Basis for recommendation

These recommendations are based on the NHS National Services Scotland (NHS NSS) guidance National infection prevention and control manual  [NHS NSS, 2024], The Health and Social Care Act 2008: code of practice on the prevention and control of infections [DHSC, 2022], and the NHS England policy document NHS England National infection prevention and control manual (NIPCM) for England [NHS England, 2024]. 

Hand hygiene

• Decontaminate hands immediately:
  • Immediately Before every episode of direct contact with a person or care, including aseptic procedures.
  • Immediately after every episode of direct contact with a person or care
  • Immediately after any exposure to body fluids, mucous membranes, non-intact skin, or wound dressings.
  • Immediately after any other activity or contact with a person's surroundings that could potentially result in hands becoming contaminated.
  • Immediately before putting on, and immediately after the removal of, gloves.
• Also decontaminate hands: 
  • Before handling an invasive device, regardless of whether gloves are used or not.
  • If moving from a contaminated body site to another body site during the care of the same person.
• Decontaminate hands preferably with a hand rub conforming to current British standards, except in the following circumstances when liquid soap and water must be used: 
  • When hands are visibly soiled or potentially contaminated with body fluids.
  • When caring for patients with vomiting or diarrhoeal disease.
  • In clinical situations where there is potential for the spread of alcohol-resistant organisms (such as Clostridiodes difficile or other organisms that cause diarrhoeal illness).
    • Antimicrobial hand wipes are permitted where there is no access to running water. Hand hygiene using a hand rub must be performed immediately after use of antimicrobial hand wipes, and hand hygiene using soap and water must be performed as soon as possible.
• Ensure hands can be decontaminated throughout the duration of clinical work: 
  • Keep arms bare below the elbow when delivering direct care. This includes wearing short-sleeved garments or being able to roll up the sleeves.
  • Remove wrist and hand jewellery.
  • Make sure that fingernails are short, clean and free of nail polish. 
  • Cover cuts and abrasions with waterproof dressings.
• Use paper towels in clinical areas and staff toilets — good quality soft paper towels will help to prevent skin abrasion.
  • Do not use fabric hand towels.
• Do not routinely use nail brushes.
  • Nail picks (single-use) may be used prior to some invasive procedures if the nails are visably dirty.
• An effective handwashing technique involves three stages: preparation, washing and rinsing, and drying.
  • Wet the hands under tepid running water (avoid using hot water, as repeated exposure to hot water may increase the risk of dermatitis) before applying liquid soap or an antimicrobial preparation.
  • Ensure the handwash solution comes into contact with all of the surfaces of the hand. Rub the hands together vigorously for a minimum of 10–15 seconds, and pay particular attention to the tips of the fingers, the thumbs and the areas between the fingers.
  • Rinse hands thoroughly, then dry with good quality paper towels.
• When Decontaminating hands using an alcohol handrub:  
  • Ensure hands are free from dirt and organic material.
  • Ensure the handrub solution comes into contact with all surfaces of the hand. Rub the hands together vigorously, paying particular attention to the tips of the fingers, the thumbs and the areas between the fingers, until the solution has evaporated and the hands are dry.
• Apply an emollient hand cream regularly to protect skin from the drying effects of regular hand decontamination. If a particular soap, antimicrobial hand wash, or alcohol product causes skin irritation, an occupational health team should be consulted. 

Personal protective equipment

• Base the selection of personal protective equipment (PPE) on the risk of: 
  • Transmission of the microorganism(s).
  • Contamination of clothing and skin by blood, body fluids, secretions or excretions.
• All PPE must be:
  • Located close to the point of use.
  • Stored to prevent contamination in a clean, dry area until required.
  • Single-use only unless specified by the manufacturer.
  • Changed immediately after each patient and/or after completing a procedure or task.
  • Disposed of after use in the appropriate waste stream or, in the case of reusable PPE such as face shields, decontaminated after each use according to the manufacturer's specifications. 
  • Discarded if damaged, contaminated, or past the expiry date.
• Equipment that may be appropriate to use includes:
  • Gloves. These must be:
    • Worn for invasive procedures, contact with sterile sites and non-intact skin or mucous membranes, and all activities that have been assessed as carrying a risk of exposure to blood, body fluids, secretions or excretions, or to sharp or contaminated instruments. The use of gloves does not replace the need for hand hygiene measures.  
    • Worn as single-use items and changed between caring for different people and between different care or treatment activities for the same person.
    • Put on immediately before an episode of contact or treatment and removed as soon as the activity is completed. They must then be disposed of correctly, in accordance with current national legislation or local policies.
    • Changed if they are damaged or damage is suspected, for example, puncture or perforation. 
    • Be appropriate for the task and well-fitting.
    • Conform to current EU legislation (CE marked as medical gloves for single use). Alternatives to natural rubber latex gloves must be available for people who have a documented sensitivity to natural rubber latex. Do not use polythene gloves for clinical interventions.
  • Disposable plastic aprons or gowns. These must be:
    • Worn if there is a risk that clothing may be exposed to blood, body fluids, secretions, or excretions. Wear a long-sleeved fluid-repellent gown if there is a risk of extensive splashing of blood, body fluids, secretions, or excretions onto skin or clothing, or an apron provides inadequate cover for the procedure or task being performed.
    • Worn as single-use items for one procedure or one episode of direct care. They must be disposed of correctly in accordance with current national legislation or local policies.
  • Face masks and eye protection. These must be:
    • Worn if there is a risk of blood, body fluids, secretions, or excretions splashing into the face and eyes. Regular corrective spectacles are not considered eye protection.
    • Not impeded by accessories such as false eyelashes or piercings.
    • Not be touched when being worn.

