Education of the Trauma Team: Video Evaluation of the Compliance with Universal Barrier Precautions in Resuscitation Adam J. Brooks, Mark Phipson, Anton Potgieter, Heidi Koertzen and Ken D. Boffard From the Department of Surgery, Johannesburg Hospital Trauma Unit, University of the Witwatersrand, Johannesburg, South Africa Eur J Surg 1999; 165: 1125–1128 ABSTRACT Objective: To assess the effectiveness of an educational symposium designed to improve compliance with universal barrier precautions by the use of video analysis of resuscitations. Design: Prospective single blind analysis of data. Setting: Hospital Trauma Unit, Johannesburg, South Africa. Subjects: 100 severely injured patients who presented to the emergency room, divided into two study periods. Interventions: An educational symposium held between the study periods, which focused on universal barrier precautions and the risk of occupational transmission of HIV. Main Outcome Measures: Compliance with items of universal precautions; mechanism; Injury Severity Score and Revised Trauma Score. Results: There was a significant improvement in compliance from 48% to 74% after the symposium (p = 0.007), with specific improvement in the wearing of masks and visors. Initially there was poor compliance with universal precautions in severely injured patients, which significantly improved to 83% compliance (p = 0.0004). Conclusion: Video analysis of resuscitations is an effective audit and educational tool that allows analysis of compliance with protocol. The education symposium was effective in altering attitudes and behaviour towards universal barrier precautions. Key words: education, trauma team, video, universal barrier precautions. INTRODUCTION Video analysis of trauma resuscitations has become an integral part of the Quality Assurance Programme at many hospitals that deal with severely injured patients all over the world. Videotape analysis is used in the audit of the process of resuscitation, which allows the team to be assessed at a remote time and location against predetermined standards and an evaluation made of adherence to protocol. We have been using video in our unit for a number of years, to provide an educational forum in which resuscitations can be discussed openly and management problems rectified. It has also allowed us to develop teaching videos in key areas. Today there is an increased potential for occupa- tional exposure of health care workers to blood borne pathogens and this has led to an increased emphasis on universal barrier precautions. Education of members of the trauma team has improved their compliance with universal barrier precautions (6), and video review has been used to document their compliance (1). With our experience of video as an educational tool in discussing resuscitation problems, we decided to use it to review the compliance of the trauma team with a minimum standard of universal barrier precautions, and subse- quently to evaluate the effectiveness of a teaching programme aimed specifically at improving compli- ance with this protocol. SUBJECTS AND METHODS The video system consisted of a high, wall-mounted video camera angled to allow the resuscitation trolley and all members of the trauma team within one metre of the trolley to be recorded. The system included audio pickup so the stage of the resuscitation, injuries, and observations could also be recorded at review. Record- ing of the resuscitation was initiated according to unit protocol on the entry of the patient to the resuscitation bay and stopped either on the transfer of the patient from the emergency room or at the discretion of the supervising consultant. Resuscitations at the Johannesburg Hospital Trauma Unit are performed in accordance with Advanced Trauma Life Support 1 protocols using a team ap- 1999 Scandinavian University Press. ISSN 1102–4151 Eur J Surg 165 ORIGINAL ARTICLE