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Eurosurveillance, Volume 7, Issue 30, 24 July 2003
Articles

Citation style for this article: Wilson J, Cookson B. New clinical guideline for prevention of healthcare associated infection in primary and community care. Euro Surveill. 2003;7(30):pii=2263. Available online: http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=2263

New clinical guideline for prevention of healthcare associated infection in primary and community care

Jennie Wilson (Jennie.Wilson@hpa.org.uk), Health Protection Agency Communicable Disease Surveillance Centre, and Barry Cookson, Health Protection Agency Specialist and Reference Microbiology Division, London, England.

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, http://www.epic.tvu.ac.uk/) (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.

Reference:
  1. Pratt RJ, Pellowe CM, Loveday HP, Robinson N, Smith GW, Barrett S, et al. The epic project: developing national evidence-based guidelines for preventing healthcare-associated infections. Phase 1: Guidelines for preventing hospital-acquired infections. J Hosp Infect 2001; 47(Suppl): 3-82. (http://www.doh.gov.uk/hai/phase1.pdf) [accessed 17 July 2003]

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