Effective infection prevention and control is central to providing high quality health care for patients and a safe working environment for those that work in healthcare settings.

Healthcare-associated infection is preventable

There are around 200,000 healthcare-associated infections (HAIs) in Australian acute healthcare facilities each year2. This makes HAIs the most common complication affecting patients in hospital. As well as causing unnecessary pain and suffering for patients and their families, these adverse events prolong hospital stays and are costly to the health system. The problem does not just affect patients and workers in hospitals — HAIs can occur in any healthcare setting, including office-based practices (e.g. general practice clinics, dental clinics) and long-term care facilities (see Glossary). Any person working in or entering a healthcare facility is at risk. However, healthcare-associated infection is a potentially preventable adverse event rather than an unpredictable complication. It is possible to significantly reduce the rate of HAIs through effective infection prevention and control.

Infection prevention and control is everybody’s business

Understanding the modes of transmission of infectious organisms and knowing how and when to apply the basic principles of infection prevention and control is critical to the success of an infection control program. This responsibility applies to everybody working and visiting a healthcare facility, including administrators, staff, patients and carers.

Successful approaches for preventing and reducing harms arising from HAIs involve applying a risk-management framework to manage ‘human’ and ‘system’ factors associated with the transmission of infectious agents. This approach ensures that infectious agents, whether common (e.g. gastrointestinal viruses) or evolving (e.g. influenza or multi-resistant organisms [MROs]), can be managed effectively.

Development of the guidelines

As part of the Australian Commission on Safety and Quality in Health Care’s (ACSQHC) HAIs priority program, the National Health and Medical Research Council (NHMRC) was asked to develop national guidelines that would provide a coordinated approach to the prevention and management of HAI. The NHMRC appointed an expert group to guide the development process (Steering Committee membership and terms of reference are given in Appendix 1). The guidelines are based on the best available evidence. They build on existing guidelines and reviews, as well as systematic reviews of the evidence.


By assisting healthcare workers to improve the quality of the care they deliver, these guidelines aim to promote and facilitate the overall goal of infection prevention and control:

The creation of safe healthcare environments through the implementation of practices that minimise the risk of transmission of infectious agents.


The scope of these guidelines was established, following an initial period of consultation that included forums involving a wide range of stakeholders (see Appendix 2).

The guidelines were developed to establish a nationally accepted approach to infection prevention and control, focusing on core principles and priority areas for action. They provide a basis for healthcare workers and healthcare facilities to develop detailed protocols and processes for infection prevention and control specific to local settings.

This approach is underpinned by a risk-management framework to ensure the basic principles of infection prevention and control can be applied to a wide range of healthcare settings including office-based practice, long-term care facilities, remote area health services, home and community nursing and emergency services.

The evidence base for the guidelines addresses the highest level of risk of infection transmission in the healthcare setting, and has predominantly been drawn from the acute-care setting. However, case studies giving examples of risk assessments have been included to help illustrate how these recommendations can be applied to other settings.

Supporting documents have been developed for healthcare workers, patients and health facility managers to assist with implementation of the guidelines. These materials will be available on the NHMRC website.

The guidelines make reference to but do not include detailed information on:

  • infectious diseases;
  • pandemic planning;
  • the reprocessing of reusable medical instruments or devices;
  • occupational health and safety;
  • hospital hotel services such as food services, laundry services or waste disposal; or
  • engineering/health facility design.

The guidelines do not duplicate information provided in existing Australian Standards but refer to specific standards wherever relevant.

Target audience

The guidelines are for use by all those working in healthcare — this includes healthcare workers, management and support staff.

Evidence base

These guidelines are based on the best available evidence and knowledge of the practicalities of clinical procedures. They draw from other work in this area, including the two previous national infection control guidelines3, international infection control guidelines, systematic literature reviews conducted to inform the development of these guidelines, work on HAI prevention from ACSQHC, national discipline-based infection control guidelines, and Australian Standards relevant to infection prevention and control. Australian data are used wherever available.

Table 2: Sources of evidence to support recommendations

Systematically developed international guidelines4

World Health Organization

Guidelines on hand hygiene in health care (2009)

United States Centers for Disease Control and Prevention

Workbook for designing, implementing and evaluating a sharps injury prevention program (2009)

Guideline for disinfection and sterilisation in healthcare facilities (2008)

Guideline for isolation precautions: preventing transmission of infectious agents in healthcare settings (2007)

Management of multidrug-resistant organisms in healthcare settings (2006)

Guidelines for infection control in the dental setting (2003)

Guidelines for environmental infection control in health-care facilities (2003)

Guidelines for prevention of intravascular device-related infections (2002; draft 2009)

United Kingdom National Institute for Health and Clinical Excellence

Surgical site infection prevention and treatment of surgical site infection (2008)

Prevention of healthcare-associated infection in primary and community care (2003)

UK Department of Health

Epic2: National evidence-based guidelines for preventing healthcare-associated infections in NHS hospitals in England (2007)

