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PubMed1991

Glove use by health care workers: results of a tristate investigation.

The Center for Devices and Radiological Health, in collaboration with the state health departments of Iowa, Maryland, and Massachusetts, conducted a multi-state, multi-institutional investigation of glove use by health care workers (HCWs). Twenty-two hospitals and four ambulatory care centers were included in the investigation. All 26 health care facilities were found to have adopted universal precautions policies for glove use by HCWs, per Centers for Disease Control guidelines. Four hundred five observations were made of HCWs performing procedures that may involve contact with patient body fluids, particularly blood. The prevalence of glove use during selected procedures was as follows: arterial blood gas procedures, 92.3%; intravenous line initiation/maintenance, 77.6%; and phlebotomy, 70.6%. Glove use during phlebotomy (p less than 0.001) and intravenous line procedures (p less than 0.05) was significantly lower in the state with a prevalence of the acquired immunodeficiency syndrome (AIDS) below the national average than in the states with a higher AIDS prevalence. The investigation suggests that health care facilities have responded to the Centers for Disease Control and Occupational Safety and Health Administration campaign to adopt universal precaution policies for glove use by HCWs. Actual glove use by HCWs appears to be substantial but not universal. Glove use by HCWs is significantly related to statewide AIDS prevalence.

Acquired Immunodeficiency Syndrome↗

PubMed1994

Effectiveness of and compliance to preventive measures against the occupational transmission of human immunodeficiency virus.

To prevent the occupational transmission of human immunodeficiency virus (HIV) and other blood-borne infections in health care settings, guidelines have been issued as universal precautions and body substance isolation. Patient testing has also been advocated. The literature on the compliance to and effectiveness of these measures was reviewed and analyzed to establish the state of knowledge and make appropriate recommendations to improve guidelines. It showed that workers' compliance to recommended measures is relatively poor. The effectiveness and cost-effectiveness of universal precautions and body substance isolation remain to be demonstrated. Testing patients for HIV infection and other bloodborne pathogens does not appear to be a more appropriate solution. Focus should be placed on preventing parenteral exposures and applying risk assessment methods to identify health care settings and procedures at higher risk. These measures would allow safer medical devices to be targeted and would ensure that financial resources would be available to implement appropriate preventive measures.

Guidelines as Topic↗

PubMed1993

The risk of exposure of third-year surgical clerks to human immunodeficiency virus in the operating room.

The exposure of third-year medical students to blood and blood products in the operating room was assessed with a questionnaire distributed at the end of their clerkship in surgery. Sixty-six (68%) of ninety-seven students reported having been exposed to blood in the operating room during their 3-month rotation in surgery. During the year there was a decrease in the exposure rate that correlated with the students' knowledge of universal precautions (r = .96). Consistent with this observation was a significant decrease in the exposure rate from the first quarter of the year to the last quarter (88% vs 56% of the students). Of the 32 students stuck or cut in the operating room, 21 (66%) were injured by the surgeon. These data underscore the risk to medical students during their clerkships and the important role that universal precautions had in their protection.

Accidents, Occupational↗

PubMed1993

Salmonella poona infection and surveillance in a neonatal nursery.

BACKGROUND: This article reports the first known outbreak of Salmonella poona infection in a neonatal unit. Three babies had stool cultures positive for the organism. At the same time, S. poona was the cause of a nationwide food-borne outbreak associated with contaminated canteloupe. To minimize the neonatal outbreak, surveys were performed and control measures were instituted. METHODS: Epidemiologic surveillance included the culture of rectal swabs collected from 48 employees, 18 babies, and four family members of the babies. Control measures used included the placement in cohorts and isolation of infected babies, strict adherence to universal precautions, and the restriction of visitation in the nursery. RESULTS: A total of three babies and one employee in the surveillance were found to have Salmonella sp. An additional two hospitalized adult patients had S. poona. Of all the people included in the surveillance, only the three babies were found to have S. poona. The hospital employee had S. enteritidis. CONCLUSIONS: Timely culture results, rapid cohort placement of infected babies, and strict adherence to universal precautions led to the successful eradication of the organism.

Adult↗

PubMed2004

Blood exposure: factors promoting health care workers' compliance with guidelines in connection with risk.

