1. Background
The healthcare environment exposes medical/nursing students (UME/BN) and residents (GME) to a variety of infectious agents due to the nature of their clinical training, which includes direct care of infected patients and the handling of potentially infectious materials and biological samples.
As part of their professional duties, medical/nursing students and residents can be exposed to bloodborne pathogens, respiratory pathogens, and other communicable diseases that are prevalent in hospital and clinical settings. These specific healthcare-related risks require the development of a clear policy to minimize and control the possibility that medical students and residents could develop preventable health-care related infections during their training as well as they could be the source of infection for patients that they take care of.
The increasing recognition of healthcare-associated infections and the importance of protecting among healthcare workers from this risk has been reflected in global health guidelines, such as World Health Organization (WHO), and those from several national health institutions, such as National Institutes of Health (NIH), and the Center for Disease Control and Prevention (CDC). Most internationally recognized universities all over the world have adopted policies aimed at minimizing risks of transmission of infectious diseases among medical students and residents, including our strategic partner UPenn.
2. Rationale
- Healthcare workers (including medical/nursing students and residents) safety: Ensuring the health and safety of medical/nursing trainees is essential not only for their well-being but also for preventing the potential spread of communicable diseases within the healthcare and even academic setting.
- Patients’ Health Protection: Healthcare trainees are often at the forefront of patient care, and their own health status can directly impact patients’ safety, especially in vulnerable populations they care for.
- Personal responsibility: As well as any healthcare professionals, nursing and medical trainees have both ethical and professional responsibility to maintain optimal health to perform their duties effectively while minimizing risk to patients, staff, and themselves.
- University responsibility: In addition to the hospital site, the University sponsoring and managing the educational programs have administrative and, in some cases, legal responsibility to control and minimize the healthcare professional risks for both students’ wellness and patients’ safety.
- Evidence-Based Practice: Many studies in the healthcare organizations demonstrate that screening, monitoring, and immunization for infectious diseases significantly reduce occupational healthcare-related risks in general.
3. Aims
The general aim of this policy is to ensure that medical/nursing students and residents undergo the necessary health assessments to identify and manage risks related to healthcare-related communicable diseases during their clinical training and work.
The specific objectives are mainly two:
- Establish periodic health check-ups: Regular health check-up for relevant communicable diseases, in order to reduce the risk of transmission within the medical community.
- Establish immunization requirements: Mandatory immunization protocols, in order to prevent the spread of preventable infectious diseases in healthcare settings.
In addition to being consistent with the evidence-based practice and international guidelines, both these actions have to be also consistent with national epidemiological situation and legal regulatory framework.
4. Recommendations
- Required Screenings: Prior to beginning the training at the hospital site(s), nursing/medical students and residents/fellows must undergo a comprehensive health evaluation that includes all the items below (in the case of undergraduate students, compliance with the items below will be mandatory before the end of their first year of studies):
- General health check-up: according to the general admission requirements of the University, based on Ministry of Health recommendations.
- Tuberculosis screening: A tuberculin skin test (TST) or interferon-gamma release assay (IGRA) for TB.
- Immunization/vaccination status: Verification of current immunizations based on official immunization records (and/or serological testing, if available) for Hepatitis B, MMR (measles, mumps, rubella), varicella (chickenpox), pertussis, polio, meningococcus, tetanus and TB.
- Recommended Screenings: Prior to beginning the training at the hospital site(s), nursing/medical students and residents/fellows are recommended to undergo bloodborne pathogen serological testing (Hepatitis B, HCV and HIV).
- Vaccinations: Before the beginning of the training at the hospital site(s), medical/nursing students and residents are required to undergo vaccinations for preventable communicable diseases, in case they are not immunized yet for: HBV, MMR, VZV, pertussis, polio, meningococcus, tetanus, TB, COVID-19, and influenza. The VinUniversity student clinic personnel will provide a list of locations where students can receive the required vaccinations. Any cost for required vaccinations will be borne entirely by the student.
- Post-Exposure Protocol: In the event of a potential exposure to a communicable agent (e.g., needle stick injury, exposure to bodily fluids), the individual must report the incident immediately to the occupational health department of the clinical training site for evaluation and follow-up, which may include prophylactic treatment and further immunization where indicated. However, it is recommended that the individual also informs the student health clinic for further assistance. In the event the incident occurs on VinUniversity campus, then the student should report to the student health clinic for assistance and instruction.
- Immunization Exemptions: Any student or resident who cannot receive a required immunization due to medical or religious reasons must provide appropriate documentation. In such cases, alternative measures, such as additional protective protocols, may be implemented.
5. Monitoring and Compliance
This policy will be enforced through the following measures:
- Documentation: Medical records will be kept to ensure compliance with immunization and screening requirements. The records will be securely stored at the VinUni student clinic.
- Verification: Each student and resident will be responsible for ensuring that their immunization and screening status is up to date.
- Follow-up: Students and residents will be monitored for any changes in their health status, particularly following potential exposures to communicable diseases.
6. Conclusion
By adhering to this policy, our institution will ensure that medical and nursing students and residents are adequately protected from communicable diseases, reducing the risks to themselves, any other healthcare workers and patients. This policy aligns with the latest international guidelines and best practices, promoting a safe and effective learning and working environment.
7. Supportive documents
Medical References
Legal References
- Law on Prevention and Control of Infectious Diseases 2007 (Law No.03/2007)
- Law on Medical Examination and Treatment 2023 (Law No.15/2023)
- Decision No. 3671/QD-BYT