In-House Medical Services and Health Management

1. Immediately apply mild pressure to the vicinity of the injury to restrict the blood flow from the wound.
2. Wash the wound thoroughly with a proprietory disinfectant.
3. Confirm the patient's HIV and hepatitis C status (presence of anti-HIV and anti-HCV antibodies). This should be ascertained either from the person's medical records or through direct testing. In the event that the patient's hepatitis B status is insufficient, the level of HBs antigen should also be determined.

An accident insurance consultant (D-Arzt) should be called in to document the case, determine the patient's current HIV, HCV and (if necessary) HBV status, and take the appropriate emergency measures. Failure to report such incidents within two weeks may impact the case's subsequent recognition as a work-related accident.

D-Arzt doctors are available for occupational medicine at the ER departments of the following clinical surgeries:
- LMU in Großhadern: +49 89 4400-73577 or
- LMU city center in the Nussbaumstraße 20: +49 89 4400-52611.

1. Patients known to be HIV-positive should visit the Outpatient Department for HIV at the Clinical Surgery in the city center (Pettenkoferstraße 8 a, +49 89 4400-53550) as soon as possible (ideally within an hour) before consulting the physician responsible for assessing work-related accidents.
   The Outpatient Department for HIV is open Monday to Friday from 8:30 a.m. to noon, and on Wednesdays from 2:30 p.m. to 5 p.m. At other times please consult the physician on duty in the Department of Internal Medicine at the Clinical Surgery (Ziemssenstraße 1) in central Munich. +49 89 4400-52111 / +49 89 4400-52112.
2. If the patient is found to have a chronic hepatitis B infection and has not been immunized or has failed to generate antibodies against HBs following vaccination, active and passive immunization measures should be taken immediately, ideally by the physician responsible for dealing with work-related accidents. If the antibody level is low (10 IU/l < Anti-HBs < 100 IU/l), a booster injection with an active vaccine can be administered, whose effect should be assessed 4 to 6 weeks later. If the patient has been successfully vaccinated within the last 5 years or an anti-HBs titer >100 IU/l has been documented within the preceding 12 months (irrespective of the date of immunization), no further steps need be taken.
3. If the patient has been infected with HCV, a further diagnostic examination within 4 to 6 weeks is essential, and should be followed by regular checks if necessary.
4. If the patient's infection status cannot be determined, or the precise nature of the object that caused the injury cannot be ascertained, an insurance-related medical assessment should be undertaken after 6 weeks.
5. In the event that the patient is found to be HCV- and HIV-negative, no further measures need by taken beyond the insurance-related medical assessment.

All expenses incurred will be reimbursed by LMU's accident insurance.

Students who are pregnant may be exposed to specific health risks in the course of their studies. Thus risks to mother and child may arise during practical training in Medicine and Veterinary Medicine, as well as from chemicals and biological agents encountered during laboratory work.

To ensure that your employer or the person responsible for your internship can take the appropriate precautions, in accordance with their duty of care, they must be made aware of your pregnancy. We therefore strongly recommend that you inform employers and supervisors of practical classes as soon as possible.

Supervisors should have decided in advance which activities can be assigned to students during pregnancy, without risk to the health of mother and child. Once informed of a student's pregnancy, supervisors must prepare a Risk Assessment in accordance with the stipulations of the Maternity Health Protection Act (in German).

In accordance with the stipulations made by the Maternity Health Protection Act, prospective mothers should NOT engage in the following activities / encounter the following substances, which involve possible exposure to risks that could endanger the health of both mother and child:

1. Hazardous chemicals
2. Ionizing radiation
3. Dust, gases, vapours, heat, cold, vibrations, noise
4. Sources of infection
5. Lifting heavy weights
6. Standing for more than 4 hours at a time
7. Activities that require frequent stretching or bending, prolonged squatting or stooping
8. Operating machines that stress the feet

1. Infection risks:

• Activities that require the handling of contaminated, pointed, or sharp objects and instruments (e.g. adminstering injections or taking blood samples).
• Changing bandages or inspection of infected wounds is allowed, provided that protective clothing and gloves are worn and no pointed or sharp instruments are used.
• Activities in casualty departments or settings in which infectious aerosols are likely to be disseminated are prohibited.
• In the absence of appropriate immunization, contact with patients who are potentially or known to be infectious is prohibited.

