COVID-19

U of L School of Medicine’s Fall 2020 Procedures for Entering Medical School

Educational Program Committee Approved: July 20, 2020

For your safety and the safety of all medical students, staff and faculty, the School of Medicine has issued a set of guidelines to follow when entering the medical school instructional building. 

  • All students, faculty and staff must comply with state and federal safety guidelines. See Kentucky state website at https://govstatus.egov.com/kycovid19 and CDC website at https://www.cdc.gov/coronavirus/2019-ncov/ for any timely updates as conditions change.
  • All members of the campus community must wear masks and practice physical distancing in public areas, including when entering and leaving buildings, classrooms, offices and bathrooms and in classrooms and labs. UofL will provide on washable mask to every employee and student on campus.
  • Flu shots are required for all students, clinical faculty and clinical staff. The university will provide free flu shots when the seasonal flu vaccine becomes available.
  • Floor markings, table arrangements, room density management, sneeze guards, extensive signage and other efforts will be made to support physical distancing throughout campus
  • Physical Plant will enhance cleaning and disinfecting throughout campus
  • The availability of hand sanitizer and disinfection kits will be dramatically increased in classrooms and other high-touch areas like food service.
  • Air flow/fresh outside air exchanges will be increased through buildings where possible.
  • Campus Health will make testing available to all faculty, students and staff displaying COVID-19 symptoms. Please call ahead for instructions about how to do this at (502) 852-6446 Testing in the absence of symptoms is not currently recommended.
  • UofL will conduct contact tracing for known student, faculty, and staff infections as they are identified in order to minimize the spread of infection.
  • All students will be required to complete the mandatory Covid-19 Infection Training from Campus Health to ensure they know the symptoms of infection and the precautions they are expected to take to minimize the risk of infection.

Specifically applicable to in-person events:

  • Any student with ill symptoms prior to any in-person event should contact their course director for special instructions, to prevent a sick student from staying in exam spaces with well students. Fill out this form to report your need for an absence and follow the directions shown after submitting the form to email your responsible faculty members/coordinators.
  • On days with in-person examinations, students will report to their assigned exam rooms. ULSOM staff will be located at the entrance to perform temperature checks using infrared thermometers.  Those individuals with a temperature below 100.4F will allowed to enter the testing space and take their exam. 
  • If an individual has a temperature above 100.4F (defined by the CDC as a high temperature), they will be directed to leave the building and contact the Campus Health Service Office for further evaluation.

Guidelines for Travel and Quarantine for Incoming Classroom and Clinical Students:

  • At this time, quarantine is recommended, not required.
  • Students who are traveling to campus from a CDC-defined hotspots: To keep you or classmates from getting sick right after the semester starts, consider self-quarantining for 14 days prior to coming to campus for required events.
  • Students traveling to Louisville via any public transportation are asked to mask and use hand hygiene for their entire trip to Louisville.
  • As professional school students who will be in contact during required presence teaching sessions with faculty and staff who care for patients in the clinical environment, you are also asked to responsibly limit your exposure to COVID-19 when away from campus. This is to ensure you stay healthy and the others that live and study with you stay healthy, and to prevent you missing school if you become ill!
  • All students have the responsibility to consider their social interactions with others carefully and to take sensible precautions to limit potential spread. The majority of exposures reported by students are occurring outside of the clinical environment, in social settings or non-patient care spaces within clinical sites where the student unmasks when in the presence of others.
  • Tips for avoiding higher risk environments/situations:
    • Avoid crowded indoor public places, ex. bars, restaurants, gyms, stores that are not managing entry to ensure 6 ft minimum between patrons or requiring masks for people < 6 ft except when eating or drinking.
    • Stay >6 ft away from others when outdoors, or greater if coughing, singing, shouting, or other high-risk activities are taking place
    • Wear a mask and use hand hygiene when inside closed spaces with other people who are not your household contacts.
    • Limit travel to the immediate Louisville area while school is in session and in-person physical presence is required.
  • Since the majority of students will travel or come into contact with a wider group of people over the Thanksgiving holiday, all content and exams will be delivered virtually for all students with no required physical presence for M1-2 students after Thanksgiving break. M3-4 students are still required to complete clinical rotations as scheduled following holidays and breaks and asked to consider their travel plans in light of the guidelines above.

