History of Guidelines for Isolation Precautions in Hospitals

Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings (2007)

Appendix A: Table 1. *
Isolation precaution documents—a historical perspective.
Year (Ref) Document Issued Comment
Isolation Techniques for Use in Hospitals, 1st ed.
  • Introduced seven isolation precaution categories with color-coded cards: Strict, Respiratory, Protective, Enteric, Wound and Skin, Discharge, and Blood
  • No user decision-making required
  • Simplicity a strength; over isolation prescribed for some infections
Isolation Techniques for Use in Hospitals, 2nd ed.
  • Same conceptual framework as 1st edition
CDC Guideline for Isolation Precautions in Hospitals
  • Provided two systems for isolation: category-specific and disease- specific
  • Protective Isolation eliminated; Blood Precautions expanded to include Body Fluids
  • Categories included Strict, Contact, Respiratory, AFB, Enteric, Drainage/Secretion, Blood and Body Fluids
  • Emphasized decision-making by users
1985-88780, 896
Universal Precautions
  • Developed in response to HIV/AIDS epidemic
  • Dictated application of Blood and Body Fluid precautions to all patients, regardless of infection status
  • Did not apply to feces, nasal secretions, sputum, sweat, tears, urine, or vomitus unless contaminated by visible blood
  • Added personal protective equipment to protect HCWs from mucous membrane exposures
  • Handwashing recommended immediately after glove removal
  • Added specific recommendations for handling needles and other sharp devices; concept became integral to OSHA’s 1991 rule on occupational exposure to blood-borne pathogens in healthcare settings
Body Substance Isolation
  • Emphasized avoiding contact with all moist and potentially infectious body substances except sweat even if blood not present
  • Shared some features with Universal Precautions
  • Weak on infections transmitted by large droplets or by contact with dry surfaces
  • Did not emphasize need for special ventilation to contain airborne infections
  • Handwashing after glove removal not specified in the absence of visible soiling
Guideline for Isolation Precautions in Hospitals
  • Prepared by the Healthcare Infection Control Practices Advisory Committee (HICPAC)
  • Melded major features of Universal Precautions and Body Substance Isolation into Standard Precautions to be used with all patients at all times
  • Included three transmission-based precaution categories: airborne, droplet, and contact
  • Listed clinical syndromes that should dictate use of empiric isolation until an etiological diagnosis is established
* Derived from Garner ICHE 1996