The Scottish Health Survey 2011 - volume 3: technical report
Annual Report of the Scottish Health Survey for 2011. Technical Report.
Appendix B: Nurse Protocols for Measurements and samples used by the National Centre for Social Research
June 2010
1 Height measurement including sitting height
1.1 Introduction
The height measurement is a measure of anthropometry, which provides information on the size and proportions of the human body. When taken in conjunction with other anthropometric measures it is an indicator of, and can predict, the nutritional status, performance, health and survival of a population and can thus be used to determine public health policies. Moreover, height is often used as an indicator of people's quality of life. This is based on evidence that final height is a combination of genetic and environmental factors, where a taller population is indicative of a better quality of life due to access to health services and nutrition.
1.2 Exclusion criteria
Respondents are excluded from the height measurement if:
- They are pregnant
- They are too stooped to obtain a reliable measurement
- After a discussion with the respondent it becomes clear that that they are too unsteady on their feet
- They are chairbound
- If the respondent finds it painful to stand or sit up straight
1.3 Equipment
You will need:
- A portable stadiometer (see figure 2 below)
- A Frankfort Plane card.
Figure 1 The stadiometer
1.4 Procedure for adults
1. Ask the respondent to remove their shoes.
2. Assemble the stadiometer, near a wall if possible, and raise the headplate to allow sufficient room for the respondent to stand underneath it. Double check that you have assembled the stadiometer correctly.
3. Ask the respondent to stand with their feet flat on the centre of the base plate, feet together and heels against the rod as this helps people to 'be at their highest'. The respondent's back should be as straight as possible, preferably against the rod but NOT leaning on it. They should have their arms hanging loosely by their sides. They should be facing forwards.
4. Move the respondent's head so that the Frankfort Plane is in a horizontal position (i.e. parallel to the floor). The Frankfort Plane is an imaginary line passing through the external ear canal and across the top of the lower bone of the eye socket, immediately under the eye (see Figure 3). This position is important if an accurate reading is to be obtained. An additional check is to ensure that the measuring arm rests on the crown of the head, i.e. the top back half. To make sure that the Frankfort Plane is horizontal, you can use the Frankfort Plane Card to line up the bottom of the eye socket with the flap of skin on the ear. The Frankfort Plane is horizontal when the card is parallel to the stadiometer arm.
Figure 2 The Frankfort Plane
5. Instruct the respondent to keep their eyes focused on a point straight ahead, to breathe in deeply and to stretch to their fullest height. If after stretching up the respondent's head is no longer horizontal, repeat the procedure. It can be difficult to determine whether the stadiometer headplate is resting on the respondent's head. If so, ask the respondent to tell you when s/he feels it touching their head.
6. Ask the respondent to step forwards. If the measurement has been done correctly the respondent will be able to step off the stadiometer without ducking their head. Make sure that the head plate does not move when the respondent does this.
7. Look at the bottom edge of the head plate cuff. There is an arrowhead pointing to the measuring scale. Take the reading from this point and record the respondent's height in centimetres and millimetres. If a measurement falls between two millimetres, it should be recorded to the nearest even millimetre (see section 2.4).
8. If the respondent wishes, record their height onto the measurement record card.
9. Push the head plate high enough to avoid any member of the household hitting their head against it when getting ready to be measured. Once you have finished measuring everyone, lower the head plate to its lowest position, ready for dismantling.
1.5 Procedure for children
The procedure for measuring children aged 2-15 differs slightly from that for adults. You must get the co-operation of an adult household member. You will need their assistance in order to carry out the protocol, as children are more likely to be co-operative themselves if another household member is involved in the measurement. If possible measure children last so that they can see what is going on before they are measured themselves.
Children's bodies are much more elastic than those of adults. Unlike adults they will need your help in order to stretch to their fullest height. This is done by stretching them. This is essential in order to get an accurate measurement. It causes no pain and simply helps support the child while they stretch to their tallest height.
1. Explain to the parent and child what you will be doing, and ensure that both are happy with the procedure.
2. In addition to removing their shoes, children should remove their socks as well to ensure that they do not slip on the base of the stadiometer, and so that you can easily check their feet are flat on the base plate, not on tiptoes.
3. Assemble the stadiometer and raise the head plate to allow sufficient room for the child to stand underneath it.
4. Ask the child to stand with their feet flat on the centre of the base plate, feet together and heels against the rod. The child's back should be as straight as possible, preferably against the rod, and their arms hanging loosely by their sides. They should be facing forwards.
5. Place the measuring arm just above the child's head.
6. Move the child's head so that the Frankfort Plane is in a horizontal position (see Figure 3). This position is as important when measuring children as it is when measuring adults if the measurements are to be accurate. To make sure that the Frankfort Plane is horizontal, you can use the Frankfort Plane Card to line up the bottom of the eye socket with the flap of skin on the ear. The Frankfort Plane is horizontal when the card is parallel to the stadiometer arm. Explain what you are doing and tell the child that you want them to stand up straight and tall, but not to move their head or stand on their tiptoes. Ask them to look straight ahead.
7. Cup the child's head in your hands, placing the heels of your palms either side of the chin, with your thumbs just in front of the ears, and your fingers going round towards the back of the neck. (See Figure 4).
Figure 3 The child stretch
8. Ask the child to breathe in. Firmly but gently, apply upward pressure lifting the child's head upward towards the stadiometer headplate and thus stretching the child to their maximum height. Avoid jerky movements, perform the procedure smoothly and take care not to tilt the head at an angle, you must keep it in the Frankfort plane.
9. Ask the household member who is helping you to lower the headplate down gently onto the child's head. Make sure that the plate touches the skull and that it is not pressing down too hard.
10. Still holding the child's head, relieve traction and allow the child to stand relaxed and breathe out. If the measurement has been done properly the child should be able to step off the stadiometer without ducking their head. Make sure that the child does not knock the head plate as they step off.
11. Read the height value in metric units to the nearest even millimetre (see section 2.4) and enter the reading into CAPI.
12. If the respondent wishes, record the reading on the child's measurement record card.
13. Push the head plate high enough to avoid any member of the household hitting their head against it when getting ready to be measured.
1.6 Additional points
- Some surveys require the respondent to be measured more than once, this will be stated in the project specific instructions. The protocol for taking the additional height measurements remains the same. Both measurements are to be recorded in CAPI and if they differ significantly CAPI will instruct you to take a third measurement.
- If the respondent cannot stand upright with their back against the stadiometer and have their heels against the rod (e.g. those with protruding bottoms) then give priority to standing upright.
- If the respondent has a hair style which stands well above the top of their head, or is wearing a religious head dress, with their permission, bring the headplate down until it touches the hair/head dress. You should never ask someone to remove a religious head dress. With some hairstyles you can compress the hair to touch the head. If you cannot lower the headplate to touch the head and think that this will lead to an unreliable measure, record this on CAPI. If it is a possible that can be altered e.g. a bun, if possible ask the respondent to change/undo it.
- If the respondent is tall, it can be difficult to line up the Frankfort Plane in the way described. When you think that the plane is horizontal, take one step back to check from a short distance that this is the case.
- You may need to tip the stadiometer to read the height of tall respondents.
- If the respondent has long hair then they may need to tuck it behind their ear in order for the head to be positioned properly. Always ask the respondent to tuck their hair behind their ears.
2 Weight Measurement
2.1 Introduction
Similar to the height measurement, the weight measurement is an indicator of and can predict the nutritional status and health of a population. When used in conjunction with the height measurement it can be used to derive the Body Mass Index, a statistical measure used to determine if an individual's weight falls within a healthy range.
2.2 Exclusion criteria
Respondents are excluded from this measurement if they are:
- Pregnant
If the woman wishes to be weighed, you can but do not enter the results into the computer. - Too frail or unable to stand upright
If you are concerned that being on the scales may cause them to be too unsteady on their feet then do not weigh them. Alternatively you can place the scales next to something that they can steady themselves on. - Over 130kg (20 ½ stone) in weight
The maximum weight registering accurately on the scales is 130kg. If you think that they exceed this limit then code it appropriately in CAPI and follow the prompts. Do not attempt to weigh them.
2.3 Equipment
There are two different sets of scales in circulation on NatCen projects. You will be provided with either:
- Tanita THD-305 scales
The weight is displayed in a window on the scales. The scales are switched on by pressing the button on the bottom right hand corner of the scales. They are battery operated and require four 1.5v AA batteries, which should be sent with the scales. They may be packed separately or one of the batteries may be turned around, to prevent the batteries from going flat, as there is no on/off switch. Ensure that you have spare batteries, just in case you need them. - Seca 870 scales
The weight is displayed in a window on the scales. The scales are switched on by briefly covering the solar cell (for no more than one second). The solar cell is on the right hand side of the weight display panel. NB You may experience difficulties switching the scales on if there is insufficient light for the solar cell. Make sure that the room is well lit. The scales have a fixed battery which cannot be removed.
Please check which scales you have been provided with and make sure that you are familiar with how they operate.
2.3.1 Calibrating the scales
The scales will need to be sent to Brentwood at regular intervals to be recalibrated to ensure that they provide accurate measurements. On each set of scales there is a label with a date that they need to be recalibrated by, ensure that they have been sent to Brentwood by this date.
2.3.2 Technical faults
Please refer to Table 1 when experiencing technical difficulties with the scales.
Table 1 Troubleshooting for the scales
| Fault | Action |
|---|---|
| Tanita THD 305 scales | |
| No row of 8s when turned on or will not turn on |
|
| Inconsistent readings |
|
| Seca 870 scales | |
| No '1888' when turned on or will not turn on |
|
| Inconsistent readings |
|
2.4 Procedure for adults
1. Weigh the respondent on a hard and even surface if possible. Carpets may affect measurements.
2. Ask the respondent to remove shoes, heavy outer garments such as jackets and cardigans, heavy jewellery, and to empty their pockets of all items.
