Universal Precaution Guidelines Research Articles

Knowledge, Attitude, and Practices towards Needle Stick Injuries among Students and Staff in a Tertiary Medical Centre in Chennai, Tamil Nadu, India

Background: Needle stick injuries are one of the greatest fears that revolves around the health care workers all over the world, and the majority of them are avoidable by following proper precautionary methods in handling the devices. Even though, by following the precautionary methods, a few accidents may happen a few times and thus resulting in a needle stick injury. The aim of our study was to assess the knowledge, attitude and practices towards Needle stick injuries among students and staff in a tertiary medical centre in Chennai, Tamil Nadu , India
 Objectives: To assess the knowledge, attitude, practices about needle stick injuries among students and staff in a tertiary medical centre in Chennai, Tamil Nadu, India.
 Materials and Methods: This descriptive cross-sectional study was conducted in Saveetha Medical College and Hospital.
 Our study included students and staff of the institution, irrespective of their age and sex. Data collection was carried out using a standardized questionnaire.
 Results: 62.1% of the participants know the last universal precaution guidelines of needle stick injuries management. 83.3% are fully vaccinated with anti-HBV.70.9% always use gloves when deal with needles. 14.3% had Needle stick Injury. 40.9% strongly believe that needle stick injury can be prevented. Since adequate awareness is created by the institution, participants in this study have higher knowledge, attitude and practices when compared to reference studies.

A Study of Needle Stick Injuries among Nursing College Students in a Tertiary Care Hospital in Chengalpattu District, Tamil Nadu

Introduction: Needle stick injuries (NSIs) are the most potential occupational hazards among nursing personnel with possible transmission of blood borne pathogens. As nursing students are in the learning stage, they might be at higher risk of acquiring the injuries.Objectives: Todetermine the prevalence of needle stick injuries and to assess the awareness, attitude and practices followed with regard to NSIs.Methodology: An online cross-sectional study was conducted from October to December 2020 among 175 students in a nursing college in Chengalpattu district Tamil Nadu, using a pretested semi- structured questionnaire, adopting universal sampling technique. Data was analyzed using SPSS version 23. Categorical variables were summarized as Percentages and chi square test was used for statistical analysis. Results: The overall prevalence of needle stick injury among nursing college students was 16%.Final year studentsweremore exposed to the injuries(35.7%). Majority (96.57%) of the students were aware about universal precaution guidelines, 57% of students were aware about the diseases transmitted by NSI, 97.71% were aware about safety devices and 67.43% of students were aware about the post-exposure prophylaxis in management of NSIs.Among the students, 71.43% had used gloves regularly, 72% were immunized against Hepatitis B, only 25.71% of students attended Integrated Counselling Testing Centre(ICTC) and more than half of the students always practiced recapping needle after giving injections. Conclusion: Majority of the students in this study were aware about NSIs, their attitude towards NSIs was agreeable. The practices reported though assessed through online survey was found to be deficient.Periodic education and training need to be done to avoid injuries in future.

English

BACKGROUND Health care workers are more prone to occupational hazards, like needlestick injuries, blood, and body fluid exposures. Needlestick injuries (NSI) are responsible for the transmission of serious infections like HIV, HBV and HCV. The occurrence of needlestick injuries is highest among the nurses. The objective of the study was to assess the knowledge, attitude and practice regarding needlestick injuries among nursing faculty in Justice K. S. Hegde Charitable Hospital, Mangalore. METHODS A cross-sectional survey was conducted among the nursing faculty working in a tertiary care hospital based on a structured questionnaire, and the obtained data were further analysed statistically. RESULTS The percentage of needle stick injury was 13.3 % among 75 nursing faculty. 94.7 % of the nurses were aware of the universal precaution guidelines and 84 % knew about post-exposure prophylaxis (PEP). 36 % of nurses knew the preventive guidelines' full details, but 50.7 % of the nurses were unaware of it. Many participants were aware that NSI transmits HIV (92 %) and Hepatitis B (68 %). The leading cause of NSI might be heavy work (54.7 %) followed by hurried procedures (41.3 %). 29.3 % of the nurses were still inclined to recapping the needle after use. 68 % of the nurses were mindful of washing hands with only water post exposure. 28 % were not willing to report a NSI. 80 % of nurses were fully immunised against Hepatitis B. CONCLUSIONS The best way to reduce NSI is to impart knowledge and awareness to the faculty. Our study showed that the knowledge, attitude, and practice among the nursing faculty were promising but requires to be further strengthened. KEY WORDS Needlestick Injury, Nursing Staff, Knowledge, Attitude, Practice

