DETERMINANTS OF EMERGENCY DEPARTMENT PROCEDURE-SPECIFIC AND CONDITION-SPECIFIC UNIVERSAL (BARRIER) PRECAUTION REQUIREMENTS FOR OPTIMAL PROVIDER PROTECTION

Study objective: To determine potential blood and body fluid (B/BF) co ntacts with specific body areas associated with procedures commonly pe rformed in the emergency department and to thereby delineate appropria te procedure-specific precautions. Design: Prospective, observational study assessing procedure-related B/BF contacts by use of stratified, blocked sampling of shifts. Participants: ED patients in an inner-city tertiary care university hospital. Results: Of 2,529 procedures perfo rmed in 1,025 patients, 1,621 (64%) were associated with barrier-prote cted or unprotected B/BF contact; 92% involved blood or bloody BF. Che st tube placement, lumbar puncture, and examination of the bleeding pa tient all resulted in B/BF contact with the facial area. All of the 18 procedure categories observed, with the exception of IM injection, re sulted in B/BF contact with hands. Many procedures resulted in contact with the body or feet. Procedure type, provider, length of time, numb er of procedures per patient, and successful completion were each inde pendently associated with B/BF contact. Number of attempts, adverse co nditions, and triage acuteness were not associated with increased like lihood of contact. Conclusion: Virtually all ED procedures require glo ves. Barrier protection for the body may be appropriate for all but th e simplest procedures. Protection for the face seems appropriate, espe cially in invasive procedures such as lumbar puncture or physical exam ination of the bleeding patient. This study, along with other publishe d data, has aided development of detailed guidelines for appropriate b arrier precautions to be taken for common ED procedures.