New clinical guideline for prevention of healthcare associated
infection in primary and community care
The new clinical guideline for prevention of healthcare
associated infection in primary and community care in England and Wales from
the National Institute for Clinical Excellence (NICE, http://www.nice.org.uk/pdf/CG2fullguidelineinfectioncontrol.pdf
aims to provide a standard set of measures that can be used by anyone giving
or receiving primary or community care. The guideline complements the phase
1 guidelines for preventing hospital acquired infections produced by the Evidence
Based Practice in Infection Control initiative (epic
(1). Despite being primarily directed at healthcare professionals in general
practice, health centres, and nursing homes, the guideline will also be relevant
to those working with patients in their own home or the community. Each section
includes recommendations about the education and training of patients, their
carers and healthcare personnel.
The new guideline is especially opportune now that patients spend less
time in hospital, and because of the increasingly complex nature of care
being delivered in the community.
In common with the epic guidelines, the NICE guideline covers
standard principles, comprising handwashing, use of personal protective
equipment, and safe use and disposal of sharps. The recommendations are
similar to those published previously, but additional evidence has been
reviewed in relation to cost effectiveness. Recommendations for urinary
catheterisation are focused on the care of patients with long term urinary
catheters. A guideline devoted to preventing healthcare associated infections
during enteral feeding is particularly welcome as it reflects the increase
in demand for this type of care in community settings. The final section
is focused on preventing healthcare associated infection in patients with
central venous catheters and is directed at general site care and catheter
management, issues of particular relevance to those working in primary care.
We do not know if there are important variations in delivery of infection
prevention and control measures in the community in different European countries.
The European Union DG SANCO funded project (http://helics.univ-lyon1.fr/),
and another funded by DG Research (HARMONY: http://www.harmony-microbe.net/
and in preparation) explored the development of surveillance of, and guidelines
for the prevention of hospital acquired infection.
The HARMONY project explored infection control policies for central venous
and urinary catheters in 48 hospitals in six countries. It used an iterative
process with healthcare workers and infection control teams in each hospital
and found a surprising degree of consensus between the participants. It
cannot be assumed that the same will be true for the community setting but,
judging from these European assessments in the acute hospital sector, the
applicability of these community guidelines may be applicable to other countries
in the EU but would be a matter for national and local assessment.
In the HELICS study, few countries have systems in place to identify healthcare-associated
infections occurring after discharge into the community from hospital. The
Netherlands and Germany were two of the very few countries with a funded
centre that reviewed guidelines on a regular basis and explored the evidence
base for these For the Dutch guidelines, see http://www.wip.nl.
Further information is available (in Dutch) from the Dutch society of hygiene
and infection prevention in healthcare settings at http://www.vhig.nl.