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, these are the techniques that people take 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. They then tell medical professionals to treat them 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. There's no signal, in most circumstances, that a patient has a stigmatized condition such as HIV.

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. It very quickly went from a big change to a fact of life.

One of the most interesting aspects of the mandate 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 change.

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. It is also a problem for several other illnesses.

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!

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 big gross. At approximately 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.