Universal precautions guideline: self-reported compliance by gastroenterologists and gastrointestinal endoscopy nurses--a decade's lack of progress.

OBJECTIVES: The aims of this study were to assess and compare the Universal Precaution (UP) practices of gastroenterologists (GE) and GI endoscopy nurses (GIEN). METHODS: We mailed a 23-item questionnaire to 250 GE and GIEN selected, respectively, from the American Board of Internal Medicine online directory and the Society of Gastroenterology Nurses and Associates membership directory. RESULTS: A total of 77 (31%) GE and 157 (60%) GIEN responded. In all, 32% of GE and 50% of GIEN washed their hands before and after handling every patient (p<0.01), and 5% of GE and 30% of GIEN wore gloves during all patient contacts (p<0.01). Fewer GE than GIEN used face shields for all procedures (14% vs 21%; p=0.02). Protective gowns were worn during all procedures by 29% of GE and 46% of GIEN (p<0.01). More GE than GIEN either did not recap used needles or used the one-handed "scoop" technique (85% vs 77%; p=0.02). When asked to give an overall assessment, 46% of GE and 60% of GIEN reported that they always complied with UP (p=0.06). Profession, age, gender, hours of daily patient contact, and adequacy of staffing did not affect compliance. CONCLUSIONS: GIEN adhered to UP recommendations better than GE regarding most items queried except in the handling of used needles. Nonetheless, for both groups, compliance with proper hand washing and use of gloves, face shields, and gowns was very poor, and handling of used needles was satisfactory.

Current liver biopsy practices for suspected parenchymal liver diseases in the United States: the evolving role of radiologists.

OBJECTIVE: The aim of this study was to determine current liver biopsy practices in the United States. METHODS: We mailed a questionnaire to 260 randomly selected members of the American Association for the Study of Liver Diseases. Statistical analysis was conducted using the chi2 test. RESULTS: A total of 128 members (49%) responded, with 106 responses suitable for inclusion. Of the respondents, 25% had a radiologist perform >50% of their patients' liver biopsies, whereas 38% personally performed all their patients' biopsies. During training, 87% of respondents were taught to perform liver biopsy using the "blind" technique, 2% with ultrasound (US) guidance, and 11% both. A total of 76% used US guidance during liver biopsy. More private practitioners than those practicing in academic centers used the "blind" technique (35% vs 18%; p = 0.02) and referred >50% of their patients for liver biopsy to Radiology (36% vs 17%; p = 0.01); desire for real-time US guidance was the main reason in 43% of cases. Of the respondents, 75% used US for safety reasons; 77% of those who did not use US believed that it was unnecessary. Overall, 87% of respondents indicated that patient safety was the most important issue during liver biopsy; only 2% thought that personal convenience and cost-effectiveness were most important. CONCLUSIONS: Respondents' chief concern was patient safety, and most used US for this reason. Private practitioners were less likely than those practicing in academic centers to use US guidance and were more likely to refer patients to Radiology.

Seroprevalence of H. pylori infection and symptoms of upper gastrointestinal tract disease in two groups of health-care workers.

The purpose of this study was to determine the seroprevalence of Helicobacter pylori and risk factors for infection in gastrointestinal endoscopy personnel and those caring for developmentally disabled individuals. We administered a structured, one-page questionnaire. Helicobacter pylori status was determined serologically. In all, 107 health-care workers participated. Direct patient contact, exposure to gastrointestinal secretions, history of peptic ulcer, and acid-suppressing medicine use were more frequent among those who worked with the developmentally disabled. Seroprevalence of Helicobacter pylori was 24% in endoscopy personnel and 47% among those who cared for the developmentally disabled (P = 0.02). Bed-sharing with a sibling during childhood, working with the developmentally disabled, and direct patient contact were associated with Helicobacter pylori infection; exposure to patients' gastrointestinal secretions was not. We conclude that those caring for developmentally disabled individuals have a higher risk of occupational acquisition of Helicobacter pylori infection than endoscopy personnel.