Occupational exposure to bodily fluids in oral and maxillofacial surgery: an evaluation of reporting practices and attitudes among staff at a major teaching hospital in the UK

Our aim was to evaluate experience, practice, and beliefs about reporting of occupational exposures to blood and other body fluids among a sample of 88 healthcare providers working in oral and maxillofacial surgery at Sheffield Teaching Hospitals. We used a cross-sectional survey to evaluate awareness of the Trust's policy for reporting occupational exposure, recent incidence of exposure, and current reporting practices. Beliefs were measured using questions derived from the theory of planned behaviour. Fifty-five people responded, 14 of whom had been exposed to bodily fluids in the previous 12 months. Of those, 10 did not report it. Fifty-three respondents were certain that the Trust had a protocol in place for reporting sharps injuries to staff. Most (n=51) said the Trust had a protocol for reporting mucocutaneous exposure to blood. Respondents placed equal importance on reporting exposures that affected both themselves and patients, but intention to report exposure of patients was significantly higher than for themselves (z score -3.18, p<0.0001). We conclude that OMFS healthcare workers generally think that occupational exposures should be reported, but there are shortcomings in practice.

Trauma center verification

Sanctioned trauma center designation began in the late 1970's to improve hospital capabilities to care for injured patients. Guided by criteria established by the American College of Surgeons Committee on Trauma and led by surgeons dedicated to improving trauma care, many states focused early on the quality of care issue only to later struggle with the political consequences that followed the designation process. Institutional commitment to trauma care was often stated but seldom measured. Unlike the designation process with its strong emphasis on capabilities assessment, the verification process focused on performance documentation. Confirmation was sought in response time of key personnel, completeness of registry database, and trauma death audits. Trauma Committee minutes were reviewed and prehospital personnel interviewed to confirm institutional involvement in paramedic education and overall EMS system design. Other areas of documentation included trauma education at all levels, research, nursing audits, and outreach programs. We conclude that trauma center designation and verification are both essential and complementary. Effective trauma system performance requires trauma center designation plus a verification process to confirm institutional commitment of these resources for optimal care of the injured patient.