Updated NICE clinical guideline provides a blueprint for the prevention of healthcare associated infections in primary and community care
Healthcare guidance body NICE has today (28 March) published its updated guideline on the prevention and control of healthcare-associated infections (HCAIs) in primary and community care. The guideline provides a blueprint for the infection prevention and control precautions that should be applied by everyone involved in the care of people who are having treatment or care either in their own home or elsewhere in the community (for example, in a care home, a GP surgery, health centre, school or prison and by the ambulance service) where NHS healthcare is provided or commissioned.
HCAIs are caused by a wide range of microorganisms. These are often carried by the patients themselves, and have taken advantage of a route into the body provided by an invasive device or procedure. HCAIs can exacerbate existing or underlying conditions, delay recovery and adversely affect quality of life. Healthcare workers, family members and carers are also at risk of acquiring infections when caring for patients. HCAIs are estimated to cost the NHS approximately £1 billion a year, £56 million of which 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 HCAI.
The updated guideline takes into account new evidence that has been published since NICE's original guideline in 2003. As well as revisiting the original recommendations on the standard principles for preventing healthcare-associated infections (hand hygiene, the use of personal protective equipment and the safe use and disposal of sharps) and those resulting from percutaneous gastrostomy feeding and vascular access devices, the updated guideline also makes new recommendations on the disposal of healthcare waste. New legislation has also meant that many of the original recommendations, as well as some of those developed as part of this review, are now mandatory. The Guideline Development Group was also aware that, for some recommendations, the consequence of not implementing them meant that the risk of adverse events, including death, was severe. Both these circumstances are reflected in the frequent use of "must" throughout the guideline. For example, one of the key priorities for implementation is that wherever care is delivered, healthcare workers must have available appropriate supplies of materials for hand decontamination, sharps containers and ,personal protective equipment.
As its starting point, the updated guideline states that 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.
Patients and carers should also be educated 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 and their role in maintaining standards of healthcare workers' hand decontamination. The guideline also states that, wherever care is delivered, healthcare workers must have available appropriate supplies of materials for hand decontamination, sharps containers and personal protective equipment.
The guideline also takes into account new evidence and makes new recommendations on:
Standard principles of hand decontamination, including the circumstances after which hands should be decontaminated and how healthcare workers should ensure that their hands can be decontaminated throughout the duration of clinical work.
- Use of personal protective equipment/clothing
- The safe use and disposal of sharps
- The use of long-term urinary catheters, including the use of antibiotic prophylaxis when changing an indwelling urinary catheter.
- Enteral feeding systems
- Vascular access devices
Christine Carson, Programme Director, Centre for Clinical Practice at NICE, said: "As a result of the rapid turnover of patients in acute care settings, complex care is increasingly being delivered in the community. This includes the care given to a large population group living at home and in care homes who have long-term conditions and who need to use catheters and venous access devices.Infection prevention in these settings is therefore just as important as in hospital. Because much care is delivered by informal carers and family members - there are currently approximately 6 million unpaid carers in the UK, a number that is likely to increase with an aging population - this guideline is as applicable to them as it is to healthcare professionals . The guideline states that everyone involved in providing care, including patients themselves, 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. These issues should be at the top of the agenda for anyone who provides care for a patient, regardless of setting and regardless of whether they are a healthcare professional, an informal carer or a family member."
Dr Julian Spinks, GP and member of the Guideline Development Group, said: "At a time where increasingly complex procedures are being provided in primary care, infection control is becoming more and more important. This guideline provides information about effective and practical measures that primary care clinicians can take to reduce the burden of healthcare-associated infection and forms an important part of the armoury for those of us who wish to provide high quality care in the community."
Zara Head, Nurse Practitioner and member of the Guideline Development Group, said: "The new guidance reflects the fact that more and more patients are being seen in primary care and more complex issues are being dealt with. It also reflects the fact that patient safety is the cornerstone of care and remains our priority."
Brian Pullen, Infection Control Manager and Registered Paramedic, South East Coast Ambulance Service NHS Foundation Trust and member of the Guideline Development Group said: "This updated guideline is not just aimed at healthcare workers, but also the patients and service users, their relatives and carers. These recommendations will make a profound difference by increasing patient safety and further enhancing the quality of care in the community and primary care setting."
Elizabeth Gibbs, Patient member of the Guideline Development Group and member of National Alliance of Childhood Cancer Parents Organisations (NACCPO), said: "Raising awareness among the general public could be the biggest factor in the prevention and control of current and future healthcare associated infections. Because everyone can be a patient or a relative or friend caring for a patient, this infection prevention and control guideline is not just for health care professionals, it is for all of us."
Notes to Editors
About the guideline
1. The clinical guideline is available on the NICE website at http://guidance.nice.org.uk/CG139 (from 28 March).
2. NICE, in partnership with the Health Protection Agency, has also produced a quality improvement guide on the prevention and control of healthcare-associated infections in secondary care. The guide is available on the NICE website at http://www.nice.org.uk/guidance/phg/hcai/QualityImprovementGuide.jsp
1. The National Institute for Health and Care Excellence (NICE) is the independent organisation responsible for providing national guidance and standards on the promotion of good health and the prevention and treatment of ill health
2. NICE produces guidance in three areas of health:
- public health - guidance on the promotion of good health and the prevention of ill health for those working in the NHS, local authorities and the wider public and voluntary sector
- health technologies - guidance on the use of new and existing medicines, treatments, medical technologies (including devices and diagnostics) and procedures within the NHS
- clinical practice - guidance on the appropriate treatment and care of people with specific diseases and conditions within the NHS.
3. NICE produces standards for patient care:
- quality standards - these reflect the very best in high quality patient care, to help healthcare practitioners and commissioners of care deliver excellent services
- Quality and Outcomes Framework - NICE develops the clinical and health improvement indicators in the QOF, the Department of Health scheme which rewards GPs for how well they care for patients
4. NICE provides advice and support on putting NICE guidance and standards into practice through its implementation programme, and it collates and accredits high quality health guidance, research and information to help health professionals deliver the best patient care through NHS Evidence.
This page was last updated: 26 March 2012