Healthcare Hygiene magazine August 2020 | Page 6
from the editor
UPPs Require a Paradigm Shift
In
a recent commentary, Weber, et
al. (2020) suggested the adoption
of what they call Universal Pandemic
Precautions, likened to the creation of
Universal Precautions (now called Standard
Precautions) which was a response to the HIV
epidemic-driven threat of bloodborne pathogens.
Standard Precautions recommend that
healthcare personnel (HCP) wear gloves for
anticipated contact with all body fluids.
The researchers remind us that, “Although
there was some initial pushback with
the implementation of Standard Precautions
due to concern that routine wearing of
gloves would be poorly received by patients
and impair the ability to perform procedures
such as placing intravenous catheters, they
are routinely practiced and accepted today.”
They add, “Similarly, the threat proffered
by the sudden appearance of COVID-19 in
the healthcare workplace resulted in the
implementation of risk mitigation strategies
that may also produce permanent behavioral
modification in the healthcare setting. As
happened during the 1980’s with the HIV/
AIDS epidemic, the introduction of a new
disease and new risks into the healthcare
setting should result in long-lasting changes
in patient care that at least offer potential for
increased patient and staff safety.”
There’s no doubt that measures need
to be taken to prevent SARS-CoV-2 transmission,
just like any infectious pathogen;
hospitals know the drill, including: screening
patients, visitors and HCP for COVID-19
symptoms prior to entry; routine use of
source control masks by patients, visitors
and HCP; frequent hand hygiene and
surface disinfection of shared equipment and
devices; enhanced PPE for HCP performing
aerosol-generating procedures and during
care of known or suspected patients with
COVID-19; and prompt testing of persons
with signs/symptoms of COVID-19 and
appropriate isolation precautions.
However, are we ready for a shift to
implementation of Universal Pandemic
Precautions (UPPs) – use of a mask and eye
protection for all direct patient contacts
or at a minimum, use of a mask and eye
protection for direct patient contact when
the patient is unable or unwilling to wear a
mask. The researchers say this is necessary
due to several factors: transmission from
pre-symptomatic an/or asymptomatic
COVID-19 patients; use of masks and
eye protection by HCP protects against
acquisition of SARS and SARS-CoV-2;
and use of UPPs would prevent HCP from
having an exposure that per the CDC would
lead to exclusion from work for 14 days.
They add that UPPS will “likely also offer a
potential beneficial effect on the prevention
of transmission of other droplet-spread
respiratory pathogens in the healthcare
setting (e.g., influenza A and B, respiratory
syncytial virus, seasonal coronaviruses, etc.),
especially during seasons in which these
and other respiratory viruses are circulating.”
In their pitch, Weber, et al. (2020)
acknowledge, “We understand that
implementation of UPPs will require
careful messaging for our colleagues and
patients. We expect that the rationale …
will be persuasive for our colleagues to
accept UPPs. Messaging to patients should
focus on describing the rationale for UPPs
including noting that use of UPPs is one of
several precautions that protect patients.
In addition, patients should be informed
that this is routine practice not specifically
focused on them individually. Finally, we
realize that institution and discontinuation
of UPPs should be based on current local
case numbers (or rates or burden) and local
prevalence of infection in asymptomatic populations
(e.g., pre-procedural test positivity
rates, as symptom screening cannot detect
these potentially infectious patients. We
realize that paradigm shifts are difficult and
as demonstrated by Semmelweis may not
be accepted. However, ultimately the use of
hand hygiene as advocated by Semmelweis
became a keystone of infection prevention.
We believe that UPPs will be accepted by
patients and staff and that it will ultimately
result in a safer healthcare environment
for all.”
What do you think?
Until next month, bust those bugs!
Kelly M. Pyrek
Editor & Publisher
[email protected]
healthcarehygienemagazine
Kelly M. Pyrek
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Reference: Weber DJ, Hayden MK,
Wright SB, et al. State of the Pandemic Commentary:
Universal Pandemic Precautions – an
Idea Ripe for the Times. Infect Control Hosp
Epidemiol. DOI: 10.1017/ice.2020.327
6 august 2020 • www.healthcarehygienemagazine.com