Limited value of annual tuberculosis symptom reminders for health care workers.

BACKGROUND: (UK) National Institute for Health and Clinical Excellence tuberculosis (TB) guidance (2006) recommends that occupational health services send annual TB symptom reminders to staff at increased risk of occupational TB exposure. AIMS: To evaluate the effectiveness of annual TB symptom reminders. METHODS: Retrospective analysis of returns from 4 years' annual TB symptom reminders compared with numbers of hospital staff diagnosed with active TB in the same time period. RESULTS: There were 405 responses to symptom reminders received during the period studied that represented a response rate of 16%. None of the respondents declared TB symptoms. Twelve staff were diagnosed with active TB over the same period. From their work location, only two of these would have received TB symptom reminders according to local TB policy. CONCLUSIONS: Annual TB symptom reminders as currently used result in little direct benefit.

Pan-Thames survey of occupational exposure to HIV and the use of post-exposure prophylaxis in 71 NHS trusts.

OBJECTIVES: To review the management of occupational exposure to definite or suspected HIV-infected blood, following the introduction of the 1997 UK Department of Health guidelines on the use of post-exposure prophylaxis. METHODS: Cross-sectional telephone survey of protocols in 71 NHS Trusts in the Pan-Thames region. Retrospective postal survey of the management of each definite or suspected HIV blood exposure between 1 July 1997 and 30 June 1999. RESULTS: Sixty-two (93%) Trusts had a written protocol, with many specialties involved in exposure management. Twenty-four Trusts reported 171 occupational exposures to definite or suspected HIV-infected blood. Of 97 definite HIV exposures, eight (8%) were discovered on post-incident HIV testing of the source patient; to which most source patients agreed when approached. Seventy-two (74%) exposed health care workers started prophylaxis and 49 (68%) completed the recommended 4-week course. Only half of those whose exposures occurred more than 6 months ago were known to have had a follow-up HIV test. CONCLUSIONS: Although most Trusts have implemented the Department of Health's guidance, collecting data on individual exposures proved difficult. We suggest that a designated department in each Trust co-ordinates and records HIV exposure management. Routine HIV testing is acceptable to most source patients and is appropriate in areas with a high prevalence of HIV seropositivity.

A survey of the use of post-exposure prophylaxis for occupational exposure to human immunodeficiency virus.

The objective of this study was to review the appropriateness of the use of post-HIV exposure prophylaxis for incidents involving occupational exposure to body fluids. The design was a retrospective analysis of the 32 incidents for which at least one dose of post-exposure prophylaxis was given, reported to the occupational health department of a London teaching hospital between 20 August 1997 and 20 January 1999. The main outcome measures were the proportion of prescriptions for exposure to a known HIV positive source, and criteria for prescribing when the source patient's HIV status was unknown. Only 31% of prescriptions were for exposure to a known HIV positive source. The reasons for prescribing post-exposure prophylaxis in the other 69% of cases were unclear. Safety data for short courses of anti-retroviral drugs in this setting could help to assess the appropriateness of their use to allay anxiety in healthcare workers, pending clarification of the source patient's HIV status. Closer collaboration between departments and more detailed guidance would improve consistency of practice, and may save some unnecessary prescriptions for expensive and toxic drugs.