Universal precautions should be used whenever an invasive procedure
exposes the operator to potentially infectious body fluids. Not
all patients infected with transmissible pathogens can be reliably
identified. Because pathogens transmitted by blood and body fluids
pose a hazard to personnel caring for such patients, particularly
during invasive procedures, precautions
are required for routine care of all patients whether or not
they have been placed on isolation precautions of any type. The
CDC calls these universal precautions.
- 1. Wash hands
before and after all patient contact.
- 2. Wash hands before and after all invasive procedures.
- 3. Wear gloves in every instance
in which contact with blood or body fluid is certain or likely.
For example, wear gloves for all venipunctures, for all IV starts,
for IV manipulation, and for wound care.
- 4. Wear gloves once and discard. Do
not wear the same pair to perform tasks on two different patients
or to perform two different tasks at different sites on the same
- 5. Wear gloves
in every instance in which contact
with any body fluid is likely, including
urine, feces, wound secretions, and fluid encountered in respiratory tract
care, thoracentesis, paracentesis.
- 6. Wear
gown when splatter of blood or body fluids on clothing seems likely.
- 7. Use additional barrier precautions
for invasive procedures in which considerable splatter or aerosol
generation is likely. Such splatter does not occur during most routine
patient care activities but can occur in the OR, ER, and ICU, during
invasive bedside procedures, and during CPR. Always wear a mask
when goggles are called for, and always wear goggles when a mask
is called for.
The FDA has recommended safer needle devices, including devices
that place a barrier between hands and needle after use. Needlestick
injury is an occupational injury among health care workers in the
United States. OSHA estimates that 600,000–800,000 needlestick
injuries occur on the job each year. Health care workers are at
risk of transmission of more than 20 blood-borne pathogens (eg,
HIV, hepatitis B and C viruses). Although it is not possible to
completely eliminate the risk of needlestick injury, it has been
estimated that 62–88% of sharps injuries can be
reduced through the use of devices and procedures designed to protect
health care workers from exposed needles. A variety of self-shielding
needle devices are on the market (see Heelstick and Fingerstick [Capillary
Blood Sampling], IV Techniques, and Venipuncture for examples).
Before any procedure, counsel the patient about the reasons for
the procedure, alternatives, and the risks and benefits. Explaining
the various steps is likely to help gain the patient’s
cooperation and make the procedure easier on both parties. In general,
procedures such as bladder catheterization, NG intubation, and venipuncture
do not require written informed consent beyond normal hospital sign-in
protocols. More invasive procedures, such as thoracentesis or lumbar