Hepatitis B transmission through blood and body fluids exposure of school personnel

BACKGROUND: Hepatitis B transmission from students to members of staff has been documented in schools, particularly nurseries and day care centres. AIMS: To investigate the frequency of exposure to blood and other body fluids within day schools and to document practices adopted by school personnel to avoid direct contact and decontaminate the environment. METHODS: Questionnaire survey among 21 public day schools in Malta. RESULTS: Episodes of significant blood exposure were rare, occurring at frequencies of 0.071 [95% confidence interval (CI): 0-0.148] incidents per thousand student days. Contact with larger volumes of other body fluids, namely urine and vomitus, was more likely: 0.12 (95% CI: 0.008-0.383) and 0.088 (95% CI: 0.048-0.128) episodes per 1000 student days, respectively. School personnel generally used correct personal protective equipment, particularly gloves, in cases of contact with blood and body fluids. Environmental disinfection methods varied considerably with only 38% of schools (95% CI: 21-59%) using recommended hypochlorite preparations. CONCLUSIONS: Exposure to quantities of blood sufficient to result in HBV transmission in day schools is rare. Emphasis should be placed on risk assessment at individual school level, concentrating on correct management of body fluid exposures through effective staff education.     

Exposures to blood and body fluids in Brazilian primary health care

Background Primary health care workers (HCWs) represent a growingoccupational group worldwide. They are at risk of infectionwith blood-borne pathogens because of occupational exposuresto blood and body fluids (BBF). Aim To investigate BBF exposure and its associated factors amongprimary HCWs. Methods Cross-sectional study among workers from municipal primaryhealth care centres in Florianópolis, Southern Brazil.Workers who belonged to occupational categories that involvedBBF exposures during the preceding 12 months were interviewedand included in the data analysis. Results A total of 1077 workers participated. The mean incidencerate of occupational BBF exposures was 11.9 per 100 full-timeequivalent worker-years (95% confidence interval: 8.4–15.3).The cumulative prevalence was 7% during the 12 months precedingthe interview. University-level education, employment as a nurseassistant, dental assistant or dentist, higher workload score,inadequate working conditions, having sustained a previous occupationalaccident and current smoking were associated with BBF exposures(P 0.05). Conclusions Primary Health Care Centres are working environmentsin which workers are at risk of BBF exposures. Exposure surveillancesystems should be created to monitor their occurrence and toguide the implementation of preventive strategies.     

2015—2018年某三级综合医院医护人员血源性职业暴露情况调查及安全防控体系构建

目的调查2015—2018年三级综合医院医护人员血源性职业暴露情况,并构建安全防控体系。方法采用回顾性分析方法对某综合医院2015—2018年医护人员血源性职业暴露情况进行调查,构建安全防控体系。结果2015—2018年某三级综合医院248人次发生血源性职业暴露,发生率为8.71%;护士血源性暴露发生率10.22%高于医生6.47%,女性9.56%高于男性6.28%,工作年限越长发生率越低,外科为高发科室,2015—2018年发生率总体呈下降趋势;血源性职业暴露发生率最高时间段为8:00~12:00(39.11%),其次为13:00~17:00(29.03%),暴露方式主要为针刺或锐器伤(65.32%),主要发生于注射结束拔针或采血环节(25.40%),手指为主要暴露部位(79.03%),多数未戴手套或眼罩(52.42%);锐器管理不规范为主要暴露原因(52.02%);其次为操作意外(31.45%)。主要暴露源为乙型肝炎病毒(28.63%),其次为丙型肝炎病毒(25.00%)。结论2015—2018年某三级综合医院医护人员血源性职业暴露高危人群为护士、女性、工作年限短、外科人员;主要暴露源为乙型肝炎病毒。     

Asthma education for school staff in Riyadh city: effectiveness of pamphlets as an educational tool

