Universal Precaution - An Introduction

1. UNIVERSAL
PRECAUTION
Dr. Ruchi Kushwaha
PG-HA Student
SGPGIMS, Lucknow

2. DEFINITION
Universal precautions are control guidelines designed to protect health
workers from exposure to diseases spread by blood and other body fluids.
It is an approach to infection control to treat all human blood and certain
human body fluids as if they were known to be infectious for HIV, HBV and other
blood borne pathogens.
- (Blood borne Pathogens Standard 29CFR1910.1030(b) definitions).
The concept of Universal Health Precautions emphasizes that all our patients
should be treated as though they have potential blood born infections, and can infect
the caring health care workers. ( CDC )

3. HISTORY OF INFECTION CONTROL PRECAUTIONS
Sl. No. Year Infection Control Precautions
1. 1877, 1910 Separates facilities, Antisepsis and disinfections ... etc
2. 1985 UNIVERSAL PRECAUTIONS (guidelines for protecting healthcare worker because the
emergence of HIV & other blood borne pathogens)
3. 1987 BODY SUBSTANCE ISOLATION ( focused on protecting patients and health personnel
from all moist body fluids not just blood: semen, vaginal secretions, wound drainage,
sputum, saliva etc
4. 1996 STANDARD PRECAUTIONS: Two level approach:
•Standard Precautions which apply to all clients and patients attending healthcare
facilities
•Transmission-based Precautions which apply only to hospitalized Patients
5. 2007 ISOLATION PRECAUTIONS (new pathogens; SARS, Avian Influenzae H5N1, H1N1)

4. We Do Not Know who is Infected ???
Human materials/Tissues considered Highly Infectious-
1. Blood
2. Semen
3. Vaginal secretions
4. C S F
5. Synovial fluids
6. Amniotic fluid
7. All other body fluids

5. Continue…
Not Infectious unless contaminated with Blood or Body fluids-
1. Faeces
2. Nasal secretions
3. Sputum
4. Sweat
5. Tears
6. Urine / Vomitus
7. Saliva unless blood stained

6. LACK OF UNIVERSAL PRECAUTION :
POTENTIAL HAZARD
Employee exposure to bloodborne pathogens from blood and Other Potentially
Infectious Materials (OPIM) because employees are not using Universal
Precautions.
Bloodborne pathogens are pathogenic microorganisms that are present in human
blood and can cause disease in humans.
Some infections that can be transmitted through contact with blood and body
fluids include:
• HIV, Hepatitis A, B, C, Staph and Strep infections, Gastroenteritis-salmonella,
and shigella, Pneumonia, Syphilis, TB, Malaria, Measles, Chicken Pox, Herpes,
Urinary tract infections, and Blood infections. The greatest risks are from HIV
and Hepatitis B and C.

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Bloodborne Pathogen Standard 29 CFR 1910.1030(d)(1) requires:
• Employees to observe Universal Precautions to prevent contact with blood or
other potentially infectious materials (OPIM).
• Under circumstances in which differentiation between body fluid types is
difficult or impossible, all body fluids shall be considered potentially
infectious materials.
• Treat all blood and other potentially infectious materials with appropriate
precautions such as:
i.) Use gloves, masks, and gowns if blood or OPIM exposure is anticipated.
ii) Use engineering and work practice controls to limit exposure.

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• OPIM is defined in 29 CFR 1910.1030(b) as:
The following human body fluids: semen, vaginal secretions, cerebrospinal fluid,
synovial fluid, pleural fluid, pericardial fluid, peritoneal fluid, amniotic fluid,
saliva in dental procedures, any body fluid that is visibly contaminated with blood,
and all body fluids in situations where it is difficult or impossible to differentiate
between body fluids;
 Any unfixed tissue or organ (other than intact skin) from a human (living or
dead); and
 HIV-containing cell or tissue cultures, organ cultures, and HIV- or HBV-
containing culture medium or other solutions; and blood, organs, or other tissues
from experimental animals infected with HIV or HBV

9. STANDARD PRECAUTIONS
The Bloodborne Pathogens Standard allows for hospitals to use acceptable
alternatives [OSHA Directive CPL 02-02-069, (2001, November 27)] to universal
precautions:
Alternative concepts in infection control are called Body Substance Isolation
(BSI) and Standard Precautions. These methods define all body fluids and
substances as infectious. These methods incorporate not only the fluids and
materials covered by the Bloodborne Pathogens Standard but expands coverage to
include all body fluids and substances.
These concepts are acceptable alternatives to universal precautions, provided that
facilities utilizing them adhere to all other provisions of the standard.
For compliance with OSHA Standards, the use of either Universal Precautions or
Standard Precautions are acceptable.

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 Standard precautions are meant to reduce the risk of transmission of bloodborne
and other pathogens from both recognized and unrecognized sources of infection
in hospitals.
 They are the basic level of infection control precautions which are to be used, as a
minimum, in the care of all patients.