The following is a list of infections that are known to present as serious to the unborn child:

• Rubella (prospective mothers should have their antibody titers checked)
• Erythema infectiosum
• Chickenpox
• Cytomegalovirus
• Genital herpes, gonorrhea
• Hepatitis A - E and G
• HIV
• Syphilis
• Malaria

2. Risks associated with hazardous chemicals

• Exposure to cytostatic or virostatic agents, gaseous or liquid disinfectants (e.g. ethylene oxide, formaldehyde) is prohibited.
• Exposure to anesthetics is to be avoided unless the recommended maximum levels of exposure can be observed.
• Exposure to nitrous oxide (laughing gas) is prohibited
• Exposure to the gaseous anesthetic halothane (in operating theaters or in the post-operative phase) is prohibited.
• Nursing mothers should not be exposed to levels of carcinogenic, mutagenic or teratogenic substances that exceed the legal limits.

Activities with some of these substances are permissible under the following conditions:

• Exposure to laughing gas or Enfluran is permissible if the levels involved comply with the legal limit (for detailed information, see the list mentioned above).

• Activities in controlled areas are prohibited.
• Activities involving contact with patients following administration of radioisotopes before the activity of the isotope has reached a safe level.
• Pregnant women and nursing mothers should not be admitted to controlled areas in which work with open sources of radioactivity takes place.

• Work in the immediate vicinity of nuclear magnetic resonance tomographs should be avoided
• Work in premises in which the noise level exceed 80 dB(A)

• Activities associated with increased risk of accidents or butting by animals (e.g. during transport)
• Avoid all contact with potentially infected or diseased animals (see list of diseases below)

Whether or not working with animals entails possible risks for the mother or the unborn child can often be decided only after inspection of the workplace concerned.

Infectious diseases which cannot be completely ruled out in animals and may present risks to students of Veterinary Medicine during pregnancy:

• Rabies
• Leptospirosis
• Brucellosis
• Anthrax
• Q fever
• Ornithosis [= Psittacosis = Chlamydia psittaci, which is listed below.PH]
• Listeriosis
• Streptococcal and Staphylococcus infections
• Toxoplasmosis
• Histoplasmosis
• LCM virus
• Chlamydia psittaci

In the event of increased susceptibility to allergies or in the case of regular exposure to extremely noxious odors, reassignment to a different area may be advisable.

During pregnancy, vaccinations should be avoided if at all possible. If there are clear grounds for doing so, and immune protection is not assured, vaccination with an inactivated preparation (see the following list) is recommended.

• Tetanus
• Rabies
• Diphtheria
• Polio
• Influenza
• Hepatitis A and B

Immunizations with live vaccines against tuberculosis, measles, mumps, rubella and poxviruses should not be performed.

In the event that an indicated immunization is not possible, the pregnant patient must take all possible precautions with respect to hygiene.

• The relevant supervisor / instructor
• The Health & Safety Officer
• Unit for Occupational Health and Sustainability
• In-House Medical Services
• If necessary, the local Corporate Inspectorate (Gewerbeaufsichtsamt) should be informed in order to arrange for a joint onsite assessment of the workplace involved.

If you have any concerns regarding the current risks at your workplace, we would be happy to advise you!

Responsibility for ensuring that students are not exposed to undue risks is part of the class supervisor's duty of care. In case of imminent risk, pregnant students and nursing mothers must be protected, even if this entails failure to complete semester requirements. In most instances, however, practical assignments can be arranged so that the semester requirements can be fulfilled without significant delay.