3. Switch on the scales and wait for 888.8 (for the Tanita scales) or 1888 (for the Seca scales) to be momentarily displayed in the window. Do not attempt to weigh anyone at this point.
4. When the display reads 0.0, ask the respondent to stand with their feet together in the centre and their heels against the back edge of the scales. Their arms should be hanging loosely at their sides and their head should be facing forward. Having the respondent stand in this position means that the most accurate weight measurement can be obtained. Ensure that they keep looking ahead - it may be tempting for the respondent to look down at their weight reading. Ask them not to do this and assure them that you will tell them their weight afterwards if they want to know.
5. The scales will need to stabilise. The weight reading will flash on and off when it has stabilised. If the respondent moves excessively while the scales are stabilising you may get a false reading. If you think this is the case reweigh the respondent.
6. The scales are calibrated in kilograms and 100 gram units (0.1 kg). Record the reading in CAPI before the respondent steps off the scales.
7. If the respondent wishes, record the reading on their measurement record card.
8. The scales should switch off automatically a few seconds after the respondent steps off them.
2.5 Procedure for children
1. You must get the co-operation of an adult household member. This will help the child to relax and children, especially small children are much more likely to be co-operative themselves if an adult known to them is involved in the procedure.
2. Children who wear nappies should be dry. If the nappy is wet, please ask the parent to change it for a dry one and explain that the wetness of the nappy will affect the weight measurement.
3. Weigh the child, following the same procedure for adults. Encourage the child to 'Be as still as a statue' for an accurate reading. If you think that the results are inaccurate, code this in CAPI.
For very young children who are unable to stand unaided or small children who find this difficult follow the procedure below you will need to ask for the assistance of an adult as the following procedure requires you to measure the adult and then the adult holding the child:
1. Explain to the adult what you are going to do and the reasons why.
2. Code in CAPI the procedure used to measure the weight of the child.
3. Weigh the adult as normal following the protocol as set out above. Enter this weight into CAPI.
4. Weigh the adult and child together and enter this into CAPI. CAPI will calculate the difference between the two weights to get the child's weight.
5. If the respondent wishes record this reading on their measurement record card.
3 Demispan Measurement
3.1 Introduction
The demispan measurement is an alternative measure of height. It is the distance between the midline of the sternal notch and the base of the fingers between the middle and ring fingers, with the arm out-stretched laterally (see Figure 5).
Figure 4 The Demispan Measurement
The demispan measurement is taken when it is difficult to measure height accurately. For example if the respondent cannot stand straight or is unsteady on their feet as is quite often in the case of the elderly and some disabled people. It is used as a proxy for a height measurement as there is a relationship between demispan and 'true height'. Additionally, height decreases with age to a varying degree depending on individuals, and thus the standard measure of height may be less useful for some older respondents. The long bones in the arm do no get shorter however, and thus can be used to estimate accurately a respondent's 'true height'.
3.2 Exclusion criteria
Respondents are excluded from the demispan measurement if:
- They cannot straighten either arm without pain or discomfort.
3.3 Equipment
You will need:
- A thin retractable demispan tape calibrated in cm and mm
- A skin marker pencil
- Micropore tape
3.3.1 Using the demispan tape
A hook is attached to the tape and this is anchored between the middle and ring fingers at the finger roots. The tape is then extended horizontally to the sternal notch.
The tape is fairly fragile. It can be easily damaged and will dent or snap if bent or pressed too firmly against the respondent's skin. Also the ring connecting the hook to the tape is a relatively weak point. Avoid putting more strain on this ring than necessary to make the measurements. When extending the tape, hold the tape case rather than the tape itself as this puts less strain on the hook and tape. When placing the tape against the sternal notch, do not press into the sternal notch so much that the tape kinks.
3.4 Preparing the respondent
Explain to the respondent the purpose of conducting the demispan measurement and explain the procedure. Further explain that the measurement requires minimal undressing because certain items may affect the accuracy of the measurement. The items of clothing that will need to be removed include:
- Ties
- Jackets, jumpers and other thick garments
- Jewellery items such as chunky necklaces/bracelets
- Shoulder pads
- High heeled shoes
- Shirts should be unbuttoned at the neck
If the respondent does not wish to remove any item that you think might affect the measurement, record that the measurement was not reliable in CAPI.
For the purpose of consistency, where possible the right arm should always be used. If this is not possible, carry out the measure on the left arm and make a note of this in CAPI.
3.5 Procedure
1. Locate a wall where there is room for the respondent to stretch his/her arm. They need to stand with their back to the wall but not support themselves on it, standing approximately 3 inches (7cm) from the wall.
2. Ask the respondent to stand with weight evenly distributed on both feet, head facing forward.
3. Have them raise their right arm and extend it horizontally to their side until it is parallel with the floor. The right wrist should be in neutral rotation and neutral flexion. Rest your left arm against the wall allowing the respondent's right wrist to rest on your left wrist.
4. When the respondent is in the correct position, mark the skin at the centre of the sternal notch using the skin marker pencil. This mark must be made when the respondent is standing in the correct position. Explain to the respondent that the mark will wash off afterwards.
5. If clothing, jewellery or subcutaneous fat obscures the sternal notch, use a piece of micropore tape on the clothing or jewellery. If the respondent refuses to the use of the marker pen or the tape, proceed with the measurement but record it as unreliable in CAPI.
6. Ask the respondent to relax while you get the demispan tape.
7. Place the hook between the middle and ring fingers of the respondent so that the tape runs smoothly across the arm.
8. Ask the respondent to get into the position they were in previously, with their arm raised horizontally, the wrist in neutral flexion and rotation. Check they are in the correct position.
9. Extend the tape to the sternal notch. If no mark was made, feel for the correct position and extend the tape to this point.
10. Ask the respondent to stretch his/her arm checking that they remain in the same position, the hook has not moved on their fingers and that the respondent is not leaning on the wall or bending at the waist.
11. Record the measurement in CAPI, in centimetres and millimetres. Always report to one decimal place. If the length lies halfway between 2 millimetres, then round to the nearest even millimetre (see section 2.4).
12. Ask the respondent to relax and loosen up the right arm by shaking it gently.
13. Repeat steps 2-11. Explain to the respondent that the measure needs to be taken again for accuracy. If the second measure is significantly different to the first, CAPI will give you an error message. At this point you can check to make sure that you have entered the readings correctly or take a third measure if there is another reason for the measurements being different. This is to be taken in the same way as the previous two. CAPI will work out which two of the three readings to use.
14. If the respondent wishes, record the results on their measurement record card. You can use the conversion chart on your showcards to convert the results into inches.
3.6 Additional points
- If the respondent is unable to stand in the correct position or finds it difficult to stand steadily, ask them to sit for the measurement. Use an upright chair and position it close to a wall. If a respondent is unable to sit or stand, the measurement can be taken when the respondent is lying down. In both cases still try to support the arm if possible. You may need to sit or kneel to take the reading.
- Record in CAPI how the measurement was taken (i.e.. with respondent standing, sitting, etc).
- If there is no wall available for the respondent to stand in front of and extend their arm horizontally, have them stand in front of any other flat surface e.g. in front of a cupboard or window, ensuring that they are not supporting their body weight on this surface.
- If the respondent is much taller than you take the measurement with the respondent sitting.
- If the respondent's arm is much longer than yours is, support the arm close to the elbow rather than wrist level. Your arm must not be between the elbow and shoulder, as this will not provide sufficient support.
4 Waist and Hip Circumferences
4.1 Introduction
There has been increasing interest in the distribution of body fat as an important indicator of increased risk of cardiovascular disease. The waist and hip circumferences are measures of the distribution of body fat (both subcutaneous and intra-abdominal). Analyses suggest that waist circumference and waist-hip ratio are predictors of health risk like the body mass index (weight relative to height).
4.2 Exclusion criteria
Respondents are excluded from the waist and hip circumference measurement if they:
- Are pregnant
- Are chairbound
- Have a colostomy / ileostomy
4.3 Equipment
You will need:
- An insertion tape calibrated in millimetres
4.3.1 Using the insertion tape
The tape is passed around the circumference and the end of the tape is inserted through the metal buckle at the other end of the tape. To check the tape is horizontal you have to position the tape on the right flank and look round the participant's back from his/her left flank to check that it is level. This will be easier if you are kneeling or sitting on a chair to the side of the respondent. When taking the reading, be sure not to lift the tape, hold it flat against the body otherwise you will get an inaccurate measurement.
4.4 Preparing the respondent
The respondent needs to be wearing light clothing. Explain to the respondent the importance of this measurement and that clothing can substantially affect the reading. If possible the respondent needs to remove:
- All outer layers of clothing, such as jackets, heavy or baggy jumpers, cardigans and waistcoats
- Shoes with heels
- Tight garments intended to alter the shape of the body, such as corsets, lycra body suits and support tights/underwear
- Belts
Pockets should be emptied and if possible ask the respondent to empty their bladder before taking the measurement. If a urine sample is to be collected, this would be a good time to ask the respondent to provide it.
Explain to the respondent that the waist and hip measurements taken on NatCen surveys are taken at different points to where the respondent might think their waist and hips are. Therefore measurements may differ to those taken for clothing purposes.
Some respondents may be wearing religious or other symbols which they cannot remove and which may affect the measurement. Do not embarrass or offend the respondent by asking them to remove such items. Record in CAPI if the measurement is likely to be affected by this.
