Universal Precautions in a Teaching Hospital

The Lowbury lecture: behaviour in infection control

The majority of healthcare-associated infections result from cross-transmission related to inappropriate patient-care practices. Improving practices frequently implies modifying healthcare workers' behaviour, a key challenge of today's infection control. To improve healthcare workers' compliance with practices, infection control should learn from the behavioural sciences. Social cognitive models can help to improve our understanding of human behaviour. Cognitive determinants that shape behaviour are acquired through the socialization process and are susceptible to change. Some models have been applied to evaluate predictors of health behaviour but, so far, none have been successfully applied to explain behaviour in the field of infection control. Successful strategies to improve infection control practices result from their multidimensional aspect. Similarly, social models that include several levels of cognitive determinants have more chance of success to explain change in behaviour. Concrete examples applied to infection control issues are presented, including special references to hand hygiene behaviour. The theory of ecological perspective, based on the idea that behaviour is viewed as being affected by and affecting multiple levels of influence, and that it both influences and is influenced by the social environment, seems promising to explain behaviour modification. Studies are needed to assess the key determinants of infection control practices and behaviour promotion among the different populations of healthcare workers, and to implement and evaluate the impact of the different components of multimodal programmes to promote optimal infection control practices.

Profiles of rural nurses' use of personal protective equipment: a cluster analysis

This study examined the relationship between profiles of rural registered nurses' levels of compliance with the use of personal protective equipment and HIV-related attitudes. Survey data were collected from 395 practicing registered nurses in nine rural counties in New York and Pennsylvania. Cluster analysis grouped respondents according to their use of protective equipment by patient HIV status. Seven profiles were identified from the resulting 13 clusters. Profiles were named according to the characteristics of the protective equipment usage that were most evident in each profile. Usage levels included minimal users, appropriate users, anticipatory users, glove users, discriminate users, maximal users, and optimal users. Of these, three were classified as compliant, one as undercompliant, and three as overcompliant. Selective compliance (changing usage in response to patients' HIV status) was characteristic of five profiles. Knowledge that patients were HIV-positive accounted for overcompliance and selective compliance and was related to nurses' HIV attitudes. Undercompliance was related to care of patients who were HIV-negative or unknown. Rural nurses' use of personal protective equipment is not homogenous but discrete and idiosyncratic. This analysis expands current knowledge and redefines nursing practice of standard precautions.

Determinants of nurses' adherence to universal precautions for venipunctures

OBJECTIVES

The aim of this study was to predict and explain nurses' adherence to Universal Precautions (UPs) when performing venipunctures.

METHODS

Data were gathered from 156 registered nurses working at a regional hospital. A self-administered questionnaire assessing the psychosocial variables (intention, attitude, subjective norm, perceived control, etc) was completed at baseline, and behavior was self-reported 3 months later.

RESULTS

The regression of intention on the variables yielded an adjusted R(2) of 0.68, with perceived barriers (beta =.62, P <.001), social norm (beta =.17, P <.01), and personal normative belief (beta =.19, P <.01) being the significant variables. With respect to the 3-month follow-up, 28% of the variance associated with UPs adherence was explained by intention (beta =.37, P <.001) and perceived behavioral control (beta =.23, P <.05). Moreover, high (n = 116) and low intenders (n = 40) differed on several normative beliefs (P =.0003) and perceived barriers (P =.0001).

CONCLUSIONS

It is suggested that perception of control, assessed either globally or by means of a belief-based measure, is a key factor in adherence. Specifically, the perceived difficulties associated with adherence to UPs appear to be related to a nurse's training on UPs and to the existence of suboptimal working conditions.

Understanding physicians' intention to use a simple infection control measure: wearing gloves

OBJECTIVE

The aim of this study was to identify the factors that explain the intention of physicians to wear gloves when contact with blood or body fluids was possible.

METHODS

A survey was given to a representative sample of physicians (general practitioners, medical specialist, and surgeons of the Canadian province of Québec). A total of 720 physicians completed the self-administered questionnaire. The respondents' intention to wear gloves, psychosocial variables (attitude, perceived social norm, perceived behavioral control, perceived risk of infection, and habit of wearing gloves), and sociodemographic variables were assessed.

RESULTS

A substantial proportion of physicians (80%) had strong intentions to wear gloves when contact with blood and body fluids was possible. Logistic regression indicated that the 3 most important factors explaining intention were perceived behavioral norm, attitudes, and perceived behavioral control. Perceived risk of infections, habit of wearing gloves, and being in a younger age category were additional factors related to intention.

CONCLUSIONS

Interventions should reinforce the perception that the use of gloves is the norm among medical professionals. These programs also should emphasize the advantages of wearing gloves, counteract the perceived disadvantages of wearing them, and enhance the ability of physicians to circumvent the difficulties of wearing gloves when required.

HIV infection: challenges for dialysis personnel

Patients with human immunodeficiency viral (HIV) infection who also require dialysis present a complex constellation of challenges for dialysis personnel. The major challenges that health care providers (HCPs) face when working with HIV-infected patients are related to overcoming personal fears and to adapting to HIV-specific patient care needs. Dialysis personnel who encounter these concerns do so with a background of experience that has prepared them to cope effectively with HIV disease in the dialysis setting. This article explores the problems of occupational exposure to HIV and chronic health care issues common to patients with HIV infection and renal disease.

Rural nurses' use of universal precautions in relation to perceived knowledge of patient's HIV status

The increased incidence of AIDS in rural areas of the United States has called attention to the practice of universal precautions by rural nurses. The purpose of this research was to determine protective barrier use by 555 nurses living in rural counties in Pennsylvania and New York State and the effect on this use of their knowledge of their patients' HIV status. Findings suggest that nurses increased their use of protection if they knew their patients were HIV-positive. However, if they thought that their patients were HIV-negative or if they did not know their patients' HIV status, they did not always use adequate protection. Findings are discussed as they relate to the context of rural nursing practice.