LAUSR

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 summarized 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 percent 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.