PURPOSE To examine the relationship between nurses' knowledge of blood-borne pathogens (BBPs), their professional behavior regarding handwashing, compliance with standard precautions (SPs), and avoidance of therapeutic contact with BBP-infected patients. DESIGN This cross-sectional design study took place in a regional medical center in Central Israel during 2003. METHODS Of the 180 participants, 159 (88.3%) were women with an average educational level of 16.40 years (SD=2.66). The mean age of the sample was 39.41 (SD=10.1). Data were collected using a structured questionnaire including sociodemographic information, level of knowledge concerning three BBPs (human immunodeficiency virus [HIV], hepatitis B virus [HBV], and hepatitis C virus [HCV]), level of compliance with SPs, understanding of SP principles, and avoidance of therapeutic contact with BBP-infected patients. FINDINGS Levels of HIV-related knowledge were significantly higher than were those of HBV- and HCV-related knowledge. Only 96 participants (54.5%) stated that all patients should be treated as BBP-carriers. The understanding of the basic principle of SPs did not influence the relationship between perceived knowledge and self-reported compliance with SPs; 77.3% of the sample reported that they avoid therapeutic contact with BBP-infected patients. The level of perceived knowledge did not contribute to the nurses' avoidance of care of BBP carriers. CONCLUSIONS Perceived knowledge of BBPs has a weak effect on compliance with SPs and willingness to care for BBP-infected patients. RECOMMENDATIONS Nurses must identify their preconceptions when caring for BBP-carriers. Further research on this issue is needed to attempt to understand the forces acting on our nursing staff, in order to ensure appropriate care of BBP-infected patients. CLINICAL RELEVANCE Our study indicated some reluctance among nurses to care for patients with blood-borne pathogens. This appears to be the result of value systems and not a lack of knowledge, indicating a need to integrate a psychoeducational approach to education of nurses.

BACKGROUND: Primary health care workers (HCWs) represent a growing occupational group worldwide. They are at risk of infection with blood-borne pathogens because of occupational exposures to blood and body fluids (BBF). AIM: To investigate BBF exposure and its associated factors among primary HCWs. METHODS: Cross-sectional study among workers from municipal primary health care centres in Florianópolis, Southern Brazil. Workers who belonged to occupational categories that involved BBF exposures during the preceding 12 months were interviewed and included in the data analysis. RESULTS: A total of 1077 workers participated. The mean incidence rate of occupational BBF exposures was 11.9 per 100 full-time equivalent worker-years (95% confidence interval: 8.4-15.3). The cumulative prevalence was 7% during the 12 months preceding the interview. University-level education, employment as a nurse assistant, dental assistant or dentist, higher workload score, inadequate working conditions, having sustained a previous occupational accident and current smoking were associated with BBF exposures (P </= 0.05). CONCLUSIONS: Primary Health Care Centres are working environments in which workers are at risk of BBF exposures. Exposure surveillance systems should be created to monitor their occurrence and to guide the implementation of preventive strategies.

There are no studies describing the attitude of healthcare workers (HCWs) towards universal precautions (UPs) in Ethiopia, in the context of the human immunodeficiency virus/acquired immunodeficiency syndrome pandemic. We investigated HCWs' knowledge and perceptions concerning UPs and exposure to blood and body fluids in two regions of eastern Ethiopia. All HCWs in 19 health institutions were surveyed using a questionnaire for data collection. Descriptive statistics and multivariate analysis using logistic regression were performed. The HCWs had insufficient knowledge and perception of UPs, along with a one-year prevalence of needlestick injury of 29.1%(95% confidence interval: 24.2-34.0). Policies and more intensive training are required for HCWs in Ethiopia.

The study objectives were to evaluate self-reported compliance with personal protective equipment (PPE) use among surgical nurses and factors associated with both compliance and non-compliance. A total of 601 surgical nurses, from 18 randomly selected hospitals (seven urban and 11 rural) in the Pomeranian region of Poland, were surveyed using a confidential questionnaire. The survey indicated that compliance with PPE varied considerably. Compliance was high for glove use (83%), but much lower for protective eyewear (9%). Only 5% of respondents routinely used gloves, masks, protective eyewear and gowns when in contact with potentially infective material. Adherence to PPE use was highest in the municipal hospitals and in the operating rooms. Nurses who had a high or moderate level of fear of acquiring human immunodeficiency virus (HIV) at work were more likely (P<0.005 and P<0.04, respectively) than staff with no fear to be compliant. Significantly higher compliance was found among nurses with previous training in infection control or experience of caring for an HIV patient; the combined effect of training and experience exceeded that for either alone. The most commonly stated reasons for non-compliance were non-availability of PPE (37%), the conviction that the source patient was not infected (33%) and staff concern that following locally recommended practices actually interfered with providing good patient care (32%). We recommend wider implementation, evaluation and improvement of training in infection control, preferably combined with practical experience with HIV patients and easier access and improved comfort of PPE.

