Out of hours management of occupational exposures to blood and body fluids in healthcare staff.
OBJECTIVE
To assess and compare the out of hours and in hours management of occupational blood and body fluid exposures in a London teaching hospital.


METHODS
The occupational health and accident and emergency records of individuals presenting with occupational body fluid exposures over a six month period at a London teaching hospital were analysed retrospectively. Main outcome measures were the completeness of records, and the appropriate management of body fluid exposures using the Department of Health guidelines as the gold standard.


RESULTS
A total of 177 body fluid exposures were reported; 109 (61.58%) were initially assessed in the occupational health department, and 68 (38.42%) in the accident and emergency department. Of those originally assessed in the accident and emergency department, only 21 (30.88%) attended the occupational health department for follow up. Occupational health staff were more consistent in assessing and managing exposures, and in a higher proportion of cases gave more appropriate advice on post-exposure prophylaxis (PEP) against hepatitis B and HIV. Of the 11 individuals prescribed HIV PEP (all by accident and emergency staff), only three subsequently attended occupational health for follow up. In all three cases therapy was discontinued, as the source was HIV negative or the exposure low risk.


CONCLUSIONS
Out of hours management of occupational body fluid exposures, particularly the prescribing of HIV PEP, was inconsistent with in hours practice. This may also be the case in other large inner city hospitals offering a similar service.
Patel
D
D
Guy's, King's, and St Thomas' School of Medicine, Occupational Health Department, St Thomas' Hospital, Lambeth Palace Road, London SE1 7EH, UK. dipti.patel@gstt.sthames.nhs.uk
Gawthrop
M
M
Snashall
D
D
Madan
I
I
D001769:Blood; D001826:Body Fluids; D003428:Cross Infection / Q000517:prevention & control / Q000635:transmission; D004636:Emergency Service, Hospital / Q000458:organization & administration / Q000592:standards*; D015658:HIV Infections / Q000517:prevention & control / Q000635:transmission; D006784:Hospitals, Teaching; D006801:Humans; D017758:Infectious Disease Transmission, Patient-to-Professional / Q000517:prevention & control*; D008131:London; D008499:Medical Records / Q000592:standards; D008505:Medical Staff, Hospital; D016273:Occupational Exposure / Q000009:adverse effects*; D009786:Occupational Health Services / Q000458:organization & administration / Q000592:standards*; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D018570:Risk Assessment; D012308:Risk Management; D013997:Time Factors