Teachers and support staff are often called upon to manage asthma at school but may have little knowledge and understanding of the condition. The objectives of this study were to develop educational package (pamphlets) about asthma, and assess its effectiveness as an educational tool for schools' staff through evaluation of its impact on the staff's asthma-related knowledge, attitudes and management practices on their pupils. A pre-post experimental research design was used in Riyadh city with distribution of self-administered questionnaires and asthma package to 4 randomly selected girls schools compounds. Participants were school staff (n = 297) of primary, intermediate and secondary schools. Results showed that only 5.7% of the staff had received previous training in asthma education. Lack of knowledge and misconceptions about asthma medication were evident among a considerable proportion of the staff specifically for use of antibiotics, steroids, side effect of ventolin, and addicting effect of inhalers. At pretest, only 35% and 40.1% of the staff had good level of knowledge and management practices. At posttest, the corresponding percentages increased significantly to be 83.9% and 68.6% respectively. The mean total score of staff's asthma related-attitudes became more favorable towards asthma education after intervention, it increased significantly from 53.5 to be 55.0. Total posttest knowledge score was the only predictor of both staff attitudes and management practices constituting 9.1% and 10.2% of their variance. The great majority cited lack of training (92%), unavailability school policy (86.8%), and shortage of educational resources (88.3%) as barriers against asthma education and management in their schools. Conclusions: Most of school staff had poor to fair level of asthma knowledge and management practices. Such simple educational intervention using pamphlets and demonstration of inhaler use and peaked flow meter was significantly successful in enhancing staff's asthma-related knowledge, attitudes and management practices among their pupils. It is very important that training is directed to all staff as pre-service and in-service programs.     

Health care workers' exposure to blood-borne pathogens in Lebanon

Background Accidental exposure to blood-borne pathogens (BBPs)is a risk for health care workers (HCWs). Aim To study the pattern of occupational exposure to blood andbody fluids (BBFs) at a tertiary care hospital. Methods This study reports a 17-year experience (1985–2001)of ongoing surveillance of HCW exposure to BBFs at a 420-bedacademic tertiary care hospital. Results A total of 1590 BBF exposure-related accidents werereported to the Infection Control Office. The trend showed adecrease in these exposures over the years with an average ±standard error of 96 ± 8.6 incidents per year. In thelast 6 years, the average rate of BBF exposures was 0.57 per100 admissions per year (average of needlestick injuries alonewas 0.46 per 100 admissions). For 2001, the rates of exposurewere found to be 13% for house officers, 9% for medical student,8% for attending physicians, 5% for nurses, 4% for housekeeping,4% for technicians and 2% for auxiliary services employees.The reason for the incident, when stated, was attributed toa procedural intervention (29%), improper disposal of sharps(18%), to recapping (11%) and to other causes (5%). Conclusions The current study in Lebanon showed that exposureof HCWs to BBPs remains a problem. This can be projected toother hospitals in the country and raises the need to implementinfection control standards more efficiently. Similar studiesshould be done prospectively on a yearly basis to study ratesand identify high-risk groups.     

Blood and body fluid exposure risks among health care workers: results from the Duke Health and Safety Surveillance System

BACKGROUND: Health care workers (HCWs) are at risk of exposures to human blood and body fluids (BBF). Needlestick injuries and splashes place HCWs at risk for numerous blood-borne infections including human immunodeficiency virus (HIV), hepatitis B (HBV), and hepatitis C (HCV). Utilizing a new comprehensive occupational health surveillance system, the objective of this research was to better define the BBF exposure risk and risk factors among employees of a large tertiary medical center. METHODS: A population of 24,425 HCWs employed in jobs with potential BBF exposures was followed for BBF exposure events from 1998 to 2002. BBF exposure rates were calculated for strata defined by age, race, gender, occupation, work location, and duration of employment. Poisson regression was used for detailed analyses of risk factors for BBF exposure. RESULTS: The study population reported 2,730 BBF exposures during the study period, resulting in an overall annual rate of 5.5 events/100 FTEs and a rate of 3.9 for percutaneous exposures. Higher rates were observed for males, persons employed less than 4 years, Hispanic employees, and persons less than 45 years of age. Much higher rates were observed for house staff, nurse anesthetists, inpatient nurses, phlebotomists, and surgical/operating room technicians. Poisson regression results strengthened and extended results from stratified analyses. Rates of percutaneous exposures from hollow needles were found to decrease over the study period; however, exposure rates from suture needles appear to be increasing. CONCLUSION: While continued training efforts need to be directed toward new HCWs, our data also suggest that employees who have been in their job 1-4 years continue to be at higher risk of BBF exposures. This research also points to the need for better safety devices/products and work practices to reduce suture-related injuries.     

