Safety zone: How to get HCWs to use precautions

Education boosts eye protection, double-gloving

Are your employees using the protective gear and safety devices you provide them? Too often they’re not. Faced with data that showed lackluster adherence to safety precautions, Barnes-Jewish Hospital in St. Louis focused on education to bring about safer work practices.

Posters, cards, and educational sessions emphasized the importance of universal precautions, such as wearing protective eyewear and double-gloving in the operating room. Adherence increased from 54% to 66% for eyewear and from 28% to 52% for double-gloving, while needlesticks and body fluid exposure declined.1

Generally, the problem isn’t that health care workers lack knowledge about universal precautions, says Lynn Kim, MPH, research coordinator in the division of infectious diseases at Washington University School of Medicine in St. Louis. "They just were too busy, especially in the ER. A case would come in and they would just go in. They said [the eyewear] wasn’t easily accessible to them. We made some changes and tried to reduce those barriers."

Health care workers also may become complacent. Barnes-Jewish Hospital used a 50-item questionnaire to assess how much emergency department personnel knew about the transmission of bloodborne pathogens, their risk of infection after a needlestick, and the effectiveness of postexposure prophylaxis.

Only 20% of the 103 ED staff members surveyed could correctly identify the risk of transmission of a bloodborne pathogen after a needlestick injury from an HIV-positive, hepatitis B-positive, or hepatitis C-positive patient.2

More than one-third of respondents considered their lifetime occupational risk of HIV infection to be "insignificant," and 15% said they "only reported needlestick injuries if they knew the patient was HIV-positive."

"There haven’t been any conversions at our hospital for HIV," says Kim. "So then they may think they’re not really at risk. But we did provide them with data of blood that was tested for patients in the ER and let them know there is HIV among patients they’re seeing."

When infection control staff observed behaviors in the emergency department and operating room, they likewise found a loose attitude among many health care workers.

Only 38% of 57 nurses and 121 surgeons surveyed reported using double gloves most of the time. Yet their actual behavior was even less protective. In an observation of 76 surgical cases totaling 200 hours, only 16% of the nurses and physicians used double gloves.

"I think they intend to be [compliant with universal precautions], but they get into their daily routine and don’t think about it," says Kim.

The hospital made some changes to make it easier for employees to comply with the precautions. For example, the gloves were moved to a shelf closer to the entrance to the ED trauma room where staff could grab them as they walked in. Trauma rooms were redesigned to reduce crowding, and limits were placed on the number of observers.

Yellow signs remind ED personnel to observe universal precautions, and a hands-on training program for medical students and interns helps them brush up on procedures associated with needlesticks, such as phlebotomy and arterial blood gases. Small reference cards remind personnel about what to do immediately after exposure to possible bloodborne pathogens, including the risks of acquiring HBV, HCV, and HIV and the phone number for reporting.

"We just kept focusing attention on [the precautions]," Kim says. "It helped people become more aware."


1. Kim L, Freeman B, Jeffe D, et al. Educational intervention improves compliance with Universal Precautions in the operating room for two years after training. Presented at the 10th annual meeting of the Society for Healthcare Epidemiology of America. Atlanta; March 5-9, 2000.

2. Kim LE, Evanoff BA, Parks RL, et al. Compliance with Universal Precautions among emergency department personnel: Implications for prevention programs. Am J Infect Control 1999; 27:453-455.