4.5 Procedure
1. Steps 1-3 apply to both waist measurement (section 8.5.1) and hip measurement (section 8.5.2).
Ensure that the respondent is standing erect in a relaxed manner and breathing normally. Weight should be evenly balanced on both feet and the feet should be about 25-30cm (1 foot) apart. The arms should be hanging loosely at their sides. This position will provide the most accurate measurement of both the waist and the hip, and will allow for them to be measured easily.
2. If possible, kneel or sit on a chair to the side of the respondent.
3. With assistance from the respondent pass the tape around the respondent's body, or if they are able to, get them to pass the tape around themselves and check that it is not twisted. Insert the plain end of the tape through the metal ring at the other end of the tape.
4.5.1 Measuring waist circumference
4. The respondent's waist is located midway between the iliac crest and the costal margin (lower rib). To locate the levels of the costal margin and the iliac crest, ask the respondent if you can touch them, and use the fingers of your right hand held straight and pointing in front of the participant to slide upward over the iliac crest.
5. Position the tape at the respondent's waist, ensuring that it is horizontal.
6. Ask the respondent to breathe out gently and to look straight ahead. This is to prevent the respondent from contracting their muscles or holding their breath.
7. Take the measurement at the end of a normal expiration by holding the buckle flat against the body and flattening the end of the tape to read the measurement from the outer edge of the buckle.
8. Record the measurement in CAPI in centimetres and millimetres. Always record to a one decimal place. If the result falls between two millimetres, record to the nearest even millimetre (see section 2.4).
9. Repeat steps 1-8 to record a second measurement. If the second reading differs significantly from the first, CAPI will report an error message. At this point check that you have entered the results into CAPI correctly. Otherwise take a third measurement, following the procedure above. Enter this result into CAPI, the computer will know which two results to use.
4.5.2 Measuring hip circumference
10. The respondent's hip circumference is the widest circumference over the buttocks and below the iliac crest.
11. Position the tape in this area ensuring that the respondent is looking straight ahead and not contracting their gluteal muscles. Ensure the tape is horizontal.
12. Measure the circumference at several positions over the respondent's buttocks, by holding the buckle flat against the body and flattening the end of the tape to read the measurement from the outer edge of the buckle.
13. Record the widest circumference in CAPI. Always record to one decimal place. Report in centimetres and millimetres. If the result falls between two millimetres, record to the nearest even millimetre (see section 2.4).
14. Repeat steps 1-3 and 9-12 to record a second measurement. If the second reading differs substantially from the first, CAPI will report an error message. At this point check that you have entered the results into CAPI correctly. Otherwise take a third measurement, following the procedure above. Enter this result into CAPI, the computer will know which two results to use.
15. If the respondent wishes, record the waist and hip measurement on their measurement record card.
4.6 Additional points
- If you have problems palpating the rib, ask the respondent to breathe in very deeply. Locate the rib and as the respondent breathes out, follow the rib as it moves down with your finger.
- The tape should be tight enough so that it doesn't slip but not tight enough to indent clothing.
- If the respondent is large, ask him/her to pass the tape around rather than 'hug' them. Remember to check that the tape is correctly placed to take the measurement and horizontal all the way around.
- Some respondents will be wearing clothing where the waistband of the trousers/skirt sits on the waist. Do not attempt to move the clothing or take the measurement at a different position. Measure the waist circumference over the waistband and make a note of this in CAPI. If the waistband is not horizontal all the way around the body i.e. it may be lower at the front, always ensure that the tape is horizontal which may mean that it passes over the waist band in some places and not in others. If there are belt loops, thread the tape through the loops so that they don't add to the measurement.
- We only want to record problems that will affect the measurement by more than would be expected when measuring over light clothing. As a rough guide only record a problem if you feel it affected the measurements by more than 0.5cm. We particularly want to know if waist and hip are affected differently.
5 Recording Ambient Air Temperature
5.1 Introduction
Many of the physical measures taken fluctuate considerably due to air temperature. To be able to standardise the results that are obtained air temperature must be recorded. CAPI will tell you when to record the air temperature.
5.2 Equipment
You will need:
- A digital thermometer
- A probe
5.2.1 Using the thermometer
1. This instrument is very sensitive to minor changes in air temperature and thus it is important that ambient air temperature be recorded at the appropriate times, as prompted by CAPI.
2. It can take a few minutes to settle down to a final reading if it is experiencing a large change in temperature.
3. When "LO BAT" is shown on the display the battery needs replacing, take no further readings.
4. To preserve battery power, the thermometer may switch itself off after 7 minutes.
5. The battery in the thermometer is a long-life battery and should last at least one year. However should it run low please purchase a new battery. Take the old one with you to ensure it is the same type. Claim in the usual way.
6. To remove an old battery and insert a new one, unscrew the screw on the back of the thermometer, insert the new battery and replace the cover.
5.3 Procedure
1. Set up the thermometer, usually on a surface near the Omron (blood pressure equipment), by plugging the probe into the socket at the top of the instrument. Do not let the probe touch anything and ensure that it is not near a radiator or in the sun. It is recommended that the probe hang over the edge of a table.
2. When prompted by CAPI to take a reading, turn on the thermometer by pressing the completely white circle.
3. Wait for the reading to stabilise and take a reading.
4. Record the air temperature in CAPI to one decimal place e.g. 21.4. Do not round this to a whole number.
5. To preserve battery life please ensure that after taking the reading the thermometer is switched off by pressing the white ring.
6 Lung Function Using Vitalograph Escort
6.1 Introduction
Lung function tests objectively assess respiratory function and are widely used in clinical practice to diagnose and monitor the progress of respiratory diseases such as asthma and chronic obstructive airways disease. A lung function test produces values across the various measures tabled below (Table 2). A wide range of variables can affect these factors, for example physical unfitness, smoking, chronic bronchitis, poorly controlled asthma, some muscular disorders and many other conditions. At a population level, these measures tell us a lot about the respiratory health of the population and are also indicators of general health.
Table 2 Lung function test values
| Test | Abbrev | Definition |
|---|---|---|
| Forced Vital Capacity | FVC | The total amount of air that can forcibly be blown out after a full inspiration, measured in litres. |
| Forced Expiratory Volume in 1 Second | FEV1 | The amount of air that can be blown out in one second, measured in litres. |
| FEV1% | FEV1/ FVC | The ratio of FEV1 to FVC. |
| Peak Expiratory Flow | PEF | The speed of air moving out of your lungs at the beginning of expiration, measured in litres per second. |
| Forced Expiratory Flow | FEF | The average flow (or speed) of air coming out of the lung during the middle portion of expiration. |
| Forced Inspiratory Flow | FIF | Similar to FEF except the measurement is taken during inspiration. |
| Forced Expiratory Time | FET | The length of expiration in seconds. |
| Tidal Volume | TV | The specific volume of air that is drawn into the lungs and then expired during a normal respiratory cycle. |
6.2 Exclusion criteria
Respondents are excluded from the lung function measurement if they:
- Are pregnant
- Have had abdominal or chest surgery in the preceding three weeks
- Have been admitted to hospital with a HEART complaint in the preceding
- six weeks
- Have had eye surgery in the preceding 4 weeks
- Have a tracheostomy
6.3 Equipment
You will need:
- A Vitalograph Escort spirometer and case
- A 1 litre calibration syringe
- Disposable cardboard mouthpieces
6.3.1 Caring for the spirometer
1. For the purposes of hygiene and accuracy, once a month or after every 50 respondents remove the flowhead and clean it in hot soapy water and allow it to dry overnight before refitting.
2. When necessary clean the exterior with a lint free damp cloth. DO NOT clean the two white cylindrical filters on the top of the unit.
6.3.2 Using the spirometer
1. Take a spare battery with you in case of battery failure. The spirometer uses a 9v pp3 battery.
2. Whenever the 'ON' button is pressed to perform a new test, ensure that the spirometer is placed on a flat surface with the mouthpiece pointing upwards.
3. Unpack the spirometer as soon as possible and keep it away from direct heat. Allow the spirometer to equilibrate to room temperature before the lung function tests are performed.
4. See Figure 6 for the spirometer unit and the display
Figure 5 The Spirometer
6.3.3 Calibration/accuracy test
1. Before using the spirometer its accuracy must be checked by calibrating it. This procedure can be done in your own home at the start of each day when you are working. If you have more than one visit in the same day you need to calibrate the spirometer only once. You should not need to take the calibration syringe with you when you make a visit.
2. Ensure that the spirometer and syringe have been in the same temperature environment for at least an hour.
3. Connect the spirometer, by the flow head, to the syringe. Pump through a few litres of air, then disconnect the spirometer.
4. Switch on the spirometer and press the small top most button to the left of the arrow keys (the accuracy check button). The display will show a number.
5. Check display is 01. If not, adjust with up/down arrow keys (see figure 6).
6. Press the left arrow key (the enter button) and wait until display shows 'blow now' and 'thumbs down' symbols.
7. Making sure the syringe piston is fully withdrawn, connect the syringe to the flow head. The handle of the spirometer should be pointing upwards.
8. Using one swift, smooth stroke pump in the volume of air (about 1 second). Don't cover the outlet with your hand.
9. Wait for a double beep then withdraw the piston fully and repeat step 8 until five single beeps occur. It is very important to wait for the double beep before withdrawing the piston each time.
10. If 'thumbs up' is displayed, the spirometer has been correctly calibrated.
11. If a 'thumbs down' sign appears on the display, then the spirometer is outside the accuracy requirements, contact Brentwood to arrange for a replacement.
12. Press the On/Off button to switch off.
6.3.4 Technical faults
Refer to table 3 if technical difficulties are experienced with the spirometer
Table 3 Troubleshooting for the spirometer
| Fault | Action |
|---|---|
| Nothing is displayed when the ON button is pressed |
|
| False readings suspected |
|
| Calibration values vary greatly |
|
If any problems persist, contact Brentwood for advice.