Educational intervention among farmers in a community health care setting

Background Farmers are at increased risk of developing work-related respiratory diseases including asthma, but little is known about their occupational health and safety (OHS) knowledge and exposure prevention practices. Educational interventions may improve knowledge and practice related to prevention. Aims To determine the feasibility of an educational intervention for farmers in a community health centre setting. Methods This was a pilot study. Farmers were recruited by the community health centre and completed a questionnaire on symptoms, OHS knowledge and exposure prevention practices. The intervention group received education on work-related asthma and exposure control strategies, and was offered spirometry and respirator fit testing. All subjects were asked to repeat the questionnaire 6 months later. Results There were 68 study participants of whom 38 formed the intervention group. At baseline, almost 60% of farmers reported having received OHS training and were familiar with material safety data sheets (MSDSs); fewer (approximately 40%) reported knowledge of OHS legislation and availability of MSDSs. Approximately, two-thirds of subjects reported using respiratory protection. The response rate for repeating the questionnaire was 76% in the intervention group and 77% in the controls. Among the intervention subjects, statistically significant increases were observed in reported safety training, familiarity and availability of MSDSs and knowledge of OHS legislation. Conclusions Gaps in OHS knowledge were observed. The educational intervention on OHS knowledge and exposure prevention practices in the community health centre setting was feasible. Larger, more-controlled studies should be undertaken as this study suggests a positive effect on OHS knowledge and prevention practices.     

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.     

Reducing Occupational Risk for Blood and Body Fluid Exposure Among Home Care Aides: An Intervention Effectiveness Study

The purpose of this quasi-experimental pretest/posttest research study was to examine the effectiveness of an intervention designed through a participatory process to reduce blood and body fluid exposure among home care aides. Employer A, the intervention site, was a large agency with approximately 1,200 unionized home care aides. Employer B, the comparison group, was a medium-sized agency with approximately 200 home care aides. The intervention was developed in partnership with labor and management and included a 1-day educational session utilizing peer educators and active learning methods to increase awareness about the risks for occupational exposure to blood and body fluids among home care aides and a follow-up session introducing materials to facilitate communication with clients about safe sharps disposal. Self-administered preintervention and postintervention questionnaires identifying knowledge about and self-reported practices to reduce bloodborne pathogen exposure were completed in person during mandatory training sessions 18 months apart. Home care aides in the intervention group for whom the preintervention and postintervention questionnaires could be directly matched reported an increase in their clients’ use of proper sharps containers (31.9% pre to 52.2% post; p = .033). At follow-up, the intervention group as a whole also reported increased use of sharps containers among their clients when compared to controls (p = .041).     

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.     

Risk perception and attitudes towards HIV in Serbian health care workers

BACKGROUND: Health care workers (HCWs) are at risk of occupational exposure to human immunodeficiency virus (HIV). AIM: To investigate the perception of professional risk from, and the knowledge, attitudes and practice of HCWs to HIV and AIDS in Serbia. METHODS: Cross-sectional study of 1,559 Serbian HCWs using self-administered anonymous questionnaires. Chi-square testing and multiple logistic regression analysis were applied. RESULTS: Eighty-nine per cent of HCWs believed that they were at risk of acquiring HIV through occupational exposure. The perception of professional risk was higher among HCWs frequently exposed to patients' blood and body fluids (OR 7.9, 95% CI 4.4-14.5), who used additional personal protection if the HIV status of patient was known (OR 2.6, 95% CI 1.5-4.6), who had experienced sharp injuries within the last year (OR 1.9, 95% CI 1.0-3.8) or who had been tested for HIV (OR 2.1, 95% CI 1.2-3.5), and among HCWs who had treated HIV-positive patients (OR 1.7, 95% CI 1.1-2.8). The majority of respondents had deficient knowledge about modes of HIV transmission. Attitudes towards HIV-positive patients were significantly different by occupation. Seventy per cent of HCWs used appropriate protection during their daily work with patients. CONCLUSIONS: HCWs require specific educational programmes and training protocols to ensure that they are adequately protected when carrying out high quality care.     

