4.2 Infection Prevention & Control Standards (IPC)

Standard Infection Control Precautions (SICPs) vs. Transmission-Based Precautions (TBPs)

Infection Prevention and Control (IPC) is fundamental to patient safety and quality nursing care. In the UK, national IPC manuals set out a two-tiered strategy: Standard Infection Control Precautions (SICPs) and Transmission-Based Precautions (TBPs).

Standard Infection Control Precautions (SICPs)

SICPs represent the baseline safety measures that must be applied to all patients in all healthcare settings at all times, regardless of whether an infection is suspected or confirmed. SICPs prevent cross-transmission between patients and protect healthcare workers.

The 10 core elements of SICPs include:

1. Patient Placement & Assessment: Screening for infection risk prior to and upon admission.
2. Hand Hygiene: Adhering strictly to national technique and the WHO 5 Moments.
3. Respiratory & Cough Hygiene: Encouraging patients to cover mouth/nose and dispose of tissues.
4. Personal Protective Equipment (PPE): Selecting appropriate PPE based on risk assessment.
5. Safe Management of Healthcare Equipment: Decontamination and sterilization protocols.
6. Safe Management of the Care Environment: Regular cleaning schedules and spill management.
7. Safe Management of Healthcare Linen: Correct segregation of clean, used, and infectious linen.
8. Safe Management of Waste: Segregation into color-coded clinical and non-clinical waste streams.
9. Management of Occupational Exposure: Safe handling of sharps and post-exposure prophylaxis.
10. Aseptic Technique: Application of ANTT® during invasive procedures.

Transmission-Based Precautions (TBPs)

TBPs are applied in addition to SICPs when caring for patients with confirmed or suspected transmissible pathogens.

Aerosol Generating Procedures (AGPs)—such as open suctioning, endotracheal intubation, tracheostomy care, and manual ventilation—generate high concentrations of airborne particles and require full airborne precautions (FFP3 respirator, eye protection, fluid-repellent long-sleeved gown, gloves).

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WHO 5 Moments for Hand Hygiene

Hand hygiene is single-handedly the most effective measure to prevent healthcare-associated infections (HCAIs). The World Health Organization (WHO) framework defines 5 critical moments when hand hygiene must be performed:

1. Before Touching a Patient: Protects the patient against harmful germs carried on the nurse's hands.
2. Before a Clean / Aseptic Procedure: Protects the patient against harmful germs, including their own, entering their body (e.g., prior to IV insertion, urinary catheterization, dressing changes).
3. After Body Fluid Exposure Risk: Protects the nurse and the healthcare environment from harmful patient germs (e.g., after handling blood, urine, wound drainage).
4. After Touching a Patient: Protects the nurse and environment after completing physical care or contact.
5. After Touching Patient Surroundings: Protects the nurse and environment after touching objects/furniture in the patient's immediate zone (e.g., bed rails, locker, IV pumps), even if the patient was not directly touched.

Hand Hygiene Products & Decontamination Rules

• Alcohol-Based Hand Rub (ABHR): Standard method for routine hand decontamination when hands are visually clean. Decontamination requires 20 to 30 seconds covering all hand surfaces.
• Liquid Soap and Water: Mandatory when hands are visibly dirty, soiled with blood or body fluids, after using the toilet, and when caring for patients with spore-forming organisms (Clostridioides difficile) or non-enveloped viruses (Norovirus). Decontamination requires 40 to 60 seconds.

CRITICAL NMC EXAM FACT: Alcohol-based hand gels do NOT kill C. difficile bacterial spores or Norovirus. Nurses MUST wash their hands with liquid soap and running water to physically wash away spores and viral particles.

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Personal Protective Equipment (PPE) Sequences

Proper selection, application (donning), and safe removal (doffing) of PPE are essential to avoid self-contamination and environment-wide cross-infection.

PPE Donning Sequence (Putting On)

Donning must be performed before entering the patient area or isolation room:

1. Perform Hand Hygiene: Clean hands using alcohol rub or soap and water.
2. Apron / Gown: Put on apron or fluid-repellent long-sleeved gown; secure waist and neck ties.
3. Mask / FFP3 Respirator: Position over nose, mouth, and chin. Fit flexible nose bridge. Perform fit check for FFP3 respirators.
4. Eye Protection (Goggles/Visor): Position over eyes and adjust headband for comfortable fit.
5. Gloves: Put on non-sterile or sterile gloves. Pull glove cuffs over the gown cuffs if wearing a gown.

