Health and Social Care Act 2008: code of practice on the prevention and control of infections and related guidance

Jan 17, 2024

Updated 13 December 2022

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Good infection prevention and control (IPC), including cleanliness, is essential to ensure that people who use health and adult social care services receive safe and effective care. This description of all activities related to infection prevention and control (including cleanliness) (IPC) was adopted in response to the consultation on the revision of the code of practice in 2015 to make it clear to non-specialists that cleanliness is an integral part of IPC. Throughout the document ‘infection prevention and control (including cleanliness)’ should be interpreted as including cleanliness. Effective prevention and control of infection must be part of everyday practice and be applied consistently by everyone.

Good management and organisational processes are crucial to make sure that high standards of IPC (including cleanliness) are developed and maintained.

This document sets out the code of practice (the code) on the prevention and control of infections under the Health and Social Care Act 2008 (H&SCA 2008). This act sets out the overall framework for the regulation of health and adult social care activities by the Care Quality Commission (CQC). It will apply to registered providers of all health and adult social care in England. Because of the wide range of services provided by all registered providers, the code will be applied in a proportionate way.

Part 2 of the code sets out the 10 criteria against which the CQC will judge a registered provider on how it complies with the IPC (including cleanliness) requirements, which are set out in the regulations. To ensure that consistently high levels of IPC (including cleanliness) are developed and maintained, it is essential that all providers of health and social care read and consider the whole document and its application in the appropriate sector and not just selective parts.

Parts 3 and 4 of this document will help registered providers interpret the criteria and develop their own risk assessments. The appendices provide examples of how a proportionate approach could be applied to the criteria in all sectors and it is important to read the examples given in the appendices, alongside the guidance under each criterion in part 3 of this document. The bibliography lists a range of supporting national guidance.

This publication replaces the previous Health and Social Care Act 2008: Code of Practice document for health and adult social care on the prevention and control of infections and related guidance. The code applies to NHS bodies and providers of independent healthcare and adult social care in England, including primary dental care, independent sector ambulance providers and primary medical care providers.

We have revised the previous code of practice document to reflect the structural changes that took effect in the NHS from 1 July 2022 and the role of IPC (including cleanliness) in optimising antimicrobial use and reducing antimicrobial resistance.

The law states that the code is to be taken into account by the CQC when it makes decisions about registration against the IPC (including cleanliness) requirements. The regulations also state that registered providers must have regard to the code when deciding how they will comply with registration requirements. So, by following the code, registered providers will be able to show that they meet the relevant requirements set out in the regulations.

However, the code is not mandatory so registered providers do not by law have to comply with the code. A registered provider may be able to demonstrate that it meets the regulations in a different way (equivalent or better) from that described in this document. The code aims to exemplify what providers need to do in order to comply with Regulations for Service Providers and Managers – Care Quality Commission 2022.

Good infection prevention control (IPC), including cleanliness and prudent antimicrobial stewardship (AMS), is essential to ensure that people who use health and social care services receive safe and effective care. Effective prevention of infection must be part of everyday practice and be applied consistently by everyone. It is also a component of good antimicrobial stewardship as preventing infections helps to reduce the need for antimicrobials.

Good management and organisational processes are crucial to make sure that high standards of IPC (including cleanliness) are set up and maintained.

As the regulator of health and adult social care in England, the Care Quality Commission (CQC) will provide assurance that the care people receive meets the fundamental standards of quality and safety. These standards are set out in the regulations.

This document outlines what registered providers in England should do to ensure compliance with the registration requirement at Regulation 12(2)(h) of the regulations. This includes ‘assessing the risk of, and preventing, detecting and controlling the spread of, infections, including those that are healthcare associated’.

It also sets out the 10 compliance criteria against which registered providers will be judged. Providers should note that Regulation 15 is also relevant to IPC (including cleanliness) and that other provisions of the regulations may also apply.

The CQC has published guidance for providers on meeting the requirements of the regulations, including the enforcement policy, and will use these documents in conjunction with this code of practice and related guidance when judging compliance. Because of the wide range of services provided by all registered providers, the code will be applied in a proportionate way.

The main purposes of the code are to:

Readers will note that only paragraphs in part 3 of this document have been numbered, as these particular sections are likely to be specifically referenced by the CQC in ensuring compliance with the regulations.

There are a wide range of terms relating to services and organisational structures, and different ways to describe the same or similar things across health and social care. In this document we have tried to harmonise some of those terms and use descriptions that are meaningful across all sectors. For example, we have used the term ‘service user’ to describe patients, donors, residents and clients.

Because National Health Service (NHS) trusts (as an entity), primary medical and dental care, independent healthcare, independent sector ambulance providers and adult social care providers are all required to register with the CQC as providers of health or social care, they are referred to in this document as ‘registered providers’.

The term ‘health and care worker’ is used to refer to anyone whose normal duties involve providing direct care to service users, for example clinical staff, nurses, healthcare assistants, care assistants as well as volunteers.

The term ‘independent-sector ambulance provider’ covers triage, medical or clinical advice provided remotely, face-to-face treatment and transport services. Transport services are those provided by means of vehicles, which are designed for the primary purpose of carrying a person who requires treatment. The term ’vehicle’ includes road, air and water ambulances.

The term ‘infection’ is used throughout this document, rather than the more explicit term ‘healthcare associated infection’, except for circumstances where the specific term is appropriate.

Antimicrobial resistance (AMR) is defined as resistance of a microorganism to an antimicrobial drug that was originally effective for treatment of infections caused by it, and applies to antivirals, antifungals, antiparasitics and antibiotics.

Antimicrobial stewardship (AMS) is defined as ‘an organisational or healthcare-system-wide approach to promoting and monitoring judicious use of antimicrobials to preserve their future effectiveness’. It includes promoting optimal diagnosis of infection, drug choice, regimen, dose, duration and administration route. The aim is for optimal clinical outcome and to limit selection of resistant strains. This is a key component of a multi-faceted approach to preventing antimicrobial resistance. The code recognises that many infections that arise in the community may not be related to the delivery of health or adult social care. Nevertheless, some of these infections may be preventable by good practice, such as hygiene and immunisation, which is dealt with in the code and the related guidance. Appendix D provides further definitions.

This document builds on the previous H&SCA 2008 code of practice for health and adult social care on the prevention and control of infections and related guidance. The previous code of practice applied to NHS bodies and providers of independent healthcare and adult social care in England and was used by the CQC to judge whether those providers complied with the registration requirement for IPC (including cleanliness).

This refreshed code strengthens some elements such as how to prevent antimicrobial resistance and provides additional clarity in some of the criteria, as well as an updated bibliography.

The way that health and adult social care is regulated has changed since April 2009 because of the introduction of the Health and Social Care Act (H&SCA) 2008.

The regulations, as made under the H&SCA 2008, describe the health and adult social care activities that may only be carried out by providers that are registered with the CQC, and set out the registration requirements that these providers must meet to become and stay registered. Further details on how the CQC assesses whether providers meet the requirements can be found here.

The H&SCA 2008 and regulations are law and must be complied with. The CQC has enforcement powers that it may use if registered providers do not comply with the law.

NHS bodies providing regulated activities, including prison healthcare services, have been required to comply with the full set of registration requirements since 1 April 2010. Independent healthcare and adult social care providers of regulated activities have been required to comply with the registration requirements since 1 October 2010. Primary dental care and independent sector ambulance providers have been required to register by April 2011, and primary medical care providers by April 2012.

The regulated activities and registration requirements are set out in the H&SCA 2008 (Regulated Activities) Regulations 2014.

Section 21 of the H&SCA 2008 enables the Secretary of State for Health to issue a code of practice about the prevention and control of healthcare associated infections. The code contains statutory guidance about compliance with the registration requirement relating to IPC (including cleanliness) (Regulation 12 (2) (h) and 21(b) of the regulations).

