A Large-Scale Snapshot of Standard Precaution Adherence: “Do as I Say Not as I Do”

Abstract

Background: Nearly 1 in 25 patients has a hospital infection at any given time, and 1 in 25 nurses suffers and bloodborne exposure every year. Basic procedures, termed standard precautions (SP) may prevent these outcomes, but they are not often used by healthcare workers. Unfortunately, data are largely limited by self-reporting because no standardized tools exist to capture observational data. Objective: The specific aim of this study was to describe the relationship between self-reported and observed SP adherence. Methods: This multisite, cross-sectional study included 2 elements: (1) surveys of nurses in US hospital units on perceptions of patient safety climate and reported SP adherence and (2) observational SP data. Survey data included 12 items on SP practices (eg, “how often you perform hand hygiene before touching a patient”) and 10 items on SP environment (eg, “my work area is not cluttered”), rated on a 5-point scale from “never” to “always” or from “strongly disagree” to ”strongly agree,” respectively. Using novel tools developed and previously pilot tested, we recruited and trained hospital-based staff on observational surveillance methodology to foster the National Occupational Research Agenda goals. The 10 observational SP items represented the following 4 categories: (1) hand hygiene, (2) personal protective equipment (PPE), (3) sharps, and (4) soiled linen handling. Observations of healthcare worker–patient interactions followed training and interrater reliability testing. All data were aggregated, and analyses were conducted at the unit level. Pearson correlation coefficients were calculated to determine the relationship between reported and observed SP practices (level of significance, P < .05). Results: In total, 6,518 SP indications were observed and 500 surveys were collected from nurses on 54 units in 15 hospitals from 6 states. The final analytic sample included 5,285 SP indications and 452 surveys from 43 units in 13 hospitals that provided both types of data. Most indications observed were of HH (72.6%). Overall SP adherence was 64.4%. In descending order, adherence rates were PPE (81.8%), sharps handling (80.9%), linen handing (68.3%), and hand hygiene (58.3%). The aggregate of positive self-reported SP practices was 95.8%, and 77.3% rated unit environment for SP adherence positively. There was no correlation between observed adherence and reported adherence (r (41) = (−).024, P = .879). Conclusions: In this study, the largest study of SP adherence, observed practice was grossly suboptimal, particularly hand hygiene. Conversely, nurses on the same units rated adherence as high, despite the environment. In combination, both sources of surveillance data provide valuable and actionable insight to target interventions.

Funding: and Disclosure Amanda Hessels reports that she is the principal investigator for the following studies: “Impact of Patient Safety Climate on Infection Prevention Practices and Healthcare Worker and Patient Outcomes” (grant no. DHHS/CDC/NIOSH 1K01OH011186 to Columbia University) and “Simulation to Improve Infection Prevention and Patient Safety: The SIPPS Trial” (AHRQ grant no. R18: 1R18HS026418 to Columbia University).