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Blood exposure: factors promoting health care workers’ compliance with guidelines in connection with risk
Linköping University, Department of Molecular and Clinical Medicine, Clinical Microbiology. Linköping University, Faculty of Health Sciences.
Linköping University, Department of Department of Health and Society. Linköping University, Faculty of Health Sciences.
Linköping University, Department of Molecular and Clinical Medicine, Clinical Microbiology. Linköping University, Faculty of Health Sciences.
2004 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 13, no 5, 547-554 p.Article in journal (Refereed) Published
Abstract [en]

Background.  Health care workers compliance with guidelines, universal precautions, in connection with tasks that could involve contact with patient's blood is unsatisfactory. In a previous paper, we identified different forces that undermine compliance. Socialization into infection control, routinization, stereotyping, perceptions of patients’ wishes and the presence of competing values and norms are examples of such forces.

Aims and objectives.  The aim of this article is to describe and analyse different forces that promote adherence to universal precautions. Behavioural variations are seen as a consequence of differences between wards with regard to the safety culture. Safety culture is conceptualized as the outcome of a constant interplay between deactivating and reactivating forces. In this article the focus is on the latter.

Method.  The grounded theory approach. Data were collected through interviews with nurses and assistant nurses.

Results.  The charge nurse, informal leaders, students, infection control nurses, type of work, availability of equipment, blood-exposure incidents and media-coverage of infectious diseases are described as potentially important for compliance. The properties these agents must possess in order to be influential are also described.

Relevance to clinical practice.  The outcome of an occupationally acquired infection can be fatal. Hence it is important that health care workers take protective measures. The results imply that mere information about safe practices alone is insufficient to achieve that goal. All factors of importance for compliance must be taken in to consideration in clinical work and in education.

Place, publisher, year, edition, pages
2004. Vol. 13, no 5, 547-554 p.
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-22595DOI: 10.1111/j.1365-2702.2004.00897.xLocal ID: 1871OAI: oai:DiVA.org:liu-22595DiVA: diva2:242908
Available from: 2009-10-07 Created: 2009-10-07 Last updated: 2017-12-13Bibliographically approved
In thesis
1. Blood exposure in health care: health care workers' and patients' experiences
Open this publication in new window or tab >>Blood exposure in health care: health care workers' and patients' experiences
2004 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The general aim of this thesis was to describe and analyse health care workers' blood-exposure incidents, protective measures, and the motives behind decision making about risks and protective measures. The aim was also to procure knowledge about patients' conceptions about their care, and if precautions taken by the health care workers were included in quaiity care. The methods used were: in study I quantitative method, in studies II and III grounded theory method, and in study IV phenomenographic method.

The aims of study I were to describe and analyse blood-exposure incidents and compliance in relation to recommended serological investigations, universal precautions and incident reporting routines and also to follow up a campaign against blood-exposure. Instruments used were incident report forms (n=473) and questionnaires (n=132), (n=108), (n=517). The majority of the 473 reported blood-exposure incidents came from nurses and the minority from physicians. Incidents occurred most often on hospital wards, the most commonly reported incident being needle-stick injuries, 35% ofwhich occurred during recapping the needle. Medicallaboratory technicians reported significantIy more mucocutaneous incidents than other professionaIs (P<0,01). Serological investigations post-exposure varied and 35% of individuaIs were not tested. In an anonymous questionnaire, the respondents recalled 1180 incidents, although onIy 9% of these were reported. Physicians reported onIy 3% of these, medical laboratory technicians reporting 36%. The under reporting was most common in operation theatres and in anaesthesia. Eighty-one percent believed that the accident could have been avoided if they had followed the recommended clinical practice. Despite knowledge of universal precautions, professionaIs continue to behave in a risky manner, which can result in blood exposure incidents and possibly a blood-borne viral infection.

The aim of study II was to identify factors that influenced health care workers' actions in situations involving a risk of blood-exposure. Nurses and assistant nurses were interviewed (n=15). The analysis showed that there was a conflict between different demands involving protecting the patient's privacy, protecting themselves from being infected and respecting the norms of the department. The process of managing this conflict was labelled 'balancing', which most often resulted in the choice of a diagnosis-related strategy, i.e. a non-compliant behaviour. The underlying causes of how patterns of action are formed by individual and socio-cultural forces resulted in five categories, which were seen as forces that could underrnine compliance.

The aim of study III was to describe and analyse different forces that promote adherence to universal precautions. Nurses and assistant nurses were interviewed (n=15, the same as in study II). The charge nurse, informal leaders, students, infection controi nurses, type of work., availability of equipment, blood-exposure incidents and media-coverage of viral blood-borne infections were described as potentially irnportant for compliance. The properties these agents must possess in order to be influential were also described. The results irnply that information about safe practices alone is insufficient to achieve that goal. All factors of importance for compliance must be taken into consideration in clinical work and in education.

The aim in study IV was to identify and describe patients' conceptions of quality care and of barrier care. The patients (n=14) were adult and treated for orthopaedic reasons. Included in their conceptions of quality care were: Nice manners, mutual achievement, being involved, being cured, being cared for, and having safe care. When comparing these conceptions with previous research about patients' views of quaIity care, the findings confirmed, to a large extent, the findings from other studies. Included in patients' conceptions of barrier care were: Regular use of gloves, regular use of masks and eye-shields, use of gloves in special situations, use of masks and eye-shields in special situations, and keeping clean. The conceptions were of an interpersonal, as well as of a medical-technical nature. Patients' conceptions of barrier care could be included in the category: Having safe care. The frequentIy expressed opinion, among nurses and assistant nurses, that patients may be offended by the use of protective equipment could be refuted.

This thesis has contributed to an improved understanding of the occurrence and handling of blood-exposure incidents. The dynamics of compliance and non-compliance with universal precautions have also been described by means of an attempt to uncover the interplay between deactivators and re-activators in the safety culture on wards. Patients' conceptions about barrier care were shown to be an integrated part of quality care.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2004. 47 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 874
Keyword
Blood-exposure, needle-stick, compliance, universal precautions, balancing, quaIity care, nursing, patients' conceptions, grounded theory, phenomenography
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-23978 (URN)3529 (Local ID)91-7373-854-9 (ISBN)3529 (Archive number)3529 (OAI)
Public defence
2004-12-09, Berzeliussalen, Hälsouniversitetet, Campus Valla, Linköpings universitet, Linköping, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2009-10-07 Created: 2009-10-07 Last updated: 2012-10-25Bibliographically approved

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Lymer, Ulla-BrittRicht, BengtIsaksson, Barbro

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