In response to the HIV epidemic, Universal Precautions were instituted in the mid-1980s. It stipulated that patients with bloodborne pathogens can be asymptomatic and unaware that they are contagious; therefore, all blood and body fluids contaminated with blood were to be treated as infectious. The Occupational Safety and Health Administration (OSHA) based its 1991 final rule on Occupational Exposure to Bloodborne Pathogens in Healthcare Settings on the concept of Universal Precautions.2
In 1996, the Centers for Disease Control and Prevention (CDC) expanded Universal Precautions into the concept of Standard Precautions.4 Standard Precautions apply not only to contact with blood and body fluids contaminated with blood, but to contact with all other potentially infectious material (OPIM), i.e., contact with all body fluids, secretions and excretions, nonintact skin, and mucous membranes regardless of suspected or confirmed presence of an infectious agent.
Today, there are two tiers of precautions: Standard and Transmission-based Precautions.1,3 Standard Precautions constitute the primary strategy for the prevention of HAIs and apply to the care of all patients in all healthcare settings, regardless of the suspected or confirmed presence of pathogenic organisms (Table 1).1,3 When Standard Precautions do not completely interrupt the transmission of a pathogen, Transmission-based Precautions are implemented.1,3
|Hierarchy of Strategies||Objectives|
|Education||Establish the rationale for policies and practices intended to prevent HAIs.|
|Immunization||Reduce the risk of vaccine preventable HAIs.|
|Engineering and work-practice controls||Eliminate or isolate hazards and promote safer behavior in the workplace.|
|Post-exposure evaluation and follow-ups||Understand policies and practices intended to reduce the risk of post-exposure infection.|
|Administrative controls||Promote an understanding of policies related to medical conditions and work restrictions.|
Periodically, outbreak investigations indicate the need to reinforce existing standards or to implement new precautions.1 Since these recommendations are considered standards of care; they are added to Standard Precautions. Since 1996, three such recommendations have been promulgated, two of which (respiratory hygiene/cough etiquettes and safe injection practices) apply to oral healthcare settings. The third element emphasizes the use of facemasks when performing lumbar puncture procedures.
The new element related to lumbar puncture procedures was prompted by eight cases of myelography-related streptococcal meningitis.1 Data from seven cases confirmed that antiseptic skin preparations and sterile gloves were used, but none of the clinicians wore a surgical mask. The evidence warrants the standard use of surgical masks by clinicians performing lumbar procedures.1 This is relevant in that it illustrates the importance of surgical masks in interrupting respiratory transmission of pathogens.