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Guidelines Regarding Infectious Diseases and Occupational Health for Applicants to and Learners of Temerty Medicine Academic Programs

Lead Writer: Expert Panel on Infection Prevention and Control, Temerty Faculty of Medicine
Date of original adoption: March 3, 1997 
Dates revised: February 11, 2013, March 27, 2024

1. JURISDICTION:

This document applies to applicants to and all learners with patient contact within Temerty Faculty of Medicine in the following programs:

  • Medical Radiation Sciences
  • Occupational Science and Occupational Therapy
  • Physical Therapy
  • Physician Assistant
  • Postgraduate Medical Education (residents, fellows)
  • Speech-Language Pathology
  • Undergraduate Medicine (MD program)

Exceptions regarding applicability, procedures, or reporting for each type of learner, if any, will be noted below.

Graduate learners who do not have patient contact in their roles are excluded from these Guidelines but must comply with existing protocols. Graduate learners based on-campus comply with the regulations as set out by the University of Toronto’s Office of Environmental Health and Safety and graduate learners based off-campus comply with the protocols of the institute in which they work.

2. INTRODUCTION:

This document is evidence-based, developed and reviewed by an Expert Panel on Infection Prevention and Control, which is advisory to the Dean, Temerty Medicine. As detailed in its terms of reference (Appendix A), the Panel addresses matters pertaining to health professional students and learners in all Temerty Medicine programs and provides advice in all matters relating to these Guidelines.

The document complies with the previous OHA/OMA Communicable Disease Surveillance Protocols on infectious disease and occupational health and other relevant guidelines; however, students should follow practices as per their assigned training sites.

This document is distinct from the Faculty of Medicine programs’ Immunization Requirements, which are based on the Council of Ontario Faculties of Medicine (COFM) Immunization and Screening Policy. The COFM policyincludes immunization recommendations, and learners must fulfill these requirements before beginning a clinical placement. Please refer to specific program offices for forms and form completion procedures/deadlines regardingsubmission of immunization data.

Applicants to and students of the MD program must ensure compliance with the Undergraduate Education: Council of Ontario Faculties of Medicine (COFM) Blood Borne Viruses Policy, to which this document also adheres.

3. PURPOSE:

This document is intended to minimize the risk and impact of infectious diseases that may pose a threat to learners and those with whom they may come into contact. It is intended to address education requirements on methods of prevention, outline procedures for care and treatment after exposure, and outline the effects of infectious and environmental disease or disability on learning activities.

4. SCOPE AND RESPONSIBILITY:

These Guidelines refer to a “responsible party” for all matters related to reporting of situations involving applicants and learners with infectious disease. The “responsible party” in each Temerty Medicine program is as follows:

  • The implementation of this document for applicants to and learners in the Undergraduate Medicine (MD) program is the responsibility of the Associate Dean, MD Program.
  • The implementation of this document for applicants to and learners in Occupational Science and Occupational Therapy, Physical Therapy, Speech Language Pathology, and Medical Radiation Sciences is the responsibility of the respective Departmental Chairs or designate.
  • The implementation of this document for applicants to and learners in the Physician Assistant Program is the responsibility of the program Director.
  • The implementation of this document for applicants to and learners in Temerty Medicine graduate programs is the responsibility of the Departmental Chairs in consultation with the Vice Dean, Research and Health Science Education.
  • The implementation of this document for Postgraduate Medical Residents and Postgraduate Clinical Fellows, and for applicants to these positions, is the responsibility of the Associate Dean, Postgraduate Medical Education.

These individuals are responsible for informing the Temerty Medicine Expert Panel of any known/diagnosed positive TB, Hepatitis B, Hepatitis C, or HIV screening tests that are brought to their attention by learners in or applicants to their program(s).

5. DISSEMINATION OF INFORMATION:

Learners will be informed of this document through both oral and written notification upon admission and at the beginning of each academic/programmatic year. Applicants will be informed of this document through written admissions materials (online or in print).

