History of Infection Control Guidelines

Original Editor - Jeremy Bryan

Top Contributors - Jeremy Bryan  

Introduction[edit | edit source]

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[1][2][edit | edit source]

1850-1900[3] - Physicians in the US, as well as other countries, began to recognize the benefits of antiseptic techniques for the control of infections.

  • Physicians conducted first epidemiological studies concerning the implementation of antiseptic techniques such as handwashing.


1877 - First hospital manual suggested housing patients with infections in separate facilities from patients without infections.

  • Gave rise to dedicated infectious disease hospitals.


1910 - Cubic System of Isolation and Barrier Nursing

  • Patients with infections were placed in separate wards.
  • Hospital staff washed hands and equipment after contact with those in the ward.


1950s [3]- Staphylococcal epidemics within hospital patients and staff sparked the first implementation of formal infection control programs

  • Maintaining a clean environment was a central focus of many of these programs.


1970 - United States Centers for Disease Control and Prevention (CDC) first introduced a framework for hospital patient isolation.

  • Framework consisted of color coded disease/infection categories with generalized precautions used for all diagnoses included in a category.
  • Categories included wound and skin, discharge, blood, enteric, protective, strict, and respiratory.


1976[3] - Joint Commission on Accreditation of Healthcare Organizations sets mandate for infection control programs.

  • Mandate required hospitals to maintain an established infection control program in order to receive Joint Commission accreditation.


1983 - CDC framework was updated to include disease-specific isolation guidelines. Previously used categories also updated.

  • Updated categories 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 by a specific category or for a specific disease or infection.
  • Clinical judgement was encouraged in the selection of precautions for each individual patient and not all precautions suggested for a category or infection/disease had to be used.


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 regardless of formally assigned precautions.
  • 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 body 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 there was a 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.


[4]

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 and is still in place today.


1996 - Guideline for Isolation Precautions in Hospitals

  • Introduced Standard Precautions, a combination of Universal Precautions and Body Substance Isolation.
    • Precautions to be utilized with all patients regardless of disease/infection status and in conjunction with any 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 these precautions sets 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.
        • Precaution assignment based on observation alone, meant to be temporary until confirmation of diagnosis.


2007 - CDC Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings

  • Current utilized guidelines
  • Emphasizes application to all healthcare settings.
  • Contents include:[5]
    • Administrative Responsibilities
    • Education and Training
    • Surveillance
    • Standard Precautions
      • Hand hygiene
      • Personal protective equipment
      • Respiratory hygiene/cough etiquette
      • Patient placement
      • Patient-care equipment and instruments/devices
      • Care of the environment
      • Textiles and laundry
      • Safe injection practices
      • Infection control practices for special lumbar puncture procedures
      • Worker safety
    • Transmission Based Precautions
      • General principles
      • Contact Precautions
        • Patient placement
        • Use of personal protective equipment
        • Patient transport
        • Patient-care equipment and instruments/devices
      • Droplet Precautions
      • Airborne Precautions
    • Protective Environment

Conclusion[edit | edit source]

It has taken a long time to reach the current infection control guidelines that we live by today and many factors have influenced their evolution. Undoubtedly the currently utilized guidelines will continue to evolve as contagious diseases and infections change, but it will always be important to understand how they got to where they are now.

Resources[edit | edit source]

References[edit | edit source]

  1. United States Centers for Disease Control and Prevention - Hospital Infection Control Practices Advisory Committee, Guidelines for Isolation Precautions in Hospitals Hospital Infection Control Advisory Committee. 1996. Available from: https://wonder.cdc.gov/wonder/prevguid/p0000419/p0000419.asp [Accessed 21st November 2022].
  2. United States Centers for Disease Control and Prevention, History of Guidelines for Isolation Precautions in Hospitals. Available from: https://www.cdc.gov/infectioncontrol/guidelines/isolation/appendix/history.html [Accessed 21st November 2022].
  3. 3.0 3.1 3.2 Smith P, Watkins K, Hewett A. Infection control through the ages. American Journal of Infection Control. 2012; 40: 35-42.
  4. Ensiklopedia Kesehatan. Body Substance Isolation Precaution. Available from: https://www.youtube.com/watch?v=1XrJ8sIWIbo [last accessed 11/26/2022]
  5. United States Centers for Disease Control and Prevention. Isolation Precautions. Available from:https://www.cdc.gov/infectioncontrol/guidelines/isolation/index.html (accessed 27 November 2022)