Student Health

University of Maryland Baltimore Campus Student Health UNIVERSITY OF MARYLAND IMMEDIATE CARE (UMIC) DEPT OF FAMILY & COMMUNITY MEDICINE

Our Mission To provide efficient, timely and evidence-based primary and urgent health care for students.

This includes a commitment: to track, review and report necessary immunizations and administer

vaccinations when due

to provide students with easy access to care when they are ill or injured to offer up-to-date health maintenance screenings and wellness exams to support students as they try to balance the stresses of work/training and

foster good mental, physical and nutritional wellbeing

to offer sexual health education, community resources/referrals, and easy

access to screening and treatment/prevention medication

to offer 24/7 access to care in the event of a blood borne pathogen exposure

(ex. needle stick incident)

Student Health Providers Mario Majette, MD Medical Director of Student & Employee Health

Elena Shu, CRNP

Niharika Khanna MD

Sarah Sampson, CRNP Associate Director of Student & Employee Health

Our goal is for students to see UMIC and the student health team as their health care home

Student Health Administrative Team Denise Mitchell, MA Student Health Coordinator

Akila, Taylor, MA

UMIC Care Team Elena Hernandez-Torres, Medical Practice Representative

Janine Parrish, Medical Practice Representative

Patrice Gray, MA

Shakieta Adams, MA

Where are we?

408 W Lombard Street •Upper Level – Immediate Care •By scheduled appointment

Mon – Fri 7a - 5p (last visit 4:45p) (667) 214 – 1899 •Lower Level – Student Health Administrative

Office

Mon – Fri 8:30a - 4:30p (667) 214 – 1847 shealth@som.umaryland.edu

Services 

Primary and preventive health care :   

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Routine adult wellness & GYN exams pre-operative exams chronic disease management

Urgent care need:            

Telemedicine Sick visits for common illnesses/injuries Minor in-office procedures Allergy shots Sexual health/contraception education, testing, treatment Sports Medicine evaluations available Travel Health Counseling Mental health issues, medication management Needle stick / Blood borne pathogen exposure evaluation COVID 19 testing Preexposure Prophylaxis (PREP) Immunizations, vaccinations and tuberculosis screening/reporting

Services

Prescriptions We will refill and continue appropriate medications for all students while they are members of the UMB community

For certain medications, including some pain medications, anxiety/sleep medications, and stimulants (ex. Adderall, Ritalin, etc), we require documentation prior to taking over prescribing. Please provide in advance or at the time of your visit all relevant medical records from your previous prescribing provider, which must include at least: 1.

the prescriber’s name,

2.

the medication name and dosing instructions and

3.

the diagnosis being treated (ex.

ADHD).

4.

the Testing confirming diagnosis

Prescribing of any controlled substances is up to the discretion of the student health provider.

Access 

Same day/next day scheduling of acute needs •

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Telemedicine appointments for acute needs 

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Activate your myportfolio account and download zoom application

Urgent Needs-In office evaluation •

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UMIC open 7am to 5pm (last visit 4:45pm)

You are advised to call ahead prior to arriving to the clinic. If there is no availability we will assess the immediacy of the need to be address and you may be worked into the schedule, otherwise you will be offered the next available appointment and asked to return at that time. In order to keep patients and our staff safe, we are preventing crowded waiting areas and are limited in the number of people we can have in the office at any given time.

Preventative care by appointment only •

Please schedule all annual physicals, pre-op’s, GYN/well-woman exams

•

Call 667-214-1899 to schedule

Immunization updates /Tuberculosis screening •

We moved to IGRA (Tspot/TB Gold) testing for Tuberculosis screening •

Why? IGRA testing is more accurate than PPD

•

No longer walkin-must schedule in advance

Exposure Protocol

- for needle sticks, blood borne pathogen exposures

24/7 Stick hotline: 667-214-1886 http://www.umaryland.edu/studenthealth/urgentneeds/blood-borne-pathogens-exposure/ If during regular UMIC hours (M-F 7-5p), call office ahead for an evaluation If after hours or when in doubt, use the hotline above to speak with a provider.