The law states that the code must be taken into account by the CQC when it makes decisions about registration against the IPC (including cleanliness) requirements in Regulations 12 (2) (h) and 21(b). The regulations also say that providers must have regard to the code when deciding how they will comply with the relevant registration requirements. So, by following the code, registered providers will be able to show that they meet the regulation on IPC (including cleanliness). However, they do not by law have to comply with the code. A registered provider may be able to demonstrate that it meets the registration requirement regulation in a different way (equivalent or better) from that described in the code.

The CQC’s guidance about compliance with the regulations includes a reference to this code in relation to the ‘premises and equipment’ regulation (Regulation 15) as CQC considers this code to be relevant for the purposes of meeting that regulation.

To become and stay registered, providers must meet the full range of registration requirements. The CQC has published guidance about how to comply with all the requirements other than the one on infection control. This guidance is contained in the CQC Guidance for providers on meeting the regulations.

The code does not replace the requirement to comply with any other legislation that applies to health and social care services; for example, the Health and Safety at Work Act 1974 and the Control of Substances Hazardous to Health Regulations 2002.

The CQC is responsible for judging compliance with the registration requirements set out in the regulations. When doing this for IPC (including cleanliness), it will take account of the code and how registered providers are complying with the code. It will do this in a way that is proportionate to the risk of infection.

All registered providers will need to have adequate systems for IPC (including cleanliness) as stated in the code (see part 2), if they are to comply with the law; but because of the wide range of services provided by all registered providers, the code will be applied in a proportionate way. For example, in an acute hospital setting there is a greater risk to service users of infection and therefore the registered provider will need to comply with most aspects of the compliance criteria. However, in a service provided in someone’s own home or a care home where people are supported to be independent in a domestic setting, the registered provider will not need to have the same facilities and approach as an acute hospital.

The CQC may use its enforcement powers or take other action where it decides that a registered provider is not meeting its legal obligations as set out in the regulations.

The CQC will reach this decision by looking at whether a registered provider can demonstrate regard to the code. If a registered provider is not following the code, then the CQC will want to consider whether that is because it is not appropriate to the type of service being provided. If it is appropriate, the CQC will want to consider whether a registered provider is still protecting people from the risk of infection in another, equally effective way.

The CQC can prosecute a provider that breaches any part of Regulation 12(2)(h) if a failure to meet the regulation results in a risk of exposure to significant harm or avoidable harm to a person using the service, or if a person using the service is exposed to a significant risk of harm.

The CQC website provides further information about how the CQC assesses registered providers and what action it can take if a registered provider does not comply with the regulations. Alternatively, you can contact its customer services team on 03000 616161.

The CQC is responsible for monitoring compliance with the requirements of the H&SCA 2008 (Regulated Activities) Regulations 2014. Commissioning organisations may wish to assure themselves that the services that they commission are meeting expected requirements, and this may involve contract monitoring of the service. In doing so, commissioners must make it clear to the provider that this does not replace or duplicate the regulatory role of the CQC.

This document provides a range of information, including appendices, tables, definitions and an extensive bibliography to support providers in complying with the regulations.

Part 2 (The code) details the criteria against which the registered provider will be judged on how it complies with the registration requirements for IPC (including cleanliness).

Part 3 (Guidance for compliance) provides guidance on how to interpret the compliance criteria and develop risk assessments.

Part 4 (Guidance tables), attached as a separate pdf document, details the relevant criteria that might apply to each regulated activity, offers potential sources of professional advice on IPC (including cleanliness) and antimicrobial stewardship, and lists which policies may be required to demonstrate compliance with Regulation 12 (Safe Care and treatment) and Regulation 15 (Premises and Equipment) of the regulations.

The appendices provide examples of how a proportionate approach could be applied to the criteria in acute care, adult social care, primary dental care, independent sector ambulance providers and primary medical care services. However, it is important to read the examples given in the appendices, alongside the guidance under each criterion in part 3 of this document, and not just selective parts.

The bibliography lists a range of supporting national guidance, advisory and regulatory documentation.

The list below is the code of practice for all providers of healthcare and adult social care on the prevention of infections for the purposes of s.21 of the H&SCA 2008.

This sets out the 10 criteria against which a registered provider will be judged on how it complies with the registration requirements related to IPC (including cleanliness), as set out in the regulations. Not all criteria will apply to every regulated activity.

Parts 3 and 4 of this document will help registered providers interpret the criteria and develop their own risk assessments.

Systems to manage and monitor the prevention and control of infection. These systems use risk assessments and consider the susceptibility of service users and any risks that their environment and other users may pose to them.

The provision and maintenance of a clean and appropriate environment in managed premises that facilitates the prevention and control of infections.

Appropriate antimicrobial use and stewardship to optimise outcomes and to reduce the risk of adverse events and antimicrobial resistance.

The provision of suitable accurate information on infections to service users, their visitors and any person concerned with providing further social care support or nursing/medical care in a timely fashion.

That there is a policy for ensuring that people who have or are at risk of developing an infection are identified promptly and receive the appropriate treatment and care to reduce the risk of transmission of infection to other people.

Systems are in place to ensure that all care workers (including contractors and volunteers) are aware of and discharge their responsibilities in the process of preventing and controlling infection.

The provision or ability to secure adequate isolation facilities.

The ability to secure adequate access to laboratory support as appropriate.

That they have and adhere to policies designed for the individual’s care, and provider organisations that will help to prevent and control infections.

That they have a system or process in place to manage staff health and wellbeing, and organisational obligation to manage infection, prevention and control.

To achieve compliance with the registration requirements relating to IPC (including cleanliness), registered providers would normally be expected to demonstrate that they have in place the policies and procedures to meet each relevant criterion listed in part 2, and have taken account of the following guidance for compliance. This guidance is not mandatory but is considered to represent the basic steps that are required to ensure that the criteria can be met.

There may be additional or alternative strategies that a registered provider is able to justify as equivalent, or more effective, in achieving compliance in their circumstances.

Registered providers are free to decide to use alternative approaches but should be prepared to justify to the CQC how the chosen approach is equally effective or better in ensuring that the criteria are met. Providers of regulated activities need to recognise that effective management of IPC is an important service-user safety issue.

The tables in part 4 may be used as a guide to help to decide on the application of the individual compliance criteria and the available sources of advice on IPC (including cleanliness).

The principle of proportionality extends throughout this guidance and the level of detail and complexity for each policy will depend on local risk assessments. In particular, a local risk assessment will be needed to assess services that combine low and higher risk activities.

1.1 These should ensure that:

1.2 All registered providers should ensure that they have:

1.3 The DIPC in NHS provider organisations should:

1.4 Outside of NHS organisations, the responsibilities of the DIPC are discharged by the IPC lead for the registered provider. This role will vary across adult social care, primary dental care, primary medical care, independent healthcare providers and independent sector ambulance providers.

The IPC lead for the registered service provider should:

1.5 Activities to demonstrate that IPC (including cleanliness) and antimicrobial stewardship are an integral part of quality assurance should include regular presentations from the DIPC and/or the IPC and antimicrobial stewardship teams to the NHS board or registered provider.

These should feature a trend analysis for infections, antimicrobial resistance, antimicrobial prescribing and compliance, with quarterly reporting to the NHS board or registered provider by clinical directors and matrons (including nurses who do not hold the specific title of ‘matron’ but who operate at a similar level of seniority and who have control over similar aspects of the service user or the service user’s environment). What is reported on will vary according to the local arrangements.

For example, it may include:

1.6 In accordance with health and safety requirements, where suitable and sufficient assessment of risks requires action to be taken, evidence must be available on compliance with the code or, where appropriate, justification of a suitable better alternative. This applies to all health and adult social care.

