Information for RCSI Students
Infectious Diseases Procedures and General Health
Background
Students and practitioners in the health care professions have always faced the possibility of exposure to infectious diseases such as Hepatitis B and TB. Equally, both have had a responsibility to protect their patients from infections which they might introduce. While the risks are small, the increasing efficiency of preventive measures such as vaccination has highlighted the importance of these diseases and measures to deal with them. RCSI has introduced procedures to offer both students and patients protection against Hepatitis B, Tuberculosis and several other common diseases.
By law, medical, nursing and physiotherapy students (but not pharmacy) are classified as Category A Healthcare Workers and must be screened for and protected against the following diseases:
· Hepatitis B
· Hepatitis C
· TB
· Varicella/zoster
· Measles
· Mumps
· Rubella
· Meningitis C
· Influenza, incl H1N1
Apart from this document, it is also important to read the RCSI Blood Borne Virus Policy.
By participating in this vaccination programme, students are agreeing to the following:
· appropriate tests and clinical follow-up for Hepatitis B and Hepatitis C
· vaccination for Hepatitis B and follow-up testing, if deemed necessary
· screening for Tuberculosis if necessary
· screening for immunity to measles, mumps, rubella and chicken-pox and to subsequent vaccination for these if necessary
· positively participation in other health screening measures as deemed appropriate by RCSI, eg anti-influenza vaccination in clinical years or MRSA screening prior to certain clinical placements
· RCSI providing evidence of compliance with these procedures to affiliated clinical partners when requested
This is complex work involving individual assessment, gathering formal documentation of previous vaccinations, blood tests to confirm current immune status for different diseases, administration of a vaccination programme (unique to each individual), and appropriate follow up. This work is carried out by the RCSI Student health service based in Mercer’s Medical Centre.
Prior to their first attendance at Mercer’s, all students must complete and submit a questionnaire (here). This should be filled out completely and emailed to Mercer’s before your initial attendance.
Please note: we will only be using your mobile number or RCSI email address to contact you (not gmail or other). If you change your phone number, it is your responsibility to inform us by calling 01-4022 300 or dropping the information into Mercer’s Medical Centre.
As this Programme continues over several years, it is vital that students inform Mercer’s if they have:
· New contact details (address or mobile number)
· Change in their health status (eg new diagnosis)
It is also important that students attend for appointments when requested. There are approximately three thousand attendances required per year to run this Programme, and we cannot offer individual appointments. All RCSI staff are aware of this Programme and understand that you may have to miss some lectures to attend. Failure to attend because of a lecture is not a valid excuse.
The most time-consuming element here is vaccination against Hepatitis B – this comprises 3 shots over a six month period with a follow up blood test two months later to confirm seroconversion. Up to 10% of students will be negative at this point and will need to have the entire course again. This obviously has implications for starting clinical attachments, doing electives etc, and is another reason to start the programme as early as possible. Many elective hospitals and prospective employers seek confirmation of your immunisation status. If this is not completed and supplied to them, then there will be no elective or job.
Pregnancy
Most of these vaccines are contra-indicated in pregnancy. It is extremely important that you do not proceed with vaccinations if you are, or may become, pregnant over the course of the immunisations. You should discuss this with the clinical staff in Mercer’s Medical Centre.
The bulk of this work should be done in first year. Subsequent clinical years will need much less done for them but will still require some attention (eg rechecking Hep C prior to IC3, annual influenza vaccinations, screening for MRSA).
The average first year will need to be seen on five occasions (although some may need up to ten attendances, eg if their initial Hep B course is unsuccessful), while in later years a single annual attendance is likely to be sufficient for most students.
Costs
A) First years, including Pre-Med and Pre-Physio:
(ie: all new RCSI students, except Pharmacy)
€250 Health Screening Package to cover the first year screening, and vaccination programme (Hepatitis B; Hepatitis C; Measles; Mumps; Rubella; Varicella; Tuberculosis).
This cost is to be paid when you check in for your first visit, using cash, cheque or credit/laser card. This is a standard capitation fee, payable by all students, irrespective of past vaccination history or number of attendances required. The vaccination programme will not commence until this fee is paid.
