The Centers for Disease Control and Prevention (CDC) have issued several guidelines to protect patients and examiners from the spread of infectious disease. All clinicians examining patients are advised to study and observe these precautions at the CDC websites. Advisories for standard and methicillin-resistant Staphylococcus aureus (MRSA) precautions and for universal precautions are summarized below.
Standard and MRSA precautions. Standard precautions are based on the principle that all blood, body fluids, secretions, excretions (except sweat), nonintact skin, and mucous membranes may contain transmissible infectious agents. Standard precautions apply to all patients in any setting. They include hand hygiene (Fig. 1-1); use of personal protective equipment (gloves; gowns; and mouth, nose, and eye protection) (Fig. 1-2); safe injection practices; safe handling of contaminated equipment or surfaces; respiratory hygiene and cough etiquette; patient isolation criteria; and precautions relating to equipment, toys, solid surfaces, and laundry handling. Because hand hygiene practices have been shown to reduce the transmission of multidrug-resistant organisms, especially MRSA and vancomycin resistant enterococcus (VRE),19 the CDC hygiene recommendations are reproduced below. White coats and stethoscopes also harbor bacteria and should be cleaned frequently.
Universal precautions. Universal precautions are a set of guidelines designed to prevent parenteral, mucous membrane, and noncontact exposures of health care workers to bloodborne pathogens, including HIV and HBV. Immunization with the HBV vaccine for health care workers with exposure to blood is an important adjunct to universal precautions. The following fluids are considered potentially infectious: all blood and other body fluids containing visible blood, semen, and vaginal secretions and cerebrospinal, synovial, pleural, peritoneal, pericardial, and amniotic fluids. Protective barriers include gloves, gowns, aprons, masks, and protective eyewear. All health care workers should follow the precautions for safe injections and prevention of injury from needlesticks, scalpels, and other sharp instruments and devices. Report to your health service immediately if such injury occurs.
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