1.7 The IPC (including cleanliness) programme should:

1.8 An IPC (including cleanliness) infrastructure should encompass the below.

In acute healthcare settings, an IPC (including cleanliness) team consisting of an appropriate mix of:

The DIPC is a key member of the IPC (including cleanliness) team. Acute healthcare settings have a multidisciplinary antimicrobial stewardship committee to develop and implement the organisation’s antimicrobial stewardship programme drawing on Start Smart then Focus (SMTF) AMS toolkit and National Institute for Health and Care Excellence (NICE) antimicrobial stewardship national guidance.

In other settings, there will be a lead who is responsible for IPC (including cleanliness) matters and is aware of the local arrangements to obtain specialist infection control and antimicrobial stewardship expertise.

24-hour access to a nominated microbiologist or consultant in health protection/communicable disease control should be available. The registered provider should know how to access this advice.

1.9 There should be evidence of joint working between staff involved in the provision of advice relating to the prevention of infection and control: those managing bed allocation; care staff and domestic staff in planning service user referrals, admissions, transfers discharges and movements between departments; and within and between health and adult social care facilities.

1.10 A registered provider must ensure that it provides suitable and sufficient information on a service user’s infection status whenever it arranges for that person to be moved from the care of one organisation to another, to or from a service user’s home, so that any risks to the service user, staff and others from infection can be minimised. If appropriate, providers of a service user’s transport should be informed of the service user’s infection status.

Refer also to CQC guidance on compliance with Regulation 12 (2)(i) on Safe Care and Treatment – shared care.

Provide and maintain a clean and appropriate environment in managed premises that facilitates the prevention and control of infections.

Refer also to section on Regulation 15 on premises and equipment, contained in the CQC guidance for providers on meeting the regulations.

2.1 To minimise the risk of infection, a registered provider should ensure that:

2.2 ‘The environment’ means the totality of a service user’s surroundings when in care premises or transported in a vehicle. This includes the fabric of the building, related fixtures and fittings, and services such as air and water supplies. Where care is delivered in the service user’s home, the suitability of the environment for that level of care should be considered.

Premises and facilities should be provided in accordance with best practice guidance. The development of local policies should take account of IPC, given by relevant expert or advisory bodies or by the IPC team. This should include liaison between any IPC practitioners and the person(s) with overall responsibility for the management of the service user’s environment, where appropriate.

Policies should address but not be restricted to:

Refer also to Regulation 15 in respect to premises and equipment contained in CQC guidance for providers on meeting the regulations.

2.3 The arrangements for cleaning should include:

2.4 The designated decontamination lead should have responsibility for ensuring that policies are implemented and that they take account of best practice and national guidance, ensuring that the following points are covered:

2.5 The reusable medical devices and equipment decontamination policy should demonstrate that:

Refer also to Regulation 15 Premises and Equipment contained in CQC guidance for providers on meeting the regulations.

Ensure appropriate antimicrobial use and stewardship to optimise service user outcomes and to reduce the risk of adverse events and antimicrobial resistance.

3.1 Systems should be in place to manage and monitor the use of antimicrobials to ensure inappropriate and harmful use is minimised and service users with severe infections, such as sepsis, are treated promptly with suitable antimicrobial(s). These systems should draw on national and local guidelines, monitoring and audit tools, including, but not limited to, NICE guidelines, guidance on patient group directions, the Treat Antibiotics Responsibly, Guidance Education Tools (TARGET) toolkit in primary care, Start Smart then Focus in secondary care and national antimicrobial prescribing competences.

3.2 Service providers, where appropriate, should have in place a designated lead for antimicrobial stewardship responsible for developing, implementing and monitoring the organisation’s stewardship programme and reporting to the executive board or equivalent, where available.

Antimicrobial stewardship must be supported by strong leadership across clinical specialties with oversight provided by an antimicrobial stewardship committee or as part of an existing committee, such as a drug and therapeutics committee or equivalent.

Membership of this committee will vary dependent on the setting but should be multidisciplinary and representative of the clinical specialities in accordance with NICE guidance. The committee should report antimicrobial stewardship activities, antimicrobial prescribing trends (this should include appropriate peer comparison data) to the trust board via the organisation’s DIPC, or the designated lead for antimicrobial stewardship.

3.3 Providers should develop a local antimicrobial stewardship policy and local infection management guidelines drawing on national guidance (including from NICE), the British National Formulary and UK Health Security Agency (UKHSA) that takes account of local antimicrobial resistance patterns.

The policy should cover the principles of diagnosis, treatment and prophylaxis of common infections, and prescribers should document allergy status, reason for antimicrobial prescription, dose, route and duration of treatment.

Adherence to antimicrobial prescribing guidance and compliance with hospital post-prescribing review at 48 to 72 hours should be monitored and audited on a regular basis, with data fed back to prescribers and incorporated into service user safety reporting systems to boards and commissioners. Peer comparison and trend data, and prescribing audits should be used to demonstrate progress in antimicrobial stewardship in all settings. There should be evidence of appropriate action taken to deal with occurrences of inappropriate prescribing of antimicrobials including, where applicable, root cause analysis, emphasis on lessons learnt and/or post-infection review.

3.4 Providers should have access to timely microbiological diagnosis, susceptibility testing and reporting of results, preferably within 48 hours of specimen taking. Prescribers should have access at all times to suitably qualified individuals who can advise on appropriate choice of antimicrobial therapy.

3.5 In acute care settings, providers should report local antimicrobial susceptibility data (drug-bug combinations) and information on antimicrobial consumption to the national surveillance body. Surveillance information should be used by the local and regional stewardship committees or equivalent to monitor local resistance patterns and guide local antimicrobial prescribing guidelines and antimicrobial stewardship activities. This information should be communicated back to prescribers across the health and social care system to improve prescribing quality.

3.6 Providers should ensure that all health and care workers involved in prescribing, dispensing and administration of antimicrobials receive induction and appropriate training in prudent antimicrobial use and the principles of antimicrobial stewardship. They should be encouraged to maintain their knowledge through training and regular educational sessions. This should include being familiar with the principles of antimicrobial stewardship as set out in the antimicrobial prescribing, stewardship competencies, NICE guidance on antimicrobial stewardship and local AMS policy.

Provide suitable accurate information on infections to service users, their visitors and any person concerned with providing further health and social care support or nursing/ medical care in a timely fashion.

4.1 Information for service users and visitors

Existing information sources suitable for people receiving care can be signposted, such as NHS Choices.

Information should be co-produced, where appropriate, with service user representation organisations, such as the local Healthwatch and Patient Advice and Liaison services (PALS), in a timely and accessible way.

4.2 Areas relevant to the provision of information

Themes relevant to the provision of information include:

4.3 Materials

Materials from global, national or local awareness campaigns could be used to develop information on appropriate principles of IPC (including cleanliness), including hand hygiene, respiratory hygiene and action to promote safe, effective and appropriate use of antimicrobials to reduce risk of developing antimicrobial resistance. Examples, such as World Health Organization (WHO) hand-hygiene tools, are included in the bibliography.

Refer also to Regulation 9, Person Centred Care, contained in CQC Guidance for providers on meeting the Regulations.

4.4 Information for those providing further support or care

A registered provider should ensure that:

4.5 Provision of relevant information across relevant organisation boundaries is covered by the regulation requirement 9, Person Centred Care. Due attention should be paid to service user confidentiality as outlined in national guidance and training material.

Ensure that people who have or at risk of developing an infection are identified promptly and receive the appropriate treatment and care to reduce the risk of transmission of infection to other people.

