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Effects of two interventions on universal precautions compliance by critical care nurses
2 2 2 Abstracts
In September 1997, mandated by the new contract to change needle disposal systems, Product B was instituted. The previous disposal containers, Product A, had been used successflflly at our 450-bed medical center for 10 years. From September 1997 to February 1998, 6 employee needlestick injuries occurred relating to the new disposal system. These injuries were the result of the needles flipping out, not dropping down, and lids not fitting tightly. A retrospective review from January 1997 through August 1997 showed only 2 injuries relating to disposal container Product A. A simple graph of incidence and time illustrating increased container-related needle stick injuries with Product B was presented to the following committees: infection control, safety, product evaluation, and risk management. Materials management and administration accepted the collaborative recommendations to reinstate Product A for safety reasons. In the 8 months following return to Product A, no needle injuries relating to containers have occurred.
MEDICAL RECORDS CONTAMINATED WITH DRIED BLOOD: A QUALITY ISSUE. M. Fisbman, MPH, CIC,*
D.J. Mikolich, MD, G.G. Fort, MD, MPH, D.T. Cataldo, MS, MT (ASCP), CLSpH. Our Lady of Fatima Hospital, North Providence, and Brown University, Providence, RI. Routine chart review over 23 months in a 256-bed c o m m u n i t y hospital revealed 246 medical records contaminated with a p p a r e n t blood. Sixty percent (60%) were anesthesiology and nursing. Also c o n t a m i n a t e d were blood transfusion, frozen section, medication and discharge records, chart folders, physician orders, consults, and progress notes. Analysis of systematically selected documents confirmed blood as the visible c o n t a m i n a n t in 27% of the cases (8/30). Total quality improvement methodology reduced the incidents by 75%. Actions included policy development, in-service education, and changes in work practices. If c o n t a m i n a t i o n does occur, gloves are donned to place the c o n t a m i n a t e d p a p e r inside a clean zippered plastic bag which is photocopied for s u b s t i t u t i o n into the record. While b l o o d b o r n e pathogen transmission is statistically improbable, we should improve work practices to eliminate blood contam i n a t i o n of charts.
EFFECTS OF TWO INTERVENTIONS ON UNIVERSAL PRECAUTIONS COMPLIANCE BY CRITICAL CARE N U R S E S . B. Roup, PhD, RN, CIC,* J. LeClair, MPH. Johns
Hopkins University, Baltimore, MD. BACKGROUND: Compliance with universal precautions, now known as standard precautions (SPs), has been studied in healthcare workers since 1989. Rates of compliance vary widely. Few studies have explored the effects of intervention strategies designed to increase compliance with SPs. OBJECTIVES: The purpose of this study was to describe, through direct observation of behavior, compli-
AJIC AprN 1999
ance rates of SPs use by critical care nurses both before and after two interventions designed to increase compliance were implemented. METHODS: Data were collected on a random sample of 126 critical care nurses on 7 critical care units. Baseline compliance data were collected for 75 days. Two (2) interventions, an educational computer program on bloodborne pathogens, and a passive feedback letter detailing blood exposures on the respective nursing units were employed. A second observation period followed the interventions to determine short-term rates of compliance. After a 60-day period of no observation, a third observation period was conducted to determine longer-term compliance. RESULTS: Rates of compliance with SPs increased significantly both short term and longer term on the nursing units with the educational computer program. CONCLUSIONS: Constant and ingenious efforts are needed to increase and sustain compliance with SPs. This study indicated that an interactive computer program, located on the nursing unit and used at the nurses' discretion, can possibly increase awareness, and thus compliance, with SPs.
./COMPUTERIZED INFECTION CONTROL MANUAL.
J. Lawhorne, RN, C.,* R. Loudermilk, RN, CIC. Oconee Memorial Hospital, Seneca, SC. BACKGROUND: Updating infection control manuals required hours retrieving and replacing pages in multiple manuals. Pages were removed to make copies and not replaced, or if updates were sent to department managers, often they did not make it to the manual. METHOD: Software and a shared directory were utilized to develop a m a n u a l to include all infection control policies, procedures, exposure control plan, and respiratory protection plan. All were linked to an easy-to-read index by use of a hyperlink feature. A shortcut icon was p l a c e d on the p e r s o n a l c o m p u t e r s , a n d l a b e l e d "Infection Control Manual." By using this icon, employees will only see the index page, which is set up similar to a Web page. Editing the m a n u a l is limited to those with rights to that c o m p u t e r file, preventing accidental deletion or changing of the contents. One h a r d c o p y of the m a n u a l is m a i n t a i n e d in the infection control office. Employee education was the largest obstacle. E d u c a t i o n d e p a r t m e n t and d e p a r t m e n t m a n a g e r s are assisting with this, as well as the ICPs. RESULTS: 100% of manuals are current with the master manual and their location is consistent. Utilization of the computer allows inclusion of photographs and colorful items in the manual, such as steps for proper bandwashing and copies of the isolation signage. CONCLUSION: Integration of infection control and computerization saves time and provides a means of maintaining current resources for employees. Future plans for this system is employee self-study for infection control topics, allowing employees to access and test on information via computer.
