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PubMed1995

Compliance with universal precautions among health care workers at three regional hospitals.

OBJECTIVE: To assess and characterize self-reported levels of compliance with universal precautions among hospital-based health care workers and to determine correlates of compliance. DESIGN: Confidential questionnaire survey of 1716 hospital-based health care workers. PARTICIPANTS: Participants were recruited from three geographically distinct hospitals. A stratified convenience sample of physicians, nurses, technicians, and phlebotomists working in emergency, surgery, critical care, and laboratory departments was selected from employment lists to receive the survey instrument. All participants had direct contact with either patients or patient specimens. RESULTS: For this study, overall compliance was defined as "always" or "often" adhering to the desired protective behavior. Eleven different items composed the overall compliance scale. Compliance rates varied among the 11 items, from extremely high for certain activities (e.g., glove use, 97%; disposal of sharps, 95%) to low for others (e.g., wearing protective outer clothing, 62%; wearing eye protection, 63%). Compliance was strongly correlated with several key factors: (1) perceived organizational commitment to safety, (2) perceived conflict of interest between workers' need to protect themselves and their need to provide medical care to patients; (3) risk-taking personality; (4) perception of risk; (5) knowledge regarding routes of HIV transmission; and (6) training in universal precautions. Compliance rates were associated with some demographic characteristics: female workers had higher overall compliance scores than did male workers (25% of female and 19% of male respondents circled "always" or "often" on each of the 11 items, p < 0.05); and overall compliance scores were highest for nurses, intermediate for technicians, and lowest for physicians. Overall compliance scores were higher for the mid-Atlantic respondents (28%) than for those from the Southwest (20%) or Midwest (20%, p = 0.001). CONCLUSIONS: This study supports earlier findings regarding several compliance correlates (perception of risk, knowledge of universal precautions), but it also identifies important new variables, such as the organizational safety climate and perceived conflict of interest. Several modifiable variables were identified, and intervention programs that address as many of these factors as possible will probably succeed in facilitating employee compliance.

Blood-Borne Pathogens↗
PubMed1992

Evaluating the compliance of universal precautions by aeromedical personnel before and after an educational seminar on infectious diseases.

STUDY OBJECTIVE: To measure the compliance of an aeromedical crew with universal precautions and demonstrate what effect education has on utilization. DESIGN: Blinded time-series design. SETTING: Helicopter emergency medical service. TYPE OF PARTICIPANTS: Aeromedical crew consisting of flight nurses, respiratory therapists, and doctors. INTERVENTIONS: A mandatory educational seminar on universal precautions as required by the Centers for Disease Control. MEASUREMENTS AND MAIN RESULTS: Before the educational seminar the flight crew utilized gloves in 42% of patient contacts and goggles 0% of the time. At that time, masks and gowns were not available. The nurses used gloves in 28/72 (39%) of patients, respiratory therapists in 27/71 (38%) of patients, and doctors in 12/19 (63%) of patients. The overall compliance after the education seminar was 61% for gloves and 0% for goggles. The nurses used gloves in 20/36 (56%) of patients, the respiratory therapist in 23/34 (68%) of patients, and the doctors in 11/16 (69%) of patients. CONCLUSIONS: The use of gloves and goggles as preventive measures to protect the aeromedical crew from the potential hazards of body fluid contact and transmission of disease during their treatment of patients is low. Compliance increased after an educational seminar on universal precautions but still remained low. Other modalities, such as quality assurance measures, continuing education, policies, and peer pressure, in addition to education, are necessary.

Aerospace Medicine↗
PubMedDate not supplied

Perception of HIV risk and reported compliance with universal precautions: a comparison of Australian dental hygienists and dentists.

PURPOSE: This paper describes the perceived risk of occupationally contracting HIV and reported compliance with universal precaution guidelines among Australian dental hygienists and dentists. METHODS: This examination is based upon responses to a mailed questionnaire from all registered dental hygienists (63% response rate, n = 208) and dentists (76% response rate, n = 550) in Western Australia. RESULTS: Results indicate that: 1) oral healthcare providers who perceive a high risk of occupationally contracting HIV report a more conservative, cautious approach to HIV infection than do providers who perceive less risk of contracting the virus; 2) dental hygienists are more likely than dentists to report a higher degree of perceived risk of occupationally contracting HIV; and 3) dentists are more likely than dental hygienists to report compliance with universal precaution guidelines in the dental practices where they work. CONCLUSION: Educating oral healthcare providers on the realistic risks of occupationally contracting HIV and the value of compliance with universal precaution guidelines may reduce undue stress and hindrances in the provision of safe and effective oral healthcare in this era of AIDS.

