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

Community health care workers’ risk perception of occupational exposure to HIV in Ibadan, south-west Nigeria

Background: The ultimate goal of all healthcare workers (HCWs) is to maintain a healthy population and environment, and to adequately manage any condition that might constitute a menace to the health of the population at large. However, the central problem arising from the perception of risk of occupationally transmitted Human Immunodeficiency Virus (HIV) infection amongst HCWs is that it may distract them from giving quality healthcare. Objectives: The study aimed at addressing the following objectives: to explore the effects of level or years of experience on risk perception regarding occupational exposure to HIV, to assess HCWs’ daily work routines’ consistency in accordance with universal precaution guidelines, to determine HCWs’ perception of workplace safety climate and identify factors that may constitute constraints to HCWs in adhering to universal precaution measures.Method: A descriptive cross-sectional survey design was utilised, using a triangulation method of data collection which involved the use of a questionnaire and direct observational methods using checklists. A total of 143 HCWs were purposively selected to form the study population.Results: The study showed a very high risk-perception amongst HCWs regarding occupational exposure to HIV and AIDS but a poor compliance with universal precautions in their professional duties. HCWs perception of risk and workplace safety climate did not influence their compliance with universal precautions (Pr > F = 0.2566; Pr > F = 0.2776).Conclusion: The need for policy guidelines to manage all aspects of risk-perception and practices of HCWs regarding HIV and AIDS in the healthcare settings most especially at the primary health care level need to be considered.

Prevalence of injuries and reporting of accidents among health care workers at the University Hospital of the West Indies

OBJECTIVES

This study investigated the knowledge, awareness and practices of health care workers towards universal precautions at the University Hospital of the West Indies. The study also examined the prevalence of injuries experienced by health care workers, as well as incidence of accidents and compliance with post-exposure prophylaxis.

MATERIALS AND METHODS

A cross sectional survey was conducted in September and October 2007. A 28-item self-administered questionnaire was provided to two hundred health care workers including medical doctors, medical technologists, nurses and porters to assess knowledge and practices regarding universal precautions, prevalence of injuries and incidence of accidents.

RESULTS

Almost two-thirds (62.3%) of the respondents were aware of policies and procedures for reporting accidents while one-third (33.2%) were unsure. All nurses were aware of policies and procedures for reporting accidents, followed by medical doctors (88%) and medical technologists (61.2%). The majority (81.5%) of the respondents experienced splashes from bodily fluid. Over three-quarters of medical doctors (78%) and two-thirds of nurses (64%) reported having experienced needle stick injuries, while the incidence among medical technologists was remarkably lower (26%). The majority of the respondents (59%) experienced low accident incidence while just over one-tenth (14%) reported high incidence. Eighty four respondents reported needle stick injuries; just under two-thirds (59.5%) of this group received post-exposure treatment.

CONCLUSIONS

The study found that majority of health care workers were aware of policies and procedures for reporting accidents. Splashes from body fluids, needle stick injuries and cuts from other objects were quite prevalent among health care workers. There is a need for monitoring systems which would provide accurate information on the magnitude of needle stick injuries and trends over time, potential risk factors, emerging new problems, and the effectiveness of interventions at The University Hospital of the West Indies and other hospitals in Jamaica.

["Standard precautions" practices among nurses in a university hospital in Western Algeria]

Health care workers are exposed daily to blood borne injury and infection with a high risk of hepatitis B or C and human immunodeficiency virus (HIV) transmission. In the 1980s, the US Centers for Disease Control and Prevention (CDC) developed a set of protocols and guidelines known as standard precautions (SP) to prevent accidental transmission of pathogens. The SP should be followed for each intervention or delivery of care in order to protect health care workers from risks associated with contact with blood and other biological liquids. A survey was conducted in a Western Algerian university hospital to assess nurses' adherence to SP practices. A questionnaire was administered to 450 nurses in the hospital workplace setting. A field survey was also conducted in order to take into account the means and support available to the nurses in these hospital departments, namely to determine availability of hand washing and drying facilities. A total of 133 nurses, 81 women and 52 men, participated in the survey. Personal and professional data, hand-washing frequency, glove wearing practices were collected as data. A large majority (95%) of nurses reported washing their hands after removing their gloves, and 69% of them reported washing their hands between two patients. Male nurses wear gloves more often than females (respectively 77% and 53%). Sharp instruments were correctly disposed of in a puncture-resistant container more of the time. Recapping needles has been reported by two-thirds of survey respondents. Lack of liquid soap and alcohol-based washing solution were noted as major deficiencies as well as the lack of means to properly dry hands in many health care wards. Lack of SP adherence is primarily due to the lack of awareness and knowledge as well as insufficient supply of equipment and materials for good hand hygiene maintenance. This study highlights the urgent need to implement a programme to improve SP adherence among nurses and to increase the supply of hand washing and drying materials. Greater adherence to SP practices will also reduce the risk of occupational exposure to blood borne injury and infection.

