A wide variety of healthcare is delivered in primary and community care settings. Healthcare-associated infections arise across a wide range of clinical conditions and can affect patients of all ages. Healthcare workers, family members and carers are also at risk of acquiring infections when caring for patients.

Healthcare-associated infections can occur in otherwise healthy individuals, especially if invasive procedures or devices are used. For example, indwelling urinary catheters are the most common cause of urinary tract infections, and bloodstream infections are associated with vascular access devices.

Healthcare-associated infections 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. Healthcare-associated infections can exacerbate existing or underlying conditions, delay recovery and adversely affect quality of life.

Patient safety has become a cornerstone of care, and preventing healthcare-associated infections remains a priority. It is estimated that 300,000 patients a year in England acquire a healthcare-associated infection as a result of care within the NHS. In 2007, meticillin-resistant Staphylococcus aureus (MRSA) bloodstream infections and Clostridium difficile infections were recorded as the underlying cause of, or a contributory factor in, approximately 9000 deaths in hospital and primary care in England.

Healthcare-associated infections are estimated to cost the NHS approximately £1 billion a year, and £56 million of this 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 healthcare-associated infections.

In 2012, this guideline updated and replaced the clinical guideline on infection control: prevention of healthcare-associated infection in primary and community care (CG2). We updated and replaced the recommendations to reflect the many changes that have happened in the NHS to help ensure patients' interests are at the centre of all activities. These changes include the launch of the NHS Constitution for England, which defines the rights and pledges that every patient can expect regarding their care. The Care Quality Commission (CQC), the independent regulator of all health and adult social care in England, which helps to ensure that health and social care is safe and monitors how providers comply with established standards. In addition, the legal framework that underpins the guidance has changed since 2003.

The 2012 guidance was also needed to reflect the fact that, due to the rapid turnover of patients in acute care settings, complex care is increasingly being delivered in the community. New standards for the care of patients and the management of devices are needed to prevent related healthcare-associated infections that could reinforce the principles of asepsis.

The 2012 guideline also addressed areas in which clinical practice for preventing healthcare-associated infections in primary and community care have changed, where the risk of healthcare-associated infections is greatest or where the evidence has changed (see update information for more details). Where high-quality evidence is lacking, the Guideline Development Group (GDG) highlighted areas for further research.

This guideline assumes that all providers of healthcare in primary and community care settings are compliant with current code of practice on preventing and controlling infections. It aims to help build on advice given in the code and elsewhere to improve the quality of care and practice in these areas over and above current standards.

The GDG recognises the important contribution that surveillance makes to monitoring infection, but it is not within the scope of this guideline to make specific recommendations about this subject.

Medical Device Regulations

The Medical devices regulations implement the EC Medical Devices Directives into UK law. They place obligations on manufacturers to ensure that their devices (including medical gloves, needles and other devices discussed in this guideline) are safe and fit for their intended purpose before they are CE marked and placed on the market in any EC member state. Guidance on the MHRA's adverse incident reporting system is available for reporting adverse incidents involving medical devices.