NICE consults on new advice on preventing and controlling healthcare-associated infections

NICE, in partnership with the Health Protection Agency (HPA), is currently developing advice on the prevention and control of healthcare associated infections (HCAIs) in secondary care settings as part of a pilot project. Draft advice, which is aimed at commissioners, managers, clinicians and other professionals working in secondary care settings, and published today for public consultation, identifies the organisational characteristics, arrangements and practices that indicate whether a secondary care trust is effectively preventing and controlling HCAIs.

Healthcare-associated infections are a key priority for the NHS. A range of policies and measures introduced by the Department of Health have been successful in helping the NHS reduce rates of MRSA and Clostridium difficile infection (CDI), but HCAIs remain a significant financial burden for the NHS. In 2009/10 there were nearly 2000 reported incidences of MRSA and over 25,000 reports of CDI at a cost to the NHS of around £260 million1. In addition, in 2009, 77 trusts reported 831 outbreaks of norovirus, the majority of which led to some form of ward closure2.

The 2009 National Audit Office report on reducing HCAIs identified four systemic issues that need to be addressed both locally and nationally in order to reduce infection rates: creating a culture of continuous improvement; the importance of a whole-system approach, with clear structures, roles and responsibilities, to achieve further reductions; ensuring staff compliance with good infection control practice; and monitoring and recording hospital prescription and use of antibiotics.

Drawing on recommendations from the best available evidence, the draft advice consists of 12 statements and indicators that provide specific, concise markers of high quality, cost-effective practice and care in the prevention and control of health care associated infections in secondary care trusts. The quality measures accompanying the advice aim to provide indicators, or ways to measure management and structural processes and associated interventions that improve outcomes in terms of reducing harm from infection in secondary care settings.

The draft statements on the prevention and control of HCAI in secondary care trusts include:

  • Trusts have a surveillance system in place to gather data and monitor HCAIs. The data collected is used to inform responses to HCAI incidents in a timely and appropriate manner.
  • Trusts work proactively engage with multi-agency collaborations to reduce HCAIs within local health and social care organisations.
  • Trusts ensure agreed, multi-agency patient admission discharge and transfer policies provide clear, concise guidance to organisations on critical steps to take to minimise harm from HCAIs.
  • Trust Boards demonstrate leadership to ensure a culture of continuous quality improvement for minimising harm to patients from HCAIs.
  • Trusts prioritise the development of a skilled and knowledgeable workforce that has the capacity and capability to deliver continuous quality improvement to prevent and control HCAIs.
  • Trusts ensure standards of cleanliness above the national minimum requirement and can demonstrate this through visual and objective scientific measurements.

Professor Mike Kelly, Director of the Centre for Public Health Excellence at NICE said: “People who use healthcare services should be entitled to receive safe and effective care, and central to that is the need for effective infection prevention and control. In recent years there has been a significant improvement in the prevention and control of healthcare associated infections, most notably MRSA and clostridium difficile, which has reflected the introduction of a number of policies and procedures designed to reduce rates of infection. Despite these successes, however, healthcare associated infections still pose an unacceptably high burden, both for patients in terms of discomfort, disability and, for some, death, and for the NHS in terms of the cost of dealing with them. Good infection control practice can only be achieved with strong organisational support and commitment to implementing policies that are practicable and effective in preventing and controlling healthcare associated infections. This draft advice outlines how secondary care organisations can take a whole system approach to tackling the problem, based on the best available evidence, and focuses on organisational-level structures, activities and practices. I would encourage all those with an interest in this area to submit their comments on this draft advice via the NICE website.”

Dr Bharat Patel, lead consultant medical microbiologist at the Health Protection Agency said: "Despite the welcome continued reductions in healthcare associated infections in England, infection control is still top of the agenda for the NHS and tackling healthcare associated infections has remained a priority. We cannot afford to become complacent. Health workers must continue to use effective infection control measures in order to drive down infections further.

"This pilot project is very important and aims to continue progressing towards minimising the risks of HCAIs in hospitals across England. The HPA supports this initiative fully and is keen to continue to work closely with colleagues in the NHS to ensure gold standard infection control and prevention in all hospitals. Initiatives such as this will ensure infection prevention and control remains at the top of NHS agenda."

This draft advice has been issued for consultation; NICE has not yet published the final advice to the NHS.

The draft advice is available for consultation on the NICE website from Monday 4 July until 5.00pm on 9 August at:

All eligible comments will be reviewed by the independent Topic Expert Group and the advice will be refined in light of this information. The final public health advice for the prevention and control of HCAI in secondary care settings is expected to be published in November 2011.


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Notes to Editors

About NICE

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 throughits 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.


1 Department of Health (2010) NHS outcomes framework 2011/12 impact assessment. London: Department of Health

2 Health Protection Agency (2010) Healthcare-associated infections and antimicrobial resistance: 2009/10. London: Health Protection Agency

This page was last updated: 04 July 2011

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Copyright 2014 National Institute for Health and Care Excellence. All rights reserved.

Accessibility | Cymraeg | Freedom of information | Vision Impaired | Contact Us | Glossary | Data protection | Copyright | Disclaimer | Terms and conditions

Copyright 2014 National Institute for Health and Care Excellence. All rights reserved.