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GPs urged to wash hands between seeing each patient

Updated NICE infection control guidance focuses on primary care

Adrian O'Dowd

Wednesday, 28 March 2012

GPs and other clinicians should decontaminate their hands immediately after direct contact with every patient, according to new guidance on infection control published today by NICE.

The watchdog, which has updated its guidance on infection control to take into account new evidence since it was first published in 2003, said care was increasingly being provided in primary care settings and more complex issues were being dealt with by GPs and practice nurses.

It was crucial, said NICE, that GPs decontaminate their hands immediately after direct contact with patients to prevent the spread of infection in healthcare settings.

It is estimated that around 300,000 patients acquire healthcare-associated infections (HCAIs) each year as a result of care in the NHS and certain HCAIs can be fatal – Clostridium difficile and methicillin-resistant staphylococcus aureus (MRSA) led to approximately 9,000 deaths in hospital and primary care in England in 2007.

NICE’s new guidance reflects the fact that more patients are being seen in primary care and the recommendation that hands be decontaminated immediately before every episode of direct contact with patients should now include aseptic procedures as well.

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.

The guidance says GPs and healthcare workers should ensure their hands are decontaminated throughout the duration of clinical work and they should do this by:

  • being bare below the elbow when giving direct patient care
  • removing wrist and hand jewellery
  • ensuring fingernails are short, clean and free of nail polish
  • by making sure cuts and abrasions are covered with waterproof dressings.

It is also recommended that GPs and healthcare workers ensure that gloves that have been exposed to body fluids and could be contaminated are disposed of correctly, and in accordance with national legislation and local policies.

Doctors are recommended to discard used sharps immediately by the person generating the sharps waste and these should be disposed of into a sharps container that conforms to current standards.

There is also a recommendation that patients and carers should be educated about hand decontamination, including information about the benefits of hand decontamination, correct techniques and timing over when it is appropriate to use liquid soap and water or handrub.

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, such as a clinical audit tool and an infection control baseline assessment tool.

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