86. Universal precautions

Question 1

A 25-year-old, HIV-positive, intravenous drug user presents for
incision and drainage of an abscess. The theatre sister is concerned about
transmission of the virus.
What do you understand by the term universal precautions?

Answer 1

Universal precautions as defined by the Center of Disease Control (CDC) in
Atlanta are:

‘A set of precautions designed to prevent the transmission of
pathogens via blood and other body fluids that may be considered potentially
infectious to healthcare workers.’

Question 2

What do you understand by the term standard precautions?

Answer 2

The term universal precautions is now being replaced with the term standard
precautions.

Standard precautions include precautions to prevent the
transmission of infections by other transmission routes,

i.e. airborne precautions, droplet precautions and contact precautions

Question 3

What are the advantages of this change in approach?

Answer 3

Standard infection control precautions, as well as protecting healthcare
workers, could prevent the transmission of many other pathogens and make a
major contribution to the reduction of healthcare-associated infection (HCAI).

Simplification of the traditional approach to isolation of infectious patients is
accomplished if the same precautions are taken with all body fluids.

There is no need to identify different levels of protection for different
infectious diseases.

The use of standard precautions, however, does not eliminate the need to
isolate some potentially infectious diseases, e.g. tuberculosis or enteric
infections.

Question 4

Can you give examples of body fluids considered to be high risk in terms
of transmitting pathogens?

Answer 4

Blood
Vaginal secretions
Semen
Synovial fluid
Cerebrospinal fluid
Pericardial fluid
Pleural fluid
Breast milk
Amniotic fluid
Any fluid that contains blood or has the potential for containing blood:
saliva during dental procedures is therefore considered high risk.

Question 5

What are the components of standard infection control precautions?

Answer 5

Handwashing
The wearing of protective clothing, including gloves
Safe handling and disposal of sharps
Dealing with blood spills promptly
Decontamination of equipment
Disposal of waste
Disposal of linen
Personal health and hygiene of staff
Patient placement/isolation

Question 6

Why are needlestick injuries important

Answer 6

Needlestick injuries are common and affect some people more than others:
nurses are the largest single group, and have high rates of injury. Over a
lifetime, the risk for an individual is finite and measurable. In some high-risk
specialties the risk is appreciable. In a study of French surgeons with a working
lifetime estimate of 210 skin punctures, the individual cumulative risks of
contamination were calculated to be 6.9% for hepatitis C and 0.15% for HIV.

For hepatitis C that is a 1 in 14 chance (of a needlestick with contaminated
blood), and for HIV it is a 1 in 660 chance. The figure for HIV is similar to
estimates for US surgeons.

The risk is one of transmission of blood-borne viruses, HBV, HCV and HIV
being the most important. The risk is dependent on the prevalence of the
viruses in the population and on the transmission rate – higher with HBV and
HCV than HIV.

The literature rates of seroconversion are 10%–30% for HBV, 1–10% for
HCV and 0.1%–0.3% for HIV. Hollow bore needles with appreciable amounts
of blood (and virus) carry the most risk. Prophylaxis and vaccination may help
in some cases.