Safe use and disposal of sharps

• Sharps include needles, cannulas, stitch cutters, scalpels, razor blades, broken glass, and medical instruments (for example, scissors and other sharp objects). 
• Train and assess all users in good practice in sharps management — this should cover the correct use and disposal of sharps and sharps safety devices, and what to do in the event of an injury.
  • Do not pass sharps directly from hand to hand — keep handling to a minimum. 
  • Do not bend or break used standard needles before disposal, and do not recap needles. 
  • If a safety device is being used, safety mechanisms should be deployed before disposal. 
  • The person generating the sharps waste should discard used sharps immediately (dispose of the needle and syringe as one unit) into the correct colour-coded sharps container, which must conform to current standards. Best practice colour coding is as follows:
    • Purple lid — cytostatic or cytotoxic medicines.
    • Orange lid — not contaminated with medicines.
    • Yellow lid  — contaminated with medicines. 
  • Sharps containers:
    • Must be located in a safe position (not on the floor) that avoids spillage, at a height that allows the safe disposal of sharps, and is away from public access areas and out of the reach of children.
    • Must not be used for any other purpose than the disposal of sharps.
    • Must not be filled above the fill line.
    • Must be disposed of when the fill line is reached and labelled with the date, source prior to disposal and a signature when assembled, locked and disposed of. 
    • Should be temporarily closed when not in use.
  • Use sharps safety devices if a risk assessment has indicated that they will provide safer systems of working for healthcare workers, carers, and patients.

Venepuncture

• Prior to the venepuncture procedure: 
  • Wash hands with liquid soap and warm running water or use alcohol hand rub using the Hand decontamination technique. 
  • Put on disposable apron.
  • Decontaminate hands again after applying the tourniquet and palpating the vein.
  • Put on disposable gloves.
  • Clean the person's skin with 70% isopropyl alcohol skin wipes for 30 seconds and allow the skin to dry.
• Once the venepuncture procedure is complete:
  • Release the tourniquet and place a low-linting sterile gauze over the puncture site.
  • Once the needle is removed, discard sharps in a sharps container.
  • Apply pressure and use an additional piece of sterile gauze if necessary. 
  • Inspect the puncture point for bleeding.
  • Apply a sterile adhesive plaster or hypoallergenic tape.
  • Remove and dispose of gloves and apron.
  • Wash hands with liquid soap and warm running water or use alcohol hand rub.

Waste disposal

• Educate people and carers about the correct handling, storage, and disposal of healthcare waste.
• Healthcare waste must be: 
  • Handled correctly.
    • Wear appropriate personal protective equipment when handling waste.
    • Hold waste bags by the neck and keep them at arm's length to reduce the risk of injury in case a sharp item has been inappropriately disposed of in the bag.
    • Never open a clinical waste bag to examine the contents.
    • Liquid waste; for example, suction canisters, should be rendered safe through the addition of a polymer gel or compound to the container, prior to its placement in a leak-proof orange-lidded bin, or leak-proof yellow-lidded bin if contaminated by pharmaceuticals.
  • Segregated correctly immediately by the person generating the waste into appropriate colour-coded storage or waste disposal bags or containers that are compliant with current national legislation and local policies. 
    • Orange — infectious waste (for example contaminated gloves or dressings).
    • Yellow and black striped — offensive/hygiene waste (for example, stoma or catheter bags).
    • Purple — cytotoxic or cytostatic medicine waste (for example, cytotoxic or cytostatic medicine containers with residue).
    • Blue — medicinal waste (for example, expired non-cytotoxic or -cytostatic medicines).
    • Black — domestic waste (for example, paper towels and food waste).
  • Labelled appropriately with the address and date prior to collection by the waste contractor (some waste contractors may undertake this) to ensure traceability if an incident occurs. 
  • Packaged for transportation — waste bags should be no more than 2/3 full. This allows enough space for the bag to be tied using a suitable plastic zip tie or secure knot.
    • If a waste bag awaiting collection is torn, the torn bag and contents should be placed inside a new waste bag.
  • Stored safely in a secure place away from public access. 
  • Transported and disposed of in accordance with current national legislation and local policies. 
  • For safe disposal of sharps, see the section on the Safe use and disposal of sharps.

