Susceptibility to varicella-zoster virus in applicants for nurse training in Scotland

We investigated the immunity to varicella-zoster virus (VZV) of a cohort of applicants for nurse training and determined the relationship between immune status and history of chickenpox or shingles based on a self-completed questionnaire. Three hundred and fifty-six applicants for nurse training were enrolled at an occupational health department in NHS Scotland and 96% were immune to VZV. The positive predictive value of a history of VZV infection for seropositivity was 98% (286/292). The negative predictive value was 14% (9/64). History of chicken pox/shingles had a sensitivity of 84% (286/341) and specificity of 60% (9/15). Screening using past clinical history compatible with VZV infection would have missed 40% of those possibly susceptible to VZV on the basis of the ELISA IgG test. We conclude absence of past history of chickenpox or shingles is an unreliable identifier of susceptibility to VZV in healthcare workers. The Control of Substances Hazardous to Health (COSHH) Regulations 1999 require employers to make effective vaccines available for those employees who are not already immune to a biological agent to which they are exposed or liable to be exposed. Serological testing of healthcare workers would better identify those who are susceptible to VZV infection.     

A survey of the delivery and uptake of influenza vaccine among health care workers

During the 1990s, policies for immunizing fit health care workers against influenza varied between National Health Service (NHS) employers and the uptake of influenza vaccine by NHS staff was poor. In light of recent Department of Health recommendations to immunize key health care staff against influenza, we explored the possible reasons for poor uptake and assessed the impact of an intensive promotion campaign on vaccine acceptance. Among 290 doctors and nurses, the main perceived barriers to influenza immunization were difficulty with practical access to vaccine and lack of time to attend. Following intensive promotion and improved local access to influenza vaccine, the uptake among health care workers was approximately doubled. However, the overall proportion of staff immunized was low (5%) and the immunization rate among medical staff was particularly poor (2%). The practical implications for influenza immunization campaigns aimed at health care workers are discussed.     

Factors influencing uptake of influenza vaccination among hospital-based health care workers

BACKGROUND: Vaccination of health care workers against influenza has been shown to lower mortality among elderly patients, but uptake of voluntary vaccination among health care workers remains low. AIMS: Factors influencing uptake of vaccination were examined among a cross-section of health care workers based in an NHS Trust. METHODS: A structured, self-administered questionnaire was mailed to a random sample of health care workers based in the acute services sector of a UK National Health Service Trust, 6 months following a voluntary immunization programme implemented as part of the Scottish Executive Health Department winter planning arrangements for 2000-2001. The programme was promoted using posters in clinical areas and a single leaflet given to all staff through a paycheck advice note. RESULTS: Five hundred and fifty-one health care workers (53%) responded to the questionnaire and influenza vaccination was accepted by 150 (28%). The occupational health poster strongly influenced the decision to accept vaccination [odds ratio (OR) = 11.01; 95% confidence interval (CI) = 2.13-56.80; P < 0.0001]. Other significant influences included female sex (OR = 9.11; 95% CI = 1.26-65.72) and perceived risk of contracting flu without the vaccine (OR = 7.70; 95% CI = 1.44-41.05). Misconceptions regarding the purpose of the vaccination campaign were common and concern regarding possible side-effects was a deterring factor for vaccination uptake. CONCLUSION: Our study showed that visual material displayed throughout the workplace strongly influenced the acceptance of influenza vaccination. Future campaigns should also emphasize the positive benefits to patients of health care worker immunization, with readily accessible information regarding side-effects available from all sources.     

Outbreak of varicella-zoster virus infection among Thai healthcare workers.

