Universal precautions were introduced in the 1980s during the AIDS epidemic to prevent transmission of diseases in healthcare settings. They involve treating all human blood and bodily fluids as if known to be infectious. Key elements include hand hygiene, use of personal protective equipment like gloves and masks, safe handling of sharps, and disinfection. Universal precautions are important for surgical practice due to risk of bloodborne pathogens like HIV, hepatitis B, and hepatitis C. Proper use of protective barriers and treatment after exposure can help prevent disease transmission to both patients and healthcare workers.

1. UNIVERSAL PRECAUTIONS
DR SAPAN KUMAR
3RD YEAR PG
GENERAL SURGERY
MKCG MCH

2. CONTENTS
• Introduction
• History
• Why universal precautions
• Key elements of universal precaution
• Universal precautions in covid 19
• Universal precautions in surgical practice
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3. Introduction
• It refers to the practice in medicine, of avoiding contact with
patient’s bodily fluids, by means of wearing nonporous articles such
as medical gloves, goggles, face shield
• Blood and certain bodily fluids are assumed to be possibly infected
and precautions are taken universally in all exposure situation
• These precautions are written in accordance with guidelines
established by CDC (centre for disease control and prevention)
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4. History
• Universal precautions were first introduced in US by CDC in the wake
of the AIDS epidemic between 1985 and 1988. universal precautions do
not apply to sputum, feces, sweat, vomitus, tear, urine, nasal secretions
unless contaminated with visible blood, because there transmission of
HIV/HepB is extremely low
• In 1987 , the practice of universal precautions were adjusted by a set of
rules known as body substance isolation. These guideline advocate
avoiding direct physical contact with all moist and potentially infectious
body substances
• In 1996, practices were replaced by latest approach known as Standard
precaution. These guidelines also introduced 3 transmission based
precautions- airborne, droplet, contact 4

5. Why universal precaution
• Universal precautions were designed for health care professionals ,
who come into contact with patient and their bodily fluids.
• Bodily fluids- blood, semen, vaginal secretions, synovial fluids,
amniotic fluids, pleural fluids, peritoneal fluids
• Body fluids ( unless contamination with blood) which do not require
precautions are- nasal secretions, vomitus, sputum, saliva, feces,
urine, sweats
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6. Standard precautions
• The CDC recommends standard precautions for the care of all
patients, regardless of their diagnosis or presumed infection status
• It is designed for care of all patients and aim to reduce risk of
transmission of infection
• Standard precautions apply to –
blood
all body fluids, secretions, excretions except sweat
non intact skin
mucous membrane
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7. Key elements of standard precautions
• Hand hygiene
• Respiratory hygiene
• Prevention of needle stick injury and sharp instruments
• Waste disposal
• PPE
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8. HAND WASHING
• Most effective method of preventing disease transmission
• Alcohol based hand wash
• Under clear running water

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10. Steps of Hand Washing
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11. Steps of surgical hand wash
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12. Hand washing procedure
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13. Respiratory Hygiene and cough etiquette
• Preventive measures are designed to limit the transmission of
respiratory pathogens spread via droplets or airborne routes
• Covering mouth and nose when coughing and sneezing
• Hand hygiene after contact with respiratory secretions
• Eg, oral cavity examination, ryle’s tube insertion
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14. Sharp instruments precautions
• All used needle and sharps to be discarded into the thick walled
puncture proff container
• All the disposable needle and sharp should be discarded into
hypochloride solution at work station before final disposal
• Shredding continues to be important method of dealing with used
needle
• Never reuse a sharp
• Never carry sharps by hand, always use a appropriate container
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15. Dealing with needle stick injuries
• All events of needle stick injuries to be reported to the supervisory
staff
• Wash the injured area with soap and running water
• Encourage bleeding if any
• Prophylaxis for prevention of HIV/HepB is top priority
• Prophylaxis should be started early if injury from the high risk group
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16. Sterilisation & Disinfection
• Sterilization- process that kills all forms of microbial life, including
endospores
• Disinfection- destroys pathogenic organisms, but not necessarily all
microorganisms, endospores
• Decontamination- removal of pathogenic microorganisms so items
are safe to handle
• Endoscope- 2% glutaraldehyde solution
• Surgical instruments- autoclave
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17. BIOMEDICAL WASTE MANAGEMENT
• Biomedical waste is defined as waste generated during diagnosis,
treatment or immunization of human beings or animals, or in research
activities
• Biomedical waste management is refer to proper collection, segregation
and disposal of waste
• Biomedical waste management rules, 2016
• Ministry of environment and forest, govt of india
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19. Personal protective equipments
• Last line of defence against infection
• It includes
• Gown
• Gloves
• Mask
• Face shield
• Foot wear
• Assess the risk of exposure to body substances before any health care
activity. Select PPE based on the assessment of risk
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20. • Mask and face shields- protect against splashes or droplets through
mucous membranes of eye, mouth,nose
• Gowns- disposable paper gowns
• Gloves- made of latex, vinyl
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21. PPE Donning
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22. PPE Doffing
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23. Examination Gloves
• Exam gloves of latex, vinyl or other non-allergic materials must
be worn
• Gloves must be removed and discarded after each use
• Peel them down without touching outside. Then wash hand
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24. Wearing of surgical gloves
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25. Covid 19
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26. Precautions in COVID 19
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27. Universal precautions in surgical practice
• Operation theatre and examination site should be organised to
minimise the risk of exposure
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28. Bloodborne pathogens
• Hepatitis B- extremely contagious, effective vaccine
• Hepatitis c- no vaccine
• HIV- no vaccine, no cure
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29. Hepatitis
• Both hepatitis B and C carry risk in surgery as they are blood-borne
pathogens that can be transmitted both from surgeon to patient and
vice versa
• Usual mode of transmission is blood to blood contact through
needle stick injury or a cut
• Most of the time hepatitis B is asymptomatic, and surgeon may
carry virus without being aware of it
• There is a effective vaccine against Hepatitis B. surgeon should
know immune status against hepB and should get vaccinated
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30. Hepatitis
• Hepatitis C infection often become chronic with risk of significant
liver damage
• It is potentially curable with interferon alfa and ribavirin
• Surgeons exposed to infection should seek medical advice and
antibody measurement
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31. HIV
• Transmitted by body fluids, particularly blood
• Increased prevalence through sexual transmission, iv drug abuse, infected
blood products
• Risk of transmission is more through needlestick injury during operations
• After exposure virus binds to the CD4 receptors with subsequent loss of CD4
cells, T helper cells
• In early weeks after HIV infection, there may be flu like symptoms, during
the phase of seroconversion, great risk of HIV transmission
• During the early phase, HAART (highly active antiretroviral therapy) , inhibit
reverse transcriptase and protease synthesis. Thus suppress the virus but do
not clear it completely. Treated patients can still transmit virus to other
• Within 2 years, untreated HIV can progress to AIDS in 25-35% of patients 31

