Adherence to universal (Barrier) precautions during interventions on critically 111 and injured emergency department patients

Gabor D. Kelen, Thomas A. Digiovanna, David D. Celentano, David Kalainov, Leslie Bisson, Edward Junkins, Allen Stein, Lisa Lofy, Carol R.J. Scott, Keith T. Sivertson, Thomas C. Quinn

Research output: Contribution to journalArticlepeer-review

88 Scopus citations


In a study undertaken to determine compliance with Universal Precautions, we observed 129 personnel performing 1, 274 interventions on 151 consecutive critically ill and injured patients in an emergency department setting in July 1988. Barrier precautions were fully adhered to 44.0% of the time. During interventions in patients with profuse bleeding, adherence was only 19.5% in contrast to 44.7% for those who were not bleeding. Adherence was 56.4% during minor interventions but only 16.7% during major procedures. Adherence rates varied among health care providers: residents, 58%; emergency staff physicians, 38%; consultant physicians, 43%; emergency nursing staff, 44%; paramedics, 8%; radiology technicians, 14%; and housekeeping, 91%. In a follow-up questionnaire that ascertained reasons for lack of compliance, 47% of providers indicated that there was not always sufficient time to put on protective material, 33% felt that precautions interfered with skillful performance of procedures, and 23% stated that materials were uncomfortable. Only 2.7% felt that Universal Precautions did not work. Since there is no proven postexposure prophylaxis for human immunodeficiency virus, Universal Precautions must be rigorously followed until such time as they are shown not to be effective or an alternate approach is developed. Strategies to improve compliance and improvements in barrier technology need to be developed.

Original languageEnglish (US)
Pages (from-to)987-994
Number of pages8
JournalJournal of Acquired Immune Deficiency Syndromes
Issue number10
StatePublished - Oct 1990


  • Emergency
  • Health care workers
  • Human immunodeficiency virus type 1
  • Infection control
  • Universal Precautions

ASJC Scopus subject areas

  • Infectious Diseases
  • Pharmacology (medical)


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