Nurses failure to appreciate the risks of infection due to needle stick accidents: a hospital based survey.

One of the most important occupational risks to healthcare workers is exposure is to blood-borne viruses. This study examined nurses' perceptions of risk of contracting infection following single or multiple exposure to blood or body fluids. Two hundred and ninety nurses were surveyed using a questionnaire. One hundred and thirty-three responded; 85 worked in higher risk areas (ITU, Haematology, Haemodialysis and Neonatal Surgical Units) (Group A) and 48 worked in lower risk areas (medical wards, an orthopaedic and an ENT ward) (Group B). Forty-nine percent of subjects from group A and 60% of subjects from Group B believed that a needle stick injury with a needle contaminated with infected blood was an unlikely source of infection. Fifteen percent from group A and 20% from group B thought that infection with a blood-borne virus following a needle stick injury contaminated with Human Immunodeficiency Virus (HIV) infected blood was very unlikely. Twelve percent from group A and 10% from Group B did not know whether resheathing needles between use can provide protection against HIV. Sixty-seven percent from group A and 71% from group B disagreed with the statement that nurses are at higher risk of exposure to HIV/HBV than the other healthcare workers. Thirteen percent from group A and 5% from group B agreed with the statement, whereas 8% from group A and 5% from group B thought that nurses are at less risk. Only 22% from group A and 23% from group B would take more precautions if they knew that the patient had HIV/HBV infection, whilst 11% and 8% respectively admitted that they would take special precautions only when the patient has clinical symptoms of HIV/HBV infection. The findings suggest that these nurses would benefit from further education regarding infection from blood-borne viruses.     

Exposure of health care workers to pentamidine isethionate.

Pentamidine isethionate is currently used for the prophylaxis and treatment of Pneumocystis carinii pneumonia. Its use has been associated with a number of symptoms in staff administering treatment, and there are some additional concerns about possible adverse health effects of long term exposure. The aim of this study was to quantify exposure of health care staff administering nebulized pentamidine to patients. Personal breathing zone and static air samples at the height of the patient's head were collected during the nebulization of pentamidine to nine sequential outpatients attending a haemophilia unit. These were analysed using a standard method allowing the exposure of staff to be estimated. The duration of treatment varied between 15 and 60 min. Personal breathing zone samples showed exposure to be between 2 and 100 micrograms/m3. Static samples showed the concentration of pentamidine in the room varied from 15 to 2,100 micrograms/m3. While these exposures were relatively low, they were higher than some other studies have reported, and may pose some risk of adverse effects to staff. Some simple measures could reduce staff exposure.     

医院工勤人员血源性职业暴露认知与自我防护能力调查

目的通过探究全国745名工勤人员关于血源性职业暴露相关认知水平、自我防护能力、与患者血源性接触率现况,为今后我国医疗机构血源性职业暴露高危人群防范体系的建立奠定基础。方法采用横断面研究设计,于2018年方便抽样选取来自中国24个省份的745名医疗机构工勤人员作为调查对象,采用自行设计的问卷进行数据收集并分析其结果。结果调研的745名工勤人员来自全国24个省份,平均年龄为(45.84±15.864)岁。其中422人(56.64%)表示接触过患者血液或体液,不同年龄、工作年限、岗位分类、医院级别的分层分析显示在患者血源性职业接触发生率方面的差异有统计学意义(P<0.05)。只有216人(42.52%)能完全正确界定可导致血源性职业暴露发生的相关疾病,不同特征工勤人员对于可能导致血源性职业暴露事件的疾病病种的正确识别率差异均有统计学意义(P<0.05)。718人(96.37%)表示需要接受相关职业防护的培训和学习,不同学历工勤人员的需求差异有统计学意义(χ^2=9.601,P=0.008)。不同学历层次、医院级别的人员主动上报率差异均有统计学意义。结论近些年,从国家到各医疗机构已逐步采取一系列措施以降低血源性职业暴露事件的风险并取得一定成效,但必须意识到,作为医院中最容易忽略的高危人员——工勤人员依然面对着巨大威胁。识别防护工作中的瓶颈与盲区,采用调动主观因素与外部客观措施有力结合的方式,是解决问题的关键。     

