Inter-professional differences in compliance with standard precautions in operating theatres: a multi-site, mixed methods study

BackgroundOccupational acquisition of blood-borne infections has been reported following exposure to blood or body fluids. Consistent adherence to standard precautions will reduce the risk of infection.ObjectivesTo identify: the frequency of self-reported adverse exposure to blood and body fluids among surgeons and scrub nurses during surgical procedures; contributory factors to such injuries; the extent of compliance with standard precautions; and factors influencing compliance with precautions.DesignA multi-site mixed methods study incorporating a cross-sectional survey and interviews.SettingsSix NHS trusts in Wales between January 2006 and August 2008.ParticipantsSurgeons and scrub nurses and Senior Infection Control Nurses.MethodsA postal survey to all surgeons and scrub nurses, who engaged in exposure prone procedures, followed by face to face interviews with surgeons and scrub nurses, and telephone interviews with Infection Control Nurses.ResultsResponse rate was 51.47% (315/612). Most 219/315 (69.5%) respondents reported sustaining an inoculation injury in the last five years: 183/315 (58.1%) reported sharps’ injuries and 40/315 (12.7%) splashes. Being a surgeon and believing injuries to be an occupational hazard were significantly associated with increased risk of sharps’ injuries (adjusted odds ratio 1.73, 95% confidence interval 1.04–2.88 and adjusted odds ratio 2.0, 1.11–3.5, respectively). Compliance was incomplete: 31/315 (10%) respondents always complied with all available precautions, 1/315 (0.003%) claimed never to comply with any precautions; 64/293 (21.8%) always used safety devices, 141/310 (45.5%) eye protection, 72 (23.2%) double gloves, and 259/307 (84.4%) avoided passing sharps from hand to hand. Others selected precautions according to their own assessment of risk. Surgeons were less likely to adopt eye protection (adjusted odds ratio 0.28, 0.11–0.71) and to attend training sessions (odds ratio 0.111, 0.061–0.19). The professions viewed the risks associated with their roles differently, with nurses being more willing to follow protocols.ConclusionInter-professional differences in experiencing adverse exposures must be addressed to improve safety and reduce infection risks. This requires new training initiatives to alter risk perception and promote compliance with policies and procedures.     

Uptake of guidelines to avoid and report exposure to blood and body fluids

BACKGROUND: Mucocutaneous and percutaneous exposure to blood and body fluids (inoculation injury) are major risk factors for occupational acquisition of bloodborne infection in health care professionals. Compliance with prescribed 'universal precautions' during exposure-prone procedures has been shown to reduce the risk of acquiring bloodborne viral infection. In addition, reporting such exposures facilitates prophylaxis. AIM: The aim of this paper is to report a study to identify strategies to minimize professionals' risks of acquiring bloodborne infections during exposure-prone procedures. METHOD: All surgeons, theatre nurses who scrub for surgery and midwives employed in general operating theatres and delivery suites within one UK National Health Service trust (n = 276) were surveyed by postal questionnaire. Data were analysed using univariate and bivariate techniques in SPSS version 10. Content analysis was undertaken on the one open-ended question. FINDINGS: The response rate was 72.5% (200/276). Only 1.5% (3/200) of respondents adopted universal precautions for all patients irrespective of whether their bloodborne viral status was known. On average, only half the recommended theatre-specific precautions were always adopted (mean 3.725/7, SD = 1.385). Most respondents (63.3%) admitted making judgements related to nationality, lifestyle or sexual orientation when making decisions about protective clothing. Many respondents (74%, 145/196) reported sustaining an inoculation injury in the 10 years prior to the study. However, under-reporting of injuries was common, and 32.4% (47/145) admitted failing to report injuries. Guideline adherence was influenced by profession, but not by time since qualification. CONCLUSIONS: The findings suggest that strategies must be developed to improve compliance with universal precautions and reporting guidelines by all health care professionals. The extent of, and reasons for, non-compliance with both local and national guidelines remain relatively unexplored.     

