Universal precautions are not universally followed
K. R. Courington, S. L. Patterson and R. J. Howard
Department of Surgery, University of Florida College of Medicine, Gainesville.
Adherence to universal blood and body fluid precautions was studied in
surgical patient care areas of a university hospital in an effort to
identify potentially hazardous health care personnel practices. Surgical
teams of an 18-unit operating room, three surgical ward patient care teams,
and patient care personnel in a 16-bed surgical intensive care unit were
observed during routine patient care activities before (study 1) and after
(study 2) specific educational programs were held to improve universal
precaution compliance. Overall, infractions occurred in 57% of 549 observed
procedures in study 1 and in 58% of 616 observed procedures in study 2. In
study 1, infractions occurred in 75% of operating room procedures, 30% of
surgical ward procedures, and 75% of surgical intensive care unit
procedures. Study 2 procedure infraction rates were 81%, 32%, and 40%,
respectively. Only surgical intensive care unit compliance significantly
improved. Noncompliance with universal precautions occurs frequently during
the care of patients who have undergone surgery, with the type of
infraction and specific offender varying according to patient locale. These
violations appear unamenable to one-time educational efforts. Substantial
overall improvement may arise from ongoing educational programs directed at
specific personnel who care for patients who have undergone surgery.
