Introduction

This quality standard covers the prevention and control of infection for people receiving healthcare in primary, community and secondary care settings.

Settings include hospitals, general practices, dental clinics, health centres, care homes, the person's own home, schools and prisons providing healthcare, and care delivered by the ambulance service and mental health services.

For more information see the topic overview.

Why this quality standard is needed

Healthcare-associated infections can develop either as a direct result of healthcare intervention (such as medical or surgical treatment) or from being in contact with a healthcare setting[1].

Healthcare-associated infections arise across a wide range of clinical conditions and can affect people of all ages. They can exacerbate existing or underlying conditions, delay recovery and adversely affect quality of life. Healthcare-associated infections can occur in otherwise healthy people, especially if invasive procedures or devices are used. Healthcare workers, family members and carers are also at risk of acquiring infections when caring for people. A number of factors can increase the risk of acquiring an infection, but high standards of infection prevention and control practice, including providing clean environments, can minimise the risk.

It is estimated that 300,000 patients a year in England acquire a healthcare‑associated infection as a result of care within the NHS. The prevalence of healthcare-associated infections in hospitals in England in 2011 was 6.4%. The most common types of healthcare-associated infection are respiratory infections (including pneumonia and infections of the lower respiratory tract) (22.8%), urinary tract infections (17.2%) and surgical site infections (15.7%)[2]. Each one of these infections means additional use of NHS resources, greater patient discomfort and a decrease in patient safety[3].

In 2007, methicillin-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[3]. Since 2006 there has been an 18-fold reduction in MRSA bloodstream infections (from 1.3% to less than 0.1%) and a 5-fold reduction in Clostridium difficile infections (from 2% to 0.4%)[2].

It is important that this quality standard is implemented alongside other national guidance, current policy documents and regulatory standards listed in the 'policy context'.

This quality standard has been developed as part of a group of topics on infection prevention and control across a range of settings. The infection prevention and control quality standard is an overarching quality standard; other quality standards and guidance have been published (for example, Surgical site infection [NICE quality standard 49]), are in development and have been referred to NICE that provide topic-specific detail on aspects of infection prevention and control.

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

  • infection rates

  • avoidable deaths from healthcare-associated infections.

How this quality standard supports delivery of outcome frameworks

NICE quality standards are a concise set of prioritised statements designed to drive measurable quality improvements within 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 outcomes framework published by the Department of Health:

Table 1 shows the outcomes, overarching indicators and improvement areas from the frameworks that the quality standard could contribute to achieving.

Table 1 NHS Outcomes Framework 2014–15

Domain

Overarching indicators and improvement areas

1 Preventing people from dying prematurely

Overarching indicator

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

1ai Adults

1aii Children and young people

4 Ensuring that people have a positive experience of care

Overarching indicator

4a Patient experience of primary care i GP services

4b Patient experience of hospital care

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

Improvement areas

Reducing the incidence of avoidable harm

5.2 Incidence of healthcare associated infection (HCAI)

5.2i MRSA

5.2ii C. difficile

Coordinated services

The quality standard for infection prevention and control specifies that services should be commissioned from and coordinated across all relevant agencies. A person-centred, integrated approach that promotes multi-agency working is fundamental to delivering high-quality care and preventing and controlling infection.

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 infection prevention and control service 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 healthcare workers and social care and public health practitioners involved in infection prevention and control should have sufficient and appropriate training and competencies to deliver the actions and interventions described in the quality standard.

Role of families and carers

Quality standards recognise the important role families and carers have in infection prevention and control. If appropriate, healthcare workers and social care and public health practitioners should ensure that family members and carers are involved in the decision-making process about investigations, treatment and care.