6.4 Preparing the respondent
Before commencing the spirometer procedure explain the following to all eligible respondents:
- The purpose of the test and how to use the spirometer.
- To ensure an accurate reading they must 'blow' as hard as they can so long as it does not cause them any pain and/or discomfort.
- The definition of an acceptable level of lung function depends on the person's age, sex and height.
- A diagnosis of abnormality is not based on a reading from a single occasion but is rather based on several measurements and on the person's clinical history.
6.4.1 Demonstrating
For an accurate reading of lung function it is very important that you demonstrate the blowing technique to each respondent. Do this using a spare mouthpiece that is not connected to the spirometer and follow the procedure below:
1. Explain that the mouthpiece should be held in place by the lips, not the teeth and that the lips are wrapped firmly around the mouthpiece so no air can escape.
2. Demonstrate a blow, pointing out afterwards the need for full inspiration, a vigorous start to exhalation and sustained expiration. The blow should be at least 3 seconds in duration and not interrupted by coughing, laughing or leakage of air. The torso should remain in an upright position throughout the blow, not hunched over at the end.
6.5 Procedure
1. The respondent must be standing, unless chairbound, and they should loosen tight clothing to allow for a bigger inspiration. If the respondent wears dentures, it is preferable that they leave them in as they will get a tighter seal with their mouth around the mouthpiece which will result in a more accurate result.
2. Following the demonstration, hand the respondent a clean disposable mouthpiece and allow the respondent at least one practice blow using the mouthpiece alone. Correct their technique where necessary.
3. Attach the respondent's mouthpiece and turn the unit on using the 'ON/OFF' button. Check that the 'low battery' symbol is not showing.
4. Gently hand the spirometer to the respondent as sudden jerky movements can destabilise the unit. If a single beep sounds at this point, wait for the spirometer to stabilise, indicated by a further double beep, before proceeding with the test. The display should also display the 'blow' symbol.
5. Ask the respondent to take as deep a breath as possible, keeping the spirometer away from their mouth, and then to hold the mouthpiece with their lips and seal their lips around it so that air does not escape while they are blowing. Check that the spirometer is held below the flowhead with the handle pointing downwards and the subject's hand is not obstructing the flowhead outlet.
6. Then say "now blow!" As the respondent is blowing encourage him/her by saying "keep going, keep going, keep going..." to get the maximum expiration possible. Observe the respondent closely for satisfactory technique. If the blow was technically unsatisfactory, they will need to blow again (refer to section 10.6).
7. Take the spirometer from the respondent and record the appropriate readings in CAPI by using the down arrow to scroll through the display.
8. Switch off the spirometer to reset the unit. This is very important, otherwise the subsequent readings are based on the best of a series of tests and not on individual blows.
9. Repeat steps 3-8 until you have obtained the required number of technically satisfactory blows (refer to project specific instructions). Most respondents should be able to manage what is required but there may be some that cannot. You must strike a balance between encouragement and over-insistence.
10. If the respondent wishes, record the results on their measurement record card, recording the highest obtained reading for each measure, even if they came from different blows.
6.6 Technically unsatisfactory blows
The following may result in a technically unsatisfactory blow, and if any of these occur the test should be repeated.
- Unsatisfactory start: excessive hesitation or "false start". It is probable that the spirometer will not record this blow (or give lung capacity as zero), but sometimes it will give a spurious reading.
- Laughing or coughing, especially during the first second of the blow. Some people will cough a little towards the end of expiration (particularly if this extends to 5 or 6 seconds) but this is acceptable.
- Holding the breath against a closed glottis (Valsalva manoeuvre). This results in spuriously high peak expiratory flow (see table 2).
- Leakage of air around the mouthpiece.
- Obstruction of the mouthpiece by tongue or teeth.
- Obstruction of the flowhead outlet by hands.
- If the spirometer takes more than 3 seconds to display the results after the end of the blow, it is likely that the results are spurious.
7 Blood Pressure
7.1 Introduction
Blood pressure is the exertion that the blood applies to the arterial walls as it is pumped through the circulatory system by the heart. Having a high blood pressure is an important risk factor for cardiovascular disease and stroke. The exact cause(s) of high blood pressure is not completely known however some factors known to affect blood pressure are smoking, family history, physical fitness and diet. It is important that we examine blood pressure using a standard method to see the distribution of blood pressure measurements across the population. This is vital for monitoring change over time.
7.2 Exclusion criteria
Respondents are excluded from the blood pressure measure if they are:
- Aged 4 years and below
- Pregnant
If a pregnant woman wishes to have her blood pressure measured, you may do so, but do not record the readings in CAPI.
7.3 Consent
In addition to the verbal consent required to conduct all NatCen procedures (refer to section 2.1), written consent is required for the results to be sent to the respondent's GP. The appropriate form must be signed and dated by the respondent.
7.4 Equipment
You will need:
- An Omron HEM 907 blood pressure monitor
- Child/ small adult cuff (17-22 cm)
- Standard adult cuff (22-32 cm)
- Large adult cuff (32-42 cm)
- An AC adapter
Please note you will not get all of the cuff sizes in some of the studies, this is dependent on the sample involved in the individual surveys.
7.4.1 Using the Omron HEM 907
Figure 7 shows the monitor of the Omron
Figure 6 The Omron HEM 907 monitor
1. Switch the monitor on by pressing the ON/OFF button. Wait for the READY TO MEASURE symbol to light, indicating the monitor is ready to start the measurement (approximately 2 seconds).
2. Check that the MODE selector is set to AVG (average) and P-SET Volume (pressure setting) is set to auto.
3. Press the start button to begin the measurement. The cuff will start to inflate and take the first measurement. When the first measurement is complete, the LCD screen will show the systolic pressure, diastolic pressure and pulse rate. It will continue to do this at one minute intervals.
4. Press the ON/OFF button to turn it off.
5. If at any stage while you are taking the measurement you need to stop the monitor, press STOP and start the procedure again, as described in section 11.6.
7.4.2 Charging the battery
The Omron HEM 907 is equipped with a rechargeable battery, which is usable for approximately 300 measurements when fully charged.
When the battery symbol in the BATTERY display starts to flash there are 20-30 measurements left, you need to charge the battery soon. When a light battery symbol appears in the BATTERY display the battery needs to be put on charge immediately.
To recharge the battery:
Connect the monitor to the mains. A battery symbol will appear in the CHARGING display when the battery is charging. When ready to use the symbol will disappear. A dark battery symbol in the BATTERY display indicates that the battery is charged and the machine is usable. The battery can be charged in approximately 12 hours.
The Omron 907 is NOT designed to work off the mains adaptor, it should be run off the battery power pack. The mains adaptor should ONLY be used to charge the battery pack.
7.4.3 Technical faults/error readings
Refer to table 4 when error readings appear on the LCD screen.
Table 4 Troubleshooting for the Omron HEM 907
| Error No. | Action |
|---|---|
| Er1, Er2 |
|
| Er3 |
|
| Er4 |
|
| Er5, Er6 |
|
| Er7, Er8 |
|
| Er9 |
|
7.5 Preparing the respondent
During the initial interview, the respondent would have been informed not to eat, smoke, drink alcohol or participate in vigorous exercise 30 minutes before the nurse visit as this can cause blood pressure to be higher than normal. Before the procedure ask to see if they have carried out any of these activities and note their response in CAPI.
Select the right arm unless this is impossible. Ask the respondent to remove outer garment (e.g. jumper, cardigan, jacket) and expose their upper right arm by rolling up their sleeve. If the sleeve constricts the arm, restricting the circulation of blood, ask the respondent if they would mind taking their arm out of the sleeve for the measurement.
7.5.1 Selecting the correct cuff
Adults
Do not measure the upper arm circumference to determine which cuff size to use. Instead, choose the correct cuff size based on the acceptable range which is marked on the inside of the cuff. You will note that there is some overlap between the cuffs. If the respondent falls within this overlap range then use the standard cuff where possible.
Children
It is important to select the correct cuff size to obtain an accurate reading and avoid injuring the child. The appropriate cuff is the largest cuff which fits between the axilla (underarm) and the antecubital fossa (front of elbow) without obscuring the brachial pulse and so that the index line is within the range marked on the inside of the cuff. You will be provided with a child's cuff as well as the other adult cuffs. Many children will not need the children's cuff and instead will require an adult cuff. You should choose the cuff that is appropriate to the circumference of the arm.
7.6 Procedure
1. Check that the monitor is working.
2. Use the right arm, unless this is impossible. If the left arm is used, record this in CAPI.
3. Get the respondent to sit in a comfortable chair with a suitable support so that the right arm is resting at a level to bring the antecubital fossa (elbow) to approximately heart level. They should be seated in a comfortable position with legs uncrossed and feet flat on the floor.
4. Wrap the correct sized cuff round the upper right arm and check that the index line falls within the range lines. Do not put the cuff on too tightly as bruising may occur on inflation. Ideally it should be possible to insert two fingers between the cuff and the arm.
5. Locate the brachial pulse just medial to the biceps tendon and position the arrow on the cuff over the brachial artery. The lower edge should be about 1-2 cm above the cubital fossa (elbow crease).
6. Explain to the respondent that you need them to sit quietly for five minutes and that during that time they cannot eat, drink or smoke.
7. During this 'quiet time' follow the procedure for taking ambient air temperature (section 9) and just before taking the blood pressure reading, make a note of the air temperature (this is not applicable for all surveys, refer to the project specific instructions).
8. After five minutes explain that you are starting the measurement, also explain that the cuff will inflate three times and each time they will feel some pressure on their arm. Ask them to relax, be seated in the position detailed in step 3 and not to speak until the measurement has been completed, as it may affect their reading.
