Hostname: page-component-78c5997874-g7gxr Total loading time: 0 Render date: 2024-11-15T01:25:05.816Z Has data issue: false hasContentIssue false
  • English
  • Français

Noncompliance With Universal Precautions and the Associated Risk of Mucocutaneous Blood Exposure Among Danish Physicians

Published online by Cambridge University Press:  02 January 2015

Suzanne Nelsing ,
Thyge Lynghøj Nielsen  and
Jens Ole Nielsen
Suzanne Nelsing*
Affiliation:
Department of Infectious Diseases, Hvidovre University Hospital, Hvidovre, Denmark
Thyge Lynghøj Nielsen
Affiliation:
Department of Infectious Diseases, Hvidovre University Hospital, Hvidovre, Denmark
Jens Ole Nielsen
Affiliation:
Department of Infectious Diseases, Hvidovre University Hospital, Hvidovre, Denmark
*
Department of Infectious Diseases 144, Hvidovre University Hospital, Kettegaard allé, 30, 2650 Hvidovre, Denmark
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

To study the compliance, and reasons for noncompliance, with Universal Precautions and the associated circumstances of mucocutaneous blood exposure (MCE) among Danish physicians.

Design:

A nationwide questionnaire survey.

Setting:

All Danish hospitals.

Participants:

All hospital-employed physicians.

Results:

Of 9,384 questionnaires, 6,256 (67%) were returned, and 6,005 were eligible for analysis. Only 35% of respondents were compliant with the basic principle of Universal Precautions. Compliance with specific barriers in the preceding week among “surgeons and pathologists” and “other physicians” was as follows: gloves, 63.0% and 23.4%; masks, 55.2% and 17.6%; and protective eyewear, 11.5% and 4.0%, respectively. Common arguments for non-compliance were “interferes with working skills,” “forget,” “wear spectacles,” “not available,” “too much trouble to get,” or “gloves do not fit.”

Detailed descriptions of 741 MCEs were obtained. Blood splashes in the eyes (n=320) was the most common MCE in surgical specialties and pathology, whereas blood on the hands (n=290) was most common in other specialties. In 20% of MCEs of the eyes, the exposure occurred despite the use of spectacles. An estimated 84% to 98% of MCEs potentially would have been preventable had appropriate barriers been worn. More than one half of MCEs were preventable by two interventions only: compulsory use of protective eyewear during operations and use of gloves during insertion of peripheral intravenous catheters.

Conclusion:

Compliance with Universal Precautions is unacceptably low, as reflected by the circumstances of MCE. Increased efforts to ensure education in Universal Precautions, easy accessibility of protective barriers, and improved design of the barriers are necessary to improve compliance and reduce the risk of MCE.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 18 , Issue 10 , October 1997 , pp. 692 - 698
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1997