6. GUIDELINES:

6.1. GUIDELINES FOR APPLICATIONS TO ALL TEMERTY MEDICINE UNDERGRADUATE, GRADUATE AND POSTGRADUATE EDUCATION PROGRAMS:

  1. Temerty Medicine will inform potential applicants that, if they are admitted into the program to which they are applying:

    1. they may be required to take part in the care of patients with various infectious diseases including Hepatitis, TB, and HIV/AIDS, during their studies;

    2. they will be trained in methods of preventing spread of infection to themselves, to other patients and other health care providers (including Routine Practices and hand hygiene);

    3. there is a risk that they may contract an infection during the course of their studies;

    4. they have a responsibility to prevent the spread of infection to others;

    5. they will be required to comply with the immunization requirements of the specific program to which they have applied within Temerty Medicine;

    6. if they have or contract an infectious disease (see examples in Section 7), they will be permitted to pursue their studies only insofar as their continued involvement does not pose a health or safety hazard to themselves or to others;

    7. they will be required to comply with the OMA/OHA Communicable Disease Surveillance Protocols that were developed in compliance with Regulation 965, Section 4, under the Public Hospitals Act. This regulation requires each hospital to have by-laws that establish and provide for the operation of a health surveillance program including a communicable disease surveillance program in respect of all persons carrying on activities in the hospital.

    8. they may be required to give body fluid specimens if they are exposed to or contract certain diseases while working in health facilities.

  2. Temerty Medicine requires successful applicants and learners to undergo TB and Hepatitis B testing, but does not require testing for Hepatitis C and HIV.

  3. Applicants with known/diagnosed active tuberculosis (TB), Hepatitis B, Hepatitis C, or HIV infection are required, upon acceptance, to inform the responsible party (as outlined in Section 4) of their condition. The diagnosis of any infectious disease in an applicant or learner shall remain confidential within a strict “need to know” environment.

  4. All newly admitted learners  to Undergraduate Medical Education (MD), Postgraduate Medical Education, graduate programs, Occupational Science and Occupational Therapy, Physical Therapy, Speech-Language Pathology, Medical Radiation Sciences, or the Physician Assistant Professional Degree program with known/diagnosed active tuberculosis infection will be reviewed by the Temerty Medicine Expert Panel, which will provide therelevant education director with recommendations regarding necessary curriculum/rotation adjustments.

    Newly admitted learners with HIV, Hepatitis B or Hepatitis C infection will only require assessment by the Expert Panel if they will be in a program that will, or may, involve the performance of or involvement with Exposure Prone Procedures (EPP). EPP are procedures where there is both a risk of injury to the learner, and a risk that the injury could result in exposure of a patient’s open tissues to blood. EPP include most major surgical, obstetrical and dental procedures and rarely some procedures performed under emergency situations (e.g. open cardiac massage). Thus, referrals to the Expert Panel will primarily come from Undergraduate Medical Education, Postgraduate Medical Education, and the Physician Assistant Professional Degree program. Where there is uncertainty about whether EPP may be performed, the applicant should be referred to the Expert Panel.

  5. As information on infectious diseases is a mandatory disclosure item on a learner’s application to the College of Physicians and Surgeons of Ontario (CPSO), Temerty Medicine may provide information and/or updates to theCollege regarding a learner’s immunization/infectious disease status and any recommendation regarding the learnerfrom the Temerty Medicine Expert Panel.

6.2. GUIDELINES FOR LEARNERS IN ALL UNDERGRADUATE, GRADUATE, AND POSTGRADUATE EDUCATION PROGRAMS IN TEMERTY MEDICINE:

  1. Temerty Medicine will inform enrolled learners that:

    1. they may be required to take part in the care of patients with various infectious diseases including Hepatitis, TB, and HIV/AIDS, during their studies;

    2. they will be trained in methods of preventing spread of infection to themselves, to other patients and other health care providers (including Routine Practices and hand hygiene);

    3. there is a risk that they may contract an infection during the course of their studies;

    4. they have a responsibility to prevent the spread of infection to others;

    5. they are required to comply with the immunization requirements of their program in Temerty Medicine;

    6. if they have or contract an infectious disease at any point prior to or during their program(see examples in Section 7), they will be permitted to pursue their studies only insofar as their continued involvement does not pose a health or safety hazard to themselves or to others;

    7. they are required to comply with the OMA/OHA Communicable Disease Surveillance Protocols that were developed in compliance with Regulation 965, Section 4, under the Public Hospitals Act. This regulation requires each hospital to have by-laws that establish and provide for the operation of a health surveillance program including a communicable disease surveillance program in respect of all persons carrying on activities in the hospital.

