Universal Precautions against Infectious Diseases

Universal precautions are simple infection control measures that reduce the risk of transmission of blood borne pathogens through exposure to blood or body fluids among patients and health care workers. Under the “universal precaution” principle, blood and body fluids from all persons should be considered as infected with HIV, regardless of the known or supposed status of the person. Improving the safety of injections is an important component of universal precautions.

Infectious diseases are caused by viruses, bacteria, parasites, and fungi. These organisms can be spread from person to person through:

• Blood and other body secretions
• Droplets breathed, sneezed, or cough out from the nose or mouth
• Skin-to-skin contact
• Sexual contact

Why it is Important

Any percutaneous or permucosal exposure to blood or body fluids represent a potential source of HIV infection. These include skin-piercing procedures with contaminated objects and exposures of broken skin, open wounds, cuts and mucosal membranes (mouth or eyes) to the blood or body fluid of an infected person.

Although they account for a minority of HIV infections, health care procedures represent a highly preventable source of HIV infection. Among health care associated sources of infection, unsafe injections are of particular concern, accounting for an estimated 3.9% to 7.0% of new infections worldwide. In addition, unsafe practices in hemodialysis and plasmapheresis centers have been associated with HIV transmission.

Health care worker protection is an essential component of any strategy to prevent discrimination against HIV infected patients by health care workers.

If health care workers feel they can protect themselves from HIV infection, they can provide better care.

Universal precautions help protect patients and their family, friends, and health care providers from infection

Barrier protection

Should be used at all times to prevent skin and mucous membrane contamination with blood, body fluids containing visible blood, or other body fluids:

• Cerebrospinal
• Synovial
• Pleural
• Peritoneal
• Pericardial
• Amniotic fluids
• Semen and vaginal secretions

Barrier protection should be used with all tissues.

The type of barrier protection used should be appropriate for the type of procedures being performed and the type of exposure anticipated. Examples of barrier protection include disposable lab coats, gloves, and eye and face protection.

What precautions should I take if I am caring for an infectious person?

GLOVES

• Wear a latex gloves when:
• You touch the infected person’s mucus membranes (nose, mouth, genital area or rectum) affected skin or body fluids such as blood, stool, and urine, drainage from a wound, saliva, or vomit
• You handle items or body surfaces soiled with blood or body fluids
• You perform procedures involving treatment of open sores (such as changing a bandage) or giving medicine with needle
• You clean up around the area where you are caring for the patient
• If a glove gets torn or damaged, you take your gloves off and wash your hands. If you are not don’t caring for the person, put on new gloves
• Put new gloves on each time you perform a procedure
• Don’t wash gloves. Discard them after each use in a special container separate from other trash

Gloves are not a substitute for hand washing. Wash your hands after wearing gloves in case the gloves have been damaged.

HAND WASHING

• Wash your hands immediately after you take your gloves off
• If you get blood or body fluid on you hands or any other body surface
• Wash you hands and the exposed part of your body immediately and thoroughly
• Wash your hands immediately before and after each contact with infected person

PROTECTIVE CLOTHING
(such as masks, goggles, gowns)

• Wear a surgical mask and eyewear during any task that may expose you to blood or other body fluids. This can prevent exposure of your mouth, nose, and eye to the infection.
• Wear disposable gown or aprons when blood or body fluids may splash. If you wear cloth gown or apron, wash it according to the instruction given below for washing lines soiled with blood.

SAFETY PRECAUTIONS WITH NEEDLES

• If possible, always use disposable needles.
• Do not recap or purposely bend needles.
• Discard needles in the way recommended by your health care provider. Put used needles in a puncture-proof container. Avoid overfilling the container.
• If you accidentally stick yourself with a needle, contact your health care provider right away.

DISPOSAL OF WASTE PRODUCTS AND WASHING OF SOILED LINENS

• Discard disposable items soiled with blood in plastic bags. Use two bags. Make sure you follow your local health department's instructions.
• Check with your health care provider and local health department before you pour any liquids such as blood, suctioned fluids, excretions, and secretions carefully down a drain connected to a sanitary sewer.
• Linens or clothing soiled with blood must be washed separately from other laundry. Use detergent and germicide.

Follow your local health department's instructions for safe washing and disposal of the water.

GUIDELINES FOR STERILIZATION OR DISINFECTION

• Use chemical germicides registered with the Environmental Protection Agency for sterilization or disinfection.
• Ask your health care provider or local health department what chemicals are safe for home use.
• Use these chemicals only in the recommended concentrations and only with proper ventilation.

Universal Precautions applies to these fluids:

• Blood
• Tissues
• Body fluids that contain visible blood
• Semen
• Vaginal secretions
• Cerebrospinal (brain and spinal cord)
• Synovial (joint)
• Pleural (lung)
• Peritoneal (abdominal)
• Pericardial (heart)
• Amniotic
• Breast milk
• Can apply to other such as feces, saliva, etc.

A simple set of effective practices designed to protect health workers and patients from infection with a range of pathogens including blood borne viruses. These practices are used when caring for all patients regardless of diagnosis.

Blood Born Pathogens

In addition to HIV, blood borne pathogens include:

• Hepatitis B and C virus
• Syphilis
• Brucellosis

Applied in caring for all patients

• Hand washing
• Decontaminate equipment and devices
• Use and dispose of needles and sharps safely (avoid recapping, especially two-handed)
• Wear protective items
• Promptly clean up blood and body fluid spills
• Use safe disposal systems for waste collectionand disposal

Promoting a Safe Work Environment

• Implement, monitor and evaluate use of universal precautions.
• Develop procedures for reporting and treating occupational exposure to HIV infection.
• Attain and maintain appropriate staffing levels.
• Provide protective equipment and materials.

Education in Infection Prevention

• Make all staff aware of established infection control policies.
• Provide ongoing training to build skills in safe handling of equipment and materials.
• Supervise and evaluate practices to remedy deficiencies.