A survey of doctors' and nurses' knowledge, attitudes and compliance with infection control guidelines in Birmingham teaching hospitals
Introduction
Healthcare workers (HCWs) are at risk of occupationally-acquired viral infections such as human immunodeficiency virus (HIV), hepatitis B (HBV), and hepatitis C (HCV).1 The most likely means of transmission of these viruses to HCWs is by direct percutaneous inoculation of infected blood by a sharps injury or via blood splashing on to broken skin or mucous membranes.2 Factors that determine risk of significant exposure to HIV include the frequency of needlestick incidents and the prevalence of HIV in the patient population.3
The risk of transmission to a HCW from an infected patient after such an injury has been shown to be one in three when a source patient is infected with HBV and is e-antigen positive, one in 30 when the patient is infected with HCV, and one in 300 when the patient is infected with HIV.4
The UK Department of Health (DoH) recommended ‘universal precautions’ in 1998.4 Universal precautions (UPs) state that as it is impossible to identify all those patients who are sero-positive to HIV, HBV, or HCV, every patient should be regarded as a potential biohazard.4., 5. The application of UPs has been shown to reduce both occupational exposure to body fluids and patient-to-patient transmission of blood-borne viruses (BBVs) via the HCW.6., 7., 8., 9. However, despite both public and professional awareness of the dangers of BBVs, compliance with UPs amongst HCWs has repeatedly been found to be low.6., 11., 12., 13., 14., 15., 16., 17.
These findings are consistent with the authors' experiences as medical students during clinical training. Doctors, in particular, were frequently observed drawing blood from patients without wearing gloves, not washing hands between patients on ward rounds, and occasionally re-sheathing needles after drawing blood. These observations prompted an examination of such practices amongst all HCWs within Birmingham's teaching hospitals.
Although several studies have examined UPs in the healthcare setting, particularly the proper use of gloves and other barriers to infection by doctors and nurses, there is a lack of studies comparing directly the two types of HCW. Moreover, previous studies have only addressed these issues within individual specialties, and it is necessary to broaden the focus of this in order to make it generalizable for hospital doctors and nurses in the UK.
We designed and carried out a study to determine the attitudes about and compliance with the DoH's UPs amongst doctors and nurses in three major teaching hospitals in Birmingham whilst also ascertaining reasons for non-compliance. We postulated that there would be a significant difference in levels of adherence and a similarity in knowledge of UPs between doctors and nurses.
Section snippets
Methods
For the purposes of this study, only participants regarded as qualified to take blood were included. ‘Blood-taking’ was considered to be venepuncture, as opposed to drawing blood/fluids from central lines. Therefore, doctors, nurses, and phlebotomists were originally chosen to complete the questionnaire.
The doctors eligible were physicians or surgeons of any grade from pre-registration house officer to consultant. The nurses were of any grade, including military nurses. The study was carried
Study population
Two hundred and thirty-one questionnaires were completed. Seventy-five were completed by doctors, 141 by nurses, and 10 by phlebotomists. Two respondents reported that they were nurses and phlebotomists. They were included in the nurse group. Three others did not specify their occupations and were excluded from analysis. Based on information provided by the Trusts' personnel departments, we have estimated that this sample represented 7% of doctors, 4% of nurses and 29% of phlebotomists at these
Discussion
The obvious limitations of this study are lack of systematic sampling and the self-selection of respondents. Moreover, replies were received from only a small proportion of staff.
We were unable to obtain a questionnaire response rate due to our methodology of leaving variable numbers of questionnaires on wards and redistributing those left untouched. Whilst this study should be generalizable for doctors and nurses working in hospital in the UK, sampling bias may have affected our results. A
Acknowledgments
We thank Dr Evan A. Stein for his advice in the writing of this manuscript.
References (26)
- et al.
Ignorance of post-exposure prophylaxis guidelines following HIV needlestick injury may increase the risk of seroconversion
Br J Anaesth
(2000) - et al.
Effect of education on the use of universal precautions in a university hospital emergency department
Ann Emerg Med
(1990) - et al.
Universal precautions in emergency medicine residencies: 1989
Ann Emerg Med
(1989) - et al.
Compliance with universal precautions among emergency department personnel caring for trauma patients
Ann Emerg Med
(1999) - et al.
Knowledge and attitudes of hospital staff to occupational exposure to bloodborne viruses
Commun Dis Public Health
(2000) Universal precautions
Nurs Standard
(1997)- et al.
The risk of needlestick injuries and needlestick-transmitted diseases in the practice of anesthesiology
Anesthesiology
(1992) - UK Health Departments. Guidance for clinical health care workers: Protection Against Infection with Blood-borne...
The need for a clear policy on glove use
Nurse Times
(1998)HIV and hepatitis—some way to go
Anaesthesia
(1992)
Are universal precautions effective in reducing the number of occupational exposures among health care workers? A prospective study of physicians on a medical service
JAMA
Compliance with universal precautions among physicians
J Occup Environ Med
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