Standard Precautions

Standard precautions were developed by the CDC in 1996, combining and expanding universal precautions (focused on bloodborne pathogens) and body substance isolation. The key concept: you cannot reliably identify which patients are infectious based on diagnosis or appearance alone, so all patients are treated as potentially infectious for all exposures.

Standard precautions do NOT replace transmission-based precautions (contact, droplet, airborne) — they are the foundation to which those additional layers are added when specific organisms require them.

Hand hygiene is the single most effective infection prevention measure. The WHO identifies five key moments:

ABHR technique: Apply one pump, cover all surfaces of both hands (palm to palm, between fingers, backs of hands, thumbs, fingertips), rub until dry — approximately 20–30 seconds. Soap and water: Wet hands, apply soap, scrub all surfaces for ≥20 seconds, rinse thoroughly, dry with clean towel.

Respiratory hygiene (cough etiquette) applies to patients, visitors, and healthcare workers with signs of respiratory infection. It was added to standard precautions after the 2003 SARS outbreak.

• Cover nose and mouth with a tissue or the crook of the elbow when coughing or sneezing
• Dispose of used tissues immediately in a no-touch receptacle
• Perform hand hygiene after contact with respiratory secretions
• Symptomatic patients in waiting areas: offer a surgical mask or seat them ≥3 feet from others
• Post respiratory hygiene instructions at healthcare facility entrances

Needlestick and sharps injuries are the primary risk for bloodborne pathogen transmission to healthcare workers. Standard precautions require:

• Never recap needles with two hands — if recapping is necessary (rare), use a one-hand scoop technique or a mechanical device
• Dispose of sharps immediately after use into a puncture-resistant sharps container
• Do not overfill sharps containers (replace at ¾ capacity)
• Never remove needles from syringes by hand
• Use safety-engineered needles and devices (with retractable or shielded needles) per OSHA requirements
• Following a needlestick: wash the wound immediately with soap and water; do not squeeze or suck; report per facility protocol immediately

Unsafe injection practices have caused healthcare-associated outbreaks of bloodborne infections including HCV and HIV. Standard precautions require:

• One needle, one syringe, one patient — never reuse
• Single-dose vials are preferred; if multi-dose vials are used, access with a new sterile needle and syringe each time
• Never use the same syringe to draw from a vial again after it has been used on a patient
• Treat medication bags, IV tubing, and preparation surfaces as clean items — do not contaminate with used needles
• Use aseptic technique for all IV access, injections, and lumbar punctures

The patient environment is a significant reservoir for healthcare-associated pathogens. Nursing responsibilities include:

• Clean and disinfect frequently touched surfaces between patient uses (bed rails, call light, overbed table, IV pole, blood pressure cuffs)
• Clean and disinfect shared patient care equipment between patients (glucometers, stethoscopes, thermometers)
• Use facility-approved disinfectants — ensure adequate contact time with the surface for efficacy
• Report spills of body fluids promptly — clean with appropriate disinfectant per facility protocol
• Handle soiled linen with minimum agitation to prevent aerosolization; bag at point of use

• Perform hand hygiene consistently at all five WHO moments — model this behavior for patients, visitors, and team members
• Select PPE based on anticipated exposure risk — assess before each patient encounter
• Educate patients and families on hand hygiene and respiratory etiquette during admission
• Report occupational exposures (needlesticks, splashes) immediately per facility protocol
• Ensure sharps containers are not overfilled; advocate for replacement when ¾ full
• Identify opportunities to reinforce standard precautions in team members — including students and visiting staff
• Document standard precaution compliance issues and patient-related infection risk per facility policy