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PubMed1994

Temporal association between implementation of universal precautions and a sustained, progressive decrease in percutaneous exposures to blood.

To evaluate whether implementation of universal precautions was temporally associated with a decrease in reported parenteral exposures to blood, we analyzed data on self-reported parenteral injuries that were prospectively collected at the Clinical Center, National Institutes of Health (Bethesda, MD), from 1985 through 1991. We also assessed whether implementation of universal precautions, in concert with initiation of a program of postexposure chemoprophylaxis with zidovudine, was associated with decreased time to reporting of occupational exposures. Our data, possibly confounded by the occurrence of an occupational infection due to human immunodeficiency virus infection in 1988, nonetheless demonstrate a temporal association between a progressive, significant decrease in percutaneous injuries and the implementation of universal precautions that has been sustained through subsequent years. The analysis remains significant, regardless of the surrogate denominator chosen for analysis. No trend toward more rapid reporting of exposures was identified. Implementation of universal precautions appears to have contributed to decreased parenteral injuries in our hospital but did not affect reporting efficiency.

Blood-Borne Pathogens↗
PubMed1996

Nurses' body fluid exposure reporting, HIV testing, and hepatitis B vaccination rates: before and after implementing universal precautions regulations.

The purpose of this study was to investigate whether mandatory universal precautions changed nurses' body fluid exposure and reporting rates, hepatitis B vaccination rates, and human immunodeficiency virus (HIV) testing rates. Random cross-sectional surveys of nurses in Tennessee were conducted in 1991 and 1993 (n = 145 in 1991; n = 143 in 1993). The questionnaire in both surveys included frequency of body fluid exposures and reporting in the past year, and whether or not the respondent had received the hepatitis B vaccine or had been HIV tested. Findings indicated that self reported needlestick injuries decreased by 69%, and other sharps injuries decreased by 81%. Only 4.1% of all exposure incidents reported on this anonymous survey were reported to employee health officials, as required. Body fluid exposure incidents were the most common form of exposure (81%) and the most underreported. Hepatitis B vaccinations significantly increased (61.4% to 82.5%), with a nonsignificant increased in HIV testing (47.2% to 55.6%) from 1991 to 1993. Findings of this study suggest that the universal precautions regulatory mandate has been effective in increasing nurses' compliance to universal precautions. Body fluid contacts were significantly underreported and showed no decrease between 1991 and 1993.

AIDS Serodiagnosis↗
PubMed1993

Universal precautions in the operating department.

Those operating theatre personnel who aim to keep up to date by reading the professional journals may well be confused and feel uninformed about the concept of universal precautions. While some authors focus on universal precautions, they do not mention operating theatres. Others continue to discuss the Human Immunodeficiency Virus (HIV), the Hepatitis B Virus (HBV) and high risk patient's. Furthermore the practical aspects of the implementation of universal precautions have not, to date, been thoroughly documented, other than the vague advice of 'treat every patient the same'. This article aims to clarify the concept of universal precautions, consider why they are needed, and suggest a possible pathway for their implementation. The three main changes in practice will also be discussed.

Humans↗
PubMed1995

Compliance with universal precautions by emergency room nurses at Maharaj Nakorn Chiang Mai Hospital.

Compliance with universal precautions (UP) by emergency room nurses in Maharaj Nakorn Chiang Mai Hospital was studied between August 1, 1992 and November 30, 1992. Data were gathered from observation, questionnaires, and focus group discussion. During a period of 3 months, 23 registered nurses and 17 practical nurses were observed during performing 509 UP-specific nursing procedures. Results showed a low rate of compliance with universal precautions among emergency room nurses. Aside from handwashing, the compliance of registered nurses was significantly higher than that of the practical nurses: 58% and 18%, respectively (P < 0.05). The most common protocol violations involved the use of barrier precautions. Gloves were the only protective attire that were worn while carrying out nursing interventions; other protective attire was completely ignored. The results also indicated that some nurses, both registered and practical, still recapped needles and demonstrated low rates of compliance with recommended handwashing procedures. In addition, they were more likely to apply the recommended universal precautions for patients with known HIV infection. The reasons for not using protective attire were similar for both registered and practical nurses i.e.: supplies not available, insufficient time, discomfort, inconvenience, habit, believing UP were not necessary, and concerns about patients' feeling and about nurses' own appearance. The findings also indicated that many emergency room nurses did not understand the implication of the UP for practice and had never participated in an inservice education programme related to UP.

