Healthcare lawsuits mostly involve a deviation from an established standard of care. To identify such deviation, the patient’s medical records need to be reviewed, preferably by professional medical review services. Failure to follow safe practices in a healthcare setting such as a hospital also amounts to deviation from the expected standard of care and can lead to cases of infection and medical negligence lawsuits. Any healthcare facility is required to follow very stringent practices as regards sterility and cleanliness of the environment in which patients are treated. Medical centers and hospitals do have good policies in place to prevent the spread of infection. The important question is whether those policies are up to date and the infection control program efficient enough to prevent pandemics and contagious diseases. If a case of infection due to negligence arises, the legal team would be looking for proof whether the healthcare facility has/has not adhered to updated health guidelines to protect their patients, staff, and the community on the whole from a pandemic or infectious disease. It is in this context that one needs to understand the expressions “universal precautions” and “standard precautions,” – important terms in legal research.
Pathogens that are responsible for infection can be bloodborne and airborne. Bloodborne pathogens are spread in the following ways:
- Direct/Indirect Contact: Direct contact is when infected blood or body fluid from one person enters another person’s body via an entry site, such as infected blood splashing in the eye when irrigating a wound. Indirect contact is when a person’s skin touches an object which contains the body fluid or blood of an infected person. This contact could occur when handling a patient’s soiled clothes that may contain the pathogen.
- Vector-Borne Transmission: This is when a person’s skin is penetrated by an infectious source such as an insect bite.
- Respiratory Droplet Transmission: Occurs when a person inhales infected droplets via a cough or sneeze.
What Are Universal Precautions?
Universal Precautions refer to the guidelines or recommendations introduced by the CDC (Centers for Disease Control) in 1983 regarding the precautions to adhere to when a patient was known or suspected to be infected with a bloodborne pathogen including Hepatitis B, HIV or any other. These blood and body fluid precautions were to be followed when treating any patient, regardless of his/her infection status. According to these guidelines, blood and body fluids of all patients were to be considered potentially infectious. Universal Precautions insisted on the use of gloves and face shields, and avoiding exposure with needles and other instruments after use when the possibility of contact with bodily fluids and blood was expected. The importance of frequent handwashing was at the core of these guidelines. In 1987, the CDC added a set of rules BSI or Body Substance Isolation that extended the concept of PPE (personal protective equipment) to include plastic aprons and covers for the hair, and shoes to keep moist body substances off the hair, skin, clothes and mucous membranes. These rules required needles to be placed in puncture-proof containers. Healthcare providers were required to thoroughly wash their hands before and after patient care, and to wear gloves. Hospital gowns, shoe covers, medical gloves, safety goggles, and surgical masks or N95 respirators were all to be utilized under BSI rules.
Universal Precautions apply to body fluids such as the following:
- CSF or cerebrospinal fluid
- Semen or vaginal secretions
- Synovial fluid
- Pericardial fluid
- Pleural fluid
- Amniotic fluid
Standard Precautions and Why These Rules Were Introduced
With the entry of very serious illnesses such as those from the Ebola virus, SARS, Zika virus, avian flu, and now COVID-19, Universal Precautions alone do not often suffice to protect healthcare professionals or patients from infection. Today, healthcare providers need to prepare against contact and airborne transmission as well as bloodborne transmission. Standard Precautions rules were established by the CDC in 1996, which expanded the focus on prevention, and the principles were applied to all patients irrespective of diagnosis or presumed infection status, or healthcare setting. Standard Precautions consider the risk of transmission of infection from recognized as well as unrecognized sources.
Standard Precautions involve the following:
- Washing hands before and after caring for the patient regardless of whether gloves are worn or not.
- Wearing clean gloves when touching contaminated items, blood and body fluids, as well as wearing a clean non-sterile gown and a mask, face shield or eye protection to guard against splashes and sprays.
- Handling soiled linen and equipment very carefully to prevent any kind of potential harm from these.
Apart from Standard Precautions, healthcare providers are expected to follow Transmission-based Precautions when treating patients who may be infected with certain infections, including the COVID-19 virus. Since these infections require extra precautions, providers are to follow contact precautions, droplet precautions, and airborne precautions all of which have particular guidelines and applications that are to be included in the policy and followed carefully to avoid legal consequences.
Universal Precautions to prevent bloodborne pathogen spread, Standard Precautions to prevent airborne pathogen spread, and Transmission-based Precautions to be used alongside Standard Precautions are all highly relevant with regard to medical malpractice and healthcare-related claims. It is important for healthcare providers as well as legal teams to understand the difference between these because the safety culture in a healthcare setting is a major consideration in medical malpractice cases. A comprehensive chart review by legal nurse consultants and other medical experts can help identify whether a healthcare provider has been in compliance with the expected standards of care.
That said, a related topic to discuss is HAI or hospital acquired infections, which we will take up in one of our next blogs.