9. Press start on the Omron HEM 907 to start the measurement. When the first measurement is complete it will be displayed on the LCD screen. Record this.
10. The unit will produce readings at one minute intervals thereafter, record the next two so you have three sets of readings in total. To check the readings press the 'Deflation' button. It is important that the three readings are recorded as the first reading is usually higher, and thus less accurate, than the other two readings as the respondent may be feeling nervous.
11. Press ON/OFF on the Omron to switch the unit off and remove the cuff from the respondent's arm.
12. If the respondent wishes, you should record details of their readings on the measurement record card.
7.7 Respondent feedback
When answering queries about a respondent's blood pressure it is very important to remember that it is NOT the purpose of the survey to provide respondents with medical advice, nor are you in a position to do so as you do not have the respondent's full medical history.
What you may say in each situation has been agreed with the Survey Doctor and CAPI will instruct you to read out the appropriate interpretations of the respondent's results. It is very important that the agreed script in the CAPI is read word for word and that personal interpretation is never offered.
The respondent feedback protocol should be strictly followed. It is very important that as little anxiety as possible is caused, but at the same time we have a duty to advise people to see their GP if the measurements indicate that blood pressure is raised.
7.7.1 Child respondents
Do not comment on a child's blood pressure readings to the child or parents. If they seek comment, state that you are not able to interpret a single blood pressure measurement without checking to see whether it is normal for the child's age and height. Reassure them that if it is found to be markedly abnormal, the Survey Doctor will get in touch with them or their GP and advise them to get it checked. This rule applies for all readings you obtain.
7.7.2 Adult respondents
As stated previously we have a duty to inform people that they need to see their GP if their blood pressure is high. It is important that the instructions below are carefully read and guidelines always followed precisely.
The computer tells you which readings your advice should be based on. This will be based on the lowest systolic and lowest diastolic reading from the last two readings (this is a change from previous practice when the highest readings were used). This will usually, but not always, be from the same reading. For example, occasionally it may be the systolic from the second reading and the diastolic from the third reading. Furthermore if the lowest systolic reading falls in one category and the lowest diastolic reading falls in another category, the higher of the two categories will be used to trigger the advice to respondents. For example the lowest systolic reading is 138 (normal) and the lowest diastolic is 96 (mildly raised) then the advice given will be based on a mildly raised reading. If the first reading is higher than the other two it should be explained that the first reading can be high because people are nervous of having their pressure taken.
Definitions of raised blood pressure differ slightly. The Survey Doctor has recommended the blood pressure ratings given below based on the most recent guidelines from the British Hypertension Society. It is important that you adhere to these definitions, so that all respondents are treated in an identical manner. These are shown in table 5.
Table 5 Definition of blood pressure ratings
| ADULTS ONLY | |||
|---|---|---|---|
| SURVEY DEFINITION OF BLOOD PRESSURE RATINGS | |||
| For men and women aged 16+ | |||
| Rating | Systolic | Diastolic | |
| Normal | <140 | and | <90 |
| Mildly raised | 140 - 159 | or | 90 - 99 |
| Raised | 160 - 179 | or | 100 - 114 |
| Considerably raised | 180 or more | or | 115 or more |
Points to make to a respondent about their blood pressure (given on screen):
Normal:
'Your blood pressure is normal.'
Mildly raised:
'Your blood pressure is a bit high today.'
'Blood pressure can vary from day to day and throughout the day so that one high reading does not necessarily mean that you suffer from high blood pressure.'
'You are advised to visit your GP within 2 months to have a further blood pressure reading to see whether this is a one-off finding or not.'
Raised:
'Your blood pressure is a bit high today.'
'Blood pressure can vary from day to day and throughout the day so that one high reading does not necessarily mean that you suffer from high blood pressure.'
'You are advised to visit your GP within 2 weeks to have a further blood pressure reading to see whether this is a one-off finding or not.'
Considerably raised:
'Your blood pressure is high today.'
'Blood pressure can vary from day to day and throughout the day so that one high reading does not necessarily mean that you suffer from high blood pressure.'
'You are strongly advised to visit your GP within 5 days to have a further blood pressure reading to see whether this is a one-off finding or not.'
(For all of the above points, you can also advise the respondent to see their practice nurse, if this is who they would typically see in relation to their blood pressure.)
Note: If the respondent is elderly and has considerably raised blood pressure, amend your advice so that they are advised to contact their GP within the next week or so about this reading. This is because in many cases the GP will be well aware of their high blood pressure and we do not want to worry the respondent unduly. It is however important that they do contact their GP about the reading within 7 to 10 days. In the meantime, contact the Survey Doctor who will inform the respondent's GP of their result, providing the respondent has given their permission (refer to table 6).
7.8 Action to be taken by the nurse after the visit
If you need to contact the Survey Doctor, unless there is a hypertensive crisis, do not do this from the respondent's home - you may cause unnecessary distress.
7.8.1 Children
No further action is required after taking blood pressure readings on children. All high readings are viewed routinely by the Survey Doctor. However, in the rare event that you encounter a child with a very high blood pressure, i.e. systolic 160 or above or diastolic 100 or above please call the Survey Doctor.
7.8.2 Adults
Table 6 summarises what action to take based on the readings you have obtained for a respondent. For this purpose you should only take into account the last two of the three readings you take, as the first reading is prone to error.
Table 6 Nurse action due to blood pressure readings
| BLOOD PRESSURE | ACTION |
|---|---|
| Normal/mildly raised/raised BP Systolic less than 180 mmHg and Diastolic less than 115 mmHg |
No further action necessary If you feel that the circumstances demand further action, inform the Survey Doctor who will then inform the respondent's GP immediately if she deems it necessary.* |
| Considerably raised BP Systolic at or greater than 180 mmHg or Diastolic at or greater than 115 mmHg |
Contact the Survey Doctor at the earliest opportunity and she will inform the respondent's GP if written consent has been given, or the respondent if not.* If the respondent has any symptoms of a hypertensive crisis** contact the survey doctor immediately or call an ambulance. The Survey Doctor must be informed as soon as possible. |
* You must still contact the Survey Doctor even if respondents tell you that their GP knows about their raised BP.
** A hypertensive crisis is an extremely rare complication of high blood pressure. Its signs and symptoms include diastolic bp > 135 mmHg, headache, confusion, sleepiness, stupor, visual loss, seizures, coma, cardiac failure, oliguria, nausea & vomiting.
The Survey Doctor will look at all high or unusual readings when they reach the office. If the reading is high, then the Survey Doctor will contact the respondent directly. The Survey Doctor will also routinely check fast and slow pulse rates so no further action is necessary regarding these.
Contact details for your Survey Doctor can be find in the project instructions. The Survey Doctor is generally available from 8.00-22.00. Calls outside these hours are either unnecessary or an emergency, in which case, the survey doctor is unlikely to be in a position to do anything practical and you should be using your professional judgement whether to call an ambulance or seek other urgent advice.
8 Saliva
8.1 Introduction
Saliva samples are taken from respondents for analysis to detect various chemical compounds (depending on the aims of the individual surveys) to provide information on peoples health and lifestyle. These compounds include:
- Cortisol, indicating an individual's stress levels.
- Cotinine, a derivative of nicotine showing levels of exposure to tobacco smoke.
8.2 Exclusion criteria
Respondents are excluded from giving a saliva sample if they:
- Are pregnant
- Are HIV positive
- Have Hepatitis B or C
Do not ask for information regarding HIV and Hepatitis B or C, however if they volunteer it, record them as unable to give a sample and make a note.
8.3 Consent
There is a separate consent form for the saliva sample. This must be signed and dated by the respondent or by the parent or legal guardian in the case of children aged 15 years and below. Please make it clear to respondents that they will not receive results regarding their saliva sample (see section 2.5).
8.4 Preparing the respondent
Explain to the respondent what you will require them to do and the reasons behind why saliva samples are taken.
There are two different procedures that can be followed depending on the aims/requirements of the survey. Please refer to the project instructions for the preferred method.
8.5 Procedure One
8.5.1 Equipment
You will need:
- A plain 5ml tube
- A short wide bore straw
- Kitchen paper
- Gloves
8.5.2 Procedure
1. Remove the cap from the plain tube Give the straw to the respondent. Explain that you want him/her to collect their saliva in their mouth and then let it dribble down the straw into the tube. The saliva does not need to go through the straw, the straw is intended to direct the saliva into the tube. Ensure that you are not getting sputum i.e. they are not clearing their chest to collect their saliva.
2. Allow the respondent 3 minutes to do this, collecting as much as you can in this time. The saliva will be frothy and will look greater in volume than it actually is, so do not give up too soon. You need at least 0.5cm on depth in the tube, not including froth.
3. If respondents find it difficult to use the straw they may dribble into the tube directly. This is acceptable, but encourage them to use the straw where possible.
4. If a respondent's mouth is excessively dry and they cannot produce saliva allow them to have a drink of plain water. Wait for 5 minutes before collecting the sample to ensure that water is not retained when the sample is given.
5. Replace the cap on the tube and report any problems in CAPI. You should wear gloves at all times when you come in contact with a saliva sample.
6. Label and package as directed in the project specific instructions.
8.6 Procedure Two
8.6.1 Equipment
You will need:
- Salivettes
- Gloves
8.6.2 Procedure
1. Figure 10 is a picture of a salivette. 'A' shows the salivette correctly assembled and 'B' shows the four different parts that it consists of: the cap, absorbent swab, inner tube and outer tube.
2. To obtain the saliva sample, remove the inner tube from the outer tube. Remove the cap from the inner tube and instruct the respondent to take the absorbent swab from the inner tube, without touching it, by lifting the tube to their lips and letting the absorbent swab fall into their mouth. Further explain that they must leave it in their mouth until it is saturated with saliva.