BACKGROUND: Health care workers compliance with guidelines, universal precautions, in connection with tasks that could involve contact with patient's blood is unsatisfactory. In a previous paper, we identified different forces that undermine compliance. Socialization into infection control, routinization, stereotyping, perceptions of patients' wishes and the presence of competing values and norms are examples of such forces. AIMS AND OBJECTIVES: The aim of this article is to describe and analyse different forces that promote adherence to universal precautions. Behavioural variations are seen as a consequence of differences between wards with regard to the safety culture. Safety culture is conceptualized as the outcome of a constant interplay between deactivating and reactivating forces. In this article the focus is on the latter. METHOD: The grounded theory approach. Data were collected through interviews with nurses and assistant nurses. RESULTS: The charge nurse, informal leaders, students, infection control nurses, type of work, availability of equipment, blood-exposure incidents and media-coverage of infectious diseases are described as potentially important for compliance. The properties these agents must possess in order to be influential are also described. RELEVANCE TO CLINICAL PRACTICE: The outcome of an occupationally acquired infection can be fatal. Hence it is important that health care workers take protective measures. The results imply that mere information about safe practices alone is insufficient to achieve that goal. All factors of importance for compliance must be taken in to consideration in clinical work and in education.

Attitude of Health Personnel↗

PubMed2001

The prevalence of, and factors related to, compliance with glove utilization among nurses in Hospital Universiti Sains Malaysia.

Increasing risk of HIV infections among health care workers has been a continuing concern. The study was designed to identify the compliance of glove utilization, and factors related to non-compliance. A sample of 150 staff nurses were recruited from the study population of 550 nurses in Hospital Universiti Sains Malaysia. Data were collected by using a structured self-administered questionnaires. The response rate was 98.4%. The study revealed a low compliance (13.5%) of glove utilization (for all 9 procedures), which varied among different procedures (27-97%). Younger nurses and those with shorter duration of working experience had better knowledge of Universal Precautions. Nurses in intensive care unit and operation theatre were better in both knowledge and compliance of glove utilization. The three commonest misconceptions were identified as "selective use of gloves for high risk groups and suspected cases", and "tendency to depend on HIV prevalence". Nurses reported practical problems including administrative and personal related such as "stock irregularity" (46%), "glove not available at the emergency sites" (44%), and "reduction of tactile sensation" (39%). It was concluded that poor knowledge and practical problems were possible responsible factors for the low compliance. A good training for nurses comprising principle and practice of Universal Precautions, updated knowledge of blood and body fluid borne infections and risk and its management, will probably improve the compliance.

Adult↗

PubMed2003

Education about treating patients with HIV infections/AIDS: the student perspective.

This study investigated dental and dental hygiene students' a) perceptions of their education about treating patients with HIV infections/AIDS, b) knowledge of universal precautions, c) attitudes towards treating these patients and patients perceived to be at risk for HIV infections, and d) evaluations of potential curricular activities such as discussion groups with HIV-infected patients. Data were collected with self-administered questionnaires from 315 dental and 89 dental hygiene students. On average, dental students reported having learned about this topic in fever courses than dental hygiene students. However, dental students answered significantly more knowledge questions about universal precautions correctly than did dental hygiene students. This knowledge increased over the program course. Male students had significantly stronger negative attitudes towards patients at risk for or with HIV infections/AIDS than female students. Overall, dental and dental hygiene students responded positively to the suggested methods for including more material about patients with HIV infections/AIDS such as case studies, discussion groups, and closely supervised clinical experiences. This study shows that dental and dental hygiene students are interested in learning more about treating patients with HIV infections/AIDS. It also adds information to previous research on factors involved in the dental healthcare providers' decisions to treat patients at risk for or with HIV infections/AIDS. The implications of these findings for curriculum development efforts are discussed.

Acquired Immunodeficiency Syndrome↗

PubMed2004

Healthcare worker safety is a pre-requisite for injection safety in developing countries.

