The use of a ward-based educational teaching package to enhance nurses' compliance with infection control procedures

Handwashing is the single most important procedure in the prevention of nosocomial infections and yet it remains the most violated of all infection control procedures. With a sequential intervention study in an intensive care unit we have demonstrated that poor handwashing practices are associated with a high nosocomial infection rate, whereas good handwashing practices are associated with a low nosocomial infection rate. An educational and enforcement program designed to improve handwashing procedures can significantly reduce endemic nosocomial infection rates.

Body substance isolation (BSI) is a system of infection precautions intended to reduce nosocomial transmission of infectious agents among patients and to reduce the risk of transmission of hepatitis B virus, human immunodeficiency virus, and other infectious agents to health care personnel. Harborview Medical Center in Seattle, Wash., was the first facility in the United States to implement the BSI system. Between 1984 and 1988 a systematic evaluation of the implementation process was conducted and the effects of BSI on appropriate glove use by hospital personnel and on the incidence of nosocomial colonization and infection by sentinel organisms was measured. Results of the evaluation showed (1) significant increments in knowledge of infection control procedures and practices as measured by comparing written examination responses before and after training sessions, (2) significant increases in appropriate glove use as determined by direct observation of hospital employees for 18 months, and (3) significant reductions in nosocomial colonization and infection caused by sentinel microorganisms during the period from 1984 to 1988.

In 1987 the Centers for Disease Control published a Universal Precautions Policy establishing blood and body fluid procedures to be used consistently with all patients. An important and unequivocal Universal Precautions Policy recommendation with regard to avoidance of needlestick injuries is that needles should never be recapped. We examined the recapping-related attitudes and behaviors of physicians and nurses at four large teaching hospitals with patients with acquired immunodeficiency syndrome and with Universal Precautions Policy in-service training programs. Compliance was found to be considerably less than optimal. According to unannounced needle counts in disposal boxes, the percentage of recapped needles was always greater than 25% and exceeded 50% in four instances. Recapping was related to inadequate knowledge, concerns about personal risk, forgetfulness, being "too busy" to follow the Universal Precautions Policy, and the misperception that recapping is a way to avoid needlestick injury. Strategies are suggested to improve and supplement traditional in-service education.