5.1 Registered providers (excluding providers of ‘personal care’) should ensure that advice is received from staff involved in a service user’s management. Registered providers should inform their IPC team and the local UKHSA health protection team (HPT) of any potential outbreaks or serious incidents relating to infection in a timely manner.

5.2 Governance arrangements should demonstrate that responsibility for IPC (including cleanliness) is effectively devolved to all teams in the organisation involved in care provision and or management of the environment.

5.3 In an adult social care service, primary care clinicians/GPs will provide the necessary initial advice when a service user develops infection. The primary care clinician/GP may wish to draw on local expertise in IPC, infection management and/or health protection.

Systems to ensure that all care workers (including contractors and volunteers) are aware of and discharge their responsibilities in the process of preventing and controlling infection.

6.1 A registered provider should, so far as is reasonably practicable, ensure that its staff, contractors, visitors and others involved in the provision of care co-operate with each other so far as is necessary to enable the registered provider to meet its obligations under the code.

6.2 The registered provider should include IPC (including cleanliness) in all job descriptions. It should also be included, together with antimicrobial stewardship, in induction programmes, and a suitable and sufficient programme of continual training for IPC should be organised for all staff and volunteers. The content should reflect the post holder’s role and level of responsibility and a record of all training should be kept.

6.3 Where staff undertake procedures, which require skills such as aseptic technique, staff must be trained and demonstrate proficiency before being allowed to undertake these procedures independently.

6.4 The registered provider should have systems in place to regularly assess the IPC (including cleanliness) skills and competencies of its directly employed staff and volunteers and review and update its training programmes as required.

6.5 In meeting the above obligations, the registered provider must take into account the needs of staff and service users, and particularly those with learning disabilities, dementia, specific vulnerabilities or protected characteristics, to ensure working arrangements are equitable.

6.6 Education and training must be made available to all staff (including support staff, volunteers, agency/locum staff and staff employed by contractors). This should incorporate the principles and practice of prevention and control of infection and should explain the risk from existing, new and emerging infectious diseases. This information should also be taken into account when assessing service users, equipment and the environment.

Provide or secure adequate isolation facilities.

7.1 Healthcare registered providers (excluding providers of ‘personal care’) delivering inpatient care should ensure that they are able to provide, or secure the provision of, adequate isolation precautions and facilities, to prevent or minimise the spread of infection to service users, staff or visitors. This may include facilities in a day care setting.

7.2 Social care settings may not have dedicated isolation facilities for service users but are expected to implement isolation precautions when a service user is suspected or known to have a transmissible infection.

7.3 Policies should be in place for the allocation of appropriate isolation facilities based on service user needs and local risk assessment. The assessment could include consideration of the need for special ventilated isolation facilities, management of appropriate PPE, bare below the elbows (BBE) protocols, waste management strategies, impact of social isolation assessments, and the monitoring of service users. Sufficient numbers of staff with suitable training should be available.

7.4 Registered providers of health and social care should ensure that they are able to provide or secure facilities to physically separate a service user from other service users in an appropriate manner, to minimise the spread of infection.

7.5 Health and social care providers should ensure they have dedicated service user equipment allocated to the isolation facilities, wherever possible. Where this is not feasible, an appropriate decontamination strategy must be in place.

Secure adequate access to laboratory support as appropriate.

8.1 A registered provider should ensure that laboratories that are used to provide testing services, in connection with arrangements for IPC, have appropriate protocols in place. These laboratories should operate according to the standards required by the relevant national accreditation bodies and associated regulatory frameworks.

In adult social care, the service user’s GP will arrange such testing and take responsibility for submitting specimens to the laboratory when necessary for the diagnosis, treatment and management of disease.

8.2 Protocols should include:

The service provider should have and adhere to policies designed for the individual’s care, and provider organisations that will help to prevent and control infections.

NHSE organisations should adopt the National Infection Prevention and Control Manual (NIPCM) as their mandatory policy. Other organisations may also choose to adopt the NIPCM or equivalent guidance as a policy.

9.1 A registered provider should, in relation to preventing, reducing and controlling the risks of infections, have in place the appropriate policies concerning the matters mentioned in a) to y) below. All policy documents should be clearly marked, with the current version indicated by a review date, and evidence of a review within the timeframe.

9.2 A guide is given in table 3 as to which policies may be appropriate to regulated activities. A decision should be made locally following a risk assessment.

9.3 Any registered provider should have policies in place relevant to the regulated activity it provides. Each policy should indicate ownership, authorship and by whom the policy will be applied. Implementation of policies should be monitored and there should be evidence of a rolling programme of audit and a stated date for revision. See the listed policies below related to 9.3 and table 3.

Preventing infections reduces the overall need to use antimicrobials and helps to reduce the opportunity  for  the development of antimicrobial resistance:

Where aseptic techniques are performed, it is important that:

Procedures to follow:

Important considerations include:

Measures to avoid exposure to BBVs (for example, hepatitis B, C and HIV) should include:

Management should ensure that:

Refer also to Regulation 19, Requirements relating to workers contained in CQC Guidance for providers on meeting the Regulations.

Management should ensure that:

The use of disinfectants is a local decision and should be based on current evidence and accepted good practice.

Decontamination involves a combination of processes and includes cleaning, disinfection and sterilisation, according to the intended use of the device. This aims to render a reusable item safe for further use on service users and for handling by staff.

Effective decontamination of reusable medical devices is an essential part of infection risk control and is of special importance when the device comes into contact with service users or their body fluids. There should be a system to protect service users and staff that minimises the risk of transmission of infection from medical devices. This requires that the device or instrument set can be clearly traced to the individual process cycle that was used to decontaminate it, such that the success of that cycle in rendering the device safe for reuse can be verified.

Reusable medical devices should be decontaminated in accordance with manufacturers’ instructions and current national or local best practice guidance. This requires that the device should be clean and, where appropriate, sterilised at the end of the decontamination process and maintained in a clinically satisfactory condition up to the point of use.

Management systems should ensure adequate supplies of reusable medical devices, particularly where specific devices are essential to the continuity of care.

Reusable medical devices employed in invasive procedures, for example endoscopes and surgical instruments, have to be either individually identifiable or identified to a set of which they are a consistent component, throughout the use and decontamination cycle, to ensure subsequent traceability.

Systems should also be implemented to enable the identification of service users on whom the medical devices have been used.

Decontamination of single-patient use devices – that is, equipment designated for use only by one patient – should be subject to local policy and manufacturer’s instructions

Refer also to Regulations 15, Premises and equipment and Regulation 12 on safe care and treatment contained in CQC Guidance for providers on meeting the Regulations.

Policies should be in place for handling devices for single use only. Single-use medical devices should be used once and disposed of safely.

Prescribing should generally be harmonised with that in the NICE infection guidelines and British National Formulary (BNF), based on local and national guidance for specific infections, such as gonorrhoea. However, locally approved guidelines may be required in certain circumstances.

Procedures should be in place to ensure prudent prescribing and antimicrobial stewardship. There should be an ongoing programme of audit, revision and update with feedback to management, prescribers and administrators. In healthcare settings this is usually monitored by the antimicrobial management team or local primary care medicine optimisation team. Antimicrobial pharmacists and integrated care board (ICB) pharmacy leads can support these activities

This includes a requirement for NHS Trust Chief Executives to report all cases of Meticillin resistant Staphylococcus aureus (MRSA), Meticillin sensitive Staphylococcus aureus (MSSA), Escherichia coli, Klebsiella species, Pseudomonas aeruginosa bloodstream infections and respiratory infections, including COVID-19.

