Noncompliance of Health Care Workers
Background. Universal precautions during resuscitations are mandated by hospital regulations. We documented adherence to universal precautions during trauma resuscitations at our level I trauma center.
Methods. During trauma resuscitations, a medical student using an elevated viewing platform observed health care workers (HCWs) for the use of barrier precautions (BPs): gloves, masks, gowns, and eyewear. Only HCWs having direct patient contact were included. The purpose of the observation was not disclosed to those being observed.
Results. In 12 resuscitations involving 104 HCWs, none had 100% compliance with BPs. Compliance rates for individual BPs were gloves, 98%; eyewear (any type), 52%; gowns, 38%; masks, 10%; and eyewear (with side protectors), 9%. Resuscitations in which bleeding was observed involved 59 HCWs with 38% compliance; only 2 used full BPs. No difference in compliance rates occurred during the study period.
Conclusions. Experienced trauma care HCWs are cavalier regarding blood-borne disease exposure risks. Measures to encourage (or force) compliance are needed.
The unpredictable nature of trauma resuscitations leads to a higher risk of transmission of blood-borne pathogens. For this reason, the Centers for Disease Control and Prevention, American College of Surgeons Committee on Trauma, and American College of Emergency Physicians all have issued policies regarding universal precautions, especially in situations such as trauma resuscitations. Most hospital policies mandate universal precautions. While universal precautions are a necessity during resuscitations, many HCWs seem not to take full advantage of BPs.
Although studies have shown varying rates (0.15% to 7.8%) of human immunodeficiency virus (HIV) in trauma patients, the rates of HIV infection seem to be higher in the trauma population compared with the general population. Since the prevalence of HIV is lower than that of most other blood-borne pathogens, the risk of hepatitis is even higher. Caplan et al found that one fourth of their trauma patients had a potential transmissible agent. Despite this increased risk, HCWs have low compliance with BPs in the emergency room. We investigated the BP compliance rate of HCWs during trauma resuscitations at our institution.
Background. Universal precautions during resuscitations are mandated by hospital regulations. We documented adherence to universal precautions during trauma resuscitations at our level I trauma center.
Methods. During trauma resuscitations, a medical student using an elevated viewing platform observed health care workers (HCWs) for the use of barrier precautions (BPs): gloves, masks, gowns, and eyewear. Only HCWs having direct patient contact were included. The purpose of the observation was not disclosed to those being observed.
Results. In 12 resuscitations involving 104 HCWs, none had 100% compliance with BPs. Compliance rates for individual BPs were gloves, 98%; eyewear (any type), 52%; gowns, 38%; masks, 10%; and eyewear (with side protectors), 9%. Resuscitations in which bleeding was observed involved 59 HCWs with 38% compliance; only 2 used full BPs. No difference in compliance rates occurred during the study period.
Conclusions. Experienced trauma care HCWs are cavalier regarding blood-borne disease exposure risks. Measures to encourage (or force) compliance are needed.
The unpredictable nature of trauma resuscitations leads to a higher risk of transmission of blood-borne pathogens. For this reason, the Centers for Disease Control and Prevention, American College of Surgeons Committee on Trauma, and American College of Emergency Physicians all have issued policies regarding universal precautions, especially in situations such as trauma resuscitations. Most hospital policies mandate universal precautions. While universal precautions are a necessity during resuscitations, many HCWs seem not to take full advantage of BPs.
Although studies have shown varying rates (0.15% to 7.8%) of human immunodeficiency virus (HIV) in trauma patients, the rates of HIV infection seem to be higher in the trauma population compared with the general population. Since the prevalence of HIV is lower than that of most other blood-borne pathogens, the risk of hepatitis is even higher. Caplan et al found that one fourth of their trauma patients had a potential transmissible agent. Despite this increased risk, HCWs have low compliance with BPs in the emergency room. We investigated the BP compliance rate of HCWs during trauma resuscitations at our institution.
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