Effect of Tele-nursing Education Program on Nurses’ Compliance with Standard Precautions during COVID- 19 Pandemic

Abstract: Coronavirus disease (COVID-19) is a great global public health concern, caused by SARS-COV2 and represents the causative agent of a potentially fatal disease. Aim: evaluate the effect of tele-nursing education program on nurses’ compliance with standard precautions during COVID-19 pandemic.A quasi-experimental research design was used. Setting: The study conducted at Specialized Medical Hospital, Mansoura, Egypt. Sample: 218 nurses transversely various clinical units of the hospital. Two tools were used in data collection; a structured interviewing questionnaire, and the compliance with standard precautions scale (CSPS). Results revealed that there was a highly statistically significant difference in all items of compliance with standard precautions scale between pretest and posttest with p value Conclusion: Application of the tele-nursing education program had a positive effect on improving the CSPS of the studied nurses as the tele-nursing appears to be a new opportunity in the COVID-19 Pandemic disaster to lessen hazard of infection. Recommendations: Written universal precautions guidelines for infection control should be available and updated periodically

Hepatitis B virus infection and associated risk factors among medical students in eastern Ethiopia.

BackgroundHepatitis B virus (HBV) is a highly contagious pathogen that has become a severe public health problem and a major cause of morbidity and mortality, particularly in developing countries. Medical students are at high occupational risk during their training. However, no facility-based studies were found among medical students in eastern Ethiopia. Thus, this study aimed to investigate the seroprevalence of Hepatitis B Virus and associated factors among medical students in eastern Ethiopia.MethodsA facility-based cross-sectional study was conducted among 407 randomly selected medical students from March to June 2018. A pretested and structured questionnaire was used to collect data on socio-demographic characteristics and other risk factors. A 5ml blood was collected, and the serum was analyzed for Hepatitis B surface antigen (HBsAg) using the Instant Hepatitis B surface antigen kit. Data were entered using Epidata version 3.1 and analyzed using SPSS statistical packages version 22. Outcome and explanatory variables were described using descriptive summary measures. Binary and multivariable logistic regression was conducted at 95% CI and an association at P-value < 0.05 was declared statistically significant.ResultsThe seroprevalence of hepatitis B virus surface antigen was 11.5% (95%CI = 8.6, 14.7). Poor knowledge of universal precaution guideline (AOR = 2.58; 95% CI = [1.35–4.93]), history of needle stick injury (AOR = 2.11; 95% CI = [1.07–4.18]) and never been vaccinated for HBV (AOR = 2.34; 95% CI = [1.17–4.69]) were found statistically significantly associated with HBsAg positivity after multivariate analysis.ConclusionHepatitis B virus infection rate is high among health care trainees in eastern Ethiopia. Improvement at health care practice centers safety through training on universal precaution guidelines, and scaling up HBV vaccination is mandatory.

Assessment of safe handling practices among resident doctors in Jos University Teaching Hospital Plateau state, Nigeria.

Background:Standard safety precautions are essential in health care delivery regardless of the presumed infectious state of the patients. Safe handling practices as detailed in the universal safety precaution guidelines are available to health care workers globally. However, there have been documentation of suboptimal adherence to it especially in the developing countries including Nigeria. Hence, this study was conducted to assess the level of safe handling practices and its determinants among resident doctors in Jos University Teaching Hospital, Plateau state, Nigeria.Methods:This was a cross sectional study conducted among 192 resident doctors using quantitative method of data collection in 2018.SPSS version 20 was used for data analysis with chi square test used to identify the determinants of safe handling practices. Crude odds ratio as well as 95% confidence interval were used with a p-value of < 0.05 considered statistically significant.Results:The mean age of the respondents in the study was 33 ± 3 years with 119 (62.0%) of the respondents being males. Good knowledge of infection, prevention and control was reported among 120 (62.5%) while 137 (71.3%) were found to have engaged in safe handling practices. Sex (OR = 4.5; 95% CI = 2.05–9.85) and level of knowledge (OR = 1.97; 95% CI = 1.05–3.72) were found as the determinants of safe handling practice.Conclusion:This study has brought to light the need for improvement in the level of compliance with safe handling practices as it is far from the optimum.

