Nurses and Standard/Universal Precautions: Analysis of Barriers Affecting Strict Compliance

Background: This research aimed to identify potentially important risk factors and barriers for less than strict compliance with universal/standard precautions (UP/SP) by nurses in health care settings. The study outcomes were compliance with the use of personal protective equipment (PPE), specifically gloves, eye shields and respiratory shields.

Methods: Members of the Massachusetts Nurses Association (MNA) were surveyed in 2009, utilizing both previously validated questions and questions developed specifically for this research.

Results: While there was a low response rate ( n=95, <5%) the MNA respondents are similar demographically to respondents in previous surveys. Compliance was not universal nor was availability of PPE. Study results supported previously identified barriers to compliance including lack of training, workplace safety climate, and availability of PPE. Higher scores for workplace safety climate, increased age, and longer nursing work experience were positively associated with compliance. The surveyed nurses also reported variation in compliance based on patient characteristics: pediatric patients (0-18), older adults (age 65+), those perceived to be low risk and those who spoke English as a second language.

Conclusion: Variation in compliance by patient demographics indicated that nurses employ personal assessment of risk regarding strict UP/SP compliance. Availability of PPE was variable. Lack of training in UP/SP was a surprising finding, with more than half the respondents receiving 30 minutes or less in annual training.