Student Health will arrange for an exposed student to be seen ASAP if needed We will discuss risks, options and recommendations We will prescribe

HIV post-exposure medications as appropriate

We will arrange for any recommended blood testing for you / source patient Students on away rotations or outside of the downtown Baltimore campus should

familiarize themselves with that site/facility’s exposure procedure, but again when in doubt you may call the 24/7 hotline above.

Health Insurance

if you choose the university student health insurance United Health Care Student Resources Plan 

New plan as of 8/1/ 2020



Check Gallagher website for specifics



No associated copays when using the Student Health Center for most office visits (procedure visits have a copay)

Using Outside Insurance Most will include: Unlimited routine health care – including most sick visits,

contraception issues, etc No Copays 

Note: non-routine health care = minor surgery/colposcopy/IUD placements, etc

Labs, X-rays, cultures, prescriptions – billed to insurance; to students if

denied/partially covered

MAY include needle stick / blood borne pathogen exposure coverage, but

check with insurer to make sure..

Health Insurance Waivers 

Students must accept UMB health insurance option or submit comparable health insurance to Gallagher.

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Deadline is September 16, to submit your waiver to Gallagher

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Open enrollment for Spring is February 14

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You must go through Gallagher to opt in/out of the UMB health insurance or provide your comparable health insurance

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https://www.gallagherstudent.com/students/studenthome.php?idField=1356

Again, check especially for coverage details in the event of needle sticks / blood borne pathogen exposure.

REQUIRED Immunizations/Screening 

Measles, Mumps, Rubella, Varicella, Hepatitis B, Tdap/Td within 10 years and TB screening.



Preferred documentation: titers (proof of immunity) > vaccination records.

Submit Information to Castle Branch https://portal.castlebranch.com/UP92

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All students (except for: UMB students in the Law school) are required to have a Hepatitis B Surface Antibody test after having had all 3 doses of the Hepatitis B vaccine

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It is encouraged to have the necessary immunization requirements prior to starting your program date. Any necessary immunization requirements can be done at the student health center

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Students will not be allowed to register for next semester classes if the immunization portion is not in compliance.

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See requirements online: https://www.umaryland.edu/studenthealth/immunization-requirements/

Tuberculosis (TB screening) 

Upon entry students need to have a TB IGRA screening test (either Tspot/TB Gold). This is submitted to Castle Branch



Annually thereafter a tuberculosis risk screening questionnaire will be used to screen for any new increased risk. This information is submitted to Castle Branch.

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Why did we update the TB screening policy? New guidelines from the CDC have been published regarding both screening, when/how often chest X-rays are needed, and who should get treated for latent tuberculosis infection (LTBI).

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For positive test results or history of positive tuberculosis screenings: 

Students will be asked to consult a medical provider for clearance

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Students will be offered treatment if LTBI is suspected

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The goal of treatment of LTBI is to minimize the risk of developing and transmitting TB later in life.

How to keep it all these records straight??

Castle Branch (CB) is an electronic health documentation program, that stores your vaccine, titer and TB screening records.  CB is FREE for UMB students and a REQUIRED service. https://portal.castlebranch.com/UP92  Students upload their immunization record, titer results and TB documentation to CB by fax or scan and online submission.  It is YOUR responsibility to open your free CB account and upload your records for verification. 

When in doubt or if you have specific questions/concerns, give us a call!

408 W Lombard St. (Lower Level) Mon – Fri 8:30a - 4:30p | (667) 214 – 1847

University of Maryland Baltimore Department of Student Health EDUCATIONAL PROGRAM FOR THOSE STUDENTS WITH POTENTIAL EXPOSURE TO BLOOD BOURNE PATHOGENS

Responsible Parties UMIC providers: Mario Majette, MD, Alex Kaysin, MD, Sarah Sampson, CRNP, Elena Shu CNRP available 24/7 for emergencies by phone:

STICK line (667) 214-1886

available for in-person evaluation at UMIC:

Mon – Fri 7a - 5p , (667) 214 – 1899

YOU also have the responsibility to report an incident and follow the protocol to ensure your own safety.

Keeping a safe work/learning environment is a team effort!

