NEW NATIONAL STRATEGIES FOR HOSPITAL INFECTION CONTROL: A CRITICAL EVALUATION (EPIDEMIOLOGY, BODY SUBSTANCE ISOLATION, INFECTION CONTROL).
Contributors: University of British Columbia.
Published: 1992
Number of pages: 154
Subjects: Health Sciences, Health Care Management.; Health Sciences, Public Health.; Health Sciences, Nursing.
Description: Isolation of those ill with contagious disease has been a fundamental infection control concept for hundreds of years. However, recent studies suggest that fewer than 50% of health-care workers comply with their hospitals' isolation precaution policies and that efficacy of some of those policies is questionable. In response, two new systems, based upon fundamentally different goals, were promoted. The Centers for Disease Control, prompted by health-care workers' concerns about occupational risk of human immunodeficiency virus (HIV), issued formal guidelines in 1987. This formed the basis for Universal Precautions (UP), a unifying strategy for precautions with all patients regardless of diagnosis intended to reduce risk to hospital staff members. Also in 1987, one hospital issued guidelines for Body Substance Isolation (BSI), hygienic precautions to be used with all patients based on recognition that colonized body substances are important reservoirs for cross-infection to both patients and staff members.

This thesis provides new tools and new information to address three vital questions: Have hospitals adopted Universal Precautions or Body Substance Isolation? Do their staff members use the new system of precautions in daily practice? Has reliable use of a new system led to decreased risk of infection?.

A confidential mailed survey of all acute-care Canadian hospitals was conducted to measure rates of guideline receipt and adoption. It also obtained information on motivations for and perceived effectiveness of strategies adopted. A self-selected group of responding hospitals subsequently participated in standardized covert observation of their nurses' infection control practice, then had the observed nurses complete a test examining their knowledge and beliefs. Employee health records were also examined to determine whether needlestick injury rates had changed since adoption of a new infection control strategy. Nurses in 35 hospitals were observed to wear gloves during only $\approx$60% of procedures in which gloving was expected: rates varied widely among hospitals. Direct examination of sharp disposal containers confirmed compliance with a policy to not recap used needles (taken as recapping rate of $\le$25%) in only 47% of 32 hospitals. Paired analysis of needlestick injury rates in 11 hospitals during comparable 90-day periods before versus after implementing UP/BSI showed no significant difference. 489 nurses completing a written test achieved their highest scores and least discordance among questions regarding procedural issues established long before UP/BSI, and lower scores or greater discordance on UP/BSI concepts of philosophy, risk recognition and newer procedures. Positive correlation between knowledge and practice was not evident. UP and BSI now mean different things in different hospitals and have not been effective in harmonizing health-care workers' infection control practices. Carefully standardized assessment methods are needed to guide their evolution to cost-effectiveness. (Abstract shortened by UMI.).
Notes: Source: Dissertation Abstracts International, Volume: 54-02, Section: B, page: 0729.

Thesis (PH.D.)--THE UNIVERSITY OF BRITISH COLUMBIA (CANADA), 1992.

School code: 2500.