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DOH Guidelines HIV INFECTED HEALTH CARE WORKERS

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DOH Guidelines HIV INFECTED HEALTH CARE WORKERS Powered By Docstoc
					DOH Guidelines
and HIV infected Health
Care Workers

Mike Jones, Dr Duncan Churchill
Claude Nicol Clinic/Lawson Unit
RSCH Brighton
Background

 In 2008 an HIV positive HCW
 (LU Pt) admitted with an acute
  infection
 Worked in an area where EPP‟s
  performed (RSCH)
 OH unaware of his status, never seen
  or assessed by them
Notes Review
   Concerns raised about LU patients who are
    currently HCW‟s not informing OH of their
    status

   Decision made to review 20 sets of notes of
    HIV infected HCW‟s attending LU

   Are we following DOH guidance (July 2005)
    on HIV infected HCW‟s ?
DOH Guidance (2005)

 HIV infected HCW‟s must not
 rely on their own assessment
 of the risk they pose to
 patients (must be an OH
 physician)           para 4.6
DOH Guidance

   …must promptly seek …expert medical and
    OH advice….must not perform EPP‟s whilst
    expert advice is sought       para 4.9

   If ….EPP‟s carried out by an infected HCW
    then they or a representative must inform
    the Director of Public Health of the relevant
    PCT on a confidential basis     para 4.11
DOH Guidance

   „If the infected HCW will not disclose
    to OH or the DPH then the HCP
    providing their clinical care should
    disclose , having informed the HCW
    first…..‟
    Summary of para 4.16
DOH Guidance


   Employers should assure infected
    health care workers that their status
    and rights as employees will be
    safeguarded as far as practicable.
    para 5.6
DOH Guidance

   The HIV physician providing … care to
    an infected worker…..should jointly
    manage the case with the OH
    physician para 6.3
Notes Review

 Details of LU patients known or
  thought to be HCW‟s provided by HIV
  physicians plus data search of 1600
  patients
 First 20 patients selected

 (LU attendees and currently HCW‟s
  who may be performing EPP‟s)
Notes Review

   Pro forma questions based on DOH
    guidelines.

   Notes also checked for references to
    discussions about HCW‟s
    responsibilities and rights.
Results

   20 sets of notes

   15 men / 5 women

   2 Drs / 17 Nurses / 1 HCA

   Diagnosed between 1994 and 2008
Results

   Do they carry out exposure prone
    procedures ? Pt self assessment.

    Yes – 0
    No – 7
    NK – 13
Results

   Were they referred to an HA after
    diagnosis ? Yes 18 No 2

   Who raised the issue of OH disclosure?
    HA 13    Nurse 4
    Dr 11    Pt     2
    In one case only no discussion
    recorded
Results

   Was there any discussion of employee
    rights ? (confidentiality, changes to
    role, redeployment etc)
    Yes 6 (HA discussion)
    No 14
Results

   Patient self reports disclosure to OH ?

    8 - stated they have informed OH

    12 – have not informed OH
Results

   Confirmation of disclosure to OH ?

    6 patients had letters to or from OH in
    their notes.
Results

   Rationale for non disclosure.
    2- Stated not carrying out EPP‟s
    1- Does “ not trust OH”
    2- Concerned re impact on career and
    do “not trust OH”
Conclusions

   A more pro active approach is required
    to encourage and support HIV infected
    HCW‟s to inform OH.
   HIV services and OH departments
    have to work together
   Clarification of rights as well as
    responsibilities of HCW‟s
Conclusions

   Needs to be clearer documentation of
    discussions regarding OH in notes.
   Notes should be reviewed to check OH
    informed (HA)
   Evidence of OH involvement should be
    filed in notes.
   New Clinic Protocol.
References

1) Department of Health July 2005
  HIV infected health care workers:
  Guidance on management and
  Patient notification
2) Cairns G (2008) „Blood Borne
  Hysteria‟ HIV treatment update
 August / September 2008

				
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