Universal Precautions: How Well are They Followed?
Abstract & Commentary
Synopsis: Observed, overall compliance with universal precautions was 67%, with a range of 25-100%.
Source: Roup BJ. Am J Crit Care 1997;6:218-224.
To examine compliance with universal precautions, Roup observed a random sample of 25 critical care nurses in a medical and surgical ICU at a large military medical center while they performed various procedures that exposed them to blood and body fluids of patients. After the observations were concluded, the nurses completed an 85-item confidential questionnaire that assessed attitudes, knowledge, and availability of supplies and equipment to carry out universal precautions.
Overall, compliance rates ranged from 25-100%, with most scores between 65% and 85%. The percentage of nurses observed to wear gloves during each of the following procedures was as follows: drawing arterial blood gases 88%, administering blood 50%, emptying urine containers 88%, and changing dressings 100%. Only two nurses were observed suctioning patients’ oral or respiratory secretions, and neither nurse wore a mask or full eye protection despite this equipment being readily available at the bedside.
Self-reported scores for compliance with universal precautions were higher than observed scores, with the exception of glove use during suctioning and dressing changes. Higher scores on a questionnaire designed to measure knowledge, attitudes, and prior experience with universal precautions did not predict the extent to which precautions were appropriately followed during the observations. Surprisingly, knowledge that a patient was known or suspected to have an infectious disease such as hepatitis or HIV infection had only had a moderate influence on whether universal precautions were followed.
COMMENT BY LESLIE A. HOFFMAN, RN, PhD
Universal precautions for handling blood and body fluids were recommended for all healthcare workers by the Centers for Disease Control and Prevention (CDC) and mandated by the Occupational Safety and Health Administration (OSHA) in 1991. Compliance of nurses with universal precautions has been the subject of at least eight prior studiesself-reported compliance rates have ranged from 66-76%, which is similar to that reported in this study.
The critical care nurses in this sample worked in a medical or surgical ICU. As required, all had received training about universal precautions within the previous 12 months. Their mean knowledge score was 7.8 + 1.2 (range 0-10), indicating a fairly high level of knowledge about universal precautions. These nurses were also experienced with the use of universal precautions, with an average of 5.8 + 4.6 years of prior work time. Given this background, the findings of this study are perplexing. In prior studies, primary reasons given for noncompliance were lack of time, interference with skill performance, and problems finding the needed supplies and equipment. Only access to supplies and equipment was surveyed here, and this factor did not influence compliance. Prior studies also indicated that knowledge of universal precautions did not predict compliance.
Other variables, such as peer pressure or nursing unit leadership, should also be examined to determine if these strategies can achieve improved compliance. Nurse managers can incorporate the use of universal precautions into performance evaluations, monitor their use, and institute a reward system to encourage compliance. Periodic observations, such as those conducted for this study, with reporting of results, may also be helpful.
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