Universal precautions

Universal precautions refers to the practice, in medicine, of avoiding contact with patients' bodily fluids, by means of the wearing of nonporous articles such as medical gloves, goggles, and face shields. The infection control techniques were essentially good hygiene habits, such as hand washing and the use of gloves and other barriers, the correct handling of hypodermic needles, scalpels, and aseptic techniques. Following the AIDS outbreak in the 1980s the US CDC formally introduced them in 1985–88. Every patient was treated as if infected and therefore precautions were taken to minimize risk.

A US Navy hospital corpsman wearing personal protective equipment (PPE) while handling blood samples.

In 1987, the practice of universal precautions was adjusted by a set of rules known as body substance isolation. In 1996, both practices were replaced by the latest approach known as standard precautions. Use of personal protective equipment is now recommended in all health care settings.

Historical significance

Universal precautions are an infection control practice. Under universal precautions all patients were considered to be possible carriers of blood-borne pathogens. The guideline recommended wearing gloves when collecting or handling blood and body fluids contaminated with blood, wearing face shields when there was danger of blood splashing on mucous membranes and disposing of all needles and sharp objects in puncture-resistant containers.

Universal precautions were introduced in the US by CDC in the wake of the AIDS epidemic between 1985 and 1988.[1][2]

In 1987, the practice of universal precautions was adjusted by a set of rules known as body substance isolation. In 1996, both practices were replaced by the latest approach known as standard precautions.[3]

Use

Universal precautions were designed for doctors, nurses, patients, and healthcare workers who came into contact with patients and their bodily fluids. This included staff and others who might not come into direct contact with patients.

Universal precautions were typically practiced in any environment where workers were exposed to bodily fluids, such as Blood, Semen, Vaginal secretions, Synovial fluid, Amniotic fluid, Cerebrospinal fluid, Pleural fluid, Peritoneal fluid, Pericardial fluid, Feces and Urine.

Bodily fluids which did not require such precautions included Nasal secretions, Vomitus, Perspiration, Sputum and Saliva.[4][5][6]

Equipment

Since pathogens fall into two broad categories, bloodborne (carried in the body fluids) and airborne, personal protective equipment included, but was not limited to barrier gowns, gloves, masks, eyewear like goggles or glasses and face shields.

Additional precautions

Additional precautions were used in addition to universal precautions for patients who were known or suspected to have an infection, and varied depending on the suspected transmission. Additional precautions were not needed for blood-borne infections, unless there were complicating factors.

Conditions demanding additional precautions were prion diseases (e.g., Creutzfeldt–Jakob disease), diseases with air-borne transmission (e.g., tuberculosis), diseases with droplet transmission (e.g., mumps, rubella, influenza, pertussis) and transmission by direct or indirect contact with dried skin (e.g., colonisation with MRSA) or contaminated surfaces or any combination of the above.

Adverse effects

As of 2010 research around stigma and discrimination in health-related settings has implicated universal precautions as a means by which health care workers discriminate against patients.[7][8] Particularly the employment of universal precautions when working with people with HIV and/or hepatitis C has been demonstrated to be inconsistent and implicated with feelings of stigmatization reported by those populations.[8] Health-cased social research in 2004 revealed that by not applying universal precautions universally, as is the purpose, health professionals are instead making judgements based on an individual's health status.[9] It is speculated that this differential approach to care stems from stigma towards HIV and hepatitis C, rooted largely in fears and misconceptions around transmission and assumptions about patient lifestyle and risk.

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See also

Footnotes
  1. CDC. Update: universal precautions for prevention of transmission of human immunodeficiency virus, hepatitis B virus, and other bloodborne pathogens in health-care settings. MMWR Morb Mortal Wkly Rep 1988;37(24):377-82, 87–8.
  2. CDC. Recommendations for preventing transmission of infection with human T- lymphotropic virus type III/lymphadenopathy-associated virus in the workplace. MMWR Morb Mortal Wkly Rep 1985;34(45):681-6, 91–5.
  3. Lam, Simon C. (2011-12-01). "Universal to standard precautions in disease prevention: Preliminary development of compliance scale for clinical nursing". International Journal of Nursing Studies. 48 (12): 1533–1539. doi:10.1016/j.ijnurstu.2011.06.009. ISSN 0020-7489. PMID 21803354.
  4. CDC. Update: universal precautions for prevention of transmission of human immunodeficiency virus, hepatitis B virus, and other bloodborne pathogens in health-care settings. MMWR Morb Mortal Wkly Rep 1988;37(24):377-82, 87–8.
  5. Lynch P, Jackson MM, Cummings MJ, Stamm WE. Rethinking the role of isolation practices in the prevention of nosocomial infections. Ann Intern Med 1987;107(2):243-6.
  6. Garner JS. Guideline for isolation precautions in hospitals. The Hospital Infection Control Practices Advisory Committee. Infect Control Hosp Epidemiol 1996;17(1):53–80.(s).
  7. Welch, S. E., & Bunin, J. (2010). Glove use and the HIV positive massage therapy client. Journal of Bodywork and Movement Therapies, 14(1), 35–39.
  8. Rintamaki, L. S., Scott, A. M., Kosenko, K. A., & Jensen, R. E. (2007). Male patient perceptions of HIV stigma in health care contexts. AIDS Patient Care and STDs, 21(12), 956–969.
  9. Treloar, C., & Hopwood, M. (2004). Infection control in the context of hepatitis C disclosure: Implications for education of healthcare professionals. Education for Health, 17(2), 183–191.
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