There will be an additional charge if Varicella vaccination is needed.
N.B. If you do not complete this first year vaccination programme by the end of September in your second year, you will be liable for additional costs as set out below.
B) Other years:
· There will be a €30 consultation fee which will cover:
· Elective form signing
· Copies of blood test results
· Official certification of immunisation and blood results
· If other blood tests are required, there will be a €30 consultation fee and a €30 charge for the tests.
· If vaccinations are required there will be an initial consultation fee of €30 and a charge for vaccines (see list below) unless provided free to Mercer’s by the HSE.
· These costs do not apply for MRSA screening or anti-influenza vaccination in clinical years or for Hepatitis C retesting in IC3
Vaccine / Dose / CostYellow Fever / 1 / € 40.00
Typhoid / 1 / € 35.00
Rabies 1.0 IM / 3 / € 60.00
Hepatitis B Adult / 3 + Blood test / € 35.00
Hepatitis A Adult / 1 / € 45.00
Hepatyrix (Hep A & Typhoid) / 1 / € 85.00
Twinrix Adult (Hep A & B) / 3 + Blood test / € 50.00
Revaxix (Tetanus/Diptheria/Polio) / 1 / € 40.00
Meningitis ACWY / 1 / € 45.00
Japanese B Encephalitis / 2 / € 80.00
Tick Borne Encephalitis / 3 / € 70.00
Cholera / 2 / €30.00
Varicella / 2 / €60.00
Blood Tests / Price
Hepatitis A, B, C,
Measles, Mumps, Rubella, Varicella / €30.00
Hepatitis B
1. First year students must attend for blood tests (Hepatitis B Surface Antigen, Hepatitis B Core Antibody, and Hepatitis B antibody if you have already had Hep B vaccinations) taken by the RCSI Student Health Service .
2. Non-immune students are required to be vaccinated against Hepatitis B through the programme carried out by the RCSI Student Health Service. Follow-up serology for evidence of immunity must be taken by the RCSI Student Health Service.
3. Students who show evidence of Hepatitis B or other serious infectivity are referred to the RCSI document Standard Operating Procedures/Policy on Blood Borne Viruses.
4. www.patient.co.uk/health/Hepatitis-B-Immunisation.htm
Hepatitis C
1. All students will be screened for Hepatitis C in first year and again prior to their clinical attachments.
2. http://www.patient.co.uk/health/Hepatitis-C.htm
Measles, Mumps and Rubella
1. Students must provide evidence of having received two doses of MMR.
2. Students who cannot provide evidence of having received both doses of MMR will receive a booster dose of MMR carried out by the RCSI Student Health Service.
3. Student without any prior vaccination should receive both doses of MMR, given at least one month apart, unless otherwise contra-indicated.
4. http://www.patient.co.uk/health/MMR-Immunisation.htm
Chicken pox
1. Students without a definite history of chickenpox or vaccination will be considered non immune, and will be tested for the presence of immunity to Varicella Zoster virus.
2. Non-immune students may need vaccination against VZV through the programme carried out by the RCSI Student Health Service. Vaccination via Student Health will incur an additional cost to the Healthcare Screening Package fee.
3. www.patient.co.uk/health.Chickenpox-in-Adults-and-Teenagers.htm
Tuberculosis
1. Students should have documented proof of prior BCG vaccination or on examination show a BCG vaccination scar.
2. If neither of the above is present then base line Mantoux testing should be performed in line with the procedure outlined in the National Immunisation Guidelines for Ireland.
3. You will also be asked to complete a simple symptom questionnaire.
4. http://www.patient.co.uk/health/Tuberculosis.htm
Meningitis C
1. Students should provide evidence of receiving one dose of Meningitis C vaccine.
2. Otherwise, students will be offered vaccination (a single shot).
3. http://www.patient.co.uk/health/Meningococcal-Group-C-Immunisation.htm
HIV
The policy for screening for HIV infection is under review at present.
http://www.patient.co.uk/health/HIV-and-AIDS.htm
MRSA
Some of the clinical locations for RCSI student attachments have now requested that students demonstrate that they are not carriers of MRSA (methicillin-resistant Staphylococcus aureus). This is a bacterial infection which is usually harmless to the healthy but can cause severe problems for vulnerable patients. More information is available here: http://www.patient.co.uk/health/MRSA.htm
Students doing one of these attachments must therefore attend Mercer’s Medical Centre to have a nasal swab taken to confirm the absence of MRSA before they start their clinical attachment.