Blood-Borne Pathogens↗
PubMed1990

Noncompliance with Universal Precautions Policy: why do physicians and nurses recap needles?

In 1987 the Centers for Disease Control published a Universal Precautions Policy establishing blood and body fluid procedures to be used consistently with all patients. An important and unequivocal Universal Precautions Policy recommendation with regard to avoidance of needlestick injuries is that needles should never be recapped. We examined the recapping-related attitudes and behaviors of physicians and nurses at four large teaching hospitals with patients with acquired immunodeficiency syndrome and with Universal Precautions Policy in-service training programs. Compliance was found to be considerably less than optimal. According to unannounced needle counts in disposal boxes, the percentage of recapped needles was always greater than 25% and exceeded 50% in four instances. Recapping was related to inadequate knowledge, concerns about personal risk, forgetfulness, being "too busy" to follow the Universal Precautions Policy, and the misperception that recapping is a way to avoid needlestick injury. Strategies are suggested to improve and supplement traditional in-service education.

Communicable Disease Control↗
PubMed1996

Nurses' compliance with universal precautions before and after implementation of OSHA regulations.

The principal objective of this study was to investigate whether or not nurses' compliance with universal precautions procedures improved after the mandatory Occupational Safety and Health Administration regulations were implemented in 1992. Two random samples of registered nurses and licensed practical nurses registered in Tennessee responded to survey questionnaires measuring universal precautions compliance and practice barriers to compliance in 1991 and 1993 (n = 306). The 1993 sample of nurses reported significantly greater compliance with universal precautions (p < 0.001) than the 1991 sample. The most noteworthy improvement between the 1991 and the 1993 groups was a significant increase in compliance for patients described as HIV/HBV-status unknown and HIV/HBV-negative (p < 0.001). Practice barriers hindering compliance with universal precautions decreased significantly (p < 0.001) in the 1991-1993 time frame. Problematic practice barriers identified in both groups were needle recapping, preference for isolation door signs, and concerns about offending patients and visitors.

Adult↗
PubMed1997

Noncompliance with universal precautions and the associated risk of mucocutaneous blood exposure among Danish physicians.

OBJECTIVE: To study the compliance, and reasons for noncompliance, with Universal Precautions and the associated circumstances of mucocutaneous blood exposure (MCE) among Danish physicians. DESIGN: A nationwide questionnaire survey. SETTING: All Danish hospitals. PARTICIPANTS: All hospital-employed physicians. RESULTS: Of 9,384 questionnaires, 6,256 (67%) were returned, and 6,005 were eligible for analysis. Only 35% of respondents were compliant with the basic principle of Universal Precautions. Compliance with specific barriers in the preceding week among "surgeons and pathologists" and "other physicians" was as follows: gloves, 63.0% and 23.4%; masks, 55.2% and 17.6%; and protective eyewear, 11.5% and 4.0%, respectively. Common arguments for non-compliance were "interferes with working skills," "forget," "wear spectacles," "not available," "too much trouble to get," or "gloves do not fit." Detailed descriptions of 741 MCEs were obtained. Blood splashes in the eyes (n = 320) was the most common MCE in surgical specialties and pathology, whereas blood on the hands (n = 290) was most common in other specialties. In 20% of MCEs of the eyes, the exposure occurred despite the use of spectacles. An estimated 84% to 98% of MCEs potentially would have been preventable had appropriate barriers been worn. More than one half of MCEs were preventable by two interventions only: compulsory use of protective eyewear during operations and use of gloves during insertion of peripheral intravenous catheters. CONCLUSION: Compliance with Universal Precautions is unacceptably low, as reflected by the circumstances of MCE. Increased efforts to ensure education in Universal Precautions, easy accessibility of protective barriers, and improved design of the barriers are necessary to improve compliance and reduce the risk of MCE.

Blood-Borne Pathogens↗
PubMed1995

Universal precautions compliance and exposure frequency to patient body fluids in nurses employed by urban and rural health care agencies.

