Decontaminate hands with each patient contact

UPDATED NICE guidance calls on all GPs and other healthcare professionals in England and Wales to decontaminate their hands immediately after each patient contact to prevent the spread of infection in healthcare settings.

Infection control: prevention and control of healthcare-associated infections reflects the fact that more and more patients are being seen in primary care and more complex issues are being dealt with by GPs and practice nurses.

HCAIs such as Clostridium difficile and methicillin-resistant Staphylococcus aureus (MRSA) led to approximately 9,000 deaths in hospital and primary care in England in 2007. The cost of HCAIS to the NHS is estimated to be around £1 billion a year, with £56 million of this thought to be incurred once patients have been discharged from hospital.

The guideline states that hands must be decontaminated immediately before and after every episode of direct contact with patients, including aseptic procedures. In addition, hands should be decontaminated after any exposure to body fluids, after contact with a patient's surroundings that could potentially result in hands being contaminated and immediately after gloves are removed.

GPs and healthcare workers engaged in clinical work should be bare below the elbow with no wrist and hand jewellery and must ensure fingernails are short, clean and free of nail polish. Cuts and abrasions must be covered with waterproof dressings.

Dr Julian Spinks, a GP and member of the Guideline Development Group for this update, said: "At a time where increasingly complex procedures are being provided in primary care, infection control is becoming more and more important.

"This guideline provides information about effective and practical measures that primary care clinicians can take to reduce the burden of healthcare-associated infection and forms an important part of the armoury for those of us who wish to provide high quality care in the community."

A range of implementation tools are being published alongside the guideline to support its use, such as a clinical audit tool and a baseline assessment tool.

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