A comparison of observed and self-reported compliance with universal precautions among emergency department personnel at a Minnesota public teaching hospital: implications for assessing infection control programs.

Abstract

To determine the level of universal precautions compliance in a hospital emergency department by two methods (direct observation of subjects versus self-reporting by questionnaire). A Level II trauma center located within a university-affiliated medical center in Minneapolis/St Paul, Minnesota. Glove and needle disposal containers were available in each treatment room; gowns, masks, and goggles were readily available. ED physicians (12 staff plus rotating residents), medical students, nursing staff, and ancillary personnel. Ten observers documented six specific behaviors among ED personnel: needle recap frequency, needle recap techniques, and use of gowns, gloves, masks, and goggles. After the observations, surveys were distributed to ED personnel by intrahospital mail in Fall 1989. During 270 observation hours, 1,018 patient-worker interactions were recorded. Gloves were the barrier worn most frequently when appropriate (74%), followed by goggles (13%), gowns (12%), and masks (1%). Needles were recapped 51% of the time, and most needles that were recapped (79%) were recapped by the two-hand technique; 5% of all needles used were left uncapped at bedside or in the trash. Physicians were observed to use gloves more frequently than registered nurses and nursing assistants; nurses were observed to recap more frequently than physicians. From the survey, the three most common reasons for noncompliance involved time (71%), dexterity (61%), and patient appearance (50%). Universal precautions are not consistently used by ED personnel, and ED personnel significantly overestimate their compliance with universal precautions.