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PubMed1999

Education of the trauma team: video evaluation of the compliance with universal barrier precautions in resuscitation.

OBJECTIVE: To assess the effectiveness of an educational symposium designed to improve compliance with universal barrier precautions by the use of video analysis of resuscitations. DESIGN: Prospective single blind analysis of data. SETTING: Hospital Trauma Unit, Johannesburg, South Africa. SUBJECTS: 100 severely injured patients who presented to the emergency room, divided into two study periods. INTERVENTIONS: An educational symposium held between the study periods, which focused on universal barrier precautions and the risk of occupational transmission of HIV. MAIN OUTCOME MEASURES: Compliance with items of universal precautions; mechanism; Injury Severity Score and Revised Trauma Score. RESULTS: There was a significant improvement in compliance from 48% to 74% after the symposium (p = 0.007), with specific improvement in the wearing of masks and visors. Initially there was poor compliance with universal precautions in severely injured patients, which significantly improved to 83% compliance (p = 0.0004). CONCLUSION: Video analysis of resuscitations is an effective audit and educational tool that allows analysis of compliance with protocol. The education symposium was effective in altering attitudes and behaviour towards universal barrier precautions.

Education, Medical, Continuing↗
PubMed1997

Human immunodeficiency virus infection and hepatitis: biosafety in radiology.

Radiologists frequently perform invasive diagnostic and therapeutic procedures involving needles and/or vascular access, and often they do so in darkened rooms. Therefore, they are at risk of exposure to blood-borne pathogens. The risk of HIV infection with a single sharp injury is low (0.3%), and on average 99.7% of exposures will not result in infection. However, this seroconversion rate is increased when a high volume of blood or a high concentration of virus is inoculated, and it is decreased by 79% when postexposure prophylaxis is used. An estimated 800,000 needle-stick injuries and other injuries from sharp objects to health care workers occur annually in the United States (25). Approximately 16,000 of these involve HIV-contaminated blood, and even more are contaminated with HBV or HCV (46). Needle-stick injury therefore poses the single greatest risk to health care workers regarding occupational transmission of HIV. Because most patients in the radiology department have an unknown HIV or hepatitis serostatus, all patients should be regarded as potentially infectious, and precautions should be universal. In fact, the 1991 OSHA ruling made compliance with the CDC Universal Precautions Guidelines the enforceable national standard. Real-time oral communication among all members of the radiology team and scrupulous attention to safe technique are absolutely essential. Radiologists are not in agreement regarding the use of precautions against injury with a sharp object and splashing (47-50). Many have adapted some of their habits to conform well to the CDC and OSHA guidelines regarding universal precautions, but some remain skeptical regarding the risk of exposure to themselves. Consequently, in some areas resistance to the above recommendations persists. However, the data to date provide a compelling argument for protection against occupational exposure to blood either by percutaneous sharp injury or splashing on mucous membranes or interrupted skin. A number of resources were made available in early 1997 for easy access to the most current data regarding occupational transmission of HIV or hepatitis. For instance, the CDC has a World Wide Web site (http://www.cdc.gov) and a facsimile information service through the Hospital Infections Program directory (telephone 404-332-4565). Also, the National AIDS Clearinghouse can be reached by telephone (800-458-5231), as can the HIV/AIDS Treatment Information Service (800-448-0440). The postexposure prophylaxis protocol used at the University of California, San Francisco, can be reviewed by visiting its World Wide Web site at http://epi-center.ucsf.edu. And up-to-date information is available to both Veterans Administration and other health care staff worldwide by J. Michael Howe, MSLS, of the AIDS Information Center, a service of the VA HIV/AIDS National Training Program, located at the Veterans Administration Medical Center, San Francisco, University of California, San Francisco (hivinfo@itsa.ucsf.edu).

Blood-Borne Pathogens↗
PubMed2003

Study on incidence of needle stick injury and factors associated with this problem among medical students.