British Society for Antimicrobial Chemotherapy

Guidelines for UK practice for the diagnosis and management of methicillin-resistant Staphylococcus aureus (MRSA) infections presenting in the community (2008)

Guidelines for the management of hospital-acquired pneumonia in the UK: Report of the Working Party on Hospital-Acquired Pneumonia of the British Society for Antimicrobial Chemotherapy (2008)

Canadian Critical Care Trials Group

Comprehensive evidence-based clinical practice guidelines for ventilator-associated pneumonia: prevention (2008)

European Association of Urology

European and Asian guidelines on management and prevention of catheter-associated urinary tract infections (2008)

Australian discipline-specific guidance

RACGP (2006) Infection Control Standards for Office Based Practices (4th edition)

Australian Dental Association (2008) Guidelines for Infection Control

Separate systematic reviews of published scientific and medical literature for areas of controversy and clinical variation5

Alcohol products and other agents for hand hygiene

Infection control measures related to the use of intravascular devices

Positive pressure rooms in reducing risk for immunocompromised patients

Staff exclusion policies relating to norovirus gastroenteritis

Personal protective equipment in reducing the transmission of multi-resistant organisms

Isolation measures for patients infected with vancomycin-resistant enterococci or multi-resistant Gram negative bacteria

Education interventions for the prevention of HAIs

Limitations of the grading process as it applies to the practice of infection control

The recommendations in these guidelines were formulated by the Infection Control Steering Committee through a process of consensus. Recommendations are given when an action is deemed critical to preventing or managing infection. Recommendations are graded according to the revised NHMRC gradings for assessing evidence, with the addition of good practice points, which outline actions that are essential to infection prevention and control but where evidence grades cannot be applied.

In many areas of infection prevention and control, the evidence may be limited by the inability to conduct certain study designs that are difficult to implement in real practice. This has implications for the level of grading that is assigned to the recommendations, since grading systems will tend to favour study designs that are sometimes not feasible or ethical to conduct in infection control settings, such as randomised controlled trials. For example, it is unethical to compare the incidence of infection related to surgical instruments by allocating one patient group to have sterilised instruments used on them and one patient group to have non-sterile instruments used on them. This may result in a lower grading due to the available evidence but sterilisation of surgical instruments is universally deemed critical to infection control.

Given that there is limited evidence available to support many routine practices intended to reduce infection risk, practice is based on decisions made on scientific principles. Some activities, such as performing hand hygiene between administering care to successive patients, have a credible history to support their routine application in preventing cross-infection. Others, such as some uniform and clothing requirements, have more to do with the ethos of quality care and workplace culture than with a proven reduction of cross-infection.

It is not acceptable to discontinue practices for which there is a solid scientific basis, even if the level of evidence is not high. Rather, routine practices should continue unless there is sufficient evidence to support alternative procedures. Continuing research is needed to keep evaluating practice, to identify evidence gaps and promote research in these areas, and to ensure that poor practices do not continue.

Table 3: NHMRC grades of evidence




Body of evidence can be trusted to guide practice


Body of evidence can be trusted to guide practice in most situations


Body of evidence provides some support for recommendation(s) but care should be taken in its application


Body of evidence is weak and recommendation must be applied with caution

The ICG Steering Committee also assigned an additional ‘grade’ referred to as a good practice point (GPP).


Body of evidence is weak or non-existent. Recommendation for best practice based on clinical experience and expert opinion

Structure of the guidelines

These guidelines are based around the following core principles:

  • an understanding of the modes of transmission of infectious agents and of risk management;
  • effective work practices that minimise the risk of transmission of infectious agents;
  • governance structures that support the implementation, monitoring and reporting of infection prevention and control work practices; and
  • compliance with legislation, regulations and standards relevant to infection control.

The parts of the document are based on these core principles and are organised according to the likely readership.

Part A presents background information that should be read by everyone working in health care (for example as orientation or as part of annual review) — this includes important basics of infection prevention and control, such as the main modes of transmission of infectious agents and the application of risk-management principles. This part of the guidelines does not include recommendations.

Part B is specific to the practice of healthcare workers and support staff, and outlines effective work practices that minimise the risk of transmission of infectious agents. Recommendations are given in Sections B1 to B3. Each section includes advice on putting the recommendations into practice, a risk-management case study and resources.

  • Section B1 describes standard precautions used at all times to minimise the risk of transmission of infectious agents;
  • Section B2 outlines transmission-based precautions to guide staff in the presence of suspected or known infectious agents that represent an increased risk of transmission;
  • Section B3 outlines approaches to the management of multi-resistant organisms (MROs) or outbreak situations;
  • Section B4 outlines processes for risk identification and the application of standard and transmission-based precautions for certain procedures; and
  • Section B5 includes supplementary information to assist in the application of standard and transmission-based precautions.

Part C describes the responsibilities of management of healthcare facilities, including governance structures that support the implementation, monitoring and reporting of effective work practices. The chapters outline the main components of a systems approach to facility-wide infection prevention and control, giving guidance on management and staff responsibilities, protection of healthcare workers, requirements for education and training of all staff, considerations for facility design and renovation, and other important activities such as surveillance and antibiotic stewardship.

