Respiratory infection control practices among healthcare workers in primary care and emergency department settings

Thesis (Ph. D.)--University of Washington, 2006.This cross-sectional study used a self-administered questionnaire to survey healthcare workers (HCWs) at five medical centers, to evaluate reported use of CDC (Centers for Disease Control and Prevention) recommended respiratory infection control practices in first contact patient care settings. The study was guided by a conceptual model and questionnaire adapted from previous studies of practices related to bloodborne pathogens. All HCWs in emergency department and primary care settings at each of the surveyed medical centers were invited to participate, and 653 (53%) completed surveys. The study found important shortcomings in overall reported personal or institutional use of CDC recommended practices, including: posted alerts (75%) or personal instructions (56%) about respiratory hygiene and cough etiquette; coughing patients seated 3 feet apart from others in waiting areas (32%); and patients with influenza-like illness placed in private exam areas (57%). Deficiencies were also observed in reported use of hand hygiene recommendations after following direct contact with patient skin while taking a pulse or blood pressure (58%), and after touching items in the immediate vicinity of a patient (59%). Use of recommended practices was generally reported more often by nursing staff than physicians, and in emergency room than primary care settings. Multivariate logistic regression revealed use of practices was positively associated with supervisory status, prior training, perceived cleanliness and orderliness of the workplace, and knowledge of notifiable condition reporting, although these associations were more pronounced among nursing staff than physicians. The findings of this study could be used to target future changes or corrective interventions in national and institutional policies, worker training strategies, and institutional facilitation of recommended practices by healthcare workers. Future research and interventions should consider the influences of the organizational climate and other possible barriers to implementation of recommended practices, as well as individual practices, perceptions and beliefs