Aims and objectives. This study aims to identify nurses' practices and opinions of handwashing during routine patient care. Background. Transmission of microorganisms from the hands of healthcare workers is the main source of cross-infection in hospitals and can be prevented by handwashing. Design and methods. A questionnaire survey was used for this study. A total of 129 clinical nurses at University of Ege Faculty of Medicine Application and Investigation Hospital at Internal Medicine Clinics was surveyed with a response rate of 100%. Data analysis was carried out using SPSS version 10. Results. The study revealed that nurses have a poor level of knowledge concerning quality of hand washing. All nursing actions related to 'clean' and 'dirty' activities were evaluated using the Fulkerson scale. The majority of nurses reported that they always wash hands after contact with contaminated and non-contaminated patients, equipment and environment. It was found that they did need to wash their hands often but that they were not able to do this because of dense working conditions, insufficiency of necessary materials and drying and sore of hands after frequent washing. Conclusion. To improve hand hygiene and quality of handwashing compliance, additional factors must be considered. These factors include improving healthcare workers - especially nurses'- skin conditions, hand hygiene techniques and disinfections substantially. Relevance to clinical practice. Hospitals need to develop and implement innovative educational and motivational programmes tailored to specific groups of health personnel.

AIMS The review examines from international research: the extent to which practitioners comply with infection control precautions; the pertinent issues that are considered influential in compliance; what strategies have been evaluated to instigate positive behaviour changes amongst practitioners and the effect of these interventions. BACKGROUND Internationally, standard/universal precautions (UP) are regarded as fundamental in the prevention and control of infection, and effective in protecting practitioners and patients. However, adherence has been problematic and the practice of standard/UPs is globally suboptimal. DESIGN AND METHODS Literature review where relevant evidence was identified using several electronic databases, from 1994 to 2006, with number of key terms utilized. Data were extracted by using key headings, which facilitated analysis. RESULTS Thirty-seven studies were appraised. Twenty-four related to measuring practitioner compliance and 13 studies that evaluated the effect of a research intervention on compliance. In addition, other studies were included which examined the specific reasons for suboptimal compliance, or discussed infection control precautions generally. CONCLUSIONS Compliance to infection control precautions is internationally suboptimal. The evidence confirms that compliance to specific aspects of standard/UPs varies, and practitioners are selective in their application of recommended practice. Compliance does improve following a structured intervention; however, research fails to indicate for how long the intervention affects practitioner compliance, or whether compliance after a period of time returns to the norm. Several reasons for non-compliance are discussed, and recommendations for future research are suggested. Relevance to clinical practice. Suboptimal compliance has significant implications for staff safety, patient protection and the care environment. Infection control teams and researchers need to consider the reasons for non-compliance and provide a supportive environment that is conducive to the routine, long-term application of standard precautions.

PURPOSE OF REVIEW For decades, healthcare workers have been known to be at risk from acquiring a variety of bloodborne pathogen infections as a result of occupational exposure. Primary prevention of exposures, as recommended by universal precautions guidelines, remains the cornerstone of protecting healthcare workers. Nonetheless, a substantial number of parenteral exposures continue to occur. Updated developments are summarized here, and recommendations for the protection of healthcare workers from bloodborne pathogens are provided. RECENT FINDINGS The predominant evidence suggests that total percutaneous injuries have decreased over the last decade. Thoughtful adherence to universal precautions remains the primary means of preventing occupational exposures and thus of reducing occupational risk of infection with bloodborne pathogens. A number of studies have provided additional evidence for the efficacy of safety devices in reducing specific subsets of injuries when combined with education and administrative interventions. Barriers to and positive predictors of universal precautions compliance have been identified. Postexposure prophylaxis remains the second line of defense; several authorities have now recommended three antiretroviral agents in this setting. SUMMARY In summary, almost two decades of experience with universal/standard precautions has resulted in a decrease in parenteral injuries, but much work remains to be done. Vaccines, effective infection control procedures, safer procedures, and safer devices will all be necessary, along with a better understanding of factors that influence healthcare worker behaviors that result in injury. In addition, a number of issues relating to the postexposure management of occupational exposures with bloodborne pathogens need to be better understood.

