New guidance highlights the importance of patient and carer involvement in preventing healthcare-associated infections.
For the past two years the National Institute for Health and Clinical Excellence (NICE) has worked with an independent group of clinical experts to update the clinical guidance on the prevention and control of healthcare-associated infections (HCAIs) in primary and community care settings, which was first published in 2003 (NICE, 2003). This new guidance is aimed at a wide audience in primary and community care, including staff of GP clinics, health centres and care homes (NICE, 2012). It is also expected that the guideline will be used to inform practice in the ambulance service, patients’ own homes and other community settings where NHS healthcare is provided or commissioned.
Changes since 2003
Since the publication of the NICE (2003) clinical guideline on preventing HCAIs, many changes have occurred in healthcare. As a result of the rapid turnover of patients in acute care settings, along with patients increasingly wanting to be treated at home, more complex care is being delivered in the community. Updated infection prevention and control guidance was needed to reflect this change.
Patient safety is paramount and preventing HCAIs remains a priority. It is esti- mated that these infections cost the NHS approximately £1bn a year and, of this, an estimated £56m is incurred following discharge from hospital - notwithstanding the discomfort, delay in recovery, decreased quality of life and even death that infection can cause.
The four main areas explored in this guideline are:
- Standard principles (including hand decontamination, personal protective equipment, safe use and disposal of sharps and waste disposal);
- Long-term urinary catheters;
- Enteral feeding;
- Vascular access devices.
The key priorities for implementation are mainly focused around education. The guideline acknowledges that family mem- bers and friends who help care for a patient have an equally important role to play in preventing infection in the community as NHS staff. One key recommendation therefore is that everyone involved in providing care, including staff, patients and carers, should be educated about the standard principles of infection prevention and control, including training in hand decontamination, the use of personal protective equipment, and the safe use and disposal of sharps.
Education on the care of invasive devices should also be included, especially when patients are discharged from hospital with a vascular access device, indwelling catheter or enteral feed. Before leaving hospital they should be trained and assessed as competent in using these devices and understand the infection-prevention principles that are set out in the guideline.
The guideline also highlights the importance of having appropriate supplies of personal protective equipment and materials that are needed for decontaminating hands available to staff in the community. This ensures staff are able to practise good infection prevention at all times.
There are some practical elements to the recommendations. For example, there is some guidance for health professionals highlighting essential points to consider when selecting the type and gauge of an indwelling urinary catheter, which must be based on an assessment of the patient’s individual characteristics. The guideline also recommends that antibiotics should not be routinely given when changing urinary catheters.
It is recommended that health workers undertaking practical procedures such as caring for vascular access devices, inserting urinary catheters or undertaking aseptic procedures should be assessed for their competence to carry them out.
This guideline provides a valuable resource with which to promote safe practice and encourage communities to work together to prevent and control infection. Education and communication between health professionals, patients and their carers is key in ensuring we all know the important roles we have, and we must continually work together effectively for the benefit of our patients and others.
The guideline is available for download here.
Michael Nevill is clinical quality and performance manager, and infection control lead, bpas, UK; Zara Head is practice nurse sister, Stainforth, Doncaster.
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National Institute for Health and Clinical Excellence (2012) Infection: Prevention and Control of Healthcare-associated Infections in Primary and Community Care. London: NICE.
National Institute for Clinical Excellence (2003) Infection Control, Prevention of Healthcare-associated Infection in Primary and Community Care. London: NICE.