Variation in interpretation and counselling of blood exposure incidents by different medical practitioners
published online 13 February 2008.
Background
Blood exposure incidents pose a risk for transmission of bloodborne pathogens for both health care workers and public health. Despite several national and international guidelines, counsellors have often different opinions about the risks caused by these incidents. Little is known about the consequences of these variations in risk assessment on the effectiveness of the treatment and the costs for the health care system.
Methods
The aim of this study was to reveal differences among diverse groups of counsellors in assessing the same blood exposure incidents. Subjects included 4 different kinds of counsellors: public health physicians from infectious disease departments and medical microbiologists, occupational health practitioners, and HIV/AIDS specialists from hospital settings. Surveys with cases of blood exposure incidents were sent to the counsellors in The Netherlands asking questions about their risk assessment and consequent treatment. Questions were categorized for hepatitis B virus (HBV), hepatitis C virus (HCV), and HIV risks.
Results
Of the 449 surveys sent, 178 were returned, of which 158 were eligible for the study. In general, occupational health practitioners and medical microbiologists showed a more rigorous approach especially with regard to prophylactic treatment when counselling HBV risk situations, whereas public health physicians and HIV/AIDS specialists were more thorough in the handling of HCV risk accidents. In HIV counselling, HIV/AIDS specialists were far more rigorous in their treatment than the other groups. For 7 of the total of 12 cases, the risk assessment with regard to HBV, HCV, and HIV differed significantly.
Conclusion
The assessment of blood exposures significantly differs depending on the medical background of the counsellor handling the incident, leading to remarkable inconsistencies in the response to prevent the transmission of bloodborne pathogens and/or to increased costs for unnecessary diagnostic tests and preventive measures. Although national guidelines for the counselling and treatment of blood exposure incidents are essential, the assessment of blood exposure incidents should be limited to as few as possible, well-trained professionals, operating in regional or national call centers, to ensure comparable assessment and corresponding application of preventive measures for all victims.
aDepartment of Medical Microbiology and Infection Control, Jeroen Bosch Hospital, ‘s-Hertogenbosch, The Netherlands
bDepartment of Infectious Diseases and Public Health, Hart voor Brabant, ‘s-Hertogenbosch, The Netherlands
cNational Hepatitis Centre, Amersfoort, The Netherlands
dDepartment of Medical Microbiology and Infectious Diseases, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands
eNijmegen University Centre for Infectious Diseases, Radboud University Medical Centre, Nijmegen, The Netherlands
fCentre for Infectious Disease Control-bLCI, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
Address correspondence to Paul Th. L. van Wijk, Jeroen Bosch Hospital, Department of Medical Microbiology and Infection Control, POB 90153, 5200 ME ‘s-Hertogenbosch, The Netherlands.
ABSTRACT