The Health Protection (Notification) Regulations 2010 and The Health Protection (Notifications) (Amendment) 2020 require:

High consequence infectious diseases (HCID)

The policy should refer to the latest guidance from the Advisory Committee on Dangerous Pathogens (ACDP) and the Control of Substances Hazardous to Health Regulations 2002 and make provision for:

In cases of acquired carbapenemase-producing Gram-negative bacteria, including carbapenemase-producing Enterobacterales (CPE), the policy should make provision for:

This should take account of local epidemiology and risk assessment of the environment, infection and service. These infections must include, as a minimum, MRSA, MSSA, Escherichia coli, Klebsiella species and Pseudomonas aeruginosa bloodstream infections; respiratory infections, including COVID-19; high consequence infectious diseases (HCIDs), diarrhoea and/or vomiting outbreaks, Clostridiodes difficile infection and transmissible spongiform encephalopathies. There should be evidence of learning from the investigation of outbreaks.

The policy should make provision for:

The specific alert organisms that follow may be relevant to any unit admitting or treating as out service users.

The policy should make provision for:

The policy should cover:

Advice on the handling of instruments and devices in procedures on service users with known or suspected CJD/vCJD, or at increased risk of CJD/vCJD, including disposal/quarantine procedures, is provided in guidance from the ACDP Transmissible spongiform encephalopathies (TSE) working group.

Refer also to Regulation 15, Premises and equipment and Regulation 12 on safe care and treatment contained in CQC Guidance for providers on meeting the Regulations.

The risks from waste disposal should be properly controlled. In practice, in relation to waste, this involves:

 Precautions in connection with handling waste should include:

Systems should be in place to ensure that the risks to service users and staff from exposure to infections caused by waste present in the environment are properly managed, and that duties under environmental law are discharged. The most important of these are:

Refer also to Regulation 15, Premises and equipment contained in CQC Guidance for providers on meeting the Regulations.

Biological samples, cultures and other materials should be transported in a manner that ensures that they do not leak in transit and are compliant with current legislation.  Staff who handle samples must be aware of the need to correctly identify, label and store samples prior to forwarding to laboratories. In addition, they must be aware of the procedures needed when the container or packaging becomes soiled with body fluids.

Appropriate procedures should include:

Policy should be based on evidence-based guidelines and should be easily accessible by all relevant care workers. Compliance with policy should be audited.

Information on policy should be included in IPC training programmes for all relevant staff groups.

Refer also to Regulation 15, Premises and equipment and Regulation 12 on safe care and treatment contained in CQC Guidance for providers on meeting the Regulations.

Policies for the purchase, cleaning, decontamination, maintenance and disposal of all equipment should take into account IPC advice that is given by relevant experts, manufacturers of equipment and advisory bodies.

For all appropriate health and social care settings, there should be evidence of local surveillance and use of comparative data, where available, to monitor infection rates, antimicrobial resistance and antimicrobial consumption, and to assess the risks of infection. This evidence should include data on alert organisms and other infections, where appropriate, alert conditions and wound infection per clinical unit or specialty.

When appropriate or where they exist, recognised definitions should be used.

Electronic reporting to UKHSA is recommended where the appropriate information technology is in place as set out in the Health Protection (Notification) Regulations 2010 to enable monitoring of outbreaks and trends at local, regional and national level.

There should also be timely feedback to clinical units, with a record of achievements and actions taken as a result of surveillance. Post-discharge surveillance of surgical site infection should be considered and, where practicable, should be implemented.  

There should be a local protocol across the health and social care systems on information-sharing when referring, admitting, transferring, discharging and moving service users within and between health and adult social care facilities.

This is to facilitate surveillance and optimal management of infections in the wider community. Guidance on data protection legislation also needs to be observed. 

Refer also to Regulation 9, Person-centred care contained in CQC Guidance for providers on meeting the Regulations.

There should be a policy concerning the appropriate provision and maintenance of isolation facilities.

This should address:

Uniform and workwear policies ensure that clothing worn by staff when carrying out their duties is clean and fit for purpose.

Particular consideration should be given to items of attire that may inadvertently come into contact with the person being cared for.

Uniform and dress code policies should specifically support good hand hygiene.

Registered providers should ensure that:

The registered provider will have a system or process in place to manage health and care worker health and wellbeing and organisational obligation to manage infection, prevention and control.

Providers have a policy that describes the process in place to manage health and care worker health and wellbeing and obligations in relation to IPC (including cleanliness), control and management.

10.1 Registered providers should note that this criterion also covers health and care worker education and training in policies and procedures to reduce the risk of occupational infection.

They should ensure that:

10.2 Occupational health services for staff should include:

10.3 Occupational health services in respect of BBVs should include:

10.4 Occupational health services in respect of respiratory viruses should include arrangements for provision of seasonal vaccines, such as influenza vaccination and COVID-19, for health and social care workers where advised and consideration for emerging viruses.

Refer also to Regulation 19, Fit and proper persons employed contained in CQC Guidance for providers on meeting the Regulations.

Guidance tables can be found in a separate document - Guidance tables for H&SCA code of practice on IPC. These tables are designed to help registered providers, the DIPC (NHS provider organisations) and service providers (adult social care, primary care dental and primary care medical and independent healthcare providers, independent sector ambulance providers) decide how the code and related guidance applies to the regulated activities and type of service they provide.

Further guidance on the activities that are covered by regulations are available on the Care Quality Commission website.

Because of the wide range of services provided in health and adult social care, service providers should carry out their own risk assessments to help them decide the elements to be included in their policies or whether or not a policy is required at all.

They will need to be able to justify their decisions.

It is essential to read the following examples alongside the guidance under each criterion in part 3 and not just selective parts.

The examples demonstrate how a proportionate approach to the guidance could apply in certain types of adult social care services. They are examples only and registered providers and the designated IPC person should carry out their own risk assessments to help them decide which parts of the criteria apply to their particular service.

Registered providers and designated IPC (including cleanliness) person(s) should make sure that they can provide evidence to support any decision to follow these examples or any other alternative approaches to the full guidance.

In a small service providing personal care or accommodation with personal care, the below apply.

Someone with appropriate knowledge and skills will become the designated IPC lead and take responsibility for IPC (including cleanliness) and relevant antimicrobial stewardship principles. This could be the registered provider, registered manager or another member of staff.

IPC (including cleanliness) programmes and infrastructures will not need to be as complex as in a larger adult social care or health setting. As a minimum the IPC measures should include:

The annual statement, for anyone who wishes to see it, including service users and regulatory authorities, will not need to be as detailed as one prepared for a health setting. The service provider will ensure their annual statement for each facility provides a short review of any:

Refer to the corresponding item in part 3 of this document.

Provide and maintain a clean and appropriate environment in managed premises that facilitates the prevention and control of infections.

Domiciliary care services and extra care that provide support in people’s own homes will not be expected to comply with this criterion. Care homes aim to provide a place where people feel at home and the arrangements to keep the environment clean must take this into account. All cleaning routines must respect the fact that in care homes a service user’s bedroom and other shared areas may have furniture and other possessions that belong to that individual.

In some care homes, the specific aim will be to support service users to be independent and to have choice and control over their daily life, including decisions about the environment in which they live.

In a service where people have a learning disability, for example, but are generally well, they will be supported to develop independent living skills. In such cases, the following points apply:

The policy should cover:

Refer to the corresponding item in part 3 of this document.

Ensure appropriate antimicrobial use and stewardship to optimise patient outcomes and to reduce the risk of adverse events and antimicrobial resistance.

Health and social care staff must know how to recognise the signs of infection, including atypical presentations, and know how to seek prompt medical advice so that diagnostic tests and antimicrobial therapy (if required) can be used optimally.

For social care services providing personal care, providers should keep accurate records of antimicrobial prescriptions, including allergies, dose, duration and reason for treatment.

Access to microbiological services and responsibility for stewardship activities rests with the service users’ GP. However, providers should engage collaboratively across the local health and social care system to improve antimicrobial use and stewardship, as appropriate. Examples could include engaging with local projects on urinary tract infections, sepsis or audits of antimicrobial use usage.

