A survey of doctors' and nurses' knowledge, attitudes and compliance with infection control guidelines in Birmingham teaching hospitals

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Abstract

This study investigated knowledge about infection control amongst doctors and nurses through a cross-sectional survey conducted between March and May 2001 in three Birmingham, UK teaching hospitals. Seventy-five doctors and 143 nurses, representing 7% and 4%, respectively, of potential respondents, participated in the study measuring knowledge of, attitudes towards, and compliance with universal precautions. Overall knowledge of risks of blood-borne virus (BBV) transmission from an infected patient after needlestick injury was low [44.0% for hepatitis B virus (HBV), 38.1% for hepatitis C virus (HCV), 54.6% for human immunodeficiency virus (HIV)]. There were significant differences between doctors and nurses concerning the estimations of HBV (e-antigen +) (P=0.006) and HIV (P<0.001) transmission risks. Eighty-six percent of nurses stated that they treat each patient as if they are carrying a BBV compared with 41% of doctors. Doctors and nurses differed significantly in their attitudes about and reported compliance with washing hands before and after patient contact and with wearing gloves when taking blood (P<0.001 for all). Doctors consistently de-emphasized the importance of, and reported poor compliance with, these procedures. Doctors were also more likely to state that they re-sheath used needles manually than were nurses (P<0.001). Thirty-seven percent of respondents reported that they had suffered a needlestick injury with a used needle, with doctors more likely to be injured than nurses (P=0.005). Twenty-eight percent of these doctors and 2% of the nurses did not report their needlestick injuries (P=0.004). Education, monitoring, improved availability of resources, and disciplinary measures for poor compliance are necessary to improve infection control in hospitals, especially amongst doctors.

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.

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