Focus groups are not simply a discussion between people, but are focused interviews exploring interactions between participants. In this paper, Ian Mansell, Glynis Bennett, Ruth Northway, Donna Mead and Laurie Moseley explore the complexities and practicalities of using focus groups in research, with reference to a study of palliative care services.

This study explores the role of the lecturer in nursing and midwifery education in the supervision of students' essays, projects and assignments. Three methods were used within the study; semi-structured interviews, questionnaires and focus groups. The results from the semi-structured interviews were used to develop a questionnaire which was distributed to the population of lecturers in nursing and midwifery education (n=285) within Wales. This article reports some of the key findings of the questionnaire survey. Lecturers report a directive style of supervision with a considerable amount of time being invested in the supervision process. The production of guidelines for good supervision practice is recommended as a way of providing consistent and fair supervision for students.

The aim of this article is to report findings from a study that asked carers for their views on a wide range of topics. Issues relevant to the current concerns of carers are reported here. A mixed method triangulated design yielded both quantitative and qualitative data. A total of 647 members of a parent/carer federation were sent a questionnaire with a section on 'current concerns'. The response rate was 23 percent (151 participants). Two focus groups were held with 15 carers who had completed the questionnaire. Issues of concern to carers included access to health and social care information and services; quality and quantity of respite care; suitable educational provision; independence and quality of life (for a person with learning disability); and what would happen to the person with learning disability when the carer was no longer able to carry out their caring role.

Access to regular, high-quality respite care has a beneficial impact on a carer's ability to fulfil their caring role, but provision varies widely. The current study aims to report family and informal carers' perceptions of respite care services offered to them by their local authority. A mixed method, triangulated design, yielded both quantitative and qualitative data. Members of a parent/carer federation were sent a questionnaire which included a section on 'respite care'; 151 of 647 responded. Two focus groups were held with 15 carers who had previously completed the questionnaire. The majority of carers reported that their respite needs were not being met. Unmet needs were hampered by the lack of information regarding criteria for access to respite. Discrepancies were evident between professionals and carers on a shared definition of respite care. Carers were unsure of exactly which activities constituted respite care and for whom the service was being provided.

Without protective practices such as antiseptic hand washing, the use of sterile/surgical gloves, safe needles, sterile equipment, and safe instrument and waste disposal procedures outlined in universal precaution guidelines, basic health workers (BHWs) are at substantial risk of blood-borne infections. This paper draws on research conducted in 28 primary health care centers in two districts of the Western Development Region, Nepal, between 2003 and 2004. Interviews were conducted to identify the infection control knowledge and practice compliance of basic health workers. Of 100 BHWs studied, only 22% had correct knowledge of universal precautions and 73% said they follow universal precaution guidelines. A total of 62% reported that they regularly used protective gloves while handling patients and 72% reported that they never used high-level disinfection to eliminate all microorganisms (bacteria, viruses, fungi, and parasites, including bacterial endospores) from instruments and other items that would come into contact with broken skin or intact mucous membranes.  Reasons for noncompliance included irregular supply of materials (31%); lack of an autoclave and other high-level disinfection equipment (50%); lack of knowledge and insufficient technical skills regarding universal precaution procedures (20%). Results showed that poor knowledge and an irregular supply of materials, equipment, and instruments prevented BHWs from using infection control measures. Formal training in universal precautions is urgently needed, and protective equipment must be provided and use must be monitored. Compliance to infection control procedures must be improved at primary health care units, especially among the basic health workers.

Concerns have been raised about whether it is possible to perform aseptic procedures within a community setting. Hallett (2000) has described how community nurses often have a fatalistic view about whether such procedures can really be performed at home. At the same time there has been an increase in the number of patients being cared for at home who need interventions which must adhere to the principles of asepsis. While it has been acknowledged for some time that community nurses must be resourceful and adapt the procedure, the view that community nurses cannot really perform aseptic procedures is a fairly new phenomenon. This article explores the reasons why concerns about the performance of aseptic procedures in the community may have arisen and what steps can be taken to address these concerns to ensure that care at home is both safe and effective.