Knowledge, awareness, and practices regarding needlestick injury among health-care workers in a tertiary care hospital of India: Annual incidence versus reporting rate

INTRODUCTION: The objective of this study was to assess the knowledge and awareness regarding needlestick injury (NSI) among health-care workers (HCWs) in a tertiary care hospital. MATERIALS AND METHODS: This cross-sectional observational study was conducted among HCWs of a tertiary care hospital, India. A predesigned closed-end questionnaire, which assessed knowledge and awareness about NSI, immunization status, and management of NSI, was the tool of data collection. RESULTS: A total of 104 HCWs participated in the study. The annual incidence of NSI was 29.80% (n = 104), whereas only 35.48% (n = 31) of these NSI cases or 10.58% (n = 104) of total HCWs reported to the concerned authority. The causes of underreporting were ignorance about contacting authority (70%), busy schedule (15%), and nonsignificant (10%). Recapping was considered as the most common cause of NSI in 31.7% followed by “haste” in 28.8%. All the HCWs received vaccination against hepatitis B; however, only 71.2% got 3 doses and booster, but only 60% knew about their protective antibody level. Unprotected sexual contact and sharp injury were known to all as the route of human immunodeficiency virus (HIV) transmission, whereas blood transfusion as a source of HIV was known to 98%. CONCLUSION: The knowledge of health-care professionals on NSIs and their preventive measures is adequate; however, training on the universal precautions guidelines and the use of safe devices has to be delivered to prevent such injuries. The importance of timely reporting and following protocols regarding postexposure prophylaxis needs emphasis. There is an urgent need for re-strengthening and expanding our knowledge of HIV transmission routes in the hospital. Awareness and importance of hepatitis B immunization status need more attention.

Investigating needle stick injuries: Incidence, knowledge and perception among South Jordanian nursing students

Needle stick injury (NSI) is one of the major causes of blood borne infections in the present day healthcare system. Among healthcare professionals, nursing students will most likely be exposed to this dilemma. Interventions like institutionalizing educational programs to produce awareness and knowledge among nurses can depict positive outcomes in changing perceptions toward safety measures. This study aimed to investigate the incidence, perspectives, views, perceptions, and knowledge of NSIs among nursing students studying at Al-Hussein Bin Talal University. The sample population consisted of all undergraduate nursing students from second to fourth academic levels at the university who consented to participate in this study. The mode of data collection utilized a self-structured questionnaire apportioned into four parts. The first portion of the questionnaire presented the socio-demographic details of the respondents. The second part of the questionnaire demonstrated questions about needle stick incidences at the clinical units of the participants; frequency of occurrences (i.e., number, nature, and rationale); place of occurrence; and, whether the event was reported to higher authorities. The third part of the questionnaire entailed queries associated with the knowledge of the students with respect to needle stick injury. The last part focused on the student's knowledge and perception on the risks associated to needle sticks injuries and the relative precautions to prevent such. The results showed that most of the students had positive perception of NSIs; while two thirds of the student nurses experienced NSI with increasing number of injured nurses occurring among second year students. This is due to the lack of knowledge regarding universal precaution guidelines and acupuncture safety device. Nursing students are at risks of getting infection. Proper steps are needed to promote awareness of NSI as well as the dangers and prevention from such events.

Compliance to standard precautions among nurses working in Qassim hospitals in KSA

Background: Compliance with standard precautions has been shown to reduce the risk of exposure to blood and body fluids. Nurses represent the largest percentage of the health care workers hence; their compliance with standard precautions guidelines seems to be more crucial in preventing the disease transmission among patients.Aim: this study aims to evaluate compliance to standard precautions among nurses working in Qassim Hospitals in KSA.Methodology: A cross sectional study was conducted in 4 multispecialty hospitals of Al-Qassim region, KSA. A purposive sampling approach was adopted whereas sample consisted of 284 male and female nurses working in multispecialty hospitals. Data collected through self-administrative questionnaire which consists of; personal and work characteristics of nurses, nurses’ knowledge and compliance of standard precautions.Results: Nearly half of nurses had poor knowledge regarding standard precautions and the majority of nurses had better compliance to standard precautions. However nearly one third of nurses had good compliance to waste disposal.Conclusions:Compulsive training courses found to be vital for developing awareness among nurses, improving compliance to standard precautions and good clinical practice.Recommendations: Further studies are recommended by using different methods for data collection. Written universal precautions guidelines for infection control should be available.