Previous studies have suggested that health care workers may differ with respect to universal precautions knowledge, compliance, practice setting barriers, or exposure to patient body fluids in rural and urban areas. The purpose of this study was to determine whether or not there are rural/urban differences in the degree of precaution taken by health care workers to prevent the spread of blood borne pathogens, specifically human immunodeficiency virus (HIV) and hepatitis B virus (HBV). A random sample of rural and urban registered and licensed practical nurses in Tennessee was surveyed. The respondents completed two instruments that assessed self-reported universal precautions knowledge, precautions, and practice barriers. No measurable differences in universal precautions knowledge, compliance, or barrier scores between the two groups were found; yet rural nurses were 2.7 times as likely to be exposed to patient body fluids than urban nurses (P < 0.005). The conclusion was that rural nurses were as experienced and as knowledgeable about universal precaution techniques as their urban peers, but their knowledge was not translated into practice to the same degree. Two possible explanations offered are (1) rural nurses are more likely to be acquainted with, and thus trusting of, their patients, and (2) the lower seroprevalence of human immunodefiency virus and hepatitis B virus in rural areas may lead to complacency.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

The challenges of teaching universal precautions to multicultural, diverse patients and their family members.

Teaching universal precautions to culturally diverse groups, whether healthcare workers, patients, or family members, is a unique challenge. In the environment of acquired immune deficiency syndrome, it involves honest and realistic appraisal of the modes of transmission and the risks involved. In addition, we must understand the fears involved, as well as the cultural perspectives that may alter the perception of the situation. This article will discuss the many cultural problems, briefly review what information needs to be included in any educational program, and focus on how we can realistically assess the risks involved and communicate those risks to healthcare workers, patients, and family members. When these risks are addressed honestly and without fear, implementation of and compliance with universal precautions will become easier, both in acute care and home care settings.

Cultural Diversity↗
PubMedDate not supplied

The direct costs of universal precautions in a teaching hospital.

An analysis of the increase in expenditures for barrier isolation materials before and after the institution of universal precautions at our 900-bed university hospital was used to generate a national estimate of the cost of implementation of the new Centers for Disease Control guidelines. Following the institution of universal precautions, use of rubber gloves at our hospital increased from 1.64 million pairs of 2.81 million pairs annually. A 5-year review of hospital purchasing and supply records in both inpatient and outpatient areas indicated that the total annual costs for isolation materials increased by $350,900. This represented an increase from $13.70 to $22.89 per admission (60%) after adjustment for inflation. The cost of isolation materials increased from $98 to $215 per 1000 outpatient visits, an adjusted increase of 92%. Two thirds of the increase (64%) was due to rubber gloves and an additional 25% was due to disposable isolation gowns. Universal precautions are estimated to have cost at least $336 million in the United States in fiscal year 1989 after adjustment for inflation. If expenditures for isolation materials at our medical center are representative, previous estimates may have significantly underestimated costs nationwide.

Centers for Disease Control and Prevention, U.S.↗
PubMed2000

A universal precautions education intervention for health workers in Sardjito and PKU Hospital Indonesia.

A non-randomized control trial was conducted to develop and evaluate a culturally appropriate academic detailing intervention on the universal precautions knowledge, attitude and behavior of health care workers in hospitals. Fivety-five health care workers (44 nurses and 11 doctors) participated in the study. They were visited individually to discuss principles of universal precautions as well as the effect of automatic pilot on their work practices. Self-reported measures of knowledge and attitudes were collected from each participant before and after the intervention. A nurse observer collected measures of participants' compliance with the universal precautions guidelines according to a pre-determined protocol before and after the intervention. There was a significantly different level of knowledge, attitudes and compliance on universal precautions between the control and intervention hospital with p=0.0007, p=0.038 and p=0.03 respectively following the intervention. It is concluded that an academic detailing approach of education used in this study has significantly improved knowledge, attitudes and compliance scores.

Health Knowledge, Attitudes, Practice↗
PubMed2003

Knowledge and practice of universal precautions among nurses in central hospital, Benin-City, Edo State, Nigeria.

