Key priorities for implementation

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[2] have available appropriate supplies of:

    • materials for hand decontamination

    • sharps containers

    • personal protective equipment. [new 2012]

  • 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[3] for patients who:

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

      • experience trauma[4] during catheterisation. [new 2012]

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[5]. [2003, amended 2012]

  • Healthcare workers caring for a patient with a vascular access device[5] 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[6] in 70% alcohol before inserting a peripheral vascular access device or a peripherally inserted central catheter. [new 2012]

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

[4] The GDG defined trauma as frank haematuria after catheterisation or two or more attempts of catheterisation.

[5] The updated recommendation contains 'vascular access device' rather than 'central venous catheter'. This change has been made because peripherally inserted catheters were included in the scope of the guideline update.

[6] In 2012 a safety alert for chlorhexidine was issued related to the risk of adverse events.

  • National Institute for Health and Care Excellence (NICE)