Attitude of Health Personnel↗
PubMed1991

Compulsory HIV antibody testing, universal precautions and the perceived risk of HIV: a survey among medical students and consultant staff at a London teaching hospital.

Routine screening of patients and health care staff for HIV has not been endorsed by the medical profession. Instead universal precautions have been recommended as being the most effective way of minimizing the occupational risk of HIV infection. Consultant staff and undergraduate medical students at the Royal Free Hospital and School of Medicine, London, were asked about their attitudes towards compulsory HIV antibody testing, their compliance with universal precautions and their perceived risk of HIV infection. A substantial proportion of staff and students supported compulsory HIV antibody testing for patients, health care workers and certain subgroups of the population. Most of the clinical students and about half the consultants failed to comply with universal precautions. Staff and students saw themselves at greater risk of HIV infection in the hospital than in their personal lives. Clearly, these beliefs and practices must be taken into account when introducing a policy of universal precautions.

AIDS Serodiagnosis↗
PubMed1994

Variables influencing worker compliance with universal precautions in the emergency department.

BACKGROUND: Emergency department health care workers frequently provide care to patients who are in unstable condition, bleeding, or in a crisis situation. To identify the variables described in the Health Belief Model affecting health care workers' compliance with practices and devices believed to reduce exposure to patients' blood, the staff of a level II trauma center were surveyed for knowledge, compliance, and training regarding universal precautions. METHODS: Fifty-three health care workers responded to an anonymous, self-report, 50-item questionnaire. Significant differences in mean scores were determined by use of a two-tailed t test. RESULTS: Health care workers estimated they were most likely to perform handwashing after contact with body fluids and to wear gloves if contact with blood was anticipated. The most common obstacles to compliance with universal precautions were lack of time, patients perceived to be at lower risk for HIV or hepatitis B infections, and interference with technical skills. Health care workers with more than three perceived obstacles to universal precautions were less likely to use gloves (p < 0.05) if contact with blood was anticipated. Health care workers with a higher number of training experiences in universal precautions were more likely to use gloves if contact with blood was anticipated (p < 0.05) and less likely to recap a needle after giving an intravascular injection (p < 0.05), drawing a blood gas sample (p < 0.05), or injecting medication into an intravenous line (p < 0.05). CONCLUSIONS: The application of the Health Belief Model to this problem suggests that an integrated approach is appropriate. Such an approach should incorporate engineering controls, cognitive approaches, behavior modification strategies, and training experiences to improve skills and dexterity.

Blood-Borne Pathogens↗
PubMed1997

Universal precautions: attitudes of Australian and New Zealand anaesthetists.

OBJECTIVE: To survey the attitudes of a group of Australasian anaesthetists to the risks of bloodborne infections, and their understanding of Universal Precautions. DESIGN: A questionnaire survey. SETTING: A conference on health risks to anaesthetists in August 1995. PARTICIPANTS: 162 Australian and New Zealand anaesthetists. RESULTS: Two-thirds of anaesthetists favoured preoperative HIV and hepatitis B and C testing; they rarely took "risk" histories from patients preoperatively. Only 37% always wore gloves while administering anaesthetics, and 67% reported they resheathed needles. Thirty-nine per cent had had needlestick injuries in the preceding 12 months; 43% did not always report them. The perceived needlestick accident rate was 1 in 1300 anaesthetics. Most (90%) were immunised against hepatitis B, but 20% of these had never had their serological response checked. Twelve per cent of anaesthetists had had occupational exposure to HIV. A high proportion of the anaesthetists understood the principles of Universal Precautions, but only half of them believed these to be practical. CONCLUSIONS: The current situation of Australasian anaesthetists not complying with Universal Precautions and not taking a risk history for bloodborne pathogens may carry the greatest risk of accidental infection.

Acquired Immunodeficiency Syndrome↗
PubMed2003

Have health conditions associated with latex increased since the issuance of universal precautions?

OBJECTIVES: This study explored whether the prevalence of latex-related health conditions has increased among individuals employed in medical occupations relative to those employed in nonmedical occupations since the issuance of universal precautions in 1987. METHODS: Data derived from the 1983 to 1994 versions of the National Health Interview Survey were used to obtain odds ratios comparing prevalence rates of latex-related symptoms over time. RESULTS: No statistical evidence was found that the universal precautions resulted in increased prevalence rates of latex-related health conditions among medical workers relative to those employed in nonmedical occupations. CONCLUSIONS: Increased use of latex gloves among health care personnel subsequent to the implementation of universal precautions appears to have had no effect on latex allergic reactions experienced by these workers.