Prevalence of Hepatitis B surface antigen among biomedical students of African descent in Usmanu Danfodiyo University, Sokoto, Nigeria.

Hepatitis B (HB) is a serious global public health problem that put health professionals particularly at risk. The aim of this study was to investigate the prevalence of Hepatitis B surface antigen (HBsAg) among Biomedical Students of African descent attending Usmanu Danfodiyo University Sokoto in North-Western Nigeria. The Onsite HBsAg (CTK Biotech, USA) was used to detect the presence of hepatitis B surface antigen. We tested 186 consecutively-recruited students consisting of 147 males and 39 females aged 18-35 years (mean age 26 ± 2.0 years). Of the 186 students tested, 25 (13.4%) were positive for HBsAg. The prevalence of HBsAg was significantly higher among students in the 21-25 years age group. Hepatitis B vaccination uptake among students was 7%. Majority of subjects were single 173(93.1%) compared to married 13 (6.9%). Ethnic distribution of the subjects indicated that 104(55.9%) were Hausa compared to Yoruba 32 (17.2%), other ethnic groups 21(11.3%), Fulani 20(10.8%) and Igbo 9(4.8%). This study indicates a high prevalence of hepatitis B virus infection among Biomedical students in Sokoto, North Western, Nigeria. Finding from this study is enough justification for the implementation of a policy to routinely test students entering into the biomedical professions for Hepatitis B virus infection. There is the need to provide hepatitis B vaccination universally to all those who are found negative prior to commencement of their biomedical training. There is also need to educate students entering biomedical professions and healthcare workers on the modes of transmission and prevention, importance of being compliant with protective vaccination as well as the need to observe universal precaution and infection control guidelines during their training and future professional practice.

Knowledge, attitude, and practice of needle stick and sharps injuries among dental professionals of Bangalore, India.

Background:A needle stick injury (NSI) is an accidental skin-penetrating stab wound from a hollow-bore needle containing another person's blood or body fluid. Healthcare workers (HCWs) including dental professionals are at an occupational risk of exposure to blood-borne pathogens following NSIs and sharps injuries (SIs). A thorough understanding of the safe practices while handling needles and sharps is crucial for HCWs to create a risk-free work place environment.Aims and Objectives:To assess the knowledge, attitude, practice, and prevalence of NSIs and SIs among dental professionals in a dental college at Bangalore.Materials and Methods:A cross-sectional survey was conducted in September 2012 using a structured, pretested, guided interview-based questionnaire that was administered to 200 dental professionals in a dental college at Bangalore to assess the knowledge, attitude, practices, and self-report information of NSIs.Results:In the present study, 81.5% of dental professionals were vaccinated against hepatitis B. A total of 27.5% participants had an NSI during the previous 12 months. About 41.80% of NSIs occurred during device recapping. Most common reason for failure to report the incidents of NSIs, as declared by 29.09% of the participants, included the fear of being blamed or getting into trouble for having an NSI.Conclusion:The knowledge of dental professionals on NSIs and their preventive measures are inadequate; however, training on Universal Precaution Guidelines, protocols regarding post-exposure prophylaxis, and safety devices has to be provided to prevent such injuries in future among the dental professionals.