Nurses are faced with professional hazards such as needle pricks and blood-borne infections in their day to day activities in the work place. This study is aimed at finding out the knowledge and practice of universal precautions among nurses at the Central Hospital, Benin City, Edo State, Nigeria. One hundred and fifty-five (155) nurses participated in the cross-sectional study. The nurses were selected using the stratified random sampling method. The nurses had a poor knowledge about universal precautions as only 34.2% of nurses had heard about universal precautions. There was also a poor observance of universal precautions. Knowledge of measures to be taken after the occurrence of occupational accidents/ injuries was also poor, as only 26(16.8%) nurses would report puncture injuries to the clinic, only 13(8.4%) nurses would screen patients for HIV antibody after consent when they sustain work related accident/injuries. Twelve (7.7%) nurses would screen patient to determine hepatitis B status of patient while only 8(5.2%) nurses would go for medical check-up/immunisation with hepatitis B vaccine.

Adult↗
PubMed1989

The relationship between knowledge about acquired immunodeficiency syndrome and the implementation of universal precautions by registered nurses.

The relationship between the level of knowledge of registered nurses (RNs) concerning acquired immunodeficiency syndrome (AIDS)-related issues and the practical observance of universal precautions was studied. It was hypothesized that the more knowledge a nurse has concerning AIDS the more likely he or she is to implement universal precautions. All registered nurses who have direct patient contact (N = 400) and are employed at a Northeastern teaching medical center, were provided a packet of three questionnaires and encouraged to participate. Two hundred thirteen (53%) RNs returned completed questionnaires. Subgroups were examined for trends relating such parameters as age and the amount of AIDS knowledge, using analysis of variance. The major hypothesis was tested by correlating the overall scores for AIDS knowledge and the implementation score. Results indicated no relationship between knowledge and the implementation of universal precautions (r = -0.12). When evaluating scores according to work areas, those subjects with higher knowledge scores had lower practice scores. Other demographic variables showed no influence on either knowledge or implementation scores as measured by this study. Further study is needed to understand what factors will motivate RNs to implement universal precautions.

Acquired Immunodeficiency Syndrome↗
PubMed1993

A training program in universal precautions for second-year medical students.

BACKGROUND: A training program in universal precautions was developed and implemented in 1991-92 for second-year students at the George Washington University School of Medicine and Health Sciences. The students were required to participate in a three-hour session that consisted of lecture, demonstration, and practice components focused on the risks of bloodborne-disease exposure and the techniques of phlebotomy and intravenous insertion using universal precautions. METHOD: All 135 second-year students participated in the lecture component, but only 120 students, who were unfamiliar with the procedures, were required to participate in the demonstration and practice components. Each of these students was asked to answer pre- and postsession knowledge questions and to rate his or her preparedness on a five-point Likert scale, ranging from 1, "not prepared at all," to 5, "well prepared." Paired t-tests were used to compare the pre- and postsession knowledge scores and self-assessed preparedness scores. At the end of the training program, the students were offered the opportunity to volunteer for additional, individualized training with the hospital phlebotomy service. Unpaired t-tests were used to compare differences between the postsession knowledge scores of the volunteers and nonvolunteers. RESULTS: A total of 103 students completed both pre- and posttests. The students' knowledge scores increased from means of 64.7% to 88.5% (p = .001). Their self-assessed preparedness scores also increased, ranging from a low of means of 1.6 presession and 3.4 postsession for intravenous insertion to a high of means of 3.19 presession and 4.26 postsession for addressing personal concerns about possible exposure. The 43 students who volunteered for additional training scored significantly better on the postsession knowledge questions than did the nonvolunteers, suggesting that those who may have needed it most failed to sign up for additional training. CONCLUSION: The training session significantly improved the students' knowledge and sense of their own competency.

Curriculum↗
PubMedDate not supplied

Adherence to universal precautions among laboratory personnel in Lebanon.

To evaluate the present situation and plan future directions with regard to implementation of universal precautions in laboratories testing blood samples, we carried out a national cross sectional study in 2003 on a representative sample of laboratories in Lebanon. We compared the results with those of a 1993 study. We found that the education profile of staff had improved, being now more specialized in laboratory science. The discrepancies between what technicians knew, believed in and practised and what was observed in the field improved to some extent in most variables. Disposal of needles and syringes had improved greatly but disposal of blood-contaminated material had not. Given the risks of improper practice, a policy of universal precautions is essential and regular training should be carried out so that staff know and practise the universal precautions and correct laboratory procedures.