Refer to the corresponding item in part 3 of this document.

Provide suitable accurate information on infections to service users, their visitors and any person concerned with providing further social care support or nursing/medical care in a timely fashion.

Domiciliary care services that provide support in people’s own homes will not need to have the full range of information suggested to meet this criterion. However, they should provide information about their approach to prevention of infection, staff roles and responsibilities, and whom people should contact concerns about prevention and control of infection.

Where they provide personal care to a group of service users in a supported living service or sheltered housing complex and take an active role in liaising with or contacting healthcare professionals on behalf of service users then the full criterion will apply. However, it may not be necessary to provide the level of detail that a healthcare setting would need.

For adult social care services providing residential care, all the information suggested in the guidance should be included. However, it may not be necessary to provide the level of detail that a healthcare setting would need.

Refer to the corresponding item in part 3 of this document.

In an adult social care service, the primary care practitioner will provide the necessary initial advice when a service user develops an infection and may wish to draw on local professional expertise in IPC or health protection. Refer to the corresponding item in part 3 of this document.

Systems to ensure that all care workers (including contractors and volunteers) are aware of and discharge their responsibilities in the process of preventing and controlling infection.

Refer to the corresponding item in part 3 of this document.

Provide or secure adequate isolation facilities.

Care homes do not need to have dedicated isolation facilities. If isolation is needed, a service user’s own room can be used. Ideally the room should be a single bedroom with en-suite facilities.

Refer to the corresponding item in part 3 of this document.

Secure adequate access to laboratory support as appropriate.

The registered GP will take responsibility for sending off any necessary routine samples to the laboratory. Adult social care services should ensure they know how to recognise infections and report these promptly to the GP or other appropriate health professional.

Refer to the corresponding item in part 3 of this document.

The registered provider has and adheres to policies designed for the individual’s care, and provider organisations that will help to prevent and control infections.

Providers must have IPC policies in place.

Providers can use table 3 and their own risk assessments to help them decide how the remaining policy areas might apply to their services.

Refer to the corresponding item in part 3 of this document.

The registered providers will have a system or process in place to manage staff health and wellbeing and organisational obligation to manage infection, prevention and control.

Providers have a system in place to manage the occupational health needs and obligations to staff in relation to infection.

Small adult social care services that are not part of a large organisational structure may not have access to occupational health services. Service providers should ensure that they are able to get advice when needed, for example through their insurance company, a GP or an occupational health agency.

The registered provider should ensure that all staff complete a confidential health assessment after a conditional offer of employment and give information about residence overseas, previous and current illness and immunisation against relevant infections.

Policies for screening of staff should include:

All health and social care workers new in post are expected to complete competency training, for example undertake ‘the care certificate’ as part of their induction. More information on the care certificate is included in the bibliography.

There are a range of knowledge and competence units for adult social care workers that can be taken as part of the diplomas for occupational competence.

There are 3 level 2 knowledge units that cover IPC, the spread of infection and cleaning, decontamination and waste management. There are 3 competence units at levels 2, 3 and 5 that support the development of skills in managing IPC (including cleanliness) in the workplace.

Details of these training units are included in the bibliography.

A record should be kept by the registered manager of all staff induction and ongoing training.

Refer to the corresponding item in part 3 of this document.

It is essential to read the following examples alongside the guidance under each criterion in part 3 and not just selective parts.

The examples demonstrate how a proportionate approach to the guidance could apply in primary care dental practices. They are examples only and registered providers and IPC will be expected to provide evidence to support any decision to implement these examples or any other alternative approaches to implementation of the full guidance.

Criterion 2 of the code describes the requirement to provide and maintain a clean and appropriate environment in managed premises that facilitates the prevention and control of infections. This includes a specific requirement for effective arrangements for the appropriate decontamination of instruments and other equipment.

The Health Technical Memorandum (HTM) 01-05 is designed to assist all registered primary dental care services in meeting satisfactory levels of decontamination. The code has taken due note of HTM 01-05 and does not impose any additional burdens on decontamination. See the decontamination self-assessment dental audit tool.

However, whilst HTM 01-05 describes essential quality requirements and provides guidance around decontamination, it is important to recognise that in the same way, the related guidance set out in this code of practice document provides guidance around the wider aspects of IPC (including cleanliness).

A designated person with appropriate knowledge and skills will take responsibility for IPC (including cleanliness) and control in the practice (the designated IPC person). This could be the registered provider, registered manager or another member of staff. The IPC lead is responsible for the development and implementation of the IPC and control and cleanliness programme for the practice. The programme should be in line with national guidance, such as the NIPCM.

Practices should consider how:

The practice should have a clear route for advice on IPC that will be included as part of their IPC policy. This might include recording information on how to contact key contacts, such as:

There should be guidance for staff about the type of circumstances in which contact should be made and how to identify which contact in the system is best able to help with the issue faced by the practice.

An annual IPC statement should be prepared and kept on record for anyone who wishes to see it, including service users and regulatory authorities. The content of might include a short review of any:

Refer to the corresponding item in part 3 of this document.

Provide and maintain a clean and appropriate environment in managed premises that facilitates the prevention and control of infections.

Practices should take account of the guidance issued by DHSC, UKHSA and NIPCM. Please refer to HTM 01-05 for further information on decontamination.

There should be a designated lead for cleaning and decontamination of the environment and equipment, who may be the same person as the lead for IPC, and who can access appropriate expert advice.

Refer to the corresponding item in part 3 of this document.

Ensure appropriate antimicrobial use and stewardship to optimise patient outcomes and to reduce the risk of adverse events and antimicrobial resistance.

Systems should be in place to manage and monitor the use of antimicrobials to ensure inappropriate use is minimised including having a designated AMS lead. These systems can draw on national and local guidelines, and monitoring and audit tools that focus on antimicrobial prescribing in dentistry available and/or signposted to in the national dental antimicrobial stewardship toolkit.

All members of the dental team should maintain their knowledge of the management of dental pain and infections and the principles of antimicrobial stewardship.

Refer to the corresponding item in part 3 of this document.

Provide suitable accurate information on infections to service users, their visitors and any person concerned with providing further social care support or nursing/medical care in a timely fashion.

Primary dental care practices may not need to supply the full range of information suggested. However, they should have information available about their approach to IPC staff roles and responsibilities, and which people they should contact if they have concerns about IPC.

It is unlikely that primary dental care practitioners will be required to provide this information except when referring service users to specialist services. In situations where service users require transfer to specialist services, staff should know how and under what circumstances information about a user’s infection status can be shared, and how to ensure that the information they share complies with the legislation on the safe handling of information.

Refer to the corresponding item in part 3 of this document.

Ensure that people who have or are at risk of developing an infection are identified promptly and receive the appropriate treatment and care to reduce the risk of transmission of infection to other people.

Dental practitioners should regularly obtain a medical history, which may assist in identifying some risk factors for infection. IPC precautions should be applied to the management of all service users, in line with national guidance.

Practices can use risk assessment processes to identify staff who may be at higher risk of transmitting or developing an infection. The practice should also have systems in place to manage the identified risk in its staff members.

Refer to the corresponding item in part 3 of this document.

Systems to ensure that all care workers (including contractors and volunteers) are aware of and discharge their responsibilities in the process of preventing and controlling infection.

The registered provider must ensure that every person working in the dental practice, including agency staff, contractors and volunteers, understand and comply with IPC measures.

Refer to the corresponding item in part 3 of this document.

Provide or secure adequate isolation facilities.

Primary dental care facilities do not require dedicated isolation facilities.

Refer to the corresponding item in part 3 of this document.

