Universal Precautions

Definition

Universal precautions are safety procedures established by the Centers for Disease Control and Prevention (CDC) and the American Dental Association (ADA).

Purpose

These precautions are used in medical and dental offices to prevent the transmission of infectious diseases to patients and health care workers.

Description

Universal precautions are standards of infection control practices designed to reduce the risk of transmission of bloodborne infections.

Personal protective equipment

Protective equipment includes gloves, gowns, masks, and eyewear worn by health care workers to reduce the risk of exposure to potentially infectious materials.

Examination gloves are used for procedures involving contact with mucous membranes. They reduce the incidence of contamination to the hands, but they cannot prevent penetrating injuries from needles or other sharp instruments. Gloves are changed after each patient and discarded, and must never be washed or disinfected for reuse. Washing with surfactants may cause wicking (the enhanced penetration of liquids through undetected holes in the glove). Disinfecting agents may cause deterioration of the gloves. Petroleum jelly may also break down latex. Utility gloves may be used when handling contaminated instruments and cleaning of the treatment area or sterilization room.

Fluid-resistant gowns, laboratory coats, or uniforms should be worn when clothing is likely to be soiled with blood or other bodily fluids. Reusable protective clothing should be washed separately from other clothes, using a normal laundry cycle. Protective clothing should be changed daily or as soon as visibly soiled. They should be removed before personnel leave areas of the dental office used for laboratory or patient-care activities.

Masks and protective eyewear, or chin-length, plastic face shields should be worn when splashing or spattering of blood or other body fluids is likely. A mask should be changed between patients or during patient treatment if it becomes wet or moist. A face shield or protective eyewear should be washed with appropriate cleaning agents when visibly soiled.

Careful handling and disposal of sharps

Sharp disposable items, such as needles, saliva ejectors, rubber prophy cups and scalpels that cannot be sterilized and are contaminated with blood or other body fluids need to be discarded in puncture resistant containers. Special delivery companies pick up the containers once they are full and replace them with empty containers.

Careful handling and cleaning of contaminated equipment

Dental instruments must be cleaned and sterilized after each use. Recommended sterilization methods include autoclaving or using a dry heat oven or "chemiclave," a unit that cleans with the use of chemicals. Sterilization equipment is commonly found in a special area of the building away from the treatment areas.

Cleaning and disinfecting of all surfaces such as lights, drawer handles, and countertops is accomplished by a chemical solution formulated to kill infectious bacteria, spores, and viruses after each patient is seen. Medical facilities follow specific heat sterilization procedures, which are outlined by the CDC. Plastic barriers cover items that are not easily disinfected by chemical spray, such as light handles, chair control buttons, and instrument trays. Many offices and hospitals have seamless floors with linoleum or a laminate surface so that spills can be contained and cleaned quickly.

Non-critical items that cannot be heat sterilized are sterilized by chemical immersion formulated to kill infectious bacteria and viruses.

Universal precautions are intended to supplement rather than replace recommendations for routine infection control, such as hand washing.

Preparation

Proper planning and management of supplies needed for universal precautions are essential in reducing the occupational risk of infectious diseases. Such measures should include, but are not limited to:

• risk assessment
• setting of standards and protocols
• risk reduction
• post-exposure measures
• first aid

Complications

Complications include the possible increase of medical and dental fees to the patient to offset costs associated with the equipment, disinfectants, and sterilization procedures needed for universal precautions.

Results

Universal precautions are designed to result in the reduction of the transmission of infectious diseases to patients and health care workers.

Health care team roles

Universal precautions require all medical and dental staff personnel involved in patient care to use appropriate personal protective equipment. Guidelines for health care settings for discarding of waste material are under a separate code by individual state agencies and governmental departments.

The environment in which health care is provided is greatly affected by universal precautions, both for the patient and care providers. Measures that promote a safe work environment include:

• education of employees about occupational risks and methods of prevention of HIV and other infectious diseases
• provision of protective equipment
• provision of appropriate disinfectants to clean up spills of blood or other body fluids
• easy accessibility of puncture-resistant sharps containers
• maintaining appropriate staffing levels
• measures that reduce and prevent stress, isolation, and burnout
• controlling shift lengths
• providing post-exposure counseling, treatment, and follow-up

The U.S. Department of Labor Occupational Safety and Health Administration (OSHA) requires employers in the medical and dental fields to make hepatitis B virus (HBV) vaccines available without cost to employees who may be exposed to blood or other infectious materials. In addition, the CDC recommends that all workers be vaccinated against HBV, as well as influenza, measles, mumps, rubella, and tetanus, both for the protection of personnel and patients.

KEY TERMS

Autoclave— A sterilization unit that uses steam under pressure.

Chemiclave— A sterilization unit that uses chemicals under pressure.

Dry heat oven— A sterilization unit that uses dry heat.

Sharps— Needles and cutting instruments such as curets and scalpel blades.

Resources

PERIODICALS

OSHA News Release. Prevention is the Best Medicine. May 9, 2001. 〈http://www.osha.gov/media/oshnews/may01/national-20010509.html〉.

ORGANIZATIONS

American Dental Association 211 East Chicago Ave., Chicago, IL 60611. (312) 440-2500. 〈http://www.ada.org〉.

Centers for Disease Control and Prevention 1600 Clifton Rd., Atlanta, GA 30333 (404) 639-3311. 〈http://www.cdc.gov〉.

U.S. Department of Labor Occupational Safety and Health Administration (OSHA) 200 Constitution Avenue, N.W., Washington, DC 20210. 〈http://www.osha.gov〉.

World Health Organization (WHO) 20, via Appia, Geneva 27, Switzerland (44) 22 791 4701. 〈http://www.who.int/〉.

OTHER

Laundry. CDC. 〈http://www.cdc.gov/ncidod/hip/Sterile/laundry.htm〉.

Waste Disposal. CDC. 〈http://www.cdc.gov/ncidod/hip/BLOOD/Waste.htm〉.

Universal Precautions. ADA frequently asked questions; 〈http://ada.org/public/faq/infection.html#precautions〉.