Medical students face the threat of needle stick injury with the consequent risk of acquiring blood-borne infection by pathogens such as HIV, Hepatitis B and Hepatitis C while performing their clinical activities in the hospitals. A cross-sectional study was conducted among 417 final year medical students from Universiti Kebangsaan Malaysia (UKM), University Malaya (UM) and Universiti Putra Malaysia (UPM). The aims of the study were to determine the incidence of cases and episodes of needle stick injury among them in the past year. This study was also done to find out the factors that might be associated with the occurrence of this problem. The factors were sociodemographic factors, duration of exposure, level of knowledge of blood-borne diseases and Universal Precaution, perception of risk of blood-borne diseases and level of practice of Universal Precaution. The incidence of needle stick injury among medical students was 14.1% (59 cases). The total number of episodes of needle stick injury was 87 and the incidence of episodes among respondents was high i.e. 20.9%. The highest incidence of episodes of needle stick injury occurred in Obstetric & Gynaecology postings, followed by Medicine and Surgery. For clinical procedures, venepuncture had the highest incidence followed by setting up drips and giving parenteral injections. The results showed the students who had needle stick injury (cases) had lower scores in the practice of Universal Precautions than non-cases (p<0.05). There was a significant association between the level of practice of Universal Precautions and the number of episodes of needle stick injury, i.e. the higher the score for the practice of Universal Precautions, the lower the number of episodes (beta=-2.03 x 10(-2), p<0.05). This study showed that medical students are at risk of needle stick injury and blood-borne infections during their clinical activities while performing procedures on patients especially for those who were poor at practising Universal Precautions. Therefore some preventive measures should be taken by the management of the universities and medical students to avoid the occurrence of these problems.

Adult↗
PubMed2006

Self-reported infection control practices and perceptions of HIV/AIDS risk amongst emergency department nurses in Botswana.

This descriptive exploratory study investigated the reported practices and perceptions of emergency nurses related to infection control in the context of the Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome (HIV/AIDS) pandemic in Botswana. Quantitative and qualitative data were collected using a self-administered questionnaire. Forty questionnaires were distributed to nurses with emergency department experience in Botswana, with a response rate of 55% (n = 22). Quantitative data were analysed using descriptive statistics while qualitative data were subjected to thematic and content analysis. The majority of respondents reported compliance with universal precautions at the hospital emergency department. However, qualitative data highlighted resource constraints that may hinder compliance with universal precautions such as a lack of appropriate facilities, a shortage of equipment and materials, inadequate staffing and absence of sustainable in-service education programs. Further, the reported compliance with Universal Precautions had not removed the fear of exposure to HIV/AIDS and perceived risk of transmission to family. The authors recommend in-service education and practice initiatives to promote sustainable compliance with universal precautions and realistic risk perception among nurses. Further research is required to evaluate nurses' compliance with universal precautions in developing countries using observational methods or in-depth interviews. This would enable exploration of nurses' actions regarding compliance with universal precautions.

Blood-Borne Pathogens↗
PubMed2000

'Everyone is scared of it inside so they start being a bit irrational': HIV/AIDS education within midwifery.

