[{"key":"dc.contributor.author","value":"Birnbaum, David Wayne","language":null},{"key":"dc.date.accessioned","value":"2008-12-20T00:00:00","language":null},{"key":"dc.date.available","value":"2008-12-20T00:00:00","language":null},{"key":"dc.date.issued","value":"1992","language":null},{"key":"dc.identifier.uri","value":"http:\/\/hdl.handle.net\/2429\/3248","language":null},{"key":"dc.description.abstract","value":"Isolation of those ill with contagious disease has been a fundamental\r\ninfection control concept for hundreds of years. However, recent studies suggest\r\nthat fewer than 50% of health\u2014care workers comply with their hospitals'\r\nisolation precaution policies and that efficacy of some of those policies is\r\nquestionable. In response, two new systems, based upon fundamentally different\r\ngoals, were promoted. The Centers for Disease Control, prompted by health\u2014care\r\nworker& concerns about occupational risk of human immunodeficiency virus (HIV)\r\nfrom a growing number of patients with acquired immunodeficiency disease\r\nsyndrome (AIDS), issued formal guidelines in 1987. This formed the basis for\r\nUniversal Precautions (UP), a unifying strategy for precautions with all patients\r\nregardless of diagnosis intended to reduce risk to hospital staff members. Also\r\nin 1987, one hospital issued guidelines for Body Substance Isolation (BSI),\r\nhygienic precautions to be used with all patients based on recognition that\r\ncolonized body substances are important reservoirs for cross\u2014infection to both\r\npatients and staff members. These new strategies have been promoted widely,\r\nbut there have been no formal assessments to reconcile controversies they\r\nraised nor to confirm their effectiveness. Further, necessary assessment tools\r\nhave not been validated.\r\nThis thesis provides new tools and new information to address three vital\r\nquestions: Have hospitals adopted Universal Precautions or Body Substance\r\nIsolation? Do their staff members use the new system of precautions in daily\r\npractice? Has reliable use of a new system led to decreased risk of infection?\r\nA confidential mailed survey of all acute\u2014care Canadian hospitals was\r\nconducted to measure rates of guideline receipt and adoption. It also obtained\r\ninformation on motivations for and perceived effectiveness of strategies adopted. A self\u2014selected group of responding hospitals subsequently participated in\r\nstandardized covert observation of their nurses infection control practices, then\r\nhad the observed nurses complete a test examining their knowledge and beliefs.\r\nEmployee health records were also examined to determine whether needlestick\r\ninjury rates had changed since adoption of a new infection control strategy.\r\nMost Canadian hospitals adopted and modified new strategies based upon\r\nreasonable but unproven extensions of logic to protect health\u2014care workers from\r\nHIV. 74% claimed UP (65%) or BSI (9%) but only 5% of 359 claiming UP and 0\r\nof 50 claiming BSI adopted all policies expected. Many hospitals had not\r\nreceived key guideline publications. Guideline source, hospital size, and other\r\nvariables were significantly associated with receipt. Nurses in 35 hospitals\r\nwere observed to wear gloves during only z60% of procedures in which gloving\r\nwas expected; rates varied widely among hospitals. Direct examination of sharps\r\ndisposal containers confirmed compliance with a policy to not recap used needles\r\n(taken as recapping rate of 25%) in only 47% of 32 hospitals. Paired analysis\r\nof needlestick injury rates in 11 hospitals during comparable 90\u2014day periods\r\nbefore versus after implementing UP\/BSI showed no significant difference. 489\r\nnurses completing a written test achieved their highest scores and least\r\ndiscordance among questions regarding procedural issues established long before\r\nUP\/BSI, and lower scores or greater discordance on UP\/BSJ concepts of\r\nphilosophy, risk recognition and newer procedures. Positive correlation between\r\nknowledge and practice was not evident. UP and BSI now mean different things\r\nin different hospitals and have not been effective in harmonizing health\u2014care\r\nworkers\u2019 infection control practices. Carefully standardized assessment methods\r\nare needed to guide their evolution to cost\u2014effectiveness.","language":"en"},{"key":"dc.format.extent","value":"3447105 bytes","language":null},{"key":"dc.format.mimetype","value":"application\/pdf","language":null},{"key":"dc.language.iso","value":"eng","language":"en"},{"key":"dc.publisher","value":"University of British Columbia","language":null},{"key":"dc.rights","value":"For non-commercial purposes only, such as research, private study and education. Additional conditions apply, see Terms of Use https:\/\/open.library.ubc.ca\/terms_of_use.","language":null},{"key":"dc.title","value":"New national strategies for hospital infection control : a critical evaluation","language":"en"},{"key":"dc.type","value":"Text","language":null},{"key":"dc.degree.name","value":"Doctor of Philosophy - PhD","language":"en"},{"key":"dc.degree.discipline","value":"Interdisciplinary Studies","language":"en"},{"key":"dc.degree.grantor","value":"University of British Columbia","language":null},{"key":"dc.date.graduation","value":"1992-05","language":"en"},{"key":"dc.type.text","value":"Thesis\/Dissertation","language":"en"},{"key":"dc.description.affiliation","value":"Graduate and Postdoctoral Studies","language":null},{"key":"dc.degree.campus","value":"UBCV","language":"en"},{"key":"dc.description.scholarlevel","value":"Graduate","language":"en"}]