This pathway covers the prevention and control of healthcare-associated infections in primary, community and secondary care.

Healthcare-associated infections can develop either as a direct result of healthcare interventions such as medical or surgical treatment, or from being in contact with a healthcare setting. Healthcare-associated infections can exacerbate existing or underlying conditions, delay recovery and adversely affect quality of life.

Healthcare-associated infections are caused by a wide range of microorganisms. The most well known include those caused by meticillin-resistant Staphylococcus aureus (MRSA), meticillin-sensitive Staphylococcus aureus (MSSA), Clostridium difficile (C. diff) and Escherichia coli (E. coli).

Patient safety has become a cornerstone of care in the NHS, and preventing healthcare-associated infections remains a priority. Healthcare-associated infections are estimated to cost the NHS approximately £1 billion a year, £56 million of which is estimated to be incurred after patients are discharged from hospital. In addition to increased costs, each one of these infections means additional use of NHS resources, greater patient discomfort and a decrease in patient safety. A 'no tolerance' attitude is now prevalent in relation to avoidable healthcare-associated infections.

Surgical site (wound) infection occurs when pathogenic organisms multiply in a surgical wound, giving rise to local signs and symptoms, such as heat, redness, pain and swelling, and (in more serious cases) with systemic signs of fever or a raised white blood cell count. Infection in the surgical wound may prevent healing taking place so that the wound edges separate, or it may cause an abscess to form in the deeper tissues.

Surgical site infections comprise up to 20% of all healthcare-associated infections. At least 5% of patients undergoing surgery develop a surgical site infection. Surgical site infections can have a significant effect on quality of life for the patient, and are associated with considerable morbidity and extended hospital stay. Surgical site infections also result in a considerable financial burden to healthcare providers. The majority of surgical site infections are preventable and measures can be taken in the preoperative, intraoperative and postoperative phases of care to reduce risk of infection.

There is a legal duty to implement some of the recommendations in this pathway in order to comply with legislation. The word 'must' is used in these recommendations and details of the relevant legislation are given in footnotes. In addition, 'must' is used in some other recommendations on patient safety where the consequences of not implementing them would be very serious – that is, there would be a greatly increased risk of adverse events, including death.