Auditing incidents of exposure to blood.
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Blood-Borne Pathogens↗
Biomedical subjects
A Cockcroft
Publications and source records attributed to A Cockcroft.
Sick doctors. Develop existing occupational health services.
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Humans↗
Prevalence of hepatitis C antibodies in clinical health-care workers.
Health-care workers are known to be at risk from occupational transmission of blood-borne viruses, including hepatitis C. There may be serious implications following infection with hepatitis C including possible transmission to patients. We determined the prevalence of hepatitis C virus (HCV) antibodies among health-care workers at risk of occupational contact with blood and body fluids and among source patients in reported blood-exposure incidents. Anonymised stored blood samples from health-care workers immunised against hepatitis B virus since 1991 (n = 1053) and blood samples from source patients in needlestick injuries (retrospective and prospective) since 1989 (n = 373) were analysed. 3 (0.28%) of the serum samples from health-care workers were found to be anti-HCV-positive. 17 (8.5%) of 200 source patients tested retrospectively between January 1989 and January 1992, and 24 (13.9%) of 173 source patients tested prospectively between January 1992 and June 1993 were anti-HCV-positive. During the second period, 15 (10.6%) of 142 source patients tested for human immunodeficiency virus (HIV) were positive and 7 (3.8%) of 184 source patients tested for hepatitis B surface antigen were positive. 6 of 24 (25%) HCV-infected patients were diagnosed only after the incident; for hepatitis B, 2 (33%) of patients were diagnosed after the incident, and for HIV all patients were previously diagnosed. The seroprevalence of HCV among these health-care workers is no higher than that reported in blood donors.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
Clinical practice and the perceived importance of identifying high risk patients.
The Royal Free NHS Trust is implementing a Universal Precautions policy for blood and body fluids. Anticipating the introduction of this policy, a questionnaire was sent to a sample of staff and students who work with patients or clinical specimens. The questionnaire covered: views about identifying 'high risk' patients and specimens; perceived risks of human immunodeficiency virus (HIV) and hepatitis B infection from blood exposures; and current practices to avoid exposure to blood. Over half the respondents thought it important to identify high risk patients and specimens. Such respondents were more likely to overestimate the risks of HIV and hepatitis B virus transmission after blood exposures, they were less likely to wear gloves and more likely to resheathe needles. Although two-thirds of respondents thought Universal Precautions would reduce their risk of blood-borne infections, they identified a number of reasons why it would be difficult for them to practice it. Those who thought it important to identify high risk patients gave more reasons than other respondents. This survey indicates that many staff believe it is important to identify high risk patients and this belief seems to influence clinical practice. In order to implement a policy of Universal Precautions successfully, it is necessary to address underlying beliefs as well as giving staff information and training.
Acquired Immunodeficiency Syndrome↗
Anxiety and perception of risk of HIV and hepatitis B infection among health-care workers reporting accidental exposures to blood and other body fluids.
We noticed considerable variation in anxiety among staff reporting blood exposure incidents and therefore undertook a study to investigate this. We studied 100 consecutive staff reporting blood or other body fluid exposures to the Occupational Health Unit. The nurse seeing the staff member administered a questionnaire about worries related to the incident, knowledge of HIV and hepatitis B transmission risks, perception of risk from the particular incident and predicted reaction of others that would be told. Level of anxiety was recorded on a visual analogue scale. Staff were then given information and counselling as usual, and asked to re-attend after a week, when the questionnaire was repeated. We found that the initial level of anxiety was not related to knowledge of HIV or hepatitis B transmission risks, but was related to perception of risk from the incident and to predicted reaction of others that would be told. The eight staff involved in exposures to known HIV-infected blood were not more anxious than the remainder. There was a reduction in anxiety between visits, which was significantly greater in women, in those who had a non-parental exposure and in those where the source patient was known. Knowledge of transmission risks also improved significantly between visits. This study underlines the importance of adequate counselling of staff who have suffered blood exposures.