HASH(0x581af60)

OBJECTIVES: The objective of this study was to investigate the knowledge, attitudes and behavior of Turkish dentists in Samsun City regarding cross-infection control. MATERIAL AND METHODS: A questionnaire was designed to obtain information about procedures used for the prevention of cross-infection in dental practices and determine the attitudes and perceptions of respondent dental practitioners to their procedures. The study population included all dentists in the city of Samsun, Turkey, in April 2005 (n=184). The questionnaire collected data on sociodemographic characteristics, knowledge and practice of infection control procedures, sterilization, wearing of gloves, mask, use of rubber dam, method of storing instruments and disposal methods of contaminated material, etc. Questionnaire data was entered into a computer and analyzed by SPSS statistical software. RESULTS: From the 184 dentists to whom the questionnaires were submitted, 135 participated in the study (overall response rate of 73.36%). As much as 74.10% dentists expressed concern about the risk of cross-infection from patients to themselves and their dental assistants. Forty-three percent of the participants were able to define 'cross-infection' correctly. The greatest majority of the respondents (95.60%) stated that all patients have to be considered as infectious and universal precautions must apply to all of them. The overall responses to the questionnaire showed that the dentists had moderate knowledge of infection control procedures. CONCLUSIONS: Improved compliance with recommended infection control procedures is required for all dentists evaluated in the present survey. Continuing education programs and short-time courses about cross-infection and infection control procedures are suitable to improve the knowledge of dentists.

AIM This paper is a report of a study exploring HIV/AIDS-related knowledge, attitudes, practices and perceptions of nurses in the largely black and rural Limpopo Province of South Africa. BACKGROUND Studies of HIV/AIDS knowledge, attitudes and practices among healthcare workers in developing countries have shown gaps in knowledge and fear of contagion, coupled with ambivalent attitudes in caring for patients with HIV/AIDS and inconsistent universal precautions adherence. METHOD A cross-sectional study of a random sample of primary health care (PHC)(n = 71) and hospital nurses (n = 69) was carried out in 2005, using a questionnaire, focus groups and in-depth interviews. FINDINGS Hospital nurses reported a higher frequency of care for patients with HIV/AIDS (P < 0.05), but less HIV/AIDS training when compared to PHC nurses (P < 0.001). HIV/AIDS knowledge was moderately adequate and associated with professional rank, frequency of care and training (P < 0.001). Attitudes towards patients with HIV/AIDS were mainly positive and were statistically significantly correlated with HIV/AIDS knowledge (P < 0.01) and training (P < 0.05). Three out of four nurses reported that they practised universal precautions (76.1%), but fear of occupational HIV transmission and lack of injection safety was found. Seven in 10 nurses reported previous needlestick injuries, but postexposure prophylaxis was not available in all healthcare facilities. Participants reported a higher workload because of HIV/AIDS, lack of training impacting negatively on their work, and stigma and shared confidentiality affecting them emotionally. CONCLUSION There is a need for accelerated HIV/AIDS training of rural nurses and for wider implementation of universal precautions and postexposure prophylaxis availability in public health facilities in southern Africa.

AIM AND OBJECTIVE To describe the rate of needlestick/sharp injuries in nursing students, to estimate the rate of vaccination administration and to define nursing students' status using universal precautions for protecting from blood-borne infections. BACKGROUND Nursing students have a high risk of occupational exposure to bloodborne pathogens because they may have insufficient background knowledge to recognise the level of risk posed by a particular patient and their inexperience with procedural skills and infection control procedures. DESIGN This study was designed as a retrospective and descriptive survey. METHODS The frequency and mechanism of needlestick/sharp injuries and hepatitis B immunisation were determined retrospectively by surveying students in three nursing schools. In November 2004, 473 students were questioned about needlestick/sharp injuries that they had sustained during their clinical practice and hepatitis B immunisations. RESULTS Forty-nine per cent of the students who responded sustained injuries; of these 74% were injured while on wards. The highest number (72.2%) had been injured by hollow-bore needles; 65.2% who were injured were not wearing gloves at the time of injury; 27% of injuries were associated with recapping the needle; 43.9% reported their injuries to administrators and the rate of those receiving medical assistance after needlestick/sharp injuries was less than not seeking assistance; 67.7% had been vaccinated against hepatitis B. CONCLUSION This study showed that nursing students frequently sustain needlestick/sharp injuries and hepatitis B immunisation rate was low. RELEVANCE TO CLINICAL PRACTICE Findings will help in designing more intensive education programs directed at the students to increase their awareness of and compliance with Universal Precautions and in instituting policies so that they are fully immunised against hepatitis B before beginning clinical practice.

This article outlines Occupational Safety and Health Administration (OSHA) guidelines for maintaining a safe dental practice workplace and covers requirements, such as education and protection for dental health care personnel. OSHA regulations aim to reduce exposure to blood-borne pathogens. Environmental infection control in dental offices and operatories is the goal of enforcement of OSHA codes of practice. Universal precautions reduce the risk for infectious disease. OSHA has a mandate to protect workers in the United States from potential workplace injuries. OSHA standards are available through online and print publications and owners of dental practices must meet OSHA standards for the workplace.