Blood and body fluid spillage

• Spillages of blood and other body fluids may transmit blood-borne viruses. 
• Appropriate PPE should be worn when treating blood or body fluid spillages.
• Spillages should be treated immediately by staff trained to do so safely. 
  • Apply chlorine-releasing granules or an appropriate spill kit when dealing with blood or body fluid, following the manufacturer’s instructions.
  • Dispose of the spillage and contents of the pack as infectious waste.
  • If the spill occurs on soft furnishings such as carpets, discuss with the infection prevention and control team.
    • Consider if the furnishings can withstand a chlorine-releasing solution or whether it is safe to clean with detergent alone. If this is not the case, or the furnishings are heavily contaminated, they should be discarded.
• Deal with spillages containing only urine, faeces, vomit, and/or sputum appropriately.
  • Soak up the spillage with disposable paper towels, a gelling agent may be used on urine spillages.
  • Decontaminate the area using a solution of 1000 parts per million available chlorine solution or 1000 parts per million available chlorine detergent/chlorine releasing solution, following the manufacturer's instructions.
    • Do not place a chlorine-based product directly on urine as toxic fumes are released.
• Once the area has been treated, wash the area with disposable paper towels and a solution of general-purpose detergent and warm water, dry the area or allow it to air dry, and perform hand hygiene.

Laundry

• Use disposable paper products (for example, paper towels and couch roll).
• • Do not use linen such as blankets, pillowcases, or fabric hand towels — it is not practical to launder items between each consultation.
• Use fabric curtains and screens — these should be laundered by a professional laundry service on a documented planned schedule (for example, 6-monthly or laundered immediately if visibly soiled). 
  • Change disposable curtains, if used, every 6 months or immediately if visibly soiled. The date the curtain is put up should be documented.
• Seal pillows and blankets in a wipeable cover with no tears and clean with a detergent wipe after use.
  • Disposable couch roll should be used to cover the pillow or maintain the patient’s modesty for procedures where this is required and disposed of after use.
• Wear personal protective equipment (for example, a disposable apron) to prevent contamination of uniform and workwear.
• Ensure uniforms and workwear are:
  • Fit for purpose and support good hand hygiene.
  • Changed immediately if it becomes visibly soiled or contaminated.
  • Laundered separately from other clothing on a hot wash cycle at the highest temperature that the fabric will tolerate.
    • Garments should be dried thoroughly. Tumble drying or ironing will further reduce the small number of microorganisms present after washing.
• Neckties and lanyards may become contaminated by pathogens, can accidentally come into contact with people, and are rarely laundered. Therefore, it is recommended that they are not worn whilst undertaking direct care activities. 

Decontamination of equipment

• Decontaminate all reusable equipment after use — the method used depends on the manufacturer’s instructions, a risk assessment of the procedure, and the item being used in accordance with Control of Substances Hazardous to Health (COSHH) Regulations.
  • Some equipment will have specific instructions which should be followed (for example, Propulse machine or peak flow meters).
• Decontamination should occur:
  • Between each patient use.
  • After blood or body fluid contamination.
  • Before inspection, servicing, repair, being loaned out, decommissioning, recycling, and disposal.
  • At regular, pre-defined intervals as part of a cleaning schedule. 
  • After visible soiling or contamination.
• There are three levels of decontamination: 
  • Cleaning — physically removes infectious agents and organic matter, but does not necessarily destroy infectious agents.
    • Clean, non-invasive, reusable equipment before disinfection or sterilisation is carried out.
    • Use detergent wipes, or a neutral detergent with warm water and single-use cloths.
    • Dry all equipment that has been cleaned thoroughly before storage.
  • Disinfection — reduces the number of viable microorganisms but may not necessarily inactivate some infectious agents. Disinfect any non-invasive, reusable equipment, following the manufacturer's instructions:
    • That has been contaminated with blood or body fluid.
    • That has come into contact with mucous membranes.
    • That is contaminated with particularly virulent or readily transmitted organisms.
    • Before use on an immunocompromised person.
  • Sterilisation — destroys all microorganisms including spores. Re-usable items requiring sterilisation must be sent to an accredited decontamination services facility.
• Ensure the correct amount of disinfectant and water are used — if a chlorine-based solution is used it should be at a dilution of 1000 ppm.
  • As diluted chlorine-based disinfectant solutions are unstable and become less effective after 24 hours, a new solution should be made each day.
• Always wear disposable gloves, an apron, and eye protection if indicated. 

