"Universal
precautions," as defined by CDC, are a set of precautions designed to
prevent transmission of human immunodeficiency virus (HIV), hepatitis B virus
(HBV), and other bloodborne pathogens when providing first aid or health care. Under
universal precautions, blood and certain body fluids of all patients are
considered potentially infectious for HIV, HBV and other bloodborne pathogens.
Universal precautions took
the place of and eliminated the need for the isolation category "Blood and
Body Fluid Precautions" in the 1983 CDC Guidelines for Isolation
Precautions in Hospitals. However, implementing universal precautions does not
eliminate the need for other isolation precautions, such as droplet precautions
for influenza, airborne isolation for pulmonary tuberculosis, or contact
isolation for methicillin-resistant Staphylococcus aureus.
Universal precautions
differ from the system of Body Substance Isolation (BSI) used in some
institutions. For information about BSI, refer to the following articles:
In 1996, CDC published new
guidelines (standard precautions) for isolation precautions in hospitals. Standard
precautions synthesize the major features of BSI and universal precautions to
prevent transmission of a variety of organisms. Standard precautions were
developed for use in hospitals and may not necessarily be indicated in other
settings where universal precautions are used, such as child care settings and
schools.
Universal precautions apply
to blood, other body fluids containing visible blood, semen, and vaginal
secretions. Universal precautions also apply to tissues and to the following
fluids: cerebrospinal, synovial, pleural, peritoneal, pericardial, and amniotic
fluids. Universal precautions do not apply to feces, nasal secretions, sputum,
sweat, tears, urine, and vomitus unless they contain visible blood. Universal
precautions do not apply to saliva except when visibly contaminated with blood
or in the dental setting where blood contamination of saliva is predictable.
Universal precautions
involve the use of protective barriers such as gloves, gowns, aprons, masks, or
protective eyewear, which can reduce the risk of exposure of the health care
worker's skin or mucous membranes to potentially infective materials. In
addition, under universal precautions, it is recommended that all health care
workers take precautions to prevent injuries caused by needles, scalpels, and
other sharp instruments or devices.
Pregnant health care
workers are not known to be at greater risk of contracting HIV infection than
are health care workers who are not pregnant; however, if a health care worker
develops HIV infection during pregnancy, the infant is at risk of infection
resulting from perinatal transmission. Because of this risk, pregnant health
care workers should be especially familiar with, and strictly adhere to,
precautions to minimize the risk of HIV transmission.
WRITTEN GUIDELINES:
UNIVERSAL PRECAUTIONS
Universal precautions are
discussed in the following documents:
These three documents may
be obtained by calling the AIDS Hotline at 1-800-342-2437 or the National AIDS
Information Clearinghouse at 1-800-458-5231.
In addition, the
Occupational Safety and Health Administration (OSHA) has published a standard
on "bloodborne pathogens." For information about this document, call
202-219-7157.
For information on
infection control in dental practice, call 1-800-458-5231 to obtain "The
Infection Control File." For further questions on dental practice, call
the Division of Oral Health, CDC, telephone 770-488-3034.
GLOVING, GOWNING,
MASKING, AND OTHER PROTECTIVE BARRIERS AS PART OF UNIVERSAL PRECAUTIONS
All health care workers
should routinely use appropriate barrier precautions to prevent skin and mucous
membrane exposure during contact with any patient's blood or body fluids that
require universal precautions.
Recommendations for the use
of gloves are presented in detail in the Morbidity and Mortality Weekly Report
dated June 24, 1988, which is available by calling the National AIDS
Information Hotline at 1-800-342-2437 or the National AIDS Information
Clearinghouse at 1-800-458-5231.
Gloves should be worn:
Gloves should be changed
after contact with each patient. Hands and other skin surfaces should be washed
immediately or as soon as patient safety permits if contaminated with blood or
body fluids requiring universal precautions. Hands should be washed immediately
after gloves are removed. Gloves should reduce the incidence of blood
contamination of hands during phlebotomy, but they cannot prevent penetrating
injuries caused by needles or other sharp instruments. Institutions that judge
routine gloving for all phlebotomies is not necessary should periodically
reevaluate their policy. Gloves should always be available to health care
workers who wish to use them for phlebotomy. In addition, the following general
guidelines apply:
The Center for Devices and
Radiological Health, Food and Drug Administration (FDA), has responsibility for
regulating the medical glove industry. For more information about selection of
gloves, call FDA at 301-443-8913.
Masks and protective
eyewear or face shields should be worn by health care workers to prevent
exposure of mucous membranes of the mouth, nose, and eyes during procedures
that are likely to generate droplets of blood or body fluids requiring
universal precautions. Gowns or aprons should be worn during procedures that
are likely to generate splashes of blood or body fluids requiring universal
precautions.
All health care workers
should take precautions to prevent injuries caused by needles, scalpels, and
other sharp instruments or devices during procedures; when cleaning used instruments;
during disposal of used needles; and when handling sharp instruments after
procedures. To prevent needlestick injuries, needles should not be recapped by
hand, purposely bent or broken by hand, removed from disposable syringes, or
otherwise manipulated by hand. After they are used, disposable syringes and
needles, scalpel blades, and other sharp items should be placed in
puncture-resistant containers for disposal. The puncture-resistant containers
should be located as close as practical to the use area. All reusable needles
should be placed in a puncture-resistant container for transport to the
reprocessing area.
General infection control
practices should further minimize the already minute risk for salivary
transmission of HIV. These infection control practices include the use of
gloves for digital examination of mucous membranes and endotracheal suctioning,
handwashing after exposure to saliva, and minimizing the need for emergency
mouth-to-mouth resuscitation by making mouthpieces and other ventilation
devices available for use in areas where the need for resuscitation is
predictable.
Although universal
precautions do not apply to human breast milk, gloves may be worn by health
care workers in situations where exposures to breast milk might be frequent,
e.g., in breast milk banking.
This page last
reviewed February 5, 1999