Legislation, regulations and standards relevant to infection prevention and control are listed at the end of each section before the references.

The appendices provide additional information on the guideline development process.

Key information is highlighted in the guidelines as follows.

Table 4: Key to types of information highlighted in the guidelines


provide key information from each section of the guidelines


(Sections B1, B2 and B3) outline the critical aspects of infection prevention and control

Patient-care tips

highlight patient considerations in the application of infection prevention and control principles

Case studies illustrate the application of risk-management principles (Sections B1, B2 and B3) and measures to support good practice (Part C).

The following table summarises the key topics discussed in the document.

Table 5: Topics discussed in the guidelines

Modes of transmission of infectious agents and an overview of risk management

Effective work practices that minimise the risk of transmission of infectious agents

Govenance structures that support implementation, monitoring and reporting of infection prevention and control practices




Basics of Infection prevention and control

Standard and transmission-based precautions

Organisational support

Infection prevention and control in the healthcare setting

A1.1 Risks of contracting

a healthcare-associated


A1.2 Standard and



A2 Overview of risk management in infection prevention and control

A2.1 Risk-management


A2.2 Risk-management


A3 A patient-centred approach

A3.1 Patient-centred health


A3.2 How does patientcentred

care relate to

infection prevention and


B1 Standard precautions

B1.1 Hand hygiene

B1.2 Personal protective


B1.3 Handling and disposing

of sharps

B1.4 Routine management

of the physical environment

B1.5 Reprocessing of

reusable instruments and


B1.6 Respiratory hygiene

and cough etiquette

B1.7 Aseptic technique

B1.8 Waste management

B1.9 Handling of linen

B2 Transmission-based


B2.1 Application of



B2.2 Contact precautions

B2.3 Droplet precautions

B2.4 Airborne precautions

B2.5 Putting it into practice

B2.6 Resources

B2.7 References

B3 Manageemnt of multi-

resistant organisms and

outbreak situations

B3.1 Management of multiresistant


B3.2 Outbreak investigation

and management

B3.3 Putting it into practice

B3.4 Resources

B3.5 References

B4 Applying standard

and transmission-based


during procedures

B4.1 Taking a riskmanagement

approach to


B4.2 Therapeutic devices

B4.3 Surgical procedures

B4.4 Putting it into practice

B4.5 Resources

B4.6 References

C1 Management and clinical


C1.1 Clinical governance

in infection prevention and


C1.2 Roles and


C1.3 Infection prevention

and control program

C1.4 Risk management

C1.5 Taking an organisational

systems approach to


prevention quality and safety

C2 Staff health and safety

C2.1 Roles and


C2.2 Health status screening

and immunisation

C2.3 Exclusion periods for

healthcare workers with

acute infection

C2.4 Healthcare workers

with specific circumstances

C2.5 Exposure-prone


C2.6 Occupational hazards

for healthcare workers

C3 Education and training

C3.1 Universities and

training colleges

C3.2 Healthcare worker


C3.3 Education strategies

C3.4 Example of education

in practice — hand hygiene

C3.5 Patient engagement

C3.6 Compliance and


C4 Healthcare-associated

infection surveillance

C4.1 Role of surveillance in

reducing HAI

C4.2 Types of surveillance


C4.3 Data collection and


C4.4 Outbreak surveillance

C4.5 Disease surveillance in

office-based practice

C4.6 Notifiable diseases

C5 Antibiotic stewardship

C5.1 Background

C5.2 Antibiotic stewardship


C5.3 Antibiotic stewardship

surveillance methods

C6 Influence of facility

design on healthcareassociated


C6.1 Facility design and

its impact on infection

prevention and control

C6.2 Mechanisms for

influencing healthcareassociated

infection through

environmental design

C6.3 The benefits of singlebed

rooms fo

Legislation, regulations and standards relevant to infection prevention and control

B1.1 Hand hygiene

B1.2.9 PPE

B1.3.6 Sharps

B1.6.4 Waste and linen handling

B2.6 Transmission-based precautions

B3.4 MROs and outbreaks

B4.5 Procedures

B5 Supplementary information

C7 Resources for organisations

  1. Cruickshank M and Ferguson J (eds) (2008) Reducing Harm to patients from Health care Associated Infection: The Role of Surveillance. Australian Commission for Safety and Quality in Health Care. p3.
  2. CDNA (2004) Infection Control Guidelines for the Prevention of Transmission of Infectious Disease in the Health Care Setting. Communicable Diseases Network of Australia.

    NHMRC (1996) Infection Control in the Healthcare Setting. Guidelines for the Prevention of Transmission of Infectious Diseases. National Health and Medical Research Council. Rescinded.
  3. These guidelines were selected based on analysis using the AGREE tool, which ensures that guidelines have been developed in a rigorous, transparent and robust manner. This process is discussed in detail in Appendix 2.
  4. Due to a paucity of evidence or low quality evidence some systematic reviews were not used to draft recommendations.