Unsafe injection practices, including the re-use of unsterile needles and syringes, are commonplace in developing country health settings, and contribute substantially to the global burden of blood-borne viral disease. Unsafe injection practices place at risk not only patients, but also healthcare workers, who practice universal precautions inconsistently and are commonly exposed to blood in the course of their work. Global awareness of the link between unsafe injection practices and the burden of blood-borne viral disease was slow to emerge but has grown in the recent years. In 1999, the World Health Organization (WHO) established the Safe Injection Global Network (SIGN), which advocates a range of interventions for the promotion of injection safety. As well as exhorting healthcare workers to use a new needle and syringe for every injection, they should also be encouraged and supported to protect themselves from exposure to blood. It is argued here that promoting the occupational safety of healthcare workers in developing countries is an essential and currently under-valued component of the response to the problem of unsafe injection practices. Protecting healthcare workers from occupational infection with blood-borne viruses has a range of potential benefits, including safer injection practices for patients and less discrimination against people with HIV/AIDS. There is an urgent need for organisational commitment to the occupational safety of healthcare workers in developing countries, along with the provision of training in injection safety and universal precautions, adequate supplies of personal protective equipment, and hepatitis B vaccination.

Blood-Borne Pathogens↗

PubMed1992

Impact of human immunodeficiency virus on medical and surgical residents.

BACKGROUND--Previous surveys of resident physicians on human immunodeficiency virus (HIV) matters have tended to focus on urban programs serving a patient population with an expected high prevalence of HIV infection. The objective of this study was to survey a community hospital residency program in a nonurban area with a perceived low HIV patient seroprevalence. METHODS--A 32-question survey was completed on an anonymous basis by the entire 74 member multidisciplinary resident physician group at a two-campus university-affiliated hospital program in southeastern Pennsylvania in May 1991. RESULTS--Residents perceived their patient population's HIV seroprevalence rate to be low although they believed their personal risk of occupational exposure to blood-borne infection was moderate to high. House staff most often complied with universal precautions for fear of acquiring a blood-borne illness and most often did not comply because of time constraints. Not perceiving the exposure as a health risk was the primary reason for nonreporting of exposures. Occupational exposure rates were alarmingly high, with suturing using a curved needle being the most common exposure method. Most residents were unfamiliar with HIV legislation. A majority of the house staff wanted improved HIV patient management training and life and disability insurance against occupationally acquired HIV. Many other important issues were addressed in this survey. CONCLUSION--Residents even in low seroprevalence environments do fear occupationally acquired HIV. A great need exists for improved training in universal precautions, acquired immunodeficiency syndrome legislation, and HIV patient management as well as for insurance against occupationally acquired HIV.

Acquired Immunodeficiency Syndrome↗

PubMed1993

Patient-to-patient transmission of hepatitis B in a dermatology practice.

OBJECTIVE: The purpose of the study was to investigate infection with hepatitis B virus (HBV) and human immunodeficiency virus (HIV) among patients in a dermatology practice. METHODS: Historical cohort, matched case-control, and cross-sectional survey methods were used. RESULTS: The age-specific incidence of reported HBV infection in the practice from 1985 through 1991 was more than 12 times the expected rate. The dermatologist was not an HBV carrier. He practiced neither universal precautions nor sterile surgical technique. Seroprevalence of markers for HBV infection was highest (36.8%) among patients who had had surgery on the same day that HBV was apparently acquired by an index case; seroprevalence was near the expected background level for patients not exposed to index cases. Of HBV-infected patients with known dates of onset, 72% had had surgery during their incubation periods. All of 30 HBV antigen specimens tested were of the same subtype. None of the patients tested, including 74 patients exposed to surgery on the same day as a patient with acquired immunodeficiency syndrome, had evidence of HIV infection. CONCLUSIONS: HBV, but not HIV, was transmitted from patient to patient by the dermatologist's failure to apply either universal precautions or sterile surgical technique.

Acute Disease↗

PubMed2004

Needlestick and sharps injuries among nurses in the healthcare sector in a city of western Turkey.

The aims of this study were to determine the rate of bloodborne infections after needlestick and sharps injuries in nurses at work, to estimate the number of vaccinations administered, and to assess whether universal precautions were being followed. The study involved 289 nurses working in five hospitals and six primary healthcare centres. Between 1 April 2002 and 31 June 2002, a total of 139 practising nurses were included in the study following a needlestick or sharps injury. The results of completed questionnaires were collated, and Chi-squared test was used for analysis. The rate of hollow-bored needle-related injuries was 76.2% (106/139). Most nurses (69.1%) did not report any details of their injuries and 32.4% (45/139) of nurses had not been vaccinated against hepatitis B virus (HBV). Only 5.3% of the nurses who responded to the compliance question indicated that they always complied with universal precautions. Of 139 nurses, 1.4% and 7.9% showed evidence of HBV infection and hepatitis C virus (HCV) infection, respectively. All those who had hepatitis B were aged 30 years or under, whereas most of those who were anti-HCV positive (81.8%) were over 30 years old (P < 0.05). Nurses working in the Turkish healthcare sector are frequently exposed to bloodborne infections. Precautions and protection from needlestick and sharps injuries are important in preventing infection of nurses. Education about the transmission of bloodborne infections, vaccination and post-exposure prophylaxis must be implemented. Further investigations are warranted to elucidate the risk to nurses of contracting these potentially serious infections.