Environmental cleanliness

• The care environment must be:
  • Visibly clean and free of non-essential items and equipment to aid in effective cleaning.
  • Well maintained, in a good state of repair, and with effective ventilation.
  • Routinely cleaned following the national cleaning standards.
• Ensure a cleaning plan is in place — this should include: 
  • The standards to be achieved.
  • Clear allocation of responsibility for cleaning of all areas and items and a designated person to lead on cleaning and decontamination.
  • Cleaning schedules and frequencies and the names of people responsible for cleaning.
  • Systems to measure outcomes, the reports required and who should receive them.
  • Operational and training policies and procedures and risk assessment protocols.
  • How cleaning services, operations and controls dovetail with arrangements for infection control, including training for all cleaning staff in infection control policies and procedures.
  • A documented record of cleaning undertaken.
  • The management arrangements in place to ensure external cleaning contractors (if used) deliver against the contract.
    • Suitable arrangements should be in place to monitor standards of cleaning and to deal with poor or unsatisfactory performance.
• Ensure blood and body fluid spillages are dealt with promptly. 
• Limit the number of cleaning products to avoid inappropriate use.
  • Detergents — warm water and neutral detergent or detergent wipes are suitable for many cleaning activities.
    • Select and use a good quality neutral detergent or detergent wipe.
    • Liquid detergents classed as anionic and non-ionic have the best detergent activity.
  • Disinfectants — these are not required for routine cleaning. 
    • Use spillage kits for disinfecting surfaces following a blood or body fluid spillage. 
    • Use disinfectants that are virucidal and bactericidal for disinfecting surfaces after dealing with a person with a known infection. 
    • Alcohol wipes can be used, but as they do not contain a cleaning agent, surfaces should first be wiped with a detergent wipe or solution of neutral detergent and warm water. Alcohol is effective against meticillin-resistant Staphylococcus aureus (MRSA) and multi-resistant gram negative bacteria (MRGNB), but is not effective against Norovirus or Clostridioides difficile.
    • Make up disinfectant solutions according to the manufacturer’s instructions.
• Use colour coding for cleaning equipment used for cleaning different areas — this ensures that these items are not used in multiple areas, therefore, reducing the risk of transmission of infection from one area to another, (for example, toilet to kitchen).
  • Yellow — treatment and minor operation rooms.
  • Green — kitchens.
  • Blue — general areas (for example, waiting rooms and consulting rooms, including sinks in general areas).
  • Red — sanitary areas, including sinks in sanitary areas.
• Measures for reducing the risk of transmission of infection from cleaning equipment include: 
  • Use single-use cloths.
  • Store equipment clean and dry after use in a designated area.
  • Store products in a designated lockable area.
  • Wash mop heads in the bucket in detergent and warm water after use, rinse and store upright to dry. Replace mop heads regularly depending on the frequency of use, or if visably stained.
    • Do not store equipment, (for example, mops) overnight in disinfectants or disinfectant solutions. If disinfection is required, wash the mop head in detergent and warm water, rinses and soak for 30 minutes in a hypochlorite solution at 1,000 ppm, rinse and then store upright to dry.
  • Floor scrubbing machines, steam cleaners, and carpet shampoo machines, should be designed to enable tanks to be emptied, cleaned, and dried.
  • Ensure each toilet has its own toilet brush and holder.
    • Place the toilet brush head beneath the water level and flush the toilet, and clean thoroughly after use.
• Measures for reducing the risk of transmission of infection from furniture, fixtures, fittings, and toys include ensuring that: 
  • Surfaces are smooth, wipeable, and non-impervious to facilitate effective cleaning.
  • Damaged surfaces are repaired or replaced. 
  • 1000 ppm available chlorine is used routinely on sanitary fittings.
  • When purchasing new furniture, fixtures, and fittings the item can be easily cleaned.
  • Toys are wipeable and in good condition, and they are cleaned regularly (for example, weekly, with detergent and warm water) and included in the cleaning schedule.
    