Perceptions and practice of universal blood and body fluid precautions by registered nurses at a major Sydney teaching hospital

Guidelines for universal blood and body fluid precautions (UBBFP) designed to protect health care workers from occupational exposure to blood borne pathogens have been developed by the US Centers for Disease Control. These guidelines have been adopted by the New South Wales Department of Health and all major Australian hospitals. To determine the degree of understanding and utilization of UBBFP by Australian nurses, 192 nurses were asked about UBBFP, recent occupational exposures and understanding of hepatitis B transmission. Seventy-three per cent of nurses stated they 'used UBBFP at all times', yet only 58% of these nurses stated they always used gloves when 'handling blood or blood equipment' and just 85% reported always using 'gloves to clean up urine and faeces'. Overall 146 (76%) nurses experienced 230 occupational exposures (168 mucocutaneous, 48 percutaneous) in the previous 6 months. These were more common in men ( P =0·024) and in operating theatres (95% of nurses) and high dependency units (88%). Percutaneous exposures were significantly more frequent in nurses who stated they did not wear gloves when handling blood/blood equipment ( P =0·036), whereas mucocutaneous exposures were significantly more frequent among nurses who stated they do not adhere to UBBFP at all times ( P =0·005). Eighty-three per cent of nurses experiencing exposures did not report all of them. In this study knowledge and adoption of UBBFP translated directly into lower risk for an occupational exposure. It is concluded that educational strategies to improve understanding and adoption of UBBFP by nurses are required.     

Increase in sharps injuries in surgical settings versus nonsurgical settings after passage of national needlestick legislation

Background

The operating room is a high-risk setting for occupational sharps injuries and bloodborne pathogen exposure. The requirement to provide safety-engineered devices, mandated by the Needlestick Safety and Prevention Act of 2000, has received scant attention in surgical settings.

Study Design

We analyzed percutaneous injury surveillance data from 87 hospitals in the United States from 1993 through 2006, comparing injury rates in surgical and nonsurgical settings before and after passage of the law. We identified devices and circumstances associated with injuries among surgical team members.

Results

Of 31,324 total sharps injuries, 7,186 were to surgical personnel. After the legislation, injury rates in nonsurgical settings dropped 31.6%, but increased 6.5% in surgical settings. Most injuries were caused by suture needles (43.4%), scalpel blades (17%), and syringes (12%). Three-quarters of injuries occurred during use or passing of devices. Surgeons and residents were most often original users of the injury-causing devices; nurses and surgical technicians were typically injured by devices originally used by others.

Conclusions

Despite legislation and advances in sharps safety technology, surgical injuries continued to increase during the period that nonsurgical injuries decreased significantly. Hospitals should comply with requirements for the adoption of safer surgical technologies, and promote policies and practices shown to substantially reduce blood exposures to surgeons, their coworkers, and patients. Although decisions affecting the safety of the surgical team lie primarily in the surgeon's hands, there are also roles for administrators, educators, and policy makers.     

临床护士发生锐器伤上报情况的调查与分析

目的了解临床护士锐器伤的上报情况,为加强护理人员锐器伤的监管工作提供依据。方法采用自行设计的问卷对某三级甲等教学医院的458名临床护士进行调查,调查内容包括护士一般情况、过去1年中的锐器伤暴露情况(暴露部位、原因、物品等)以及锐器伤后上报情况(上报次数、未报告原因等)。结果 458名调查对象中发生锐器伤者292名(1 286例次),发生率为63.76%;主要致伤物品为头皮针、安瓿瓶及皮下注射针具等;护士发生锐器伤后的上报率仅为21.58%(63/292),未上报的首要原因为"太忙而没有时间汇报"。结论医院应重视锐器伤上报管理工作,针对上报率低以及不知道上报程序等原因,加强对护理人员锐器伤的监管工作,严格督促其执行伤后上报程序,并对伤者采取积极的预防处理措施。     