Attitude of Health Personnel↗
PubMedDate not supplied

Changing knowledge, behavior, and practice related to universal precautions among hospital nurses in China.

PURPOSE: To evaluate the effect of an educational training program for hospital nurses on universal precautions in Changsha, Hunan Province, People's Republic of China. METHOD: Using a quasi-experimental design, 50 of 100 randomly selected hospital nurses were randomly assigned to receive an educational intervention. Questionnaires were administered to the 100 nurses prior to and 4 months after the training. FINDINGS: Knowledge, practice, and behaviors related to universal precautions and the prevalence of hepatitis B immunization improved among nurses in the group who received training. No significant change in the frequency of glove use was found. Underreporting of sharps injuries to hospital authorities continued in both groups. CONCLUSION: Although educational training significantly improved Chinese nurses' knowledge, practice, and behavior related to universal precautions, there remains room for improvement in glove use and needlestick injury reporting.

Adult↗
PubMed1991

Frequency of nonparenteral occupational exposures to blood and body fluids before and after universal precautions training.

PURPOSE: During annual periods before and after Universal Precautions training, we compared the frequency of health care workers' self-reported cutaneous exposures to blood and various body substances from any patient and from patients presumed infected with human immunodeficiency virus type 1 (HIV-1). SUBJECTS AND METHODS: Self-reported cutaneous exposures to blood, sputum, urine, feces, and other body substances were evaluated separately in 559 workers during the first survey and 269 workers during the second. RESULTS: Mean annual blood exposures decreased from 35.8 to 18.1, and mean annual exposures to all substances decreased from 77.8 to 40.0 (p less than 0.001 for both determinations). Two matched analyses of a subset of 200 participants who completed both surveys had similar results. Reported exposures to blood, presumably infectious blood, sputum, presumably infectious sputum, and urine were significantly decreased. Participants were tested for antibodies to HIV-1; no participant reporting cutaneous exposures acquired HIV-1 infection. The upper bound for the 95% confidence interval for the risk of HIV-1 infection associated with a single cutaneous exposure was 0.04% for blood presumed to contain HIV-1 and 0.02% for any body substance presumed to contain HIV-1. CONCLUSIONS: These data suggest that Universal Precautions training significantly decreased but did not eliminate cutaneous exposures to blood and body substances. The results further suggest that the risk for HIV-1 infection associated with cutaneous exposures is substantially lower than the risk associated with parenteral exposures.

Body Fluids↗
PubMed1992

A comparison of observed and self-reported compliance with universal precautions among emergency department personnel at a Minnesota public teaching hospital: implications for assessing infection control programs.

STUDY OBJECTIVES: To determine the level of universal precautions compliance in a hospital emergency department by two methods (direct observation of subjects versus self-reporting by questionnaire). SETTING: A Level II trauma center located within a university-affiliated medical center in Minneapolis/St Paul, Minnesota. Glove and needle disposal containers were available in each treatment room; gowns, masks, and goggles were readily available. PARTICIPANTS: ED physicians (12 staff plus rotating residents), medical students, nursing staff, and ancillary personnel. METHODS: Ten observers documented six specific behaviors among ED personnel: needle recap frequency, needle recap techniques, and use of gowns, gloves, masks, and goggles. After the observations, surveys were distributed to ED personnel by intrahospital mail in Fall 1989. RESULTS: During 270 observation hours, 1,018 patient-worker interactions were recorded. Gloves were the barrier worn most frequently when appropriate (74%), followed by goggles (13%), gowns (12%), and masks (1%). Needles were recapped 51% of the time, and most needles that were recapped (79%) were recapped by the two-hand technique; 5% of all needles used were left uncapped at bedside or in the trash. Physicians were observed to use gloves more frequently than registered nurses and nursing assistants; nurses were observed to recap more frequently than physicians. From the survey, the three most common reasons for noncompliance involved time (71%), dexterity (61%), and patient appearance (50%). CONCLUSION: Universal precautions are not consistently used by ED personnel, and ED personnel significantly overestimate their compliance with universal precautions.

Data Collection↗