3. Ask them to move it around in their mouth, gently biting on it, as this helps to ensure thorough wetting of the absorbent swab. It will vary from person to person, however 3 minutes will usually be ample.
4. If a respondent's mouth is excessively dry and they cannot produce saliva allow them to have a drink of plain water. Wait for 5 minutes before collecting the sample to ensure that water is not retained when the sample is given.
5. When the absorbent swab is sufficiently wet, ask the respondent to remove it from their mouth and put the absorbent swab back into the inner tube, avoiding touching it if they can.
6. Wearing gloves, check that the swab is saturated. The tube should feel noticeably heavier than an unused one. If the swab rattles around in the tube then it is not wet enough and you need to give it back to the respondent to put back in their mouth.
7. Once you are satisfied that it is saturated replace the cap on the inner tube and put the inner tube back in the outer one (the inner tube has a hole in the bottom so will leak in the post if not placed in the outer tube). Record in CAPI any problems you may have had. You should wear gloves at all times when you come in contact with a saliva sample.
8. Label and package as directed in the project specific instructions.
Figure 7 'A': an assembled salivette, 'B': the various components
9 Spot Urine
9.1 Introduction
Urine, a waste product of human bodily functioning, can be analysed to provide information on various factors depending on the compound to be analysed (table 7). The information that is obtained is highly accurate and cannot be taken from any other source. Please note that the compounds that are analysed are dependent on the individual survey.
Table 7 Compounds in urine analysis
| Chemical | Definition |
|---|---|
| Potassium | Potassium is both an electrolyte and a mineral which works to keep a balance in bodily fluids and has an important role in nerve and muscle functioning. Potassium is found in fruit and vegetables and thus also indicates the fruit and vegetable intake of individuals. |
| Sodium (salt) | Sodium is both an electrolyte and a mineral which works to keep a balance in bodily fluids and has an important role in nerve and muscle functioning. Sodium is found in most foods and has been shown to contribute to high blood pressure which is a major risk factor in the development of cardiovascular disease. |
| Urea and Nitrogen | Urea and nitrogen are natural by-products of the human body. They are analysed to give an indication of kidney function. They also provide information on the amount of protein in an individual's diet. |
9.2 Exclusion criteria
Respondents are excluded from giving a urine sample if they:
- Are pregnant
- Are HIV positive
- Have Hepatitis B or C
Do not ask for information regarding HIV and Hepatitis B or C, however if they volunteer it, record them as unable to give a sample and make a note.
Women who have their period are not excluded from giving a urine sample. Respondents with a catheter are also not excluded. If the sample is taken from a catheter bag, this should be recorded in CAPI. It does not matter how long the urine has been in the collection bag.
9.3 Consent
There is a separate consent form for the urine sample. This must be signed and dated by the respondent or by the parent/legal guardian in the case of respondents aged 15 years and below. Please make it clear to respondents that they will not receive results regarding their urine sample.
9.4 Equipment
You will need:
- A 100ml Polypropylene disposable beaker
- A 10ml Sarstedt urine collection syringe and extension tube containing a small amount of a preservative
- An instruction leaflet on how to use and fill the Sarstedt syringe
- Coloured labels
- Gloves
- A polythene bag to store the equipment in and can be used to discard the used equipment once the sample has been taken (optional).
9.5 Preparing the respondent
Explain to the respondent that you need a urine sample and why it is important. Explain the equipment to them and show them how to use the Sarstedt syringe. A demonstration consisting of a syringe and a beaker filled with water can be used for this purpose. The instruction leaflet, similar to Section 16.5.1, can be left with the respondent for easy reference while performing the urine collection in private, if required. Explain the procedure below to the respondent. Tell them that you need them to follow the procedure as carefully as possible.
9.5.1 Urine sample syringe instructions
9.6 Procedure
1. Respondents are to wash their hands with soap and water prior to voiding to avoid contaminating the sample with substances which may be on their hands. It is important that the inside of the urine collection beaker is not touched or allowed to come into contact with any part of the respondent's body, clothing or any external surfaces.
2. Ask the respondent to collect a mid flow sample of their urine in the disposable collection beaker.
3. Immediately after voiding they need to collect a sample of the urine by using the syringe as you have demonstrated to them and by following the instructions on the card. The collection of the urine sample needs to happen immediately after voiding to minimise specimen exposure to air.
4. Ask the respondent to wash the outside of the filled and sealed syringe and dry it using toilet roll, once the sample collection is complete.
5. If the respondent is unable to fill the syringe him/herself, or would rather not do so, you can do this for them. Emphasise that the sample needs to be taken from the sample straight away in order to minimise specimen exposure to air, so as soon as they have finished they need to bring it to you or leave it in the bathroom and notify you that the sample is ready. Please ensure that you are wearing gloves before attempting to fill the syringe for this respondent, you should wear gloves at all times when you come in contact with a urine sample.
6. Make sure that the plastic cap is securely sealed and the syringe plunger stalk snapped.
7. Label and package the sample according to the project specific instructions.
8. To dispose of the sample, pour the remaining urine in the toilet and throw the beaker and used equipment in the rubbish bin (if the respondent prefers, this can be put in a polythene bag first and then thrown in the rubbish bin).
10 24 Hour Urine
10.1 Introduction
A 24 hour urine sample is taken for the same reasons as presented in section 16.1, however it gives a more comprehensive overview of a respondent's nutrition and diet that cannot be obtained from a spot sample.
10.2 Exclusion criteria
All respondents with the following exceptions are able to give urine:
- Women who are pregnant
- Women who have their period are not excluded from giving a sample, however they may prefer to collect the urine on non period days
- To test for the completeness of a sample, respondents might be asked to take p-aminobenzoic acid (PABA) tablets. Some surveys will exclude respondents if they are unwilling or unable (due to medications they are currently taking or allergies) to take these tablets, other surveys will include them even if they cannot/will not take PABA. Please refer to project specific instructions for further information regarding this.
10.3 Consent
There is a separate consent form for the urine sample. This must be signed and dated by the respondent or by the parent/legal guardian in the case of respondents aged 15 years and below. Please make it clear to respondents that they will not receive results regarding their urine sample.
There are two nurse visits in the 24 hour urine protocol. The first requires the nurse to introduce and explain to the respondent how to collect the sample over the allocated 24 hour period. The second visit requires the nurse to take sub samples from the urine that the respondent has collected. Both of these visits are outlined below.
10.4 Nurse visit one
10.4.1 Equipment
To collect the urine sample the respondent will need:
- A 5 litre capacity screw cap (or jerry can) 24 hour container to serve as the collection container for urine. This contains a small amount of the preservative boric acid (powder).
- A 2 litre capacity screw cap collection container for collections made away from the home
- A 1 litre capacity plastic jug to be kept inside a re-sealable plastic bag when not used
- A funnel to be kept inside a re-sealable plastic bag when not used
- Plastic carrier bags for transporting the equipment away from home
- An aide memoire safety pin for the respondent to pin the under and outer garments together during the period of the collection to remind that the specimen of urine about to be passed should be collected.
- Three PABA tablets
What is PABA?
To test for the completeness of the urine sample, three p-aminobenzoic acid (PABA) tablets need to be taken by the respondent (also see section 17.2). PABA is an intermediate in the synthesis of folic acid in bacteria. It is consumed in small amounts as part of our usual diet and is found, for example, in liver, kidney, brewer's yeast, molasses, whole grains, mushrooms and spinach and can be made by intestinal bacteria. Larger amounts of PABA are found in some vitamin preparations.
Following ingestion, PABA is passively absorbed mainly from the small intestine. From there it enters the portal circulatory system. Some metabolism of PABA occurs in the liver and PABA and its metabolites are mainly excreted in the urine.
The PABA tablet is very small and best swallowed whole. It is not recommended to dissolve it in water or any other drink. If crushed between the teeth PABA tastes acidic and is unpleasant but there is no long lasting after taste.
Some medicines, such as paracetemol, interfere with the test used for PABA and PABA itself may interfere with the functioning of sulphonamide based antibiotics (however it will not cause the respondent direct harm if they are taking sulphonamide based antibiotics). People will be excluded from taking PABA if they are on sulphonamide based antibiotics. Other reasons why people are excluded from taking PABA include those who are allergic to vitamin preparations, hair dyes or sunscreen lotions and those who have severe lactose intolerance (this may not mean that they are excluded from giving a sample however, refer to project specific instructions).
10.4.2 Preparing the respondent
- Using CAPI, check the respondents eligibility to take part in the measurement
- Introduce and explain the 24 hour urine sample to the respondent, explaining the instructions for collection (sections 17.4.3 and 17.4.4) in detail.
- Provide the respondent with any written instructions and the equipment that they will need.
10.4.3 Procedure for taking PABA
Please explain this procedure to the respondents:
1. Each respondent will have three PABA tablets which are to be taken at evenly spaced intervals throughout the waking day.
2. The first tablet should be taken just before the urine collection starts, i.e. after the first morning void that is not collected.
3. The second PABA tablet should be taken around midday and the third and final tablet in the evening, preferably with supper.
4. If respondents forget to take the morning PABA tablet they should take it as soon as they remember and no later than midday. If respondents forget the midday tablet they should take it as soon as they remember and no later than 4pm. PABA should not be taken after 10pm because approximately 8 hours are needed for PABA clearance through the kidneys to ensure that all PABA is excreted by the time the respondent collects their final sample, the first morning void.
10.4.4 Respondent procedure for collecting the sample
Please explain this procedure to the respondent:
1. The 24 hour collection should start with the second morning void. The 24 hour period will last throughout the night and will include the first morning void on the following day e.g. if the respondent starts the 24 hour collection with the second morning void on a Tuesday then they stop collecting after their first morning void on Wednesday. During this time period all urine that is passed is to be collected.
