The purpose of this study was to identify factors related to compliance with the 1996 US Public Health Service Guidelines for the management of occupational exposures to blood or other body fluids possibly contaminated with the human immunodeficiency virus (HIV).1 The Guidelines call for rapid exposure reporting with evaluation of the exposure risk, counseling and prophylactic treatment with anti-retroviral medications and follow-up care as needed. With an estimated 300,000 to 500,000 bloodborne exposures in occupational settings each year, these Guidelines potentially affect a large number of employees.2-3 The Guidelines are designed to reduce the risk not only for employees at acute care health facilities, but also for employees across a broad range of occupations, including non-hospital based health care workers and public safety workers. The extent to which these Guidelines are followed, and equally important, the identification of problems with compliance and follow-through, remains largely unknown. Our previous research emphasized the identification of barriers to compliance with universal precautions in both hospital- based and non-hospital based health care workers, as well as exposure risk in public safety workers, including law enforcement employees (including prison workers). This line of research led to successful intervention research and the implementation of strategies for risk reduction in health care worker populations. While the methods and findings from this line of earlier work have been demonstrated to help reduce exposures, the 1996 Guidelines are directed at activities to perform following an exposure, and the problems and barriers here may be quite different from the barriers to compliance with universal precautions. Thus this study was specifically designed to identify barriers to implementation of the 1996 Guidelines. To address this issue we surveyed a sample of emergency medical service (EMS) workers recruited from first responder facilities located in Baltimore County, Maryland. The survey instrument was informed by extensive qualitative processes and extensive pre and pilot testing. Anonymous questionnaires were self-administered by a convenience sample of EM) workers employed throughout the county at a variety of facilities and locations (e.g., urban, rural, suburban). The response rate was nearly 50%. The major goals of the study were: 1. To assess and evaluate the infection control programs for minimizing risk of bloodborne pathogens in EMS. 2. To assess and characterize adherence to the US Public Health Service Guidelines at both the employee and employer levels. 3. To determine the characteristics that distinguish exposed workers who experienced full versus incomplete compliance with the US Public Health Service Guidelines. Characteristics include worker-centered variables (e.g., sociodemographics, exposure history, employee reporting practices, and organizational variables (e.g., adequacy of resources to implement the Guidelines, safety climate, training and education). 4. To identify data-driven strategies to improve implementation and compliance with the Guidelines among a population of health care workers at potential risk of exposure.
Mailman School of Public Health, Columbia University, 600 W 168th Street, 4th Floor, New York, NY 10032