Adult↗
PubMed2006

Practice of universal precautions among healthcare workers.

INTRODUCTION: Healthcare workers (HCWs) are exposed to bloodborne infections by pathogens, such as HIV, and hepatitis B and C viruses, as they perform their clinical activities in the hospital. Compliance with universal precautions has been shown to reduce the risk of exposure to blood and body fluids. This study was aimed at assessing the observance of universal precautions by HCWs in Abeokuta, Ogun State, Nigeria. SUBJECTS AND METHODS: The study was conducted in September 2003 in Abeokuta metropolis, Ogun State, Nigeria. The respondents were doctors, trained and auxiliary nurses, laboratory scientists and domestic staff. They were selected through a multistage sampling technique from public and private healthcare facilities within the metropolis. The instrument was an interviewer-administered, semistructured questionnaire that assessed the practice of recapping and disposal of used needles, use of barrier equipment, handwashing and screening of transfused blood. RESULTS: There were 433 respondents, 211 (48.7%) of which were trained nurses. About a third of all respondents always recapped used needles. Compliance with nonrecapping of used needles was highest among trained nurses and worst with doctors. Less than two-thirds of respondents (63.8%) always used personal protective equipment, and more than half of all respondents (56.5%) had never worn goggles during deliveries and at surgeries. The provision of sharps containers and screening of transfused blood by the institutions studied was uniformly high. A high percentage (94.6%) of HCWs observed handwashing after handling patients. The use of barrier equipment was variable in the institutions studied. CONCLUSION: Recapping of used needles is prevalent in the health facilities studied. Noncompliance with universal precautions place Nigerian HCWs at significant health risks. Training programs and other relevant measures should be put in place to promote the appropriate use of protective barrier equipment by HCWs at all times.

Blood-Borne Pathogens↗
PubMed2005

Health care workers' knowledge on HIV and AIDS: universal precautions and attitude towards PLWHA in Benin-City, Nigeria.

OBJECTIVE: Health care workers are at risk of becoming infected with blood-borne pathogens, including HIV. The study was designed to test health care workers knowledge about HIV transmission, universal precautions and their attitude towards people living with HIV and AIDS. DESIGN: A cross-sectional study. SETTING: University of Benin Teaching Hospital, Benin-City, Nigeria. PARTICIPANTS: 120 Health Care Workers (HCWs) who were occupationally exposed to patient's blood and body fluids completed a self administered structured questionnaire between March and May 2004. The HCWs consisted of 50 doctors drawn from obstetrics and gynaecology (25) and surgery departments (25). 70 nurses from accident and emergency unit (23), labour ward (18), labour ward theatre (4), main surgical theatre (22) and family planning clinic (3). RESULTS: The mean age of the health care workers and duration of practice were 39.8 +/- 8.0 years and 14.0 +/- 8.2 years respectively. Though many of the respondents demonstrated good knowledge about HIV transmission, more than 25% of them thought that HIV could be transmitted through saliva, vomit, faeces and urine. They over estimated their risk of acquiring HIV infection following needle stick injury, exposure of mucocutaneous membrane and intact skin to infected blood and body fluids. There was poor adherence to universal precautions which was attributed to lack of knowledge and availability of materials in 48% and 60% of the workers respectively. Over 40% of the health care workers exhibited discriminatory attitude towards people living with HIV and AIDS. There was no statistical significant difference (p > 0.05) in the knowledge of HIV and AIDS transmission and infection prevention practices amongst the doctors and nurses. Similarly there was no significant difference in their discriminatory attitude towards PLWHA. CONCLUSION: We recommend that seminars, workshops should be organized on a continuous basis for health care workers on universal precautions, stigma and discrimination reduction. Those trained should train others on the job. The institution should also make available materials needed to protect workers against the risk of acquiring pathogenic infection in the course of providing health services to their patients.

Acquired Immunodeficiency Syndrome↗
PubMed1994

Use of universal precautions in interventional radiology: results of a national survey.

OBJECTIVE: To determine current use of universal precautions by practicing interventional radiologists in the United States. METHODS: National survey mailed to interventional radiologists, conducted anonymously in November 1991. Of 1530 survey forms mailed to practicing interventional radiologists, 817 (53%) were returned and 804 (52%) were completed and evaluable. Both academic and private practice settings were represented. RESULTS: Eighty-five percent of respondents had changed their use of infection control measures in the previous 10 years. Of these, 96% cited personal concerns about AIDS as a reason for making changes. Sixty-two percent made changes in response to Centers for Disease Control and Prevention and Occupational Safety and Health Administration recommendations as well. Use of barrier precautions was quite variable. Although 86% of respondents always wore a sterile gown during procedures, only 32% routinely wore a face mask or shield and only 29% of those who did not wear corrective glasses routinely wore protective eye gear during procedures. Seven percent of respondents routinely double gloved for procedures. Twenty percent of reported percutaneous injuries occurred during recapping of used sharps; an additional 6% were related to improper disposal of used sharps. CONCLUSIONS: We conclude that use of universal precautions by interventional radiologists in the United States is variable. Some practices that may lead to preventable injury to health care workers remain common.

