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Nurse perceptions and practice in Australia

 

Clinical bottom line

Exposure rates were high, with 29% of nurses having a percutaneous exposure and 67% having a mucocutaneous exposure over six months. Few exposures were reported, and 19% of needlestick injuries went unreported.


Reference

VM Knight & NJ Bodsworth. Perceptions and practice of universal blood and body fluid precautions by registered nurses at a major Sydney teaching hospital. Journal of Advanced Nursing 1998 27: 746-751.

Study

Universal blood and body fluid precautions require all body fluids to be treated as infectious regardless of the source person's diagnosis and mandate barrier precautions whenever there is potential contact between healthcare workers and non-intact skin, mucous membranes, blood or other body fluids. In New South Wales CDC guidelines were used as a foundation for a local infection control policy.

The study sought to investigate nurses knowledge by use of a questionnaire. Subjects were asked about knowledge of hepatitis B virus transmission, knowledge and adoption of universal blood and body fluid precautions, and occupational exposure.

Results

Of 400 questionnaires sent to nurses in a major Sydney teaching hospital, 192 (48%) were returned. Most were women (85%) and the average age was 30 years. Nurses worked in a variety of clinical settings.

Knowledge of HBV transmission

Four questions were asked about circumstances that are associated with HBV transmission, two true and two false (Table 1). Some were correctly identified, but only 10% of nurses answered all four questions correctly.

Table 1: Knowledge about HBV transmission

Which is associated with HBV transmission?

True or False

Percent with correct answer

Childbirth

True

69

Sexual intercourse

True

93

Eating contaminated food

False

75

Contact with urine and faeces

False

13

Knowledge and adoption of universal blood and body fluid precautions

Use of universal blood and body fluid precautions at all times was reported by 73% of nurses. But only 50% of nurses always wore gloves to take blood samples, remove cannulas, or put up infusion bags, and 77% always wore gloves to clean up urine and faeces.

Occupational exposure

Of the 192 nurses, 146 (76%) experienced a total of 230 occupational exposures to blood or body fluids in the previous six months (240 exposures per 100 nurse years). Mucocutaneous exposures were more common (175 per 100 nurse years) than percutaneous exposures (65 per 100 nurse years). Percutaneous exposures were more frequent in nurses who did not wear gloves when handling blood or blood equipment.

Most nurses (83%) did not report all incidents, and 50% did not report any incidents of exposure. The reasons included not believing there was a risk (75%), but ignorance of the reporting procedure was very low (2%). For needlestick injuries, 19% went unreported.

Comment

These are remarkable results, in terms of a lack of knowledge of HBV transmission, an inconsistent approach to universal blood and body fluid precautions, a high level of exposure, and a cavalier attitude to the fact of exposure.