Navigation

Summary of guidance relevant to general practice in March 2012

Infection control (update)

GPs and other healthcare professionals should decontaminate their hands immediately after direct contact with patients to prevent the spread of infection in healthcare settings, according to updated guidelines.

The guidance reflects the fact that more and more patients are being seen in primary care and more complex issues are being dealt with by GPs and practice nurses.

The guideline says that hands must be decontaminated immediately before every episode of direct contact with patients, and that this should now include aseptic procedures as well.

Furthermore, hands should be decontaminated after every episode of direct patient contact or care, after to any exposure to body fluids, after contact with a patient's surroundings that could potentially result in hands being contaminated, and after gloves are removed.

GPs and healthcare workers should ensure their hands are decontaminated throughout the duration of clinical work.

They should do this by being bare below the elbow when giving direct patient care, removing wrist and hand jewellery, ensuring fingernails are short, clean and free of nail polish, and by making sure cuts and abrasions have waterproof dressings.

Guidelines on techniques for effective handwashing remain unchanged. However, in a further update, it is recommended that GPs and healthcare workers ensure that gloves that have been exposed and could be contaminated are disposed of correctly, and in accordance with national legislation and local policies.

Used sharps should be discarded immediately by the person generating the sharps waste. The sharps should be disposed of into a sharps container that conforms to current standards.

Additionally, all healthcare workers, including those in community settings must have adequate supplies for decontamination.

Patients and carers should be educated about hand decontamination. This should cover the benefits of hand decontamination, correct techniques and timing over when it is appropriate to use liquid soap, the availability of hand decontamination facilities, and what their roles are in maintaining standards.

Support tools to help you put this guidance into practice

NICE has developed a costing statement, audit and baseline assessment tools to help put this guidance into practice.

Dabigatran (Pradaxa) for atrial fibrillation

Patients with atrial fibrillation can now be offered the drug dabigatran (Pradaxa) as an alternative to warfarin in order to reduce the risk of stroke and blood clots, says NICE.

People with AF are at higher risk of developing blood clots and subsequent stroke. The risk of stroke can be reduced substantially through anticoagulants such as warfarin.

Warfarin has been a routine medication for preventing strokes. But it is inconvenient for some patients because careful monitoring and regular blood tests are needed to prevent excessive bleeding from cuts or stomach ulcers, requiring frequent clinic visits.

Dabigatran is the first new treatment in 50 years to be approved for the prevention of stroke in patients with AF.

The drug is a type of anticoagulant, taken orally, that inhibits the thrombin enzyme and so helps prevents blood from clotting.

In final guidance, NICE recommends that the drug be offered as an option for preventing stroke and blood clots for people with nonvalvular atrial fibrillation who have one or more of certain risk factors.

These include if the patient has had a stroke, a transient ischaemic attack (mini stroke) or embolism in the past, their left ventricular ejection fraction is below 40 per cent, they have had heart failure of New York Heart Association class 2 or above, are 75 or older, or 65 or older with either diabetes mellitus, coronary artery disease or hypertension.

NICE also says that the decision as to whether to start the treatment with dabigatran should be taken after a discussion over its risks and benefits in comparison with warfarin.

These risks and benefits should be considered in light of the person's international normalised ration (INR), in other words, how fast their blood clots.

Support tools to help you put this guidance into practice

NICE has produced a clinical audit tool and an electronic audit tool for this piece of guidance.

28 March 2012

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.

Selected, reliable information for health and social care in one place

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.