English

INTRODUCTION: Needle stick injuries are one of the greatest risks faced by the front line healthcare workers in the light of HIV/ AIDS, Hepatitis B and C. Yet, these exposures have often been considered as part of the job and neglected. OBJECTIVE : 1. To study prevalence of needle stick injury among health care workers of a private tertiary care hospital. 2. To assess the knowledge, attitude and practices of needle stick injury among them. METHODOLOGY : Hospital based cross sectional study was carried out with preformed pretested questionnaire on all (42) health care workers of a private tertiary care hospital. RESULTS: Results showed that out of 42 subjects 35(83.3%) had a history of needle-stick injury but only 11% reported the injuries to the hospital authority and received PEP prophylaxis against HIV. Only 11 HCW's (26.2%) were aware about where to report the NSI incident. 4.8% and 95.3% of health care workers, respectively, were unaware of the fact that hepatitis B and hepatitis C can be transmitted by needle-stick injuries. Only 21.5% were in the habit of using gloves for phlebotomy procedures all the time. 40.5% were of the impression that needle should not be recapped after use but 21.5% of them didn't implement it. Only 38.1% were aware of Universal Precaution Guidelines. 18 subjects (42.9%) had been vaccinated against hepatitis B; while 26 subjects (47.6%) were not vaccinated against hepatitis B.23 subjects (54.8%) knowing their HBsAg status. Majority of HCW (95.3%) were demanding training and awareness of NSI. CONCLUSION: The study revealed that knowledge among health care workers about the risk associated with needle-stick injuries and use of preventive measures was inadequate. Standard operating procedure (SOP) should be formulated and followed by them.

Community health care workers’ risk perception of occupational exposure to HIV in Ibadan, south-west Nigeria

BackgroundThe ultimate goal of all healthcare workers (HCWs) is to maintain a healthy population and environment, and to adequately manage any condition that might constitute a menace to the health of the population at large. However, the central problem arising from the perception of risk of occupationally transmitted Human Immunodeficiency Virus (HIV) infection amongst HCWs is that it may distract them from giving quality healthcare.ObjectivesThe study aimed at addressing the following objectives: to explore the effects of level or years of experience on risk perception regarding occupational exposure to HIV, to assess HCWs’ daily work routines’ consistency in accordance with universal precaution guidelines, to determine HCWs’ perception of workplace safety climate and identify factors that may constitute constraints to HCWs in adhering to universal precaution measures.MethodA descriptive cross-sectional survey design was utilised, using a triangulation method of data collection which involved the use of a questionnaire and direct observational methods using checklists. A total of 143 HCWs were purposively selected to form the study population.ResultsThe study showed a very high risk-perception amongst HCWs regarding occupational exposure to HIV and AIDS but a poor compliance with universal precautions in their professional duties. HCWs perception of risk and workplace safety climate did not influence their compliance with universal precautions (Pr > F = 0.2566; Pr > F = 0.2776).ConclusionThe need for policy guidelines to manage all aspects of risk-perception and practices of HCWs regarding HIV and AIDS in the healthcare settings most especially at the primary health care level need to be considered.

Risk of infection among primary health workers in the Western Development Region, Nepal: knowledge and compliance

Without protective practices such as antiseptic hand washing, the use of sterile/surgical gloves, safe needles, sterile equipment, and safe instrument and waste disposal procedures outlined in universal precaution guidelines, basic health workers (BHWs) are at substantial risk of blood-borne infections. This paper draws on research conducted in 28 primary health care centers in two districts of the Western Development Region, Nepal, between 2003 and 2004. Interviews were conducted to identify the infection control knowledge and practice compliance of basic health workers. Of 100 BHWs studied, only 22% had correct knowledge of universal precautions and 73% said they follow universal precaution guidelines. A total of 62% reported that they regularly used protective gloves while handling patients and 72% reported that they never used high-level disinfection to eliminate all microorganisms (bacteria, viruses, fungi, and parasites, including bacterial endospores) from instruments and other items that would come into contact with broken skin or intact mucous membranes. Reasons for noncompliance included irregular supply of materials (31%); lack of an autoclave and other high-level disinfection equipment (50%); lack of knowledge and insufficient technical skills regarding universal precaution procedures (20%). Results showed that poor knowledge and an irregular supply of materials, equipment, and instruments prevented BHWs from using infection control measures. Formal training in universal precautions is urgently needed, and protective equipment must be provided and use must be monitored. Compliance to infection control procedures must be improved at primary health care units, especially among the basic health workers.

Knowledge and practice of universal precautions against blood borne pathogens amongst house officers and nurses in tertiary health institutions in Southeast Nigeria.