OBJECTIVE: To describe views put forward by student midwives and lecturers about education on the human immunodeficiency virus (HIV). DESIGN: Multi-method. Participants completed a questionnaire containing open and closed questions, and took part in focus-group discussions. SETTING: All institutions providing pre-registration midwifery education in the South Thames Region of the UK. PARTICIPANTS: Students (n = 336) and lecturers of midwifery (n = 51). MEASUREMENTS: Closed questions from the questionnaire were analysed for frequency distributions, intra-group cross tabulations of selected variables and inter-group comparisons. Open questions from the questionnaire and transcripts of focus group discussions were investigated using thematic analysis and constant comparative techniques. FINDINGS: Recent structural changes within midwifery education had increased lecturers' workloads. Curriculum pressures led to lecturers making assumptions about students' existing levels of knowledge, particularly regarding universal precautions, although both lecturers' and students' weakest areas of knowledge in relation to HIV were those specifically related to midwifery. The perceived risk of occupational infection was relatively high and linked to individual perceptions of the virus. However, neither anxiety nor knowledge levels were reflected by consistent use of universal precautions. KEY CONCLUSIONS: Knowledge obtained within midwifery education may be difficult to translate into clinical practice. Underlying issues such as perceptions of the virus and orthodoxies of midwifery practice inhibited students from using universal precautions, even when they recognised that consistent use of universal precautions could help reduce the risk of occupational transmission of HIV. The social construction of HIV and ideological constructions of midwifery practice, such as the client/midwife relationship, may be sufficiently powerful to have an effect on clinical practice and reduce the use of universal precautions. IMPLICATIONS FOR PRACTICE: Emphasising the place of clinical knowledge within a broader issue-based context may help lecturers and students address the challenge of implementing safe, non-discriminatory use of universal precautions.

Acquired Immunodeficiency Syndrome↗
PubMed1991

Does knowledge of human immunodeficiency virus infection decrease the frequency of occupational exposure to blood?

Implementation of universal precautions is advocated to prevent exposure to human immunodeficiency virus (HIV) and other bloodborne pathogens. Critics of this approach argue that additional benefit can be derived by identifying and labeling patients known to be infected. Knowledge of HIV infection status could result in a reduced exposure rate by two mechanisms: (a) by motivating improved compliance with universal precautions, or (b) by allowing changes in procedure or technique not feasible for all patients. Compliance with universal precautions may reduce the frequency of some types of exposure but has not been associated with a reduction in the frequency of needlestick exposures in several studies. Despite the perception by some health care workers that awareness of HIV status will result in improved safety, no objective data have demonstrated a direct benefit from testing or identifying infected patients. Health care workers who recognize the presence of occupational HIV risk are apt to be motivated to practice universal infection control precautions and experience little additional benefit from testing individual patients. Health care workers in low prevalence areas may experience less incentive to comply routinely with universal precautions and selectively may be motivated when HIV infection is diagnosed in individual patients. However, routine testing in areas of low HIV prevalence is not likely to be cost effective. Until further research clarifies the efficacy and costs of universal precautions or HIV testing, infection control standards should maximize local autonomy in developing rational policies consistent with institutional needs.

HIV Infections↗
PubMedDate not supplied

Preventing transmission of blood-borne pathogens to health care workers.

Health care workers are exposed to blood-borne pathogens, mainly the human immunodeficiency virus, hepatitis B virus and hepatitis C virus. Infection by these viruses leads to chronic or fatal illnesses which are expensive and difficult to treat. Individuals who harbour these viruses may be asymptomatic and hence all patients should be assumed to harbour a blood-borne pathogen. All health care workers should take adequate precautions (a set of guidelines termed 'universal precautions'). Methods of preventing transmission of blood-borne pathogens include vaccination against hepatitis B virus, following universal precautions and taking adequate post-exposure prophylaxis.

Blood-Borne Pathogens↗
PubMed2004

Standard precautions and post exposure prophylaxis for preventing infections.

In health care set up, risk of acquiring infection by both patients and health care worker (HCW) from each other is fairly high. Despite progress, hospital acquired infections (HAI) are a problem in both developed and developing countries and are an important cause of death. Many different microbes cause HAI in both patients and HCW; these include various commensals, pathogenic bacteria, viruses, parasites, and fungi. Among these HIV, hepatitis B, and hepatitis C are of major significance to HCW. 'Standard precautions' have now replaced the term 'universal precautions', and are designed to reduce the risk of transmission of microorganisms in health care set-up from both recognized and unrecognized sources. Ultimate aim is to reduce the risk of disease transmission in the healthcare setting, both to the patient and the provider, and thus reduce morbidity. This applies to all patients, regardless of their diagnosis and expands the coverage of universal precautions by recognizing that any body fluid may contain contagious and harmful microorganisms. This article reviews the standard precautions and discusses current guidelines on post exposure prophylaxis (PEP).

