History of Infection Control Guidelines

No matter what practice setting, maintaining good infection control methods are of vital importance to protect not only the clinician, but also the patients that they treat. Over the years, infection control practices have taken many different forms. Fundamental to the idea of infection control is the maintenance of barriers or safeguards between the clinician and the patient with the infection, disease, or pathogen.

United States

1877 - First hospital manual suggested housing infectious patients in separate facilities from non-infectious patients, giving rise to infectious disease hospitals. 1910 - Cubic system of isolation and barrier nursing, where infectious patients were placed in separate wards. Hospital staff washed hands and equipment after contact with those in the ward. 1970 - The United States Centers for Disease Control first introduced a framework for hospital patient isolation. This framework consisted of color coded disease/infection categories with generalized precautions used for all diagnoses included in the category. The categories included wound and skin, discharge, blood, enteric, protective, strict, and respiratory. In 1983 the framework was updated to include disease-specific isolation guidelines. The previously used categories were also updated. Categories now included Blood and Body Fluid Precautions, Drainage/Secretion Precautions, Enteric Precautions, Tuberculosis Isolation, Strict Isolation, Contact Isolation, and Respiratory Isolation. Disease specific guidelines tailored for a specific infection or disease. Selection of precautions could be based on the ones suggested for a specific category or for a specific disease or infection. It was encouraged that the selection of precautions be customized to each patient with not all of the precautions from a category or diseased/infection needing to be utilized if not appropriate. 1985 - Universal Precautions introduced in response to HIV epidemic and increasing reports of clinical staff becoming infected with HIV from accidental needle sticks and contact with patient’s blood. Blood and Body Fluid Precautions now applied to all patients not just those in that category of isolation. Blood and Body Fluid precautions expanded from only glove and gown use to the addition of eye protection and masking for specific procedures and the use of individual ventilation devices for CPR. Gloves to be worn if potential for contact with blood or specific bodily fluids and hands to be washing after removal. 1987 - Body Substance Isolation All moist body substances including blood, urine, feces, saliva, sputum, wound discharge, and any other bodily fluids were considered infectious, regardless of the patient’s actual infection status, and were therefore required to be isolated. Gloves to be worn if potential for contact with any moist body substance and, after removal, hands only needed to be washed if visibly soiled. “Stop Sign Alert” posted on door of patients with airborne transmittable infection/disease, instructing visitors/staff to check with nurse regarding the need to wear a mask. Staff immunization/immunity required for entry into rooms of patients with measles, mumps, rubella, or varicella. 1989 - Occupational Safety and Health Administration (OSHA) Bloodborne Pathogens Regulations Expansive guideline for the protection of workers from blood borne pathogens. Has continued to be updated and clarified for specific environments and situations since creation. 1996 - Guideline for Isolation Precautions in Hospitals Introduction of Standard Precautions, a combination of Universal Precautions and Body Substance Isolation. Precautions to be utilized with all patients regardless of disease/infection status or other implemented precautions. Replaced category and disease specific precautions with with Airborne Precautions, Droplet Precautions, and Contact Precautions, based on disease/infection mode of transmission. Two criteria for assigning to a patient. Confirmed presence of specific disease, infection, or pathogen. Observation of selected signs and or symptoms suggestive of possible presence of disease, infection, or pathogen warranting the need for Airborne, Droplet, or Contact Precautions. Meant to be temporary until confirmation of diagnosis. 2007 - Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings Current utilized guidelines Emphasized application to all healthcare settings. Full guidelines can be found here: https://www.cdc.gov/infectioncontrol/guidelines/isolation/index.html