These are procedures to be followed by all staff who are caring for a patient believed to be harboring a highly contagious dangerous pathogen, such as AIDS (acquired immunodeficiency syndrome), that is transmitted in blood, blood products, and other body fluids. Universal precautions were described in directives and guidelines issued by the Centers for Disease Control and Prevention (CDC) in 1987, and in standards published by the Occupational Safety and Health Administration (OSHA) in 1991. Revisions are published from time to time in Morbidity and Mortality Weekly Reports (MMWR). Universal precautions in care of patients are an enhanced form of barrier nursing, but they are used also in handling pathology specimens that are known or suspected to be infected with dangerous pathogens. All medical, nursing, and laboratory staff, including mortuary attendants, wear gloves, waterproof aprons, gowns, masks, and protective eye shields to prevent exposure to pathogens of potential portals of entry for infection (nose, mouth, mucous surfaces, conjunctival membranes, abrasions and lacerations on the skin, etc.). Specific precautions are set out for surgical, obstetric, and invasive diagnostic procedures, renal dialysis, dentistry, and mouth-to-mouth resuscitation. Surgical gloves must be worn when performing simple procedures such as drawing blood from veins and conducting intra-oral examination or manipulation. OSHA standards include procedures for cleaning and disposing of used surgical equipment, needles, and laundry, and for disposal of contaminated waste. Universal precautions are intended to supplement, not replace routine infection-control procedures, such as handwashing and the use of surgical gloves, and do not eliminate the need for other categories of disease-specific isolation measures, such as isolation procedures that are used for open pulmonary tuberculosis and "enteric" procedures used for cases of infectious diarrhea. Some patient advocates at first regarded the use of universal precautions as actually or potentially stigmatizing—tending to label patients as "contaminated" and therefore "bad," but this attitude has been overcome by careful explanation and the use of educational material.
JOHN M. LAST