Post-exposure prophylaxis protocol for exposure to blood-borne pathogens: an intervention to improve knowledge and practice among medical students in a South African hospital

Background:Globally, approximately three million healthcare workers experience a percutaneous injury each year. Medical students are at a particularly high risk of exposure to blood-borne pathogens. Despite this, the rate of non-reporting is still high. Objectives: The objectives of this study were to describe and improve the knowledge and practice of the post-exposure prophylaxis (PEP) protocol among medical students, through the implementation of quality-improvement interventions, with a view to improving the protocol. Methods: This was an intervention study conducted among third- to fifth-year students, in 2015 and 2016. The quality-improvement interventions took place over 11 months and included the issuing of laminated protocols, posters and lectures. Data from survey questionnaires were used to quantify the impact of these interventions. Student practice was measured by the number of correct steps of the protocol completed. McNemar and Wilcoxon signed-rank tests were used to test differences in the paired categorical data. Results: Of approximately 750 students who participated in the study intervention, 407 returned the initial questionnaire and 148 returned the post-intervention survey questionnaire. Eighty-six students (21.1%) completed both questionnaires. The blood-borne pathogen exposure rate prior to the intervention period was 28.0%. In the paired group, reporting of exposures increased from 12.2% in 2015 to 31.3% in 2016. Knowledge of the PEP protocol increased significantly in the paired group, from 17.4% to 40.2% (p < 0.001). Prior to the intervention, 91.7% completed fewer than half of the steps of the PEP protocol. This decreased significantly to 69.4% in the paired group, post-intervention (p = 0.03). Conclusion: Practice of the PEP protocol significantly improved after the intervention was implemented. In addition, there was a significant improvement in the knowledge of students about postexposure management. However, many exposures were still unreported post-intervention, indicating that more work is needed to improve reporting behaviour

International HIV Dementia Scale: Screening for HIV-Associated Neurocognitive Disorders in Occupational Settings

This study investigated whether the International HIV Dementia Scale (IHDS) can be used to screen for milder forms of HIV-associated neurocognitive disorder (HAND) in occupational health settings. It explored first; the effect of demographic variables on IHDS performance in a sample of HIV-negative employees and second; the extent to which the IHDS can differentiate between milder forms of HAND in HIV-infected employees. Data from 476 HIV-negativeand 90 HIV-positive individuals indicated that; although clinicians need to be sensitive to the effect of education and test-language proficiency; separate norms based on socio-demographic variables are not required in this context; and that the IHDS shows promise for identifying milder forms of HAND in this HIV-positive sample; with ?10 the recommended cut-off for further referral. In conclusion; there is support for the IHDS to screen for HAND where this may impact on safety-critical tasks in the workplace