Secure adequate access to laboratory support as appropriate.

This refers to laboratory support for diagnosis or surveillance of infection. Primary care dental practices are not required to have routine access to microbiology laboratory services.

Refer to the corresponding item in part 3 of this document.

The registered provider has and adheres to policies designed for the individual’s care, and provider organisations that will help to prevent and control infections. Providers must have IPC policies in place.

Providers can use table 3 and their own risk assessments to help them decide how the remaining policy areas might apply to their services.

Refer to the corresponding item in part 3 of this document.

The service providers will have a system or process in place to manage the staff health and wellbeing and organisational obligation to manage infection, prevention and control.

Staff should have access to appropriate occupational health advice. Policies for the protection of staff can include for example:

Refer to the corresponding item in Part 3 of this document.

It is essential to read the following examples alongside the guidance under each criterion in part 3 and not just selective parts.

The examples demonstrate how a proportionate approach to the guidance could apply in primary medical care practices. They are examples only and registered providers and IPC (including cleanliness) leads should carry out their own risk assessments to help them decide which parts of the criteria apply to their particular service.

Registered providers and IPC (including cleanliness) leads will make sure that they can provide evidence to support any decision to follow these examples or any other alternative approaches to the full guidance.

A designated person with appropriate knowledge and skills will take responsibility for IPC in the practice. This could be the registered provider, registered manager or another member of staff.

IPC programmes, assurance framework and infrastructures will not need to be as complex as in larger health or adult social care settings. It is not envisaged that there should be a DIPC in most primary medical care settings. The IPC programme should say as a minimum what:

The provider should have a record of the names and contact details of health practitioners who can provide advice. GP colleagues for the provider, local UKHSA health protection team, ICBs, NHS and the local authority are likely to be key contacts. There should be guidance for staff about the type of circumstances in which contact should be made.

An annual statement, for anyone who wishes to see it, including service users and regulatory authorities, should be prepared by the designated IPC individual for each registered provider. This should provide a short review of any:

Refer to the corresponding item in part 3 of this document.

Provide and maintain a clean and appropriate environment in managed premises that facilitates the prevention and control of infections.

There should be a designated lead for cleaning and decontamination of the environment, who may be the same person as the lead for IPC and who can access appropriate expert advice.

The furnishing of premises should take account of national guidance, and rooms with specialist functions, for example minor surgery, should be adapted accordingly following a risk assessment. Clinical procedures, planned examination of wounds and potential infected sites should be carried out in a designated setting designed for the purpose, for example a treatment room.

The environmental cleaning and decontamination policy should specify how to clean all areas, fixtures and fittings, and specify what products to use. In those practices that perform invasive procedures, including minor surgery and acupuncture, a policy must be in place for the appropriate decontamination of the rooms used for those procedures. There should be a cleaning schedule, covering communal areas, consultation rooms, treatment areas and specialist surgical or other areas.

Refer to the corresponding item in part 3 of this document.

Ensure appropriate antimicrobial use and stewardship to optimise patient outcomes and to reduce the risk of adverse events and antimicrobial resistance.

Primary medical care practitioner prescribing accounts for 80% of NHS antibiotic use and this antibiotic use must be both necessary and appropriate. Antibiotics should not be prescribed or supplied for viral infections.

Antimicrobial prescribing should follow local policies and national guidance such as NICE managing common infections, guidance for primary care and TARGET antibiotics toolkit. Evidence to demonstrate adoption and adherence to policies and guidelines should be available to commissioners.

Prescribers should have access to advice on antibiotic use from medicines optimisation teams and microbiologists, and used when required.

Primary care practices should participate in local and national activities designed to support antimicrobial stewardship, such as backup or delayed antibiotic prescribing, and national antibiotic awareness campaigns.

Refer to the corresponding item in part 3 of this document.

Provide suitable accurate information on infections to service users, their visitors and any person concerned with providing further social care support or nursing/ medical care in a timely fashion.

Primary medical care practices should make information available about their approach to prevention and control of infection, staff roles and responsibilities, and who people should contact where there are concerns about prevention and control of infection. They should also make available up-to-date information on current infection issues, for example influenza, COVID-19 and circulating infections.

Practices may wish to involve or seek advice from their patient groups on the material they are using and how it is disseminated. Practices may wish to display their policies and information on their website or other websites, where appropriate.

Primary medical care practitioners are key providers of information to other health and adult social care providers and to public health authorities, both concerning individual users and community outbreaks. Appropriate information should be held in the practice patient summary record.

The registered provider may share information with other health and adult social care providers as appropriate, paying attention to service users’ confidentiality. This could include circumstances where:

Refer to the corresponding item in part 3 of this document.

The primary medical care practitioner will provide initial advice and treatment when a service user under their care develops an infection, and will assess any potential communicable disease control issues. In most cases further action will not be needed.

If required, the primary medical care practitioner may consult with the designated source of specialist infection control advice and/or the local health protection team or refer to more specialist care. This may be applicable, for example, in cases of smear-positive pulmonary tuberculosis, highly transmissible diseases such as chickenpox or norovirus, or suspected outbreaks.

Refer to the corresponding item in part 3 of this document.

Systems to ensure that all care workers (including contractors and volunteers) are aware of and discharge their responsibilities in the process of preventing and controlling infection.

The registered provider must ensure that every person working in the practice, including agency staff, locum staff, support staff, external contractors and volunteers, understand and comply with the need to prevent and control infections, including those associated with invasive devices.

Refer to the corresponding item in part 3 of this document.

Provide or secure adequate isolation facilities.

Primary medical care facilities do not require dedicated isolation treatment rooms but are expected to implement reasonable precautions when a service user is suspected or known to have a transmissible infection.

Refer to the corresponding item in part 3 of this document.

Secure adequate access to laboratory support as appropriate.

Primary care practices should have access to a diagnostic microbiology and virology laboratory service, which operates according to the requirements of the relevant national accreditation bodies for the investigation and management of disease. This may be from an NHS acute trust or from an alternative provider. For the NHS, this will be provided through local commissioning arrangements; non-NHS GPs will need to make appropriate arrangements.

Refer to the corresponding item in part 3 of this document.

The registered provider should have and adhere to policies, designed for the individual’s care and provider organisations that will help to prevent and control infections.

Providers can use table 3 and their own risk assessments to help them decide how the remaining policy areas might apply to their services.

Refer to the corresponding item in part 3 of this document.

The registered providers will have a system or process in place to manage the staff health and wellbeing and organisational obligation to manage infection, prevention and control.

Risk assessments of need should be carried out for immunisation, in particular hepatitis B and COVID-19.

Access to an occupational health service should be available.

Refer to the corresponding item in part 3 of this document.

The following are extracts from the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014: Part 3 Section 2.

12.(1) Care and treatment must be provided in a safe way for service users. (2) Without limiting paragraph (1), the things that a registered person must do to comply with that paragraph include:

15.(1) All premises and equipment used by the service provider must be:

(2) The registered person must, in relation to such premises and equipment, maintain standards of hygiene appropriate for the purposes for which they are being used.

(3) For the purposes of paragraph (1)(b), (c), (e) and (f), ‘equipment’ does not include equipment at the service user’s accommodation if:

The following bibliography represents current guidance, best practice and legislation that sets the level of care which should be applied in the prevention and control of infection in health and adult social care.

It is expected that more chronic illness will be managed within the community, and it is beneficial for adult social and health care to be aware of each other’s needs and priorities. It is for this reason that we do not differentiate between these two areas of care. It is not expected that carers become experts in both sectors – only that in the interests of service users’ safety and high standards a greater awareness is achieved.

However, when a medical procedure is carried out in an adult social care setting, the relevant healthcare guidance should be consulted. Procedures should be performed only by carers who have demonstrated the appropriate competency and who are able to work to levels that may be indicated in the following publications.