To examine the knowledge and practice, as well as factors influencing universal precautions practices amongst Nigerian House officers and Nurses. A Cross-sectional descriptive study. Sample selection was by stratified random sampling. Information was elicited using pretested, structured, self-administered questionnaire. Data were analyzed using EPI-info. Most Doctors, 66.6%, were aged 26-30 years while the Nurses, 41.1%, were aged 40 years. 57.6% of the Doctors were males, while 85.7% of the nurses were females. Knowledge of universal precautions measures was high for both categories of respondents--97.0% for doctors and 92.0% for nurses, although practice was better for the nurses, 75.0%, compared to the doctors, 15.2%, p < 0.05. The most important factor influencing universal precautions practice is the lack of provision of adequate protective equipments. Other factors, all of which show significant difference between the doctors and nurses (p < 0.05), include carelessness; lack of display of universal precautions guidelines; emergency nature of the procedure; insufficient water supply; patient perceived to be at low risk of blood borne pathogens; pressure of time; and universal precautions equipments interfering with technical skills. Although knowledge of universal precautions is high for both house officers and nurses, practice is however better amongst the latter than the former. The effective knowledge and practice of universal precautions amongst hospital workers are of absolute necessity to prevent infections from blood and body fluid pathogens.

Estudio sobre la exposición ocupacional a sangre y fluidos corporales en el personal de enfermería de un hospital de referencia de Buenos Aires, Argentina

To determine the frequency of occupational blood and body fluids exposure (OBBFE) among the nursing staff at the Dr. Diego Paroissien Hospital in Buenos Aires, Argentina; analyze the possible risk factors associated; and assess the level of knowledge regarding universal precautions and control procedures following exposure: A cross-sectional descriptive study was performed using a voluntary and anonymous survey administered between April and May 2005. In addition to personal and professional data, information was collected on knowledge and practice of universal precautions and procedures, OBBFE experienced, barriers to following the standards, and whether or not the Hepatitis B vaccine had been received. The dependent variable in the analysis was ever having experienced an OBBFE accident: Of the 186 responses analyzed, 77.7% were female, the mean age was 44.6 +/- 8.9 years, and the institution was 13.3 +/- 6.4 years old. Of those surveyed, 91 (48.9%) indicated that at some time they had an OBBFE, with 33 (17.7%) of these having occurred during the previous year; 73.0% confirmed that the tools necessary for complying with universal precautions were available always or almost always; 76.2% felt they had complete information, although 56.3% said they had not received adequate training; and, 94.1% claimed to have been vaccinated against Hepatitis B. Being overworked (54.5%), insufficient training (21.8%), and a lack of protective tools (18.8%) were the reasons most often identified as impeding compliance with universal precaution guidelines. Not having received training during the preceding year and having recently started work in a clinical or adult intensive-care unit were significantly associated with having experienced an OBBFE: These results signal a risk alert for OBBFE among health care workers and underscore the need for improving standards and surveillance.

EMTS' knowledge regarding transmission of infectious disease

Objective. To describe EMTs' knowledge of CDC universal precaution guidelines and transmission routes for human immunodeficiency virus (HIV), hepatitis, meningitis, and tuberculosis (TB) and their perceived exposures to and concerns about these diseases. Methods. A convenience sample of EMTs were surveyed at mandatory continuing education meetings in a midwest community (pop. 523,191) between October 1 and November 30, 1996. The survey contained 101 questions about knowledge of universal precautions, transmission routes, postexposure actions, personal and family concerns, and demographics. Correct responses were based on CDC guidelines, and incorrect answers were added. Results. Four hundred of 425 surveys (94%) were returned. Eighty-one percent of the EMTs were full-time paramedics with 9.4 (95% CI 8.7-10.0%) years of experience. Seventy-five percent reported HIV, hepatitis, and TB education, while 57% reported meningitis education within the preceding year. Ninety-one percent knew universal precautions should be used with every patient. Needlestick was correctly reported as a transmission route for HIV (98%) and hepatitis (92%), but incorrectly reported for TB (37%) and meningitis (60%). Tuberculosis (94%) and meningitis (64%) were correctly identified as airborne. Thirty-four percent of the EMTs reported inadequate knowledge of infectious diseases (IDs) to protect themselves. Their perceived exposure for all four diseases ranged from 65% to 73%, but only 10-40% reported follow-up testing. Families' concern about EMTs' exposure was reported as moderate to high by 63% of the respondents. Conclusions. There appears to be a need for continuing education for EMTs focusing on the routes of transmission of IDs, their chance of exposure, appropriate use of protective equipment, and the need for follow-up testing. This may allow more effective use of protective equipment and allay fears of EMTs and their families. PREHOSPITAL EMERGENCY CARE 2000;4:57-61