    8. they may be required to give body fluid specimens if they are exposed to or contract certain diseases while working in health facilities.

  2. Temerty Medicine requires learners to undergo tuberculosis (TB) and Hepatitis B testing, but does not require testing for Hepatitis C and HIV.

  3. Learners with a known/diagnosed infection for any of active tuberculosis, Hepatitis B, Hepatitis C, or HIV are required to inform the responsible party (as outlined in 4) of their condition immediately. The diagnosis of any infectious disease in a learner shall remain confidential within a strict “need to know” environment.

  4. All learners in Undergraduate Medical Education, Postgraduate Medical Education, graduate programs, Occupational Science and Occupational Therapy, Physical Therapy, Speech Language Pathology, Medical Radiation Sciences, or the Physician Assistant Professional Degree program with active tuberculosis infection will be reviewed by the University of Toronto, Faculty of Medicine Expert Panel on Infection Control, which will provide the relevant education director with recommendations regarding necessary curriculum/rotation adjustments.

    Learners with HIV, Hepatitis B or Hepatitis C infection will only require assessment by the Expert Panel if they will be in a program that will, or may, involve the performance of or involvement with Exposure Prone Procedures (EPP). EPP are procedures where there is both a risk of injury to the learner, and a risk that the injury could result in exposure of a patient’s open tissues to blood.  EPP include most major surgical, obstetrical and dental procedures and rarely some procedures performed under emergency situations (e.g. open cardiac massage).  Thus, referrals to the Expert Panel will primarily come from Undergraduate Medical Education, Postgraduate Medical Education, and the Physician Assistant Professional Degree program.  Where there is uncertainty about whether EPP may be performed, the applicant should be referred to the Expert Panel.

  5. As information on infectious diseases is a mandatory disclosure item on a learner’s application to the College of Physicians and Surgeons of Ontario (CPSO), Temerty Medicine will provide advice to the learner recommending required disclosure of information to the College regarding his/her immunization/infectious disease status.

6.3. GUIDELINES FOR LEARNERS WITH AN INFECTIOUS DISEASE:

  1. The learner must comply with the infectious diseases surveillance protocols adhered to by Temerty Medicine and its affiliated training sites, provide body fluid specimens as requested, and agree to be monitored by an infection control specialist, with regular reporting, if required.

  2. All learners are expected to be in a state of health such that they may participate in their academic and clinical programs, including patient care, without posing a risk to themselves or to others. Learners with an infectious disease may pursue their studies only insofar as their continued involvement does not pose a health or safety hazard to themselves or others. Such a health or safety hazard, if protracted, may preclude them from participation in certain aspects of clinical work essential to the satisfactory completion of their program of study.

  3. Learners who have symptoms of an acute illness that is likely infectious in etiology should not attend in the teaching site until their symptoms have improved; this includes but is not limited to fever, “colds”, cough, sore throat, vomiting, diarrhea, rashes, and conjunctivitis. Learners who are absent from mandatory educational activities due to illness should notify their program in accordance with the program-specific attendance/absence guidelines/policies.

    4. The diagnosis of any infectious disease in a learner shall remain confidential within a strict “need to know” environment.

6.4. GUIDELINES REGARDING LEARNERS’ PARTICIPATION IN CARE OF PATIENTS WITH INFECTIOUS DISEASES:

  1. Learners are required to participate in the care of all patients assigned to them, including patients with infectious diseases, to a level commensurate with their level of training. Such participation is necessary for the learner's education as well as for satisfactory completion of academic and clinical training requirements.