2. Respondents are to pass urine into the 1 litre plastic jug. Using the funnel provided, the respondent needs to pour the urine into the 5 litre collection container. It needs to be stressed to respondents that it is crucial that they pass the urine into the 1 litre jug first as the 5 litre collection container contains the preservative boric acid which can cause skin irritations if they come in direct contact with it.
3. If, during the 24 hour period, the respondent is away from home, they have the option to take the 2 litre storage container to store the urine in until they get home. They must still pass the urine into the 1 litre jug and then use the funnel to transfer it into the 2 litre container. When respondents get home the urine collected in the 2 litre container must be transferred into the 5 litre container so that it can mix with the preservative.
4. Instruct the respondent to store the 5 litre collection container in a cool, dry place until it is collected.
10.5 Nurse visit two
10.5.1 Equipment
To collect sub samples of the 24 hour urine collection, the nurse will need:
- Electro Samson hand held scales for weighing the urine collection container
- 10ml Sarstedt Urine syringe (for instructions on use, refer to section 16.5.1), as many as is required for each survey e.g. the survey asks for five aliquots you will need five Sarstedt syringes per respondent.
- Disposable gloves
- Disposable work mat
- Disposable apron
10.5.2 How to use the scales
1. Attach handle to the scales. Start with the notch in the handle facing you, hook pointed upwards. Position the loop at the top of the scales in the notch until the loop is flat against the back of the notch. Lift the handle slightly so the scales are hanging from the hook of the handle.
2. Press the 'On/Zero' button to turn the scales on. The display will briefly show a row of 8s, followed by 0.00. Do not weigh anything until the display shows 0.00.
3. Holding the handle of the scales in the middle, as this will ensure the scales are vertical and provide a more accurate reading, place the handle of the 5L collection bottle onto the hook of the scales.
4. Allow the reading on the display to stabilise and press 'Hold' to lock in the weight shown on the display.
5. Press 'Off' to turn scales off.
6. Remove handle before storing the scales.
10.5.3 Nurse procedure for collecting the sub samples
1. Collect the urine sample in the 5 litre collection container from the respondent so that it can be weighed.
2. Assemble the scales, turn them on and wait for the display to read 0.00. Holding the handle in the middle, place the sample on the hook at the bottom of the scales. Place the 'Hold' button to lock in the reading on the display.
3. Record the weight in CAPI and on the despatch sheet. The weight must be recorded on the despatch sheet as it helps the lab to identify if the sample is complete or not.
4. Remove the sample and reset the display to zero by pressing 'On/Zero'. Weigh the sample for a second time according to steps 2 and 3.
5. If the two recorded weights differ by more than 0.2kg, weigh the sample for a third time and record this reading in CAPI and on the despatch note.
6. After the container has been weighed, invert it and rotate the sample 20 times to ensure that the urine is thoroughly mixed.
7. Lay out the disposable working mat and, wearing gloves and the apron, transfer some of the urine from the 5 litre collection container into the 1 litre jug.
8. Still wearing gloves and apron, use the Sarstedt syringe(s) to collect as many sub samples from the jug as required (specified in the project specific instructions). For instruction on how to use the Sarstedt syringe refer to section 16.5.1.
9. Label the sub samples as you take them and prepare them for despatch as described in the project specific instructions.
10. After collecting the sub samples, dispose of the rest of the urine sample in the 5 litre collection container and what is remaining in the 1 litre jug by pouring it in the toilet (you or the respondent can do this).
11. Rinse any containers that have been used and ask the respondent to dispose of them with the household waste. If the respondent is unable to do this, pack the used equipment away and take it away for disposal elsewhere.
12. Some surveys will also require the respondent to complete a sheet which records if any urine samples were missed during the 24 hour period. If this is the case, you will need to go through this sheet with the respondent to check that it is complete.
11 Blood Sampling (non fasting and fasting)
The protocol for taking blood samples set out below is written in accordance with the Clinical Procedure Guidelines: Venepuncture. All nurses are to read this document before carrying out any venepuncture procedure.
11.1 Introduction
Blood samples are taken from respondents as they provide information on various analytes, giving a detailed description of the health of an individual. They are integral to the research NatCen undertakes as they give a comprehensive representation of the health of the population that cannot be obtained from any other source.
Each study is interested in different analytes and the ones to be analysed for each survey can be found in the project specific instructions. Table 8 shows information regarding the different analytes and what they measure.
Table 8 Blood analytes
| Analyte | What it measures |
|---|---|
| Apolipoprotein E | This is involved in the transport of cholesterol and plays a protective role. |
| C-reactive protein | The level of C-reactive protein in the blood gives information on inflammatory activity in the body, and it is also associated with risk of heart disease. |
| Creatinine | Creatinine is a waste product of protein metabolism and is used in the assessment of kidney function. An abnormally high level of creatinine is found in individuals with kidney insufficiency and failure. |
| Fibrinogen | Fibrinogen is a major determinant of platelet aggregation and blood viscosity. It is a major independent risk factor for cardiovascular disease (CVD) and may interact with lipids to promote CVD risk. |
| Folic acid (folate) | Folic acid is a B vitamin. It is used in the body to make new cells and helps to prevent anaemia and birth defects of the brain and spinal cord. |
| Genetics | Genetic factors are associated with some common diseases such as diabetes and heart disease and relate to general biological aspects of the ageing process. |
| Glycated Haemoglobin | Glycated haemoglobin is a measure of the respondent's longer term glycaemic status. High levels are indicative of poor control of, or undiagnosed diabetes. |
| Haemoglobin, ferritin and transferrin receptors | Haemoglobin carries oxygen around the body to cells. It is too low in people with anaemia. Ferritin and transferrin receptors are indicators of iron stores: ferritin is reduced and soluble and transferrin receptor levels are increased if there is iron-deficiency, e.g. an inadequate iron supply in the diet. |
| Mean corpuscular (cell) volume | A measure of the average red blood cell volume. Mainly used in the classification of anaemia. |
| Minerals Se and Zn | Selenium (Se) is a component of some of the enzymes which protect the body against damage due to oxidation. It is also necessary for the use of iodine in thyroid hormone production and for immune system function. Zinc (Zn) is present in many enzymes and is essential for cell division and therefore growth and tissue repair. It is also necessary for normal reproductive development. Zinc is required for the functioning of the immune system and in the structure and function of the skin and thus wound healing. |
| Serum Albumin | Albumin is a blood plasma protein which is essential in maintaining fluid pressure in the body. It also plays a role in transporting fatty acids around the body. It is analysed in blood samples as an indicator of liver disease and kidney disorders. |
| Total, LDL and HDL cholesterol | Total cholesterol and LDL cholesterol increase the risk of atherosclerosis ('furring' of the arteries). Raised levels are associated with higher risks of heart attacks, while HDL cholesterol has a protective role. |
| Triglycerides | Together with total and HDL cholesterol, they provide a lipid (fat) profile which can give information on the risk of CVD. |
| Vitamin A and carotenoids | Vitamin A is essential to the normal structure and function of the skin and mucous membranes. It is also required for cell differentiation and therefore normal growth and development, and for normal vision and the immune system. Some carotenoids have provitamin A activity, thus acting as antioxidants to protect cells against oxidative damage. |
| Vitamin B1 (thiamin) | Vitamin B1 is required for energy production and carbohydrate metabolism. It is also involved in the normal functioning of the nervous system and the heart. |
| Vitamin B2 (riboflavin) | Vitamin B2 is needed for the release of energy from fats, carbohydrates and protein and the production of red blood cells. It is also needed for the normal structure and function of the mucous membranes and skin. |
| Vitamin B6 (pyridoxine) | Vitamin B6 is essential for the metabolism of protein. It is also involved in iron metabolism and transport. |
| Vitamin B12 (cyanocobalamin) | Vitamin B12 is required to make new cells as well as for normal blood formation and function. It is also needed for the normal structure and function of nerves. Dietary intake is exclusively from animal sources, e.g. eggs, milk, meat and fortified foods. |
| Vitamin C | Vitamin C is required for normal structure and function of skin, cartilage and bone as it is involved in the production of collagen, the protein in connective tissue. Thus it is involved in the healing process as well as the normal structure and function of blood vessels and neurological function. Vitamin C also contributes to the absorption of iron from some foods, in particular plant foods. |
| Vitamin D | Vitamin D is formed by the action of ultra violet light on the skin. This is the most important source as few foods contain significant amounts of vitamin D, e.g. eggs, oily fish and meat. Vitamin D undergoes changes in both the liver and the kidneys before working as a hormone in controlling the amount of calcium absorbed by the intestine. It is also essential for the absorption of phosphorous and for normal bone mineralization and structure. Vitamin D is also involved in the process of cell division in many other body tissues. |
| Vitamin E | Vitamin E is a group of compounds called tocopherols, of which alpha tocopherols is the most active. It acts as an antioxidant and is required to protect cells against oxidative damage by free radicals. |
| White blood cells | White blood cells are made by bone marrow and help the body fight infection and other diseases. There are various types of white blood cells. |
The blood will not be tested for any viruses, such as HIV (AIDS).
11.2 Exclusion criteria
- All respondents with the following exceptions are eligible to give blood:
- Pregnant women
- Respondents who are HIV positive or who have hepatitis B or C (see section 11.8.6)
- People with clotting or bleeding disorder
- By clotting or bleeding disorders we mean conditions such as haemophilia and low platelets, i.e. thrombocytopenia. There are many different types of bleeding/clotting disorders but they are all quite rare. The reason these respondents are excluded from blood sampling is that:
a) the integrity of their veins is extremely precious
b) we do not wish to cause prolonged blood loss
For the purposes of blood sampling, those who have had, for example, a past history of thrombophlebitis, a deep venous thrombosis, a stroke caused by a clot, a myocardial infarction or an embolus are NOT considered to have clotting disorders. - Those aged 16 and over who have had a fit (e.g. epileptic fit or convulsion) in the last 5 years should not be asked to provide a blood sample. Children, those aged 15 and under, who have ever had a fit should not be asked to provide a blood sample, even if the fit occurred some years ago.