Guidelines regarding Symptoms and Exposures for all students:

Exposures protocol:

  • CLASSROOM students who believe they have had a COVID-19 exposure according to CDC guidelines who are asymptomatic should:
    • Fill out this form to report your need for an absence and follow the directions shown after submitting the form to email your responsible faculty members/coordinators.
    • Self-quarantine at home for 14 days
  • CLINICAL students who believe they have had a COVID-19 exposure according to CDC guidelines who are asymptomatic should:
    • Contact Dr. Farmer at Russell.farmer@louisville.edu and their clerkship director or lead faculty member for their rotation
    • Self-monitor symptoms for 14 days with twice daily temperature checks
    • Continue on clinical service, taking all of the same precautions already recommended.
    • If they live with other people, they should self-quarantine within the home for 14 days by staying in their own room by themselves and greatly minimizing use of shared space, using hand hygiene meticulously, and masking whenever in shared spaces just as they would at work.
    • During this isolation period, students should immediately report any temps >100.4F, loss of taste, or any other new symptoms to Campus Health for further instructions, and notify Dr. Farmer and their clerkship director or lead faculty member they have to stay home from clinical rotations for the period indicated by those instructions.
  • ANY student who develops symptoms must contact Campus Health immediately for further instructions, and may not return to the clinical environment until they have satisfied the conditions of symptom-free days, time since onset of symptoms, negative infectious workup, or any other conditions deemed appropriate by Campus Health. Fill out this form to report your need for an absence and follow the directions shown after submitting the form to email your responsible faculty members/coordinators. If the student has another health care provider, Campus Health can work with that health care provider to ensure the same conditions of return are met for all students prior to re-entry into the clinical environment.

Guidelines for Supervising Faculty and Institutions:

1.Students must have standard PPE provided to them for patient care.  This includes a simple face mask to be worn at all times while in the clinical environment.  Students may also choose to wear eye protection, caps/hair coverings, shoe coverings, scrubs at their discretion.

2.Protocols or guidelines that attendings and residents follow at specific facilities regarding donning and doffing or preservation of PPE and supplies, students must also follow (bagging and sterilization of N-95 masks for re-use, limitation of those at bedside to those specifically assigned to the patient, etc).

3.Students may not participate in the direct care with patients who are known to be COVID-19 positive

4.Students may see patients who are being evaluated for suspected COVID-19 infection, and are required to be provided/wear the same PPE as any other care provider in contact with that patient.

5.If the patient under investigation is undergoing an aerosolizing procedure, or will be undergoing continuous treatments that are known to be aerosolizing, ie continuous nebulization treatments, the student may not have contact with the patient or enter the room during the period of time that the aerosolizing procedure or treatment is being administered.

6.If a patient’s COVID-19 status is an initially negative test that is a suspected false negative due to clinical status/symptomatology, students may not see these patients.  Patients who are suspected to have a false negative test should not be cared for by/ assigned to a medical student.

7.Students are excluded from aerosolizing procedures on COVID-19-unknown patients unless appropriate protection – N95 level or similar PPE – can be provided. This includes:

a.Intubation

b.Endoscopy

c.Laparoscopic / robotic surgery

d.Continuous nebulizer treatments, high flow nasal cannula

8.Protocols must be in place at each clinical site in case of known or suspected exposure of a student to COVID-19 or in case a student develops ill symptoms, including:

a.Requiring students to contact Student Health immediately and follow the instructions they set forth. This may include the student needing to leave the clinical environment for follow-up appointments or testing, or exclusion from the work environment. If there are any concerns or questions about these instructions as they are relayed by the student, please contact russell.farmer@louisville.edu

b.Ensuring students can comply with any additional guidelines set forth by their current clinical environment/health system related to exposure or symptoms, if they are more stringent than those given by Campus Health.

c.Requiring students to contact their Undergraduate Medical Education office: russell.farmer@louisville.edu

Patient Care Guidelines for Medical Students in the Clinical Environment

1.General Guidelines:

a.Students are to follow PPE and Screening guidelines provided by each Clinical Learning Environment / Sponsoring Institution. 