  2. All learners are expected to understand and adhere to infection control policies, including the principles of Routine Practices and hand hygiene, when participating in the examination and care of all patients, regardless of the diagnosis or known health status of the patient.

  3. Learners are responsible for conducting themselves in a manner that is consistent with the health and safety of themselves and others, and shall be given appropriate training to do so. Learners who fail to meet these responsibilities may, depending on the circumstances, face sanctions under the provisions of the University of Toronto Standards of Professional Practice Behaviour for all Health Professional Students.

6.5. GUIDING PRINCIPLES REGARDING LEARNERS WHO ARE EXPOSED TO AN INFECTIOUS DISEASE OR OTHER ADVERSE EXPOSURE IN THE COURSE OF THEIR TRAINING:

  1. Temerty Medicine requires that all educational programs have published documents outlining the course of action to be taken for learners who incur an injury or other medically- related incident, including an incident that may have placed them at risk of acquiring an infectious disease, during the performance of activities as a part of their educational program. Any such document must provide a course of action to promote both the emotional and physical wellbeing of the learner.

  2. Learners are expected to comply with the published documents in 6.5.1. Note: Under the UE:COFM Blood Borne Pathogen Policy Undergraduate Medical Education learners (MD students) are ethically obligated to know their serological status.

  3. Learners who develop markers of an infectious disease are required, as per 6.2.2, to inform the responsible party in their educational program of their status. The case will be then be handled as described in 6.2.3.

6.6. GUIDELINES ON LEARNERS WHO ARE EXPOSED TO AN INFECTIOUS DISEASE OR ADVERSE EXPOSURE DURING THE TIME PERIOD OF TRAINING OUTSIDE TRAINING ACTIVITIES:

  1. Note: Under the UE:COFM Blood Borne Pathogen Policy, Undergraduate Medical Education learners (MD students) are ethically obligated to know their serological status. Learners who may suspect they may have become infected with any of the infectious diseases included in Section 7 should seek medical attention.

  2. Learners who develop markers of an infectious disease are required, as per 6.2.2, to inform the responsible party in their educational program of their status. The case will then be handled as described in 6.2.3.

6.7. GUIDELINES ON CO-RESPONSIBILITY WITH TEACHING SITES:

Temerty Medicine and its teaching sites are jointly responsible for ensuring that learners are adequately instructed in infection control. This will include the following:

  1. The Faculty will provide to learners in all educational programs an introductory program on Routine Practices, hand hygiene, and other core competencies of infection control and occupational health, and will inform learners of their responsibilities with respect to infection control and occupational health.

  2. All Ontario hospitals are required to comply with the Communicable Diseases Surveillance Protocols for Ontario hospitals developed under the Public Hospital Act, Regulation 965. Compliance with these Protocols requires the hospitals to provide instruction in infection control precautions and occupational health to learners.

7. SPECIFIC INFECTIOUS DISEASES INCLUDED IN THIS DOCUMENT BUT NOT LIMITED TO:

Blood-borne pathogens: HIV/Hepatitis B, C

Enteric pathogens: Salmonella / Shigella / Campylobacter / E-coli 0:157/ Norovirus/Rotavirus

Other: Influenza / Meningococcal disease / Measles / Mumps /Rubella / Tuberculosis / Varicella / Pertussis/ Hepatitis A/Adenovirus Conjunctivitis

Appendix A

Expert Panel on Infection Prevention and Control: Terms of Reference and Review Process

The Expert Panel on Infection Prevention and Control (hereafter referred to as the “Panel”) is advisory to the Dean, Temerty Faculty of Medicine and, on an as needed basis, to the Deans of the Health Science Faculties at the University of Toronto. The Panel will address matters pertaining to health professional learners and provide advice in all matters relating to Guidelines Regarding Infectious Diseases and Occupational Health for Applicants to and Learners of Temerty Medicine Academic Programs.