Infection control practices in public dental care services: findings from one South African Province

Infection control practices which increase the risk of blood-borne virus transmission with associated dental practice in one South African province were studied. All 24 state dental clinics were observed for adequate provision to carry out good infection prevention and control (IPC) practice, 75 staff including dentists, nurses and dental assistants were interviewed to assess IPC knowledge and 23 dental procedures were observed. Significant findings were the difference between knowledge and practice, despite adequate provisions for safe infection control practice. The lack of protective eye wear during a dental procedure, not washing hands between patients, not disassembling an item prior to disinfection or sterilization, and not using a sterile drill for each patient were identified. A rapid method for detection of occult blood was used as a marker for inadequate IPC practice. Contaminated dental items of equipment just prior to patient use in 25% of equipment tested and 37% of surfaces and surrounding areas in the dental clinics and units were recorded. This study concludes that, despite provision for safe dental practice available in state dental clinics, there was a lack of knowledge application in clinical practice. The risk of blood-borne virus transmission in a population with high human immunodeficiency virus (HIV) prevalence cannot be ignored.     

Occupational Exposure to Human Immunodeficiency Virus in Health Care Providers: A Retrospective Analysis

Objectives:

To determine the population at risk, risk factors, and outcome of occupational exposure to blood and body fluids in health care providers.

Materials and Methods:

Retrospective review of two and half year data of ongoing surveillance of occupational exposure to blood and body fluids in a tertiary care hospital.

Results:

103 Health Care Providers (HCP) reported an occupational exposure to blood and body fluids during the period under review. These comprised 72 (69.9%) doctors, 20 (19.4%) nursing personnel, and 11 (10.6%) cleaning staff. Of the doctors, 65% were interns. 53.4% HCP had work experience of less than one year. Circumstances of exposure included clinical procedures (48%), sweeping/handling used sharps (29%), recapping (16%), and surgery (6.9%). 74.3% of the exposures were due to non-compliance with universal precautions and were thus preventable. The device most frequently implicated in causing injury was hollow bore needle (n=85, 82.5%). Human Immunodeficiency Virus (HIV) status of the source was positive in 6.8% cases, negative in 53.4% cases, and unknown in remaining 39.8% cases. Postexposure prophylaxis (PEP) was indicated in 100 (97.08%) cases and was initiated within 2 h of exposure in 26.8% HCP. In 23.2% HCP, PEP initiation was delayed beyond 72 h of exposure due to late reporting. Thirteen HCP received expanded and the remaining received basic regime. Of the 82 HCP followed up, 15 completed the full course, while 55 stopped PEP after the first dose due to negative source status. Twelve HCP with exposure to blood of unknown HIV status discontinued PEP despite counseling. Complete follow-up for seroconversion was very poor among the HCP. HIV status at 6 month of exposure is not known for any HCP.

Conclusions:

Failure to follow universal precautions including improper disposal of waste was responsible for majority of occupational exposures. HCP need to be sensitized regarding hospital waste management, management of occupational exposure, need for PEP, and continued follow-up.     

Health and safety practices among farmers and other workers: a needs assessment.

The development of appropriate health and safety interventions for farmers and agri-workers is important world-wide but data on present practices and attitudes to change are lacking. A representative quota sample (n = 1,938) of the Irish population was surveyed on lifestyle practices and workplace risk assessment and control measures, in relation to chemical exposure, manual handling and machinery. Focus group discussions were conducted also with 47 representatives of national farming organizations. As compared with the general workforce, farmers had a significantly (p < 0.01) lower level of assessment of risk hazards associated with manual handling and machinery. Both farmers and employees in workplaces with less than 20 employees reported a significantly lower level of safety training. Male farmers had a particularly negative health profile with only 18% reporting regular dental checks, 26% practising skin protection and 29% taking regular exercise. Discussions indicated that barriers to change included low perceived susceptibility, lack of time and resources. Mental health issues were particularly highlighted. We conclude farmers differ significantly in many instances from the rest of the workforce in regard to occupational health and safety issues and specific interventions in key areas are required for the agri-sector.     

