Inter-professional differences in compliance with standard precautions in operating theatres: A multi-site, mixed methods study

Background: Blood-borne viral infections including HIV, hepatitis B and hepatitis C can be contracted by healthcare professionals during exposure prone following exposure to blood or body fluids. Standard precautions can reduce the risk of infection.Objectives: The study aimed firstly to identify the frequency and causes of adverse exposures to blood and body fluids by surgeons and scrub nurses performing exposure prone procedures and secondly, to identify the extent of compliance with standard precautions and factors influencing compliance Design: A multi-site mixed methods study: a cross-sectional survey followed by a series of semi structured interviews.Settings: Six NHS trusts in Wales Participants: Surgeons and scrub nurses who performed exposure prone procedures and Senior Infection Control Nurses.Methods: A postal survey to all surgeons and scrub nurses followed by face to face interviews with puposively selected participants, and a telephone interview with Infection Control Nurses.Results: 315/612 surgeons and scrub nurses participated (response rate 51.47%). Most 219/315 (69.5%) respondents reportedsustaining an inoculation injury in the last five years: Sharps injuries were miost common (183/315, 58.1%) followed by splashes of blood or body fluid to the mucous membrane (40/315, 2.7%) splashes. Being a surgeon and believing injuries to be anoccupational hazard were significantly associated with increased risk of sharps’ injuries (adjusted odds ratio 1.73, 95% confidence interval 1.04–2.88 and adjusted odds ratio 2.0, 1.11–3.5, respectively). Compliance with standard precautions was poor with only 31/315 (10%) respondents always adhering to all precautions, 1/315 (0.003%) claimed never to comply with anyprecautions. Individual risk assessments informed the decision whether to take precuations. Compliance among surgeons was poorer among surgeons than nurses. For example, in relation to adoption of eye protection (adjusted odds ratio 0.28, 0.11–0.71) attendance at training sessions (odds ratio 0.111, 0.061–0.19). Conclusion: Compliance with standard precautions is poor. This may lead to an unacceptable risk of occupational acquisition of blood-borne viral infection. Strategies that respect inter-professional differences must be developed to to alter risk perception, improve compliance with standard precautions and reduce infection risks