In this issue of Occupational Medicine
Honorary Assistant Editor
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Lost in translation: Guidelines to implementation |
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 Top Lost in translation: Guidelines... References |
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This edition of Occupational Medicine contains a number of items concerning blood-borne viruses, guidelines for screening healthcare workers and audits of implementation of such guidelines [1–3].
Many of the issues are brought together in two leading editorials by William Irving and Paul Grime [4, 5] Of note is the debate over calculating the actual risk of transmission of blood-borne viruses and translating this into evidence-based clinical guidelines. Irving disagrees with the rates calculated by Steiner et al. [3]. His editorial gives some insight into the thinking behind the development of the hepatitis C infected healthcare workers guidelines [6] and the reasons for stopping short of screening all health care workers performing exposure-prone procedures.
Grime discusses in more detail the pros and cons of such screening programmes including the recently launched Department of Health guidance on health clearance for tuberculosis, hepatitis B, hepatitis C and HIV [7]. He includes a plea for a more practical and proportional response to assessing risks both to patients and healthcare workers.
Evidence presented in audits of guideline implementation in both Scotland and England confirm that despite clearly thought out rationale for guidelines issued from central government bodies, much of the message is lost in translation [2, 3]. Both audits demonstrate inconsistent implementation, with many areas exceeding the screening criteria in part due to lack of clarity regarding categorization of staff groups to be tested.
The value of audit in reviewing and influencing practice is also shown in the paper by Williams et al. [1]. The data presented relate to management of occupational exposure to hepatitis C in the 1990s. Of the sample, 40% of healthcare workers did not return for any follow-up despite being confirmed as exposed to a hepatitis C positive source blood. It is hoped by the authors that education of all new healthcare workers in relation to the risks will ensure more effective follow-up in future.
Elsewhere in this issue, research from Norway also raises the need to reinforce preventative measures to reduce risk [8]. Bull reviewed injury incidence before and after the introduction of wearing mandatory eye protection in a metalworking yard. Perhaps not surprisingly the rates of injury fell following the introduction of the use of eye protection and the incidence rate declined from 6 to 0.4 per million working hours. This equates to a more than 90% reduction in eye injuries and a lot of people without eye problems. It seems that if guidelines can be clear, concise and specific to risk then implementation, and more importantly, population health benefit, is achievable.
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TopLost in translation: Guidelines...References |
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- Williams S, Libotte V, Ramsay M. Compliance with follow-up after occupational exposure to hepatitis C. Occup Med (Lond) (2007) 57:596–598.
- Gibson K, Kennedy I. Implementation of the hepatitis C guidelines in UK health care workers. Occup Med (Lond) (2007) 57:599–601.
- Steiner M, Murphy E, Roy K, Dick F. Benchmarking self-reported practice regarding Scottish Executive guidance on hepatitis C infected health care workers. Occup Med (Lond) (2007) 57:607–609.
- Irving W. Guidelines on prevention of transmission of hepatitis C virus infection in the workplace: do they work in practice? Occup Med (Lond) (2007) 57:542–544.
- Grime P. Blood-borne virus screening in health care workers: is it worthwhile? Occup Med (Lond) (2007) 57:544–546.
- Department of Health Hepatitis C infected health care workers. HSC 2002/10. (2002) London: DH Publications. August.
- Department of Health Health clearance for tuberculosis, hepatitis B, hepatitis C and HIV: New healthcare workers. (2007) DH publications.
- Bull N. Mandatory use of eye protection prevents eye injuries in the metal industry. Occup Med (Lond) (2007) 57:605–606.
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