NICE Updates Infection Prevention Guidance

In short

UK’s National Institute for Health and Clinical Excellence (NICE) has updated its recommendations relating to the prevention of healthcare associated infection (HCAI), which its data suggest affects 300,000 NHS patients annually with 9000 deaths from MRSA alone. The new guidance supercedes that issued in 2003 in light of new evidence gathered since that time.


According to the NICE release, which can be found here, the cost of HCAIs to the NHS is estimated to be around £1 billion a year, with £56 million of this thought to be incurred once patients have been discharged from hospital.

NICE has updated its guidance to reflect new evidence and also the fact that more and more patients are being seen in primary care and more complex issues are being dealt with by GPs and practice nurses.

So what’s changed?

The guideline now says that:

  • hands must be decontaminated immediately before every episode of direct contact with patients, and that this should now include aseptic procedures as well.
  • hands should be decontaminated after every episode of direct patient contact or care, after to any exposure to body fluids, after contact with a patient’s surroundings that could potentially result in hands being contaminated, and immediately after gloves are removed.
  • GPs and healthcare workers should ensure their hands are decontaminated throughout the duration of clinical work.
  • healthcare workers should be being bare below the elbow when giving direct patient care, removing wrist and hand jewellery, ensuring fingernails are short, clean and free of nail polish, and by making sure cuts and abrasions are covered with waterproof dressings.

In a further update, it is recommended that GPs and healthcare workers ensure that gloves that have been exposed to body fluids and could be contaminated are disposed of correctly, and in accordance with national legislation and local policies. Furthermore, used sharps should be discarded immediately by the person generating the sharps waste, using a sharps container that conforms to current standards.

Additionally, all healthcare workers, including those in community settings must have available appropriate supplies for decontamination.

Better education

Patients and carers should be educated about hand decontamination. This should cover the benefits of hand decontamination, correct techniques and timing over when it is appropriate to use liquid soap and water or handrub, the availability of hand decontamination facilities, and what their roles are in maintaining standards.

Clinician comments

Dr Julian Spinks, a GP and member of the Guideline Development Group for this update, said: “At a time where increasingly complex procedures are being provided in primary care, infection control is becoming more and more important.

“This guideline provides information about effective and practical measures that primary care clinicians can take to reduce the burden of healthcare-associated infection and forms an important part of the armoury for those of us who wish to provide high quality care in the community.”

Source: NICE