Lookback exercise

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A lookback exercise is undertaken when a cohort of individuals can be identified as having been exposed to a particular risk, especially when they may benefit from interventions such as diagnostic testing and treatment.

The term is often used to describe situations when a healthcare worker has been practising "exposure prone procedures", and patients are at risk of having become infected with a blood-borne infection, such as Hepatitis B, Hepatitis C, HIV, or Creutzfeldt-Jakob disease (CJD). UKAP will advise on the need for a lookback exercise when the infection is a blood-borne virus.[1] For incidents where the potential infectious agent is CJD the relevant body is the CJD Incidents Panel (CJDIP).

Another common situation is when people have been exposed to foodborne (including waterborne) or droplet-borne infection, such as to a patient or healthcare worker with pulmonary tuberculosis, or to a cooling tower which is producing legionella. The term can also refer to situations when people have, or may have, been exposed to another hazard - usually an infectious hazard, but toxic or radiation hazards could also lead to a lookback exercise.[2]

The logical sequela to a lookback exercise - and often assumed when referring to a lookback exercise - is a patient notification exercise (PNE), in which patients are informed that they have (possibly) been exposed to an infection risk. In the course of such exercises patients may be offered counselling, screening, and/or treatment as appropriate. In some situations there may be no immediate treatment available - this raises interesting ethical questions about the value of storing their names in a database, in the hope that treatments may be available in the future, and about whether such patients should be notified: on the one hand, notifying them when no treatment is available, and the risk is small, would cause anxiety in otherwise healthy individuals; on the other hand some would argue that they have a right to know...[3]

The CJDIP launched a large consultation programme, culminating in a large meeting at Westminster Hall (on 17 April 2002), chaired/facilitated by Michael Buerk, specifically considering the issues around CJD. A report of this meeting is available; and other reports and documents relating to this consultation are available via the CJDIP page at the HPA website (under Framework Document, as "Report on written consultation" and its annexes). This consultation process considered in detail the ethical issues around:

  • informing people (or not informing them) that they have been, or may have been, exposed to a risk that cannot currently be quantified; and
  • keeping information on such individuals in order to gain knowledge about the level of risk associated with particular levels of exposure.

References

  1. HIV Infected Health Care Workers: guidance on management and patient notification. Department of Health. 28 July 2005. Last accessed 28/8/06.
  2. [http://www.bmj.com/cgi/content/abstract/bmj.39367.455243.BEv1 ubin GJ, Page L, Morgan O, Pinder RJ, Riley P, Hatch S, et al. Public information needs after the poisoning of Alexander Litvinenko with polonium-210 in London: cross sectional telephone survey and qualitative analysis. BMJ 2007:bmj.39367.455243.BE
  3. O Blatchford, S J O'Brien, M Blatchford, A Taylor. Infectious health care workers: should patients be told? J Med Ethics 2000; 26:27-33.
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