Policy Statement on Infectious Diseases for All Clinical Programs
The Faculty of Dentistry has adopted the "Guidelines on Infections Diseases and Health Care Workers" approved by the Association of Canadian Faculties of Dentistry (ACFD).
Acceptance into a clinical program in the UBC Faculty of Dentistry is contingent upon completion of appropriate immunization and screening.
Entry into the healthcare professions is a privilege that carries a responsibility to do no harm. Direct patient care, including invasive procedures, is required during the educational programs of dental professionals. This places patients and healthcare workers (HCWs) at increased risk of transmission of infections including airborne diseases, and bloodborne pathogens (BBPs) – HIV/AIDS, hepatitis B virus (HBV) and hepatitis C virus (HCV).
Students in clinical programs in the UBC Faculty of Dentistry will be required to treat patients with infectious diseases (including HIV, HBV and HCV) should they be assigned to them.
Applicants need to fulfil requirements related to health status - including infection with HBV, HCV and HIV – and immunizations to be considered for admission (see below).
It is not possible to complete the clinical components necessary for graduation without performing invasive / exposure-prone procedures.
Students and applicants with HIV-related health problems, hepatitis B or other infections may be unable to practice dentistry safely and competently.
HCWs, including dentists and dental hygienists, are at risk for exposure to blood-borne pathogens. Healthcare students are also vulnerable to exposures especially those in dentistry. Dental and dental hygiene students are at higher risk for needle-stick injuries than are experienced practitioners. There are vaccines to protect against HBV and other infections and a policy of mandatory immunizations and screening of HCWs and trainees protect patients, students and HCWs. HCWs, including dental workers, who do invasive procedures have an ethical obligation to know their own infectious disease status and to be medically assessed for risk of transmission of any infection.
Applicants must submit a health record which evidences the following immunizations to UBC Student Health Services in order to be considered for admission.
- Diphtheria and tetanus: Completion of a primary series of at least 3 doses of a combined tetanus, pertussis and diphtheria preparation and booster within the last 10 years is required.
- Polio: Completion of a primary series of at least 3 doses of oral polio vaccine or inactivated polio vaccine is required.
- Measles: Completion of two doses of measles vaccine or documented proof of disease (i.e. presence of measles IgG) is required as evidence of protection. Adults born after 1970 without a history of the disease require at least 1 dose of MMR (measles-mumps-rubella) vaccine.
- Mumps: Completion of at least one dose of mumps vaccine or documented proof of disease (i.e. presence of mumps IgG) is required. If non-immune, 1 dose of MMR vaccine is required.
- Rubella: Completion of at least one dose of rubella vaccine or documented proof of disease (i.e. presence of rubella IgG) is required. If non-immune, 1 dose of MMR vaccine is required.
- Varicella: Completion of 1 dose (before age 13) or 2 doses (if given after age 13) of varicella vaccine, or proof of the disease (i.e. history of varicella or presence of varicella zoster virus IgG) is required.
- Tuberculosis (TB): Negative two step tuberculin skin test (TST) within the last 12 months is required. If there is a previously documented positive TST, previous treatment for active TB or treatment for latent TB, medical evaluation is needed to deem the person non-contagious.
- Hepatitis B: Completion of a HBV-containing (hepatitis B virus) vaccine series and documented seroconversion with antibodies to hepatitis B surface antigen (anti-HBs) is required. Testing should be done at least one month (but no later than six months) after the final immunization in the series. Lack of seroconversion requires revaccination and reassessment for immunity. If a healthcare worker never before tested is found not to have protective antibody, re-immunization with a full series of hepatitis B containing vaccine is indicated . HBV immunization is not required if there is evidence of immunity due to prior infection (anti-HBs positive and/or antibodies to hepatitis B core antigen [anti HBc] positive).
Immunizations are available from your family physician, public health clinics, or the UBC Student Health Service.
Guidelines for Student Applicants with Infectious Diseases
Bloodborne Pathogens: Compared with HCV or HIV, transmission of HBV is the greatest hazard in healthcare settings to those who are not immune. The presence of HBeAg indicates a high risk of infectivity. Healthcare workers, including students, who are infected with HCV, HIV, or HBV with no evidence of HBe antigen or a high viral load (>103 genome equivalents/mL) are considered low risk for transmission.
Hepatitis B: Applicants who are HBsAg-positive and HBeAg-positive or who have a viral load greater than 103 genome equivalents/mL CANNOT be accepted into clinical programs.
Applicants who are HBsAg-positive but HBeAg-negative can be accepted, but should receive counselling before beginning the clinical program.
Non-responders (non-immune) to the hepatitis B vaccine should be tested on a regular basis for the presence of HBeAg and viral DNA and be removed from direct patient care activities if found to be positive for HBeAg or if they exceed a viral load greater than 103 genome equivalents/mL. Current recommendations should be followed in the event of exposure to a non-responder.
Hepatitis C: Applicants who are carriers of Hepatitis C may be accepted, but should receive counselling before beginning the clinical program.
Human Immunodeficiency Virus (HIV): Applicants who are HIV positive may be accepted, but should be counselled before admission to clinical programs. Students with risk factors for HIV should be counselled to seek HIV testing on a volunteer basis.
Communicable Disease Status: Any applicant with an infectious disease has a moral and ethical obligation to inform the appropriate authority in their educational institution to receive appropriate counselling and recommendations. This is consistent with the Canadian Dental Association’s Code of Ethics.