Excerpt

Since the publication of the NICE clinical guideline on the prevention of healthcare-associated infections (HCAI) in primary and community care in 2003, many changes have occurred within the NHS that place the patient firmly at the centre of all activities. First, the NHS Constitution for England defines the rights and pledges that every patient can expect regarding their care. To support this, the Care Quality Commission (CQC), the independent regulator of all health and adult social care in England, ensures that health and social care is safe, and monitors how providers comply with established standards. In addition, the legal framework that underpins the guidance has changed since 2003.

New guidance is needed to reflect the fact that, as a result of the rapid turnover of patients in acute care settings, complex care is increasingly being delivered in the community. New standards for the care of patients and the management of devices to prevent related healthcare-associated infections are needed that will also reinforce the principles of asepsis.

This clinical guideline is a partial update of ‘Infection control: prevention of healthcare-associated infection in primary and community care’ (NICE clinical guideline 2; 2003), and addresses areas in which clinical practice for preventing HCAI in primary and community care has changed, where the risk of HCAI is greatest or where the evidence has changed. The Guideline Development Group (GDG) recognise the important contribution that surveillance makes to monitoring infection, but it is not within the scope of this guideline to make specific recommendations about this subject. Where high-quality evidence is lacking, the GDG has highlighted areas for further research.

Contents

• Explaining the changes in the partial update
• Guideline development group and project team
• 1. Introduction
  • 1.1. Introduction (2012)
  • 1.2. Introduction (2003)
• 2. Development of the guideline
  • 2.1. What is a NICE clinical guideline?
  • 2.2. Remit
  • 2.3. Who developed this guideline?
  • 2.4. What this guideline update covers
  • 2.5. What this guideline update does not cover
  • 2.6. Structure of the updated guideline
  • 2.7. Relationships between the guideline and other NICE guidance
  • 2.8. Background and context to the Guidelines (2003)
  • 2.9. Scope and Purpose of the Guidelines (2003)
• 3. Methods
  • 3.1. Methods (2012)
  • 3.2. Methods (2003)
• 4. Guideline summary
  • 4.1. Key priorities for implementation
  • 4.2. Full list of recommendations
  • 4.3. Key research recommendations
• 5. Standard Principles
  • 5.1. Introduction
  • 5.2. Education of patients, carers and their healthcare workers
  • 5.3. Research recommendation
• 6. Standard principles for hand decontamination
  • 6.1. Introduction
  • 6.2. Why is hand decontamination crucial to the prevention of healthcare-associated infection in the community?
  • 6.3. When to decontaminate hands
  • 6.4. Choice of hand cleaning preparation
  • 6.5. Decontaminating wrists and bare below the elbow policy
  • 6.6. Is hand decontamination technique important?
  • 6.7. Does hand decontamination damage skin?
  • 6.8. Research recommendations
• 7. Standard principles for the use of personal protective equipment
  • 7.1. Introduction
  • 7.2. Infection Control Dress Code – protect your patients and yourself!
  • 7.3. Gloves: their uses and abuses
  • 7.4. Which types of gloves provide the best protection against healthcare-associated infections?
  • 7.5. When should plastic aprons or fluid repellent gowns be worn?
  • 7.6. When is a facemask, eye protection or other facial protection necessary?
• 8. Standard principles for the safe use and disposal of sharps
  • 8.1. Introduction
  • 8.2. Sharps injuries – what’s the problem?
  • 8.3. Do safety cannulae reduce sharp injuries compared to standard cannulae?
  • 8.4. Do safety needle devices reduce sharps injuries compared to standard needles?
• 9. Waste disposal
  • 9.1. Introduction
• 10. Long term urinary catheters
  • 10.1. Introduction
  • 10.2. Education of patients, carers and healthcare workers
  • 10.3. Assessing the need for catheterisation
  • 10.4. Catheter drainage options
  • 10.5. Types of long-term catheters
  • 10.6. Asepsis
  • 10.7. Catheter Insertion
  • 10.8. Catheter Maintenance
  • 10.9. Do bladder instillations or washouts reduce catheter associated symptomatic urinary tract infections?
  • 10.10. Use of antibiotics when changing long-term urinary catheters
  • 10.11. Areas for Further Research
  • 10.12. Research Recommendations
• 11. Enteral feeding
  • 11.1. Introduction
  • 11.2. Education of patients, carers and healthcare workers
  • 11.3. Preparation and storage of feeds
  • 11.4. Administration of feeds
  • 11.5. Care of insertion site and enteral feeding tube
  • 11.6. Areas for Further Research
• 12. Vascular access devices
  • 12.1. Introduction
  • 12.2. Education of patients, carers and healthcare professionals
  • 12.3. Aseptic technique
  • 12.4. Skin decontamination prior to insertion of peripheral vascular access devices
  • 12.5. Types of vascular access device dressing
  • 12.6. Vascular access device frequency of dressing change
  • 12.7. Decontaminating skin when changing dressings
  • 12.8. General Principles for management of vascular access devices
  • 12.9. Administering infusions or drugs
  • 12.10. Areas for Further Research
  • 12.11. Research recommendations
• 13. Glossary
• 14. Abbreviations
• 15. Reference List
• Appendix A. Scope of partial update
• Appendix B. Declarations of interests
• Appendix C. List of stakeholders
• Appendix D. 2003 guideline appendices
• Appendix E. Review protocols
• Appendix F. Literature search strategies
• Appendix G. Clinical evidence tables
• Appendix H. Economic evidence tables
• Appendix I. Forest plots
• Appendix J. Cost-utility analysis: Intermittent self catheterisation
• Appendix K. Systematic review of health related quality of life for symptomatic UTI
• Appendix L. Excluded studies
• Appendix M. High priority research recommendations
• Appendix N. Bibliography