Transcript DOH Guidelines HIV INFECTED HEALTH CARE WORKERS

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