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PubMed1996

Rural nurses' use of universal precautions in relation to perceived knowledge of patient's HIV status.

The increased incidence of AIDS in rural areas of the United States has called attention to the practice of universal precautions by rural nurses. The purpose of this research was to determine protective barrier use by 555 nurses living in rural counties in Pennsylvania and New York State and the effect on this use of their knowledge of their patients' HIV status. Findings suggest that nurses increased their use of protection if they knew their patients were HIV-positive. However, if they thought that their patients were HIV-negative or if they did not know their patients' HIV status, they did not always use adequate protection. Findings are discussed as they relate to the context of rural nursing practice.

Adult↗
PubMed2003

Universal precautions guideline: self-reported compliance by gastroenterologists and gastrointestinal endoscopy nurses--a decade's lack of progress.

OBJECTIVES: The aims of this study were to assess and compare the Universal Precaution (UP) practices of gastroenterologists (GE) and GI endoscopy nurses (GIEN). METHODS: We mailed a 23-item questionnaire to 250 GE and GIEN selected, respectively, from the American Board of Internal Medicine online directory and the Society of Gastroenterology Nurses and Associates membership directory. RESULTS: A total of 77 (31%) GE and 157 (60%) GIEN responded. In all, 32% of GE and 50% of GIEN washed their hands before and after handling every patient (p<0.01), and 5% of GE and 30% of GIEN wore gloves during all patient contacts (p<0.01). Fewer GE than GIEN used face shields for all procedures (14% vs 21%; p=0.02). Protective gowns were worn during all procedures by 29% of GE and 46% of GIEN (p<0.01). More GE than GIEN either did not recap used needles or used the one-handed "scoop" technique (85% vs 77%; p=0.02). When asked to give an overall assessment, 46% of GE and 60% of GIEN reported that they always complied with UP (p=0.06). Profession, age, gender, hours of daily patient contact, and adequacy of staffing did not affect compliance. CONCLUSIONS: GIEN adhered to UP recommendations better than GE regarding most items queried except in the handling of used needles. Nonetheless, for both groups, compliance with proper hand washing and use of gloves, face shields, and gowns was very poor, and handling of used needles was satisfactory.

Adult↗
PubMed2000

Behavioral-diagnostic analysis of compliance with universal precautions among nurses.

This study used the PRECEDE model (L.W. Green, M.W. Kreuter, S.G. Deeds, & K.B. Partridge, 1980) to examine individual, job-task, and environmental-organizational factors related to compliance with universal precautions (UP) among nurses. Structural equation modeling showed that the hypothesized model did a better job predicting general compliance (R2 = .41) than compliance with personal protective equipment (PPE; R2 = .18). All 3 categories of diagnostic factors (predisposing, enabling, and reinforcing) influenced general compliance, but predisposing factors were relatively unimportant for compliance with PPE. With a set of nested models, the greatest improvement in model fit occurred when the indirect effects of reinforcing factors were added. A positive safety climate may increase the likelihood that the work environment will contain features that enable workers to comply with safe work practices.

Acquired Immunodeficiency Syndrome↗
PubMed1996

Infection control and universal precautions.

Surgical interventions are now carried out in many settings other than purposely designed operating theatre suites. NATN is pleased to welcome nurses working in areas other than operating theatres to associate membership of the Association. In response to this diversity of surgical settings, an examination of the basic principles of infection control and the application of universal precautions may be valuable.

Humans↗
PubMed2001

Improved compliance with universal precautions in the operating room following an educational intervention.

Observation of surgical personnel in four specialties (cardiothoracic, general, gynecologic, and orthopedic) in the operating room was performed prior to implementation of an educational intervention designed to improve compliance with Universal Precautions and at 1- and 2-years post-intervention. Use of protective eyewear and double gloving increased following the intervention, whereas the incidence of documented blood and body fluid exposures decreased.

Blood-Borne Pathogens↗
PubMedDate not supplied

OSHA regulations on universal precautions: a sample training curriculum.

