Key priorities for implementation

Key priorities for implementation

The following recommendations have been identified as priorities for implementation.

Standard principles: general advice

  • Everyone involved in providing care should be:

  • Wherever care is delivered, healthcare workers must[2] 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[3] for patients who:

      • have a history of symptomatic urinary tract infection after catheter change or

      • experience trauma[4] 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[5]. [2003, amended 2012]

  • Healthcare workers caring for a patient with a vascular access device[5] 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]

[3] At the time of publication of the guideline (March 2012), no antibiotics have a UK marketing authorisation for this indication. Informed consent should be obtained and documented.

[4] The GDG defined trauma as frank haematuria after catheterisation or two or more attempts of catheterisation.

[5] The updated recommendation contains 'vascular access device' rather than 'central venous catheter'. This change has been made because peripherally inserted catheters were included in the scope of the guideline update.

  • NICE has accredited the process used by the Centre for Clinical Practice at NICE to produce guidelines. Accreditation is valid for 5 years from September 2009 and applies to guidelines produced since April 2007 using the processes described in NICE's 'The guidelines manual' (2007, updated 2009). More information on accreditation can be viewed at
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