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Additional information for medical students

UCL Workplace Health undertakes confidential medical assessments for medical students coming to study at UCL.

The following information is for medical students only and should be read in conjunction with the confidential medical assessments information for student groups

Hepatitis B, Hepatitis C and HIV

All students should be offered Exposure Prone Procedure (EPP) screening. Any student who declines EPP screening can complete non-EPP medical training, Students who have a positive blood results can complete training if certain criteria are fulfilled.

From our consent form: The information in this document is designed to support informed consent to being tested for Blood Borne Viruses (BBVs) and to provide answers to the questions you may have about screening.

NOTE: If you first require more information or have any queries you can discuss matters, in confidence, with a clinical member of staff from UCL Workplace Health prior to testing.  Please call (020) 7679 2802 or email uclstudentoh@ucl.ac.uk to arrange this.

Why are medical students being offered additional health screening?

The Public Health England requires additional health screening for all new health care workers, including medical students, who participate in Exposure Prone Procedures (EPP – see definition on page 5). This requires that you undergo testing for Hepatitis B, Hepatitis C and HIV. At the time of testing you must show photo ID (passport or driving licence), so please bring that with you.

Will I require rescreening?

Routine re-screening of newly qualified doctors in the UK will not normally be required if they are new graduates of UK Medical Schools.  However, students will still be bound by their professional obligations to inform the Occupational Health Department if, after original screening, they may have been exposed to risk of contracting a BBV.  Based on an individual risk assessment further testing could be required.

Detectable antibodies to blood borne viruses may not develop until some weeks after infection, so a test carried out in the first 3 months after an exposure may not be reliable.  A test carried out after this time is more likely to be accurate.  Examples (non-exhaustive) of risk factors for blood borne viral disease and carrier status include:

  • You have ever injected drugs using equipment shared with someone else
  • You have been accidentally exposed to blood of a person infected with Hepatitis B, Hepatitis C or HIV (e.g. a needle-stick injury)
  • Blood transfusions where blood is not effectively screened for blood borne viruses
  • You have had unprotected penetrative sex (i.e. without using a condom)
  • You have had a tattoo or body piercing in places with poor procedures for sterilising equipment or materials.
  • Medical or dental treatment in countries where Hepatitis B, C or HIV is common and where equipment may not be sterilised properly.

What are the advantages of being tested for blood borne viruses?

Advantages include:

  1. You’ll be able to plan your career.  If your blood tests are negative, the whole range of medical careers will be open to you.
  2. You will be able to participate in exposure prone procedures.  Exposure prone procedures can form an important part of medical training and, although not mandatory, UK medical schools believe that students should not be denied the opportunity to undertake them.
  3. EPPs comprise part of the normal work of a significant number of clinicians and there is, therefore, a national requirement for a substantial proportion of the postgraduate medical workforce to be competent in EPPs.
  4. If your blood tests are positive for infection, then some careers, particularly in surgical specialties, will not be open to you, unless you had treatment to eradicate or supress the infection. Early diagnosis has a positive impact on morbidity and mortality.  For Hepatitis B and C, it is easier to treat an infection in the earlier stages.  For HIV, once diagnosed, a person can be monitored and anti-viral treatment started before irreversible damage to the immune system occurs.
  5. You will be complying with your professional duty to get tested if you have been at risk.
  6. If you have been worrying about possibly being infected, a test can give you certainty.  If negative, it can provide you with peace of mind.  If positive, you can start to take control of your problem.
  7. If you turn out to be infected, you can take steps to limit the risk of transmission to others, including sexual partners.

What are the disadvantages of being tested?

There are some potential disadvantages to being tested for these infections, which you should be aware of. These include:

  1. Discovering that you are infected with blood borne viruses can be stressful.
  2. If you are infected you may have difficulty obtaining life insurance. (Insurance companies do not impose higher premiums simply because a person has had a test for HIV or hepatitis).
  3. Some countries will not grant visas to foreign nationals infected with HIV.
  4. You may encounter prejudicial behaviour from others if they discover you are HIV or hepatitis C positive.
  5. If you have had unsafe sex in the past, a negative test may give a false sense of security and tempt you to continue this risky behaviour.
  6. If you have been at risk of exposure in the past 12 weeks, a test now may be falsely negative. You should defer testing until 12 weeks after your last risk.
  7. Tests can yield false positive results. However, this risk is very small.

Why is testing required?

Hepatitis B and C can cause a chronic infection of the liver, which over time can lead to cirrhosis and death from liver failure or cancer.  A person may be a carrier of hepatitis B (have the antigen) even though they appear to have a satisfactory surface antibody level. For this reason, hepatitis B antibody and antigen are tested. We also test for core anti-body to check if you have natural immunity to hepatitis B (meaning you have had the disease and cleared it naturally).  Hepatitis B and C infection can sometimes be suppressed or eradicated with medication.

Human immunodeficiency virus (HIV) infection is a chronic condition which over a period of years progressively damages a person’s immune system, eventually causing AIDS. There is no cure for HIV at present, but treatment with anti-viral drugs can suppress viral replication enough to prevent or slow down the damage to the immune Public Health England recommends that all new healthcare workers, whether undertaking EPPs or not, should be offered the opportunity of having tests for hepatitis B, hepatitis C and HIV carrier status.

