Factors that influenced compliance of health care workers in the emergency department with universal precautions and other practices thought to reduce the transmission of blood born pathogens were investigated. Variables were described using the Health Brief Model. Of the 95 workers in a level-II trauma emergency department of a midwestern, suburban hospital, 56 responded to a questionnaire. Nine of these were physicians, 35 were registered nurses, five were nursing assistants or licensed practical nurses, and two were classed as other. The respondents indicated that they were most likely to perform handwashing after contact with body fluids and to wear gloves when they anticipated contact with blood. Lack of time, feeling that the patients were at lower risk for human immunodeficiency virus or hepatitis-B infections, and interference with technical skills were the reasons most often given for not adhering to universal precautions. Those workers who had a high degree of experience in universal precautions were more likely to use gloves when anticipating blood contact, and were less likely to recap a needle after an intravascular injection or after the drawing of a blood gas sample or even injecting medication into an intravenous line. The authors conclude that an integrated approach is appropriate which would incorporate engineering controls, cognitive approaches, behavior modification strategies, and training experiences to improve skills and dexterity.