Algorithms↗
PubMed1998

[The nursing team and occupational accidents with potentially contaminated material in the era of HIV].

This investigation was carried out in order to: identify the occurrence of professional accidents with perforate cutting potentially contaminated material among nurses and nursing auxiliaries that work in a general teaching hospital in the interior of the state of São Paulo. The other objectives were: to associate the occurrence of accident with the professional category and period of work; to identify the type of perforate cutting material most involved in accidents, to identify the attitudes taken by the person accidented. The data were collected on individual interview based on a structured formulary in which the following information was registered: the probable reason of accident, how long the professional has been working on such function, the material involved in the accident, the actions taken after the accident. It was evidenced that the Standard Precautions or the Universal Precautions as they used used to be nominated are not being used as they should be. Such attitude brings risks to the nursing team. We think that this team needs specific orientations through continuing education concerning the theme.

Accidents, Occupational↗
PubMed1994

MRSA in the operating department.

In recent years, infection control in the operating department has focused on the concept of universal precautions. This allows protection for both patients and staff in relation to blood borne pathogens. Recent research, however, suggests that the introduction of universal precautions could lead to an increase in the transmission of other pathogens, for example, Methicillin Resistant Staphylococcus Aureus (MRSA). This article aims to provide a brief overview of the universal precautions, followed by an in-depth consideration of MRSA, its history, incidence, transmission, effect and implications for both patients and staff in the operating department.

Cross Infection↗
PubMedDate not supplied

Need for HIV education among public health personnel in Michigan.

Knowledge and attitudes related to human immunodeficiency virus (HIV) and the use of the universal precautions recommended by the Centers for Disease Control and Prevention were investigated among 807 State and 2,797 local public health personnel in Michigan in September 1989. Survey results indicated that the majority of respondents were well-informed regarding the major routes of HIV transmission, but many respondents hold misconceptions regarding nonviable routes of transmission and about policies on HIV counseling and testing. Respondents reporting occupational exposure to blood or semen reported inconsistent use of universal precautions. Most respondents believed in providing the same quality of care for those with HIV infection as for noninfected persons. However, 32.4 percent believed that they should have the right to refuse treatment, and 9.4 percent reported that they would not be willing to provide routine public health services to an HIV-infected client. The results of this research suggest that in Michigan, public health personnel are in need of HIV education that focuses on the correction of misconceptions about HIV transmission, counseling, and testing policies; the development of appropriate attitudes toward persons infected with HIV; and the appropriate use of universal precautions. Findings also suggest that inadequate protective equipment is an important barrier to the consistent use of universal precautions.

Adult↗
PubMed1992

Entering first-year residents' experiences and knowledge of infection control of hepatitis B and HIV, at five university-affiliated hospitals.

In 1990, the authors surveyed 149 entering first-year residents at five university-affiliated hospitals concerning the residents' experiences and knowledge of infection control. Sixty residents (40%) had experienced a needlestick injury during medical school, but only 35 of these residents (58%) had reported the mishap. One hundred thirty-nine residents (93%) had received the hepatitis B vaccine. Of those 60 who had experienced a needlestick injury, 57 (95%) had received the vaccine. Of the 149 residents, 111 (74%) reported having received instructions in universal precautions, as advocated by the Centers for Disease Control. There was a trend for residents who had received the vaccine also to have been instructed in universal precautions. Regarding the residents' knowledge of infection control, there was no statistically significant difference between the responses of those who had been instructed in universal precautions and those who had not. The authors conclude that students are at risk for needlestick injuries; however, underreporting is frequent.

Educational Measurement↗
PubMed1998

Infection control and HIV-related discrimination and anxiety. Glove use during venipuncture.

