Determinants of emergency department procedure- and condition-specific universal (barrier) precaution requirements for optimal provider protection.

Abstract

To determine potential blood and body fluid (B/BF) contacts with specific body areas associated with procedures commonly performed in the emergency department and to thereby delineate appropriate procedure-specific precautions. Prospective, observational study assessing procedure-related B/BF contacts by use of stratified, blocked sampling of shifts. ED patients in an inner-city tertiary care university hospital. Of 2,529 procedures performed in 1,025 patients, 1,621 (64%) were associated with barrier-protected or unprotected B/BF contact; 92% involved blood or bloody BF. Chest tube placement, lumbar puncture, and examination of the bleeding patient all resulted in B/BF contact with the facial area. All of the 18 procedure categories observed, with the exception of i.m. injection, resulted in B/BF contact with hands. Many procedures resulted in contact with the body or feet. Procedure type, provider, length of time, number of procedures per patient, and successful completion were each independently associated with B/BF contact. Number of attempts, adverse conditions, and triage acuteness were not associated with increased likelihood of contact. Virtually all ED procedures require gloves. Barrier protection for the body may be appropriate for all but the simplest procedures. Protection for the face seems appropriate, especially in invasive procedures such as lumbar puncture or physical examination of the bleeding patient. This study, along with other published data, has aided development of detailed guidelines for appropriate barrier precautions to be taken for common ED procedures.