- People who are currently on anticoagulant drugs, e.g. Warfarin therapy
- Check if the respondent has a clotting or bleeding disorder or is on anticoagulant drugs, such as Warfarin, and record this in CAPI. These are very uncommon. If you find someone with these problems, do not attempt to take blood, even if the disorder is controlled.
Aspirin therapy is not a contraindication to blood sampling. If you are uncertain whether a condition constitutes a contraindication to blood sampling, the Survey Doctor will be happy to answer your queries. - Adults who are not willing or able to give their consent in writing or children whose parent/guardian is unwilling or unable to give consent in writing.
Additional exclusions for fasting blood:
- People who have eaten or drunk something (except water) in the last eight hours
- Children under the age of 4 will not be asked to fast.
Insulin-dependent diabetic informants who had to eat in the last 8 hours before their insulin injection are eligible to give a fasting blood sample but you should make a note in CAPI. They should also take breakfast as soon as possible after blood sampling.
11.3 Consent
As blood sampling is an invasive procedure we need to ensure that fully informed written consent is obtained from each respondent. Information on what they are consenting to is mainly given in the Stage 2 leaflet, and the respondent confirms that they have been provided with this information on the consent form.
The leaflet 'Giving a blood sample' also provides useful information about the risks around giving a sample and after-care. This is information that you should be giving verbally in any case, and you therefore do not need to ensure that the respondent has read this leaflet in advance as long as you make sure you have covered all the points yourself.
On no account should you ever take blood before you have obtained written consent to do so from the respondent.
There are three further written consents we wish to obtain in most surveys in respect to blood sampling
a. Consent to send the results to the GP
b. Consent to store a small amount of the blood
c. Consent to send the results to the respondent
You should seek to obtain all these consents before you take any blood.
Small quantities of blood are being stored in special freezers for further analysis in the future. Future analysis will definitely not involve tests for viruses (e.g. HIV (AIDS) test). Your survey specific instructions will specify whether or not there may be any genetic testing. Any future analysis will be unlinked which means that the researcher doing the analysis will not be able to link it back to the respondent. Respondents will therefore not receive the results of any tests done on their blood in the future.
The questions on the CAPI questionnaire will take you step by step through all the procedures for obtaining consents. Make sure you follow these carefully - recording consent codes as instructed and giving reasons for refusals, if applicable.
In summary:
- Ask the respondent if they would be willing to have a blood sample taken. Try to reassure respondents about the process, and be prepared to answer their concerns. You will need to explain the importance of written consent to the respondent
- Obtain written consents on the appropriate consent form. Remember to enter their name at the head of this form before asking the respondent to sign.
- Remember to enter your name in the qualified nurse space provided on each form.
- Check that you have circled the correct consent codes on the front of the consent booklet.
11.4 Equipment
The equipment required is listed on page 8 of the Clinical Practice Guideline for Venepuncture (CPG). Any additional equipment, specific to a project, will be listed in the project instructions.
11.5 Preparing the respondent
Protocol on preparing the respondent can be found in the CPG on page 8.
Further points to note include:
- Ask the respondent to remove any jackets, thick garments and/or roll their sleeves up.
- Instruct the respondent to remain as still as possible
11.6 Procedure
The procedure for taking the blood sample can be found in the CPG pages 9-12. This procedure is to be followed. It is to be used in conjunction with CAPI which will guide you through the blood sampling process.
Some surveys will use a different system for taking blood samples e.g. the monovette system. Refer to project specific instructions for how to use the specific equipment and take the blood sample. In all surveys the CPG should be referred to for guidelines on evidence based best practice.
Additional points to note include:
- Ametop Gel®, a local anaesthetic, will only be used in some projects (refer to project instructions). There is a CPG on use of Ametop which must be followed.
- The vacutainers should be filled to capacity in turn and inverted gently on removal to ensure complete mixing of blood and preservatives (in some surveys not all tubes will need to be inverted, refer to project specific instructions).
IMPORTANT WARNING
Never re-sheath the needle after each use
Do not allow the disposal box to become overfull as this can present a potential hazard
11.7 Labelling & packaging the sample(s)
Label the tubes as you take the blood. Refer to project specific instructions for further guidance about labelling and packaging the blood samples.
It cannot be stressed enough the importance of correctly labelling each tube with the correct serial number for the person from whom the blood was obtained. Apart from the risk of matching up the blood analyses to the wrong person's data, we will be sending the GP the wrong results. Imagine the implications of an abnormal result being reported to the wrong respondent.
11.8 Other important points
11.8.1 'Giving a blood sample' leaflet
We need to be sure that each respondent is left with information about giving a blood sample, including information about who to contact should they experience any side effects as a result of the blood sample.
To provide them with this information, leave the respondent with the leaflet 'Giving a blood sample'. The leaflet includes information on any possible side effects they may experience such as pain and bruising, and how to care for the puncture site. It is also a useful leaflet to leave behind to reassure the friends and family of the respondent of the procedure used should they have any concerns after your visit.
There are two versions of this leaflet, depending on whether ametop gel will be offered. Your survey specific instructions will tell you which one to use.
11.8.2 Venupuncture check questions
Always complete the Venepuncture checklist on CAPI for every respondent from whom you attempt to take blood. This shows that you have followed the correct procedure, and noted, where applicable, any abnormalities, and the action you took. The checklist is usually towards the end of the CAPI.
Please remember to check the respondent just before you leave and note any changes in their physical appearance in CAPI.
11.8.3 Fainting respondents
If a respondent looks or feels faint during the venepuncture procedure, it should be discontinued. The respondent should be asked to lie down with feet elevated.
If they agree for the test to be continued after a suitable length of time, the procedure should be performed with the respondent lying down and the circumstances should be recorded in CAPI. It is acceptable for the respondent to discontinue the procedure but agree to give the blood sample at a later time.
Remain with the respondent until they feel able to slowly move to a sitting position and until they are happy for you to leave them. Ensure you submit a Special Report Form to the Operations Standards Co-ordinator detailing what happened and how the respondent appeared when leaving.
11.8.4 Handling & disposal of needles and other materials
Safe disposal of needles is required to control the risk of injury from the disposed sharps. Without the safe disposal of needles there is an increased risk of needle stick injuries and/or psychological trauma due to fear of potential infection.
Precautions
- Wear gloves at all times when performing the venepuncture procedure
- Do not carry sharps unnecessarily
- Handling must be kept to a minimum
- Needles must not be passed directly from hand to hand
- Needles must not be bent or broken prior to use
- Needles should not be resheathed by hand
- Never lay sharps down on beds or work surfaces, or leave lying amongst paper towels or linen
- Sharps should be disposed of at the point of use
- Never hand sharps to anyone
Disposal
Do's:
- Always wear gloves when performing venepuncture procedure
- Bins should conform to British Standard 7320
- Sharps must always be disposed of in the approved yellow 'sharps bins'
- Sharp bin should be available beside you before opening and using the sharp
- Ensure that the lid is secure
- Dispose of the sharp bin when the manufacturer's marked line has been reached or when it is three quarters full
- Carry sharp containers by the handle
- Dispose of the sharp in the bin immediately after use
- Check to ensure that the bin lid is securely attached to the base and that the flap has been securely closed and sealed
Don'ts:
- Overfill sharps bins
- Fill sharps containers above the manufacturer's marked line
- Dispose of sharps with other clinical waste
- Place used sharps containers in yellow bags for disposal
- Put your hands into sharps bins
- Never return any used sharps bins by post or courier to the Operations Department or other member of the freelance nurse or interviewer panel
Place the used needles and the vacutainer holders in the sharps box and put gloves etc in the self-seal disposal bag. The needle disposable box should be taken to your local hospital or GP practice for incineration. Telephone them beforehand, if you are not sure where to go. If you cannot find a place to dispose of the sharps bin, contact your nurse supervisor who will be able to give you information on appropriate places.
The sealed bag containing gloves etc can be disposed of with household waste as long as it does not have any items in it that are contaminated by blood.
11.8.5 Needle stick injuries
The following information is based on guidelines from the Department of Health, immediately following exposure.
First Aid
- Encourage wound to bleed.
- Do not suck.
- Wash liberally with soap and water without scrubbing, do not use antiseptics and skin washes.
- Dry and apply waterproof dressing.
- Exposed mucous membrane and conjunctivae should be irrigated copiously with water.
Following the above procedure it is recommended that the nurse attend a nearby accident and emergency department to ensure immediate current needle stick injury assessment/ treatment.
Please note that you should not take any further action in the respondent's home; any further procedures which might be necessary (such as taking a sample of the respondent's blood) would be carried out by somebody else.
Report
- Incident to be reported as soon as possible to Nurse Supervisor, who will report the incident to the Survey Doctor.
- Special Report form to be completed and sent to Operations Standards Co-ordinator at Brentwood.
As soon as the nurse supervisor hears, she will ensure that the nurse is offered appropriate advice and support.
11.8.6 Respondents who are HIV or Hepatitis B positive
If a respondent volunteers that they are HIV, Hepatitis B or Hepatitis C positive, do not take a blood sample. Record this as the reason in the CAPI. You should never, of course, seek this information.
11.9 Respondent feedback
Results from some blood tests (though not necessarily all) can be sent to the respondent. If the respondent gives written consent for the results of their blood sample to be sent to their GP then they are able to get feedback on the results.
Contact
Email: Julie Ramsay
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