Inter-professional differences in compliance with standard precautions in operating theatres: a multi-site, mixed methods study

Abstract

Background: Occupational acquisition of blood-borne infections has been reported following exposure to blood or body fluids. Consistent adherence to standard precautions will reduce the risk of infection.

Objectives: To identify: the frequency of self-reported adverse exposure to blood and body fluids among surgeons and scrub nurses during surgical procedures; contributory factors to such injuries; the extent of compliance with standard precautions; and factors influencing compliance with precautions.

Design: A multi-site mixed methods study incorporating a cross-sectional survey and interviews.

Settings: Six NHS trusts in Wales between January 2006 and August 2008.

Participants: Surgeons and scrub nurses and Senior Infection Control Nurses.

Methods: A postal survey to all surgeons and scrub nurses, who engaged in exposure prone procedures, followed by face to face interviews with surgeons and scrub nurses, and telephone interviews with Infection Control Nurses.

Results: Response rate was 51.47% (315/612). Most 219/315 (69.5%) respondents reported sustaining an inoculation injury in the last five years: 183/315 (58.1%) reported sharps' injuries and 40/315 (12.7%) splashes. Being a surgeon and believing injuries to be an occupational hazard were significantly associated with increased risk of sharps' injuries (adjusted odds ratio 1.73, 95% confidence interval 1.04-2.88 and adjusted odds ratio 2.0, 1.11-3.5, respectively). Compliance was incomplete: 31/315 (10%) respondents always complied with all available precautions, 1/315 (0.003%) claimed never to comply with any precautions; 64/293 (21.8%) always used safety devices, 141/310 (45.5%) eye protection, 72 (23.2%) double gloves, and 259/307 (84.4%) avoided passing sharps from hand to hand. Others selected precautions according to their own assessment of risk. Surgeons were less likely to adopt eye protection (adjusted odds ratio 0.28, 0.11-0.71) and to attend training sessions (odds ratio 0.111, 0.061-0.19). The professions viewed the risks associated with their roles differently, with nurses being more willing to follow protocols.

Conclusion: Inter-professional differences in experiencing adverse exposures must be addressed to improve safety and reduce infection risks. This requires new training initiatives to alter risk perception and promote compliance with policies and procedures.