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Fitch, KM, Alvarez, LP, Medina, RDA, Morrondo, RN. Occupational transmission of HIV in health care workers. A review. European Journal of Public Health 1995;5:175–186.CrossRefGoogle Scholar
2. Mitsui, T, Iwano, K, Masuko, K, et al. Hepatitis C virus infection in medical personnel after needlestick accident. Hepatology 1992;16:1109–1114.CrossRefGoogle ScholarPubMed
3. Sartori, M, La Terra, G, Aglietta, M, Manzin, A, Navino, C, Verzetti, G. Transmission of hepatitis C via blood splash into conjunctiva. Scand J Infect Dis 1993;25:270–271. Letter.CrossRefGoogle ScholarPubMed
4. Centers for Disease Control. Recommendation for protection against viral hepatitis. MMWR 1985;34:313–325.Google Scholar
5. Centers for Disease Control. Recommendations for prevention of HIV transmission in health-care settings. MMWR 1987; 36(suppl):1S–18S.Google Scholar
6. Kelen, GD, Green, GB, Purcell, RH, et al. Hepatitis B and hepatitis C in emergency department patients. N Engl J Med 1992; 326:1399–1404.CrossRefGoogle ScholarPubMed
7. De Carli, G, Puro, V, Binkin, NJ, Ippolito, G, the Italian Study Group on Occupational Risk of HIV Infection. Risk of human immunodeficiency virus infection for emergency department workers. J Emerg Med 1994;12:737–744.Google Scholar
8. Hammond, JS, Eckes, JM, Gomez, GA, Cunningham, DN. HIV, trauma, and infection control: Universal Precautions are universally ignored. J Trauma 1990;30:555–558.Google Scholar
9. Henry, K, Campbell, S, Collier, P, Williams, CO. Compliance with Universal Precautions and needle handling and disposal practices among emergency department staff at two community hospitals. Am J Infect Control 1994;22:129–137.Google Scholar
10. Kristensen, MS, Wernberg, NM, Anker-Moller, E. Healthcare workers' risk of contact with body fluids in a hospital: the effect of complying with the Universal Precautions policy. Infect Control Hosp Epidemiol 1992;13:719–724.CrossRefGoogle Scholar
11. Stotka, JL, Wong, ES, Williams, DS, Stuart, CG, Markowitz, SM. An analysis of blood and body fluid exposures sustained by house officers, medical students, and nursing personnel on acute-care general medical wards: a prospective study. Infect Control Hosp Epidemiol 1991;12:583–590.CrossRefGoogle ScholarPubMed
12. Becker, MH, Janz, NK, Band, J, Bartley, J, Snyder, MB, Gaynes, RP. Noncompliance with Universal Precautions policy: why do physicians and nurses recap needles? Am J Infect Control 1990;18:232–239.Google Scholar
13. Hersey, JC, Martin, LS. Use of infection control guidelines by workers in healthcare facilities to prevent occupational transmission of HBV and HIV: results from a national survey. Infect Control Hosp Epidemiol 1994;15:243–252.CrossRefGoogle ScholarPubMed
14. Saghafi, L, Raselli, P, Francillon, C, Francioli, P. Exposure to blood during various procedures: results of two surveys before and after the implementation of Universal Precautions. Am J Infect Control 1992;20:53–57.CrossRefGoogle ScholarPubMed
15. Nelsing, S, Nielsen, TL, Brínnum-Hansen, H, Nielsen, JO. Incidence and risk factors of occupational blood exposure—a nation-wide survey among Danish doctors. Eur J Epidemiol 1997;13:1–8.Google Scholar
16. Nelsing, S, Nielsen, TL, Nielsen, JO. Percutaneous blood exposure among Danish doctors: exposure mechanisms and strategies for prevention. Eur JEpidemiol 1997;13:387–393.CrossRefGoogle ScholarPubMed
17. Gershon, RRM, Vlahov, D, Felknor, SA, et al. Compliance with Universal Precautions among health care workers at three regional hospitals. Am J Infect Control 1995;23:225–236.Google Scholar
18. Centers for Disease Control and Prevention. HIV/AIDS surveillance report. 1996;8:15.Google Scholar
19. Bennett, NT, Howard, RJ. Quantity of blood inoculated in a needlestick injury from suture needles. J Am Coll Surg 1994;178:107–110.Google Scholar
20. Johnson, GK, Nolan, T, Wuh, HC, Robinson, WS. Efficacy of glove combinations in reducing cell culture infection after glove puncture with needles contaminated with human immunodeficiency virus type 1. Infect Control Hosp Epidemiol 1991;12:435–438.Google Scholar
21. Gerberding, JL, Littell, C, Tarkington, A, Brown, A, Schecter, WP. Risk of exposure of surgical personnel to patients' blood during surgery at San Francisco General Hospital. N Engl J Med 1990;322:1788–1793.CrossRefGoogle ScholarPubMed
22. Beekmann, SE, Vlahov, D, Koziol, DE, McShalley, ED, Schmitt, JM, Henderson, DK. Temporal association between implementation of Universal Precautions and a sustained, progressive decrease in percutaneous exposures to blood. Clin Infect Dis 1994;18:562–569.Google Scholar
23. Sygdommen AIDS og retningslinier til forebyggelse af HIVinfektion. The Danish National Board of Health, Copenhagen, 1988.Google Scholar