The proper application of infection control principles will minimize any risk of transmission of Human Immunodeficiency Virus (HIV) from Health Care Worker to patients, patient to Health Care Workers, or patient to patient. HIV infection alone does not justify or support limiting a Health Care Worker's professional duties. The current assessment of the risk that infected Health Care Workers will transmit HIV to patients during invasive procedures does not justify mandatory testing of Health Care Workers. Limitations, if any, should be determined on a case-by-case basis after consideration of the factors that influence transmission risk, including inability and/or unwillingness to comply with infection control standards and/or functional impairments which interfere with the job performance of the Health Care Worker.

(1) Definitions - For the purpose of these regulations, the terms used herein are defined as follows:
(a) Chief Medical Officer - the state health officer, or his designee, appointed by the commissioner of health, who is responsible for and advises the Commissioner and department on all matters of state health policy, including public health.
(b) Commissioner - the Commissioner of Health or his designee.
(c) Health Care Worker (HCW) - Any orthopedic physician assistant whose activities involve contact with patients or with blood or other body fluids in a health care setting, including students, residents and trainees.
(d) Hospital HIV Confidential Expert Review Panel (Hospital HIV Review Panel) - As established by Tennessee Department of Health rules 1200-14-3-.01 to .03 this is a Tennessee hospital committee, appointed by the hospital Chief of Staff, composed and functioning in accordance with the guidelines of the American Hospital Association and the provisions of Tennessee Code Annotated, Section 63-6-219 which is convened with the purpose of establishing practice standards, on a case by case basis, for any HIV infected HCW, employed at or practicing their profession in the hospital, at the HCWs request.
(e) Tennessee Department of Health HIV Confidential Expert Review Panel (TDH HIV Review Panel) - As established by Tennessee Department of health rules 1200-14-3-.01 to .03 this is a Tennessee Department of Health committee, appointed by the Chief Medical Officer of the State, which is convened with the purpose of establishing practice standards for any HIV infected HCW.
(f) Universal Precautions - an approach to infection control according to which all human blood and certain human body fluids are to be treated as if known to be infectious for HIV and/or other blood-borne pathogens. In order to prevent the transmission of blood-borne infections, Universal Precautions requires the blanket implementation of infection control procedures, including, in regard to the use and disposal of needles and other sharp instruments, appropriate care and proper utilization of handwashing and protective barriers. Guidelines for Universal Precautions are published by the

Centers for Disease Control and Prevention (CDC) and can be found in CDC Recommendations For Prevention of HIV Transmission In Health-Care Settings. [MMWR 1987; 36 (suppl. no. 2S) pp 1-18s] and CDC Update: Universal Precautions For Prevention of Transmission of Human Immunodeficiency Virus, Hepatitis B Virus, and Other Bloodborne Pathogens In Health Care Settings. [MMWR 1988; 37: pp 377-82, 387-8,] or their successor publications and/or more current updates.