1. Membership (Appointed by the Dean, Temerty Medicine or Designate)

Voting Members

  • Hospital Epidemiologist (Chair)
  • Hepatologist
  • HIV specialist / Infectious Disease Physician
  • Occupational Health Physician

Non-voting Members (required)

  • Representative from Postgraduate Medical Education
  • Representative from Office of Learner Affairs
  • Director, Enrolment Services & Faculty Registrar, MD Program

Non-voting Members (as required)

  • Representative from the Council of Health Sciences Education subcommittee
  • Health Professional Program Director(s)
  • Postgraduate Program Director(s)

Administrative support will be provided by the Office of the Vice Dean, Medical Education.

2. Appointment Process and Term of Office

Voting panel members are appointed as required by the Vice Dean, Medical Education, acting on behalf of the Dean.  Voting members shall have a term of three years, renewable.

3. Quorum

Consists of three voting members of the Panel, to include:

  • Chair; and
  • Two voting members.

The Chair may invite consultants to provide further expert opinion on complex situations or specific training program requirements.

4. Functions

At the request of the Dean (or delegate) the Panel will provide:

  1. Advice regarding practice or practice experience and monitoring for health professional learners identified to be infected with a blood-borne pathogen (BBP) or active tuberculosis infection.  The process for these recommendations is outlined below.
  2. Advice on policy and modifications of policy regarding blood-borne communicable diseases as they affect health professional learners of the Temerty Faculty of Medicine and other Health Science Faculties on an as needed basis.  
  3. Advice on modifications of and additions to the curriculum for health professional learners infected with blood-borne pathogens.
  4. Advice on matters relating to immunization policies and advice on surveillance for tuberculosis.
  5. Updates on policy dependent on new information, new vaccine availability or issues identified by the Temerty Faculty of Medicine and other Health Science Faculties on an as needed basis.  
  6. Reports on an annual basis to theMedical Education Executive Committee on the aggregated number of learners reviewed, types of issues and resolution.
  7. Advise on the development of guidelines and processes to address accommodation needs of vulnerable learners with respect to communicable diseases in the clinical workplace.
  8. Review cases referred to the (sub)committee and advise on appropriate infection control mitigation strategies for at-risk learners.

5. Process of Review of Health Professional Learners:

Guiding Principles: 

The health status of health professional learners shall remain confidential to the greatest extent possible. Infected health professional learners shall normally remain anonymous to the Panel.

Health professional learners with a communicable disease may pursue their studies only as long as their continued involvement does not pose a risk to themselves or others. 

Health professional learners will be required to comply with existing or future provincial communicable disease surveillance protocols.

Step One - Referral:

1.1 Referrals to the Panel shall be by the Associate Dean or Director of the relevant education program or designate or by the Associate Dean, Office Learner Affairs or designate.  Health professional learners may self-report, be identified by a licensing body or be identified as a non-responder after immunization.  The reason(s) for referral must be clearly stated and any relevant documentation included for the Panel Chair’s review.

1.2 Health professional learners with new or existing hepatitis B virus (HBV), hepatitis C virus (HCV) or human immunodeficiency virus (HIV) infection or active tuberculosis infection must notify the Associate Dean or Director of the relevant education program or designate, the Associate Dean, Learner Affairs (for those in the Temerty Faculty of Medicine)  or senior academics (for those in other faculties) who will consult with the Expert Panel and other experts as appropriate. Self-reporting by the learner must take place prior to the start of the academic session.

1.3 Senior academics from other University faculties will first consult with the Panel’s Chair for guidance in determining the appropriateness of the referral of cases related to learners in their Faculty.

Step Two – Pre-Review Process:

2.1   Health professional learners with new or existing HBV, HCV or HIV who may, as part of their education and training, participate in exposure prone procedures (EPP) will be reviewed by the panel. This will include all health professional learners that will be rotating on surgical, obstetrical and dental rotations, and emergence rotations, including electives. Where there is doubt about what constitutes an EPP, or which rotations may involve an EPP, the chair of the Expert Panel must be consulted. These  health professional learners shall be provided with a copy of these Terms of Reference.