In September 1997, mandated by the new contract to change needle disposal systems, Product B was instituted. The previous disposal containers, Product A, had been used successflflly at our 450-bed medical center for 10 years. From September 1997 to February 1998, 6 employee needlestick injuries occurred relating to the new disposal system. These injuries were the result of the needles flipping out, not dropping down, and lids not fitting tightly. A retrospective review from January 1997 through August 1997 showed only 2 injuries relating to disposal container Product A. A simple graph of incidence and time illustrating increased container-related needle stick injuries with Product B was presented to the following committees: infection control, safety, product evaluation, and risk management. Materials management and administration accepted the collaborative recommendations to reinstate Product A for safety reasons. In the 8 months following return to Product A, no needle injuries relating to containers have occurred.
MEDICAL RECORDS CONTAMINATED WITH DRIED BLOOD: A QUALITY ISSUE. M. Fisbman, MPH, CIC,*
D.J. Mikolich, MD, G.G. Fort, MD, MPH, D.T. Cataldo, MS, MT (ASCP), CLSpH. Our Lady of Fatima Hospital, North Providence, and Brown University, Providence, RI. Routine chart review over 23 months in a 256-bed c o m m u n i t y hospital revealed 246 medical records contaminated with a p p a r e n t blood. Sixty percent (60%) were anesthesiology and nursing. Also c o n t a m i n a t e d were blood transfusion, frozen section, medication and discharge records, chart folders, physician orders, consults, and progress notes. Analysis of systematically selected documents confirmed blood as the visible c o n t a m i n a n t in 27% of the cases (8/30). Total quality improvement methodology reduced the incidents by 75%. Actions included policy development, in-service education, and changes in work practices. If c o n t a m i n a t i o n does occur, gloves are donned to place the c o n t a m i n a t e d p a p e r inside a clean zippered plastic bag which is photocopied for s u b s t i t u t i o n into the record. While b l o o d b o r n e pathogen transmission is statistically improbable, we should improve work practices to eliminate blood contam i n a t i o n of charts.
EFFECTS OF TWO INTERVENTIONS ON UNIVERSAL PRECAUTIONS COMPLIANCE BY CRITICAL CARE N U R S E S . B. Roup, PhD, RN, CIC,* J. LeClair, MPH. Johns
Hopkins University, Baltimore, MD. BACKGROUND: Compliance with universal precautions, now known as standard precautions (SPs), has been studied in healthcare workers since 1989. Rates of compliance vary widely. Few studies have explored the effects of intervention strategies designed to increase compliance with SPs. OBJECTIVES: The purpose of this study was to describe, through direct observation of behavior, compli-
AJIC AprN 1999
ance rates of SPs use by critical care nurses both before and after two interventions designed to increase compliance were implemented. METHODS: Data were collected on a random sample of 126 critical care nurses on 7 critical care units. Baseline compliance data were collected for 75 days. Two (2) interventions, an educational computer program on bloodborne pathogens, and a passive feedback letter detailing blood exposures on the respective nursing units were employed. A second observation period followed the interventions to determine short-term rates of compliance. After a 60-day period of no observation, a third observation period was conducted to determine longer-term compliance. RESULTS: Rates of compliance with SPs increased significantly both short term and longer term on the nursing units with the educational computer program. CONCLUSIONS: Constant and ingenious efforts are needed to increase and sustain compliance with SPs. This study indicated that an interactive computer program, located on the nursing unit and used at the nurses' discretion, can possibly increase awareness, and thus compliance, with SPs.
./COMPUTERIZED INFECTION CONTROL MANUAL.
J. Lawhorne, RN, C.,* R. Loudermilk, RN, CIC. Oconee Memorial Hospital, Seneca, SC. BACKGROUND: Updating infection control manuals required hours retrieving and replacing pages in multiple manuals. Pages were removed to make copies and not replaced, or if updates were sent to department managers, often they did not make it to the manual. METHOD: Software and a shared directory were utilized to develop a m a n u a l to include all infection control policies, procedures, exposure control plan, and respiratory protection plan. All were linked to an easy-to-read index by use of a hyperlink feature. A shortcut icon was p l a c e d on the p e r s o n a l c o m p u t e r s , a n d l a b e l e d "Infection Control Manual." By using this icon, employees will only see the index page, which is set up similar to a Web page. Editing the m a n u a l is limited to those with rights to that c o m p u t e r file, preventing accidental deletion or changing of the contents. One h a r d c o p y of the m a n u a l is m a i n t a i n e d in the infection control office. Employee education was the largest obstacle. E d u c a t i o n d e p a r t m e n t and d e p a r t m e n t m a n a g e r s are assisting with this, as well as the ICPs. RESULTS: 100% of manuals are current with the master manual and their location is consistent. Utilization of the computer allows inclusion of photographs and colorful items in the manual, such as steps for proper bandwashing and copies of the isolation signage. CONCLUSION: Integration of infection control and computerization saves time and provides a means of maintaining current resources for employees. Future plans for this system is employee self-study for infection control topics, allowing employees to access and test on information via computer.