(2) Administration and Implementation of the Policy
(a) All HCWs shall adhere to Universal Precautions in the provision of health care services. HCWs must comply with current guidelines for disinfection and sterilization of reusable devices used in medical procedures. All HCWs shall receive periodic training in infection control procedures, including Universal Precautions.
(b) All HCWs are encouraged to undergo personal assessments to determine their need for HIV testing. These assessments should include consideration of known high-risk behavior as well as risks associated with health care-related occupational exposure. If they are at risk, HCWs should determine their HIV status in order to protect and improve their health and to receive appropriate counseling. The decision to be tested for HIV is the responsibility of the individual HCW.
(c) Pursuant to Tennessee Department of Health rule 1200-14-3-.03, the Chief Medical Officer of the State of Tennessee will, at the request of an HIV infected HCW, convene an expert review panel to provide advice and give guidelines for assuring patient safety in the provision of the HCWs health care services.
(d) Pursuant to Tennessee Department of Health rule 1200-14-3-.03, the Chief Medical Officer of the State of Tennessee may, at the request of an HIV infected HCW, allow a Tennessee licensed hospital to convene a hospital based Hospital HIV Review Panel to provide advice and give guidelines for assuring patient safety in the provision of the HCWs health care services in lieu of presenting the matter to the TDH HIV Review Panel. All records and information held by the hospital for review by this panel relating to known or suspected cases of infection with HIV in any HCW are strictly confidential, shall not be released or made public by the Department or the hospital or the Hospital HIV Review Panel upon subpoena, court order, discovery, search warrant or otherwise, except as may be authorized under T.C.A. §§ 10-7-504(a), 63-6-219 or 68-10-113.
(e) The review panel may recommend modification of procedures, notification of patients, or monitoring of restrictions if the panel determines that a significant risk of transmission to patients may exist. The recommendations of the review panel will then be set out in a written agreement and, if agreed to by the HCW, such agreement will be evidenced by the HCWs signature.
1. If the infected HCW is dissatisfied with the recommendation of the Hospital HIV Review Panel, the HCW may appeal to the TDH HIV Review Panel for a de novo evaluation.
2. If the infected HCW is dissatisfied with the recommendation of the TDH HIV Review Panel, the HCW may request a contested case hearing before the Commissioner, in the manner provided by the terms of the Tennessee Uniform Administrative Procedures Act (UAPA), Title 4, Chapter 5 of the Tennessee Code Annotated.
3. Willful or knowing or repeated rejection or violation of the panel's recommendations by the HCW, or inability to follow the panel's recommendation because of mental or physical disease or defect, shall be reported to the Tennessee Department of Health Division of Health Related Boards as indicated by the evaluation, for appropriate disciplinary action.
(f) In determining the advisability of voluntary HIV testing and in evaluating the medical practices of an infected HCW, the expert review panel and/or the individual HCW should refer to the current disease control guidelines established by the CDC and disease control standards recognized by national professional medical organizations. In addition, the panel should refer to the following:
1. Many procedures pose negligible risk to the patient of exposure to infection through the HCWs blood when performed using standard infection control techniques, including Universal Precautions. Examples of these procedures include: physical examinations; blood pressure checks; eye examinations; phlebotomy; administration of intramuscular, intradermal or subcutaneous injections (i.e., vaccinations); needle biopsies, needle aspirations or lumbar punctures; angiographic procedures; vaginal, oral or rectal exams; endoscopic and bronchoscopic procedures; and insertion or maintenance of peripheral and central intravascular lines, nasogastric tubes, endotracheal tubes, rectal tubes or urinary catheters. Even if a HCW were to sustain an injury while performing these procedures, it is highly unlikely that the patient would be exposed to the HCWs blood. Thus, no restriction on performance of these procedures are necessary provided that standard infection control practices are used.
2. Those HCWs for whom HIV counseling and testing has been previously recommended by the Public Health Services (PHS), due to occupational or nonoccupational exposure to HIV, are encouraged to voluntarily ascertain their HIV antibody status. HCWs (1) who are infected with HIV, and (2) who perform surgical or obstetrical procedures that involve entry into tissues, cavities, or organs, should not continue to perform those procedures until they have sought counsel from the expert review panel.
3. Among the items the review panel should consider, on an individual basis, in evaluation of an HIV seropositive HCW are the following:
(i) Whether the HCW performs procedures in which injury could result in contamination of a patient's body cavity, subcutaneous tissues, or muccous membranes by the HCWs blood (e.g., procedures in which hands may be in contact with sharp instruments, objects, or sharp tissues inside a patient's body cavity, particularly when the hands are not completely visible);
(ii) Factors affecting the performance of procedures by the individual HCW (e.g., techniques used, skill and experience, and compliance with recommended infection control practices); and
(iii) The medical condition of the HCW (e.g., the presence of physical conditions or mental impairment that may interfere with the HCWs ability to perform these procedures safely).
4. Depending upon its individualized evaluation, the panel should determine whether or under what circumstances the HCW may continue to perform or be restricted from performing procedures. In some circumstances, the panel may recommend modification and monitoring or procedures performed by the HCW to decrease the risk.
(i) If the panel determines that this HCWs performance of all or certain procedures poses a significant risk of infection to patients, and such significant risk cannot be eliminated by reasonable accommodation, then the HCW should be restricted from performing such procedures.
(ii) If the panel determines that the HCWs performance does not pose a significant risk for infection of patients during the procedures within HCWs scope of practice, then no restrictions are indicated. Hence, notification of the patient regarding HCWs infection status prior to the performance of such procedures is not necessary.
(g) HCWs whose practices are modified because of their HIV infection status should, whenever possible, be provided opportunities to continue appropriate patient-care activities. Career counseling and job retraining should be encouraged to promote the continued use of the HCWs talents, knowledge and skills.


Tenn. Comp. R. & Regs. 0880-10-.22
Original Rule filed July 10, 1997; effective September 23, 1997. Amendment filed June 10, 1998; effective October 28, 1998.

Authority: T.C.A. §§ 4-5-202, 4-5-204, 63-19-104, 63-19-201, and 68-11-222.

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