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Universal Precautions

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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.

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  • 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 patient.
  • 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.

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Accidental Needlesticks

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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).

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Informed Consent

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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 puncture, ...

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