Effectiveness of protocols for preventing occupational exposure to blood and body fluids in Dutch hospitals

Compliance of different healthcare workers (HCWs) (nurses, physicians, laboratory technicians and cleaners) with protocols to prevent exposure to blood and body fluids (BBF) was studied. Questionnaires were used to assess perception of risks, familiarity with protocols, motivation and actual behaviour. Performance of the protocols in practice was also tested. The practical test provided more reliable results than the questionnaire. HCWs overestimated their knowledge and skills, and compliance was influenced by risk perception. HCWs encountered problems with comprehension, acceptability and applicability of protocols, especially for post-exposure precautions. Protocols are not tailored to the differences in knowledge, risk perception and practical needs of different professional groups, probably because HCWs have rarely been involved in writing them and they are governed more by legal considerations than applicability. Most HCWs experienced a lack of organizational support to aid compliance. To improve compliance, we recommend information and training on risk management and individual responsibilities regarding the safety of coworkers and patients, participation of HCWs in protocol development, and support of management to avoid reversion to previous habitual behaviour.