Editing Universal precautions

{{Short description|Medical standard for contact avoidance}}
{{more refs|date=April 2020}}
[[File:US Navy 061129-N-5416W-005 Hospital Corpsman Seaman Jered Cotshwar sort's blood samples during a ship's blood drive aboard the Nimitz-class aircraft carrier USS Theodore Roosevelt (CVN 71).jpg|thumb|A US Navy hospital corpsman wearing personal protective equipment (PPE) while handling blood samples.]]

'''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 shield]]s. 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 needle]]s, [[scalpel]]s, 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.<ref>{{Cite web |date=2019-04-09 |title=History {{!}} Appendix A {{!}} Isolation Precautions {{!}} Guidelines Library {{!}} Infection Control {{!}} CDC |url=https://www.cdc.gov/infectioncontrol/guidelines/isolation/appendix/history.html |access-date=2024-05-02 |website=www.cdc.gov |language=en-us}}</ref>

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 '''[[Transmission-based precautions#Standard precautions|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 shield]]s 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 [[Centers for Disease Control and Prevention|CDC]] in the wake of the AIDS epidemic between 1985 and 1988.<ref name=cdc>CDC. [https://www.cdc.gov/mmwr/preview/mmwrhtml/00000039.htm 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.</ref><ref>CDC. [https://www.cdc.gov/mmwr/preview/mmwrhtml/00033093.htm 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.</ref>

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.<ref>{{Cite journal|date=2011-12-01|title=Universal to standard precautions in disease prevention: Preliminary development of compliance scale for clinical nursing|journal=International Journal of Nursing Studies| language=en| volume=48| issue=12| pages=1533–1539| doi=10.1016/j.ijnurstu.2011.06.009|pmid=21803354|issn=0020-7489|last1=Lam|first1=Simon C.}}</ref><ref>Adebayo O, Labiran A, Imarhiagbe L. Standard Precautions in clinical practices: A review. Int. J. Health Sci. Res. 2015;5:521-8.</ref>

== Use ==
Universal precautions were designed for doctors, nurses, patients, and healthcare workers who came into contact with patients and their bodily fluids.<ref name=":0">{{Citation |last=Broussard |first=Ian M. |title=Universal Precautions |date=2022 |url=http://www.ncbi.nlm.nih.gov/books/NBK470223/ |work=StatPearls |place=Treasure Island (FL) |publisher=StatPearls Publishing |pmid=29262198 |access-date=2023-02-12 |last2=Kahwaji |first2=Chadi I.}}</ref> This included staff and others who might not come into direct contact with patients.<ref name=":0" />

Universal precautions were typically practiced in any environment where workers were exposed to bodily fluids, such as [[blood]], [[semen]], [[vaginal secretion]]s, [[synovial fluid]], [[amniotic fluid]], [[cerebrospinal fluid]], [[pleural fluid]], [[peritoneal fluid]], [[pericardial fluid]], [[feces]] and [[urine]].<ref name=":0" />

Bodily fluids which did not require such precautions included [[nasal secretion]]s, [[vomitus]], [[perspiration]], [[sputum]] and [[saliva]].<ref >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.</ref><ref >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.</ref><ref >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).</ref>

== Equipment ==
Since [[pathogen]]s fall into two broad categories, bloodborne (carried in the body fluids) and airborne,  [[personal protective equipment]] included, but was not limited to [[Hospital gown|barrier gowns]], [[gloves]], [[mask]]s, eyewear  like [[goggles]] or [[glasses]] and [[face shield]]s.<ref name=":0" />

== Additional precautions ==
{{Main|Transmission-based precautions}}
Additional precautions are used in addition to universal precautions for patients who are known or suspected to have an infection that requires extra measures, depending on the suspected route of transmission.<ref>{{Cite journal|last=Doyle|first=Glynda Rees|last2=McCutcheon|first2=Jodie Anita|date=2015-11-23|title=Appendix 1: Glossary|url=https://opentextbc.ca/clinicalskills/back-matter/appendix/|language=en}}</ref> Additional precautions are not needed for blood-borne infections unless there are complicating factors or to avoid leukocyte-related complications of blood transfusion.<ref>{{Cite journal |last=Cleemput |first=Irina |last2=Leys |first2=Mark |last3=Ramaekers |first3=Dirk |last4=Bonneux |first4=Luc |date=October 2006 |title=Balancing evidence and public opinion in health technology assessments: The case of leukoreduction |url=https://www.cambridge.org/core/product/identifier/S0266462306051312/type/journal_article |journal=International Journal of Technology Assessment in Health Care |language=en |volume=22 |issue=4 |pages=403–407 |doi=10.1017/S0266462306051312 |issn=0266-4623}}</ref>

Conditions demanding additional precautions are [[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 [[Methicillin-resistant Staphylococcus aureus|MRSA]]) or contaminated surfaces or any combination of the above.<ref>{{Cite journal |last=Doyle |first=Glynda Rees |last2=McCutcheon |first2=Jodie Anita |date=2015-11-23 |title=1.4 Additional Precautions and Personal Protective Equipment (PPE) |url=https://opentextbc.ca/clinicalskills/chapter/1-8-masks/ |language=en}}</ref>

== 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.<ref >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.</ref><ref name="Rintamaki et al" >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.</ref>  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.<ref name="Rintamaki et al" /> 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.<ref >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.</ref> 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.{{cn|date=April 2020}}

== See also ==
* [[Barrier nursing]]
* [[Body substance isolation]]
* [[Viral hemorrhagic fever]]
* [[Hepatitis B]]

== Footnotes ==
{{Reflist}}

== External links ==
* [https://www.cdc.gov/MMWR/preview/mmwrhtml/00023587.htm Recommendations for Prevention of HIV Transmission in Health-Care Settings]

{{Health care}}

{{DEFAULTSORT:Universal Precautions}}
[[Category:Medical hygiene]]
[[Category:Infection-control measures]]