Health & safety
Healthcare p rofessionals and students have an above-average exposure to infectious diseases. Risk can be reduced by:
1. Frequent hand washing
2. Practising standard precautions
Needlesticks and other occupational exposures can lead to infection with HIV, Hepatitis B and Hepatitis C. Avoid being infected by blood-borne and other pathogens by practising standard precautions and avoiding as much as possible di rect exposure to human body fluids.
- Take care in handling, cleaning or disposing of sharp needles, scalpels etc.
- Always dispose of ?sharps' safely. Discard all sharps in designated sharps containers immediately after use.
- Use protective bar riers (gloves / goggles / waterproof aprons /waterproof footwear) when appropriate and possible.
- Immediately and thoroughly wash hands and other skin surfaces that are contaminated by blood or other body fluids.
- Routinely wash hands before and after examining a patient or client.
3. Being immunised
Immunisation can drastically reduce your chances of contracting many diseases. Keep your recommended immunisations up-to-date.
Hepatitis B immunisation must be administered to all healthcare workers. It is compulsory for all undergraduate Health Sciences students to have received a full course of Hepatitis B immunisations by the end of October in your first year of study. If you are in First Year, you will not be permitted to register for your Second Year until you have submitted written proof that you have received a full course of such immunisations.
Immunisations can be obtained from the Student Wellness Service (by appointment - telephone 021 650 1020), your own GP and certain pharmacies. Other immunisations that are strongly recommended include an annual influenza immunisation, Hepatitis A (if non-immune) and Chickenpox (if non-immune).
Exposure to tuberculosis is inevitable in your training as a health professional. The lifetime risk of tuberculosis following exposure is about 10%, with about 3% occurring in the first few years. If you have HIV infection this risk increases to 10% per annum. Drug resistant tuberculosis is particularly difficult to treat. Drug resistance is more common in patients who have previously been treated for tuberculosis.
Various measures can be taken to reduce exposure:
- When in contact with patients with an unexplained cough, formally identified pulmonary TB patients presenting for the 1st time, or confirmed drug-sensitive tuberculosis patients who have not been on anti-tuberculous treatment for ≥ 2 weeks, you must wear an N95 particulate filter respirator mask of the correct type and size for your face as identified when fit-tested.
Note that an ordinary surgical mask is completely ineffective in preventing your being infected with TB. If, however, you yourself have TB, a surgical mask will help prevent your infecting someone else. And remember that an N95 mask is only effective if worn in the correct way.
Under normal working conditions, an N95 mask will remain effective for at least 8 hours of continuous use. Mask efficacy is reduced if it becomes torn or moist. If the N95 mask is used intermittently, then it will be effective for 1-4 weeks, depending on the frequency of use. It is best to store these masks in a paper packet between use. Finally regarding masks, please be aware that facial hair can impair N95 mask efficiency. If you choose nonetheless to wear a beard, you need to be particularly careful when in contact with tuberculosis patients.
- Where possible, avoid patients with smear-positive pulmonary tuberculosis (the most infectious form), unless you are directly involved in their care. These patients should be rapidly placed on effective therapy. If they are hospitalised they should be nursed in a side ward with good ventilation (difficult to achieve in many hospitals.) Only if you are directly involved in such a patient's care should you enter and then only if you are wearing an N95 mask.
- If at all possible, avoid contact with patients who are known to have, or are suspected to have multi-drug resistant (MDR) or extensively-drug resistant (XDR) pulmonary tuberculosis. The general rule for students is that you must NOT enter an isolation cubicle accommodating a patient with MDR or XDR pulmonary tuberculosis or a patient with extrapulmonary drug resistant tuberculosis where pulmonary involvement has not been ruled out. The only exception currently is Audiology students who are may be required to monitor the hearing of MDR-TB patients while they are on treatment. In this case, every conceivable precaution must be taken to minimize the risk of infection including the wearing of a new, properly fitting N95 respirator mask.
Please note that in general you should not receive bedside teaching from clinical staff involving patients with MDR or XDR pulmonary tuberculosis. If this happens nonetheless, please inform your tutor or supervisor who will be able to confirm whether or not there was good reason for departing from this general guideline.
