Table 1.

History of guidelines for isolation precautions in hospitals^∗

Year (reference)	Document issued	Comments
19701095	Isolation Techniques for Use in Hospitals, 1st ed	• Introduced 7 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; overisolation prescribed for some infections.
19751100	Isolation Techniques for Use in Hospitals, 2nd ed	• Same conceptual framework as first edition.
19831096, 1097	Guideline for Isolation Precautions in Hospitals	• Provided 2 systems for isolation: category-specific and disease-specific.
		• Protective isolation eliminated; blood precautions expanded to include body fluids.
		• Categories included strict, contact, respiratory, acid-fast bacteria, enteric, drainage/secretion, blood and body fluids.
		• Emphasized decision making by users.
1985-88778, 894	Universal Precautions	• Developed in response to the 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 health care workers from mucous membrane exposures.
		• Handwashing recommended immediately after glove removal.
		• Added specific recommendations for handling needles and other sharp devices; concept became integral to the OSHA's 1991 rule on occupational exposure to blood-borne pathogens in health care settings.
19871098	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.
19961	Guideline for Isolation Precautions in Hospitals	• Prepared by the Healthcare Infection Control Practices Advisory Committee.
		• Melded major features of Universal Precautions and body substance isolation into Standard Precautions to be used with all patients at all times.
		• Included 3 transmission-based precaution categories: Airborne, Droplet, and Contact.
		• Listed clinical syndromes that should dictate use of empiric isolation until an etiologic diagnosis is established.

^∗Derived from Garner and Simmons.¹⁰⁹⁹