The RCSI Clinical Co-Ordinator (Dr.Claire Condron) will inform you of a dedicated clinic time allocated to do this work and it is important that you attend at that time. Given the number of students involved, Mercer’s cannot offer individual appointments and if you miss the dedicated clinic, then your attachment will not proceed.
The results are usually available after one week and will be emailed to you. If you have not received your results within ten working days, please contact Mercer’s at 01 – 4022 300. The result may also be forwarded to the relevant clinical attachment, as evidence of RCSI compliance with the requested procedure.
The vast majority of such screens (>99%) are negative and for those individuals, that is the end of the process. However, if your swab comes back as positive for MRSA, you will need to undergo:
· further swabbing (nose/groin/any areas of broken skin)
· treatment – usually just an ointment or other topical treatment in the first instance
· three sets of follow-up swabs to ensure clearance
· redeployment until clear.
In the very unlikely event of a student being permanently colonised, then this will require careful assessment and occupational health advice.
Outbreak Situations
1. In the event of an outbreak of any infectious illness on campus, in clinical locations or in the wide local community, students are required to adhere to all infection control measures recommended during that outbreak.
2. Students who contract an infectious illness should adhere strictly to the minimum period of isolation recommended and must not return to the clinical environment until that period has elapsed and they have recovered from their illness.
3. Students should avail of any other appropriate immunisation as and when recommended during an outbreak situation. This may include obtaining boosters to previously completed primary immunisation courses.
Students who show evidence of active infection at any stage of their medical career will be required to withdraw from patient contact, undertake treatment and demonstrate non-infectivity before re-admission.
ADVICE TO DOCTORS WITH SERIOUS CONTAGIOUS/INFECTIOUS DISEASES
It is unethical for doctors who believe that they might be infected with a serious contagious disease (e.g. Hepatitis, HIV etc.) not to seek and accept advice from professional colleagues as to how far it is necessary for them to limit their practice in order to protect their patients. Colleagues who are consulted have a dual role. They must counsel and support the doctor concerned, but they must ensure that the doctor does not pose a risk to patients and others. If such a risk exists, the Fitness to Practice Committee must be informed as soon as possible.
A Guide to Ethical Conduct and Behaviour, 1998
The Medical Council
It is the College’s opinion that the above Medical Council advice applies equally to clinical students. Students have a responsibility to protect the interests of the public and their colleagues and to inform the College if any form of physical, mental or other ill-health appears to seriously affect competence and responsibility to patients.
Summary of Process
1. All new students are invited to an Orientation Day, where you will be given initial information on this screening and vaccination programme.
2. You will then receive an email with detailed information.
3. It is important that you then read the two key documents available online (Infectious Diseases Procedures and General Health and Blood Borne Virus Policy).
4. Please then complete the RCS Student Vaccination/Screening Programme Form and submit online.
5. You should receive an email confirmation that this Form has been successfully received.
6. Mercer’s Medical Centre will then contact you by email with the date and time of your first appointment. It is most important that you attend at the scheduled time. We cannot offer alternative appointments. All RCSI staff are aware of this Programme and understand that you may have to miss some lectures to attend for this. Failure to attend because of a lecture is not a valid excuse.
7. If you have supporting documentation about previous vaccinations or illnesses, please bring it with you to the first appointment.
8. At the end of that initial meeting, you will be given a follow-up appointment.
Frequently Asked Questions
Where can I get a copy of the Vaccination/Screening Programme Form?
Click here
Who must complete the Vaccination/Screening Programme Form?
All incoming male and female students, regardless of age, must complete the Form.
What should I do if my physician doesn’t speak English?
You will need to have the information needed for the form and all your relevant records translated into English.
Can I scan my immunization records and send them attached to an e-mail?
No. Email isn’t a secure way of sending documents, and we take the confidentiality of your medical information very seriously.