Health professionals' knowledge of prevention strategies and protocol following percutaneous injury

Prevention strategies and protocols for the management of percutaneous injuries are developed for the purpose of preventing transmission of HIV and other infections. However, implementation thereof requires health professionals to be conversant with the content of protocols and ways to prevent percutaneous injuries. The purpose of the study was to determine health professionals' knowledge of prevention strategies and protocols following percutaneous injury. The purpose was addressed within a quantitative survey design. Data were collected by means of a self-administered questionnaire. The study was conducted at a public-sector tertiary academic hospital in Gauteng. Seven units within the hospital were randomly selected for investigation. These included, trauma, intensive care, medical, surgical, maternity, theatre and paediatrics. A population of 800 health professionals worked within the sampled units. Health professionals were stratified according to the following three categories, doctors, registered and enrolled nurses and medical and nursing students. A sample size of 200 health professionals was purposively selected of which a response rate of 79.5% (n = 159) was achieved. The sample consisted of 76.7% (n = 122) registered and enrolled nurses, 13.2% (n = 21) doctors and 8.8% (n = 14) medical and nursing students; 1.3% (n = 2) did not specify their health professional category. Awareness of the existence of a protocol for percutaneous injury amounted to 96.2% (n = 153). General knowledge of the contents of the protocol reflected a different picture; only 26.4% (n = 42) of health professionals could accurately quote the procedure following a percutaneous injury as recommended by the South African Institute of Medical Research (SAIMR) protocol. The lack of knowledge of the existence of a protocol was most evident in the medical and surgical units. A total of 16.4% (n = 26) of health professionals reported having sustained a percutaneous injury. A doctor (33.3%) was more likely to sustain a percutaneous injury than a nurse (15.6%). Intensive care units reported the highest incidence of percutaneous injuries (31%; n = 9). Health professionals were unlikely to report a percutaneous injury; as only 53.8% (n = 14) reported the injury. The results of this research indicate that although knowledge of protocol and prevention strategies was inadequate these alone are insufficient to reduce the incidence of percutaneous injury.     

护理人员在静脉输液操作中针刺伤的调查研究

目的 了解云南省护理人员在静脉输液操作中发生针刺伤的情况,并提出有效的防护对策.方法 利用组织护理学术活动机会,对云南地区15所医院的323名护士随机发放问卷调查表,对调查资料采用回顾性分析方法.结果 323名护士针刺伤发生率为92.26%;护龄短的护士针刺伤发生率明显高于护龄长的护士,两者比较有统计学意义(P＜0.01);静脉输液操作中以针头用后重新套入针帽、吸取药液配液体时、安装或取下注射器/输液器针帽时较其他环节更容易发生针刺伤.针刺伤前接种乙肝疫苗的护士仅占55.36%;针刺伤后能够采取正确处理方法的护士仅占52.34%;对针刺伤防护知识基本了解的护士仅占26.85%;针刺伤好发部位以手掌居多,占78%.结论 静脉输液操作中针刺伤已成为护士最常见的职业损伤,增强护士安全防护意识至关重要,应制定静脉输液中防止针刺伤的规范操作流程,建立静脉输液针刺伤报告及回访制度,提高静脉输液器材的安全性,最大限度地减少对护士造成的危害.     

传染病护理人员伤害多因素分析

目的:从伤害类型、程度、部位、时间、频率、原因探讨传染病护理人员伤害的相关因素,为传染病护理人员制定预防伤害措施和伤害后处理措施提供依据.方法:采用伤害问卷调查表对从事传染病护理工作的195名护理人员进行回顾性调查.结果:195名护士在不同部位均遭受过不同类型的伤害.其中以针刺伤、玻璃安瓿伤最常见分别占64.62%、76.92%,受伤部位以手指为主,加药时受伤多见,工作繁忙是导致受伤的主要原因.结论:传染病护理人员经常面临多种伤害,护理管理者应重视伤害对他们的影响,加强职业防护培训及职业心理教育,严格规范操作规程,配备充足的护理人员,强化乐观的从业思想,是保证职业安全的有效手段.     