OBJECTIVE: To evaluate the correlation between self-report of a prior history of chickenpox and results of varicella-zoster virus (VZV) immunoglobulin (Ig) G serologic test results in an outbreak of VZV infection among Thai healthcare workers (HCWs) and to conduct a cost-benefit analysis of establishing routine VZV immunization as part of an occupational health program on the basis of the outbreak data. METHODS: All exposed patients received prophylaxis and the HCWs in our 3 intensive care units (ICUs) were prospectively evaluated. HCWs were assessed for disease history and serologic evidence of VZV IgG. A cost-benefit analysis was performed. RESULTS: After 140 HCWs and 18 ICU patients were exposed to VZV, 10 HCWs (7%) with active VZV infection were relieved from work until skin lesions were crusted. Acyclovir (ACV) was prescribed to all 10 HCWs with active disease, and all 18 exposed patients received prophylaxis with ACV. Of 140 HCWs, 100 consented to longitudinal follow-up. Twenty-three (100%) of the HCWs who reported a history of chickenpox also had serologic test results that were positive for VZV IgG, compared with 30 (39%) of 77 HCWs who reported no prior history of chickenpox, yet had test results that were positive for VZV IgG. Reported history of chickenpox had a sensitivity of 43%, a specificity of 100%, a positive predictive value of 100%, and a negative predictive value of 61% with respect to VZV infection immunity. The total cost estimate for this outbreak investigation was $23,087. CONCLUSIONS: An HCW's reported history of chickenpox was a reliable predictor of immunity; a report of no prior history of chickenpox was unreliable. Our cost-benefit analysis suggests that the costs of an occupational health program that included VZV surveillance and immunization for the next 323 HCWs would be approximately equal to the excess costs of $17,227 for the ACV therapy, HCW furloughs, and staff overtime associated with this outbreak.     

Reported needlestick and sharp injuries among health care workers in a Greek general hospital

Between July 1990 and June 1996, 284 exposures to infectious material were reported by 247 health care workers (HCWs) at AHEPA University Hospital, Thessaloniki, Greece, representing an overall rate of 2.4% reported injuries per 100 HCWs/year. Nurses reported the highest rates of incidents (3.0%) and in all but one working group women exhibited higher injury rates per year than male HCWs. Young workers (21-30 years old) were primarily affected in incidents (P < 0.001). Needles were the most common implement causing injury (60.6%) and resheathing of used needles as well as garbage collection were common causes of injury. None of the HCWs seroconverted in exposures where immune status to blood-borne pathogens was estimated. Efforts by the infection control committee need to be more intense, in order to increase the rate of reported staff injuries. This will facilitate identification of unsafe practices and provide more adequate preventive measures.     

Occupational Health Services in Manufacturing Industries in Nigeria

The provision of adequate health care facilities to cater forthe health of workers is an important consideration in the managementof manufacturing industries, since productivity is dependenton the health status of the workers. There are very few studiesevaluating the health care provision in Nigerian industries.This study elucidates such health care services in Edo and DeltaStates of Nigeria. One hundred and thirty-five (56%) of the241 registered manufacturing industries in Edo and Delta Statesof Nigeria were randomly selected and investigated. The responserate was 91.1% and the result showed that the medical staffcomprised 2.5% of the total workforce, with the large scaleindustries contributing the highest proportion of these. Fourpoint five per cent of the medical staff had formal trainingin occupational health and 15.6% of them visited the factoryshop floor. The doctor:staff ratio in the medium and large scaleindustries were 1:819 and 1:618 respectively. It was found thatall the industries used the health care facilities providedby the government, there were no clinics in all the small scaleindustries and group practice was not used by any of the industriesstudied. Pre-employment medical examinations were carried outin each of the groups of industries (100%, 39.4% and 5%) respectively,as were periodic medical examinations during employment, althoughto a lesser extent (100%, 13.2%, 0%) for the large, medium andsmall scale industries respectively. These finding suggest theavailability of a reasonable standard of health care provisionfor large scale industries and somewhat less availability formedium and small scale industries. Health education of boththe employers of labour, and the employees and the enforcementof existing laws are needed to improve the existing standardof occupational health services.     

Implementation of the hepatitis C guidelines in UK health care workers

BACKGROUND: The UK Health Department circular HSC 2002/010 requires health care employers to test certain groups of health care workers (HCWs) for hepatitis C, without additional funding. Little is known about the consistency of implementation of such guidelines. AIM: This study audited the process, completeness and problems of implementation of circular HSC 2002/010 in acute and ambulance trusts in London and the Southeast of England. METHOD: Telephone questionnaire survey of 51 National Health Service trusts between July and October 2005. RESULTS: The response rate was 92% (47/51). Eighty-five per cent (40/47) of the trusts reported partial or full implementation of the guidance. All compliant trusts reported testing HCWs entering exposure prone procedure specialities, although 40% (16/40) were testing more staff than specified in the guidance. CONCLUSION: Most trusts (85%) in this audit reported having implemented the guidance 3 years after publication and 90% claimed not to have needed additional funding. Implementation may be improved by greater clarity about which staff should be tested, frequency of testing and by raising HCWs awareness about hepatitis C infection and treatment. Newly published health clearance guidance addresses some of these points.     

