Universal precautions

Universal precautions are based on the assumption that all blood and body fluids are a possible source of infection, and as such describe systems of safe practice aimed at:

• reducing the risk of cross-infection to and from clients and staff members
• maintaining the confidentiality of known carriers of infections
• reducing the level of contact that staff have with blood and body fluids.

Responsibilities
As stated above, employers are responsible for ensuring that the working environment is maintained in such a way as to minimize risk, and that regulations are adhered to. In relation to universal precautions, this includes the immunization and education of staff, the provision of adequate staffing levels, making contemporary, evidence-based guidelines readily available, and providing:

• handwashing facilities
• sharps containers
• protective clothing, for example masks and gloves
• disposal bags for infected waste
• adequate cleaning materials and equipment.

Health care workers have a legal and professional responsibility to effectively utilize these provisions. Whilst copies of hospital guidelines are usually found within each individual unit or clinical area it remains the responsibility of the employee to read these, apply them to practice and assess the potential risks involved
with all activities. Support is available within most clinical areas from specialist infection control teams, who provide advice and support for clients, staff and relatives in relation to infection management.

Let us now look at each provision in turn, noting its importance and utilization.

Handwashing:
Cross-infection, that is, the spread of infection from one person or area to another, is often caused through direct hand contact. Resident bacteria are present in the deep layers of the skin on the hands and, whilst difficult to remove by handwashing, have a low potential to cause infection.

Transient bacteria, on the other hand, have a shorter lifespan but can pass easily from one person to another and have been found to be responsible for the majority of hospital-acquired infections. Effective techniques for washing hands are sufficient to remove most of these bacteria and thus radically reduce the potential for and incidence of cross-infection, yet numerous studies inform us that hospital staff do not undertake the activity either regularly or effectively (EPIC 2001).

Hospital-acquired infections – infections passed from one person to another whilst in hospital – also known as nosocomial infections, can cause deterioration in health, prolong hospital admissions and even lead to death, as well as affecting clients’ overall well-being. They therefore impact not only on clients and their families but also on the health service and staff through increases in spending, longer waiting lists and the potential for future litigation. Indeed some infections have now become resistant to all available treatments; it is therefore crucial that their spread be prevented.

In acknowledging this problem, which currently costs the Health Service in excess of £21 million per year, the Department of Health (2001) has published benchmark standards for reducing the number of hospital-acquired infections. This document states that hands should be washed before and after every client contact or activity that may contaminate the hands. Prior to washing the hands some general points to consider include:

• The removal of all jewellery. Most hospital policies allow staff to wear a plain band wedding ring whilst working in the health care setting but no other jewellery, including wristwatches. This reduces the risk of bacteria being harboured beneath such items, reduces the risk of accident or injury in the workplace and facilitates good handwashing technique.
• Any abrasions or cuts should be covered with an occlusive, waterproof dressing. This reduces the risk of cross-infection thus protecting staff and clients.
• Fingernails should be short and filed smooth, to reduce the risk of accident or injury to client or staff and to reduce the risk of harbouring infection.
• Skin should be well moisturized, reducing the risk of skin dryness and damage and thus reducing the potential for harbouring bacteria.