Poor knowledge--predictor of nonadherence to universal precautions for blood borne pathogens at first level care facilities in Pakistan

Background

We conducted an assessment of knowledge about blood borne pathogens (BBP) and use of universal precautions at first level care facilities (FLCF) in two districts of Pakistan.

Methods

We conducted a cross-sectional survey and selected three different types of FLCFs ; public, general practitioners and unqualified practitioners through stratified random sampling technique. At each facility, we interviewed a prescriber, a dispenser, and a housekeeper for knowledge of BBPs transmission and preventive practices, risk perception, and use of universal precautions. We performed multiple linear regression to assess the effect of knowledge score (11 items) on the practice of universal precautions score (4 items- use of gloves, gown, needle recapping, and HBV vaccination).

Results

We interviewed 239 subjects. Most of the participants 128 (53%) were recruited from general practitioners clinics and 166 (69.5%) of them were dispensers. Mean (SD) knowledge score was 3.8 (2.3) with median of 4. MBBS prescribers had the highest knowledge score while the housekeepers had the lowest. Mean universal precautions use score was 2.7 ± 2.1. Knowledge about mode of transmission and the work experience alone, significantly predicted universal precaution use in multiple linear regression model (adR² = 0.093).

Conclusion

Knowledge about mode of transmission of blood borne pathogens is very low. Use of universal precautions can improve with increase in knowledge.

Knowledge, attitude, and practices related to standard precautions of surgeons and physicians in university-affiliated hospitals of Shiraz, Iran

OBJECTIVE

To measure levels of knowledge, attitudes, and practice toward standard precautions (SP) in medical practitioners of Shiraz University of Medical Sciences affiliated hospitals in Iran.

METHOD

In this cross-sectional study, knowledge, attitude, and practice related to SP among four medical staff groups - surgeons, surgical residents, physicians and medical residents - were assessed using a questionnaire.

RESULTS

Across the four medical staffing groups the median levels of knowledge ranged from 6 to 7 (maximum score 9), median attitude scores were high ranging from 35 to 36 (maximum score 45), while median practice scores were low, ranging from 2 to 3 (maximum score 9). A moderate relationship between knowledge and attitudes was found in surgical residents and medical residents (r=0.397, p=0.030 and r=0.554, p=0.006, respectively). No significant correlation was found between knowledge and practice between the groups. A significant but poor (r=0.399, p=0.029) relationship between attitude and practice was found in surgical residents.

CONCLUSION

Specific training programs may have to target newly graduated medical practitioners to establish acceptance of appropriate practices that will enable them to adopt and adhere to SP while their older counterparts may require more intense continuous assistance.

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.

An intervention study to evaluate nursing management of peripheral intravascular devices

This study examined the impact that implementation of guidelines for the management of peripheral intravascular devices had on nurses' knowledge and practice as well as patient outcome. A pre- and posttest nonequivalent experimental study was conducted in a Hong Kong tertiary care teaching hospital. The results showed that the percentage of correct answers for all questions was significantly higher at the posttest. The overall results also showed significant practice improvement in terms of the flushing agent used, documentation, and site dressing. There also was a decrease in the incidence of extravasation and phlebitis. It was concluded that evidence-based practice is important for improving patient outcomes. Compliance with the guidelines served as an important measure for the prevention of intravascular device-related complications.

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.

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.

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.

Using peer feedback to improve handwashing and glove usage among Thai health care workers

BACKGROUND

Without protective practices such as Universal Precautions, health care workers are at substantial risk for bloodborne infection, especially in areas such as Thailand with high prevalence of HIV infection. The purpose of this study was to evaluate the effectiveness of a peer feedback program (PFP) on handwashing and glove wearing (HW/GW) among Thai health care workers.

METHODS

Subjects (N = 91) were randomly assigned to receive PFP versus no treatment. By using a checklist, peer observers rated HW/GW compliance in their coworkers during patient care. For 1 month, the investigator posted a report of compliance behaviors from each 3 days of observations. HW/GW was also assessed by the investigator by direct observation at 1 month before the intervention, during the intervention period, and 1 month after the intervention.

RESULTS

Baseline HW/GW rates for the PFP and control groups were 49.2% and 61.5%, respectively. The PFP group had a significantly higher adjusted compliance rate than the control group during the intervention period (P =.0001). However, there was no significant difference in the compliance scores obtained 1 month after the intervention.

CONCLUSIONS

The PFP was effective during the intervention period, but there was no retention of effect. Therefore, adjunct methods should be sought to promote retention of effect.