Occupational risk of infection by varicella zoster virus in Belgian healthcare workers: a seroprevalence study

OBJECTIVES—To assess the prevalence of varicella zoster virus (VZV) antibodies in Flemish (Belgian) healthcare workers, to investigate the association between seronegativity and selected variables, and to assess the reliability of recall about disease as a predictor of immunity.
METHODS—A seroprevalence study of VZV antibodies (IgG) was conducted among a systematic sample of 4923 employees in various professional groups, employed in 22 hospitals in Flanders and Brussels (Belgium). Information about sex, age, department, job, and years of employment, the country of origin, and history of varicella was obtained. The presence of VZV antibodies was investigated with the enzyme linked immunosorbent assay (ELISA), Enzygnost anti VZV / IgG (Dade Behring, Marburg, Germany). Statistical analysis was performed by calculating prevalences and prevalence ratios (PRs) and their 95% confidence intervals (95% CIs). Sensitivity, specificity, and positive and negative predictive values (PPV and NPV) of the recalled history were determined.
RESULTS—The prevalence of VZV seropositivity in Flemish healthcare workers was 98.5% (95% CI 98.1 to 98.8). Seronegativity was significantly associated with age and job, increasing with both older and younger age. The prevalence of seronegative workers was significantly less in nursing staff than non-nursing staff. There was no significant difference for sex and years of employment. The PPV and NPV of recalled history were 98.9% and 3.4%. Sensitivity and specificity were 83% and 38.9%.
CONCLUSION—The prevalence of VZV seropositivity was very high in this sample of Flemish healthcare workers. Because of this low overall susceptibility, VZV infection seems not to be an important occupational risk among healthcare workers in Flanders. The increasing seronegativity above the age of 45 is possibly due to a loss of detectable antibodies. A positive history of varicella was a good predictor of immunity, but a negative history had no value as a predictor of susceptibility in adults.


Keywords: varicella; healthcare workers; occupational risk     

Psychological impact of the 2003 severe acute respiratory syndrome outbreak on health care workers in a medium size regional general hospital in Singapore

AIMS: To describe the psychological impact of severe acute respiratory syndrome (SARS) on health care workers in a regional general hospital 2 months post-outbreak. METHOD: Doctors and nurses were encouraged to participate. The survey consisted of self-report measures: demographics, the General Health Questionnaire (GHQ) 28 and Impact of Events Scale (IES). A questionnaire enquiring about changes in life's priorities due to SARS and circumstances that helped with coping was used. Participation was strictly voluntary and responses anonymous. RESULTS: In total 177 out of 661 (27%) participants [40 out of 113 (35%) doctors and 137 out of 544 (25%) nurses] had a GHQ 28 score >or=5. Doctors [P = 0.026, odds ratio (OR) = 1.6 and 95% confidence interval (CI) = 1.1-2.5] and single health care workers were at higher risk (P = 0.048, OR = 1.4 and 95% CI = 1.02-2.0) compared to nurses and those who were married. Approximately 20% of the participants had IES scores >or=30, indicating the presence of post-traumatic stress disorder (PTSD). Four areas were classified as more important using factor analysis: health and relationship with the family, relationship with friends/colleagues, work and spiritual. The areas for coping strategies were clear directives/precautionary measures, ability to give feedback to/obtain support from management, support from supervisors/colleagues, support from the family, ability to talk to someone and religious convictions. Support from supervisors/colleagues was a significant negative predictor for psychiatric symptoms and PTSD. Work and clear communication of directives/precautionary measures also helped reduce psychiatric symptoms. CONCLUSIONS: Many health care workers were emotionally affected and traumatized during the SARS outbreak. Hence, it is important for health care institutions to provide psychosocial support and intervention for their health care workers.     

