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DOH Guidelines and HIV infected Health Care Workers Mike Jones, Dr Duncan Churchill Claude Nicol Clinic/Lawson Unit RSCH Brighton
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Background In 2008 an HIV positive HCW In 2008 an HIV positive HCW (LU Pt) admitted with an acute infection (LU Pt) admitted with an acute infection Worked in an area where EPP’s performed (RSCH) Worked in an area where EPP’s performed (RSCH) OH unaware of his status, never seen or assessed by them OH unaware of his status, never seen or assessed by them
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Notes Review Concerns raised about LU patients who are currently HCW’s not informing OH of their status 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 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 ? Are we following DOH guidance (July 2005) on HIV infected HCW’s ?
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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 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
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DOH Guidance …must promptly seek …expert medical and OH advice….must not perform EPP’s whilst expert advice is sought para 4.9 …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 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
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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…..’ ‘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 Summary of para 4.16
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DOH Guidance Employers should assure infected health care workers that their status and rights as employees will be safeguarded as far as practicable. Employers should assure infected health care workers that their status and rights as employees will be safeguarded as far as practicable. para 5.6 para 5.6
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DOH Guidance The HIV physician providing … care to an infected worker…..should jointly manage the case with the OH physician para 6.3 The HIV physician providing … care to an infected worker…..should jointly manage the case with the OH physician para 6.3
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Notes Review Details of LU patients known or thought to be HCW’s provided by HIV physicians plus data search of 1600 patients 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 First 20 patients selected (LU attendees and currently HCW’s who may be performing EPP’s) (LU attendees and currently HCW’s who may be performing EPP’s)
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Notes Review Pro forma questions based on DOH guidelines. Pro forma questions based on DOH guidelines. Notes also checked for references to discussions about HCW’s responsibilities and rights. Notes also checked for references to discussions about HCW’s responsibilities and rights.
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Results 20 sets of notes 20 sets of notes 15 men / 5 women 15 men / 5 women 2 Drs / 17 Nurses / 1 HCA 2 Drs / 17 Nurses / 1 HCA Diagnosed between 1994 and 2008 Diagnosed between 1994 and 2008
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Results Do they carry out exposure prone procedures ? Pt self assessment. Do they carry out exposure prone procedures ? Pt self assessment. Yes – 0 Yes – 0 No – 7 No – 7 NK – 13 NK – 13
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Results Were they referred to an HA after diagnosis ? Yes 18 No 2 Were they referred to an HA after diagnosis ? Yes 18 No 2 Who raised the issue of OH disclosure? Who raised the issue of OH disclosure? HA 13 Nurse 4 HA 13 Nurse 4 Dr 11 Pt 2 Dr 11 Pt 2 In one case only no discussion recorded In one case only no discussion recorded
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Results Was there any discussion of employee rights ? (confidentiality, changes to role, redeployment etc) Was there any discussion of employee rights ? (confidentiality, changes to role, redeployment etc) Yes 6 (HA discussion) Yes 6 (HA discussion) No 14 No 14
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Results Patient self reports disclosure to OH ? Patient self reports disclosure to OH ? 8 - stated they have informed OH 8 - stated they have informed OH 12 – have not informed OH 12 – have not informed OH
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Results Confirmation of disclosure to OH ? Confirmation of disclosure to OH ? 6 patients had letters to or from OH in their notes. 6 patients had letters to or from OH in their notes.
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Results Rationale for non disclosure. Rationale for non disclosure. 2- Stated not carrying out EPP’s 2- Stated not carrying out EPP’s 1- Does “ not trust OH” 1- Does “ not trust OH” 2- Concerned re impact on career and do “not trust OH” 2- Concerned re impact on career and do “not trust OH”
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Conclusions A more pro active approach is required to encourage and support HIV infected HCW’s to inform OH. 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 HIV services and OH departments have to work together Clarification of rights as well as responsibilities of HCW’s Clarification of rights as well as responsibilities of HCW’s
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Conclusions Needs to be clearer documentation of discussions regarding OH in notes. Needs to be clearer documentation of discussions regarding OH in notes. Notes should be reviewed to check OH informed (HA) Notes should be reviewed to check OH informed (HA) Evidence of OH involvement should be filed in notes. Evidence of OH involvement should be filed in notes. New Clinic Protocol. New Clinic Protocol.
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References 1) Department of Health July 2005 HIV infected health care workers: HIV infected health care workers: Guidance on management and Patient notification Guidance on management and Patient notification 2) Cairns G (2008) ‘Blood Borne Hysteria’ HIV treatment update August / September 2008
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