Metal hypersensitivity screening among frontline healthcare workers—A descriptive study

Abstract

Aims and objectives The study aims were to (a) assess allergy screening practices, (b) determine the awareness of metal hypersensitivity among frontline healthcare workers and (c) examine perceived barriers to implementing metal hypersensitivity screening into clinical practice. Background Adverse device‐related events, such as hypersensitivity to metals, are well documented in the literature. Hypersensitivity to metal is a type IV T‐cell‐mediated reaction that can occur after cardiac, orthopaedic, dental, gynaecological and neurosurgical procedures where a device with metal components is implanted into the body. Patients with hypersensitivity to metal are likely to experience delayed healing, implant failure and stent restenosis. Identifying patients with a history of metal hypersensitivity reaction could mitigate the risk of poor outcomes following device implant. Yet in clinical practice, healthcare workers do not routinely ask about the history of metal hypersensitivity when documenting allergies. The existing literature does not report why this is not included in allergy assessment. Design Following the STROBE checklist, a cross‐sectional, descriptive study was conducted. Methods Frontline healthcare workers were recruited using professional contacts and social online media to complete an online questionnaire. Quantitative data were summarised descriptively while thematic analysis was used to examine barriers to implementation. Results Three hundred forty‐five participants from 14 countries completed the questionnaire, with the majority (187/54%) practicing in Canada, in general medicine and intensive care units. Ninety per cent of the participants did not routinely ask about metal hypersensitivity when evaluating allergy history. Of the respondents, 86% were unaware of the association between metal hypersensitivity and poor patient outcomes. After presented with the evidence, 81% indicated they were likely or very likely to incorporate the evidence into their clinical practice. Common themes about barriers to implementing were ‘Standards of Practice’, ‘Knowledge’ and ‘Futility of Screening’. Conclusion The findings suggest lack of awareness as the main reason for not including metal in routine allergy assessment.

The lived experiences of metal hypersensitivity

“…It is unclear why the risk of metal hypersensitivity was not disclosed during the consenting process to any of the 16 participants, but it might be due to the controversy in the literature about whether clinicians are convinced about the evidence in this area. 8 Hallock et al 37 demonstrated that, despite knowing about metal hypersensitivity, few orthopedic surgeons screened for it. 38 In the literature, metal hypersensitivity is noted as a “rare” effect, 39 although the epidemiological data in this area is incomplete because the condition is underreported and difficult to diagnose.…”

“…We discussed the findings of our previous studies. 8,29 The patient partner noted that the enablers and barriers identified by the healthcare workers about screening for hypersensitivity reaction to metal 8 did not consider the issue of informed consent. This discussion led to the overarching research question: “Among patients with metal hypersensitivity, what information would have helped them make an informed decision about metal implants?” We used interpretative phenomenology because it allows us to use the informants’ experiences as well as integrating our own experiences as healthcare providers to patients requiring surgery and those with hypersensitivity reactions.…”

“…nickel, cobalt, and gold) can also have negative impacts on health. 8 These metals are considered inert due to their relative resistance to corrosion and presumed biocompatibility. 9 However, evidence suggests that in the body, metals corrode through slow and inevitable processes, such as mechanical wear and tear, physiochemical corrosion, and cellular-gated mechanisms.…”

Hypersensitivity Reaction to Metal: A Bibliometric Study

“…Only one study was conducted by nurse researchers, which contributes to the lack of explicit knowledge among nurses. Screening for hypersensitivities in clinical practice is an activity that nurses perform routinely, thus educating them about metal hypersensitivity can help identify gaps in clinical practice, reduce risks to patient health, and increase the success of the implant ( Dordunoo et al, 2021 ; Kumar et al, 2016 ). We emphasize the importance of expanding investments in nursing research to enhance the detection and clinical management of metal hypersensitivity.…”

“…They contribute critical assessments (e.g., allergy assessment and patient education) that drive medical decision-making throughout the pre-, intra-, and postoperative phases. However, there is evidence that nurses lack implicit and explicit knowledge of hypersensitivity reactions to metal components in implantable devices ( Dordunoo et al., 2021 ). How this evidence to practice gap in nursing affects patient outcomes is unknown but may contribute to the underreporting of metal hypersensitivity.…”