Management of hepatitis B immunizations and blood exposure incidents in primary care

AIM: To investigate how well primary care health care workers, with no access to an occupational health service (OHS), have managed their hepatitis B immunizations and blood exposure incidents, compared with National Health Service Trust staff, with access to an OHS. METHOD: A questionnaire was sent to 78 general practitioners (GPs), 93 general practice nurses, 81 NHS Trust consultants and 88 NHS Trust community nurses, in the Airedale area of West Yorkshire in June 2001. RESULTS: The response rate was 80%. GPs were significantly less likely than consultants to have received a hepatitis B booster vaccination after their primary course (57 versus 80%, P < 0.009) and significantly less likely to have had their blood anti-HBs test checked after their last vaccination (74 versus 94%, P < 0.011). General practice nurses were significantly less likely to fill in a blood exposure incident form after an injury than community nurses (56 versus 91%, P < 0.006). Overall, the group with access to an OHS was significantly more likely to have received a hepatitis B booster (P < 0.036), have had a blood anti-HBs test after last vaccination (P < 0.010) and to have filled in a blood exposure incident form after last blood exposure (P < 0.033), than the group without access to an OHS. CONCLUSION: Any future OHS with responsibility for primary care, should consider calling in all GPs and general practice nurses for a review of their hepatitis immunity and for education regarding the management of blood exposure incidents.     

Evaluation of potential reduction in blood and body fluid exposures by use of alternative instruments

BACKGROUND: Injuries from needlestick, sharps injuries and splashes lead to exposure to blood and body fluids with the potential for transmission of blood-borne viruses. AIMS: To identify alternative instruments, which if used would improve worker safety. METHODS: Retrospective review of 161 injuries with identification of safer alternative products for instruments that caused injury. The proportion of injuries that could be prevented was calculated [with 95% confidence intervals (CI)]. RESULTS: The average rate of injury was 7.8/1000 employees per annum (95% CI, 6.8-9.4/1000). In the 2 years the highest rates of injury occurred in pre-registration house officers (164/1000; 95% CI, 64-264/1000), phlebotomists (154/1000; 95% CI, 15-291/1000) and senior house officers (45/1000; 95% CI, 13-77/1000). An upper estimate of 65% (95% CI, 58-72%) of incidents would have been preventable with a change to alternative devices. CONCLUSIONS: Change to the use of intrinsically safer instrumentation has the potential to prevent injury to healthcare workers.     

A survey of the provision of educational supervision in occupational medicine in the Armed Forces

OBJECTIVE: The aim of this study was to assess whether balanced educational supervision was being provided for occupational medicine (OM) specialist registrars (SpRs) in the Armed Forces and to consider the effectiveness of current supervision. METHODS: Anonymized postal questionnaires, using Likert five-point response scales, were sent to Service OM SpRs and their educational supervisors (Ed Sup) to assess the degree of understanding of the purpose, effectiveness and organization of the educational supervision being provided. RESULTS: Completed questionnaires were returned from 35 (92%) specialists and 14 (61%) SpRs. Less than a third of the specialists were involved as Ed Sup and only three (11%) had undergone any formal medical education training. There was an agreement about the purpose and effectiveness of educational supervision between both the groups, though there appeared to be a bias towards providing supportive functions with patient management and educational components scoring less highly. CONCLUSIONS: A high response rate enabled an accurate assessment of OM supervision practices in the Armed Forces to be made. There was agreement over the relative effectiveness, importance and coverage of educational supervision, though this was being provided by a relatively small group of OM specialists, few of whom had undertaken any formal medical education training. The supervision provided also appeared to be biased towards providing supportive functions rather than patient management and educational components of training, which may result in an unbalanced training for the SpRs. Having assessed the relatively close-knit service OM community, there would be value in seeing whether similar patterns prevail in the wider OM community.