Compliance with standard precautions among gastrointestinal endoscopists and endoscopy nurses in Japan

Abstract

1,2 Standard precautions (SPs) are important, given that knowledge of a patient’s infection status is only presumptive. It is also impossible to predict when accidents might occur. Therefore, we examined the level of compliance with SPs in Japanese GEs and GENs. We mailed a questionnaire to 229 GEs and 223 GENs selected at random from Hiroshima University Hospital and its affiliated hospitals in January 2011. The questionnaire comprised questions covering such topics as immediate availability of personal protective equipment (PPE, including gloves, masks, gowns, goggles, and face shields) in endoscopic settings and frequencies of wearing gloves, masks, and gowns and of handwashing before and after endoscopic procedures. A total of 165 GEs (72%) and 143 GENs (64%) returned the questionnaire. Goggles were reported to be immediately available by 41% of GEs and 69% of GENs (P < .0001). Face shield availability was reported by 22% of GEs and 32% of GENs (P ¼.004). Gloves were used during every endoscopic procedure by most GEs (97%) and GENs (94%). All GEs and 90% of GENs always changed gloves during procedures (P < .0001); however, more than one-third of GEs and GENs did not always use a mask and protective gown. Goggles or face shields were used during every procedure by only 5% of GEs and 10% of GENs. In all, 13% of GEs and 19% of GENs reported full compliance with the SPs (P ¼ .184). The most frequent reason for noncompliance with SPs given by GEs was “too busy to comply with SPs” (26%), followed by “protective equipment not easily accessible” (20%). Reasons given by GENs were “too busy to comply with SPs” (29%), followed by “more concerned about patient care” (23%). “SPs not taught during training” and “lack of knowledge about SPs” were reported by 18% and 19% of GEs and 13% and 11% of GENs, respectively. In the present study, we found challenges to reducing the risks of pathogen exposure in GEs and GENs in endoscopic settings in Japan. First, more than 10% of GEs and GENs indicated that SPs were not taught during training or that they had a lack of knowledge about SPs. Senior staff involved in infection management should train their colleagues. Good knowledge may be the first step in improving workplace conditions. 3,4 Second, we found low immediate availability of goggles and face shields in endoscopic settings. Even though the endoscopic staff has adequate knowledge of SPs, if PPE is not easily available, they cannot comply with the SPs. The results of this study should help to draw attention to a pervasive problem in gastrointestinal endoscopy and prompt consideration of efforts to correct it. Education of health care workers about SPs should be considered a priority. There may even beacasefortheenforcementoftheapplicationofSPsinpatientcare, for the protection of both health care workers and their patients.