MRSA 2015

University of Auckland Faculty of Medical & Health Sciences

Screening clinical attachment students for risk of Staphylococcus aureus transmission.
Patients, and other people with whom the student comes in contact, can be at increased risk of acquiring
Staphylococcus aureus colonisation if the student has a condition which leads to increased shedding of S. aureus.
The following questions are intended to identify those students who, if colonised with S. aureus, would pose an
increased risk of transmitting that infection to others. Students with a condition that would increase the risk of
transmission will be screened for S.aureus colonisation and offered treatment to eradicate that colonisation and
hence reduce the risk of them infecting their patients.
The FHMS has undertaken to screen students annually to facilitate their entry into host institutions for clinical
experience. Students are required to complete the screening assessment to be able to participate in placements.
Notwithstanding the outcome of the screening however, the student should be aware that the host institution has
the right to request further testing.
Please answer the following questions, NB a star (*) indicates that the question must be answered before you
submit this survey.
1. Do you have, or have you had in the past MRSA (Methicillin resistant Staphylococcus aureus)
colonisation or infection*?
Yes

No

2. Please give details if you have answered yes to question 1

3. Have you had recurrent boils or abscesses (NOT folliculitis) in the past year*?
Yes

No

4. Please give details if you answered yes to question 3

5. Have you had active, uncontrolled eczema in the past year*?

No

Yes

6. Please give details if you answered yes to question 5

7. Do you have, or have you had in the past year, chronic infective sinusitis (NOT hayfever)*?
Yes

No

8. Please give details if you answered yes to question 7

9. Have you ever had Bronchiectasis*?

No

Yes

10. Please give details if you answered yes to question 9

Consent Statement: I certify that the responses given are true. I understand that the information related to
S. aureus screening is required by the FHMS as evidence of complying with the Policy on Transmissible
and Blood-Borne Infections, and will be placed on my personal file and I have a right to access it. I also
consent to FHMS disclosing this information to the University of Auckland Student Health Service if
followup under this policy is considered necessary, subject to the Privacy Act 1993.
Please sign this form and hand into reception at the School of Pharmacy, Level 3, Building 505
I Agree

Name

SignedAUID.

Date.