OBJECTIVE: Reports into HIV-related discrimination reveal continuing concerns about the behaviour of health care workers, particularly with reference to practices such as excessive or selective infection control. This study examines whether the selective adoption of an infection control procedure (using gloves during venipuncture) is related to discriminatory attitudes, anxiety about HIV/AIDS and the degree of contact with HIV-infected patients. METHOD: In 1993 and 1994, 451 general practitioners (GPs) were surveyed in six of the 12 New South Wales Health Areas and Regions. The sample included 49 anti-retroviral prescribers. GPs were presented with six patient scenarios and asked with whom they would use gloves during venipuncture. RESULTS: 41.9% of GPs reported that they would selectively use gloves, and generally targeted the homosexual patient only, or combinations of patients that included the homosexual man. GPs revealed poor compliance with universal precautions, as only 37.5% reported that they would use gloves with all of the six patients. Intended glove use was significantly related to HIV-related discrimination (p < 0.0001) and anxiety about HIV/AIDS (p < 0.0001). GPs who selectively chose to use gloves had the highest discrimination and anxiety scores; GPs who chose not to use gloves with any of the patients had the lowest discrimination and anxiety scores, and were more likely to work in HIV medicine. Except for differences in Health Area, this study did not identify any factors that helped to explain which GPs consistently followed universal precautions. CONCLUSION: This study demonstrates that selective infection control is related to discriminatory attitudes and anxiety about HIV/AIDS. GPs can avoid a discriminatory practice by consistently following universal precautions. More research is needed to identify the factors that promote good infection control practices.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

EMTs' knowledge regarding transmission of infectious disease.

OBJECTIVE: To describe EMTs' knowledge of CDC universal precaution guidelines and transmission routes for human immunodeficiency virus (HIV), hepatitis, meningitis, and tuberculosis (TB) and their perceived exposures to and concerns about these diseases. METHODS: A convenience sample of EMTs were surveyed at mandatory continuing education meetings in a midwest community (pop. 523,191) between October 1 and November 30, 1996. The survey contained 101 questions about knowledge of universal precautions, transmission routes, postexposure actions, personal and family concerns, and demographics. Correct responses were based on CDC guidelines, and incorrect answers were added. RESULTS: Four hundred of 425 surveys (94%) were returned. Eighty-one percent of the EMTs were full-time paramedics with 9.4 (95% CI 8.7-10.0%) years of experience. Seventy-five percent reported HIV, hepatitis, and TB education, while 57% reported meningitis education within the preceding year. Ninety-one percent knew universal precautions should be used with every patient. Needlestick was correctly reported as a transmission route for HIV (98%) and hepatitis (92%), but incorrectly reported for TB (37%) and meningitis (60%). Tuberculosis (94%) and meningitis (64%) were correctly identified as airborne. Thirty-four percent of the EMTs reported inadequate knowledge of infectious diseases (IDs) to protect themselves. Their perceived exposure for all four diseases ranged from 65% to 73%, but only 10-40% reported follow-up testing. Families' concern about EMTs' exposure was reported as moderate to high by 63% of the respondents. CONCLUSIONS: There appears to be a need for continuing education for EMTs focusing on the routes of transmission of IDs, their chance of exposure, appropriate use of protective equipment, and the need for follow-up testing. This may allow more effective use of protective equipment and allay fears of EMTs and their families.

Centers for Disease Control and Prevention, U.S.↗
PubMed1994

Clinical practice and the perceived importance of identifying high risk patients.

