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Abstract
Prevention of transmission of bloodborne pathogens to health care workers (HCWs) involved
in resuscitation of critically injured patients presents special challenges. As a
step toward creation of a standard, a telephone survey of the infection control practices
in this setting of the 100 busiest EDs in the United States (US) was performed. Departmental
staff who were knowledgeable about ED infection prevention protocols were questioned
about general policy, barrier protection measures, sharps management, and educational
programs directed to HCWs. Surveys were completed for 82 EDs. Of these, 56 (68%) either
function as primary trauma care facilities for the local community, or are designated
level 1 trauma centers by the American College of Surgeons. Specific infection control
protocols for trauma resuscitation had been printed and posted by 18 EDs (22%), with
the remaining 64 (78%) using the same universal precautions for care of the severely
injured as for other patients. A specific policy relating to invasive procedures had
been promulgated by 66 EDs (80%). Barrier protection was used by protocol or by custom
for care of all critically injured patients by 43 EDs (52%). Impermeable gowns with
sleeves were available in 63 EDs (77%). Eye or face protection included face shields
by 74 EDs (90%), face masks by 76 EDs (93%), and goggles by 72 EDs (88%). Only 59
EDs (72%) reported that sharp containers were always within arm's reach of HCWs with
material to discard. Specially adapted equipment included self-sheathing intravenous
catheters (21, 26%) and needle/syringe combinations (16, 20%). Considerable variation
exists in infection control practices in busy US EDs during resuscitation of critically
injured patients. Modalities used include education, strategies for handling contaminated
material, protective garb, and equipment specially adapted to minimize exposure. EDs
should give careful consideration to organizing resuscitation of critically injured
patients to minimize risk of transmission of bloodborne pathogens to HCWs.
Keywords
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Article Info
Publication History
Accepted:
May 28,
1993
Received:
November 18,
1992
Footnotes
☆Presented at the Society for Academic Emergency Medicine annual meeting, Toronto, May, 1992.
Identification
Copyright
© 1994 Published by Elsevier Inc.