- Preventive anti-tuberculous therapy is indicated for healthcare workers who are immune-suppressed from medication or illness (notably HIV infection). It is therefore critical to know your HIV status. The precise regimen is unclear - isoniazid 300 mg daily for 6 months is appropriate following exposure, but if exposure is ongoing (as it will be until at least after your community service) ongoing isoniazid is probably indicated and should be discussed with an infectious disease specialist.
Remember what the common symptoms associated with tuberculosis are:
- night sweats
- loss of appetite
- loss of weight
If these symptoms occur, please seek medical advice from UCT's Student Wellness Service without delay.
If you are found to be positive for TB, you are asked to advise (confidentially) the Faculty's Student Development and Support team so that you can be given the support and essential follow-up that you will require. In these circumstances you are also required to stay out of class and out of the work environment until you are sputum-negative for drug sensitive TB and for a longer period to be determined by the doctor attending to you after sputum-negativity for MDR TB.
- Make sure that you are familiar with the other infectious diseases to which you might be exposed - in addition, that is, to tuberculosis [see above]. Know what symptoms to watch out for and, if you detect any of them or simply feel ill, consult your GP or the Student Wellness Service without delay.
- Consult the Student Wellness Service or a general practitioner if unwell.
- Stay at home if you have signs and symptoms of an infection. Avoid infecting your colleagues and clients by staying away if you are vomiting, have diarrhoea or are running a fever.
Please familiarise yourself with the Faculty's policy on Reducing the risk of tuberculosis in undergraduate Health Sciences students.
HIV AND AIDS
Test regularly and know your status!
It is vital that everyone knows their HIV status.
It is even more vital for you as student health professionals. Among the reasons for this is that one of the occupational hazards that you face, is accidental exposure to blood and other body fluids that may be infected with HIV. Should you suffer such an exposure, your treatment will be crucially determined by whether you are HIV positive or negative.
Another occupational hazard that you face as student health professionals is above-average exposure to TB. We are all at risk of contracting TB but those of us who are immunocompromised, are at even greater risk and must practice extra care in taking the necessary precautions. For this reason it is absolutely essential that we know our HIV status and whether or not we are immunocompromised.
Therefore, make sure that you go regularly for HCT (HIV Counselling & Testing). It's quick and easy: a few drops of blood are taken with a finger prick and the results are obtained in about 15 minutes. You can expect to be provided with counselling before and after the test.
There are many places that you can go for HCT including any clinic or community health centre. On-campus the UCT Student Wellness Service provides free testing.
To test at the Student Wellness Service rooms at 28 Rhodes Avenue, Mowbray, call 021 650 1020 or 021 650 1017 for an appointment: Mondays - Fridays 08h30-16h30 (except Thursdays when they open at 09h30).
Alternatively drop-in at room 5.07, level 5, Sports Centre, Upper Campus - no appointment required: Mondays - Thursdays 10h00-15h00.
Information and advice
For more information and confidential advice on issues relating to HIV and AIDS, contact HAICU (HIV/AIDS Institutional Co-ordination Unit) on 021 650 1006 or visit their website.
Visit the University's policy on HIV & AIDS.
You might be feeling really ?down' or you might be worried that a friend or classmate of yours seems seriously depressed and you want to help.
Maybe you want some more information before deciding what to do.
For a wealth of helpful information visit South African Depression and Anxiety Group (SADAG) or call them on 011 262 6396 or 0800 20 50 26 and speak to a trained counsellor who can assist you further. SADAG's offices are open 7 days a week from 08h00 to 20h00.
Alternatively you could consider approaching either the Student Wellness Service's Counselling Services on 021 650 1017 or 021 650 1020 (Mondays - Fridays 08h30-16h30 [except Thursdays when they open at 09h30]) or the Student Development and Support team by emailing Nonkosi Malala or calling her on 021 406 6749.
Among the emergency numbers on the UCT Counselling Services' website are the following that you might find useful:
Psychiatric Crisis & Emergency Support
C23 Psychiatric Emergency Unit
Groote Schuur Hospital
Tel: 021 404 2175
Tel: 021 461 1111 / 3
Suicide Crisis Line
Tel: 0200 567 567 (Toll free)
Stress and trauma are occupational hazards for student health professionals.
If you are concerned about how you or a friend are coping, get help as soon as possible.