Adult↗
Evaluation of a programme of health measurements and advice among hospital staff.
This paper reports the evaluation of a pilot health promotion initiative among hospital staff. Health screening and advice were available during one week. Staff who attended completed a questionnaire about diet, alcohol, exercise, smoking, stress and health perceptions. They were randomly assigned to receive advice and set targets for changing their lifestyle or simply to be given their results. A sample of non-attending staff was sent the same questionnaire. Attenders were invited to return after six months. Of the 297 staff who attended the first session, 83 returned after six months. Of the non-attending staff, 192 returned a questionnaire. Attenders were older, more concerned and more knowledgeable about their health and under-represented by clinical and manual staff. Weight, exercise frequency and perceptions of health were related to the likelihood of re-attending. Those in the 'advice' group were more likely to lose weight and increase their exercise. It is difficult to achieve wide participation in health promotion activities but a simple intervention can have useful effects.
Evaluation Studies as Topic↗
Hepatitis B immunization and exposure to blood among surgical staff.
A questionnaire was sent to all 158 staff of the operating department of a London teaching hospital to confirm their hepatitis B immunization status and establish the number of incidents involving exposure to blood during the preceding 4 weeks. Of these personnel, 104 (66 per cent) were known to be immune to hepatitis B either through immunization (97) or previous infection (seven). A further 23 (15 per cent) had completed a course of immunization but their seroconversion had not been checked. There were 26 sharps injuries sustained by 14 (12 per cent) of 119 staff and 240 other exposures to blood. Four of the sharps injuries had been reported. Staff known to be immune were more likely than those with unknown or negative immunity to report incidents (20 versus 0 per cent (95 per cent confidence interval of difference 2-38 per cent)). Doctors sustained more non-sharps exposures to blood than others (47 versus 23 per cent (95 per cent confidence interval of difference 7-40 per cent)). An important minority of operating department staff remains unimmunized against hepatitis B, although exposure to blood is common. Incidents are rarely reported and staff with unknown or negative immunity seem less likely to report than those known to be immune.
Blood↗
Site of injection for vaccination.
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Hepatitis B Vaccines↗
Review of management of incidents involving exposure to blood in a London teaching hospital, 1989-91.
OBJECTIVE: To review management of incidents involving exposure to blood reported to an occupational health unit. DESIGN: Analysis of all reported incidents from January 1989 to June 1991. SETTING: London teaching hospital. SUBJECTS: 447 health care workers and students. MAIN OUTCOME MEASURES: Immunisation against hepatitis B virus before exposure, proportion of known source patients tested for hepatitis B surface antigen and HIV antibodies, and reasons for not testing known source patients. RESULTS: 447 incidents were reported: 337 sharps injuries and 110 other exposures. 310 staff reporting incidents (205 (82%) nurses) were already immune to hepatitis B virus, nearly always because of immunisation. 345 source patients were identified, 77 of whom had already been tested for hepatitis B surface antigen (28 positive results) and 58 for HIV antibodies (18 positive results). Of those not previously tested, 145 of 266 were subsequently tested for hepatitis B surface antigen (two positive) and 149 of 287 for HIV antibodies (none positive). The main reasons for not testing source patients were that the incident was not considered a risk, that the patient had gone home, and that the clinical team were unwilling to ask the patient. Specific hepatitis B immunoglobulin was given to 18 staff who were not immune and was avoided in 11 cases by a negative result for the patient. Prophylactic zidovudine was discussed but not given to any staff member. CONCLUSIONS: Management of exposure to blood is improved by widespread immunisation against hepatitis B virus and by knowledge of source patients' hepatitis B virus and HIV status.
Blood↗
Tuberculosis screening in health service employees: who needs chest X-rays?
