Universal Precautions Are Not Universally Followed

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Abstract
• Adherence to universal blood and body fluid precautions was studied in surgical patient care areas of a university hospital in an effort to identify potentially hazardous health care personnel practices. Surgical teams of an 18-unit operating room, three surgical ward patient care teams, and patient care personnel in a 16-bed surgical intensive care unit were observed during routine patient care activities before (study 1) and after (study 2) specific educational programs were held to improve universal precaution compliance. Overall, infractions occurred in 57% of 549 observed procedures in study 1 and in 58% of 616 observed procedures in study 2. In study 1, infractions occurred in 75% of operating room procedures, 30% of surgical ward procedures, and 75% of surgical intensive care unit procedures. Study 2 procedure infraction rates were 81%, 32%, and 40%, respectively. Only surgical intensive care unit compliance significantly improved. Noncompliance with universal precautions occurs frequently during the care of patients who have undergone surgery, with the type of infraction and specific offender varying according to patient locale. These violations appear unamenable to one-time educational efforts. Substantial overall improvement may arise from ongoing educational programs directed at specific personnel who care for patients who have undergone surgery. (Arch Surg. 1991;126:93-96)