2.2   Health professional learners with new or existing HBV, HCV or HIV that will not be performing EPP at any point do not require full panel review. These learners will receive information indicating the importance of following Infection Prevention and Control Routine Practices at all times during clinical rotations, the need to notify their program if their educational plan changes to involve EPP, and the steps that should be taken if any inadvertent exposure of a patient to the blood of the health professional learner occurs. Additionally, programs should have a mechanism to link health professional learners from outside Ontario with appropriate speciality care for their HIV, HBV, or HCV infection, if required.

2.3   Health professional learners with an active tuberculosis infection will be review by the panel. These learners shall be provided with a copy of these Terms of Reference.

2.4   Health professional learners that require Panel review will provide any written documents required for the Panel’s consideration to the appropriate administrative staff in the relevant Associate Dean’s or Director’s office in the Faculty of Medicine or the equivalent senior academic officer in other faculties. 

2.5   If a health professional learner requests an appearance before the Expert Panel, it will be granted.

Step Three - Panel Review:

3.1   The Panel Chair or designate shall assemble any documentation relevant for referral to the Panel including documents provided by the Associate Dean (or delegate), Director (or delegate), health professional learner, or others. The documents provided to the Panel at its meetings shall be retained confidentially in the custody of the Panel Chair or designate.

3.2   The Expert Panel will review relevant laboratory data and medical reports and level of training of the health professional learner. For all health professional learners, the relevant program director or supervisor will be invited to attend the meeting. Legal counsel will be sought by the Expert Panel when appropriate.  The Panel shall meet in camera; discussion of the health professional learner is conducted non-nominally.  However as gender, year of training, speciality and other personal information may be discussed, identification of the learner may be possible and Panel members must therefore be reminded not to disclose the name within the discussion or outside of the meeting.

3.3.  At or following the meeting, the Panel may:

a)  Determine whether there is a medical condition that affects or may affect the ability of a health professional learner to participate, perform or continue in their educational program and decide on a recommendation concerning the health professional learner; or

b)  Determine that further information or other medical assessment is required.  Any further medical information or other assessment shall be assembled by the appropriate staff in the relevant program office, and forwarded to the Panel Chair.

c)  Once any further information/assessment is completed and reports received, the Panel Chair will invite the health professional learner to meet to review the information and/or reports and sign the letter of contract with the Expert Panel.  The health professional learner shall be invited to provide any further written documents for the Panel, e.g. further medical assessment and monitoring requirements.

d) The Panel shall then meet to review the additional information, assessments, reports and/or health professional learner’s documents.  At or following the meeting, step 3.3 shall be repeated as necessary.

3.4   Deliberations and decisions of the Panel and the information received by the Panel shall be confidential except for such disclosure as is necessary for the Panel’s report.  The Panel will secure all documents relevant to the review process.

Step Four – Recommendation:

After the Panel determines with sufficient information, whether or not a medical condition exists that affects or may affect the ability of a health professional learner to participate, perform or continue in the educational program of their Faculty, the report of the Panel will include a recommendation that:

4.1   The health professional learner be allowed to continue in the program without modifications or accommodations to the program, or

4.2   The health professional learner be allowed to continue in the program with specified modifications or accommodations to the program, or

4.3   The health professional learner be allowed to continue in the program conditionally upon receiving appropriate further investigation and/or treatment, which may include further review and recommendations by the Panel, or

4.4   The health professional learner be allowed to continue in another program, with or without modifications or accommodations to that program (dependent on suitability, program capacity and approval), or

4.5   The health professional learner be required to withdraw either permanently or for an indefinite or specified period of time with appropriate investigation and/or treatment to be obtained, with re-registration conditional upon further review and recommendation by the Panel

Admission to or continuance in the program is dependent upon demonstrated compliance with Panel Recommendations.

The health professional learner appeals process will be that of the Temerty Faculty of Medicine and the University of Toronto. In the event that the health professional learner appeals a decision which is based upon a recommendation of the Panel, the documents provided to the Panel at its meetings may form part of the record for any appeals.

Step Five - Panel Report:

5.1  The determination and any recommendation of the Panel shall be reported in writing and be addressed to the appropriate Associate Dean or Director and copied to the Associate Dean, Learner Affairs. The health professional learner shall be provided with a copy of the report.