    • Note: magazines are allowed in waiting rooms.

Respiratory and cough hygiene

• To minimise the risk of cross-contamination from respiratory illness: 
  • Cover the nose and mouth with a disposable tissue when sneezing, coughing, wiping and blowing the nose.
  • Dispose of all used tissues promptly into a waste bin.
  • Wash hands with non-antimicrobial liquid soap and warm water after coughing, sneezing, using tissues, or after contact with respiratory secretions or objects contaminated by these secretions.
  • Where there is no running water available or hand hygiene facilities are lacking, use hand wipes followed by alcohol-based hand rub and wash hands as soon as possible. 
  • Keep contaminated hands away from the eyes nose and mouth.
• Staff should promote respiratory and cough hygiene helping those (eg, elderly, children) who need assistance with this, eg providing patients with tissues, a dedicated receptacle i.e. waste bag for used tissues and hand hygiene facilities as necessary.

Basis for recommendation

These recommendations are based on the National Institute for Health and Care Excellence (NICE) guidance Healthcare-associated infections: prevention and control in primary and community care [NICE, 2017], the NHS England National infection prevention and control manual (NIPCM) for England [NHS England, 2024], the NHS National Services Scotland (NHS NSS) National Infection Prevention and Control Manual [NHS NSS, 2024], and Infection Prevention and Control policies for general practice Safe management of the care environment [IPC, 2023d], Safe management of linen, including uniforms and workwear [IPC, 2023e], Venepuncture [IPC, 2023f], Safe disposal of waste, including sharps [IPC, 2023g], Safe management of sharps and inoculation injuries [IPC, 2023h], Safe management of care equipment [IPC, 2023i], and Hand hygiene [IPC, 2023j].

What precautions are needed for long-term urinary catheters?

• In addition to the general precautions for people with invasive devices, specific precautions for people with urinary catheters include: 
  • Use aseptic procedure for all catheterisations.
  • When changing catheters in people with a long-term indwelling urinary catheter:
    • Do not offer antibiotic prophylaxis routinely.
    • Consider antibiotic prophylaxis for people who have a history of symptomatic urinary tract infection after catheter change or experience trauma during catheterisation.
• Maintenance precautions include:
  • Ensure the catheter is connected to a sterile closed urinary drainage system or catheter valve.
  • Decontaminate hands and wear a new pair of clean, non-sterile gloves before manipulating a catheter, and decontaminate hands after removing gloves. 
  • Educate people managing their own catheters, and their carers about the need for hand decontamination before and after manipulation of the catheter.  
  • Advise men to wash the meatus daily with soap and water.
• To minimise the risk of blockages, encrustations, and catheter-associated infections:
  • Develop a patient-specific care regimen.
  • Consider approaches such as reviewing the frequency of planned catheter changes and increasing fluid intake.
  • Document catheter blockages.
• Other precautions include: 
  • Obtain urine samples from a sampling port using an aseptic technique (if/when required). 
  • Position urinary drainage bags below the level of the bladder, but not in contact with the floor. 
  • Use a link system to facilitate overnight drainage, to keep the original system intact. 
  • Empty the urinary drainage bag frequently enough to maintain urine flow and prevent reflux, and changed it when clinically indicated. 
• Do not use bladder instillations or washouts to prevent catheter-associated infections.

What precautions are needed for enteral feeding devices?

• Use pre-packaged, ready-to-use feeds whenever possible in preference to feeds which require decanting, reconstitution or dilution. 
  • The chosen system should require minimal handling to assemble, and be compatible with the patient's enteral feeding tube.
• Ensure effective hand decontamination before starting feed preparation. 
• When preparing feeds: 
  • Use a clean working area and only use equipment dedicated for enteral feed use.
  • Mix feeds using cooled boiled water or freshly opened sterile water and a no-touch technique.
• When administering feeds:  
  • Use minimal handling and an aseptic technique to connect the administration system to the enteral feeding tube. 
  • Use administration sets and feed containers once and discard after each feeding session.
• Store feeds according to the manufacturer's instructions and, where applicable, food hygiene legislation — if ready-to-use feeds are not available, feeds may be prepared in advance, stored in a refrigerator, and used within 24 hours. 
• Maintain the insertion site and enteral feeding tube:
  • Wash the stoma daily with water and dry thoroughly. 
  • Flush the enteral feeding tube before and after feeding or administering medications using single-use syringes or single-patient-use (reusable) syringes according to the manufacturer's instructions to prevent blockages. Use:
    • Freshly drawn tap water for people who are not immunosuppressed.
    • Cooled freshly boiled water or sterile water from a freshly opened container for people who are immunosuppressed. 

