Standard precautions in healthcare represent the minimum infection prevention practices applied during all patient care encounters. These practices are universally employed to protect both the patient and the healthcare worker from the spread of infectious agents. The goal is to establish a foundational level of safety by reducing the risk of transmission from sources that may not be immediately apparent. Consistently applying these measures minimizes the opportunity for microorganisms to move between individuals or from the environment to a person.
The Foundational Principle of Standard Precautions
The philosophy underlying Standard Precautions is universal: treating all human blood, body fluids, secretions, excretions (except sweat), non-intact skin, and mucous membranes as potentially infectious. This approach acknowledges that many disease carriers are asymptomatic or undiagnosed, meaning their infectious status is unknown during the encounter. This system evolved from the earlier “Universal Precautions,” which focused primarily on preventing the transmission of bloodborne pathogens like HIV and Hepatitis B.
The current Standard Precautions model expands this concept to include all potential sources of infection, not just bloodborne ones. This universal application requires healthcare personnel to perform a risk assessment before every patient interaction to determine necessary protective equipment or actions. Because any patient may harbor a transmissible agent, these precautions must be embedded as a routine part of providing care in all settings.
Essential Practices for Healthcare Workers
Hand Hygiene
Hand hygiene is the single most effective measure to prevent the spread of infection within a healthcare environment. Healthcare workers must clean their hands at five critical moments: before touching a patient, before clean or aseptic procedures, after body fluid exposure risk, after touching a patient, and after touching patient surroundings. When hands are visibly soiled, washing with soap and water is required.
If hands are not visibly soiled, the preferred method is the use of an alcohol-based hand rub (ABHR), which is more effective and faster at killing microorganisms. The use of gloves does not replace the need for hand hygiene; hands must be cleaned immediately after gloves are removed because gloves can develop microscopic defects or become contaminated.
Use of Personal Protective Equipment (PPE)
Personal Protective Equipment (PPE) acts as a physical barrier between the healthcare worker and potential infectious materials. The specific PPE used—including gloves, gowns, masks, and eye protection—is determined by the anticipated exposure risk of the procedure. Gloves are worn when contact with blood, body fluids, non-intact skin, or contaminated items is expected.
A gown protects the worker’s skin and clothing during procedures that may involve splashes or sprays of bodily fluids. Masks and eye protection, such as goggles or face shields, protect the mucous membranes of the eyes, nose, and mouth from droplet or spray contamination. The proper sequence for donning and removing PPE safeguards the worker from self-contamination.
Safe Injection Practices
Safe injection practices prevent the transmission of infectious diseases through contaminated sharps or medications. Aseptic technique must be maintained during the preparation and administration of parenteral medications, including using a sterile needle and syringe for every injection. Medications should be drawn from single-dose vials whenever possible to prevent contamination of the source medication.
Sharps Safety
Sharps safety involves precautions to prevent injuries from needles, scalpels, and other sharp instruments. After use, contaminated sharps must be immediately disposed of in designated puncture-proof containers, which are rigid and leak-proof. Needles should never be recapped, bent, or broken by hand, as this increases the risk of an accidental needlestick injury and potential bloodborne pathogen exposure.
Respiratory Hygiene/Cough Etiquette
Respiratory Hygiene, often called Cough Etiquette, prevents the spread of respiratory pathogens. This practice applies to anyone entering a healthcare setting with signs of a respiratory infection, such as coughing or sneezing. Individuals are instructed to cover their mouth and nose with a tissue when coughing or sneezing, or to cough into their elbow if a tissue is unavailable. Healthcare facilities aid this by providing tissues, no-touch receptacles for disposal, and alcohol-based hand rub for immediate use after contact with respiratory secretions.
Equipment Handling
Safe handling of patient care equipment prevents the transfer of microorganisms between patients. Reusable equipment must be properly cleaned, disinfected, or sterilized according to established protocols after use and before being used on another patient. The required level of cleaning depends on the item’s intended use and the infection risk it poses. Single-use items must be disposed of correctly in the appropriate waste stream immediately following the procedure.
Standard Precautions Versus Transmission-Based Precautions
Standard Precautions (SP) form the fundamental tier of infection prevention, applied universally to all patients. Transmission-Based Precautions (TBP) are the second tier, implemented in addition to SP when a patient is known or suspected to be infected or colonized with a highly transmissible pathogen. TBP are tailored to the specific route of transmission to ensure enhanced containment.
Contact Precautions
Contact Precautions are used for pathogens spread through direct patient contact or contact with contaminated environmental surfaces. This requires the dedicated use of a gown and gloves upon entering the patient’s room, which are removed before exiting.
Droplet Precautions
Droplet Precautions target pathogens transmitted via large respiratory droplets generated by coughing, sneezing, or talking. This mandates the use of a surgical mask by the healthcare worker when working within a close distance of the patient.
Airborne Precautions
Airborne Precautions are reserved for the smallest particles that can remain suspended in the air over long distances, requiring specialized engineering controls. Patients are placed in an Airborne Infection Isolation Room (AIIR), which maintains negative air pressure to prevent contaminated air from escaping. Personnel must wear a specialized respirator, such as an N95 mask, to filter these fine airborne particles.