Acquired Immunodeficiency Syndrome↗
PubMed1997

Compliance with universal precautions among physicians.

This study characterized and assessed self-reported levels of compliance with universal precautions (UP) among hospital-based physicians, and determined significant factors associated with both compliance and noncompliance. The physicians (n = 322) were a subgroup of a larger study population of hospital-based health care workers recruited from three geographically distinct locations (n = 1746), and were surveyed using a detailed confidential questionnaire that assessed personal, work-related, and organizational factors. Compliance with UP was measured through 11 items that examined how often physicians followed specific recommended work practices. Compliance was found to vary among the 11 items: they were high for certain activities (eg, glove use, 94%; disposal of sharps, 92%) and low for others (eg, wearing protective clothing, 55%; not recapping needles, 56%). Compliance with all items was low (31% to 38%). Stepwise logistic regression revealed that noncompliant physicians were likely to be age 37 or older, to report high work stress, and to perceive a conflict of interest between providing patient care and protecting themselves. Compliant physicians were more likely to be knowledgeable and to have been trained in universal precautions, to perceive protective measures as being effective, and to perceive an organizational commitment to safety.

Adult↗
PubMed1993

Needlestick injuries among critical care nurses before and after adoption of universal precautions or body substance isolation.

A small, self-selected sample of Canadian acute-care hospitals participated in an analysis of their critical care nurses' needle disposal practices and needlestick injury experience before and after adopting new Universal Precautions or Body Substance Isolation infection control strategies. Covert observation of disposal practices, review of employee health injury reports and direct survey of the nurses indicated that employee health records documented fewer injured nurses during a thirty-day period (2.3% of 929 nurses in 33 hospitals) than was found by surveying nurses directly (3.5% of 312 nurses in 11 hospitals; only 36% of these injuries had been documented in employee health records). Injury rates in only one of eleven hospitals indicated appreciable needlestick risk reduction after adopting Universal Precautions or Body Substance Isolation, and an association between reduced needle recapping and reduced needlestick injury was not evident. Rates of injury found in this research remain commensurate with rates reported before the era of Universal Precautions and Body Substance Isolation. These findings suggest that new strategies have not had significant impact on healthcare workers' greatest source of exposure to bloodborne pathogens.

Canada↗
PubMed1993

Survey of NCAA institutions concerning HIV/AIDS policies and universal precautions.

Attention has recently been focused on issues concerning HIV disease and competitive athletics. These issues have included HIV testing of athletes, participation by HIV-infected athletes, and the practice of "Universal Precautions" by members of the athletic health care team. A survey of all NCAA member institutions was conducted to further investigate these areas. Routine testing for the HIV virus is rare in NCAA member athletic departments. Policies of NCAA member institutions athletic departments concerning participation with HIV virus are few but nearly half restrict participation. Only 12 schools reported having HIV-positive athletes or AIDS-diagnosed athletes at their institutions. There is a need for increased awareness, knowledge, and practice of "Universal Precautions" in all athletic training rooms.

AIDS Serodiagnosis↗
PubMed1991

Universal precautions: how effective are they against methicillin-resistant Staphylococcus aureus?

1. Because MRSA is commonly carried asymptomatically, colonized patients and caregivers are usually not recognized. During outbreaks, colonized and infected patients act as reservoirs and caregivers become transient carriers. 2. Because universal precautions and body substance isolation were originally developed in response to the AIDS epidemic to meet the safety needs of hospital caregivers, the use of universal precautions in extended care facilities should be further studied and refined. 3. In planning for effective training, enforcement, and compliance with universal precautions, it is essential that employees understand not only the importance of protecting themselves, but also the need to prevent cross-infection. 4. If a patient has an MRSA respiratory tract infection, the environment, including the air, may become heavily contaminated. Caregivers should wear masks to prevent nasal colonization.

Cross Infection↗
PubMed1992

A universal precautions monitoring system adaptable to any health care department.

