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.

This quality standard should be read alongside NICE quality standard 61, which is an overarching quality standard on infection prevention and control, and NICE quality standard 49, which covers surgical site infection in all healthcare settings. Other related quality standards, including a quality standard on antimicrobial stewardship that is in production, are listed in related NICE quality standards.

The quality statements that follow build upon the code of practice on the prevention and control of infections that applies to all providers of healthcare and adult social care under The Health and Social Care Act 2008.

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.

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:

Tables 1–3 show the outcomes, overarching indicators and improvement areas from the frameworks that the quality standard could contribute to achieving.

Table 1 NHS Outcomes Framework 2015–16


Overarching indicators and improvement areas

1 Preventing people from dying prematurely

Overarching indicators

1a Potential Years of Life Lost (PYLL) from causes considered amenable to healthcare

i Adults ii Children and young people

4 Ensuring that people have a positive experience of care

Overarching indicators

4b Patient experience of hospital care

Improvement areas

Improving people's experience of outpatient care

4.1 Patient experience of outpatient services

Improving people's experience of accident and emergency services

4.3 Patient experience of A&E services

Improving women and their families' experience of maternity services

4.5 Women's experience of maternity services

Improving children and young people's experience of healthcare

4.8 Children and young people's experience of inpatient services

Improving people's experience of integrated care

4.9 People's experience of integrated care*

5 Treating and caring for people in a safe environment and protecting them from avoidable harm

Overarching indicators

5a Deaths attributable to problems in healthcare

5b Severe harm attributable to problems in healthcare

Improvement areas

Reducing the incidence of avoidable harm

5.2 Incidence of healthcare‑associated infection (HCAI)


ii C. difficile

Improving the culture of safety reporting

5.6 Patient safety incidents reported

Alignment with Adult Social Care Outcomes Framework and/or Public Health Outcomes Framework

* Indicator is complementary

Indicators in italics in development

Table 2 The Adult Social Care Outcomes Framework 2015–16


Overarching and outcome measures

3 Ensuring that people have a positive experience of care and support

Overarching measure

3A Overall satisfaction of people who use services with their care and support

Placeholder 3E: The effectiveness of integrated care*

Aligning across the health and care system

* Indicator complementary

Table 3 Public health outcomes framework for England, 2013–16


Objectives and indicators

3 Health protection


The population's health is protected from major incidents and other threats, whilst reducing health inequalities


3.7 Comprehensive, agreed inter‑agency plans for responding to public health incidents

4 Healthcare public health and preventing premature mortality


Reduced numbers of people living with preventable ill health and people dying prematurely, whilst reducing the gap between communities


4.3 Mortality rate from causes considered preventable*

4.8 Mortality rate from communicable diseases

Alignment across the health and social care system

* Indicator shared with the NHS Outcomes Framework

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 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.