In 1987, the CDC recommended the use of blood and body substance precautions for all patients through a system called universal precautions. The initial precautions applied to all body substances. These recommendations were revised in 1988 to include only those body fluids associated epidemiologically with transmission of blood-borne pathogens.36 Exposures related to oropharyngeal or respiratory secretions (airborne or droplet), parasitic infectious exposures, and contact exposures were not considered in the revised precautions. Confusion resulted, with hospitals adopting some but not all aspects of universal precautions or body substance isolation. Such confusion has led to lack of uniformity in infectious disease precautions from facility to facility. The focus of universal precautions and body substance isolation is on blood and blood-containing fluids, and the recommendations inadequately address infections transmitted by air or droplet. Confusion, lack of uniform application of infection control precautions, and the emergence of antibiotic-resistant organisms have promoted the development of a new system that is simple, is easy to apply, and pertains to all methods of infectious disease transmission.
In 1996, the Hospital Infection Control Practices Advisory Committee of the CDC devised a new system of isolation precautions to address all methods of disease transmission and to bring uniformity to hospital infection control practices. The new guidelines contain two tiers of precautions: standard and transmission-based. Standard precautions combine the major features of body substance isolation and universal precautions. Transmission-based precautions are designed for patients with documented or suspected transmissible pathogens for which additional protection beyond standard precautions is required. Transmission-based precautions are of three types: airborne, droplet, and contact. They are to be utilized in addition to, not in place of, standard precautions. 37 Unlike universal precautions, which list specific body fluids that may transmit blood-borne pathogens, or body substance isolation, which considers all body fluids to pose risk for transmission of blood-borne pathogens, standard precautions assume a broader approach to health care and patient protection, by including agents transmitted by routes other than blood.
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