Universal Precautions to Prevent HIV in Hospitals

Guidelines Aim to Prevent Infection in Healthcare Settings

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The Centers for Disease Control and Prevention (CDC) defines universal precautions as a set of safeguards designed to "prevent transmission of HIV, hepatitis B virus (HBV) and other bloodborne pathogens when providing first aid or health care."

Universal precaution regulations are overseen in the U.S. by the Occupational Safety and Health Administration (OSHA), an agency which falls under the Department of Labor.

It was formed after the enactment of the Occupational Safety and Health Act of 1970, which endeavored to ensure that employees are provided a hazard-free environment, including the avoidance of exposure to toxic chemicals, excessive noise, mechanical dangers, heat or cold stress, or unsanitary conditions.

Under the Act, individual states are encouraged to adopt their own occupational safety and health plans, but, generally speaking, within the scope of healthcare, such precautions are considered standard whatever the state or institution.

Universal Precaution Guidelines

Under universal precautions, blood and certain body fluids are considered potentially infectious and, as such, require strict adherence to these standard precautions.

Universal precautions apply to equipment and devices, specifically:

  • Those that enter the patient's vascular system or other normally sterile areas of the body, which should be universally sterilized before being used for each patient.

  • Those that touch intact mucous membranes but do not penetrate the patient's body surfaces,which again should be sterilized when possible or undergo high-level disinfection if they cannot be sterilized before being used for each patient.

  • Those that do not touch the patient or that only touch intact skin of the patients, which need only be cleaned with a detergent or as indicated by the manufacture.

    Universal precautions are designed avoidance with such bodily fluids as:

    • blood
    • bodily fluids containing visible blood
    • semen
    • vaginal fluid
    • cerebrospinal
    • synovial, pleural, peritoneal, pericardial and amniotic fluids

    Universal precautions apply to all healthcare workers (HCWs) who are advised that:

    • The appropriate use of hand washing, protective barriers, and care in the use and disposal of needles and other sharp instruments should always be maintained
    • HCWs who have lesions, sores or weeping dermatitis should refrain from direct patient care and from handling  equipment and devices used in performing invasive procedures until the condition resolves.
    • HCWs who perform procedures with exposure risk should know their HIV status.
    • HCWs who perform procedures with exposure risk and do not know if they have HBV immunity (by way of vaccination or previous exposure) should know their HBV status.
    • HCWs who are infected with HIV or HBV (and test positve for HBV) should not perform exposure-prone procedures unless they have sought counsel from an expert review panel and been advised that they may continue.

    HIV/HBV Testing Guidelines for Health Care Workers

    Currently available data provides no rationale by which to restrict HCWs infected with HIV or HBV from performing invasive procedures not identified as exposure-prone, provided they comply with universal precautions.

    Mandatory testing of  HIV or HBV is not recommended. Epidemiological evidence has not shown that such testing is associated with reduced HIV/HBV risk from HCW to patients when proper education, training and management systems are in place.

    Since the introduction of HBV testing in the early 1970s, there have been no more than 300 patients infected with HBV from an HBV-infected HCW. Similarly,  from 1972 to 2003, only three cases of  HIV transmission and eight cases of hepatitis C (HCV) transmission were confirmed from an infected HCW to a patient.


    Centers for Disease Control and Prevention (CDC). "Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings 2007." Atlanta, Georgia; accessed online October 9, 2015.

    Occupational Safety and Health Administration. "All About OSHA." Washington, D.C.; U.S. Department of Labor; 2006; publication OSHA 3302-06N. 

    Puro, V.;  Scognamiglio, P.; and Ippolito, G. "HIV, HBV, or HCV transmission from infected health care workers to patients." Med Lav.  November-December  2003; 94(6):556-68.

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