Summary of recommendations

These guidelines provide recommendations that outline the critical aspects of infection prevention and control. The recommendations were developed using the best available evidence and consensus methods by the Infection Control Steering Committee1. They have been prioritised as key areas to prevent and control infection in a healthcare facility. It is recognised that the level of risk may differ according to the different types of facility and therefore some recommendations should be justified by risk assessment. When implementing these recommendations all healthcare facilities need to consider the risk of transmission of infection and implement according to their specific setting and circumstances.

The recommendations should be read in the context of the evidence base. This is discussed in Sections B1, B2 and B3, which also include advice on the practical application of the recommendations. The table below lists recommendations and the section of the guidelines in which they are discussed.

Recommendation

Refer to:

Standard precautions (see Section B1)

Hand hygiene

1. Routine hand hygiene

Hand hygiene must be performed before and after every episode of patient contact. This includes:

  • before touching a patient;
  • before a procedure;
  • after a procedure or body substance exposure risk;
  • after touching a patient; and
  • after touching a patient’s surroundings.

Hand hygiene must also be performed after the removal of gloves.

Section B1.1.2

2. Choice of product for routine hand hygiene practices

For all routine hand hygiene practices in healthcare settings, use alcohol-based hand rubs that:

  • contain between 60% and 80% v/v ethanol or equivalent; and
  • meet the requirements of EN1500.

Section B1.1.3

3. Choice of hand hygiene product when hands are visibly soiled

If hands are visibly soiled, hand hygiene should be performed using soap and water.

Section B1.1.3

4. Hand hygiene for Clostridium difficile and non-enveloped viruses

Hand hygiene should be performed using soap and water when Clostridium difficile or non-enveloped viruses such as norovirus are known or suspected to be present and gloves have not been worn. After washing, hands should be dried thoroughly with single-use towels.

Section B1.1.3

Personal protective equipment

5. Wearing of aprons/gowns

Aprons or gowns should be appropriate to the task being undertaken. They should be worn for a single procedure or episode of patient care and removed in the area where the episode of care takes place.

Section B1.2.3

6. Use of face and protective eyewear for procedures

A surgical mask and protective eyewear must be worn during procedures that generate splashes or sprays of blood, body substances, secretions or excretions into the face and eyes.

Section B1.2.4

7. Wearing of gloves

Gloves must be worn as a single-use item for:

  • each invasive procedure;
  • contact with sterile sites and non-intact skin or mucous membranes; and
  • any activity that has been assessed as carrying a risk of exposure to blood, body substances, secretions and excretions.

Gloves must be changed between patients and after every episode of individual patient care.

Section B1.2.5

8. Sterile gloves

Sterile gloves must be used for aseptic procedures and contact with sterile sites.

Section B1.2.5

Handling and disposal of sharps

9. Safe handling of sharps

Sharps must not be passed directly from hand to hand and handling should be kept to a minimum.

Needles must not be recapped, bent or broken after use.

Section B1.3.2

10. Disposal of single-use sharps

The person who has used the single-use sharp must be responsible for its immediate safe disposal. Used disposable sharps must be discarded into an approved sharps container at the point-of-use. These must not be filled above the mark that indicates the bin is three-quarters full.

Section B1.3.3

Routine environmental cleaning

11. Routine cleaning of surfaces

Clean frequently touched surfaces with detergent solution at least daily, and when visibly soiled and after every known contamination.

Clean general surfaces and fittings when visibly soiled and immediately after spillage.

Section B1.4.2

12. Cleaning of shared clinical equipment

Clean touched surfaces of shared clinical equipment between patient uses, with detergent solution.

Exceptions to this should be justified by risk assessment.

Section B1.4.2

13. Surface barriers

Use surface barriers to protect clinical surfaces (including equipment) that are:

  • touched frequently with gloved hands during the delivery of patient care;
  • likely to become contaminated with blood or body substances; or
  • difficult to clean.

Exceptions to this should be justified by risk assessment.

Section B1.4.2

14. Site decontamination after spills of blood or other potentially infectious materials

Spills of blood or other potentially infectious materials should be promptly cleaned as follows:

  • wear utility gloves and other PPE appropriate to the task;
  • confine and contain spill, clean visible matter with disposable absorbent material and discard the used cleaning materials in the appropriate waste container;
  • clean the spill area with a cloth or paper towels using detergent solution.

Use of chemical disinfectants such as sodium hypochlorite should be based on assessment of risk of transmission of infectious agents from that spill.

Section B1.4.3

Transmission-based precautions (see Section B2)

Contact precautions

15. Implementation of contact precautions

In addition to standard precautions, implement contact precautions in the presence of known or suspected infectious agents that are spread by direct or indirect contact with the patient or the patient’s environment.

Section B2.2.2

16. Hand hygiene and personal protective equipment to prevent contact transmission

When working with patients who require contact precautions:

  • perform hand hygiene;
  • put on gloves and gown upon entry to the patient-care area;
  • ensure that clothing and skin do not contact potentially contaminated environmental surfaces; and
  • remove gown and gloves and perform hand hygiene before leaving the patient-care area.

Section B2.2.3

17. Patient-care equipment for patients on contact precautions

Use patient-dedicated equipment or single-use non-critical patient-care equipment.

If common use of equipment for multiple patients is unavoidable, clean the equipment and allow it to dry before use on another patient.

Section B2.2.3

Droplet precautions

18. Implementation of droplet precautions

In addition to standard precautions, implement droplet precautions for patients known or suspected to be infected with agents transmitted by respiratory droplets that are generated by a patient when coughing, sneezing or talking.