There is uncertainty in the NHS about which individuals should be offered pre-employment screening by chest X-ray and whether this procedure is of value in the detection of tuberculosis. To provide evidence for practice, pre-employment chest X-ray and tuberculin skin test status were examined retrospectively for employees of a health district. Cases were those with an abnormal chest X-ray; referents were a sample of the remainder with a normal chest X-ray. The majority of the population had positive tuberculin skin tests and there was no difference between cases (58 positive out of 68) and referents (170 positive out of 212). Most of the X-ray abnormalities were trivial; four findings were thought significant, but would have caused no problems if undetected and none of these findings was related to tuberculosis. We conclude that in new employees in Hampstead health district, X-ray abnormalities are rare and not predicted by testing tuberculin skin reactivity; neither procedure is justified routinely as a means of screening for tuberculosis. The situation in districts with a high incidence of tuberculosis needs to be investigated.
Adolescent↗
Emotional distress in doctors: sources, effects and help sought.
All doctors in a London Teaching Hospital were sent a self-administered, anonymous questionnaire, to study past episodes of emotional distress. We inquired about frequency of past and current emotional distress, sources of distress, effects on work and home life, type of help sought and perceived outcome of that help. Of 320 doctors, 210 (66%) responded. One hundred and forty-one (68%) reported previous episodes of moderate or severe emotional distress. Logistic regression revealed that distress was significantly more common in younger doctors and in women. Many respondents reported work problems as causing their distress and work was frequently adversely affected by episodes of distress. Professional help was rarely sought; non-professional help was from family and friends. Current emotional distress was related to a history of past distress, especially among the most junior doctors. We conclude that past emotional distress is reported by most doctors, with work pressures an important contributing factor. Doctors do not appear to use available sources of professional help. Our findings confirm that doctors have difficulty disclosing psychological problems. Specific programmes aimed at prevention and management of distress in doctors need to be initiated and evaluated.
Adult↗
A study of the detailed circumstances of 'sharps' injuries in health care workers.
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Adult↗
Compulsory HIV antibody testing, universal precautions and the perceived risk of HIV: a survey among medical students and consultant staff at a London teaching hospital.
Routine screening of patients and health care staff for HIV has not been endorsed by the medical profession. Instead universal precautions have been recommended as being the most effective way of minimizing the occupational risk of HIV infection. Consultant staff and undergraduate medical students at the Royal Free Hospital and School of Medicine, London, were asked about their attitudes towards compulsory HIV antibody testing, their compliance with universal precautions and their perceived risk of HIV infection. A substantial proportion of staff and students supported compulsory HIV antibody testing for patients, health care workers and certain subgroups of the population. Most of the clinical students and about half the consultants failed to comply with universal precautions. Staff and students saw themselves at greater risk of HIV infection in the hospital than in their personal lives. Clearly, these beliefs and practices must be taken into account when introducing a policy of universal precautions.
AIDS Serodiagnosis↗
The language of breathlessness. Use of verbal descriptors by patients with cardiopulmonary disease.
The main objective of the present study was to test the hypothesis that patients with cardiopulmonary disease can reliably identify different sensory qualities of their experience of breathlessness. A secondary aim was to examine whether there was any relationship between such specific descriptors of the sensation of breathlessness and a patient's clinical diagnosis. A randomly ordered list of 45 descriptors of breathing discomfort related to exertion was administered on two occasions to 208 patients with cardiopulmonary disease; patients identified the descriptors that applied to their own experience. A total of 169 patients were considered reliable in that their responses were repeatable between questionnaires; there was evidence that an individual's reliability could be assessed by asking repeat questions within a questionnaire. With these patients, individual descriptors generated different degrees of yes and no response and were answered with a variable consistency, suggesting that some questions may be more useful than others in discriminating between the quality of patients' sensations. Overall, patients with obstructive disorders (asthma and chronic obstructive airways disease [COAD]) answered yes more often than those with restrictive or cardiac conditions, possibly reflecting differences in severity of disease. A cluster analysis separated the descriptors into 12 groups which appeared to describe different aspects of breathing discomfort. Relative to their response to other clusters, COAD patients were more inclined to identify distress, asthma patients to indicate wheeziness, restrictive patients to report rapid breathing, and the cardiac group to describe a need to sign. A second cluster analysis separated patients into 12 groups based on responses for the descriptor clusters.(ABSTRACT TRUNCATED AT 250 WORDS)
Adolescent↗
Survey of student nurses' smoking habits in a London teaching hospital.