Adolescent↗

PubMed1992

Human immunodeficiency virus transmission in health care settings. Risks to health care workers.

Taken together, studies of seroconversion, exposure incidents, and compliance with Universal Precautions Policy help researchers understand the risks to health care workers of occupationally acquired HIV infection. The seroconversion studies show that the risk of infection is low (1 in 250) even when the incident is a percutaneous exposure to blood from a known HIV-positive patient. When the exposure is to blood from a patient whose HIV-status is unknown, or if the exposure is not through the skin, or if the exposure is to a body substance other than blood, the risk is considerably lower. The studies of exposure incidents show that for most health care workers, percutaneous exposures to blood are infrequent. Studies of compliance with Universal Precautions Policy show that exposure incidents that do occur can be prevented nearly half the time. The risk of patient-to-provider transmission of HIV is small but not completely negligible. This small risk can be made even smaller by adhering to recommended infection control guidelines, but it cannot be eliminated completely. Although most health care workers enter the medical field accepting that their work may expose them to infectious agents, there is still a desire for risk-free practice. Achieving an entirely risk-free practice is probably impossible; it is certainly not within reach today. For the foreseeable future, the only reasonable course is to fully understand the risks, to enter into practice psychologically prepared to accept these risks, and to practice in a way that minimizes exposures without compromising patient care.

Acquired Immunodeficiency Syndrome↗

PubMed1997

A descriptive study of blood exposure incidents among healthcare workers in a university hospital in Sweden.

In an attempt to document blood exposure incidents and compliance with recommended serological investigations, universal precautions and incident reporting routines, data was collected from occupational injury reports during a two-year period. In addition, a sample of healthcare workers (HCWs) answered a questionnaire about blood tests and work routines. In a third part of the study some HCWs were asked about the type and actual frequency of incidents, together with the number of reported incidents during the two-year study period. Of a total of 473 reported occupational blood exposures, the majority came from nurses and the minority from physicians. Most reported incidents occurred on hospital wards. The most common incidents were needlestick injuries, and 35% occurred when the needle was recapped. Medical laboratory technicians (MLT) reported significantly more mucocutaneous incidents than other professionals (P < 0.01). In 10% of the incidents, the patient had a known blood-borne infection. Serological investigations post-exposure varied among professional groups, and 35% were not tested. No seroconversion was shown in the HCWs tested. In the third part of the study, respondents recalled 1180 incidents, although only 9% of these had been reported. The majority occurred in operating theatres, and in connection with anaesthesia. There was a significant difference (P < 0.001) between the different professional groups with regard to the frequency of incident reporting. Physicians reported only 3% and MLTs 36% of the incidents. Eighty-one percent believed that the accident could have been avoided. Despite knowledge of universal precautions, professionals continue to behave in a risky manner, which can result in blood exposure incidents.

Adolescent↗

PubMed1994

Reality of glove use and handwashing in a community hospital.

BACKGROUND: Since the advent of universal precautions and body substance isolation, few studies have examined the relationship between glove use and handwashing. METHODS: During a 5-month period in 1991, 477 structured observations were conducted on 19 patients care units at a community teaching hospital during each of three shifts. Patient care contacts were defined as either high level or low level according to potential for blood or body fluid contact. RESULTS: Health care workers were potentially exposed to body fluids (high-level contact) on 152 occasions. Eighty-eight percent of all high-level contacts were limited to the hands; 47% of these contacts occurred during the night shift. Handwashing occurred after 32% of high-level contacts. Health-care workers wore gloves in 57% of high-level contacts. Rates of handwashing and glove use varied markedly among patient care units. Correct handwashing (> or = 9 seconds) occurred after 20% of contacts when health care workers wore gloves but after only 3% of high-level contacts when gloves were not used (p = 0.004). CONCLUSIONS: Despite universal precautions or body substance isolation, educational efforts, and written policies, rates of handwashing and glove use are inadequate in cases of potential blood and body fluid contact. The perceived need for gloves may encourage handwashing.