i.Most healthcare workers are participating in symptom questionnaires +/- temperature checks at most locations

IF YOU ARE FEBRILE SEE BELOW FOR “CONTACT FOR EXPOSURE & TREATMENT”

ii.Some sites may allow personal face masks / homemade masks in certain locations

iii.Norton related facilities are requiring daily use of disposable ear-loop masks

iv.Use gloves for all patient exams/interactions (should be doing this anyway!)

v.If a PPE shortage develops and you cannot be protected effectively as instructed by the training resources below, halt your clinical activities with regard to that patient immediately and notify your Clerkship Liaison / Coordinators / Elective Director / Farmer

2.PPE / Infection Control and Prevention

i.Mask Wearing: All students must at a minimum wear a simple face mask at all times while in the clinical space. This applies to shared space with healthcare providers also, ie break rooms, etc.

ii.Fit testing for N95’s: You can call Campus Health at 852-6446.  They will guide you through timing and scheduling around this.  You hopefully will not need these masks, but it would be good to know your size should it be required. 

iii.Eye protection: eye protection is required all clinical situations, and free eye protection is available for student pickup in Student Affairs.

iv.Hand Washing – standard before-and-after clinical contact hand sanitation applies.  This is more important between each patient now more than ever.  Don’t be embarrassed, let the team and patient see you do it.  Also, we recommend thorough hand washing with chlorhexidine at designated sinks on wards/clinics at multiple points of the day (arriving / leaving ward, leaving for home, soilage, any time).  YOU CANNOT BE PENALIZED for protecting yourself on the wards by practicing good hand hygiene.  If you receive pushback, please fill out the mistreatment form at: https://louisville.edu/medicine/studentaffairs/mistreatment-form/  and/or make sure your Clerkship Director/Elective Director/Dr. Farmer is aware.

v.Cleaning stethoscopes and other medical devices, ie reflex hammers: Use the sanitizing wiped provided to clean any durable personal equipment used to examine a patient before and after each use.

vi.Tech/Devices – patient care areas have device “friendly” wipes to clean your phones/tablets/laptops.  Think of using these at the end of shift.  Many have been using them and then placing phone in glove/wipe/etc. to transport home.

vii.Workplace clothing – We will be waiving the need for “professional” attire during all clerkship rotations.  If possible, please wear clothes into the hospital, change into scrubs, and change again prior to leaving.  Also, we advise you to choose a single pair of shoes that are comfortable and washable to wear to and from the hospital.   If this becomes an issue with availability, please contact your Clerkship Coordinator/Director/Dr. Farmer.

viii.Guidelines for PPE use if needed – Please see the following attached resources provided by the CDC for the use of PPE:

a.YouTube Video

b.PDF (also attached)

ix.COVID negative patients

1.Standard PPE applies including gowns / gloves for C. diff / VRE / MRSA / viral isolation.  Each patient’s room should have isolation guidelines posted on the door as an inpatient. Outpatient rotations will have PPE plans in place, follow their practice guidelines. 

x.Aerosolizing Procedures- standard precautions apply for COVID-19 negative patients. If patient has unknown COVID status and students are participating in endoscopy, oral/airway procedures, or laparoscopic/robotic surgery, students will need to wear an n95 or equivalent mask or exclude themselves from the procedure room. 

3.Care for COVID + Patients

a.Students are not to care for COVID+ patients under any circumstance.  There are to be no exceptions.  Code Blue / ACLS / PALS / Code Stroke / Rapid Response in COVID-19 positive or COVID-19 unknown patients are included here and are not an exception to this rule, as code situations may carry higher risks of transmission.

b.Students will not be penalized in any form for protecting their own health with regard to COVID-19.  This includes grades, evaluations, letters of recommendation, or any other form of assessment.  If you are concerned you may have experienced this form of mistreatment, contact the Clerkship Director/Elective Director/Dr. Farmer or fill out the mistreatment reporting form on the SA website: https://louisville.edu/medicine/studentaffairs/mistreatment-form/

4.Students with underlying health conditions: Students who are pregnant, postpartum/breastfeeding, immunosuppressed, or with other health conditions that place them at increased risk should contact Student Health through immunize@louisville.edu for a specific answer to their question.