1. Training must be provided to each newly hired employee before that employee can work in a risk environment. Current staff must be trained annually, and additional training must be provided when infection control or universal precaution techniques are revised. 2. Training should include written material, oral presentations, films, videos, computer programs, and audio tapes at the employee's educational, literacy, and language level. Interactive discussion between the trainer and employees is required. 3. Employee evaluation should consist of written pretraining and posttraining tests and a practical demonstration of steps to protect against infectious diseases in the workplace.

Curriculum↗
PubMed1998

Hepatitis B and hemodialysis: the impact of universal precautions in preventing the transmission of bloodborne viruses.

A detailed description is presented of the hemodialysis treatment for 6 weeks of a patient strongly positive for hepatitis B virus ([HBV], hepatitis B surface antigen, hepatitis B e antigen, HBV DNA), which was performed without any special precautions. All 59 patients potentially exposed to the HBV-positive patient, of whom 29 appeared fully unprotected by antibody, were followed for at least 9 months but remained negative. This illustrates the feasibility of following Universal Precautions instead of using exceptional procedures for one single agent.

Adult↗
PubMedDate not supplied

Low seroconversion for hepatitis C virus (HCV) antibody achieved by universal precautions alone.

Since the cloning of Hepatitis C virus in 1988 positive serology for HCV antibody in haemodialysis populations has been reported at varying rates of 2 to 70%. To date there is no consensus regarding strategies which would curtail spread of HCV in the dialysis unit. In our satellite dialysis programme we implemented Universal Precautions as the sole strategy for containment and HCV monitored closely the outcome of this decisions.

Cross Infection↗
PubMed1998

Does clinical experience affect medical students' knowledge, attitudes, and compliance with universal precautions?

OBJECTIVE: To investigate differences in second-, third-, and fourth-year medical students' knowledge of bloodborne pathogen exposure risks, as well as their attitudes toward, and intentions to comply with, Universal Precautions (UP). DESIGN: Cross-sectional survey. PARTICIPANTS AND SETTING: Surveys about students' knowledge, attitudes, and intentions to comply with UP were completed by 111 second-year (preclinical), 80 third-year, and 60 fourth-year medical students at Washington University School of Medicine in the spring of 1996. RESULTS: Preclinical students knew more than clinical students about the efficacy of hepatitis B vaccine, use of antiretroviral therapy after occupational exposure to human immunodeficiency virus, and nonvaccinated healthcare workers' risk of infection from needlestick injuries (P<.001). Students' perceived risk of occupational exposure to bloodborne pathogens and attitudes toward hepatitis B vaccine did not differ, but preclinical students agreed more strongly that they should double glove for all invasive procedures with sharps (P<.001). Clinical students agreed more strongly with reporting only high-risk needlestick injuries (P=.057) and with rationalizations against using UP (P=.008). Preclinical students more frequently reported contemplating or preparing to comply with double gloving, wearing protective eyewear, reporting all exposures, and safely disposing of sharps, whereas students with clinical experience were more likely to report compliance. Clinical students also were more likely to report having "no plans" to practice the first three of these precautions (P<.001). CONCLUSIONS: Differences in knowledge, attitudes, and intentions to comply with UP between students with and without clinical experience may have important implications for the timing and content of interventions designed to improve compliance with UP.

Adult↗
PubMed1999

Compliance with universal precautions in correctional health care facilities.

There were three main objectives of this cross-sectional study of Maryland State correctional health care workers. The first was to evaluate compliance with work practices designed to minimize exposure to blood and body fluids; the second, to identify correlates of compliance with universal precautions (UPs); and the third was to determine the relationship, if any, between compliance and exposures. Of 216 responding health care workers, 34% reported overall compliance across all 15 items on a compliance scale. Rates for specific items were particularly low for use of certain types of personal protective equipment, such as protective eyewear (53.5%), face mask (47.2%) and protective clothing (33.9%). Compliance rates were highest for glove use (93.2%) waste disposal (89.8%), and sharps disposal (80.8%). Compliance rates were generally not associated with demographic factors, except for age; younger workers were more likely to be compliant with safe work practices than were older workers (P < 0.05). Compliance was positively associated with several work-related variables, including perceived safety climate (i.e., management's commitment to infection control and the overall safety program) and job satisfaction, and was found to be inversely associated with security-related work constraints, job/task factors, adverse working conditions, workplace discrimination, and perceived work stress. Bloodborne exposures were not uncommon; 13.8% of all respondents had at least one bloodborne exposure within the previous 6 months, and compliance was inversely related to blood and body fluid exposures. This study identified several potentially modifiable correlates of compliance, including factors unique to the correctional setting. Infection-control interventional strategies specifically tailored to these health care workers may therefore be most effective in reducing the risk of bloodborne exposures.