As a preliminary to a 3-year intervention project to reduce smoking levels and prevent smoking commencement among student nurses, a survey of smoking habits among all 368 student nurses at The Royal Free Hospital was conducted in the Autumn of 1988. Absence rates of smokers and those who had never smoked were also studied. The response rate was high (95%) and the survey showed a high percentage (43%) of smokers among the student nurses. There was a higher proportion of smokers among those who did not respond to the first mailing of the questionnaire. The absence rate among smokers was almost twice that of the nonsmokers (P less than 0.005) and the number of days absent was related to the number of cigarettes smoked (P less than 0.05). Sixty-two per cent of nurses who smoked before they started their training (n = 125) said they had increased their smoking since commencing training and 39 (11%) nurses started smoking after starting nurse training. 'Stress', greater opportunity to smoke and peer influence were given as reasons for increased smoking and smoking commencement during nurse training.
Absenteeism↗
Knowledge and attitudes of health care workers about AIDS and HIV infection before and after distribution of an educational booklet.
Hospital workers (509) in a health authority were surveyed, and asked if they were in contact with HIV positive or AIDS patients; about their perception of risk; of their knowledge about and attitudes towards HIV and AIDS problems at work; and their desire for more information about AIDS and HIV. Overall scores for level of knowledge and attitudes were calculated; clinical workers scored better than non-clinical workers. Following the first survey, an information booklet was distributed to all health authority staff and after distribution, 232 staff were surveyed again. In this group (the follow-up group), there was a reduction in perceived risk, an improvement in the level of knowledge and in attitudes, and a reduction in the desire for further information. The group who initially had the least level of knowledge and most unfavourable attitudes (non-clinical workers) were the group who improved most.
Acquired Immunodeficiency Syndrome↗
Antibody response after hepatitis B immunisation in a group of health care workers.
Hepatitis B immunisation has been offered to staff of Hampstead Health Authority since 1982 and is now offered to all staff with clinical contact. Three doses of 20 micrograms of vaccine are given at zero, one, and six months and the antibody response is measured three months later. Results were analysed to seek for associations with the antibody response. At the time of analysis, 2739 people had started vaccination and 1067 had completed the course and had a measurement of antibody response. Vaccine injections were initially into the buttock and later into the arm; measurement of antibody levels was initially by radioimmunoassay (RIA) and later by enzyme immunoassay (EIA). A positive antibody response was defined as a positive/negative ratio of greater than 10 for RIA or a level of greater than 10 mIU/ml for EIA. Associations between antibody response and other variables were tested by chi 2 and a multiple logistic regression analysis was undertaken to examine the effects of variables in combination. The overall antibody response rate was 95%. Men and women did not respond differently but there were significantly more positive responses with the EIA testing method and a tendency for more positive responses with arm injections. The responders were significantly younger than the non-responders and had significantly lower values of body mass index (wt/ht2).(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
AIDS/HIV counselling in occupational health.
AIDS/HIV counselling will increasingly become part of the role of occupational health professionals. Issues that arise in the occupational setting include: occupational transmission, knowledge and attitudes, problems with family and friends, AIDS dementia, and uncertainty. Dilemmas can occur in relation to contamination incidents, HIV positive employees, or staff refusing to work because of fears of HIV/AIDS. It it easier to deal with the problems that arise if the issues have been thought through beforehand. Examples are given of problems that have occurred in a setting of occupational health in the British Health Service and their resolution is discussed.
Counseling↗