What precautions are needed for vascular access devices?

• Decontaminate the skin at the insertion site with chlorhexidine gluconate in 70% alcohol before inserting a peripheral vascular access device. 
  • Use a sterile transparent semipermeable membrane dressing to cover the insertion site. 
    • Replace the dressing covering central venous access devices insertion site every 7 days, or sooner if the dressing is no longer intact or moisture collects under it. 
    • Leave the dressing applied to a peripheral cannula insertion site in situ for the life of the cannula, provided that the integrity of the dressing is retained. 
    • Replace dressings on tunnelled or implanted central venous catheter sites every 7 days until the insertion site has healed unless there is an indication to change them sooner. 
  • Consider a sterile gauze dressing covered with a sterile transparent semipermeable membrane dressing only if the patient has profuse perspiration or if the vascular access device insertion site is bleeding or oozing. If a gauze dressing is used:
    • Change it every 24 hours, or sooner if it is soiled.
    • Replace it with a sterile transparent semipermeable membrane dressing as soon as possible. 
  • Ensure that catheter-site care is compatible with catheter materials (tubing, hubs, injection ports, luer connectors and extensions) and check compatibility with the manufacturer's recommendations. 
• Decontaminate the central venous catheter insertion site and surrounding skin during dressing changes using chlorhexidine gluconate in 70% alcohol, and allow to air dry.
  • Consider using an aqueous solution of chlorhexidine gluconate if the manufacturer's recommendations prohibit the use of alcohol with the catheter.
  • Use individual sachets of antiseptic solution or individual packages of antiseptic-impregnated swabs or wipes.
• The general principles for management of vascular access devices include: 
  • Decontaminate hands before accessing or dressing a vascular access device, and use an aseptic technique when accessing the system.
  • Decontaminate the injection port or vascular access device catheter hub before and after accessing the system using chlorhexidine gluconate in 70% alcohol.
    • Consider using an aqueous solution of chlorhexidine gluconate if the manufacturer's recommendations prohibit the use of alcohol with the catheter.
  • Preferably, use: 
    • A single lumen catheter to administer parenteral nutrition. If a multilumen catheter is used, one port must be exclusively dedicated for total parenteral nutrition, and all lumens must be handled with the same attention to aseptic technique. 
    • A sterile 0.9 percent sodium chloride injection to flush and lock catheter lumens. When recommended by the manufacturer, implanted ports or opened-ended catheter lumens should be flushed and locked with heparin sodium flush solutions. 
  • Do not routinely use: 
    • In-line filters for infection prevention. 
    • Antibiotic lock solutions, or systemic anticoagulants to prevent catheter-related bloodstream infections (CRBSI). 
    • Systemic antimicrobial prophylaxis to prevent catheter colonisation or CRBSI during the use of a central venous catheter. 
  • If needleless devices are used:
    • Follow the manufacturer's recommendations for changing the needleless components.
    • Ensure that all components of the system are compatible and secured, to minimise leaks and breaks in the system. 
    • Minimise the risk of contamination by decontaminating the access port with either alcohol or an alcoholic solution of chlorhexidine gluconate before and after using it to access the system.
  • In general, administration sets in continuous use do not need not be replaced more frequently than at 72-hour intervals unless they become disconnected or a catheter-related infection is suspected or documented. Replace administration sets for: 
    • Blood and blood components every 12 hours, or according to the manufacturer's recommendations. 
    • Parenteral nutrition infusions every 24 hours — if the solution contains only glucose and amino acids, administration sets in continuous use do not need to be replaced more frequently than every 72 hours. 
  • Avoid the use of multidose vials, in order to prevent the contamination of infusates. 

Basis for recommendation

These recommendations are based on the National Institute for Health and Care Excellence (NICE) guidance Healthcare-associated infections: prevention and control in primary and community care [NICE, 2017] and the Infection Prevention Control policy for general practice invasive devices [IPC, 2023k]. 