Section B2.3.2

19. Personal protective equipment to prevent droplet transmission

When entering the patient-care environment, put on a surgical mask.

Section B2.3.3

20. Placement of patients requiring droplet precautions

Place patients who require droplet precautions in a single-patient room.

Section B2.3.3

Airborne precautions

21. Implementation of airborne precautions

In addition to standard precautions, implement airborne precautions for patients known or suspected to be infected with infectious agents transmitted person-to-person by the airborne route.

Section B2.4.2

22. Personal protective equipment to prevent airborne transmission

Wear a correctly fitted P2 respirator when entering the patient-care area when an airborne-transmissible infectious agent is known or suspected to be present.

Section B2.4.3

23. Placement of patients requiring airborne precautions

Patients on airborne precautions should be placed in a negative pressure room or in a room from which the air does not circulate to other areas.

Exceptions to this should be justified by risk assessment.

Section B2.4.3

Multi-resistant organisms (MROs) (see Section B3)

24. Implementation of core strategies in the control of MROs (MRSA, MRGN, VRE)

Implement transmission-based precautions for all patients colonised or infected with a multi-resistant organism, including:

  • performing hand hygiene and putting on gloves and gowns before entering the patient-care area;
  • using patient-dedicated or single-use non-critical patient-care equipment;
  • using a single-patient room or, if unavailable, cohorting patients with the same strain of multi-resistant organism in designated patient-care areas; and
  • ensuring consistent cleaning and disinfection of surfaces in close proximity to the patient and those likely to be touched by the patient and healthcare workers.

Section B3.1.2

Finding information

These recommendations provide the basis for appropriate infection prevention and control practice in the healthcare setting. Practical guidance on their implementation is given in Part B of these guidelines. The following table provides a directory for this guidance.

Table 1: Directory of key information in these guidelines

When you need to know…

Read Section...

Infection prevention and control basics

What are standard precautions and how are they applied

Basics - Section B1

How are transmission-based precautions applied

Basics - Section B2

How to help patients become involved in infection control

Section A3;

Patient-care tips also highlighted

How to apply the process of risk management

Section A2

Hand hygiene

When to perform hand hygiene

Basics - Section B1.1

Contact - Section B1.1.2

Droplet - Section B2.2

MROs - Section B2.3

What hand hygiene products to use and how

Basics - Section B1.1.3

Case Studies - Section B1.1.6

MROs - Section B3.1.2

What to do if there are cuts or abrasions on your hands

Section B1.1.4

About jewellery or artificial fingernails and infection

Section B1.1.4

How to care for your hands

Section B1.1.5

Personal protective equipment

How to decide what PPE is needed for a particular situation

Section B1.2

What PPE to wear for routine clinical practice

Section B1.2.4

What PPE to wear when there is a risk of contamination with blood, body substances, secretions, or excretions

Aprons and gowns - Section B1.2.3

Face and eye protection - Section B1.2.4

Gloves - Section B1.2.5

What PPE to wear when transmission-based precautions are implemented

Contact - Section B2.2

Droplet - Section B2.3

Airborne - Section B2.4

MROs - Section B3.1.2

When to wear aprons and gowns

Aprons and gowns - Section B1.2.3

Contact - Section B2.2

When to wear face and eye protection

Basics - Section B1.2.4

Droplet - Section B2.3

Airborne - Section B2.4

When to wear gloves

Basics - Section B1.2.5

Contact - Section B2.2

Case Study - Section B1.2.8

What is the correct procedure for putting on and removing PPE

Basics - Section B1.2.7

Handling and disposal of sharps

How to avoid sharps injuries

Basics - Section B1.3

Case study - Section B1.3.5

How to use needleless devices

Basics - Section B1.3.2

How to safely dispose of sharps

Basics - Section B1.3.3

What to do if a sharps injury is sustained

Basics - Section B1.3.5

Environmental cleaning

What products and processes to use for routine environmental cleaning of surfaces

Basics - Section B1.4.2

When to use disinfectants

Basics - Section B1.4.2

Transmission-based precautions - Section B2.1.2

MROs - Section B3.1.2

How to minimise contamination of cleaning implements and solutions

Basics - Section B1.4.4

What products and processes to use when there is a spill of blood or body substances

Basics - Section B1.4.3

Case study - Section B1.4.4

How often to clean specific surfaces and items

Basics - Section B5.1

Reprocessing of reusable medical instruments and equipment

How to decide the level of reprocessing required for reusable medical equipment and instruments

Basics - Section B1.5

How to decide which reprocessing is required

Basics - Section B1.5.3

Case study - Section B1.5.7

Issues associated with standard precautions

How to practice respiratory hygiene and cough etiquette

Basics - Section B1.6

What is aseptic non-touch technique

Basics - Section B1.7

How to handle clinical waste and linen

Basics - Section B1.8

When there is a suspected or known infection

What transmission-based precautions are required for a specific infectious agent

Summary - Section B1.8 and Section B5

When to implement transmission-based precautions

General - Section B2

Contact - Section B2.2

Droplet - Section B2.3

Airborne - Section B2.4

How to wear a P2 respirator correctly

Basics - Section B2.4.3

When to implement the use of single-use or patient-dedicated equipment

Contact - Section B2.2

MROs - Section B3.1.2

What to consider when transferring patients

Contact - Section B2.2

Droplet - Section B2.3

Airborne - Section B2.4

Where to place patients to avoid cross-contamination

Contact - Section B2.2

Droplet - Section B2.3

Airborne - Section B2.4

MROs - Section B3.1.2

Outbreak - Section B3.2.2

Footnotes:
  1. Membership and terms of reference of the Infection Control Steering Committee are given in Appendix 1.