Universal precautions for the prevention of HIV and HBV infection in health care settings. Committee for Science and Education, Medical Association of South Africa.

OBJECTIVE: To outline the principles guiding the deliberate actions that should be taken in health care settings to prevent the spread of pathogens, especially HIV and hepatitis B virus (HBV), to patients and health care workers (HCWs).

OUTCOMES: Universal precautions should be implemented in all health care settings.

EVIDENCE: Based on similar international recommendations.

VALUES: An adaptation of an existing guideline, it was sent to 87 organisations for comment. The comments received were included where possible in this guideline. It is the right of HCWs and patients to be protected from nosocomial HIV and HBV infection.

BENEFITS, HARMS AND COSTS: The prevention of costly HIV and HBV infection by simple, rational precautions in the health care setting. The cost to the health care system has not been measured. The cost to individual patients or HCWs who acquire either infection is inestimable.

RECOMMENDATIONS: The guideline recommends that the four basic elements of universal precautions be implemented appropriately in all health care settings: (i) body fluids should be handled with the same precautions as blood; (ii) avoidance of sharps (sharp objects); (iii) avoidance of skin or mucous membrane contamination; (iv) cleaning/disinfecting/sterilising.

VALIDATION: The draft guideline was subjected to extensive external review by specialist, generalist and health professional groups. These included HIV activist groups. There were no major disputes about the content. The most important amendment to the draft guideline is the inclusion of HBV and other related pathogens together with the HIV. DEVELOPMENT AND FUNDING: The Medical Association of South Africa Committee for Science and Education. ENDORSEMENTS: The MASA and twenty national health care organisations and three provincial health authorities (see list at end of document).