Health literacy: universal precautions needed

Inadequate health literacy adversely affects health care outcomes and the quality of life of 90 million Americans and costs the health care system dollars 73 billion annually. Current strategies addressing inadequate health literacy primarily target physicians, nurses, and pharmacists but omit the allied health practitioners responsible for providing most patient services. The 2003 Coalition for Allied Health Leadership Health Literacy Project team undertook a survey of allied health professionals and educators to assess their awareness and needs concerning inadequate health literacy. Less than one third of all respondents were aware of the issues surrounding health literacy or that health literacy resources are available or had institutional policy or goals to address health literacy. Brochures and videos were identified most frequently as new resources needed to establish or increase the effectiveness of health literacy awareness programs. The results of this project indicated that there is substantial opportunity to increase awareness of the impact of health literacy, to develop and assess institutional policies toward health literacy, and to create new resources to promote health literacy within the allied health professions. Any approach to improving health literacy must be universal by involving all health care professionals and all patients in the intervention.     

Compliance with universal precautions in a medical practice with a high rate of HIV infection.

BACKGROUND: Universal precautions have been recommended to limit occupational exposure to the human immunodeficiency virus (HIV) and other infectious agents, but whether these recommendations have been incorporated into routine practice has not been demonstrated. METHODS: Using a one-group, before-after design, we assessed the knowledge and attitudes concerning universal precautions and the level of compliance with these recommendations. The health care professionals had various levels of training and worked in an ambulatory practice with a high rate of HIV. A total of 195 procedures involving potential exposure to various body fluids were observed. RESULTS: No improvement in compliance with recommended precautions was observed following a didactic educational program for either latex glove use (44 percent versus 49 percent, chi 2 less than 1, P greater than 0.2) or appropriate use of hand washing (34 percent versus 47 percent, chi 2 = 3.38, P = 0.07). Faculty demonstrated the lowest levels of adherence to universal precautions. While knowledge of precautions was high, staff members at all levels overestimated their own compliance with these recommendations. CONCLUSIONS: Although the number of observations limits the conclusions, the results suggest that the basic protective measures included in universal precautions are not being routinely applied in ambulatory medical practice. Furthermore, didactic educational programs might not be sufficient to improve compliance. Finally, faculty in training programs should monitor their own compliance with universal precautions because of their responsibilities as role models for physicians in training.     

Knowledge and self-reported use of universal precautions in a university teaching hospital

This article reports a study of knowledge and self-reported use of universal precautions by professionals (individuals on the medical staff, in nursing service, in the laboratory, and in the social service, pastoral care, and respiratory care departments) and nonprofessionals (individuals working in the dietary and environmental services departments) in a university teaching hospital. Nonprofessional workers were found to be less knowledgeable about universal precautions than were professional workers. Appropriate use of universal precautions significantly correlated with a worker's perceived risk of exposure (positively correlated), the belief that HIV is easy to "catch" (negatively correlated), and the extent of the worker's involvement with HIV-infected patients (positively correlated). Use of universal precautions was not found to be significantly correlated with belief in universal precautions as a reasonable way to protect oneself from contracting HIV in the workplace. Recommendations are made for increasing appropriate use of universal precautions.     

Compliance with universal precautions in correctional health care facilities

There were three main objectives of this cross-sectional study of Maryland State correctional health care workers. The first was to evaluate compliance with work practices designed to minimize exposure to blood and body fluids; the second, to identify correlates of compliance with universal precautions (UPs); and the third was to determine the relationship, if any, between compliance and exposures. Of 216 responding health care workers, 34% reported overall compliance across all 15 items on a compliance scale. Rates for specific items were particularly low for use of certain types of personal protective equipment, such as protective eyewear (53.5%), face mask (47.2%) and protective clothing (33.9%). Compliance rates were highest for glove use (93.2%) waste disposal (89.8%), and sharps disposal (80.8%). Compliance rates were generally not associated with demographic factors, except for age; younger workers were more likely to be compliant with safe work practices than were older workers (P < 0.05). Compliance was positively associated with several work-related variables, including perceived safety climate (i.e., management's commitment to infection control and the overall safety program) and job satisfaction, and was found to be inversely associated with security-related work constraints, job/task factors, adverse working conditions, workplace discrimination, and perceived work stress. Bloodborne exposures were not uncommon; 13.8% of all respondents had at least one bloodborne exposure within the previous 6 months, and compliance was inversely related to blood and body fluid exposures. This study identified several potentially modifiable correlates of compliance, including factors unique to the correctional setting. Infection-control interventional strategies specifically tailored to these health care workers may therefore be most effective in reducing the risk of bloodborne exposures.     

Nutrition assessment: a management tool for providing quality care.

When planning nutrition intervention programs in a health care facility or the community, an analysis of the service population is necessary to determine the levels of care than can be provided. The use of screening and monitoring techniques will maximize the resources that are available and increase the amount of care that can be given. By using baseline nutrition assessment data, health outcomes can be measured over time and cost-effectiveness of the program can be evaluated. Examples of studies that measure effectiveness of nutrition services and programs are reviewed. Specific steps are suggested to simplify the documentation of the process and outcomes of nutrition intervention.     

