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Final Issue: Volume 16 Number 51
Published on: 21 December 2006
Final Issue in PDF
Last updated: Volume 15, No.10 (PDF file, 696 KB)
On 9 March 2005, the Medicines and Healthcare Regulatory Products Agency (MHRA) posted a Medical Device Alert on its website at <http://www.mhra.gov.uk/> about the Bignell Heaf testing device.
Bignell Surgical Instruments Ltd is withdrawing all Heaf testing heads currently in circulation. This follows six reports received by MHRA of small metal fragments being found in the forearm where the test is administered with a Bignell Heaf test head. Of the six cases reported, all were detected shortly after the Heaf test had been performed. The small metal splinters are easily removed. Bignell has identified the fragments as swarf – fine metal filings produced by machining during the production of the needles. Some batches have been found to be affected, but it has not been possible to identify the full extent of the problem. For this reason all Bignell Surgical Heaf test heads currently in circulation are being recalled.
The Bignell Heaf test is widely used in the schools BCG programme and, following the cessation of production of the Uniheaf device in January 2005, is the only Heaf testing device on the market. The Department of Health (DH) reports that there is a back-up supply of replacement Bignell stock which is ready to be distributed to schools and that more are expected to be available shortly.The DH recommends that local BCG schools programmes should be temporarily suspended until replacement stock is obtained.
The Health Protection Agency’s Centre for Infections has published an update on the international tables of occupational transmission of HIV in healthcare workers, a summary of reports up to December 2002 on the Agency’s website at: <http://www.hpa.org.uk/infections/topics_az/bbv/pdf/intl_HIV_tables_2005.pdf> (1). The tables collate both ‘documented’ and ‘possible’ HIV seroconversion cases occurring in healthcare workers following occupational exposure that have been reported to the Centre for Infections by national surveillance centres, or published in the literature. The majority of cases reported are from countries with established surveillance systems and this edition has no further information on cases occurring in south east Asia, the Indian sub-continent, or Africa.
Since the last update published in 1999 (2), there have been six documented and eighteen possible HIV seroconversions added to the tables, giving a total, to December 2002, of 106 documented and 238 possible cases. Two cases have been reclassified from ‘documented’ to ‘possible’ transmission, due to subsequent information being reported to the Centre for Infections. Twenty-four cases of documented HIV seroconversion occurred despite initiation of HIV post-exposure prophylaxis (PEP).
Percutaneous exposure was the predominant route of transmission of individual cases of documented HIV seroconversions accounting for 96 out of the 106 exposures. Twenty-four of documented cases involved source patients that were reported to have AIDS.
Nurses and clinical laboratory workers, who together contributed the highest proportion of reported occupationally-acquired HIV infection, accounted for 69% (73/106) of documented cases, and 39% (94/238) of possible cases. Thirteen per cent (14/106) of documented and 12% (28/238) of probable cases were in doctors, which included medical students, but not surgeons. In comparison, surgeons accounted for less than 1% (1/106) of documented cases and 7% (17/238) of possible cases. Dentists and dental workers contributed 3% (8/238) of possible cases and no documented cases.
It is essential that healthcare workers in the United Kingdom report occupational exposures and that the appropriate systems for doing so are available to them. This is to ensure that the exposure is appropriately managed and includes obtaining a baseline blood sample from the affected healthcare worker, providing HIV PEP in a timely manner, and appropriate follow-up tests are performed. Healthcare workers should receive training and education on the management and prevention of occupational exposures, including the use of universal precautions, where appropriate, and the correct disposal of sharps.
It should be noted that only tables 3-6 and 8 have been updated and included in this edition. For details of the other tables, please refer to the previous edition (December 1999) (2).
Please notify Sarah Tomkins/Dr Fortune Ncube with regard to any errors or omissions of cases in this report, at the: Health Protection Agency Centre for Infections, Department of HIV and Sexually Transmitted Infections, 61 Colindale Avenue, London, NW9 5EQ, United Kingdom. (email: <firstname.lastname@example.org> or <email@example.com>.
1.Health Protection Agency. Occupational transmission of HIV – summary of published reports. March 2005 Edition (data to the end of December 2002). London: Health Protection Agency, March 2005 [cited 10 March 2005]. Available at:<http://www.hpa.org.uk/infections/topics_az/bbv/pdf/intl_HIV_tables_2005.pdf>.
2.Public Health Laboratory Service. Occupational transmission of HIV – Summary of published reports. December 1999 Edition (data to the end of June 1999). London: PHLS, December 1999 [cited 10 March 2005]. Available at:
The results of the first three and a half years of the Department of Health's mandatory methicillin resistant Staphylococcus aureus (MRSA) surveillance system in acute Trusts in England have been published on the Department of Health (individual Trust and national data) and Health Protection Agency (regional data) websites.
MRSA bacteraemia numbers and rates by individual named Trusts are now available for the period April to September 2004 on the Department of Health website at
Results for the first three years of the mandatory surveillance system (April 2001 to March 2004) are also included. Data from the first three years are published in six-monthly periods for the first time to allow comparison with the most recent six months data.
In order to allow some comparison of similar institutions acute NHS Trusts have been categorised into:
• 'single specialty' Trusts (for example, Trusts only undertaking orthopaedics or cancer or children's health services);
• 'specialist' Trusts (Trusts with specialist services which receive patients referred from other Trusts for these services);
• 'general acute' Trusts (Trusts providing general acute healthcare services).
The data differs from previously published data in that it is being published 6 monthly (previously the individual Trust numbers and rates were published annually) and the bed occupancy data used to calculate the rates are from the same time period as the numbers of bacteraemias reported, other than for April to September 2004, for which the appropriate activity figures are not yet available.
The Agency’s website contains a summary of the national and regional reports submitted to the HPA on behalf of the Department of Health. <http://www.hpa.org.uk/infections/topics_az/staphylo/staphyl_six_monthly.htm>. The Agency will publish further data on MRSA at six-monthly intervals.