BODY SUBSTANCE PRECAUTIONS (BSP):
DRESSING FOR THE OCCASION
The concepts and principles of universal and body substance precautions (BSP) were introduced in the late 1980's in response to the growing concern among hospital staff about the risk of transmission of HIV and other blood-borne pathogens. BSP is a practice which requires health care workers to consider all body substances (including blood, serous fluid, urine, feces, saliva, sputa, and other bodily fluids and secretions) from patients and the immediate patient environment as being potentially infectious or carrying microorganisms which may be transmitted from one patient to another.
The concept of BSP provides a system which interrupts the cross transmission of organisms from infected or colonized patients and provides increased protection for both patients and health care providers (HCP). The use of appropriate barrier precautions, whether gloves, gowns or masks is determined by an assessment of the degree of exposure to body substances anticipated by the HCP. Therefore it is interaction rather than diagnosis driven where the HCP uses appropriate barrier precautions for the task at hand which is akin to dressing accordingly for the type of weather which is to be encountered.
Basic Principles Of BSP
Good handwashing after any contact with the patient or the patient's immediate environment (regardless of the use of gloves) remains the most effective method of preventing transmission of microorganisms.
Gloves are to be worn for any anticipated contact with blood, body substances of any kind (including urine, feces, and saliva), mucous membranes and non-intact skin, and are never worn between patients or washed.
Either latex or vinyl gloves are appropriate for most non-sterile patient care activities, although latex may provide a better fit for some tasks.
Long sleeve cloth gowns should be worn to prevent arms or clothing becoming soiled depending on the task being performed.
Masks should be worn if the patient is not able to cover his/her mouth when coughing, if there may be spraying of blood or secretions, or if a patient is on respiratory precautions.
Respiratory isolation should include a negative pressure room, the use of masks, the doors closed and a stop sign.
Plastic aprons should be worn if there may be soiling of the HCP clothing.
Eye protection/ face shields should be worn if there is a possibility of splashing or spraying of fluid.
Needles must not be recapped and are to be placed into puncture resistant sharps containers.
All linen, including that from an isolation room, is to be placed into a single clear plastic bag, and double bagging is not required unless the bag is ripped.
All laboratory specimens must be placed into plastic bags and secured.
There is no "special" terminal cleaning of a room required, except under special circumstances as requested by Infection Control, as through cleaning should always be done. Terminal "fogging" of rooms is a relic of the past.
All spills, whether blood or body fluid, must be carefully cleaned up and the area disinfected as soon as possible.
Single rooms are used for respiratory isolation for patients who may soil the environment and in specific settings as deemed necessary by Infection Control (i.e. antibiotic-resistant organisms or organisms with enhanced virulence).
Examples:
Any diarrheal illness must be treated with good handwashing, gloves, gowns or aprons as necessary with on-going cleaning of the patient environment, toilet, equipment and commode chair.
Handwashing and the appropriate use of gloves, eye protection or gowns and aprons as necessary should be considered for any blood/body fluid exposure (e.g. Invasive procedure, surgeries) either directly or indirectly through immediate patient environment.
Gowns should be used when caring for patients with drug-resistant organisms or untreated Scabies.
Eye protection or face shields when cannulating a haemodialysis fistula or caring for a bleeding trauma patient in the emergency department.
Masks are to be worn by a patient who is in Respiratory isolation whenever out of the room.
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