David Snashall

Utility of history, examination and laboratory tests in screening those returning to Europe from the tropics for parasitic infection

Summary objectives  To examine the utility of the different elements of screening expatriates and travellers returned from the tropics for parasitic disease (exposure history, symptoms, examination and laboratory tests).

Out of hours management of occupational exposures to blood and body fluids in healthcare staff

Aims: To assess and compare the out of hours and in hours management of occupational blood and body fluid exposures in a London teaching hospital. Methods: The occupational health and accident and emergency records of individuals presenting with occupational body fluid exposures over a six month period at a London teaching hospital were analysed retrospectively. Main outcome measures were the completeness of records, and the appropriate management of body fluid exposures using the Department of Health guidelines as the gold standard. Results: A total of 177 body fluid exposures were reported; 109 (61.58%) were initially assessed in the occupational health department, and 68 (38.42%) in the accident and emergency department. Of those originally assessed in the accident and emergency department, only 21 (30.88%) attended the occupational health department for follow up. Occupational health staff were more consistent in assessing and managing exposures, and in a higher proportion of cases gave more appropriate advice on post-exposure prophylaxis (PEP) against hepatitis B and HIV. Of the 11 individuals prescribed HIV PEP (all by accident and emergency staff), only three subsequently attended occupational health for follow up. In all three cases therapy was discontinued, as the source was HIV negative or the exposure low risk. Conclusions: Out of hours management of occupational body fluid exposures, particularly the prescribing of HIV PEP, was inconsistent with in hours practice. This may also be the case in other large inner city hospitals offering a similar service.

Health of the working age population

New report recommends integration of occupational health into mainstream health care