Universal Precautions vs. Standard Precautions

Most healthcare lawsuits involve a deviation from an established standard of care. To some extent, all medical centers and care facilities have policies in place to prevent the spread of infection. But are their guidelines up to date in light of recent public health issues?  Is a provider’s infection control program making all reasonable efforts to guard against pandemics or contagious diseases that are either rare or unheard of? Are processes streamlined to ensure safety when a health professional is cut with “sharps” or splashed with body fluid?

In examining a case, legal teams search for evidence that a facility has – or has not – followed the most current health guidelines to protect staff, patients, and the community at large from infectious disease. Two similar terms pop up in legal research: Universal Precautions and Standard Precautions.

To understand both these terms, attorneys and paralegals must first consider the two main types of pathogen transmission: bloodborne and airborne.

Universal Precautions

In 1983, Centers for Disease Control (CDC) published the Guideline for Isolation Precautions in Hospitals. One section, “Blood and Body Fluid Precautions,” encouraged in-hospital healthcare workers to adhere to these precautions when a patient was known or suspected to be infected with a bloodborne pathogen like HIV or Hepatitis B.

The CDC followed up with Recommendations for Prevention of HIV Transmission in Health-Care Settings in August 1987.  These 1987 recommendations encouraged the use of blood and body fluid precautions for all patients regardless of their infection status.

The extension of precautions to all patients was referred to as Universal Precautions. Under these guidelines, blood and body fluids of all patients were considered potentially infectious. Universal Precautions specified the use of gloves and face shields and avoiding exposure with needles and other instruments after use when the potential for contact with blood and bodily fluids was anticipated. The importance of frequent handwashing was at the core of these recommendations.

By 1987, a set of rules known as Body Substance Isolation (BSI) was added. It expanded the concept of personal protective equipment to include plastic aprons and covers for hair and shoes to keep all moist body substances off hair, skin, clothes, and mucous membranes. BSI went beyond simply discarding needles in puncture-resistant containers to placing them in puncture-proof containers. Hands were to be thoroughly washed before as well as after patient care and wearing gloves. Body Substance Isolation utilized hospital gowns, medical gloves, shoe covers, safety goggles, and surgical masks or N95 respirators. However, there was not a consistent interpretation or use in either BSI or universal precautions.

Standard Precautions

Times have changed since Universal Precautions were first set in place. The 21st century has seen devastating illness from Ebola virus, avian flu, West Nile virus, SARS, Zika virus and biological warfare as well as the pandemic flu from previous generations. Gloves alone do not completely protect a health professional or patient. Even diseases usually transmitted by contact can be aerosolized by saliva and respiratory secretions. Irrigating a wound can risk a splash back of fluid. Respirator masks can be contaminated. Today, public health officials must prepare against contact and airborne transmission as well as bloodborne risks.

In 1996, the Centers for Disease Control and Prevention established the term Standard Precautions. This broadened the focus on prevention, applying the principles to all patients regardless of diagnosis or presumed infection status.  These guidelines consider the risk of transmission of illness from both recognized and unrecognized sources.

In the very simplest terms, Standard Precautions involve washing hands before and after patient contact, whether or not gloves are worn. They involve wearing clean gloves when touching blood, body fluids, and contaminated items, as well as a clean, non-sterile gown and a mask, eye protection or face shield in the likely event of splashes or sprays. Soiled equipment and linen are carefully handled to prevent injuries from used equipment.

These measures are the minimum infection prevention practice applying to all patient care, regardless of the healthcare setting or whether a patient is known or suspected to carry disease.

Transmission-Based Precautions

Transmission-Based Precautions are the second tier of basic infection control and are to be used in addition to Standard Precautions for patients who may be infected or colonized with certain infections, including the virus that causes COVID-19, for which additional precautions are needed to prevent infection transmission.  Those include Contact Precautions, Droplet Precautions, and Airborne Precautions.  Each have specific guidelines and applications which must be addressed in policy and followed by staff to avoid legal ramifications.

Universal Precautions vs. Standard Precautions

In summary, universal precautions involve precautions taken with all patients, regardless of suspicion of infection, to prevent the spread of bloodborne pathogens. In an inevitable evolution, standard precautions, in contrast, are steps taken to encompass fighting the spread of airborne pathogens in situations where providers come into contact with any form of body fluid. Transmission-Based precautions are more specific and used in addition to standard precautions when certain infections are present.  The type of precaution applied in a facility is essential to most medical malpractice and healthcare-related claims. Understanding the difference is key both for healthcare providers and legal teams.

The presence or absence of a “safety culture” (also known as a safety climate) promoting appropriate infection precautions is a key component in any medical malpractice case.  Med Law’s team of nurse consultants can help pinpoint whether a provider has been in compliance and can be a strong partner in pursuing or defending a medical malpractice suit. We’d love to chat with you – contact us today to schedule a conversation.

Med Law Advisory Partner’s team of medical-legal consultants can help you pinpoint whether a provider has been in compliance and be your best foot forward in pursuing or defending a medical malpractice suit. We’d love to chat with you – contact us today to schedule a conversation. 

Founded by Alicia Davis, RN, LNCC, Med Law Advisory Partners (formerly ALN Consulting) provides resources and expertise in the areas of health care litigation and health systems improvement. Med Law Advisory Partners’ team has had the privilege of working with national and regional healthcare systems, legal firms, insurers, and senior-living operators for nearly 20 years, providing medical-legal case investigation.

Originally published July 29, 2016. Post last reviewed and updated Feb. 18, 2021.