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High Risk Stickers A safer way to practice? Brendan Healy Consultant in Infectious Diseases and Microbiology High Risk Stickers • High risk (HR) specimens should be labelled with a HR yellow sticker in accordance with laboratory standard operating procedures (SOPs) [2]. • COSSH – Employers have a duty to protect employers from harm. Doctors have a duty to inform laboratory staff of potential hazardous samples What are the risks? Blood borne viruses (BBVs) are transmitted by entry of blood or other bodily fluids containing viruses into the body of a susceptible person. BBVs of main concern: • Hepatitis B • Hepatitis C • Human Immunodeficiency Virus (HIV) All these viruses are in ACDP Hazard Group 3 and therefore are considered high risk [4]. Infected individuals with BBVs may not show symptoms or even be aware that they are carrying it. Avoid the risk – Universal Precautions • Risk assessment • COSHH – Under COSHH requirements, if the risk assessment shows that there is a risk of exposure to biological agents, and effective vaccines exist, these should be offered to those not already immunised • Immunisations • Personal protective equipment (PPE) - (HSE, 2001) recommends that “gloves should be worn for all work with material known or suspected of containing hazard group 3 biological agents”[4] • Biochemistry designated high risk area Results % of patients truly HR compared to % of patients inappropriately labelled HR 35% 65% Inappropriately labelled HR HR In a cohort of 200 patients, 65% were truly HR and 35% were inappropriately labelled HR. Truly HR, 37% Hep C, 32% HIV, 27% Hep B, 4% Mixed BBVs. Results % Patients inappropriately labelled HR 4% 17% no clear reason possible reasons no specimens 79% Results Possible reasons why non-HR patients were inapproriately labelled as HR (T=Tested, NT=Not Tested for BBVs) 17% 4% 4% 4% 50% 4% 17% MRSA Pos, T VRE, NT Group A strep, T Syphilis Pos, NT HEP C AB False Pos Past HEP B or C, T Results There was no clear reason why some non-HR patients were inappropriately labelled as HR 2% 5% BBV test carried out 26% No BBV test carried out 67% BBV test carried out as part of Pregnancy Screen Paeds oncology patient, no BBV test carried out Avoid the risk – Universal Precautions • Risk assessment • Immunisations • Personal protective equipment (PPE) - (HSE, 2001) recommends that “gloves should be worn for all work with material known or suspected of containing hazard group 3 biological agents”[4] Lumley