Key priorities for implementation

The following recommendations have been identified as priorities for implementation.

Standard principles: general advice

  • Everyone involved in providing care should be:

  • Wherever care is delivered, healthcare workers must have available appropriate supplies of the following in accordance with current health and safety legislation:

    • materials for hand decontamination

    • sharps containers

    • personal protective equipment. [new 2012]

      At the time of publication (March 2012), these requirements were covered by the: Health and Safety at Work Act 1974, Management of Health and Safety at Work Regulations 1999, Health and Safety Regulations 2002, Control of Substances Hazardous to Health Regulations 2002, Personal Protective Equipment Regulations 2002 and Health and Social Care Act 2008.

  • Educate patients and carers 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

    • their role in maintaining standards of healthcare workers' hand decontamination. [new 2012]

Standard principles for hand decontamination

  • Hands must be decontaminated in all of the following circumstances:

    • immediately before every episode of direct patient contact or care, including aseptic procedures

    • 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. [new 2012]

Long-term urinary catheters

  • Select the type and gauge of an indwelling urinary catheter based on an assessment of the patient's individual characteristics, including:

    • age

    • any allergy or sensitivity to catheter materials

    • gender

    • history of symptomatic urinary tract infection

    • patient preference and comfort

    • previous catheter history

    • reason for catheterisation. [new 2012]

  • 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. [2003]

  • When changing catheters in patients with a long-term indwelling urinary catheter:

    • do not offer antibiotic prophylaxis routinely

    • consider antibiotic prophylaxis for patients who:

      • have a history of symptomatic urinary tract infection after catheter change or

      • experience trauma (the GDG defined trauma as frank haematuria after catheterisation or two or more attempts of catheterisation) during catheterisation. [new 2012]

        At the time of publication (March 2012), no antibiotics have a UK marketing authorisation for this indication. Informed consent should be obtained and documented.

Vascular access devices

  • Before discharge from hospital, patients and their carers should be taught any techniques they may need to use to prevent infection and safely manage a vascular access device[2003, amended 2012]

  • Healthcare workers caring for a patient with a vascular access device should be trained, and assessed as competent, in using and consistently adhering to the infection prevention practices described in this guideline. [2003, amended 2012]

  • 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.

    In 2012, an MHRA safety alert for chlorhexidine was issued related to the risk of adverse events. [new 2012]