Adult↗
PubMed2000

Determinants of nurses' adherence to universal precautions for venipunctures.

OBJECTIVES: The aim of this study was to predict and explain nurses' adherence to Universal Precautions (UPs) when performing venipunctures. METHODS: Data were gathered from 156 registered nurses working at a regional hospital. A self-administered questionnaire assessing the psychosocial variables (intention, attitude, subjective norm, perceived control, etc) was completed at baseline, and behavior was self-reported 3 months later. RESULTS: The regression of intention on the variables yielded an adjusted R(2) of 0.68, with perceived barriers (beta =.62, P <.001), social norm (beta =.17, P <.01), and personal normative belief (beta =.19, P <.01) being the significant variables. With respect to the 3-month follow-up, 28% of the variance associated with UPs adherence was explained by intention (beta =.37, P <.001) and perceived behavioral control (beta =.23, P <.05). Moreover, high (n = 116) and low intenders (n = 40) differed on several normative beliefs (P =.0003) and perceived barriers (P =.0001). CONCLUSIONS: It is suggested that perception of control, assessed either globally or by means of a belief-based measure, is a key factor in adherence. Specifically, the perceived difficulties associated with adherence to UPs appear to be related to a nurse's training on UPs and to the existence of suboptimal working conditions.

Adult↗
PubMed1997

Healthcare workers' attitudes and compliance with universal precautions: gender, occupation, and specialty differences.

We describe variations in healthcare workers' attitudes toward double gloving and reporting needlesticks, and in their readiness to comply with double gloving and hepatitis B vaccine. Differences related to occupation, specialty, and gender have implications for the need to tailor interventions for specific groups of healthcare workers to improve compliance with Universal Precautions.

Adult↗
PubMed1993

Introduction of universal precautions in a psychiatric hospital--The Riverview Hospital experience.

Despite a large and rapidly growing body of knowledge concerning the human immunodeficiency virus and treatment of the acquired immune deficiency syndrome (AIDS) cases in general hospital settings, there is a dearth of information about the care of those psychiatric patients who might be at high risk for exposure to the virus and, hence, at high risk for contracting the illness. This article deals with the approach taken by a large Canadian psychiatric hospital in educating staff and clients about AIDS, and to the development of a comprehensive Universal Precautions system to supplement existing infection control protocols.

Hospitals, Psychiatric↗
PubMedDate not supplied

Universal precautions and dedicated machines as cheap and effective measures to control HCV spread.

Haemodialysis patients are at great risk for HCV infection, and a strict relationship is clear between anti-HCV positivity and dialysis age or hospital dialysis, irrespective of previous blood transfusions. Notwithstanding that, the precise root of its nosocomial nontransfusional diffusion among haemodialysis patients is not clear yet. As isolation is a very expensive policy, we evaluated whether simpler measures such as the observance of the Universal Precautions (UP), and the use of anti-HCV positive patient dedicated monitors can stop the diffusion of HCV infection in a hospital haemodialysis centre. Since January 1990 to December 1991 (1st phase), the patients shared the monitors irrespective of their serological status for HCV, and training of the dialysis care staff was not performed with regard to the UP. Since January 1991 to June 1996 (2nd phase), according to the UP, strictly personal dialysis-tools were used for all patients, anti-HCV positive patients were assigned to dedicated monitors in defined (not separated) areas of the dialysis rooms and the dialysis care staff was trained to the strict observance of the UP. In the first phase of the follow-up 5 seroconversions occurred; none occurred in the second one. Our study shows that isolation is not required for such patients. We believe that measures such as the application of UP, dedicated machines and continuous training of the care staff, instead of the isolation of positive patients, result in the same efficacy and are cheaper than isolation of positive patients. Therefore they are mandatory for all haemodialysis centres.

