Current through Register Vol. 49, No. 2, February 2024
REGULATION 16
PHYSICIANS, HIV AND HBV
Arkansas Code §
17-95-409(7)
and (10) provides that the Arkansas State
Medical Board may revoke or suspend a license if the practitioner is grossly
negligent and becomes physically incompetent to practice medicine to such an
extent as to endanger the public.
Public
Law 102-141 passed in the First Session of the
102nd Congress of the United States of America
approved on 28 October, 1991 provides that the states will establish guidelines
to apply to health professionals and will determine appropriate disciplinary
and other actions to ensure compliance with those guidelines in order to
prevent the transmission of human immunodeficiency syndrome and hepatitis B
virus during exposure-prone invasive procedures except for emergency situations
where the patient's life or limb is in danger.
DEFINITIONS:
As used in this Rule the term:
1. HIV means the human immunodeficiency
virus, whether HIV-1 or HIV-2.
2.
HIV seropositive means with respect to practitioner, that a test under the
criteria of the Federal Centers for Disease Control or approved by the Arkansas
State Medical Board has confirmed the presence of HIV antibodies.
3. HBV means hepatitis B virus.
4. HCV means hepatitis C virus.
5. HbeAg seropositive means with respect to a
practitioner, that a test of the practitioner's blood under the criteria of the
Federal Centers for Disease Control or approved by the Arkansas State Medical
Board has confirmed the presence of the hepatitis Be antigens.
6. Body fluids means amniotic, pericardial,
peritoneal, pleural, synovial and cerebrospinal fluids, semen, vaginal
secretions and other body fluids, secretions and excretions containing visible
blood.
7. Exposure-prone Procedure
means an invasive procedure in which there is a risk of percutaneous injury to
the practitioner by virtue of digital palpation of a needle tip or other sharp
instrument in a body cavity or the simultaneous presence of the practitioner's
fingers and a needle or other sharp instrument or object in a poorly visualized
or highly confined anatomic site, or any other invasive procedure in which
there is a significant risk of contact between the blood or body fluids of the
practitioner and the blood or body fluids of the patient.
8. Invasive procedure means any surgical or
other diagnostic or therapeutic procedure involving manual or instrumental
contact with or entry into any blood, body fluids, cavity, internal organ,
subcutaneous tissue, mucous membrane or percutaneous wound of the human
body.
9. Practitioner means
physician or physician's trained assistant, who performs or participates in an
invasive procedure or functions ancillary to invasive procedures.
GENERAL REQUIREMENTS:
10. A practitioner who performs or
participates in an invasive procedure or performs a function ancillary to an
invasive procedure shall, in the performance of or participation in any such
procedure or function be familiar with, observe and rigorously adhere to both
general infection control practices in universal blood and body fluid
precautions as then recommended by the Federal Centers for Disease Control to
minimize the risk of HBV or HIV from a practitioner to a patient, a patient to
a practitioner, or from a patient to a patient.
11. Universal blood and body fluid
precautions for purposes of this section, adherence to the universal blood and
body fluid precautions requires observance of the following minimum standards:
Protective Barriers:
A practitioner shall routinely use appropriate barrier
precautions to prevent skin and mucous membrane contact with blood and other
bodily fluids of the patient, to include:
(1) Gloves shall be used by the physician and
direct care staff during treatment, which involved contact with items
potentially contaminated with the patient's bodily fluids. Fresh gloves shall
be used for all such patient contact. Gloves shall not be washed or reused for
any purpose. The same pair of gloves shall not be used, removed, and reused for
the same patient at the same visit or for any other purpose.
(2) Masks shall be worn by the physician and
direct care staff when splatter or aerosol is likely. Masks shall be worn
during surgical procedures except in those specific instances in which the
physician determines that the use of a mask would prevent the delivery of
health care services or would increase the hazard and risk to his or her
patient.
(3) Protective eyewear
shall be worn by the physician and offered to all patients during times when
splatter or aerosol is expected.
(4) Hands and other skin surfaces shall be
washed immediately and thoroughly if contaminated with blood or other bodily
fluids. Hands shall be washed immediately after gloves are removed.