Compliance with follow-up after occupational exposure to hepatitis C

BACKGROUND: Accidental percutaneous exposure to blood containing hepatitis C virus (HCV) is reported by health care workers more frequently than exposure to human immunodeficiency and hepatitis B virus. The transmission rate following such an exposure is approximately 1.9%. Little is known about the attendance rate of such staff for follow-up testing following exposure to HCV. AIM: To determine whether our follow-up programme for staff exposed to hepatitis C would allow the early detection and treatment of infected staff members. METHOD: We reviewed all staff exposures to hepatitis C reported to the occupational health department of a London teaching hospital over a 8-year period. RESULTS: Of 105 exposures, 21% of staff attended for early (6 or 12 weeks) and late (26 weeks) post-exposure follow-up. Thirty-seven per cent attended early follow-up only and 1% attended late having not attended early follow-up. Forty per cent did not attend any follow-up appointments with us. CONCLUSION: With the availability of effective treatment for early HCV infection, it is vital that occupational health departments encourage staff to attend at least for early follow-up. Access to HCV-RNA testing at this early stage should allow detection and early treatment of the small proportion who seroconvert.     

Evaluation of an occupational health service for general practitioners and their staff in a primary care trust

BACKGROUND: An occupational health service was set up in 2002 for general practitioners (GPs) and their staff in a London primary care trust (PCT). The service was based on a needs assessment undertaken in the locality in 1998. AIMS: To evaluate awareness, usage and perceived helpfulness of the service amongst GPs and practice managers, and to ascertain current perceived priorities for what to include in the service. METHODS: Questionnaire survey sent postally and electronically to 199 named GPs and 69 practice managers in 78 practices in the PCT. RESULTS: Overall 119/268 (44%) responses were received from 54/78 practices (69%). Awareness of the existence of the service was high (76%), and although uptake had been poor, this was not related to a perception that the service was unlikely to be helpful. Almost all those who had used the service had found it helpful. Nineteen (16%) respondents asked for more information about the service. Advice on health and safety law and fitness for work assessments were the highest priorities and hepatitis B immunization lowest, as in the 1998 needs assessment. However, a discrepancy between GPs and practice managers with regard to the perceived relative importance of pre-employment health screening and counselling/stress management emerged. CONCLUSIONS: The service is valued by users but could be developed by exploring new ways to disseminate information about the service and deliver it.     

The involvement of occupational health services prior to ill-health retirement in NHS staff in Scotland and predictors of re-employment

OBJECTIVE: To assess the process, causes and outcomes of retirement because of ill-health in NHS staff in Scotland. Particular areas to be investigated include the involvement of occupational health services, access to rehabilitation and redeployment, current health, whether working again and to identify predictors of re-employment. METHOD: An ill-health retirement (IHR) questionnaire was mailed to 863 NHS staff awarded IHR benefits by the Scottish Public Pensions Agency between April 1998 and March 2000. RESULTS: In all, 49% of the 863 postal questionnaires were returned. The most common reasons for retiring were diseases of the musculoskeletal system (38%) and mental disorders (21%). Seventy-one percent of the participants reported their ill-health was partly or completely work related and 29% not work related. Ninety-two percent of NHS staff had attended an occupational health department prior to IHR. Twenty-three percent of participants had no contact with their line manager during their illness prior to retiral. Eighteen percent of individuals were offered the opportunity of working part-time and 15% offered alternative work. Seventeen percent of participants have obtained other work. Predictors of re-employment after IHR were: medical condition, managerial responsibility, improvement of health, wanting to work again, occupation and age at retirement. CONCLUSION: This is the first comprehensive study investigating NHS staff experiences of IHR in Scotland. This study illustrates the need for improved support and rehabilitation for ill-health care workers and that there is the potential to reduce levels of ill-health retirement.     

