CHAPTER ONE
1.0 INTRODUCTION
1.1 BACKGROUND OF STUDY
The pandemic of human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS) in the 1980s challenged health care personnel. The emotional response to a public health threat required a focus on the essential issues: how do health do health care personnel in all settings provide care and service to infected patients while protecting themselves from acquiring the disease? The (CDC) reflected a principle that has become routine for personnel in diverse health care arena.
In 1877, infected patients were quarantined with other sick patients in special houses known as infectious disease hospitals. However, patients acquired other infectious disease from infected patients until those with the same diseases were grouped in the same room. This was isolation and cohort concept. Observation by health care personnel noted that controlling the spread of disease would involve more prevention, thus nursing aseptic procedure were added to control disease transmission.
By 1910, the cubic system of placing infected patients in multiple bed wards was introduced. Nurses wore gowns as barrier attire and antiseptic hand cleansing followed patient contact. Disinfection of patient contaminated object was accomplished.
In 1950, when staphylococci out break were occurring, infected patients were segregated in a single, specially designed isolation room or regular hospital patient rom.
In 1970, Centre for disease control (CDC) published its initial isolation technique, “isolation techniques for use in hospital 1st edition” detailing the requirements and rationale for safe patient isolation practices in hospitals of varying sizes.
A coloured card system of isolation was developed designating five categories: strict isolation, respiratory isolation, protective isolation enteric precaution and wound and skin precautions.
In 1975 revision, specific safety requirements pertained to disposable needles and syringes with no recapping, reuse and purposely bending them before depositing them in a prominently labelled, impervious puncture-resistant container for incineration or autoclaving before discarding. Updated isolation techniques came in 1978 as new syndromes were identified “isolation techniques for use in hospital, 2nd edition”
By 1983, the title of isolation precaution in hospitals” and consulted with CDC personnel in these guidelines. The major changes in 1983 guideline were designating seven isolation categories were added to the five categories of 1970 which are: tuberculosis isolation and contact isolation. Health care workers employed their critical decision making skills to protect themselves with barriers to tailor the precautions based on the age, and behaviour of the patient in isolation and to establish a balance between the ideal and practical precautions to isolate the disease, not the patient.
In august 1987, CDC initially introduced the concept of universal precautions (UP), stating blood and certain body fluid of all patients are considered potentially infectious for HIV, hepatitis B virus (HBV) and other blood borne infection status.
The universal precaution requirements espoused barrier techniques to block persons from bodily fluid and supported vaccination against hepatitis B virus.
In 1987, another approach, body substance isolation (BSI), advocated that all moist body substance were potentially infectious and gloves should be worn for anticipated contact with these substances.
The term “standard precaution” (SP) appeared in the 1966 CDC isolation revision. The preamble to these recommendations explains that standard precautions are a synthesis of two other precautions, universal precautions and body substance isolation and apply to all patients receiving health care regardless of their diagnosis or presumed infection state.
Thus, standard precaution is the current isolation terminology and the fundamental premise employed by health care personnel when rendering care to every patient.
In 2007, safe injection practices, respiratory hygiene, cough etiquette and infection control practice for lumber puncture procedure were added.
