Adherence to universal (barrier) precautions during interventions on critically ill and injured emergency department patients

Article Abstract:

Emergency department personnel routinely come into contact with the blood and body fluids of patients. The number of patients who come to the emergency department and are infected with human immunodeficiency virus (HIV) may be large. Two previous studies reported that 3 to 4 percent of emergency patients have unsuspected HIV-1 infection. This creates the potential for exposure of personnel to the virus. The only reliable way of minimizing the chance of infection is adherence to Universal Precautions, including the wearing of gowns, surgical masks, goggles, and gloves, as recommended by the Centers for Disease Control for prevention of blood-borne infections. Compliance with Universal Precautions by health care personnel was examined. The personnel were in contact with patients who were critically ill or injured, in the emergency department at the Johns Hopkins Hospital in Bethesda, Maryland, an inner city hospital. One-hundred-twenty-nine personnel performing 1,274 interventions on 151 patients were observed in July 1988. Barrier precautions were fully adhered to only 44 percent of the time. In patients with profuse bleeding, adherence to barrier precautions occurred only 19.5 percent of the time. During major interventions, in which there is a risk of spraying of blood or profuse bleeding, adherence occurred 16.7 percent of the time. Adherence occurred in 56.4 percent of minor interventions, in which there was a risk of contact with blood but little chance of spray or profuse bleeding. Therefore, adherence to the Universal barrier precautions was inversely related to the need to perform the procedure immediately. The rates of adherence varied among the health care personnel as follows: residents (trainees), 58 percent; emergency staff physicians, 44 percent; paramedics, 8 percent; radiology technicians, 14 percent; and housekeeping, 91 percent. A questionnaire on the reasons for lack of compliance with precautions was given to the personnel. Forty-seven percent said that there was not enough time to put on protective devices, 33 percent felt that the precautions interfered with the performance of procedures, and 23 percent felt that the protective devices were uncomfortable. Only 2.7 percent felt that the Universal Precautions do not work. Although it is known that transmission of HIV in the occupational setting occurs most frequently from needle sticks or other sharp injuries, the barrier precautions should still be rigorously followed. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Safety and security measures, Prevention, HIV infection, HIV infections, Emergency medical services, Medical personnel, Disease transmission, Emergency medical personnel, Emergency medical technicians, Emergency physicians, Protective coverings

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Hepatitis B and hepatitis C in emergency department patients

Article Abstract:

Routine testing of patients at an inner-city emergency room for infection with HIV-1 alone would miss a significant number of patients infected with hepatitis B virus (HBV) or hepatitis C virus (HCV). Of 2,523 patients tested for infection with HBV, HCV or HIV-1, 612 (24%) were infected with at least one type of virus. Among patients with positive test results, 129 (five percent) were positive for HBV infection, 458 (18%) were positive for HCV infection (18%) and 152 (six percent) were positive for HIV-1 infection. Testing for HIV-1 alone would have missed 73% of the patients with at least one other infection than HIV. Screening patients for HIV alone would have failed to detect (80%) of the patients infected with HCV and 87% of the patients infected with HBV. Eighty-three percent of intravenous drug users were infected with at least one type of virus. Seventy-nine percent of individuals with homosexual activity and 23% of those with heterosexual activity as their only admitted risk factor were infected with at least one type of virus.

Demographic aspects, HIV (Viruses), HIV, Hepatitis C, Hepatitis B

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Human immunodeficiency virus infection in emergency department patients: epidemiology, clinical presentations, and risk to health care workers: the Johns Hopkins experience

Article Abstract:

The impact of the AIDS epidemic on the emergency department of an urban teaching hospital is studied. Six percent of emergency patients were infected with the AIDS virus, compared with five percent the previous year. Of the 57 patients with a known history of AIDS infection, 50 percent had no insurance, versus only 35 percent of uninfected patients. AIDS-infected people were three times more likely than other people to be admitted to the emergency department. Health care providers followed precautions to avoid infection during 44 percent of medical procedures, but during only 19 percent of procedures performed while the patient was bleeding profusely. The most common reasons given by health care providers for not following the precautions were insufficient time to don the protective attire and interference of the attire with the procedure. Strategies should be developed to appropriately use emergency services and maximize protection of health care providers.

Testing, Medical care, Surveys, Patients, Hospitals, Hospital emergency services, Johns Hopkins Hospital (Baltimore, Maryland), HIV antibodies

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