When in doubt, find instructions, contact info, forms online 24/7: https://www.umaryland.edu/studenthealth/urgent-needs/blood-bournepathogens-exposure/

Staff Responsibilities 

Clinical sites provide and train you on the the proper and consistent use of personal protective equipment

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Provide a non punitive atmosphere that encourages reporting exposures

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Provide a healthcare provider to be available 24/7 for exposures

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Educate students on bloodborne infections and post exposure prophylaxis

What is a bloodborne pathogen exposure?

Blood borne pathogens are infectious microorganisms in human blood that can cause disease in humans. These pathogens include, but are not limited to, hepatitis B (HBV), hepatitis C (HCV) and human immunodeficiency virus (HIV).

Needle sticks and other sharps-related injuries may expose workers to blood borne pathogens. Workers in many occupations, including first responders, housekeeping personnel in some industries, nurses and other healthcare personnel, are at risk for exposure to blood borne pathogens. What is are the types of exposures? 

Parenteral inoculation (ex. needle stick / sharps stick)



Eye splashes (ex. patient blood, saliva, wound debris (chest tube)



Bites

The potential risk of infection is dependent on type and details of the

exposure

Preventative Strategies 

Adherence to standard safety practices / techniques



Use proper universal precautions : treat all human body fluids as if known to be infectious of blood borne pathogens. Handle of all sharps with care and dispose properly.

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Proper wear and use of PPE 

Gloves, gowns, goggles, masks

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Know and follow all on-site safety measures created to reduce the risk of exposure to infectious agents

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Know who to contact in case of an injury or for questions/concerns. In general, you can follow the lead of your supervisors/instructors on site.

In the event of an exposure, or possible exposure: 

Immediately stop what your doing, thoroughly wash the affected site and report it to your supervisor.

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DON’T WAIT or delay care

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Call the 24/7 needle stick hotline: (667) 214-1886

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We may advise you to go to UMIC during open hours

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If appropriate we may have you collect source patient samples for testing (we will review with you instructions on the phone, but all instructions and required lab forms available online too).

Based on type of exposure risk (low or high) and results of source patient determine next steps 

Nothing further



Initial and serial testing of student (time of exposure, 4-6wks, 3mo)

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Post-exposure prophylaxis (PEP) treatment

Hepatitis B 

All Students (except law) have to document Hepatitis B immunity with a positive hepatitis B titer



Upload your titer result to Castle Branch 

Student Health will be tracking with the Electronic Immunization record/Castle Branch

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All those without proof of titer or a negative titer will receive emails to provide testing result or revaccinate if previously not immune.

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Lab orders for blood draws can be ordered at Student Health via telemedicine

Hepatitis B 

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Hepatitis B is a viral DNA infection that affects the liver. Most treatment is supportive. Less than 1% result in liver failure and less than 5% result in chronic infection.

Great news! We have a vaccine to prevent it! 

If your titer shows immunity you are IMMUNE

So if a Hep B Exposure occurs:  You are immune and nothing further needs to be done concerning Hep B  If not immune at time of exposure you will be instructed for consult and decision made on whether you need to be sent to the Emergency Room for prophylaxis.

Risk is 6-30% from a single needle stick/cut exposure.

Hepatitis C 

Hepatitis c is RNA viral infection causing liver inflammation leading to liver damage.

It is spread through contaminated blood. There are multiple strains of the hepatitis c virus.

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Currently there is no vaccine for Hepatitis C

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Acute Hepatitis C infections can spontaneously clear on their own, this is called spontaneous viral clearance. This occurs in 15-25% of those infected.

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Chronic hepatitis C responds well to antiviral therapy.

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Hepatitis C transmission does occur in occupational health settings

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Risk is 0.2% for percutaneous (sharps/needlesticks) injuries

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There are a few reported cases of transmission from eye splashes

There is no accepted Hepatitis C post exposure prophylaxis treatment at this time

So if a Hepatitis C Exposure occurs: 

Immediate baseline Hep C Ab

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At 6 weeks will order Hep C RNA test

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At 12 weeks will repeat Hep C Ab

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At 6 months will repeat Hep C Ab depending if source patient positive for Hepatitis C

HIV 

Weakens the immune system by destroying white blood cells that fight off infection.