PPE Doffing Sequence (Taking Off)

Doffing must be performed at the doorway or outside the isolation room (except mask/respirator, which is removed outside the room after closing the door):

1. Gloves: Remove gloves first as they are the most heavily contaminated item. Use glove-to-glove, skin-to-skin technique.
2. Hand Hygiene: Decontaminate hands immediately after glove removal.
3. Apron / Gown: Unfasten ties; peel apron/gown away from neck and shoulders, touching inside only. Fold/roll inwards and discard in clinical waste.
4. Eye Protection: Remove goggles/visor from the back of head handling head strap only (front is contaminated).
5. Mask / Respirator: Remove from the back of head by handling elastics/straps. Do not touch front of mask. Discard in clinical waste.
6. Perform Hand Hygiene: Perform thorough final hand hygiene.

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Major Healthcare-Associated Infections (HCAIs)

1. Meticillin-Resistant Staphylococcus aureus (MRSA)

• Nature: Strain of S. aureus resistant to beta-lactam antibiotics (penicillins, cephalosporins).
• Screening & Suppression: Elective surgical admissions are screened via nasal/groin swabs. Positive patients undergo a 5-day decolonization protocol using mupirocin 2% nasal ointment (applied 3 times daily to nostrils) and chlorhexidine 4% body wash/shampoo.

2. Clostridioides difficile (C. diff)

• Pathophysiology: Anaerobic spore-forming bacterium causing severe toxin-mediated colitis and pseudomembranous colitis. Typically triggered by broad-spectrum antibiotic therapy (e.g., broad-spectrum penicillins, cephalosporins, fluoroquinolones, clindamycin) disrupting normal gut flora.
• Key Symptoms: Foul-smelling, profuse watery diarrhea, abdominal cramping, fever, leukocytosis.
• Management: Isolate in single room with en-suite. Soap and water hand hygiene ONLY. Environmental cleaning with sporicidal agents (chlorine-releasing agents 1,000 ppm). Prescribed oral vancomycin or fidaxomicin (first-line).

3. Norovirus

• Nature: Non-enveloped RNA virus causing acute epidemic gastroenteritis ('winter vomiting bug').
• Control: Highly contagious via aerosols from projectile vomiting and fecal-oral route. Patients must be isolated until 48 hours symptom-free. Soap and water hand hygiene required.

4. Escherichia coli (E. coli) & Gram-Negative Bloodstream Infections

• Focus: E. coli is the leading cause of Gram-negative sepsis in the NHS, frequently originating from catheter-associated urinary tract infections (CAUTIs).
• Prevention: Strict adherence to urinary catheter insertion guidelines, maintaining a closed drainage system, prompt removal of unnecessary catheters, and daily meatal hygiene.

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Aseptic Non-Touch Technique (ANTT®)

ANTT® is the standardized framework used across NHS trusts to maintain asepsis during clinical procedures (e.g., wound care, IV administration, urinary catheter insertion, central line access).

Core Concepts of ANTT®

• Key Parts: The exact parts of equipment that, if contaminated, could infect the patient (e.g., syringe tips, needle hubs, IV cannula ports, sterile dressing undersides). Key Parts must NEVER be touched directly by unsterile hands or items.
• Key Sites: The open wounds or surgical access sites where micro-organisms could gain entry (e.g., insertion sites, open surgical wounds, vascular access sites).

Surgical Asepsis vs. Standard Asepsis

• Standard ANTT: Used for simple, short-duration procedures (<20 mins) with few/small Key Parts (e.g., peripheral IV push, simple wound dressing). Uses non-sterile gloves provided Key Parts are not touched directly ('non-touch' technique).
• Surgical ANTT: Used for complex, long-duration procedures with multiple large Key Parts (e.g., central line insertion, complex surgical dressing). Requires sterile gloves, full sterile drapes, and a strict sterile field.