The Royal Free NHS Trust is implementing a Universal Precautions policy for blood and body fluids. Anticipating the introduction of this policy, a questionnaire was sent to a sample of staff and students who work with patients or clinical specimens. The questionnaire covered: views about identifying 'high risk' patients and specimens; perceived risks of human immunodeficiency virus (HIV) and hepatitis B infection from blood exposures; and current practices to avoid exposure to blood. Over half the respondents thought it important to identify high risk patients and specimens. Such respondents were more likely to overestimate the risks of HIV and hepatitis B virus transmission after blood exposures, they were less likely to wear gloves and more likely to resheathe needles. Although two-thirds of respondents thought Universal Precautions would reduce their risk of blood-borne infections, they identified a number of reasons why it would be difficult for them to practice it. Those who thought it important to identify high risk patients gave more reasons than other respondents. This survey indicates that many staff believe it is important to identify high risk patients and this belief seems to influence clinical practice. In order to implement a policy of Universal Precautions successfully, it is necessary to address underlying beliefs as well as giving staff information and training.

Acquired Immunodeficiency Syndrome↗
PubMed2004

Uptake of guidelines to avoid and report exposure to blood and body fluids.

BACKGROUND: Mucocutaneous and percutaneous exposure to blood and body fluids (inoculation injury) are major risk factors for occupational acquisition of bloodborne infection in health care professionals. Compliance with prescribed 'universal precautions' during exposure-prone procedures has been shown to reduce the risk of acquiring bloodborne viral infection. In addition, reporting such exposures facilitates prophylaxis. AIM: The aim of this paper is to report a study to identify strategies to minimize professionals' risks of acquiring bloodborne infections during exposure-prone procedures. METHOD: All surgeons, theatre nurses who scrub for surgery and midwives employed in general operating theatres and delivery suites within one UK National Health Service trust (n = 276) were surveyed by postal questionnaire. Data were analysed using univariate and bivariate techniques in SPSS version 10. Content analysis was undertaken on the one open-ended question. FINDINGS: The response rate was 72.5% (200/276). Only 1.5% (3/200) of respondents adopted universal precautions for all patients irrespective of whether their bloodborne viral status was known. On average, only half the recommended theatre-specific precautions were always adopted (mean 3.725/7, SD = 1.385). Most respondents (63.3%) admitted making judgements related to nationality, lifestyle or sexual orientation when making decisions about protective clothing. Many respondents (74%, 145/196) reported sustaining an inoculation injury in the 10 years prior to the study. However, under-reporting of injuries was common, and 32.4% (47/145) admitted failing to report injuries. Guideline adherence was influenced by profession, but not by time since qualification. CONCLUSIONS: The findings suggest that strategies must be developed to improve compliance with universal precautions and reporting guidelines by all health care professionals. The extent of, and reasons for, non-compliance with both local and national guidelines remain relatively unexplored.

Attitude of Health Personnel↗
PubMed1998

Improved compliance with recommended infection control practices in the dental office between 1994 and 1995.

OBJECTIVE: To investigate changes in Ontario dentists' infection control practices between 1994 and 1995. METHODS: Data from responses of 4003 dentists to a 1994 survey and responses of 987 dentists to a 1995 survey were compared by using descriptive statistics from all respondents and McNemar's test for paired data from those participating in both surveys. RESULTS: Response rates were 70% (1994) and 62% (1995). There were improvements in reports of routine use of gloves (92% to 94%); masks (73% to 79%); and protective eyewear (83% to 84%); vaccination for hepatitis B virus (HBV) or naturally acquired immunity of dentists (93% to 94%); HBV vaccination of clinical staff (64% to 77%); heat sterilization of handpieces (83% to 95%); and no extra precautions for patients with HIV (13% to 48%). Pairwise comparison of data for 788 dentists participating in both surveys showed statistically significant increases in reports of all practices except use of protective eyewear. The 1995 follow-up data also indicated low compliance with handwashing (74% before treating each patient; 62% after removing gloves); flushing water lines after treating each patient (54%); and using postexposure protocol for needlesticks and cuts (36%). CONCLUSIONS: Dentists' reports of compliance with recommended infection control practices and universal precautions against HBV and HIV infection increased between 1994 and 1995, but most dentists apparently have not adopted universal precautions. More education is needed to promote universal precautions, HBV vaccination for clinical staff, handwashing, and postexposure protocol.

Dental Offices↗