Nurses' inclination to report work-related injuries: organizational, work-group, and individual factors associated with reporting.

Work-related injuries such as back strain are common among health care workers. Work-related injury data are a primary data source with which managers can assess workplace safety, yet many work-related injuries go unreported. This study examined organizational, work-group, and individual factors, and nurses' inclination to report a work-related injury. Using a cross-sectional mailed survey, a probability sample of currently employed nurses (N = 1,163) indicated their inclination to report a workplace injury. Inclination to report injuries was higher in organizations with onsite health programs and when health and safety committees included non-management nurses and occupational health representatives. Reporting was reduced when nurses felt a lack of concern for staff welfare from supervisors and a climate of blame for worker injuries were present. Nurses were also less inclined to report work-related injuries when working in jobs with non-standard work arrangements. Improvements in the reporting climate may influence the completeness and, thus, the value of injury data for identifying hazards in the workplace. These data could provide valuable information for targeting preventive initiatives.     

精神科护士患者安全文化态度现状及其影响因素分析

目的 了解精神科护士患者安全文化态度的现状,探讨精神科护士患者安全文化态度的影响因素,为提高精神科护士患者安全文化态度水平,保障患者安全提供参考。方法 采用医院护理人员患者安全文化态度调查问卷及护理不良事件报告障碍问卷对广东省精神病专科医院434名护士进行调查。结果 精神科护士患者安全文化态度总分(86.78±14.53)分,护理不良事件报告障碍总分为(54.38±12.0)分,单因素分析显示,不同性别、职称、职务、每月夜班数的护士,患者安全文化态度得分比较,差异有统计学意义(P＜0.05)。不良事件报告障碍得分与患者安全文化态度得分呈显著的负相关(r=-0.537,P＜0.001)。多元线性回归分析显示,不良事件报告障碍为患者安全文化态度的独立影响因素(R²=0.295,_△R²=0.287,F=35.876,P＜0.001)。结论 精神科护士患者安全文化态度水平有待提高,医院管理者应该重视影响精神科护士患者安全文化态度的因素,深入探索精神科安全文化的建设,提高安全文化水平,增强安全防范意识,保障患者的安全。     

Exposure to noise in orthopaedic theatres – do we need protection?

Aim: To detect noise levels, generated by high‐powered tools in orthopaedic theatres at varying distances from the operating site, and its impact on hearing in staff and patients. Methods: Sound‐level meter was used to measure the sound level generated by various high‐powered tools in routine orthopaedic procedures, at varying distances from the operating site. These recorded noise levels were compared against the UK noise safety guidelines. Result: We found that the noise generated was often significantly higher than the safety guidelines. Conclusion: Noise levels in orthopaedic theatres can be at unacceptable levels, which could potentially lead to hearing problems in the staff and patients. We believe that all patients, especially the elderly patients, (who are more prone to hearing problems) should have hearing protection during orthopaedic operations that use high‐powered tools. Surgeons and scrubbed theatre staff should take precautions.     

手术室护士压力性损伤管理自我效能感现状及影响因素分析

目的 了解手术室护士压力性损伤管理自我效能感现状及影响因素,为提升护士压力性损伤管理自我效能水平,实施针对性干预提供参考。方法 采用主动性人格量表、关怀行为量表、变革型领导量表、护理临床决策量表和护士压力性损伤管理自我效能感量表对广西、四川、贵州、云南、新疆、重庆10所三级甲等医院的469名手术室护士进行调查。结果 护士压力性损伤管理自我效能得分为(28.71±6.32)分,学历、主动性人格、关怀行为、变革型领导及护理临床决策是压力性损伤管理自我效能的影响因素(P＜0.005),能解释总变异的39.8％。结论 手术室护士压力性损伤管理自我效能处于中等偏上水平,其影响因素较多。护理管理者可通过采取实施变革型领导、建立良好的护理临床决策氛围等有效措施帮助护士提高压力性损伤管理自我效能。     