Prevalence of low back pain among staff in a rural hospital in Nigeria

A cross-sectional study was carried out in a rural hospital in south-western Nigeria to determine the prevalence of low back pain among its staff. The questionnaire administered to staff sought information on social and demographic characteristics, job history, smoking status, frequency and severity of low back pain and factors predisposing to low back pain. Seventy-four out of a total of 80 workers participated in the study. The prevalence of low back pain among staff was 46%. The highest prevalence of back pain (69%) was recorded among nursing staff, followed by secretaries/administrative staff (55%) and cleaners/aides (47%). Heavy physical work (45%), poor posture (20%) and prolonged standing or sitting (20%) were the most frequent activities reported to be associated with low back pain among these workers. The prevalence of low back pain among these workers is comparable to that of workers in high income countries. Health education on posture and correct lifting techniques can be introduced to reduce the burden of low back pain among these workers.     

Low prevalence of clinical latex allergy in UK health care workers: a cross-sectional study.

The prevalence of natural rubber latex allergy amongst health care workers has been reported to vary between 1 and 40%. This is because different diagnostic criteria have been used on heterogeneous groups of subjects. We have undertaken a cross-sectional study of all 5600 employees in two National Health Service trusts served by one department of occupational health and one department of clinical immunology. The period prevalence (1999-2000) for Type I clinical latex allergy in the clinical health care workers was found to be 17/3500 (0.5%). Difficulties in diagnosis and factors which may have contributed to this low prevalence rate are discussed. No cases were forced to leave health care work as a consequence of their allergy.     

The impact of educational interventions on primary health care workers' knowledge of occupational exposure to blood or body fluids

AIM: To assess the impact of educational interventions on primary health care workers' knowledge of management of occupational exposure to blood or body fluids. METHODS: Cluster-randomized trial of educational interventions in two National Health Service board areas in Scotland. Medical and dental practices were randomized to four groups; Group A, a control group of practices where staff received no intervention, Group B practices where staff received a flow chart regarding the management of blood and body fluid exposures, Group C received an e-mail alert containing the flow chart and Group D practices received an oral presentation of information in the flow chart. Staff knowledge was assessed on one occasion, following the educational intervention, using an anonymous postal questionnaire. RESULTS: Two hundred and fifteen medical and dental practices were approached and 114 practices participated (response rate 53%). A total of 1120 individual questionnaires were returned. Face to face training was the most effective intervention with four of five outcome measures showing better than expected knowledge. Seventy-seven percent of staff identified themselves as at risk of exposure to blood and body fluids. Twenty-one percent of staff believed they were not at risk of exposure to blood-borne viruses although potentially exposed and 16% of exposed staff had not been immunized against hepatitis B. Of the 856 'at risk' staff, 48% had not received training regarding blood-borne viruses. CONCLUSIONS: We found greater knowledge regarding management of exposures to blood and body fluids following face to face training than other educational interventions. There is a need for education of at risk primary health care workers.     

Feasibility of lumbar supports for home care workers with low back pain

The aims of this study were to assess the compliance of home care workers with low back pain (LBP) in using a lumbar support, to establish the benefit experienced from the support, and to determine the predictive factors for that compliance and benefit. Only home care workers who had LBP at the start of the study or who had experienced at least two episodes of LBP in the 12 months prior to the study could apply for participation. The study consisted of two phases. In phase I (the first week of the study), workers used the lumbar support each working day. In phase II (the following 6 months), subjects were instructed to use the lumbar support only on those working days when they experienced LBP. Weekly questionnaires were used to measure compliance; monthly questionnaires were used to measure the benefit experienced. Fifty-nine workers participated in the study. Overall, they scored their perceived benefit from the lumbar support as 7 on a scale of 0-10, and 61-81% of the workers were compliant. Multiple linear regression analysis showed that the best predictor for experienced benefit is the degree of confidence in expected pain reduction due to the lumbar support, measured after phase I (R(2) = 0.70). Multiple logistic analysis showed that the best predictor for compliance is the extent to which subjects consider they can influence their own health status (R(2) = 0.49). Because both the benefit experienced and the compliance rate were substantial, the use of lumbar supports by home care workers with LBP seems feasible. However, we cannot recommend extensive use of lumbar supports in home care workers with LBP based solely on the results of the present study. First, there is a clear need for a randomized clinical trial on this topic.     