Blood-borne viruses

• Blood borne-viruses (BBVs) include: 
  • Human immunodeficiency virus (HIV), which causes acquired immune deficiency syndrome (AIDS). For more information, see the CKS topic on HIV infection and AIDS. 
  • Hepatitis B virus (HBV). For more information, see the CKS topic on Hepatitis B. 
  • Hepatitis C virus (HCV). For more information, see the CKS topic on Hepatitis C. 
• Precautions to prevent inoculation with BBVs include:
  • Standard precautions — used appropriately these should be sufficient to ensure that no extra precautions are required for people known to carry these viruses.
    • Blood and body fluid spillage — urine, faeces, sputum, tears, sweat and vomit are not considered to pose a risk unless they are contaminated with blood. 
    • Waste disposal. 
    • Venepuncture and sharps disposal — specimens and request forms from people known to be or suspected of being infected with blood-borne viruses should be labelled with a ‘Danger of Infection’ or ‘hazard’ sticker.
  • Use of safety sharps where appropriate.
  • Appropriate management of percutaneous exposures (sharps/splash injuries).
  • Protection of clinical and other staff with hepatitis B vaccination.
• Standard infection prevention and control precautions for reducing the risk of transmission of BBVs include:
  • Keep cuts or broken skin covered with waterproof dressings.
  • Protect eyes, mouth and nose from blood splashes where there is a risk of splashing.
  • Avoid direct skin contact with blood and blood-stained body fluids
    • If blood/blood-stained body fluids are splashed on the skin, wash off with liquid soap and warm running water.
  • Wear disposable latex/nitrile gloves when contact with blood or body fluids is likely.
  • Always clean hands after removing gloves.
  • Always clean hands before and after giving first aid.
  • Contain and promptly disinfect surfaces contaminated by spillages of blood and body fluids.

Clostridioides difficile

• Follow standard procedures, including. 
  • Hand hygiene — use liquid soap and warm running water.
    • Do not use alcohol hand rubs as these do not kill spores.
  • Personal protective equipment — wear disposable gloves and an apron.
    • Remove these (gloves first then apron) and dispose of them appropriately. If in the person's home, use the household waste and wash hands thoroughly.
  • Environmental cleanliness — C. difficile spores can survive in the environment for years if not properly cleaned. If a person with confirmed C. difficle infection has been in the practice within 48 hours of having diarrhoea, the immediate environment must be decontaminated using a 1000 ppm chlorine-based disinfectant solution or 2 in 1 detergent and chlorine based disinfectant solution.  
• Advise symptomatic people to:
  • Wash hands thoroughly with liquid soap and warm running water, especially after going to the toilet and before preparing or eating food.
  • Use a separate towel to dry hands and to wash it daily.
    • This should not be used by other members of the household or visitors.
  • Close the toilet seat lid before flushing after an episode of diarrhoea — this will reduce spread onto surrounding surfaces.
  • Clean hard surfaces in toilets/bathrooms (for example, taps, toilet flush, door handles, soap dispenser) at least daily using household bleach. 
  • Wash soiled clothing and bedding as soon as possible — these should be washed separately from other people’s laundry at the highest temperature the fabric will tolerate.
  • Have a shower or bath every day if possible, as C. difficile can be present on other areas of the body.
  • Stay at home until free from diarrhoea for 48 hours to prevent spreading it to other people, if possible.
  • Drink plenty of fluids to prevent dehydration.
• Also advise them:
  • Not to take medicines to stop diarrhoea (unless prescribed by a healthcare professional), as this will stop C. difficile being cleared from the body. 
  • That visitors, including pregnant women and children, are not at risk if they are healthy.
  • That once recovered, there is no risk to other people.
  • If they been given a C. difficile card to show it to healthcare professionals.
• See the CKS topic Diarrhoea - antibiotic associated for more information.

Creutzfeldt-Jakob disease

• No special measures over and above standard infection control procedures are required when caring for people with CJD or vCJD, as it is unlikely that a procedure will be undertaken that involves contact with high or medium risk tissues.

Multi-resistant gram negative bacteria (MRGNB)

• Follow standard infection control precautions and good hand hygiene practice. 
  • Hand hygiene is essential before and after direct contact — use liquid soap and warm running water or alcohol hand rub.
• No specific precautions are required for people attending for a routine GP consultation, however, personal protective equipment should be worn if an examination is undertaken involving contact with body fluids.
  • Schedule people attending for a procedure (for example, wound dressing) at the end of the session to allow for environmental cleaning, if possible.
  • Wear disposable gloves and apron when in contact with body fluids  — dispose of these after each procedure.
  • Wear long sleeved fluid-repellent gowns, if there is a risk of extensive splashing of body fluids to the uniform.
  • Clean the treatment couch and immediate area with detergent and warm water followed by a hypochlorite solution at a dilution of 1000 ppm, e.g. Haz tabs, Presept or a disinfectant wipe if the person has attended for a procedure.
  • Dispose of waste contaminated with body fluids as infectious waste.

