A number of patients who have been treated at Royal Cornwall Hospitals NHS Trust (RCHT) have today (Tuesday 2 May) been sent letters inviting them to specially arranged clinics for precautionary blood tests.
At RCHT the recall affects 57 patients who were treated by a locum doctor, whom has been diagnosed as HIV positive, and worked at the Royal Cornwall Hospital for a six month period between 2011 and 2012. Clinical evidence shows any risk of infection is extremely low and it is highly unlikely that any patient identified will have been infected with HIV.
The doctor is no longer working for the NHS.
Royal Cornwall Hospitals Trust Medical Director, Dr Malcolm Stewart said:
“We understand this will be concerning to patients, however, it should be stressed that the risk of the virus having been passed on to any of the individuals we are writing to is extremely low. There has not been any instance of cross-infection following similar look back exercises in the UK in the past.
“We are writing to 57 patients offering the opportunity, as a precaution, to return to the hospital for a blood test. There is no need for individuals to take any special precautions in advance of receiving our letter.
“The doctor was involved in orthopaedic operations at the Royal Cornwall Hospital for a six month period between 2011 and 2012. It is important to emphasise that this recall only affects those patients to whom we are sending letters today.
“Other patients having orthopaedic procedures during 2011 and 2012, or at any other time, do not have cause for concern. However, we have set up a helpline – 01872 252200 – for anyone who may wish to seek reassurance. The helpline will be open until 8pm today and then from 9am to 5pm on weekdays until 12th May.”
Whilst any risk to patients is extremely low, patients are being invited for testing as a precautionary measure at dedicated clinics. Support and counselling will be available and each hospital has set up a helplines. The majority of patients will be told their results within 72 hours by phone and letter. Patients unable to attend the weekend clinics will be able to attend at other times in the week or may choose to go for testing at their GP.
Dr David Levy, a Regional Medical Director for NHS England, said: “We understand that this will be a worrying time for patients who are being invited for precautionary testing and their families. However, clinical evidence shows that the risk of infection is extremely low and it is highly unlikely that any of the patients being contacted will have been infected with HIV. Advice and counselling is available for those affected by this recall, and we would encourage them to access this support. It is our first priority to identify and provide reassurance to the individuals being contacted at this time. We continue to work closely with Public Health England and other organisations involved to understand the details of what has been a complex incident.”
Healthcare workers and the reporting of HIV to employers
Established procedures are in place regarding health care workers infected with HIV. As long as a healthcare worker who is diagnosed with HIV takes and maintains a course of drugs which eradicate the virus in the bloodstream they may return to work, providing they follow all appropriate infection control procedures and any other restrictions on their practice that their professional body may order.
Health care workers are required to tell their employer if they have become infected – their details are then held on a confidential register and the health care worker is required to have three-monthly testing to ensure compliance with treatment that ensures there is no risk of them passing on the virus.
The doctor at the heart of this precautionary patient notification exercise is no longer working for the NHS. They were referred to the General Medical Council (GMC), which placed conditions on their registration. Subsequently the GMC has served an interim suspension order on the doctor earlier this year because they failed to comply with the conditions placed upon them. NHS England can confirm that no patients were put at risk during that time as their records show no category 3 exposure-prone procedures were carried out.
When a healthcare worker is diagnosed with HIV, it is normal practice for the NHS to undertake a review to identify any patient who has undergone procedures which may have placed them at risk of infection by the health care worker before their formal diagnosis. The notification exercise is being co-ordinated by NHS England Midlands and East and guided by the UK Advisory Panel for Healthcare Workers infected with Blood-borne Virus (UKAP) which recommended, as a precautionary measure, identification of patients who had undergone a category 3 exposure-prone procedure (EPP) between June 2010 and June 2016. Exposure-prone procedures are those where there is a risk that injury to the worker could result in exposure of the patient’s open tissues to the blood of the worker. UKAP has advised this time period because the first confirmed blood test which showed the doctor was HIV positive was in February 2016 and the last recorded HIV negative test was June 2010.
The risk to patients
The current recall is a precautionary measure – the risk to patients is extremely low and it is highly unlikely that any patient will have been infected with HIV. Worldwide, there have only ever been four reports of possible transmissions of HIV from infected healthcare workers performing exposure prone procedures, neither of which were in the UK. These cases were some years ago and surgical infection control practices and checks have further improved over recent years.
The circumstances in which HIV could be transmitted from an infected healthcare worker to a patient are limited to ‘exposure-prone procedures’, in which injury to the healthcare worker could result in the worker’s blood contaminating the patient’s open tissues. These include procedures where the worker’s gloved hands may be in contact with sharp instruments, needle tips and sharp tissues, for example bone; inside a patient’s open body cavity or wound, where the hands or fingertips may not be completely visible at all times.
The data available from previous patient notification exercises indicates strongly that the overall risk of transmission of HIV from infected health care workers to patients is very low. Between 1988 and 2008 in the UK, there were 39 patient notification exercises reported to UKAP; these exercises found no transmission of HIV from an infected health care worker to a patient despite about 10,000 patients having been tested.