DEVELOPMENT OF A NUMERIC HEALTH-CARE WORKER RISK-ASSESSMENT SCALE TO EVALUATE POTENTIAL FOR BLOOD-BORNE PATHOGEN EXPOSURES

Background: An attempt to develop a Health Care Worker Risk Assessment Scale to evaluate potential for exposure to blood-borne pathogens was made in late 1989 through 1990. The research questions were as follow s: (1) Can a scale be developed to assign weights to variables that in fluence health care workers' risk of exposure to blood-borne pathogens ? (2) If so, what variables would be included? Methods: A five-round D elphi technique was used with 26 panel members from 15 U.S. states and the United Kingdom who were recognized experts in strategies to reduc e health care workers' risk of exposure to blood-borne pathogens. The scale included four elements, each scored up to 40 points. Elements we re as follows: (1) potential route of exposure, (2) experience of heal th care worker and cooperation of patient, (3) prevalence of blood-bor ne pathogens, and (4) difficulty in managing the situation. A minimum score of 20 indicated an extremely low-risk situation; a maximum score of 160 indicated an extremely high-risk situation. Results: Consensus was achieved among the panel members in identifying the elements that contributed to risk for exposure to blood-borne pathogens and in appl ying the scale to carefully worded vignettes. This required several mo difications of both the scale and the vignettes to ensure consistent i nterpretation of the terms used. In all vignette situations, the risk- abatement strategy was specific to the situation depicted in the vigne tte and not to the task itself; the value of a numeric scale is thus q uestionable. Conclusions: Even with the participation of 26 expert pan elists, we were unable to develop a numeric scale to objectively quant ify risk in such a way that risk-reduction strategies could be based o n the scale rather than on the specific risk elements in a situation. Instead of attempting to use a scale such as this to quantify risk obj ectively, educators or clinicians may be better advised to teach healt h care workers the four scale elements so that health care workers can subjectively use these elements to evaluate and modify their own risk situations.