Meticillin-resistant Staphylococcus aureus

• Follow standard infection control precautions and good hand hygiene practice. 
  • Hand hygiene is essential before and after direct contact — use liquid soap and warm running water or alcohol hand rub.
• No specific precautions are required for people attending for a routine GP consultation, however, personal protective equipment should be worn if an examination is undertaken involving contact with body fluids.
  • Schedule people attending for a procedure (for example, wound dressing) at the end of the session to allow for environmental cleaning, if possible.
  • Wear disposable gloves and apron when in contact with body fluids  — dispose of these after each procedure.
  • Wear long sleeved fluid repellent gowns if there is a risk of extensive splashing of body fluids to the uniform.
  • Clean the treatment couch and immediate area with detergent and warm water followed by a hypochlorite solution at a dilution of 1000 ppm, e.g. Haz tabs, Presept or a disinfectant wipe if the person has attended for a procedure.
  • Dispose of waste contaminated with body fluids as infectious waste.

Norovirus

• Follow standard infection control precautions and good hand hygiene practice. 
• When assessing people with suspected norovirus:
  • Wash hands with liquid soap and warm running water and dry with paper towels.
    • Alcohol hand rub should not be used as it is not effective at killing norovirus.
  • Wear a disposable apron and gloves.
  • Wash hands again after removing the apron and gloves. 
• Encourage people with symptoms to wash their hands thoroughly with liquid soap and warm running water:
  • After an episode of vomiting or diarrhoea,
  • After using the toilet.
  • Before eating and drinking.
• During periods of increased activity with norovirus: 
  • Remind practice staff to wash their hands thoroughly (rather than using alcohol hand rub) after patient contact, before their breaks and before eating and drinking.
• Advise people (including staff) with vomiting and/or diarrhoea to stay off work until they are symptom-free for 48 hours. 
  • If this occurs at work, send staff home immediately.
• If a person vomits, clear up spillages promptly:
  • Wear personal protective equipment (for example, apron and gloves).
  • Ventilate the area by opening doors and windows, if possible.
  • Use an appropriate body fluid spillage kit to clean the affected area.
    
    • Do not use a chlorine-based disinfectant in a carpeted area, clean with detergent and warm water, a carpet cleaning machine or steam cleaner.
  • Dispose of waste and personal protective equipment as infectious waste.
  • Wash hands with liquid soap and warm running water.
  • If a mop and bucket are used, they should be in accordance with the national colour coding.
    • After use, the mop head should be disposed of immediately as infectious waste and the bucket washed with detergent and warm water and then wiped with a chlorine-based disinfectant at 1,000 parts per million and stored upside down.
  • All cloths used must be single use and disposed of after use.

Panton-Valentine Leukocidin staphylococcus aureus (PVL-SA)

• Discuss a confirmed diagnosis of PVL-SA with the local Community Infection Prevention and Control (IPC) or Public Health England (PHE) team.
• Follow standard infection control precautions and good hand hygiene practice. 
  • Hand hygiene is essential before and after direct contact — use liquid soap and warm running water or alcohol hand rub.
• No specific precautions are required for people attending for a routine GP consultation, however, personal protective equipment should be worn if an examination is undertaken involving contact with body fluids.
  • Schedule people attending for a procedure (for example, wound dressing) at the end of the session to allow for environmental cleaning, if possible.
  • Wear disposable gloves and apron when in contact with body fluids  — dispose of these after each procedure.
  • Wear long sleeved fluid repellent gowns if there is a risk of extensive splashing of body fluids to the uniform.
  • Disinfect the treatment couch, surfaces, immediate area, and any medical devices used if the person has attended for a procedure. Use a dual acting product — for example, Chlor-Clean, Actichlor plus, made into a solution at a concentration of 1,000 parts per million (ppm), or a wipe, such as Clinell Universal.
  • Dispose of waste contaminated with body fluids as infectious waste.

Basis for recommendation

These recommendations are based on the NHS National Services Scotland (NHS NSS) National Infection Prevention and Control Manual [NHS NSS, 2024], and the Infection Prevention and Control policies for general practice Blood-borne viruses [IPC, 2023l], C. difficile (Clostridioides difficile) [IPC, 2023c], CJD (Creutzfeldt-Jakob disease) [IPC, 2023m], MRGNB including CPE [IPC, 2023n], MRSA [IPC, 2023a], and Viral gastroenteritis/ norovirus [IPC, 2023o], and PVL-SA [IPC, 2023b].

Transmission routes

The COVID-19 pandemic highlighted that the traditional method of describing respiratory transmission routes (droplet or airborne) may not be reflective of what happens in real life, and is likely to change. The application of TBPs may differ depending on the setting and the known or suspected infectious agent [NHS England, 2024; NHS NSS, 2024].