Universal Precautions vs Standard Precautions? Which One to Use

Both universal and standard precautions protect against the spread of disease. But when people first hear about universal precautions and standard precautions, they might assume that universal precautions are more widespread or harsher. In reality, neither is the case.

Standard precautions have actually taken the place of universal precautions in many scenarios, as a stronger alternative. So why this confusing terminology? Well, the answer might lie in the timing of when these guidelines came into the picture.

Learning the difference between universal precautions vs. standard precautions can help workers in all kinds of professions understand safety. And the safety isn’t just for the workers themselves. Following these guidelines can help protect patients, clients, and colleagues as well.

Here’s my basic overview of the difference between these different guidelines, especially given the pandemic we’re all living in right now.

The Beginnings of Universal Precautions

People started using universal precautions before the introduction of standard precautions. This might explain why the word “universal” is there when it’s actually less universal than the newer guidelines. Universal precautions aren’t so universal right now, but they were meant to be universal at the time.

Universal precautions came about in the 1980s as a response to HIV and Hepatitis B, two diseases that were often transmitted through blood and certain fluids like semen. Before these precautions were in place, people were already careful when treating a patient who had tested positive for either disease.

But that wasn’t enough. Because these bloodborne diseases had become so common, people started calling for a set of guidelines that workers could use in any circumstance, whether or not a patient had definitely tested positive.

The universal aspect of these guidelines was in the assumption of danger. Basically, rather than going into full safety mode when treating a patient who you know has HIV or another pathogen, the idea is to assume that anyone might have a bloodborne infectious disease. So the full safety mode would happen all the time, or universally.

The Beginnings of Standard Precautions

Aside from the term “universal,” the word “standard” in standard precautions is also a bit of a misnomer. Standard, in this case, does not mean that guidelines are less severe than universal precautions. The introduction of standard precautions was meant to usher in a new, higher standard for safety.

While universal precautions focused on bloodborne pathogens primarily, standard precautions applied to a wider variety of circumstances. They built on universal precautions but added new focuses, like respiratory disease.

For example, cough etiquette and efforts like “Cover Your Cough” are part of today’s standard precautions. While droplet and airborne transmission weren’t priorities during the time of universal precautions, it soon became clear that they were serious risks.

Which One is More Comprehensive?

Standard precautions are more comprehensive than universal precautions. This is because universal precautions are limited to blood and certain fluids like cerebrospinal fluid. Other fluids only fall under universal precautions if they visibly include contamination by blood.

These guidelines made sense at the beginnings of universal precautions because this was an era focused on the dangers of HIV and Hepatitis B. Fluids like urine were not a huge threat at this time because they did not contribute significantly to the spread of these diseases. Blood, on the other hand, was a major path of disease transmission.

Since then, though, fluids other than blood became more relevant. For example, nasal fluids and saliva contributed to the spread of airborne epidemics. Universal precautions needed an update that expanded its use to more situations.

For people who are looking for the most comprehensive guidelines, standard precautions are the way to go.

What Do These Precautions Entail?

I’ve talked about the difference between the comprehensiveness of universal vs. standard precautions, but what does this mean in real-life terms? What makes a set of guidelines more or less comprehensive?

Well, these precautions are a set of safety rules. They include guidelines for personal protective equipment (PPE) like gloves and goggles. And they tell workers how to handle potential biohazards like needles and contaminated surfaces.

These basics are present in both universal and standard safety precautions, but the situations they apply to are different. For example, both universal and standard safety precautions have guidelines about protective barriers against fluids. But universal precautions would apply to a smaller set of fluids than standard safety precautions.

Who Do These Guidelines Protect?

There are at least two ways to look at safety precautions. One is that this is a protection for the workers. If a workplace violates certain safety precautions, the employees there might be able to file a complaint.

For example, a job might require that employees use PPE in order to follow proper universal precautions or standard precautions. But if the workplace itself does not provide the PPE, workers might be able to make a complaint. They’re putting themselves at higher risk than their job should entail.

Another way to look at safety precautions is as a protection for the public. If a worker fails to properly decontaminate a surface according to proper precautions, they might be putting clients and patients in danger.

In practice, not everyone actually follows the safety precautions their workplace entails. This could be because they don’t take the risks seriously or because their workplace isn’t offering them enough protective gear. A recent observational study found that less than 30 percent of nurses and nursing assistants followed the PPE portion of their workplace safety precautions, compared to 100 percent of infectious disease physicians and 86.7 percent of maintenance workers.

Universal Precautions vs. Standard Precautions in the Workplace

Workplace safety organizations like OSHA sometimes give different recommendations than the CDC guidelines.

For example, sometimes OSHA recommends universal precautions as a minimum when the CDC recommends standard precautions. It’s important for workers to know the difference. If they feel they aren’t being protected by OSHA’s recommendations, they might find the CDC guidelines better suited for their job.

In some cases, OSHA recommendations seem more relaxed when they actually aren’t. OSHA sometimes does this by putting forth universal precautions but expanding certain parts. I’ll explain an instance of this in the field of dentistry in a later section.

One benefit of using standard precautions is that they pair well with a set of additional guidelines called transmission-based precautions. The CDC calls these the “second tier of basic infection control,” and employers and managers can use them in conjunction with standard precautions.

Precautions During the Pandemic

Simply put, the COVID-19 pandemic has changed everything. While some occupations and situations call for universal precautions in normal circumstances, a pandemic calls for more severe measures.

The CDC (Centers for Disease Control and Prevention) require universal precautions for the regular flu but standard precautions for a pandemic flu. These measures have been in place for at least a decade, long before we knew about the pandemic we are currently living through.

For this particular pandemic, though, the CDC has released changes to its existing guidelines to respond to the current state of disease transmission. On July 15th, 2020, they updated their guidelines to raise concerns about protective eyewear. Specifically, they pointed out that eyewear with gaps (like safety glasses) are not fully protective.

Different Professions

Universal and standard precautions affect a wide variety of professions. These include body art professions like tattooists and body piercers. These workers know that they will encounter fluids like blood on a regular basis, so they have to take special care to make sure they remove the risk of disease of transmission.

Then there are the more obvious professions, like healthcare workers and first responders.

In the dental profession, sometimes people recommend universal precautions. But in this case, there’s actually very little (if any) difference between universal and standard precautions in practice. This is because the fluids covered under universal precautions include OPIM, or “Other Potentially Infectious Materials.”

Though saliva is usually not considered part of OPIM, it is an OPIM in the field of dentistry. This means the comprehensiveness of standard precautions doesn’t actually add something that wasn’t there to begin with.

Other Kinds of Precautions

There are many other sets of guidelines besides universal and standard precautions. These include droplet precautions, airborne precautions, contact precautions, and full barrier precautions.

These days, universal precautions are very rarely if ever recommended on their own. Standard precautions have become the new baseline (hence “standard”), while other sets of guidelines add to these standard rules.

Now, during the COVID-19 pandemic, some people are calling for a new set of pandemic precautions. They are calling their proposed changes “universal pandemic precautions” or “standard pandemic precautions.”

Stay Safe Out There!

Pandemic or not, safety guidelines are extremely important tools in the fight against disease transmission. And so is learning about them!

People who haven’t looked into the difference between universal precautions vs. standard precautions might not realize that their names are misleading. They might implement universal precautions in the workplace because they assume these are more, well, universal. But with the right understanding of how these guidelines came about, workers can understand what they’re signing up for.

And for a more in-depth look at bloodborne pathogens and how to protect against them, you can sign up for our comprehensive online course.

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