The Purpose of Universal Precautions

The term universal precautions refers to certain steps that medical professionals and others take for infection-control. In other words, universal precautions are the techniques that people use to reduce the risk of transmitting HIV and other infectious diseases. The scientific basis of universal precautions is that individuals should treat any blood or bodily fluid as though it contains HIV, hepatitis, or another infectious agent.

In other words, universal precautions assume that all bodily fluids are dangerous. Medical professionals are then expected to treat these fluids accordingly. This not only protects caregivers. It also has a social benefit. By applying the same procedures to everyone, i.e. universally, using universal precautions reduces stigma. How? Before universal precautions, a doctor wearing gloves and a mask was a signal that their patient had something "dangerous." Now, doctors wear gloves and other appropriate protective gear with everyone. When healthcare providers are wearing gloves, it just means they're following the rules. The protective devices aren't a signal that a patient has a stigmatized condition such as HIV. In fact, in most cases, protections for people with infectious diseases are the same as for people without them. That's the entire purpose of universal precautions.

OSHA mandated the use of universal precautions as a form of infection control in the early 1990s. The change occurred after it became clear that HIV spread through exposure to blood and certain other bodily fluids. Several decades later, it's amazing to imagine that there was a time when doctors didn't regularly glove up. These days, the thought of a medical provider not wearing gloves is enough to make many people squirm. Universal precautions very quickly went from a big change to a fact of life.

One of the most interesting aspects of the mandate to use universal precautions is how long it took to go into place. The 1987 CDC document on which OSHA standards are based explicitly acknowledges the fact that medical history and examination are not reliable methods of identifying blood-borne illnesses. In other words, doctors had known for years there was no good way to tell which patients might have infectious blood. But it took a while to turn that knowledge into a change in practice.

The fact is, it takes time for blood-borne illnesses to be detected. This is still true. Just look at the case of HIV. It takes special tests to detect the virus during the early weeks of HIV infection. That is also a problem for several other illnesses. When tests aren't accurate right away, you never know if there is a risk of exposure. So you treat everyone as though they may be a risk.

There are two reasons that healthcare professionals use universal precautions. The first reason is to protect patients. Washing hands, changing gloves, wearing masks, all reduce the risk of passing a disease from patient to patient... or doctor to patient. The second reason is to protect themselves. Protective gear reduces the exposure of professionals to blood-borne illnesses and other infectious diseases. Universal precautions make the healthcare workplace much safer. 

The specific implementation of universal precautions varies from situation to situation. For example, nurses might just wear gloves during standard outpatient care. In other situations, gowns, masks, and eye shields may be indicated. In general, the higher risk of spraying fluids, the more precautions are needed. That's why dentists wear so much gear! Their work is messy and blood and other body fluids may spray around.

There are many young people who have never seen a doctor who didn't examine them using gloves. They just accept that taking precautions around bodily fluid is normal. These young people might find it hard to believe that there was a time when those protections were not standard. They may even find it a little bit gross. At more than twenty-five years after universal precautions became the standard, it's hard to remember a time when gloves weren't a requirement for doctors. That's true even for those of us who experienced it in our youth.