11. HEALTH-CARE FACILITY RECOMMENDATIONS
FOR STANDARD PRECAUTIONS
• The CDC recommends Standard Precautions for the care of all patients,
regardless of their diagnosis or presumed infection status.
• Standard Precautions apply to-
1) Blood
2) All body fluids, secretions, and excretions, except sweat, regardless of whether or
not they contain visible blood
3) Non-intact skin; and
4) Mucous membranes

12. KEY ELEMENTS OF STANDARD PRECAUTION
1. Hand Hygiene
2. Gloves
3. Facial Protection
4. Gown
5. Prevention of needle stick and injuries from other sharp instruments
6. Respiratory hygiene and cough etiquette
7. Environmental cleaning
8. Linen
9. Waste Disposal
10. Patient care equipment

13. HAND HYGIENE
Techniques:
• Hand washing (40–60 sec):
Wet Hands And Apply Soap
Rub All Surfaces
Rinse Hands And Dry Thoroughly With A Single Use Towel
Use Towel To Turn Off Faucet.
• Hand Rubbing (20–30 Sec):
Apply Enough Product To Cover All Areas Of The Hands
 Rub Hands Until Dry

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Indications:
Before and after any direct patient contact and between patients, whether or not
gloves are worn.
 Immediately after gloves are removed.
 Before handling an invasive device.
After touching blood, body fluids, secretions, excretions, non-intact skin, and
contaminated items, even if gloves are worn.
During patient care, when moving from a contaminated to a clean body site of the
patient.
After contact with inanimate objects in the immediate vicinity of the patient.

15. GLOVES
 Wear when touching blood, body fluids, secretions,
excretions, mucous membranes, non intact skin
Change between tasks and procedures on the same
patient after contact with potentially infectious material
Remove after use, before touching non-contaminated
items and surfaces, and before going to another patient
 Perform hand hygiene immediately after removal.

16. FACIAL PROTECTION (EYES, NOSE, AND MOUTH)
• Wear
(1) a surgical or procedure mask and
eye protection (goggles) or
(2) a face shield to protect mucous membranes of
the eyes, nose, and mouth during activities that are
likely to generate splashes or sprays of blood,
body fluids, secretions, and excretions.

17. GOWN
 Wear to protect skin and prevent soiling of clothing
during activities that are likely to generate splashes
or sprays of blood, body fluids, secretions, or excretions.
 Remove soiled gown as soon as possible, and
perform hand hygiene.

18. PERSONAL PROTECTIVE EQUIPMENT (PPE)
• ASSESS THE RISK of exposure to body substances or contaminated surfaces
BEFORE any health-care activity. Make this a routine!
• Select PPE based on the assessment of risk:
1. Clean non-sterile gloves
2. Clean, non-sterile fluid-resistant gown
3. Mask and eye protection or a face shield

19. PREVENTION OF NEEDLE STICK AND INJURIES
FROM OTHER SHARP INSTRUMENTS
• Use care when:
 Handling needles, scalpels, and other sharp instruments or devices
 Cleaning used instruments
 Disposing of used needles and other sharp instruments

20. RESPIRATORY HYGIENE AND COUGH ETIQUETTE
Persons with respiratory symptoms should apply source control measures:
Cover their nose and mouth when coughing/sneezing with tissue or mask, dispose of
used tissues and masks, and perform hand hygiene after contact with respiratory
secretions.
Health-care facilities should:
Place acute febrile respiratory symptomatic patients at least 1 metre (3 feet) away
from others in common waiting areas, if possible.
Post visual alerts at the entrance to health-care facilities instructing persons with
respiratory symptoms to practise respiratory hygiene/cough etiquette.
Consider making hand hygiene resources, tissues and masks available in common
areas and areas used for the evaluation of patients with respiratory illnesses.

21. ENVIRONMENTAL CLEANING
• Use adequate procedures for the routine cleaning and disinfection of
environmental and other frequently touched surfaces.

22. LINENS
Handle, transport, and process used linen in a manner which:
 Prevents skin and mucous membrane exposures and contamination of clothing.
 Avoids transfer of pathogens to other patients and or the environment.

23. WASTE DISPOSAL
Ensure safe waste management.
Treat waste contaminated with blood, body fluids, secretions and excretions as
clinical waste, in accordance with local regulations.
Human tissues and laboratory waste that is directly associated with specimen
processing should also be treated as clinical waste.
Discard single use items properly.

24. PATIENT CARE EQUIPMENT
 Handle equipment soiled with blood, body fluids, secretions, and excretions in a
manner that prevents skin and mucous membrane exposures, contamination of
clothing, and transfer of pathogens to other patients or the environment
 Clean, disinfect, and reprocess reusable equipment appropriately before use with
another patient

25. IMPORTANT ADVICE
 Promotion of a safety climate is a cornerstone of prevention of transmission of
pathogens in health care.
 Standard precautions should be the minimum level of precautions used when
providing care for all patients.
Risk assessment is critical. Assess all health-care activities to determine the
personal protection that is indicated.
Implement source control measures for all persons with respiratory symptoms
through promotion of respiratory hygiene and cough etiquette.

26. TRANSMISSION-BASED PRECAUTIONS
Transmission-Based Precautions (i.e., Airborne Precautions, Droplet
Precautions, and Contact Precautions), are recommended to provide additional
precautions beyond Standard Precautions to interrupt transmission of pathogens in
hospitals
Transmission-based precautions can be used for patients with known or suspected
to be infected or colonized with epidemiologically important pathogens that can be
transmitted by airborne or droplet transmission or by contact with dry skin or
contaminated surfaces. These precautions should be used in addition to standard
precautions
• Airborne Precautions used for infections spread in small particles in the air such
as chicken pox.

27. Continue…
• Droplet Precautions used for infections spread in large droplets by
coughing, talking, or sneezing such as influenza.
• Contact Precautions used for infections spread by skin to skin contact or
contact with other surfaces such as herpes simplex virus.
Airborne Precautions, Droplet Precautions, and Contact Precautions. May be
combined for diseases that have multiple routes of transmission
 When used either singularly or in combination, they are to be used in addition to
Standard Precautions.

28. Refrences
1. www.OSHA.gov
2. https://www.cdc.gov/mmwr/preview/mmwrhtml/00000039.htm
3. http://www.who.int/csr/resources/publications/EPR_AM2_E7.pdf

29. Thank You !