护生临床意外损伤调查分析及预防对策

目的调查分析护理专业实习生(护生)在临床工作中发生意外损伤的情况,并探讨预防对策,以便加强护生安全意识并采取相应防护措施。方法采用自行设计回顾性问卷对331名护生进行抽样调查,并对发生医疗意外损伤的情况进行统计分析。结果调查问卷显示,73.1%护生发生过针刺伤,64%损伤发生在操作前,最常见的损伤原因是防范意识淡漠,获得防护知识的主要途径为在校期间的学习。结论护生在临床工作中常发生意外损伤,针刺伤普遍存在,故应在学校及临床教学中加强职业安全教育,提高护生对临床意外损伤的认知和预防能力,以减少职业损伤。     

军队医院护士锐器伤的不安全因素与防护措施

目的研究军队医院护士锐器伤发生的不安全因素,为军队护士预防锐器伤提供依据。方法采用流行病学调查]方法对广州市5所军队医院的1461名临床护士锐器伤发生的相关因素进行问卷调查。结果护士锐器伤的月发生率为35.9%,发生密度为0.75次/(人·月),导致锐器伤的主要不安全因素包括缺乏自我防护意识、错误的行为习惯、过多接触针头、不良的环境因素、安全产品运用的滞后、注射后用具处理不当等。结论加强护士培训,提高自我防护意识,制定安全指南,提供安全性护理用具,减少护士不必要的针头接触,建立安全注射管理与监测组织,促进安全注射相关法规的健全等措施可减少护士锐器伤的发生。     

Organizational risk management and nurses' perceptions of workplace risk associated with sharps including needlestick injuries in nurses in New South Wales, Australia

This study aimed to determine nurse reported organizational risk management and nurses' perceptions of workplace risk associated with sharps-related injuries. A cross-sectional survey was carried out on a sample of nurses from the New South Wales Nurses' Association, Australia in 2007 (n =7423), and there were 1301 eligible participants. Overall, 73% participants reported that organizational policies were followed in the event of a "sharps including needlestick" injury. Participants reported working in sharps safety oriented organizations, routine hepatitis B vaccination, sharps disposal containers at point-of-use locations and availability of safety engineered devices in their organizations. Sharps including needlestick injury data were not routinely provided to staff, many nurses reported recapping and just one-third had recently attended sharps injury prevention training. Nurses' perceptions of risk associated with sharps including needlestick injury were variable. Health-care organizations are responsible for provision of safe workplaces and work practices, policies, workplace culture and prevention strategies, and appropriate responses when nurses are injured. These results have been used to propose recommendations to improve some of these risk management strategies.     

护士不良事件报告认知与态度现状及其影响因素

目的:调查我院护士对不良事件报告认知与态度的现状;探讨其影响因素,为完善护理不良事件报告系统提供依据。方法:选取我院495名护士进行调查。采用自行修订的"不良事件报告认知与态度问卷"进行调查。结果:①护士对不良事件的认知与态度的积极应答率为64.89%,总均分为(3.67±0.95)分,问卷5个维度按积极应答率的高低降序排列依次为执行意向、管理期望、科室文化、惩罚环境、报告认知。②年龄、护龄、职称与报告的认知和态度呈正相关(P<0.01)。③岗位、护龄是不良事件报告认知与态度的影响因素。④年龄、科室文化、惩罚环境、管理期望是不良事件执行意向的影响因素。结论:护士对不良事件报告的认知与态度是较正向的。年龄、护龄越大,职称、岗位越高,护士对不良事件报告的认知与态度越正向。岗位、护龄影响不良事件报告认知与态度。年龄、科室文化、惩罚环境、管理期望影响不良事件执行意向。建议医院针对目标群体的需求和特点,采取更具敏感性的干预策略;从系统的角度审视安全问题,开展系统化的安全管理,进一步完善不良事件报告系统,促进不良事件的报告行为。