Compliance with barrier precautions during paediatric trauma resuscitations
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Updated: May 20, 2026
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Published on: May 26, 2023
Deirdre C Kelleher1, Elizabeth A Carter, Lauren J Waterhouse
1Division of Trauma and Burns, Children's National Medical Center, Washington, DC 20010, United States.
Insights
Barrier precaution compliance during pediatric trauma resuscitations was 81.3%. Compliance varied by team role, with bedside staff showing higher adherence than those not at the bedside, particularly for penetrating injuries.
Area of Science:
- Pediatric Emergency Medicine
- Infection Control
- Trauma Surgery
Background:
- Barrier precautions are crucial for preventing blood-borne pathogen transmission.
- Low compliance is noted in adult trauma teams, but pediatric resuscitation compliance is understudied.
- Perceived risk of disease transmission may be lower in pediatric cases.
Purpose of the Study:
- To identify factors associated with barrier precaution compliance during pediatric trauma resuscitations.
- To evaluate compliance with gowns and gloves policy in this setting.
Main Methods:
- Video review of 128 pediatric trauma resuscitations involving 1138 team members.
- Assessment of compliance with established policies for gowns and gloves.
- Multivariate logistic regression to analyze the impact of team role, resuscitation factors, and injury type.
Main Results:
- Overall barrier precaution compliance was 81.3%.
- Higher compliance (90.7%) was observed among bedside roles compared to non-bedside roles (65.1%).
- Compliance increased with penetrating injuries, highest activation levels, and pre-patient arrival, but was lowest among surgical attendings (20.8%).
Conclusions:
- Barrier precaution compliance in pediatric trauma resuscitations is variable and influenced by team role and patient factors.
- Interventions are needed to standardize compliance across all team members.
- Improving adherence to universal precautions is essential for patient and provider safety.
Purpose:
Barrier precautions protect patients and providers from blood-borne pathogens. Although barrier precaution compliance has been shown to be low among adult trauma teams, it has not been evaluated during paediatric resuscitations in which perceived risk of disease transmission may be low. The purpose of this study was to identify factors associated with compliance with barrier precautions during paediatric trauma resuscitations.
Methods:
Video recordings of resuscitations performed on injured children (<18 years old) were reviewed to determine compliance with an established policy requiring gowns and gloves. Depending on activation level, trauma team members included up to six physicians, four nurses, and a respiratory therapist. Multivariate logistic regression was used to determine the effect of team role, resuscitation factors, and injury mechanism on barrier precaution compliance.
Results:
Over twelve weeks, 1138 trauma team members participated in 128 resuscitations (4.7% penetrating injuries, 9.4% highest level activations). Compliance with barrier precautions was 81.3%, with higher compliance seen among roles primarily at the bedside compared to positions not primarily at the bedside (90.7% vs. 65.1%, p<0.001). Bedside residents (98.4%) and surgical fellows (97.6%) had the highest compliance, while surgical attendings (20.8%) had the lowest (p<0.001). Controlling for role, increased compliance was observed during resuscitations of patients with penetrating injuries (OR=3.97 [95% CI: 1.35-11.70], p=0.01), during resuscitations triaged to the highest activation level (OR=2.61 [95% CI: 1.34-5.10], p=0.005), and among team members present before patient arrival (OR=4.14 [95% CI: 2.29-7.39], p<0.001).
Conclusions:
Compliance with barrier precautions varies by trauma team role. Team members have higher compliance when treating children with penetrating and high acuity injuries and when arriving before the patient. Interventions integrating barrier precautions into the workflow of team members are needed to reduce this variability and improve compliance with universal precautions during paediatric trauma resuscitations.
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