The Occupational Safety and Health Administration has proposed monitoring employee compliance with universal precautions, as recommended by the Centers for Disease Control. Our respiratory care department, following a four-step system development plan, has developed and implemented a universal precautions monitoring system that is easy to adapt to any health care department. The results from monitoring can be used for educational planning, quality assurance purposes, and employee performance reviews.

Cooperative Behavior↗
PubMed1998

Universal precautions prevent hepatitis C virus transmission: a 54 month follow-up of the Belgian Multicenter Study. The Universitaires Cliniques St-Luc (UCL) Collaborative Group.

The isolation of anti-hepatitis C virus (HCV) in hemodialyzed (HD) patients has been repeatedly advocated to prevent nosocomial HCV transmission. We evaluated the incidence of seroconversion for HCV in Belgian HD patients, and demonstrate the complete prevention of HCV transmission by adherence to the universal precautions advocated by the Centers for Disease Control (Atlanta, GA, USA). All (N = 963) HD patients from 15 units, none of which isolates anti-HCV positive patients, were tested by a second or third generation enzyme-linked immunosorbent assay (with confirmation by a second- or third-generation recombinant immunoblot assay or the polymerase chain reaction) every 18 months from May 1991 to November 1995. Follow-up was available in 488 patients (drop-outs resulting from death or transplantation mainly). The yearly incidence of seroconversion for HCV over the initial 18 months was 1.41%, with evidence suggestive of nosocomial HCV transmission. Universal precautions were therefore reinforced. The incidence of seroconversion subsequently fell to 0.56% and 0%, respectively (P = 0.014), despite the facts that the average transfusion load and the proportion of patients with dialyzer reuse or with monitors disinfected after each session did not change significantly. We conclude that the strict enforcement of universal precautions fully prevents HCV transmission to HD patients. The isolation of anti-HCV positive patients is not warranted.

Adolescent↗
PubMed1991

Monitoring universal precautions: a new assessment tool.

OBJECTIVES: Two pilot studies were conducted to produce efficacy data on an observational tool designed to assess the use of Universal Precautions (UP) in patient care settings. The instrument addresses barrier precautions, hand-washing, handling of sharps, and avoidance of unprotected mouth to mouth resuscitation. DESIGN: The Universal Precautions Assessment Tool was submitted to a panel of 3 experts to establish consensual validity. It was pilot tested by 2 simultaneous observers to establish interrater reliability. SETTING: Pilot Study I was conducted in 3 different units within a 100-bed U.S. Army hospital. Pilot Study II was conducted in the emergency department of a large university-based hospital. PARTICIPANTS: Subjects observed were registered nurses providing acute patient care. RESULTS: Two simultaneous raters calculated UP compliance rates of 76.4% and 78.6%, respectively, for 9 nurses in Pilot Study I, and 62% and 65%, respectively, for 5 nurses in Pilot Study II. The intraclass correlation coefficient for the raters' scores in Pilot Study I was 0.992 with a 95% confidence interval (0.979, 0.997). Consensual validity was established. CONCLUSIONS: The instrument has acceptable interrater reliability under the conditions used. Limitations to use include the possibility of a Hawthorne effect and the fact that assessing proper implementation of UP occasionally relies on a "judgment call" by the observer. With test conditions adjusted to minimize these limitations and with proper consideration of sample size, the tool can be used by researchers and by monitors of hospital quality control to measure UP compliance of caregivers individually or collectively.

Cooperative Behavior↗
PubMed1992

Exposure to blood during various procedures: results of two surveys before and after the implementation of universal precautions.

In an attempt to define better situations involving exposure to blood, we surveyed nurses (N = 565) in a 1000-bed university hospital to determine the following for the last working shift: the rate of cutaneous exposure to blood for different procedures, the rate of needlestick injury, and the prevalence of hand lesions. Among nurses who had performed at least one of the specified procedures, 42% had been exposed to blood with unprotected skin. Direct examination of 100 pairs of hands revealed that 57% of the nurses had either acute or chronic skin lesions. Universal precautions were introduced, and a similar survey (N = 541) was carried out 1 year later to assess compliance. Exposure of unprotected skin to blood had been reduced to 27%, although 46% of nurses had not used gloves for any of the procedures they had performed. The main reason given by nurses for not wearing gloves was that they did not consider the patient to be at risk for carrying a blood-borne infection. The rate of needlestick injuries was high and had remained stable at approximately 2.8 needlesticks/nurse per year, as determined by information from the last working shifts. We conclude that compliance of nursing personnel with universal precautions was insufficient, despite an informational campaign throughout the hospital. Repeated instruction on barrier precautions and the prevention of needlestick injury (including the correct use of disposable containers) is necessary to ensure optimal protection.

Blood↗