Quality standard


This quality standard covers organisational factors in preventing and controlling healthcare‑associated infections in secondary care settings.

Organisational factors include management arrangements, policies, procedures, monitoring, evaluation, audit and accountability. Secondary care settings include hospital buildings and grounds; inpatient, day case and outpatient facilities and services; elective and emergency care facilities; and hospital maternity units and services. Throughout this quality standard, the term 'hospital' is used for ease of reference to represent the organisation responsible for services provided in secondary care settings.

This quality standard should be read alongside NICE's quality standards on infection prevention and control and surgical site infection. Other related quality standards are listed in related NICE quality standards.

The quality statements that follow build on the Health and Social Care Act 2008: code of practice on the prevention and control of infections of practice.

For more information see the healthcare-associated infections topic overview.

Why this quality standard is needed

Healthcare‑associated infections are a serious risk to patients, staff and visitors. They can cause significant morbidity to those infected and significant costs for the NHS. As a result, infection prevention and control is a key priority for the NHS.

Healthcare‑associated infections cover any infection contracted:

  • as a direct result of treatment in, or contact with, a health or social care setting

  • as a result of healthcare delivered in the community

  • outside a healthcare setting (for example, in the community) and brought in by patients, staff or visitors and transmitted to others (for example, norovirus).

The most well‑known healthcare‑associated infections, for which mandatory reporting is currently required, include those caused by meticillin‑resistant Staphylococcus aureus (MRSA), meticillin‑sensitive Staphylococcus aureus (MSSA), Clostridium difficile (C difficile) and Escherichia coli (E coli). Other gram‑negative bacteria (including antibiotic‑resistant bacteria) and norovirus can also cause healthcare‑associated infections.

The English National Point Prevalence Survey (Health Protection Agency, 2012) identified that 6.4% of inpatients in acute care hospitals in 2011 had a healthcare‑associated infection. The 6 most common types of healthcare‑associated infections, which accounted for more than 80% of all healthcare‑associated infections, were pneumonia and other respiratory infections (22.8%), urinary tract infections (17.2%), surgical site infections (15.7%), clinical sepsis (10.5%), gastrointestinal infections (8.8%), and bloodstream infections (7.3%).

The quality standard is expected to contribute to improvements in the following outcomes:

  • hospital‑acquired harm

  • length of stay in acute care

  • antimicrobial resistance

  • avoidable morbidity

  • avoidable mortality

  • incidence of C difficile and MRSA

  • patient experience

  • avoidable hospital admissions

  • accident and emergency department attendance.

How this quality standard supports delivery of outcome frameworks

NICE quality standards are a concise set of prioritised statements designed to drive measurable improvements in the 3 dimensions of quality – patient safety, patient experience and clinical effectiveness – for a particular area of health or care. They are derived from high‑quality guidance, such as that from NICE or other sources accredited by NICE. This quality standard, in conjunction with the guidance on which it is based, should contribute to the improvements outlined in the following 3 outcomes frameworks published by the Department of Health:

Patient experience and safety issues

Ensuring that care is safe and that people have a positive experience of care is vital in a high‑quality service. It is important to consider these factors when planning and delivering services that seek to prevent and control healthcare‑associated infections.

Coordinated services

The quality standard for healthcare‑associated infections specifies that services should be commissioned from and coordinated across all relevant agencies. A person‑centred, integrated approach to providing services is fundamental to delivering high‑quality care and preventing and controlling healthcare‑associated infections in secondary care settings.

The Health and Social Care Act 2012 sets out a clear expectation that the care system should consider NICE quality standards in planning and delivering services, as part of a general duty to secure continuous improvement in quality. Commissioners and providers of health and social care should refer to the library of NICE quality standards when designing high‑quality services. Other quality standards that should also be considered when choosing, commissioning or providing a high‑quality services related to healthcare‑associated infections are listed in related NICE quality standards.

Training and competencies

The quality standard should be read in the context of national and local guidelines on training and competencies. All health, public health and social care practitioners involved in the prevention and control of healthcare‑associated infections in secondary care settings should have sufficient and appropriate training and competencies to deliver the actions and interventions described in the quality standard. Quality statements on staff training and competency are not usually included in quality standards. However, recommendations in the development source(s) on specific types of training for the topic that exceed standard professional training are considered during quality statement development.

Role of families and carers

Quality standards recognise the important role families and carers have in supporting people with healthcare‑associated infections in secondary care settings. If appropriate, healthcare professionals should ensure that family members and carers are involved in the decision‑making process about investigations, treatment and care and are also provided with advice and guidance on hygiene and infection prevention and control.