title: Blood and body fluid exposures: consent for source patient testing.
abstract: BACKGROUND
  Exposure to blood and body fluids (BBF) remains a major occupational hazard in health care. Routine testing of source patients for blood borne viruses where exposure has occurred is recommended in the UK. Whilst in practice source patient identification may be challenging the reasons why identified individuals are not tested, including issues relating to consent and procedure compliance, are not fully understood.
  
  
  OBJECTIVE
  To identify the frequency of serological testing in identified source patients and the reasons for not testing, including refusal and absence of consent.
  
  
  METHODS
  A review of all BBF exposure incidents reported to the Sheffield Occupational Health Service between 1 January 2009 and 31 December 2009.
  
  
  RESULTS
  Of 490 reported BBF exposure incidents source patients were identified in 87% of cases and tested in 56% of the incidents. Rates of source patient testing were higher following incidents affecting medical (76%) and nursing staff (69%) than those involving non-clinical (36%) and dental staff (17%). Reasons for not testing source serology among identifiable patients (151) were not recorded in 66% of incidents, in 20% there was incapacity to give consent and in 5% testing was refused.
  
  
  CONCLUSIONS
  This study found that despite guidance, routine source testing is not universal. Incapacity to consent is a contributory factor for some source serology not being tested and clarification of the ethical and legal position would be helpful. Larger studies should explore other reasons why identified source patients are not tested in practice and explore the policy implications of those findings.
authors.affiliation: Sheffield Occupational Health Service, Northern General Hospital, Sheffield Teaching Hospitals, NHS Foundation Trust, Silverwood S5 7AU, UK. prosenjitgiri@hotmail.com
authors.forename: P
authors.initials: P
authors.lastname: Giri
authors.forename: S
authors.initials: S
authors.lastname: Basu
authors.forename: A
authors.initials: A
authors.lastname: Adisesh
authors.forename: A
authors.initials: A
authors.lastname: Rimmer
mesh_terms: D017848:Blood-Borne Pathogens; D001826:Body Fluids / Q000821:virology; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D017758:Infectious Disease Transmission, Patient-to-Professional / Q000191:economics / Q000706:statistics & numerical data*; D007258:Informed Consent / Q000941:ethics*; D016602:Needlestick Injuries / Q000191:economics / Q000523:psychology; D016273:Occupational Exposure / Q000191:economics / Q000706:statistics & numerical data*