Kelen G, Fleetwood D, DiGiovanna T; International Conference on AIDS.
Int Conf AIDS. 1990 Jun 20-23; 6: 424 (abstract no. 3090).
Division of Emergency Medicine, Johns Hopkins University, Baltimore, MD, USA
OBJECTIVE: To determine the effect on HCW behavior of an institutional policy mandating adherence to Universal Precautions, with repercussions for non compliance. METHODS: During July 1989, exactly 1 year after the previous study using the same methodology, health care workers (HCWs) were observed 24 hours a day in the emergency department performing procedures on every patient with critical illness or injury who required immediate intervention. HCWs were blinded as to the purpose of the observer. Mid-year between the two studies, the institution initiated a policy mandating compliance with infection control precautions. Educational programs were unchanged. Expected precautions were based on type of intervention and bleeding status of the patient. Interventions were classified as a major, minor, or physical exam only. Bleeding status was defined as profuse, active or none. For major procedures or profuse bleeding, all precautions were required (gloves, gown, mask eye protection). For minor procedures or active bleeding, at least gloves were required. RESULTS: During the month, 125 HCWs performed 1,419 procedures on 168 patients. Overall adherence improved to 74.4% compared to 44.0% in the previous year (P less than .01). Most providers improved substantially: residents 58% to 82%, attendings 38% to 64%, consultants 43% to 65%, nurses 44% to 75%, radiology 14% to 79% (each P less than .01). Paramedics, who are not accountable to the institution, failed to improve: 8% to 14% (p greater than .2). Adherence during major procedures improved from 17% to 55%, and in the face of profuse bleeding from 19.5% to 47% (P less than .01). At least gloves were worn 85% of the time when indicated. Spot checks up to 2 months following the study revealed adherence to precautions was maintained at 73%. CONCLUSION: As evidenced by comparing paramedics to other providers, implementing Universal Precautions as policy can dramatically improve provider compliance.
Publication Types:
Keywords:
- Allied Health Personnel
- Emergency Service, Hospital
- Gloves, Protective
- Guideline Adherence
- Health Personnel
- Hospital Departments
- Humans
- Protective Clothing
- Universal Precautions
- methods
Other ID:
UI: 102197281
From Meeting Abstracts