinical rotations for Hepatitis B with a HBsAg and HBcAb.
- Students who have positive serological screening for Hepatitis B infection will also be required to have Hepatitis B PCR and Hepatitis B e antigen tests.
- Students who have an HBV PCR viral load of 1000 IU/ml or greater, or have a positive HBeAg, may pose a greater risk to patients when performing Category III exposure –prone procedures as defined in the SHEA 2011 guidelines and will have restrictions regarding full participation in these exposure prone procedures.
- Students will not have any restrictions if the following criteria are met:
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- HBV viral load is consistently less than 1000 IU/ml;
- have no prior documented transmission in a health care setting;
- are compliant with the recommendations of the oversight panel;
- followed by a specialist in the management of Hepatitis B disease with monitoring at least every 6 months.
- Students with chronic Hepatitis B infection who may be rotating on surgical or obstetrics/gynecology rotations are required to have HBV PCR testing at least every 6 months, regardless of their HBeAg status.
Hepatitis C:
- Students with a positive Hepatitis C status must have their viral load checked at least every six months and are expected to be followed by a physician with expertise in the management of Hepatitis C infection.
- Given the recent advances in the treatment of Hepatitis C, students will be encouraged to seek optimal management, including treatment with effective anti-viral agents to achieve cure of the viral infection.
- Students with a Hepatitis C status whose viral loads are greater than or equal to 2000 IU/ml will be restricted from participating in Category III procedures.
- Students with a positive Hepatitis C status whose viral loads are less than 2000 IU/ml will not have any restrictions of participation in clinical training, including performance of Category III procedures, but are required to double glove when performing any invasive procedures and for any contact with mucous membranes or non-intact skin.
HIV:
- Students with a positive HIV status must have their viral load checked at least every six months and are expected to be followed by a physician with expertise in the management of HIV infection.
- Students with a positive HIV status whose viral loads are greater than or equal to 200 copies/ml will be restricted from participating in Category III procedures until they have achieved virologic suppression.
- Students with a positive HIV status whose viral loads are less than 200 copies/ml will not have any restrictions of participation in clinical training but are required to double glove when performing any invasive procedures and for any contact with mucous membranes or non-intact skin.
Reviewed and approved: May 1, 2024
Medical Education Executive Council