Universal precautions
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Universal precautions is the term used to describe the practice in medicine of avoiding contact with patients' bodily fluids, by means of the wearing of nonporous articles such as gloves, goggles, and face shields. Medical instruments, especially scalpels and hypodermic needles should be handled and disposed of properly in a sharps container. Pathogens fall into two broad categories: bloodborne (carried in the body fluids) and airborne. Standard universal precautions cover both types.
Universal precautions should be practiced in any environment where workers are exposed to bodily fluids, such as:
- blood
- semen
- vaginal secretions
- synovial fluid
- amniotic fluid
- cerebrospinal fluid
- pleural fluid
- peritoneal fluid
- pericardial fluid
Bodily fluids that do not require such precautions include:
- feces
- nasal secretions
- urine
- vomitus
- perspiration
- sputum
- saliva (In the dental setting, saliva is likely to be contaminated with blood, and should be handled properly.)
Universal precautions were the infection control techniques that were recommended following the AIDS outbreak in the 1980's. It is a term that is not recommended to be used now though, because ‘universal’ implies perfect protection, and it doesn’t give that. Universal precautions apply to blood, semen, vaginal secretions and some body fluids (not sweat, faeces, urine, sputum, vomit) as listed above.
The system now recommended to apply is a two-tiered system, using the terms standard and additional precautions. Standard precautions apply to all patients no matter what their infectious status is known or suspected to be. This applies to blood (wet and dry), ALL bodily fluids except sweat, as well as non-intact skin and mucous membranes. Essentially both standard and universal precautions are good hygiene habits, such as hand washing and the use of gloves and other barriers, good sharps usage, aseptic techniques.
Additional precautions are used as well as standard precautions for patients who are known or suspected to have an infectious conditions, and vary depending on the infection control needs are for that patient. Additional precautions are not needed for blood-borne infections, unless there are complicating factors.
Conditions indicating additional precautions: Prion diseases eg.CJD (mad-cow disease) Diseases with air-borne transmission (eg TB) Diseases with droplet transmission (eg mumps, rubella, influenza, pertussis) Transmission by direct or indirect contact with dried skin (eg colonisation with Multiply Resistant Staph. Aureus), or contaminated surfaces or by any combination of the above.
Universal precautions are recommended not only for doctors, nurses and patients but for health care support workers. Some support workers, most notably laundry and housekeeping staff, may be required to come into contact with patients or with body fluids.
Protective clothing may include but is not limited to:
- barrier gowns
- rubber gloves
- eyewear (goggles or glasses)
- facemasks
- hair nets
- shoe coverings
See also: body substance isolation Template:Med-stub