NICE consults on updated clinical guideline on prevention of healthcare associated infections in primary and community care
The National Institute for Health and Care Excellence (NICE) has today published draft guidelines on the prevention and control of healthcare-associated infections in primary and community care. In taking into account new evidence that has been published since NICE's original guideline in 2003, the draft guideline provides the most comprehensive and up-to-date set of recommendations yet on infection prevention and control precautions that should be applied by all healthcare workers in the care of patients in community and primary care settings, including ambulance services.
As well as updating 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 the use of long-term urinary catheters, enteral (artificial) feeding systems and vascular access devices (VADs), the draft guideline also makes new recommendations on the disposal of healthcare waste.
In 2004, the Department of Health reported that approximately 300,000 healthcare-associated infections occurred per year in hospital and primary care in the UK. In 2007, infectious diseases accounted for 70,000 deaths, 150,000 hospital admissions and 40% of GP consultations in the UK. In the same year, meticillin resistant Staphylococcus aureus (MRSA) bloodstream infections and Clostridium difficile infections were recorded as the underlying cause of, or a contributory factor to, approximately 9000 deaths in hospital and primary care. On average, these infections add 11 days of hospitalisation for each person infected and cost the NHS around £1 billion a year (£56 million of which is estimated to be incurred following discharge of patients from hospital).
Draft key recommendations include:
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 protective clothing and the safe use and disposal of sharps.
Hands must be decontaminated in all of the following circumstances:
- immediately before every episode of direct patient contact or care
- 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.
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.
Skin Decontamination prior to insertion of peripheral VADs
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.
Draft recommendations on healthcare waste disposal include that it must be labelled, stored, transported and disposed of in accordance with current national legislation and local policies, and that patients and carers are educated about its correct handling, storage and disposal.
Dr Fergus Macbeth, Director of the Centre for Clinical Practice at NICE said: "Advances in healthcare mean that many more people now survive serious illness and injury. However, the downside to this is that there is 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, which puts them at increased risk of healthcare associated infections. These can exacerbate existing or underlying conditions, delay recovery and adversely affect quality of life. Since the original NICE guideline was published in 2003, new evidence has emerged about the most effective ways to minimise the risk of such infections and this has been reviewed by the Guideline Development Group.
Dr Macbeth continued: "In addition, 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. Patient safety has rightly become a cornerstone of care and preventing healthcare-associated infections remains a key priority in the patient safety agenda. The updated NICE guideline will reassure those who use primary and community healthcare services that the NHS is following the most up-to-date advice on the best ways to minimise the risks of healthcare-associated infections."
Notes to Editors
About the draft guideline
1. The draft clinical guideline is available on the NICE website at http://guidance.nice.org.uk/CG/WaveR/85
2. NICE, in partnership with the Health Protection Agency, is also producing advice on the prevention and control of healthcare-associated infections, in secondary care. Draft advice is available on the NICE website at http://www.nice.org.uk/guidance/phg/advicehealthcareassociatedinfectionsconsultation.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: 12 July 2011