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Prevention and control of healthcare-associated infections
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 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.
Use of 'must' in recommendations
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.
The NICE guidance that was used to create the pathway.
Infection control. NICE clinical guideline 139 (2012)
Surgical site infection. NICE clinical guideline 74 (2008)
Prevention and control of healthcare-associated infections. NICE public health guidance 36 (2011)
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These resources will help to inform discussions with providers about the development of services and may include measurement and action planning tools.
Education and learning
NICE produces resources for individual practitioners, teams and those with a role in education to help improve and assess users' knowledge of relevant NICE guidance and its application in practice.
Service improvement and audit
These resources provide help with planning ahead for NICE guidance, understanding where you are now, and conducting improvement initiatives.
Information for the public
NICE produces information for the public that summarises, in plain English, the recommendations that NICE makes to healthcare and other professionals.
NICE has written information for the public explaining its guidance on each of the following topics.
Patients and healthcare professionals have rights and responsibilities as set out in the NHS Constitution for England – all NICE guidance is written to reflect these. Treatment and care should take into account individual needs and preferences. People should have the opportunity to make informed decisions about their care and treatment, in partnership with their healthcare professionals. If someone does not have the capacity to make decisions, healthcare professionals should follow the Department of Health's advice on consent, the code of practice that accompanies the Mental Capacity Act and the supplementary code of practice on deprivation of liberty safeguards. In Wales, healthcare professionals should follow advice on consent from the Welsh Government.
If the person is under 16, healthcare professionals should follow the guidelines in Seeking consent: working with children. If a young person is moving between paediatric and adult services their care should be planned and managed according to the best practice guidance described in the Department of Health's Transition: getting it right for young people.
Updates to this pathway
12 February 2013 Minor maintenance updates.
September 2012 Links to Prevention and control of healthcare-associated infections (NICE public health guidance 36) updated. Implementation tools added.
An aseptic technique ensures that only uncontaminated equipment and fluids come into contact with susceptible body sites. It should be used during any clinical procedure that bypasses the body's natural defences. Using the principles of asepsis minimises the spread of organisms from one person to another.
Surgery involving an incision in which no inflammation is encountered, without a break in sterile technique, and during which the respiratory tract, alimentary or genitourinary tracts are not entered.
Surgery involving an incision through which the respiratory, alimentary, or genitourinary tract is entered under controlled conditions but with no contamination encountered.
Surgery involving an incision in which there is a major break in sterile technique or gross spillage from the gastrointestinal tract, or an incision in which acute, non-purulent inflammation is encountered. Open traumatic wounds that are more than 12–24 hours old also fall into this category.
The excision or wide removal of all dead (necrotic) and damaged tissue, that may develop in a surgical wound.
'Hands on' or face-to-face contact with patients. Any physical aspect of the healthcare of a patient, including treatments, self-care and administration of medication.
An incision undertaken during an operation in which the viscera are perforated or when acute inflammation with pus is encountered (for example, emergency surgery for faecal peritonitis), and for traumatic wounds where treatment is delayed, there is faecal contamination, or devitalised tissue is present.
The use of handrub or handwashing to reduce the number of bacteria on the hands. In this pathway this term is interchangeable with 'hand hygiene'.
A preparation applied to the hands to reduce the number of viable microorganisms. This guidance refers to handrubs compliant with British standards (BS EN1500; standard for efficacy of hygienic handrubs using a reference of 60% isopropyl alcohol).
Occurs when a wound has been sutured after an operation and heals to leave a minimal, cosmetically acceptable scar.
Occurs when a wound is deliberately left open at the end of an operation because of excessive bacterial contamination, particularly by anaerobes or when there is a risk of devitalised tissue, which leads to infection and delayed healing. It may be sutured within a few days (delayed primary closure), or much later when the wound is clean and granulating (secondary closure), or left to complete healing naturally without the intervention of suturing.
People employed by the health service, social services, a local authority or an agency to provide care for a sick, disabled or elderly person.
Any waste produced by, and as a consequence of, healthcare activities.
Modern (post-1980) dressing materials. Designed to promote the wound healing process through the creation and maintenance of a local, warm, moist environment underneath the chosen dressing, when left in place for a period indicated through a continuous assessment process.
Blood flow through tissues or organs. If not optimal, it can increase the risk of infectious complications (particularly surgical site infections).
Equipment that is intended to be worn or held by a person to protect them from risks to their health and safety while at work. Examples include gloves, aprons, and eye and face protection.
Adult or child receiving healthcare
Adult or child receiving healthcare
Prevention and control of healthcare-associated infections in primary and community careView the 'Prevention and control of healthcare-associated infections in primary and community care' path
Prevention and control of healthcare-associated infections in secondary careView the 'Prevention and control of healthcare-associated infections in secondary care' path
Paths in this pathway
- Prevention and control of healthcare-associated infections in primary and community care
- Standard principles of prevention and control of healthcare-associated infections in primary and community care
- Long-term urinary catheters: prevention and control of healthcare-associated infections in primary and community care
- Enteral feeding: prevention and control of healthcare-associated infections in primary and community care
- Vascular access devices: prevention and control of healthcare-associated infections in primary and community care
- Prevention and control of healthcare-associated infections in secondary care
- Surgical site infection: prevention and treatment
Pathway created: March 2012 Last updated: February 2013
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