Blood↗

PubMed1989

HIV and the older adult taking the necessary precautions.

1. With the awareness that the population of older adults with whom nurses and other health-care workers come in contact may indeed be HIV infected, the need for universal precautions becomes imperative in all health-care settings. 2. The subpopulations of older adults in which HIV infection is most likely to be concentrated are the same as those for any other age group; ie, homosexual and bisexual men, IV drug users and their partners, people who have received blood products, and sexual partners of people who are HIV infected. 3. It is important for nurses to recognize that older adults may be manifesting the signs of symptoms of AIDS; for example, some people diagnosed with Alzheimer's disease may actually have AIDS-related dementia. 4. Gerontological nurses need to be the initiators of implementing universal precautions in their health-care settings.

Aged↗

PubMed1998

Testing a new alcohol-free hand sanitizer to combat infection.

Universal precautions require that perioperative health care personnel wash their hand before and after all patient contact. Time constraints, however, can make adhering to universal precautions, including proper hand washing, difficult. Some perioperative health care workers, therefore, routinely use rise-free hand sanitizers to supplement normal hand washing. This study evaluated immediate and persistent antimicrobial effectiveness of two alcohol--containing hand sanitizers and a novel surfactant, allantoin, benzalkonium chloride (SAB) hand sanitizer using a federally approved effectiveness protocol. Results indicate that all three products were equally effective after a single application. After repeated use, the alcohol-containing sanitizers did not meet federal performance standards, and the alcohol-free sanitizer did. These properties and others illustrated in this article indicate that the nonflammable, alcohol-free SAB hand sanitizer is the most favorable of the rise-free hand sanitizer formulas for normal hand washing.

Adolescent↗

PubMed1992

HIV issues for rural hospitals in U.S. frontier areas.

A Survey of 108 hospital administrators in the eight states of the Mountain Census Region was conducted to identify frontier rural hospitals' experiences (fewer than 50 beds) in the provision of care and services to patients with HIV infection; to assess the availability of HIV care and services in these small, remote rural hospitals; and to assess the status of education and policy development related to HIV infection. Of the 62 hospitals that responded, 16 (26%) had provided care and services to HIV-infected patients. Acute inpatient and emergency room care were the services most commonly utilized. An additional 11 hospitals reported the presence of HIV-positive individuals in their medical service areas. Thus, nearly 44 percent of the hospitals were aware of the importance of addressing HIV infection as a local concern. Employees in the hospitals that had experienced caring for HIV-positive persons expressed more concern about acquiring HIV infection than those in hospitals that had not. Four nursing assistants, two registered nurses, and one dietary worker had refused to provide care. HIV education consisted primarily of video programs, presentations by in-house staff, and sending employees away to workshops. Despite this HIV education, most staff remain fearful of caring for HIV infected patients. Major concerns expressed by the hospital administrators were related to enforcing universal precautions, confidentiality, staff response, community acceptance, and cost of care. Only 30 hospitals (48%) had AIDS policies in effect, and these focused primarily on infection control and universal precautions.(ABSTRACT TRUNCATED AT 250 WORDS)

HIV Infections↗

PubMedDate not supplied

Knowledge and attitude assessment of Quebec daycare workers and parents regarding HIV/AIDS and hepatitis B.

ISSUES: Cases of discrimination occur in Quebec daycares towards HIV-positive children as well as HIV-negative children born to seropositive parents. OBJECTIVES: Offer three-hour information sessions on bloodborne diseases, specifically HIV and hepatitis B, universal precautions, as well as legal, ethical and psychosocial aspects of HIV/AIDS to: 1) ensure that daycare workers have basic medical information on transmission of HIV and other bloodborne infections, 2) review basic hygiene including universal precautions, 3) link daycares to HIV/AIDS resources in their communities, and 4) facilitate the development of pro-active daycare policies for the integration of HIV-positive children. RESULTS: In total, 108 information sessions were given, in which 349 daycares participated. Results show an important difference in terms of knowledge and attitudes of the participants. Of the daycares which participated in the information sessions, 37% have developed their own pro-active policy.

Adult↗