1. High Risk Stickers A safer way to practice?
Brendan Healy
Consultant in Infectious Diseases and Microbiology

2. High Risk Stickers
High risk (HR) specimens should be labelled with a HR yellow sticker in accordance with laboratory standard operating procedures (SOPs) [2].
COSSH – Employers have a duty to protect employers from harm. Doctors have a duty to inform laboratory staff of potential hazardous samples

3. What are the risks?
Blood borne viruses (BBVs) are transmitted by entry of blood or other bodily fluids containing viruses into the body of a susceptible person.
BBVs of main concern:
Hepatitis B
Hepatitis C
Human Immunodeficiency Virus (HIV)
All these viruses are in ACDP Hazard Group 3 and therefore are considered high risk [4].
Infected individuals with BBVs may not show symptoms or even be aware that they are carrying it.

4. Avoid the risk – Universal Precautions
Risk assessment
COSHH – Under COSHH requirements, if the risk assessment shows that there is a risk of exposure to biological agents, and effective vaccines exist, these should be offered to those not already immunised
Immunisations
Personal protective equipment (PPE) - (HSE, 2001) recommends that “gloves should be worn for all work with material known or suspected of containing hazard group 3 biological agents”[4]
Biochemistry designated high risk area
There are currently no vaccines available against hepatitis C or HIV. A safe and effective vaccine for the prevention of hepatitis B infection is
available.

5. Results
In a cohort of 200 patients, 65% were truly HR and 35% were inappropriately labelled HR.
Truly HR, 37% Hep C, 32% HIV, 27% Hep B, 4% Mixed BBVs.

6. Results
Out of the inappropriately labelled patients , 79% showed no clear reasons as to why this was. These patients were either tested for BBVs, not tested or had a BBV test as part of a pregnancy screen – one patient was a paeds oncology patient. However, for 17% of patients there were possible reasons as to why they had been mislabelled including; MRSA pos or past Hep B/C . The remaining 4% had no specimens to suggest they should be HR.

7. Results
Out of the inappropriately labelled patients , 79% showed no clear reasons as to why this was. These patients were either tested for BBVs, not tested or had a BBV test as part of a pregnancy screen – one patient was a paeds oncology patient. However, for 17% of patients there were possible reasons as to why they had been mislabelled including; MRSA pos or past Hep B/C . The remaining 4% had no specimens to suggest they should be HR.

8. Results
Out of the inappropriately labelled patients , 79% showed no clear reasons as to why this was. These patients were either tested for BBVs, not tested or had a BBV test as part of a pregnancy screen – one patient was a paeds oncology patient. However, for 17% of patients there were possible reasons as to why they had been mislabelled including; MRSA pos or past Hep B/C . The remaining 4% had no specimens to suggest they should be HR.

14. Avoid the risk – Universal Precautions
Risk assessment
Immunisations
Personal protective equipment (PPE) - (HSE, 2001) recommends that “gloves should be worn for all work with material known or suspected of containing hazard group 3 biological agents”[4]

18. Lumley