Articles
Monitoring adherence to Standard Precautions*,**

https://doi.org/10.1067/mic.2001.111226Get rights and content

Abstract

Background: Health care workers (HCWs) do not consistently follow Standard Precautions (SP). This is a serious problem because inadequate compliance is associated with increased blood exposure thus predisposing HCWs to bloodborne pathogen transmission. Methods: The primary goal of this study was to identify institutional factors associated with adequacy of HCW training to monitor coworkers’ adherence to SP. Surveys were sent to all community hospital infection control practitioners (ICPs) in Iowa and Virginia. ICPs indicated on a 5-point Likert scale, ranging from strongly disagree to strongly agree, their assessment of HCW training adequacy. Data from another statewide survey of HCWs in Iowa were assessed to validate this outcome measure. Multiple logistic regression models were developed to identify predictors of assessed training adequacy. Independent variables included methods of education, training, approaches to SP compliance assessment, provision of SP reinforcement by clinical leaders, and organizational data. Results: A total of 149 institutions (62%) participated. Models of training program adequacy varied across occupations. Management commitment to SP training programs, leadership support, frequency of providing bloodborne pathogen information, and safety climate were important institutional predictors of assessed adequacy of training. The outcome was validated by demonstrating an association between the ICPs’ assessment of HCW training and workers who reported having sufficient information to comply with SP (P <.05). Conclusions: Institutional safety climate, leadership support, and frequency of education play an important role in HCWs’ training adequacy to monitor coworkers’ adherence to SP. Occupational groups should be considered independently when strategies are developed to increase compliance. Interventions based on modifiable factors identified by this study may reduce bloodborne pathogen exposure among HCWs. (AJIC Am J Infect Control 2001;29:24-31)

Section snippets

Survey design and administration

A 7-page survey was constructed to examine factors likely to be associated with SP compliance. Survey items included methods of education and training, frequency of educational intervention, surveillance for percutaneous injury and mucocutaneous blood exposure, approaches to assessment of SP compliance, and ICP perception of adequacy of employee training for monitoring compliance. After approval by the Institutional Review Board, surveys were mailed to ICPs at all community hospitals and the

Response bias

The organizational characteristics of responding and nonresponding hospitals were quite comparable. However, responding hospitals were less likely to be affiliated with a medical school (18% vs 31%, P <.05), although there are relatively few medical schools in either state. Responders had a slightly lower mean number of annual outpatient visits (69,550 vs 81,360, P <.05).

Descriptive information

There were 149 institutional respondents (62%); 96 from Iowa and 53 from Virginia (72% and 50%, respectively). Although

Discussion

This study is unique in that statewide surveys of community hospitals in Iowa and Virginia were performed, and thus represent the views of ICPs at a large number of institutions. Few studies have considered both organizational context and program factors as potential determinants of increased SP compliance and monitoring.

Our study suggests that institutional program and safety climate factors play an important role in the ICPs’ perception of HCWs’ training adequacy to monitor coworkers’

Acknowledgements

We appreciate the important contributions of Larry Murphy, PhD, James Grosch, PhD, and Linda Martin, PhD, of the National Institute of Occupational Safety and Health in completing the study and of ICPs in Iowa and Virginia for providing these data.

References (29)

  • SE Beekmann et al.

    Temporal association between implementation of universal precautions and a sustained, progressive decrease in percutaneous exposures to blood

    Clin Infect Dis

    (1994)
  • ES Wong et al.

    Are Universal Precautions effective in reducing the number of occupational exposures among health care workers?

    JAMA

    (1991)
  • M Kristensen et al.

    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)
  • DJ Diekema et al.

    Blood and body fluid exposures during clinical training: relation to universal precautions knowledge

    J Gen Intern Med

    (1996)
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    *

    Partially supported by the Centers for Disease Control and Prevention/National Institute for Occupational Safety and Health Cooperative Agreement, No. U60/CCU 172173.

    **

    Reprint requests: Bradley N. Doebbeling, MD, MSc, SE 625 GH, Department of Internal Medicine, The University of Iowa College of Medicine, 200 Hawkins Dr, Iowa City, IA 52242.

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