Universal/Standard Precautions

What are Universal/Standard Precautions?

Universal precautions is a term used to describe how to control or decrease the risk of spreading infections. The United States Occupational Safety and Health Administration (OSHA) recommends that employers and employees follow Universal Precautions to treat all human blood and certain human body fluids as if they were infectious. It is impossible to know who may be carrying a bloodborne illness, such as HIV. (https://www.osha.gov/SLTC/etools/hospital/hazards/univprec/univ.html) Similarly, the United States Centers for Disease Control (CDC) expanded upon Universal Precautions and recommend using Standard Precautions to further protect against the spread of infection. The CDC describes "Standard Precautions" as minimum infection prevention practices that apply to all patient or student care. These practices are designed to protect you and to prevent you from spreading infections among others.

The recommendations described in this module represent minimum infection prevention measures. Refer to your delegating RN for more detailed guidance and references on the information included in this module.

What do Standard Precautions include?

1. Hand hygiene
2. Use of personal protective equipment (e.g., gloves, gowns, masks)
3. Safe injection practices
4. Respiratory hygiene/cough etiquette. Each of these elements of Standard Precautions are described in the sections that follow.

When should I use Standard Precautions?

Standard Precautions should be used and applied when you may come in contact with:

• Blood
• All body fluids, secretions, and excretions, except sweat, regardless of whether or not they contain visible blood
• Non-intact skin; and
• Mucous membranes, such as the nostrils, lips, mouth, eyelids, ears, genital area, and anus.

Hand Hygiene

Good hand hygiene, including use of alcohol-based hand rubs and handwashing with soap and water, is critical to reduce the risk of spreading infections. Compared with soap and water, use of alcohol-based hand rub can increase compliance with recommended hand hygiene practices by requiring less time, irritating hands less, and facilitating hand hygiene. For these reasons, alcohol-based hand rub is the preferred method for hand hygiene except when hands are visibly soiled (e.g., dirt, blood, body fluids), or after caring for patients with known or suspected infections in which case soap and water should be used.

Recommendations for hand hygiene:

• Situations where hand hygiene should be performed include:
  • Before touching a patient/student, even if gloves will be worn
  • Before exiting the care area after touching the person or the person’s immediate environment
  • After contact with blood, body fluids or excretions, or wound dressings (e.g., obtaining a blood sample for glucose check)
  • Prior to performing a task (e.g., preparing an insulin injection)
  • If hands will be moving from a contaminated-body site to a clean-body site
  • After glove removal
• Use soap and water when hands are visibly soiled (e.g., blood, body fluids), or after caring for patients with known or suspected infections.

Personal Protective Equipment

Personal Protective Equipment (PPE) refers to wearable equipment that is intended to protect you from exposure to or contact with infectious agents. Examples include:

• Gloves
• Gowns
• Face masks
• Respirators
• Goggles
• Face shields

How you determine whether or not to use PPE is based on the nature of the patient interaction and potential for exposure to blood, body fluids or secretions. Examples of appropriate use of PPE for the wearing of gloves include:

• Performing a blood glucose test
• Giving an insulin injection
• Checking the urine for ketones
• Contact with mucous membranes
• Non-intact skin or potentially infectious material

Examples of appropriate use of other types of PPE include:

• Use of a gown to protect skin and clothing during procedures or activities where contact with blood or body fluids is anticipated
• Use of mouth, nose and eye protection during procedures likely to generate splashes or sprays of blood or other body fluids

Hand hygiene is always the final step after removing and disposing of PPE.
Each facility/setting should evaluate the services they provide to determine specific needs and to assure that appropriate PPE is available.

Safe Injection Practices

Injection safety includes practices intended to prevent transmission of infectious diseases between one patient and another, or between a patient and healthcare provider during preparation and administration of injected medications.

Recommendations for safe injection practices:

• Use clean technique, which includes the use good hand hygiene, when preparing and administering medications
• Prepare insulin injection in an area that is clean and free from clutter
• Cleanse the top of the medication vial with an alcohol wipe before inserting a needle or device into the vial
• Never administer medications from the same syringe or insulin pen to multiple patients, even if the needle is changed
• Do not reuse a syringe to enter a medication vial or solution
• Dispose of used syringes and needles immediately after use in a sharps container that is closable, puncture-resistant, and leak-proof.

Respiratory Hygiene/Cough Etiquette

Respiratory Hygiene/Cough Etiquette is an element of Standard Precautions that highlights the need for prompt use of infection prevention measures. This applies to any person with signs of illness including cough, congestion, runny nose, or production of respiratory secretions

Recommendations for respiratory hygiene/cough etiquette:
Use measures to contain respiratory secretions of persons who have signs and symptoms of a respiratory infection. This will prevent the spread of the infection to others.

• Cover their mouths/noses when coughing or sneezing
• Use and dispose of tissues
• Perform hand hygiene after hands have been in contact with respiratory secretions
• Provide tissues and no-touch receptacles for disposal of tissues
• Provide resources for performing hand hygiene in or near waiting areas
• Offer masks to coughing patients and other symptomatic persons upon entry to the facility
• Provide space and encourage persons with symptoms of respiratory infections to sit as far away from others as possible. If available, facilities may wish to place these patients in a separate area while waiting for care