Auditing incidents of exposure to blood

EDITOR,—Ruth R White and Elisabeth J Ridgway highlight variations in the management of reported sharps injuries in Mersey Regional Health Authority.1 The management of common conditions, especially when there is believed to be room for variation, is a good topic for audit. The North Thames (East) Regional Occupational Health Audit Group, which has representatives from all the occupational health units in the region, recently audited the management of reported incidents of exposure to blood.

Of the 17 occupational health units, 15 participated in the audit. All were involved in the management of reported exposure to blood in some way; four were not responsible for the initial management. Only one unit ran an out of hours service for such incidents; for several others this was provided by another department. Eleven units routinely stored a sample of blood from the staff member involved. The policies about approaching source patients to request tests for bloodborne viral infections varied considerably: for hepatitis B surface antigen this was routine in four units and done in high risk cases in eight; for HIV antibody it was routine in three units and done in high risk cases in eight; and for antibodies to hepatitis C it was routine in only one unit, with four other units requesting testing in some cases. Prophylactic procedures for hepatitis B and HIV infection after sharps injuries also varied. Hepatitis B specific immunoglobulin was given more widely than is recommended by the Public Health Laboratory Service,2 including in circumstances in which the status of the source patient was not known (two units).

At the Royal Free Hospital all known source patients are approached for testing for hepatitis C antibodies, although this goes beyond recent guidelines from the Public Health Laboratory Service.3 We have found hepatitis C antibodies in 14% of source patients in reported incidents of exposure to blood, with a quarter of these infections being previously unknown.4 The decision whether to test source patients routinely for hepatitis C virus and other bloodborne viruses will depend on the rates of infection in each hospital and the resources available for counselling and testing. Many occupational health units in our region do not have access to testing for hepatitis C antibodies in source patients.

The audit exercise in the region has been helpful, allowing units to compare their practices and providing support for units requesting additional resources. The level of provision of occupational health care varies too much at present to allow the development of formal guidelines that all can follow, but we hope that this may be possible in the future.