Evidence-based care for low back pain in workers eligible for compensation

BACKGROUND: Although guidelines for the management of low back pain have been promoted, few studies have assessed their effectiveness. One previous study did not include patients with workers' compensation claims. AIM: To assess the efficacy of evidence-based care for acute low back pain in patients eligible for workers' compensation. METHODS: In a prospective audit, workers in a health service who presented with acute low back pain were offered the option of usual care from their general practitioner or care provided by a staff specialist who practiced according to evidence-based guidelines. Outcomes were measured in terms of return to normal duties, time off work, recurrence of pain or persistence of pain. RESULTS: Evidence-based care was accepted by 65% of injured workers. Compared with those who elected usual care, these workers had less time off work, spent less time on modified duties and had fewer recurrences. A significantly greater proportion (70%) resumed normal duties immediately, and fewer developed chronic pain, than those managed under usual care. Three types of patients were identified: those who complied readily with evidence-based care, those who initially expressed firm beliefs about how they should be managed and those with occupational psychosocial factors. CONCLUSIONS: Evidence-based care can be successful in retaining patients at work, reducing time off work or on modified duties and reducing recurrences and chronicity. The gains are achieved by conscientiously talking to the patients, and not by any particular or special passive interventions.     

Job satisfaction of health care staff employed at health centres in Turkey

The objective of the study was to identify job satisfaction levels and their causes among health care workers employed at public health centres. A survey was therefore carried out of health care workers in 21 health centres in Konya, Turkey. The Minnesota Satisfaction Questionnaire was used to investigate job satisfaction. The satisfaction score and proportion of those satisfied were determined according to demographic features. The percentage of satisfied health care workers was 60% and the satisfaction score was 3.8 +/- 0.5. Midwives had the lowest satisfaction scores. Working environment and income were the most important factors for dissatisfaction. There was no correlation between global satisfaction and other demographic variables. These results showed that the health care workers at public health centres in the province have low satisfaction scores. Improving working conditions and income may improve the overall quality of health care provision.     

Increased cancer risk among surgeons in an orthopaedic hospital

BACKGROUND: Five cancer cases over 7 years were reported in a small orthopaedic hospital where radiation protection practice was poor. AIM: To investigate whether workers subject to routine radiation dosimetric assessment in that hospital had an increased cancer risk. METHODS: One hundred and fifty-eight workers subject to routine dose assessment and 158 age-sex-matched unexposed workers were questioned about cancer occurrence. All tumours were analysed as a single diagnostic category. RESULTS: Cumulative 1976-2000 cancer incidence was 29 (9/31), 6 (8/125) and 4% (7/158) in orthopaedics, exposed other than orthopaedics, and unexposed workers, respectively. At logistic regression analysis, working as orthopaedic surgeon significantly (P<0.002) increased the risk of tumours. CONCLUSION: These findings caution against surgeons' underestimation of the potential radiation risk and insufficient promotion of safe work practices by their health care institutions.     

The analysis of sensitivity, specificity, positive predictive value and negative predictive value of cold provocation thermography in the objective diagnosis of the hand-arm vibration syndrome

The diagnosis of digital artery vasospasm in the hand-arm vibration syndrome (HAVS) is clinically based, and the need for an accurate objective test to support the diagnosis has been highlighted. This study aims to analyse the potential of cold provocation thermography (CPT) to fulfill this role. CPT was performed on two groups of subjects: 10 controls and 21 patients with Raynaud's phenomenon (RP) secondary to HAVS. After taking a pre-cooling image, patients donned latex gloves and immersed their hands in water at a temperature of 5 degrees C for 1 min. The patients removed their hands from the water and discarded the gloves, and further images were taken every 30 s for 10 min. On each image, the temperatures of the tip and base were analysed for each digit. The sensitivity, specificity, positive and negative predictive values for fingertip temperatures only, fingertip and fingerbase temperatures combined, and fingertip temperature, fingerbase temperature and temperature gradient combined were determined. Patients with RP secondary to HAVS demonstrated significantly lower finger tip and base temperatures and lower digital temperature gradients at all time intervals when compared with controls (P < 0.01, Student's t-test). CPT has good sensitivity, specificity, positive predictive value and negative predictive value; it strongly supports the clinical diagnosis of digital vasospasm.