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Currently no vaccine for HIV

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HIV transmission does occur in occupational health settings 

Risk is <1% in percutaneous injury.

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Risk of transmission of body fluids to eyes/mucus membranes even lower

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Risk depends extent of exposure 

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Needle size, amount of blood, etc.

HIV prophylaxis is AVAILABLE as a 2-drug regimen x4wks 

Time is of the essence! The sooner the better, but prophylaxis started up to 72hrs after exposure has demonstrated effectiveness in preventing infection

So if a HIV Exposure occurs: 

Immediate baseline HIV Ag/Ab

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At 6 weeks will order HIV Ag/Ab

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At 12 weeks will repeat HIV Ag/Ab

Reactive Strategies WHAT TO DO IF YOU HAVE AN EXPOSURE: 1.Wash the affected site with soap and water (no need to ‘bleed’ or ‘milk’ the site of exposure) 2.Rinse thoroughly with water if exposure occurs at a mucous membrane (ex. nose, mouth) 3.If it’s an eye splash, go to your eye station and irrigate your eyes x 15min 4.REPORT to your supervisor and call the hotline: 667-214-1886 for further information/instructions

Reactive Strategies Remember that all contact information (including the needle stick hotline), instructions and necessary forms can also be found online 24/7 at: https://www.umaryland.edu/student health/urgent-needs/blood-bornepathogens-exposure/ Each off-campus site (not at the Baltimore downtown campus) has its own needle stick/blood borne pathogen exposure protocol.

Familiarize yourself with this protocol and the appropriate contact people/hotlines so youâ&#x20AC;&#x2122;ll know what to do in the case of an emergency at off campus clinicals.

WHEN IN DOUBT, CALL US AT UMIC OR THE NEEDLE STICK HOTLINE.

COVID Keys to Preventing Transmission 

Hand Hygiene

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Transmission-based Precautions (social distance)

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Mask

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Eye Protection

CDC COVID-19 Case Definition (current)

ď ľ

Symptoms may appear 2-14 days after exposure to the virus.

People with these symptoms may have COVID-19: Fever/chills

Cough

Shortness of Breath

Congestion or runny nose

Headache

Sore throat Fatigue

Muscles Aches

New Loss of sense of smell/taste Nausea

Vomiting Diarrhea

Student Health Attestation For COVID-19 •

The UMB campus and your schools have put measures in place to help reduce your risk of contracting COVID19. However, as a student that participates in on-campus learning, I understand there is a risk of acquiring COVID-19 within the campus setting.

•

As a University of Maryland Baltimore student, I agree: •

I will practice physical distancing while on campus.

•

I will practice appropriate hand hygiene.

•

I will wear a mask while inside all UMMS facilities at all times.

•

I will wear a mask and eye protection during patient care encounters.

•

I am aware that I cannot participate in the direct in-person care of any known or suspected COVID-19 patient/client.

•

I will monitor myself and report any COVID-19 symptoms to the Hotline 1-800-701-9863.

•

I will report any international travel to the COVID-19 Hotline: 1-800-701-9863

•

I will report any known community/campus exposure to the COVID-19 hotline: 1-800-701-9863

•

I will report if I have been tested for COVID-19 by an off campus facility: 1-800-701-9863

•

I will not attend campus activities, in-person classes, clinical rotations, field placements or internships if requested to quarantine by a medical professional.

•

I understand that for medical/personal reasons I can ask to delay my return to clinical activities (such as taking a medical leave of absence). I also understand that taking leave could delay the completion of program requirements and graduation. Individual details should be discussed with the dean's office of your school.

References 

Biosafety in Microbiological and Biomedical Laboratories (BMBL) 4th edition. Available at : http://www.cdc.gov/of/ohs/biosfty/bmbl4/bmbl4s7e.htm

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OHS safety manual at : http://www.cdc.gov/od/ohs/manual/mannav.htm



Mandell: Principles and Practice of Infectious Diseases, 5th ed.

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http://www.cdc.gov/hepatitis/hcv/hcvfaq.htm

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https://www.cdc.gov/hiv/workplace/healthcareworkers.html

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https://www.cdc.gov/coronavirus/2019-ncov/index.html