32. Bodily fluids require universal precautions
• Blood
• Wound secretions
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33. Surgeons with HIV or Hepatitis patients
• Patients (with HIV or Hepatitis) may present to surgeons for operative
treatment if they have surgical disease.
• Universal precautions have been drawn up by CDC and adopted by
NHS (National Health Service)
• In summary
Use of full face mask, protective spectacles
Use of fully waterproof, disposable gowns and drapes,
particularly during seroconversion
Boots to be worn, not clogs, to avoid injury from dropped
sharps
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34. Double gloving (large size on inside is comfortable)
Allow only essential personnel in OT
Avoid unnecessary movement in OT
Respect is required with sharps, with passage in a kidney
dish
Slow meticulous operative technique is needed with
minimized bleeding
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35. After Contamination
• Needle stick injuries are commonest after surgical procedure
• Hollow needle injury carries greater risk of viral transmission
• The injury part should be washed under running water, incident
should be reported
• Local policies dictate wheather post exposure antiretroviral treatment
should be given
• Occupational health advice is required after high risk exposure
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36. Post exposure prophylaxis Hepatitis B
• Hepatitis B immunoglobulin (HBIG)- as soon as possible ,
ideally within 6 hours , not later than 48 hours
• Recommended dose is 0.05 to 0.07 mg/kg, two doses at 30 days
apart
• At the time victims blood should be drawn for HbsAg testing
If positive- full vaccination needed as per schedule
If negative- no action need
• Simultaneous administration of HBIG and HepB vaccine is
more efficacious than HBIG alone
• If possible HepB vaccine 1ml to be taken within 7 days of
exposure, next 1month and 6month
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37. Post exposure prophylaxis HIV
• Risk of transmission by hollow needle is 0.3%
• Risk from broken skin, mucous membrane is 0.1%
• Post exposure prophylaxis reduces the risk of seroconversion by
80%, if started within one hour of exposure
• Should be started within 2 hours not later than 72 hours
• PEP is continued for 4 weeks
• As per NACO, recommended regimen is
Tenofovir (300mg) + Lamivudine (300mg) + Efavirenz (600mg)
once daily for 28 days
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38. Ethical Issue
• HIV and Hepatitis patients have same right to equal health care and
treatment as normal patients
• Much stigma has been attached , because of taboo behaviours and fear
of infection
• Consequences have included discrimination and reluctant to test and
to disclose the status
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39. Confidentiality of patient
• Confidentiality is right of every individual under medical care
• Permission should be sought from patient, before information is
passed to any other person who does not need to know, including
relative and health workers
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40. Transmission based precautions
• Transmission based precautions are recommended to provide
additional precautions beyond standard precautions to interrupt
transmission
• Airborne precautions- spread of small particles in air. Eg chicken pox
• Droplet precautions- spread of large droplets by coughing, talking,
sneezing. Eg, influenza
• Contact precautions- spread by skin to skin contact. Eg, herpes
simplex
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