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Association of Anaesthetists of Great Britain & Ireland Needlestick Working Party Report Council of the Association of Anaesthetists of Great Britain & Ireland (AAGBI) established a Working Party on Needlestick Injuries in December 2007. Its initial membership was: Dr Andrew Hartle (Chair) Dr Steve Yentis Dr Stuart White Dr Mark Hearn Dr Dominic Bell Dr Daniel Sokol Ms Kim Sunley Dr Andy Lim Ms Janette Roberts AAGBI Council AAGBI Council Consultant Anaesthetist, Brighton GAT Representative Intensive Care Society Lecturer in Medical Ethics & Law Royal College of Nursing Royal College of Anaesthetists Patient Liaison Group The Working Party was to consider the testing of patients for Blood Borne Viruses (BBV) after needlestick and other occupational injuries, especially in the light of recent legislative change (Human Tissue Act 2004 [HTA] and Mental Capacity Act 2005 [MCA]), and the withdrawal of previous guidance from the General Medical Council (GMC). The legal ‘limbo’ surrounding the testing of patients who lacked capacity, and who had been the source of a needlestick or other occupational injury had been described in detail in Stuart White’s editorial in Anaesthesia (Needlestuck. Anaesthesia 2007; 62: 1199-201). Initial guidance from the GMC had been that testing of such patients could take place in exceptional circumstances. The introduction of HTA and MCA had led to that guidance being withdrawn, and advice from Medical Indemnity organisations was now that such testing without the patient’s consent was unlawful. This now meant that Healthcare professionals who sustained occupational exposure were unable to know the viral status of the source when making decisions about the initiation or discontinuation of post exposure prophylaxis (PEP).
At the first meeting held on 9 th May 2008 it was agreed that there were three strands to the WP’s remit: • Establish what changes were possible to the current legal situation and make recommendations. • Identify mechanisms by which change could be effected. • Identify ways by which public support for such change could be achieved, including identifying other stakeholders. The WP discussed the apparent variability of response to the current situation. In some units patients were never tested after occupational injury, but in others testing may still be performed, either with or without the agreement of next of kin. This creates a ‘postcode lottery’ in the management of occupational injuries, and also places healthcare workers at risk of legal, disciplinary or regulatory action. Such inconsistency in management is not acceptable. After some discussion, the following possible changes were agreed, roughly in order of most to least restrictive, and possibly in ascending order of likely public acceptability: • Blanket testing of all patients. • Testing of all patients who become the source of a needlestick/infective injury. • ‘Presumed Consent’ for testing unless prior evidence of objection. • The previous status quo, i.e. testing only after an individual risk/benefit analysis (to include psychological as well as physical risk). • Testing with the consent of next of kin. • No testing without specific consent from the patient. Members of the WP agreed to analyse each of these options, before making recommendations to Council. Those analyses are attached. The WP agreed that, before the situation of testing arose, first priorities for all stakeholders should be: • Prevention/preventative technology • Improved (confidential) reporting • De-stigmatisation
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Recommendations for the Safe Transf
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CONTENTS Section I Summary and Reco
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SECTION II - BACKGROUND In 1996 the
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SECTION IV - ORGANISATION AND COMMU
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SECTION V - STAFFING REQUIREMENTS A
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A p p ropriate re s p i ra t o ry s
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SECTION VII - THE TRANSFER The tran
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SECTION VIII - EQUIPMENT AND DRUGS
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SECTION IX - EDUCATION AND TRAINING
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SECTION X - RESOURCE IMPLICATIONS F
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APPENDIX I INDICATIONS FOR INTUBATI
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APPENDIX III ADDITIONAL INFORMATION
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AAGBI SAFETY GUIDELINE Suspected An
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GUIDELINES Suspected Anaphylactic R
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Suspected anaphylactic reactions as
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Storage of Drugs in Anaesthetic Roo
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Storage of Drugs in Anaesthetic Roo
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This guideline was originally publi
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1. Summary 1.1 Safety, quality and
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3. Responsibility of anaesthetists
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equipment officer is encouraged to
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EU procurement thresholds Threshold
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Third party servicing is another op
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number of re-uses (e.g. re-usable L
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14. Incident reporting and investig
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available from www.hse.gov.uk 14.4
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DB DoH EBME EC EU FRCA HN HSE IEC I
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8. OPSI. Statutory Instrument 2006
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Eire Tel: 00353 1 676 4971 Website:
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Peri-operative management of the ob
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Guidelines Peri-operative managemen
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Recommendations 1 Every hospital sh
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is an increased incidence of prolon
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techniques, and when used with neur
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Table 5 The STOP-BANG screening que
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eturn of airway reflexes with desfl
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numbers of staff are needed to roll
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Membership of the Working Party Dr
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