Cross Infection↗
PubMed1994

An evaluation of hospital emergency department (HED) adherence to universal precautions.

A longitudinal cross sectional study of Hospital Emergency Department (HED) procedures over a nine month period was conducted. A total of 1,541 procedures were observed on 56 randomly selected 8-h work shifts. Shifts were distributed: 34% day shift; 34% evening shift; and 32% on the night shift. Observations on the evening shift were oversampled to capture an adequate number of trauma patients. Observations were distributed: 33% day shift; 39% evening shift; and 28% on the night shift. Measurements included: type of procedure; adherence to specific barrier technique, i.e., use of gloves, gowns, masks, and eye protection; and occurrence of adverse exposure. Ten types of HED procedures were documented and analyzed. Computerized tracking of study observations established periodic rates of HED health care worker (HCW) adherence to universal precautions. These data are important for internal quality control/assurance programs and rate comparisons within and across institutions over time. The longitudinal evaluation of the database revealed that glove compliance increased over the period of the study and adverse exposure decreased. Conducting ongoing or periodic observational studies of this kind are important and necessary in order to gauge HED response to the epidemiologic challenges of urban society.

Cross-Sectional Studies↗
PubMedDate not supplied

Mucocutaneous exposure to body fluids during digestive endoscopy: the need for universal precautions.

BACKGROUND: Endoscopy personnel are at high risk of exposure to infectious body fluids during endoscopy. There are no studies documenting the frequency of such exposure. AIM: To determine the frequency of exposure to body fluids, and factors that may modify the risk of exposure during digestive endoscopy. METHODS: During a 10-month period, 948 endoscopy procedures done by two endoscopists were assessed for the occurrence of splashes to uncovered parts of the body. Odds ratio was used to determine any change in the exposure risk with different risk factors. RESULTS: The overall frequency of splash to any part of the body was 13.2% (95% CI 10.8-15.9). Common sites of exposure were the eyes, face, forearms and feet. Splash to the skin of the face, forearms and feet occurred in 9.5% (95% CI 7.5-11.8). The risk remained unchanged during therapeutic endoscopy, assisted endoscopy, or endoscopy with biopsy or cytology. Using video endoscopy led to significant reduction in splashes on the skin. Overall splash rate to the eyes was 4.1% (95% CI 2.9-5.6). This remained unchanged during therapeutic endoscopy, assisted endoscopy, and endoscopic biopsy or cytology sampling. The risk was not reduced during video endoscopy. CONCLUSIONS: Endoscopy results in muco-cutaneous exposure to potentially infectious body fluids in 13% or more procedures. The risk of exposure is not reduced by video endoscopy, or by avoiding instrumentation of the biopsy channel. We recommend that all endoscopists and endoscopy assistants must follow universal precautions.

Body Fluids↗
PubMed1998

[Poor compliance with universal precautions among Danish physicians].

In a nation-wide survey among Danish doctors, the compliance and reasons for non-compliance with universal precautions (UP) and the associated circumstances of mucocutaneous blood exposure (MCE) were studied. Of 9384 questionnaires, 6256 (67%) were returned and 6005 were eligible for analysis. Only 35% complied with the basic principles of UP. Compliance with protective barrier use in surgical versus non-surgical specialties was: Gloves 63.0% and 23.4%, masks 55.2% and 17.6% and protective eyewear 11.5% and 4.0% respectively. Common given reasons for non-compliance were: "Interferes with working skills", "forget", "wear spectacles", "not available", "too much trouble to get" or "gloves do not fit". Of 741 MCE described in detail, an estimated 84-98% were potentially preventable if appropriate barriers had been worn. More than half of MCE were preventable by two interventions only: Compulsory use of protective eyewear during operations and of gloves during insertion of peripheral i.v.-catheters. In conclusion compliance with UP is unacceptably low and the majority of MCE were potentially preventable if appropriate barriers had been worn.

Accidents, Occupational↗