A blood borne virus carrier may be unaware that he or she is infected with a blood borne virus.  If a student who is infected with any of the viruses injured themselves during an EPP this could allow the virus to be transmitted to the patient.  As new healthcare workers, under Department of Health requirements, medical students who wish to participate in EPP must first be tested under identity validated conditions for hepatitis B, C and HIV.

If you are found to be a carrier of a blood borne virus you must accept OHS advice. As part of this, you will not be allowed to assist with, or undertake, surgical procedures unless you are able, following treatment, to fulfil certain criteria (see below). This restriction will be formalised by the Medical School. You will still be permitted to continue on the course and qualify as a doctor.

What will happen if I do not agree to be tested?

Testing is voluntary. If you do not agree to be tested, Workplace Health will inform the medical school that you are not cleared for participation in exposure prone procedures.

What will happen if I am not cleared for participation in exposure prone procedures?

The medical school is required to have robust procedures in place for ensuring that students who have not received health clearance do not participate in exposure prone procedures. As well, a responsibility lies with the students to ensure that they and their patients are not put at risk.

If you have not been cleared, whether through declining testing or because of a positive result, the medical school will be advised and arrange for you to be counselled about the limitations that you should place on your practice.  This restriction will be formalised by the Medical School and you will be required to agree to conformity with the list of restrictions on your clinical training.

How will the testing be carried out?

The Department of Health has strict requirements for the management and quality control of testing. These include: validation of identity by photographic proof at the time the sample is taken; taking of blood in standardised conditions; and use of an accredited laboratory, (e.g. one holding full or provisional accreditation status issued by Clinical Pathology Accreditation UK Ltd)  which is experienced in performing the necessary tests and which participates in appropriate external quality assurance schemes.  All these conditions will be met by the service provided by UCL Workplace Health.

What pre-test counselling will be offered?

The principal method of pre-test is this fact sheet. This is consistent with current BBV screening practices in other sectors of the health service, such as antenatal care. However, as already stated, if you first require more information or have any queries you can discuss matters, in confidence, with a clinical member of staff from the Workplace Health team prior to testing or on the day. Where indicated or requested, a separate appointment at Workplace Health will be made.

What post-test counselling will be offered?  

Students who test positive for a BBV will have an appointment with the Occupational Health Physician who will facilitate referral to your General Practitioner who will arrange any required treatment.  You will be informed of your result by email or telephone first. No further counselling will be offered if your result is negative but is available upon request. A copy of the laboratory report will be provided. This is usually within a week to 10 days after the blood is taken.

What should I do if I am concerned that I may have risk factors placing me at higher risk of a positive test?

If you believe that you are at higher risk of having a blood borne virus infection, you may undertake screening as planned. However, you may wish to seek advice and personal counselling from Workplace Health, and/or from another health professional, prior to testing. If you have had exposure to risk within the preceding twelve weeks, you should contact Workplace Health for advice.

Can I undertake testing for health clearance through an alternative route?  

In order to meet the administrative and quality standards required by the Public Health England, tests must be undertaken in a UK accredited laboratory having been undertaken in an Occupational Health Department. Testing all medical students in the required timeframe requires significant resources and it is therefore expected that students will attend for testing as scheduled. If you have a scheduling clash, as per the information you will have received from the medical school, your appointment with Workplace Health takes priority.

Why do I need to be tested if an Occupational Health Service has already tested me for this?

The PHE guidelines require photo identity validated samples for EPP health clearance so if your results state that identity was verified and were processed in a UK accredited laboratory then the results you have may be acceptable. Please bring them with you to your appointment.   

Who will have access to test results?

The Workplace Health will advise any employing/hosting NHS Trust/ Human Resource/Medical School if you are able to undertake EPP or not. They will not have access to your blood test results.

References and further reading.

Definition of Exposure-prone procedures (EPPs)                

Exposure-prone procedures (EPPs) are those invasive procedures where there is a risk that injury to the worker may result in the exposure of the patient’s open tissues to the blood of the worker. These include procedures where the worker’s gloved hands may be in contact with sharp instruments, needle tips or sharp tissues (e.g. spicules of bone or teeth) inside a patient’s open body cavity, wound or confined anatomical space where the hands or fingertips may not be completely visible at all times. However, other situations, such as pre-hospital trauma care, should be avoided by healthcare workers who are restricted from performing EPPs.  Restrictions are also placed in obstetrics and renal medicine. 

Procedures where the hands and fingertips of the worker are visible and outside the patient’s body at all times, and internal examinations or procedures that do not involve possible injury to the worker’s gloved hands from sharp instruments and/or tissues, are considered not to be exposure-prone, provided that routine infection-control procedures are adhered to at all times.  

Examples of procedures that are not exposure-prone include: 

  • taking blood (venepuncture);
  • setting up and maintaining IV lines or central lines (provided that any skin-tunnelling procedure used for the latter is performed in a non-exposure-prone manner, i.e. without the operator’s fingers being at any time concealed in the patient’s tissues in the presence of a sharp instrument);
  • minor surface suturing;
  • the incision of external abscesses;
  • routine vaginal or rectal examinations;
  • Simple endoscopic procedures.