Barrier precautions in trauma resuscitation: real-time analysis utilizing videotape review.

Blood-borne pathogens threaten all individuals involved in emergency health care. Despite recommendations by the Centers for Disease Control and the American College of Emergency Physicians, documented compliance with universal precautions in trauma resuscitation has been poor. The purpose of this study was to determine the factors that predispose to noncompliance with barrier precautions at a level I trauma center. Videotapes of trauma resuscitations performed during 1 month (n = 66) were reviewed. Full compliance with barrier precautions was documented in 89.1% of health care workers. Of the noncompliant health care workers, 50.7% were emergency department personnel and 47.8% were first responders to the trauma resuscitation area. Barrier precaution compliance improved from 62.5% to 91.8% with prenotification of patient arrival. Immediate access to barrier equipment is essential for all potential in-hospital first responders. Prehospital communication systems should be optimized to ensure prenotification.

[1]  G. Kelen,et al.  Substantial improvement in compliance with universal precautions in an emergency department following institution of policy. , 1991, Archives of internal medicine.

[2]  P. L. Rush,et al.  Monitoring universal precautions: a new assessment tool. , 1991 .

[3]  D. Talan,et al.  Compliance with universal precautions in a university hospital emergency department. , 1989, Annals of emergency medicine.

[4]  T. Kerns,et al.  Seroprevalence of human immunodeficiency virus, hepatitis B virus, hepatitis C virus, and rapid plasma reagin in a trauma population. , 1995, The Journal of trauma.

[5]  K Henry,et al.  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. , 1992, Annals of emergency medicine.

[6]  J. G. Adair,et al.  The Hawthorne effect: A reconsideration of the methodological artifact. , 1984 .

[7]  Americancollegeofemergencyphy AIDS--statement of principles and interim recommendations for emergency department personnel and prehospital care providers. American College of Emergency Physicians. , 1988, Annals of emergency medicine.

[8]  R. Brookmeyer,et al.  Unrecognized human immunodeficiency virus infection in emergency department patients. , 1988, The New England journal of medicine.

[9]  S. Jones,et al.  Was There a Hawthorne Effect? , 1992, American Journal of Sociology.

[10]  J. Davis,et al.  The risk of exposure of third-year surgical clerks to human immunodeficiency virus in the operating room. , 1993, Archives of surgery.

[11]  Gordon Diaper The Hawthorne Effect: a fresh examination , 1990 .

[12]  W. Spitzer,et al.  Principles and Practice of Research , 1991, Springer US.

[13]  T. Quinn,et al.  Human immunodeficiency virus infection in emergency department patients. Epidemiology, clinical presentations, and risk to health care workers: the Johns Hopkins experience. , 1989, JAMA.

[14]  D. Heymann,et al.  Transmission of HIV, hepatitis B virus, and other bloodborne pathogens in health care settings: a review of risk factors and guidelines for prevention. World Health Organization. , 1991, Bulletin of the World Health Organization.

[15]  M. Kristensen,et al.  Healthcare workers' risk of contact with body fluids in a hospital: the effect of complying with the universal precautions policy. , 1992 .

[16]  Geertsma Rh,et al.  Television videotape recording: an adjunct in teaching emergency medical care. , 1969 .

[17]  D. Talan,et al.  Effect of education on the use of universal precautions in a university hospital emergency department. , 1990, Annals of emergency medicine.

[18]  S. Shackford,et al.  Video recording trauma resuscitations: an effective teaching technique. , 1988, The Journal of trauma.

[19]  J. Huff,et al.  Universal precautions in emergency medicine residencies: 1989. , 1989, Annals of emergency medicine.

[20]  D. N. Cunningham,et al.  HIV, trauma, and infection control: universal precautions are universally ignored. , 1990, The Journal of trauma.

[21]  D. Diamond,et al.  ATLS-based videotape trauma resuscitation review: education and outcome. , 1993, The Journal of trauma.

[22]  H. McIlvaine Parsons,et al.  Hawthorne:: An Early OBM Experiment , 1991 .