title: Trauma team utilization of universal precautions: if you see something, say something.
abstract: OBJECTIVE
  The risks deriving from the lack of compliance with universal safety precautions (USPs) are unequivocal. However, the adoption of these prophylactic precautions by healthcare providers remains unacceptably low. We hypothesized that trauma teams are not routinely adhering to USPs and that a brief educational intervention, followed by real-time peer feedback, would substantially improve compliance rates.
  
  
  METHODS
  This before-and-after interventional study took place in the resuscitation bay of a Level I Trauma Center during trauma team activations. Six USPs were examined: hand washing (before and after patient contact), use of gloves, gowns, eye protection, and masks. Surgery and Emergency Medicine attending physicians, residents, and nurses, who had direct patient contact, were included. Following 162 baseline observations, an educational intervention in the form of brief lectures was conducted, emphasizing the danger to self from dereliction of USPs. Subsequently, 167 post-intervention observations were made after a one-month period of knowledge decay. Finally, real-time feedback was provided by trauma team leaders and study staff. Adherence to prophylactic measures was recorded again.
  
  
  RESULTS
  Baseline compliance rates were dismal. Only hand washing prior to patient interaction, the use of eye protection, and the use of masks improved significantly (p < 0.05) after the educational initiative. However, compliance rates remained suboptimal. No difference was noted regarding the three other USPs. Impressively, following real-time behavioral corrections, compliance improved to nearly 90 % for all USPs (p < 0.05).
  
  
  CONCLUSIONS
  Compliance with OSHA-required USPs during trauma team activations is unacceptably low, but can be dramatically improved through simple educational interventions, combined with real-time peer feedback.
authors.affiliation: Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital & Harvard Medical School, 165 Cambridge Street, Suite 810, Boston, MA, 02114, USA.
authors.forename: T
authors.initials: T
authors.lastname: Peponis
authors.affiliation: Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital & Harvard Medical School, 165 Cambridge Street, Suite 810, Boston, MA, 02114, USA.
authors.forename: M C
authors.initials: MC
authors.lastname: Cropano
authors.affiliation: Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital & Harvard Medical School, 165 Cambridge Street, Suite 810, Boston, MA, 02114, USA.
authors.forename: A
authors.initials: A
authors.lastname: Larentzakis
authors.affiliation: Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital & Harvard Medical School, 165 Cambridge Street, Suite 810, Boston, MA, 02114, USA.
authors.forename: M G
authors.initials: MG
authors.lastname: van der Wilden
authors.affiliation: Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital & Harvard Medical School, 165 Cambridge Street, Suite 810, Boston, MA, 02114, USA.
authors.forename: Y A
authors.initials: YA
authors.lastname: Mejaddam
authors.affiliation: Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital & Harvard Medical School, 165 Cambridge Street, Suite 810, Boston, MA, 02114, USA.
authors.forename: C A
authors.initials: CA
authors.lastname: Sideris
authors.affiliation: Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital & Harvard Medical School, 165 Cambridge Street, Suite 810, Boston, MA, 02114, USA.
authors.forename: M
authors.initials: M
authors.lastname: Michailidou
authors.affiliation: Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital & Harvard Medical School, 165 Cambridge Street, Suite 810, Boston, MA, 02114, USA.
authors.forename: K
authors.initials: K
authors.lastname: Fikry
authors.affiliation: Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital & Harvard Medical School, 165 Cambridge Street, Suite 810, Boston, MA, 02114, USA.
authors.forename: A
authors.initials: A
authors.lastname: Bramos
authors.affiliation: Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital & Harvard Medical School, 165 Cambridge Street, Suite 810, Boston, MA, 02114, USA.
authors.forename: S
authors.initials: S
authors.lastname: Janjua
authors.affiliation: Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital & Harvard Medical School, 165 Cambridge Street, Suite 810, Boston, MA, 02114, USA.
authors.forename: Y
authors.initials: Y
authors.lastname: Chang
authors.affiliation: Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital & Harvard Medical School, 165 Cambridge Street, Suite 810, Boston, MA, 02114, USA. DKING3@PARTNERS.ORG.
authors.forename: D R
authors.identifier: http://orcid.org/0000-0003-1028-1478
authors.initials: DR
authors.lastname: King
mesh_terms: D000328:Adult; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D007318:Inservice Training; D008297:Male; D016272:Occupational Health / Q000193:education*; D010348:Patient Care Team / Q000458:organization & administration*; D011446:Prospective Studies; D014193:Trauma Centers / Q000458:organization & administration*; D016635:Universal Precautions
keywords: Compliance; Hand washing; Occupational safety; Prophylactic measures; Universal safety precautions