DOH Guidelines and HIV infected Health Care Workers

1. DOH Guidelines and HIV infected Health Care Workers Mike Jones, Dr Duncan Churchill Claude Nicol Clinic/Lawson Unit RSCH Brighton

2. 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

3. 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 ?

4. 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

5. 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

6. 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

7. 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

8. DOH Guidance • The HIV physician providing … care to an infected worker…..should jointly manage the case with the OH physician para 6.3

9. 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)

10. Notes Review • Pro forma questions based on DOH guidelines. • Notes also checked for references to discussions about HCW’s responsibilities and rights.

11. Results • 20 sets of notes • 15 men / 5 women • 2 Drs / 17 Nurses / 1 HCA • Diagnosed between 1994 and 2008

12. Results • Do they carry out exposure prone procedures ? Pt self assessment. Yes – 0 No – 7 NK – 13

13. Results • Were they referred to an HA afterdiagnosis? 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

14. Results • Was there any discussion of employee rights ? (confidentiality, changes to role, redeployment etc) Yes 6 (HA discussion) No 14

15. Results • Patient self reports disclosure to OH ? 8 - stated they have informed OH 12 – have not informed OH

16. Results • Confirmation of disclosure to OH ? 6 patients had letters to or from OH in their notes.

17. 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”

18. 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

19. 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.

20. 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