Standard Precautions and Universal Precautions
Schools and Early Childhood and Education programs (ECE) provide safe, supportive environments that promote student health and well-being. The Centers for Disease Control and Prevention (CDC) recommends implementing everyday prevention strategies as part of normal operations to reduce illness and illness-related absenteeism. These strategies include standard precautions, and additional infection prevention measures.
CDC recommends adherence to standard precautions that represent a broader approach designed to prevent all types of infection transmission, whereas the Occupational Safety and Health Administration (OSHA) still mandates adherence to universal precautions to control occupational exposure to bloodborne pathogens (BBPs) to comply with their safety.
Standard Precautions
Standard Precautions are used to reduce the risk of transmission of microorganisms (germs) that can cause infection—even when a person is not known or suspected to be infectious.
They apply to contact with:
- Blood
- All body fluids and excretions (except sweat)
- Non-intact skin
- Mucous membranes
Standard precautions include:
- Hand hygiene
- Respiratory hygiene and cough etiquette
- Use of personal protective equipment (PPE)
- Cleaning and disinfection
- Proper placement of ill and well individuals
- Adequate ventilation
Hand Hygiene
Handwashing is the single most important way to prevent the spread of communicable diseases.
Proper Handwashing
- Use soap and water for at least 20 seconds.
- Dry hands thoroughly with disposable paper towels.
- If soap and water are unavailable, use hand sanitizer with at least 60% alcohol.
Wash Hands:
- Upon arrival and before leaving
- When moving between groups of children
- Before and after:
- Eating or handling food
- Feeding a child
- Administering medication
- Water play
- After:
- Diapering or using the toilet
- Handling bodily fluids
- Handling uncooked food
- Contact with animals or cleaning cages/litter boxes
- Outdoor play, sandboxes, or playground use
- Handling trash
Teach and reinforce proper handwashing techniques for children.
For additional information, refer to CDC's About Hand Hygiene in Schools and Early Care and Education Settings.
Respiratory Hygiene & Cough Etiquette
Teaching respiratory etiquette reduces the spread of respiratory viruses, such as:
Reinforce:
- Cover mouth and nose with a tissue when coughing or sneezing
- Dispose of tissues immediately in the trash
- If no tissue is available, cough or sneeze into the elbow—not hands
- Wash hands immediately after coughing, sneezing, or blowing the nose
- Avoid close contact with sick individuals
- Stay home when ill, when possible
For details click on CDC's Healthy Habits: Coughing and Sneezing.
Personal Protective Equipment (PPE)
PPE minimizes exposure to infectious materials.
Types of PPE:
- Gloves – For contact with blood, body fluids, mucous membranes, or non-intact skin
- Masks/Respirators – To reduce droplet or airborne transmission
- Gowns – To protect skin and clothing
- Face shields/Goggles – To protect eyes, nose, and mouth from splashes or sprays
Important:
- Remove and dispose of PPE properly after use
- Perform hand hygiene immediately after removing PPE
- School nurses and health staff should follow healthcare-specific guidance when applicable
Guidance intended for healthcare settings, such as CDC's Core Infection Prevention and Control Practices for Safe Healthcare Delivery in All Settings, is appropriate for school health staff, for example, school nurses or school-based health center personnel.
Cleaning, Sanitizing, and Disinfecting
Cleaning
Removes dirt and most germs using soap, water, and scrubbing.
- Clean frequently touched surfaces regularly:
- Toys
- Door handles
- Tables
- Faucets
- Drinking fountains
Sanitizing
Reduces germs to safe levels.
Use:
- Weaker bleach solutions
- EPA-registered sanitizing sprays
- Dishwasher (for appropriate items)
Sanitize:
- Items that contact children's mouths
- Infant feeding items
- Toys
Disinfecting
Kills remaining germs after cleaning.
Use:
- Stronger bleach solutions
- EPA-registered disinfectants
Disinfect:
- During illness outbreaks
- When surfaces are visibly soiled
- After contamination with blood or bodily fluids
Best Practices:
- Always clean before sanitizing or disinfecting
- Follow product label instructions
- Increase frequency during outbreaks
- Maintain a cleaning schedule chart
- Follow strict diapering and feeding sanitation procedures
Look for environmentally safer products labeled by the EPA's Design for the Environment (DfE) program under the Federal Insecticide, Fungicide, and Rodenticide Act (FIFRA).
For additional details, review information in:
CDC: How to Clean and Disinfect Early Care and Education Settings
CDC: Healthy Habits: Diaper Changing Steps for Childcare Settings
CDC: How to Clean, Sanitize, and Store Infant Feeding Items Frequently Asked Questions
CDC: Cleaning and Disinfecting with Bleach
CDC: How to Safely Clean and Sanitize with Bleach
EPA: Selected EPA-Registered Disinfectants
EPA: Learn About Design for the Environment (DfE) Certification
Proper Placement of Ill and Well Individuals
Isolation
- Designate an isolation room or area
- Ensure adult supervision for ill children
- Send sick children home promptly
- Communicate exclusion policies clearly to parents
Separation Strategies:
- Space sleeping areas (mats, cribs, cots) apart
- Keep children in consistent groups
- Assign caregivers consistently
- Separate diapered and toilet-trained children
- Ensure food handlers do not perform diapering during food preparation times
Adequate Ventilation
Ventilation reduces airborne virus particles and supports healthy indoor environments.
Strategies:
- Open windows and doors when safe
- Air out rooms daily—even in winter
- Use child-safe fans
- Conduct activities outdoors when possible
- Optimize HVAC system settings
- Use exhaust fans in restrooms and kitchens
- Keep vehicle windows open when safe
Refer to CDC guidance on Ventilation in Schools and Childcare Programs for details.
Universal Precautions
The Occupational Safety and Health Administration defines Universal Precautions to prevent exposure to:
- Blood
- Body fluids visibly contaminated with blood
These precautions primarily protect healthcare personnel (HCP), including school nurses, from occupational exposure to bloodborne pathogens such as:
- Hepatitis B Virus (HBV)
- Hepatitis C Virus (HCV)
- HIV
HBV vaccination is strongly recommended for HCP at risk of exposure.
Exposure Incident Protocol
If a needlestick, cut, or blood exposure occurs:
- Wash the site immediately with soap and water
- Flush splashes to nose, mouth, or skin with water
- Irrigate eyes with clean water or saline
- Report the incident to a supervisor immediately
- Seek medical evaluation promptly
- Begin recommended post-exposure treatment as soon as possible
For details visit:
CDC: Best Practices for Occupational Exposure to Blood
CDC: Bloodborne Infectious Disease Risk Factors (includes management of exposure)
OSHA: Worker protections against occupational exposure to infectious diseases
Additional resources:
CDC: Everyday Actions for Schools to Prevent and Control the Spread of Infections
CDC: When Students or Staff are Sick
CDC: Protecting Against Infections in Early Care and Education Programs
Implementing Standard and Universal Precautions as part of daily school and childcare operations protects students, staff, and families. Consistent hand hygiene, respiratory etiquette, proper use of PPE, thorough cleaning practices, thoughtful separation policies, and effective ventilation significantly reduce the spread of infectious diseases and promote a healthy learning environment.
