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Blood exposure in health care: health care workers' and patients' experiences
Linköping University, Department of Molecular and Clinical Medicine, Clinical Microbiology. Linköping University, Faculty of Health Sciences.
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 [en]
Blood-exposure, needle-stick, compliance, universal precautions, balancing, quaIity care, nursing, patients' conceptions, grounded theory, phenomenography
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-23978Local ID: 3529ISBN: 91-7373-854-9 (print)OAI: oai:DiVA.org:liu-23978DiVA: diva2:244294
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
List of papers
1. A descriptive study of blood exposure incidents among healthcare workers in a university hospital in Sweden
Open this publication in new window or tab >>A descriptive study of blood exposure incidents among healthcare workers in a university hospital in Sweden
1997 (English)In: Journal of Hospital Infection, ISSN 0195-6701, E-ISSN 1532-2939, Vol. 35, no 3, 223-235 p.Article in journal (Refereed) Published
Abstract [en]

In an attempt to document blood exposure incidents and compliance with recommended serological investigations, universal precautions and incident reporting routines, data was collected from occupational injury reports during a two-year period. In addition, a sample of healthcare workers (HCWs) answered a questionnaire about blood tests and work routines. In a third part of the study some HCWs were asked about the type and actual frequency of incidents, together with the number of reported incidents during the two-year study period. Of a total of 473 reported occupational blood exposures, the majority came from nurses and the minority from physicians. Most reported incidents occurred on hospital wards. The most common incidents were needlestick injuries, and 35% occurred when the needle was recapped. Medical laboratory technicians (MLT) reported significantly more mucocutaneous incidents than other professionals (P < 0·01). In 10% of the incidents, the patient had a known blood-borne infection. Serological investigations post-exposure varied among professional groups, and 35% were not tested. No seroconversion was shown in the HCWs tested. In the third part of the study, respondents recalled 1180 incidents, although only 9% of these had been reported. The majority occurred in operating theatres, and in connection with anaesthesia. There was a significant difference (P < 0·001) between the different professional groups with regard to the frequency of incident reporting. Physicians reported only 3% and MLTs 36% of the incidents. Eighty-one percent believed that the accident could have been avoided. Despite knowledge of universal precautions, professionals continue to behave in a risky manner, which can result in blood exposure incidents.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-84861 (URN)10.1016/S0195-6701(97)90210-3 (DOI)
Available from: 2012-10-25 Created: 2012-10-25 Last updated: 2017-12-07Bibliographically approved
2. Health care workers' action strategies in situations that involve a risk of blood exposure
Open this publication in new window or tab >>Health care workers' action strategies in situations that involve a risk of blood exposure
2003 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 12, no 5, 660-667 p.Article in journal (Refereed) Published
Abstract [en]

• Previous research shows that health care workers (HCWs) often act in a risky way in blood-exposure situations, and thereby run the risk of becoming infected by blood-borne pathogens.

• A qualitative study was conducted in order to describe factors that influence HCWs' actions in such situations. Nurses and nursing assistants were interviewed.

•  The analysis shows that HCWs perceive that there is a conflict among different demands. These demands are protecting the patient's privacy, protecting themselves from being infected and respecting the norms of the department.

• The process of managing this conflict is labelled `balancing', which most often results in the choice of a diagnosis-related strategy.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-26499 (URN)10.1046/j.1365-2702.2003.00644.x (DOI)11055 (Local ID)11055 (Archive number)11055 (OAI)
Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2012-10-25Bibliographically approved
3. Blood exposure: factors promoting health care workers’ compliance with guidelines in connection with risk
Open this publication in new window or tab >>Blood exposure: factors promoting health care workers’ compliance with guidelines in connection with risk
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.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-22595 (URN)10.1111/j.1365-2702.2004.00897.x (DOI)1871 (Local ID)1871 (Archive number)1871 (OAI)
Available from: 2009-10-07 Created: 2009-10-07 Last updated: 2012-10-25Bibliographically approved
4. Patients’ conceptions of quality care and barrier care
Open this publication in new window or tab >>Patients’ conceptions of quality care and barrier care
2006 (English)In: Journal of Evaluation In Clinical Practice, ISSN 1356-1294, E-ISSN 1365-2753, Vol. 12, no 6, 682-691 p.Article in journal (Refereed) Published
Abstract [en]

Aim  To describe patients’ conceptions of quality care and barrier care.

Methods  As this study concerned conceptions of care, a phenomenographic approach was chosen. Fourteen adult orthopaedic patients participated. Data-collection was performed by means of semi-structured interviews. The qualitative data were analysed with two foci, conceptions of quality care and conceptions of barrier care. Different categories of understanding, that is, conceptions, constitute the the essential outcome of phenomenographic analysis. The research was conducted in one county hospital and in one regional hospital situated in different cities in the south of Sweden.

Results and Conclusions  Patients’ conceptions of quality care resulted in six categories. When comparing the findings with previous research in this field, the findings of the present study confirmed to a large extent the findings from other studies of quality care. Patients’ conceptions of barrier care resulted in five categoris. The conceptions of barrier care must be considered as elements in patients’ conceptions of quality care, and this must be called atention to in efforts to measure patient satisfaction and in analyses of good care. It also can influence health care workers’ compliance to guidelines in infection control procedures.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-35740 (URN)10.1111/j.1365-2753.2006.00636.x (DOI)28386 (Local ID)28386 (Archive number)28386 (OAI)
Available from: 2009-10-10 Created: 2009-10-10 Last updated: 2012-10-25Bibliographically approved

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