Universal Precaution Compliance by Orthopaedic Trauma Team Members in a Major Trauma Resuscitation Scenario

Abstract

INTRODUCTION We determined the compliance rates of orthopaedic trauma team members in applying universal precautions in major trauma resuscitation scenarios and the availability of universal precautions in accident and emergency (A&E) departments throughout England.MATERIALS AND METHODS A national telephone survey was implemented contacting the first on-call orthopaedic surgeon and A&E departments in hospital trusts accepting major trauma throughout England. A questionnaire was employed to ascertain current practice, experience and availability of universal precautions when managing a major trauma patient. RESULTS Overall, 112 first on-call orthopaedic surgeons and 99 A&E departments responded. There was good compliance for using gloves (99%) and aprons (86%). There was poor compliance in using eye protectors (21%), face masks (18%), shoe covers (4%) and head caps (4%). Trainees applied universal precautions according to the level of risk they subjectively perceived. All A&E departments had gloves and aprons but the availability of the other universal precautions was less. Of trainees, 76 reported that all universal precautions were not readily available in the A&E department.CONCLUSION Orthopaedic trauma team members are very compliant in using gloves and aprons, but should be more compliant in using eye protectors. It is questionable whether face masks, head caps and shoe covers need to be used in all trauma scenarios. In general, universal precautions should be more available in the A&E departments. There should be better communication between A&E departments and the trauma team regarding the availability of universal precautions.

Infection Prevention in the Emergency Department

“…12,43,45,46 In surveys of ED HCP, commonly cited barriers to adherence to standard precautions have included lack of time, a perception that a patient is at low risk for being infected with HIV or another bloodborne pathogen, interference with dexterity and technical skills, and poor access to PPE at the bedside. [47][48][49][50][51] In some cases, HCP also report uncertainty of which protective barriers to use and when, reflecting inadequate training or knowledge retention. 52,53 Several intervention studies have sought to improve HCP adherence to standard precautions in the ED (Table 2).…”

Healthcare workers and health care-associated infections: knowledge, attitudes, and behavior in emergency departments in Italy

“…Indeed, these HCWs are in the forefront of assisting patients prior a diagnosis, who are critically ill, and with life-threatening conditions. To this end, there has been limited attention paid to investigating knowledge, attitudes, and behavior of HCWs' regarding control policies within this setting [9][10][11][12]. Therefore, the objectives of this study were to provide an assessment of the level of knowledge, attitudes, and compliance regarding standard precautions about HAIs among HCWs in emergency departments (EDs) in an area of Italy, and to identify the determinants associated with them.…”

The Orthopaedic Surgeon and HIV in Jamaica

“…Available evidence suggests that occupational risk of HIV transmission is low [4,10]. However, there is the view that there is underreporting [4,11].…”

“…In addition to this, a high percentage of admissions are as a result of motor vehicle accidents because the hospital is located off a major highway in the country. Many have stated that preoperative screening has not been found to be cost-effective and that universal precautions should be applied to every surgical procedure [4,10,13]. The Ministry of Health in Jamaica has however mandated that all elective patients be screened for HIV in order to have an accurate HIV registry which may help to propose various guidelines.…”