Protection of healthcare workers from bloodborne pathogens

For decades, healthcare workers have been known to be at risk from acquiring a variety of bloodborne pathogen infections as a result of occupational exposure. Primary prevention of exposures, as recommended by universal precautions guidelines, remains the cornerstone of protecting healthcare workers. Nonetheless, a substantial number of parenteral exposures continue to occur. Updated developments are summarized here, and recommendations for the protection of healthcare workers from bloodborne pathogens are provided. The predominant evidence suggests that total percutaneous injuries have decreased over the last decade. Thoughtful adherence to universal precautions remains the primary means of preventing occupational exposures and thus of reducing occupational risk of infection with bloodborne pathogens. A number of studies have provided additional evidence for the efficacy of safety devices in reducing specific subsets of injuries when combined with education and administrative interventions. Barriers to and positive predictors of universal precautions compliance have been identified. Postexposure prophylaxis remains the second line of defense; several authorities have now recommended three antiretroviral agents in this setting. In summary, almost two decades of experience with universal/standard precautions has resulted in a decrease in parenteral injuries, but much work remains to be done. Vaccines, effective infection control procedures, safer procedures, and safer devices will all be necessary, along with a better understanding of factors that influence healthcare worker behaviors that result in injury. In addition, a number of issues relating to the postexposure management of occupational exposures with bloodborne pathogens need to be better understood.

Universal precautions: a survey of community nurses' experience and practice.

Universal precautions are a set of guidelines which aim to protect health care workers from blood-borne infections. Community nurses often have to deliver care to people in less than ideal home conditions, their ability to comply with all universal precautions may therefore be compromised. This paper presents the findings of a questionnaire survey which aimed to explore community nurses' experience and practices of using universal precautions. A questionnaire survey was used for this study. All community learning disability nurses, community mental health nurses and generic community nurses from one Welsh Health Authority were surveyed (n = 543) with a response rate of 70%. The majority of community nurses reported compliance with universal precautions, although a small number of nurses stated that they re-sheathed needles, inappropriately stored sharps containers, inadequately wore gloves and experienced difficulties in handwashing. Community nurses work in a unique and unpredictable environment, which may result in nurses being unable to comply with existing universal precautions guidelines. The production of new infection control guidelines for the community by the National Institute of Clinical Excellence in June 2003, has addressed some of the difficulties faced by community nurses.

EMTS' K NOWLEDGE R EGARDING T RANSMISSION OF I NFECTIOUS D ISEASE

Objective. To describe EMTs' knowledge of CDC universal precaution guidelines and transmission routes for human immunodeficiency virus (HIV), hepatitis, meningitis, and tuberculosis (TB) and their perceived exposures to and concerns about these diseases. Methods. A convenience sample of EMTs were surveyed at mandatory continuing education meetings in a midwest community (pop. 523,191) between October 1 and November 30, 1996. The survey contained 101 questions about knowledge of universal precautions, transmission routes, postexposure actions, personal and family concerns, and demographics. Correct responses were based on CDC guidelines, and incorrect answers were added. Results. Four hundred of 425 surveys (94%) were returned. Eighty-one percent of the EMTs were full-time paramedics with 9.4 (95% CI 8.7–10.0%) years of experience. Seventy-five percent reported HIV, hepatitis, and TB education, while 57% reported meningitis education within the preceding year. Ninety-one percent knew universal precautions should be used with every patient. Needlestick was correctly reported as a transmission route for HIV (98%) and hepatitis (92%), but incorrectly reported for TB (37%) and meningitis (60%). Tuberculosis (94%) and meningitis (64%) were correctly identified as airborne. Thirty-four percent of the EMTs reported inadequate knowledge of infectious diseases (IDs) to protect themselves. Their perceived exposure for all four diseases ranged from 65% to 73%, but only 10–40% reported follow-up testing. Families' concern about EMTs' exposure was reported as moderate to high by 63% of the respondents. Conclusions. There appears to be a need for continuing education for EMTs focusing on the routes of transmission of IDs, their chance of exposure, appropriate use of protective equipment, and the need for follow-up testing. This may allow more effective use of protective equipment and allay fears of EMTs and their families.