Safety practice is an important element of workplace safety and quality of health care. To investigate the safety practice and professional exposure to blood and blood-containing materials during a one-year period among Health Care Workers (HCWs) in Serbia. Cross-sectional study of 1559 Serbian HCWs using a self-administered questionnaire. Mantel-Haenszel statistics and multiple logistic regression analysis were used in statistical analysis. Fifty-nine percent (921) of HCWs had skin contact with patients blood, followed by 51%(791) with needle stick injuries, 38%(599) with cuts from sharp instruments, and 34% with contact of eye and other mucosa with patient's blood. Nurses reported professional exposure more often than others. Safety practices consisted of using appropriate barriers (gloves, mask, glasses) in all procedures with patients and were used by 58%, 23%, and 4% of HCWs, respectively. Doctors protected themselves more regularly than others. Hospital protocols for post exposure prophylaxis and safety disposal of medical waste are not common in Serbian health care settings. Safety practices in use were having hospital guidelines for safety practice in hospitals [odds ratio (OR)=1.58, 95% confidence interval (CI)=1.14-2.19], carrying out some form of intervention with risks of infection (OR=3.76, 95% CI=2.57-5.51), and HCWs aware of the professional risk of acquiring infection (OR=1.48, 95% CI=1.28-1.79). This study indicates that emphasis on work practice, attire, disposal systems and education strategies, should be employed to reduce professional exposure to blood and blood containing materials among HCWs in Serbia.

AIMS The aim of this study was to establish the degree to which clinical supervision might influence levels of reported burnout in community mental health nurses in Wales, UK. METHODS The research instruments used were the Maslach Burnout Inventory and the Manchester Clinical Supervision Scale. At the time of the survey 817 community mental health nurses were reported to work within Wales. Two hundred and sixty (32%) community mental heath nurses working in 11 NHS Trusts responded to the survey. RESULTS One hundred and eighty-nine (73%) community mental heath nurses had experience of clinical supervision in their present posts and 105 (40%) in their previous posts. The findings from the Maslach Burnout Inventory indicated high levels of emotional exhaustion for 36%, high levels of depersonalization for 12% and low levels of personal accomplishment for 10% of the community mental heath nurses surveyed. Univariate analysis showed that those community mental heath nurses who were younger, male and who had not experienced six or more sessions of clinical supervision were more likely to report cold negative attitudes towards their clients as indicated by higher scores on the depersonalization subscale of the Maslach Burnout Inventory. One hundred and sixty-six community mental heath nurses had experienced six or more sessions of clinical supervision and had completed the Maslach Burnout Inventory. Higher scores on the Manchester Clinical Supervision Scale were also associated with lower levels of measured burnout, with significant negative correlations between the total Manchester Clinical Supervision Scale score and the emotional exhaustion subscale (r =-0.148, P = 0.050) and the depersonalization subscale (r =-0.220, P = 0.003) of the Maslach Burnout Inventory. These findings suggest that if clinical supervision is effective then community mental heath nurses are likely to report lower levels of emotional exhaustion and depersonalization. CONCLUSIONS The findings from this study suggest that if clinical supervision is effective then community mental heath nurses report lower levels of burnout. Further research is required to determine the long-term benefits of implementing clinical supervision and to determine which other factors have an influence on levels of burnout for this group of nurses. Health service organizations have a responsibility for ensuring that all individual practitioners have access to effective clinical supervision and the Nursing and Midwifery Council could extend the registered nurses personal accountability to include - to seek clinical supervision as and when necessary.

As there is a high risk of indirect and direct transmission of infectious agents in chronic hemodialysis, infection control procedures should be established in dialysis units. This paper presents the findings of a questionnaire designed to survey the current status of infection control procedures in hemodialysis settings. Two hundred and forty-three hemodialysis units in Japan were surveyed. Nearly 90% of hemodialysis units reported compliance with each procedure recommended by the Center for Disease Control and Prevention in the United States, including use of disposable gloves, handling of non-disposable or non-single-use items, and routine serological testing of blood-borne viruses. However, more than 50% of units reported that they did not comply with recommendations concerning some procedures, such as places for preparing medications and their delivery, clean areas in the units, vaccination for hepatitis B, and additional measures for hepatitis B surface antigen (HBs-Ag) positive patients. Especially, the concept of universal precautions seemed to be misunderstood in units with a high prevalence of anti-hepatitis C antibody-positive (anti-HCV Ab-positive) patients. In conclusion, further intensive education and training will be necessary to establish infection control procedures.