Healthcare-associated infections: prevention and control in primary and community care – NICE guideline

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This National Institute for Health and Care Excellence (NICE) guideline covers preventing and controlling healthcare-associated infections in children, young people and adults in primary and community care settings. It provides a blueprint for the infection prevention and control precautions that should be applied by everyone involved in delivering NHS care and treatment.

Key recommendations

Standard principles: general advice

  • Everyone involved in providing care should be:
    • educated about the standard principles of infection prevention and control and
    • trained in hand decontamination, the use of personal protective equipment, and the safe use and disposal of sharps. [2012]
  • Wherever care is delivered, healthcare workers must have available appropriate supplies of:
    • materials for hand decontamination
    • sharps containers
    • personal protective equipment. [new 2012]
  • Educate patients and carers about:
    • the benefits of effective hand decontamination
    • the correct techniques and timing of hand decontamination
    • when it is appropriate to use liquid soap and water or handrub
    • the availability of hand decontamination facilities
    • their role in maintaining standards of healthcare workers' hand decontamination. [new 2012]

Standard principles for hand decontamination

  • Hands must be decontaminated in all of the following circumstances:
    • immediately before every episode of direct patient contact or care, including aseptic procedures
    • immediately after every episode of direct patient contact or care
    • immediately after any exposure to body fluids
    • immediately after any other activity or contact with a patient's surroundings that could potentially result in hands becoming contaminated
    • immediately after removal of gloves. [new 2012]

Long-term urinary catheters

  • Select the type and gauge of an indwelling urinary catheter based on an assessment of the patient's individual characteristics, including:
    • age
    • any allergy or sensitivity to catheter materials
    • gender
    • history of symptomatic urinary tract infection
    • patient preference and comfort
    • previous catheter history
    • reason for catheterisation. [new 2012]
  • All catheterisations carried out by healthcare workers should be aseptic procedures. After training, healthcare workers should be assessed for their competence to carry out these types of procedures. [2003]
  • When changing catheters in patients with a long-term indwelling urinary catheter:
    • do not offer antibiotic prophylaxis routinely
    • consider antibiotic prophylaxis for patients who:
      • have a history of symptomatic urinary tract infection after catheter change or
      • experience trauma during catheterisation. [new 2012]

Vascular access devices

  • Before discharge from hospital, patients and their carers should be taught any techniques they may need to use to prevent infection and safely manage a vascular access device. [2003, amended 2012]
  • Healthcare workers caring for a patient with a vascular access device should be trained, and assessed as competent, in using and consistently adhering to the infection prevention practices described in this guideline. [2003, amended 2012]
  • Decontaminate the skin at the insertion site with chlorhexidine gluconate in 70% alcohol before inserting a peripheral vascular access device or a peripherally inserted central catheter. [new 2012]

Clinical context

Patient safety has become a cornerstone of care, and preventing healthcare-associated infections remains a priority. It is estimated that 300,000 patients a year in England acquire a healthcare-associated infection as a result of care within the NHS. In 2007, meticillin-resistant Staphylococcus aureus (MRSA) bloodstream infections and Clostridium difficile infections were recorded as the underlying cause of, or a contributory factor in, approximately 9,000 deaths in hospital and primary care in England.

Healthcare-associated infections are estimated to cost the NHS approximately £1 billion a year, and £56 million of this is estimated to be incurred after patients are discharged from hospital. In addition to increased costs, each one of these infections means additional use of NHS resources, greater patient discomfort and a decrease in patient safety. A no-tolerance attitude is now prevalent in relation to avoidable healthcare-associated infections.

Audience

The population covered in this guideline is all adults and children receiving healthcare for which standard infection-control precautions apply in primary care and community care. This guideline is commissioned by the NHS, but people providing healthcare in other settings, such as private settings, may also find the guidance relevant.

This guideline applies to all healthcare workers employed in primary and community care settings, including ambulance services, and should ensure safe practice if applied consistently. Much care is also delivered by informal carers and family members, and this guideline is equally applicable to them.

Rationale for the update

Since the publication of the NICE clinical guideline on the prevention of healthcare-associated infection in primary and community care in 2003, many changes have occurred within the NHS that place the patient firmly at the centre of all activities. First, the NHS Constitution for England defines the rights and pledges that every patient can expect regarding their care. To support this, the Care Quality Commission (CQC), the independent regulator of all health and adult social care in England, ensures that health and social care is safe, and monitors how providers comply with established standards. In addition, the legal framework that underpins the guidance has changed since 2003.

New guidance is needed to reflect the fact that, as a result of the rapid turnover of patients in acute care settings, complex care is increasingly being delivered in the community. New standards for the care of patients and the management of devices to prevent related healthcare-associated infections are needed that will also reinforce the principles of asepsis.

You can read the guideline on NICE's website.