NHS England (2013), Everyone counts: planning for patients 2014/15 to 2018/19

Department of Health and Public Health England (2013), Prevention and control of infections in care homes: an informative resource

Department of Health and Public Health England (2013), Prevention and control of infection in care homes: summary for staff

Care Quality Commission (CQC) (2014), Guidance for providers on meeting the regulations

Care Quality Commission (CQC) (2022), Infection prevention and control in care homes

Department of Health and Social Care (2022), Infection prevention and control: resource for adult social care

National Institute of Health and Care Excellence (NICE) (2020), Helping to prevent infection

Department of Health and Social Care and Public Health England (2013), Care homes: infection prevention and control

NHS England (2022), National infection prevention and control manual for England

NHS England (2022), Leadership and worker involvement toolkit

Care Quality Commission (CQC), Raising a concern with CQC

Single Source Regulations Office (SSRO), Whistleblowing policy

Health and Care Act 2022

World Health Organization (WHO) (2016), Guidelines on core components of IPC programmes at the national and acute health care facility level

Health and Safety Executive (HSE), Hierarchy of risk-reduction measures

Association of Ambulance Chief Executives (2022), IPC guidance changes to the seasonal respiratory infections (SRIs) in health and care setting – NASIPCG

Association of Ambulance Chief Executives (2022), IPC and working safely guidance for ambulance trusts: FAQs – NASIPCG

National Institute for Health and Care Excellence (NICE) (2022), Antimicrobial stewardship

National Institute for Health and Care Excellence (NICE) (2022), Infection guidelines

Public Health England (2015), Start smart then focus: antimicrobial stewardship toolkit for English hospitals

National Institute of Health and Care Excellence (NICE) (2014), Infection prevention and control: Quality statement 1: antimicrobial stewardship

National Institute for Health and Care Excellence (NICE) and Public Health England (2021), Summary of antimicrobial prescribing guidance – managing common infections

Department of Health Advisory Committee on Antimicrobial Resistance and Healthcare Associated Infection (ARHAI) and Public Health England (2013), Antimicrobial prescribing and stewardship competences

Department of Health and Social Care (2019), Tackling antimicrobial resistance 2019 to 2024: the UK’s 5-year national action plan

UK Health Security Agency (UKHSA), English surveillance programme for antimicrobial utilisation and resistance (ESPAUR) reports

National Institute of Health and Care Excellence (NICE) (2013), Patient group directions

Royal College of General Practitioners (RCGP), TARGET antibiotics toolkit hub

Public Health England (2020), Dental antimicrobial stewardship toolkit

UK Health Security Agency (UKHSA) (2021), Antibiotic awareness resources

Health Education England (HSE), Antimicrobial resistance resources

NHS Education for Scotland, Scottish Reduction in Antimicrobial Prescribing (ScRAP) Programme

European Centre for Disease Control (ECDC), European Antibiotic Awareness Day (EAAD)

British Association for Sexual Health and HIV (BASHH), Sexual health treatment guidance

National Institute for Health and Care Excellence (NICE) (2015), Antimicrobial stewardship: systems and processes for effective antimicrobial medicine use (NICE guideline NG15)

National Institute for Health and Care Excellence (NICE) (2019), Pneumonia (community-acquired): antimicrobial prescribing

National Institute for Health and Care Excellence (NICE) (2019), Pneumonia (hospital-acquired): antimicrobial prescribing

Public Health England (2021), Summary of antimicrobial prescribing guidance: managing common infections,

World Health Organization (WHO) (2022), WHO strategic priorities on antimicrobial resistance: preserving antimicrobials for today and tomorrow

National Institute for Health and Care Excellence (2022), Pneumonia in adults: diagnosis and management

Faculty of General Dental Practice (2020), Antimicrobial prescribing in dentistry good practice guidelines, 3rd Edition

Medicines and Healthcare products Regulatory Agency (2017), Patient group directions: who can use them

World Health Organization (WHO), World Antimicrobial Awareness Week

World Health Organization (WHO) (2021), WHO policy guidance on integrated antimicrobial stewardship activities

National Institute for Health and Care Excellence (NICE) (2022), Summary of antimicrobial prescribing guidance – managing common infections

HM Government (2019), The UK’s 20-year vision for antimicrobial resistance

Department of Health and IPC Society (revised 2013), Local self-assessment dental audit tool and supporting documents for assessing implementation of HTM 01-05: decontamination in primary care dental practices and related IPC

Oloyede O, Cramp E, Ashiru-Oredope D, ‘Antimicrobial stewardship: development and pilot of an organisational peer-to-peer review tool to improve service provision in line with national guidance. Antibiotics (Basel)’,2021 Jan 5;10(1):44.

TARGET (2021), Antibiotic prescribing in primary care UTI audit for people with catheters

NHS England (2019), Dental record keeping standards: a consensus approach

British Dental Association (BDA), Antibiotic prescribing audit tool for dentists

Health and Safety Executive (HSE) (2018), Managing infection risks when handling the deceased

National Institute of Health and Care Excellence (NICE) (2015), Medicines optimisation: the safe and effective use of medicines to enable the best possible outcomes

Loveday HP, Wilson JA, Pratt RJ, and others (2014), epic3: National evidence-based guidelines for preventing healthcare-associated infections in NHS hospitals in England, Journal of Hospital Infection 86 (supplement 1)

National Institute for Health and Care Excellence (NICE) (2012), Infection prevention and control of healthcare-associated infections in primary and community care

National Institute of Health and Care Excellence (NICE) (2012), Patient experience in adult NHS services: improving the experience of care for people using adult NHS services

Oxfordshire Association of Care Providers (2017), Personal assistants and the Care Quality Commission

Mental Capacity Act 2007

Mental Capacity Act 2005

Care Act 2014

NHS England (2021), The matron’s handbook

NHS England (2017), Accessible Information Standard

Royal College of Nursing/IPC Society (2014), Infection prevention and control commissioning toolkit: guidance and information for nursing and commissioning staff in England

NHS England Patient Safety Alert (2014), Risks arising from breakdown and failure to act on communication during handover at the time of discharge from secondary care

Care Quality Commission (CQC), Regulation 9: Person-centred care

National Institute for Health and Care Excellence (NICE), Shared decision making

National Institute for Health and Care Excellence (NICE) (2018), Decision-making and mental capacity

BSC, the Chartered Institute for IT and the Department of Health (2013), Keeping your online health and social care records safe and secure

NHS England (2014), Confidentiality Policy

Department of Health (2003), Confidentiality: NHS Code of Practice (England)

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Department of Health (2014), HTM 00: Policies and principles of healthcare engineering

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Health and Safety Executive (HSE) (2006), Natural rubber latex sensitisation in health and social care

Health and Safety Executive (HSE) (2005), Biological agents: managing the risks in laboratories and healthcare premises

Health and Safety Executive (HSE) (2003), Health and safety regulation: a short guide

Health and Safety Executive (HSE) (1999), Management of Health and Safety at Work Regulations 1999. Statutory Instrument No.3242

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Department of Health (2009), HBN 04-01: Adult in-patient facilities

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Department of Health (2010), Uniforms and workwear: guidance for NHS employers

Medicines and Healthcare products Regulatory Agency (2015), Managing medical devices: guidance for health and social care organisations

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Health and Safety Executive (HSE) (2003), Safe working and the prevention of infection in clinical laboratories and similar facilities

Health and Safety Executive (HSE) (2001), The management, design and operation of microbiological containment laboratories

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UK Health Security Agency (2021), MRSA, MSSA, Gram-negative bacteraemia and CDI: quarterly report

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Public Health England (2012), Clostridium difficile: updated guidance on diagnosis and reporting

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