The Centers for Disease Control and OSHA have set policies regarding the use of precautions to protect health care workers. Universal Precautions or Standard Precautions are infection control guidelines designed to protect health care providers from exposure to diseases spread by blood and certain body fluids. Perinatal Specialists should develop a strategy of "Universal Precautions." Universal Precaution policies should stress that all clients should be assumed to be infectious for blood-borne diseases such as human immuno-deficiency virus HIV or hepatitis B virus HBV.

Why Use Precautions
According to the Centers for Disease Control, blood is the single most important source of HIV, HBV, and other bloodborne pathogens. Infection control efforts for HIV, HBV, and other bloodborne pathogens must focus on preventing exposures to blood.

Fluids To Avoid
Universal precautions apply to blood, tissues and to the following fluids: cerebrospinal fluid (CSF), synovial fluid, pleural fluid, peritoneal fluid, pericardial fluid, and amniotic fluid. The risk of transmission of HIV and HBV from these fluids is unknown; epidemiologic studies are currently inadequate to determine the potential risk from exposures to them. However, HIV has been isolated from CSF, synovial, and amniotic. In view of the unknown nature of transmission, universal precautions might also apply to vaginal secretions.

Protective Wear & Safety
In adopting or adapting policies for Universal Precautions, Perinatal Specialists should consider the use of protective barriers such as (latex or non-latex) gloves, paper gowns, masks or protective eye wear, which can reduce the risk of exposure of skin or mucous membranes to potentially infective materials. Gloves and eye wear with side panels can be purchased from medical supply stores.

While Perinatal Specialists typically do no clinical tasks during the course of a labor and birth, they should also protect themselves against injuries caused by needles, scalpels and other sharp instruments or devices.

Handwashing is the single most important procedure for preventing nosocomial infections. Handwashing is defined as a vigorous, brief rubbing together of all surfaces of lathered hands, followed by rinsing under a stream of warm clean water. Handwashing with antimicrobial/antibacterial products kills or inhibits the growth of microorganisms; this process is often referred to as chemical removal of microorganisms. Most resident microorganisms are found in superficial skin layers, but about 10%-20% can inhabit deep epidermal layers. Hand washing with plain soaps and detergents is effective in removing many transient microbial flora. Resident microorganisms in the deep layers may not be removed by handwashing with plain soaps and detergents, but usually can be killed or inhibited by handwashing with products that contain antimicrobial ingredients.

When To Use Precautions
Universal Precautions should be implemented anytime the Perinatal Specialist anticipates the possibility of coming in contact with body fluids. Notifying the client of such policies during a prenatal visit will greatly reduce the anxiety and stress associated with the use of precautions.

References:

1. Bobak, I., Jensen, M. Maternity & Gynecologic Care: The Nurse and the Family. (1989) St. Louis: Mosby Publishers.
2. Nichols, F., Humenick, S. Childbirth Education: Practice, Research & Theory (2000) Saunders & Co.
3. Whitely, N. A Manual of Clinical Obstetrics (1985) Philadelphia: J.B. Lippincott Company.
4. Reeder, S., Martin, L., and Koniak-Griffin, D. Maternity Nursing: Family, Newborn, and Women's Health Care. (1997) Philadelphia: J.B. Lippincott Company.