Beyond universal precautions.

Universal precautions have gained wide acceptance in the literature and are promoted by major health care regulatory bodies as a measure to prevent nosocomial transmission of bloodborne diseases. Nevertheless, Dr. James G. Wright and associates (see pages 1089 to 1095 of this issue) provide evidence of the infrequent use of universal precautions by surgeons in Toronto. Their findings are consistent with those of similar studies and point to the limitations of any safety approach that relies on the active compliance of individuals rather than on passive, environmental controls. Successful approaches to optimizing workplace safety should first emphasize passive measures for risk abatement, including firm policies, the use of safer equipment and techniques, procedural safeguards and regular monitoring. Routine voluntary screening of patients undergoing procedures that pose a high risk of contamination may improve compliance to safety procedures by health care personnel. Further study is required.