PERCUTANEOUS PRECAUTIONS:
12. A practitioner shall take
appropriate precautions to prevent injuries caused by needles, scalpels, and
other sharp instruments or devices during procedures; when cleaning used
instruments; during disposal of used needles; and when handling sharp
instruments after procedures. If a needle stick injury occurs, the needle or
instrument involved in the incident should be removed from the sterile field to
prevent needle stick injuries, needles should not be recapped, purposely bent
or broken by hand, removed from disposable syringes, or otherwise manipulated
by hand. After they are used, disposable syringes and needles, scalpel blades,
and other sharp items should be placed for disposal in puncture resistant
containers located as close as practical to the use area. Large-bore reusable
needles should be placed in puncture-resistant containers for transport to the
reprocessing area.
13.
Resuscitation Devices. To minimize the need for emergency mouth-to-mouth
resuscitation, a practitioner shall ensure that mouthpieces, resuscitation
bags, or other ventilation devices are available for use in areas in which the
need for resuscitation is predictable.
14. Sterilization and Disinfection.
Instruments or devices that enter sterile tissue or the vascular system of any
patient or through which blood flows should be sterilized before reuse. Devices
or items that contact intact mucous membranes should be sterilized or receive
high-level disinfection. Sterile disposable needles shall be used. The same
needle may be recapped with a single-handed recapping technique or recapping
device and subsequently reused for the same patient during the same
visit.
15. A practitioner who is
HbeAg seropositive or HIV seropositive or who otherwise knows or should know
that he or she carries and is capable of transmitting HBV or HIV or
HCV, shall not thereafter perform or participate
directly in an exposure-prone procedure except as provided in this Rule or
Regulation.
16. A practitioner may
participate in exposure-prone procedure with a patient when each of the
following four conditions have been met:
(A)
The practitioner has affirmatively advised the patient, or the patient's
lawfully authorized representative, that the practitioner has been diagnosed as
HbeAg seropositive, HIV seropositive and/or HCV as the case may be.
(B) The patient or the patient's lawfully
authorized representative, has been advised of the risk of the practitioner's
transmission of HBV, HIV and/or HCV to the patient during an exposure-prone
procedure. The practitioner, shall personally communicate such information to
the patient or the patient's representative. The physician shall also
communicate such information to the patient's physician.
(C) The patient, or the patient's lawfully
authorized representative, has subscribed a written instrument setting forth:
(1) Identification of the exposure-prone
procedure to be performed by the practitioner with respect to the
patient.
(2) An acknowledgment that
the advise required by Subsections (15)(a) and (15)(b) hereabove have been
given to and understood by the patient or the patient's representative;
and
(3) The consent of the patient,
or the patient's lawfully authorized representative, to the performance of or
participation in the designated procedure by the practitioner.
(D) The practitioner's HbeAg
and/or HIV seropositivity and HCV diagnosis has been affirmatively disclosed to
each practitioner or other health care personnel who participates or assists in
the exposure-prone procedure.
REVOCATION OF CONSENT:
17. Consent given pursuant to this section
may be revoked by a patient or a patient's lawfully authorized representative
at any time prior to performance of the subject procedure by any verbal or
written communication to the practitioner expressing an intent to revoke,
rescind or withdraw such consent.
REPORTS AND INFORMATION CONFIDENTIALITY:
18. Reports and information
furnished to the Arkansas State Medical Board relative to the HbeAg, HIV or HCV
status of the practitioner shall not be deemed to constitute a public record
but shall be deemed and maintained by the Board as confidential and privileged
as a medical record and shall not be subject to disclosure by means of subpoena
in any judicial, administrative or investigative proceedings; provided that the
practitioner adheres to the Rules and Regulations of the Board and is willing
to subject himself to counseling, review and monitoring by the Board or its
designated agent.
19. Upon the
Board learning that a practitioner is HbeAg or HIV seropositive or HCV
diagnosis the Board, or the Board's agents, will make contact with said
practitioner, review the Rules and Regulations of the Board and set up a
process of monitoring that individual's practice.
20. The monitoring of practitioners and
disciplining of practitioners as set forth in this Rule and Regulation will be
reported to the Arkansas Department of Health but will remain
confidential.
21. If the
practitioner does not comply with this Rule and Regulation of the Board that
practitioner will be deemed to have been grossly negligent and committed
ignorant malpractice and further that practitioner would be physically
incompetent to practice medicine to such an extent as to endanger the public;
thus subjecting the practitioner to a disciplinary hearing and possibly
sanctioning of his license.