Dzifa Dordunoo1, Michelle Hass2, Catherine Smith3, Martha L Aviles-Granados1, Miriam Weinzierl1, Judith A Anaman-Torgbor4, Ajijoon Shaik5, Anastasia Mallidou1, Farzad Adib6. 1. School of Nursing, University of Victoria, Victoria, British Columbia, Canada. 2. Center for Learning and Innovation, Scripps Health, San Diego, California, USA. 3. Faculty of Health Studies, University of the Fraser Valley, Abbotsford, British Columbia, Canada. 4. School of Nursing and Midwifery, University of Health and Allied Sciences, Ho, Ghana. 5. Nursing Department, School of Health and Human Services, Camosun College, Victoria, British Columbia, Canada. 6. Department of Allergy and Immunology, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California, USA.
Abstract
AIMS AND OBJECTIVES: The study aims were to (a) assess allergy screening practices, (b) determine the awareness of metal hypersensitivity among frontline healthcare workers and (c) examine perceived barriers to implementing metal hypersensitivity screening into clinical practice. BACKGROUND: Adverse device-related events, such as hypersensitivity to metals, are well documented in the literature. Hypersensitivity to metal is a type IV T-cell-mediated reaction that can occur after cardiac, orthopaedic, dental, gynaecological and neurosurgical procedures where a device with metal components is implanted into the body. Patients with hypersensitivity to metal are likely to experience delayed healing, implant failure and stent restenosis. Identifying patients with a history of metal hypersensitivity reaction could mitigate the risk of poor outcomes following device implant. Yet in clinical practice, healthcare workers do not routinely ask about the history of metal hypersensitivity when documenting allergies. The existing literature does not report why this is not included in allergy assessment. DESIGN: Following the STROBE checklist, a cross-sectional, descriptive study was conducted. METHODS: Frontline healthcare workers were recruited using professional contacts and social online media to complete an online questionnaire. Quantitative data were summarised descriptively while thematic analysis was used to examine barriers to implementation. RESULTS: Three hundred forty-five participants from 14 countries completed the questionnaire, with the majority (187/54%) practicing in Canada, in general medicine and intensive care units. Ninety per cent of the participants did not routinely ask about metal hypersensitivity when evaluating allergy history. Of the respondents, 86% were unaware of the association between metal hypersensitivity and poor patient outcomes. After presented with the evidence, 81% indicated they were likely or very likely to incorporate the evidence into their clinical practice. Common themes about barriers to implementing were 'Standards of Practice', 'Knowledge' and 'Futility of Screening'. CONCLUSION: The findings suggest lack of awareness as the main reason for not including metal in routine allergy assessment.
AIMS AND OBJECTIVES: The study aims were to (a) assess allergy screening practices, (b) determine the awareness of metalhypersensitivity among frontline healthcare workers and (c) examine perceived barriers to implementing metalhypersensitivity screening into clinical practice. BACKGROUND: Adverse device-related events, such as hypersensitivity to metals, are well documented in the literature. Hypersensitivity to metal is a type IV T-cell-mediated reaction that can occur after cardiac, orthopaedic, dental, gynaecological and neurosurgical procedures where a device with metal components is implanted into the body. Patients with hypersensitivity to metal are likely to experience delayed healing, implant failure and stent restenosis. Identifying patients with a history of metalhypersensitivity reaction could mitigate the risk of poor outcomes following device implant. Yet in clinical practice, healthcare workers do not routinely ask about the history of metalhypersensitivity when documenting allergies. The existing literature does not report why this is not included in allergy assessment. DESIGN: Following the STROBE checklist, a cross-sectional, descriptive study was conducted. METHODS: Frontline healthcare workers were recruited using professional contacts and social online media to complete an online questionnaire. Quantitative data were summarised descriptively while thematic analysis was used to examine barriers to implementation. RESULTS: Three hundred forty-five participants from 14 countries completed the questionnaire, with the majority (187/54%) practicing in Canada, in general medicine and intensive care units. Ninety per cent of the participants did not routinely ask about metalhypersensitivity when evaluating allergy history. Of the respondents, 86% were unaware of the association between metalhypersensitivity and poor patient outcomes. After presented with the evidence, 81% indicated they were likely or very likely to incorporate the evidence into their clinical practice. Common themes about barriers to implementing were 'Standards of Practice', 'Knowledge' and 'Futility of Screening'. CONCLUSION: The findings suggest lack of awareness as the main reason for not including metal in routine allergy assessment.