Physical activity assessment: validation of a clinical assessment tool

BACKGROUND: Physicians report that they fail to counsel patients about physical activity due to a lack of practical tools, time, reimbursement, knowledge, and confidence. This paper reports concurrent and criterion validation of the Physical Activity Assessment Tool (PAAT), designed to rapidly assess patient physical activity in clinical settings and reduce time for assessment, and thus to facilitate counseling. METHODS: Adult volunteers (n=68) completed the PAAT and International Physical Activity Questionnaire-Long Form (IPAQ-Long) twice and wore a Manufacturing Technology, Inc. (MTI) accelerometer for 14 days in 2003. Continuous and categorical measures of physical activity by PAAT were compared to MTI accelerometer and IPAQ-Long in analyses conducted in 2003 to 2006. Consistent with national recommendations, participants were classified as active if they accumulated more than 150 minutes per week of moderate to vigorous physical activity (MVPA) or more than 60 minutes per week of vigorous physical activity. RESULTS: The PAAT was significantly correlated with the IPAQ (r=0.562, p<0.001) and MTI (r=0.392, p=0.015) for MVPA. Seven-day test-retest reliability was comparable for PAAT (r=0.618, p<0.001) and MTI (r=0.527, p<0.001). PAAT classified participants as "active" or "under-active" concordantly with MTI for 69.8% of participants and with IPAQ for 66.7%; strength of agreement was fair (kappa=0.338 and 0.212, respectively). The PAAT classified fewer participants as active than either the MTI (p=0.169) or IPAQ (p<0.001), and measured physical activity more like the direct objective measure (MTI) than did IPAQ. CONCLUSIONS: The concurrent and criterion validity of the PAAT are comparable to self-report instruments used in epidemiologic research.     

Improved compliance with universal precautions in the operating room following an educational intervention.

Observation of surgical personnel in four specialties (cardiothoracic, general, gynecologic, and orthopedic) in the operating room was performed prior to implementation of an educational intervention designed to improve compliance with Universal Precautions and at 1- and 2-years post-intervention. Use of protective eyewear and double gloving increased following the intervention, whereas the incidence of documented blood and body fluid exposures decreased.     

Connecticut's new comprehensive and universal early childhood health assessment form

Health assessments are required for entrance into child care, Head Start, and preschool programs. However, state and federal screening and documentation mandates vary, and programs create their own forms for keeping required data on file. Inconsistent recording formats present challenges for primary care providers who must document each child's health status and for program administrators who wish to collect data across groups of children. This article describes how the passage of new legislation in Connecticut establishing a statewide prekindergarten program presented the opportunity to develop a comprehensive early childhood health form for all early childhood programs, which promotes children's access to health services and coordination of care among health care professionals, early childhood providers, and families.     

Adverse exposures and universal precautions practices among a group of highly exposed health professionals

An anonymous national survey of a representative population of healthcare workers who were thought likely to have frequent and intensive exposures to blood and other body fluids (certified nurse-midwives [CNMs]), was conducted to assess the type and frequency of self-reported occupational exposures to blood and body fluids experienced, the extent to which barrier precautions and other infection control measures were used, whether or not reported use of barriers was associated with a lower perceived rate of exposures and factors that influenced the use of infection control procedures. Of those responding, 74% had soiled their hands with blood at least one time in the preceding six months, 51% had splashed blood or amniotic fluid in their faces and 24% reported one or more needlestick injuries during that same period. Our study also found evidence of an association between the practice of needle recapping and the occurrence of needlestick injury (p = .003). Despite a high level of training and knowledge, only 55% reported routinely practicing universal precautions (UPs). Several factors that potentially influenced the use of UPs were studied, including healthcare worker perceptions of risk of occupational bloodborne infection, knowledge of routes of transmission of bloodborne pathogens and rationale for not using appropriate barriers. Our data suggest that occupational exposures occur frequently and that healthcare workers' (HCWs') perceptions of risk for occupational infection play an important role in influencing use of UPs. This study emphasizes the importance of developing new strategies for UP training.     

新型农村合作医疗制度的缺陷与防范分析

文章分析了新型农村合作医疗制度的缺陷主要表现在三方面：一是财政补贴与自愿参与挂钩。易形成逆向转移支付。二是保大不保小，增加了逆向选择风险和推广的难度；三是财政拨款的方式，引发“套资”行为。     

Healthcare workers' risk of contact with body fluids in a hospital: the effect of complying with the universal precautions policy.

OBJECTIVE: To test whether healthcare workers' knowledge of and compliance with the basic principle of the Universal Precautions policy (i.e., that all patients should be treated equally regarding contact with body fluids) influenced the rate of contact with patient blood. DESIGN: Survey based on anonymous questionnaires. SETTING: A 380-bed secondary and tertiary care hospital receiving emergency and elective patients. PARTICIPANTS: All employees having any contact with patients. Nine hundred one of 1,308 (69%) of the questionnaires were returned. RESULTS: Twelve percent of the respondents (95% confidence interval [CI95] = 10.0%-14.4%) had experienced any contact with patient blood in the week preceding their answer. Physicians had the highest rate of contact with blood followed by nurses. In the five groups--physicians, nurses, laboratory technicians and phlebotomists, nursing aides, and student nurses--contact with blood was less frequent in the subgroup that did know and comply with the basic principle of the Universal Precautions policy, compared with the subgroup that did not. When adding the results for the 5 groups, contact with blood was experienced by 91 of 571 (15.9%, CI95 = 13%-19%) of the personnel who did not know and comply with Universal Precautions. The personnel who did know and comply with Universal Precautions had a significantly lower (9 of 111 [8.1%], p < .05, CI95 = 3.8%-15%) rate of contact with blood. CONCLUSIONS: The healthcare workers who knew and complied with Universal Precautions had a significant lower rate of contact with patient blood than those who did not.