NHS England » Chapter 1: Standard infection control precautions (SICPs)

1.1 Patient placement/assessment for infection risk1.2 Hand hygiene1.3 Respiratory and cough hygiene1.4 Personal protective equipment (PPE)1.5 Safe management of care equipment1.6 Safe management of the care environment1.7 Safe management of linen1.8 Safe management of blood and body fluid spillages1.9 Safe disposal of waste (including sharps)1.10 Occupational safety: prevention of exposure (including sharps injuries)

Standard infection control precautions (SICPs) are to be used by all staff, in all care settings, at all times, for all patients whether infection is known to be present or not, to ensure the safety of those being cared for, staff and visitors in the care environment.

SICPs are the basic infection prevention and control measures necessary to reduce the risk of transmitting infectious agents from both recognised and unrecognised sources of infection.

Sources of (potential) infection include blood and other body fluids, secretions or excretions (excluding sweat), non-intact skin or mucous membranes and any equipment or items in the care environment that could have become contaminated.

The application of SICPs during care delivery is determined by assessing risk to and from individuals. This includes the task, level of interaction and/or the anticipated level of exposure to blood and/or other body fluids.

To protect effectively against infection risks, SICPs must be used consistently by all staff. SICPs implementation monitoring must also be ongoing to ensure compliance with safe practices and to demonstrate ongoing commitment to patient, staff and visitor safety as required by the Health and Safety Executive and the care regulators, the Care Quality Commission.

There are 10 elements of SICPs:

Patients must be promptly assessed for infection risk on arrival at the care area, eg inpatient/outpatient/care home, (if possible, prior to accepting a patient from another care area) and should be continuously reviewed throughout their stay.

This assessment should influence placement decisions in accordance with clinical/care need(s).

Patients who may present a cross-infection risk include those:

Further information can be found in the patient placement literature review.

Hand hygiene is considered one of the most important ways to reduce the transmission of infectious agents that cause healthcare associated infections (HCAIs).

Clinical hand-wash basins must:

Hand hygiene facilities should include instructional posters.

*refer to NHS England uniforms and workwear guidance (Appendix B) for more information on the use of over-sleeves and longer-sleeved uniforms.

Wash hands with non-antimicrobial liquid soap and water if:

In all other circumstances, use alcohol-based handrubs (ABHRs) for routine hand hygiene during care.

ABHRs must be available for staff as near to the point of care as possible. Where this is not practical, personal ABHR dispensers should be used, eg within the community, domiciliary care, mental health units etc.

Where running water is unavailable, or hand hygiene facilities are lacking, staff may use hand wipes followed by ABHR and should wash their hands at the first opportunity.

Always perform hand hygiene before putting on and after removing gloves.

For how to wash hands, see the step-by-step guide in appendix 1 of this document.

For how to hand rub, see the step-by-step guide in appendix 2 of this document.

Surgical scrubbing/rubbing (this applies to those undertaking surgical and some invasive procedures):

For surgical scrubbing (not rubbing), follow the step-by-step guide in appendix 3 of this document.

For surgical rubbing (not scrubbing), follow the step-by-step guide in appendix 4 of this document.

For hand hygiene posters/leaflet, refer to the resources section of NIPCM.

Further information in the hand hygiene literature reviews:

Respiratory and cough hygiene is designed to minimise the risk of cross transmission of known or suspected respiratory illness (pathogens):

Staff should promote respiratory and cough hygiene helping those (eg, elderly, children) who need assistance with this, eg providing patients with tissues, plastic bags for used tissues and hand hygiene facilities as necessary.

Further information can be found in cough etiquette/respiratory hygiene in the hospital setting literature review.

Before undertaking any procedure, staff should assess any likely exposure to blood and/or other body fluids, non-intact skin or mucous membranes and wear personal protective equipment (PPE) that protects adequately against the risks associated with the procedure. The principles of PPE use set out below are important to ensure that PPE is used correctly to ensure patient and staff safety. Avoiding overuse or inappropriate use of PPE is a key principle that ensures this is risk-based and minimizes its environmental impact. Where appropriate, consideration should be given to the environmental impact of sustainable or reusable PPE options versus single-use PPE while adhering to the principles below.

All PPE must be:

NB Reusable PPE such as goggles/face shields/visors, must be decontaminated after each use according to manufacturer's instruction.

Gloves must be:

Sterile gloves must be worn:

NB Double gloving is NOT recommended for routine clinical care. However, it may be required for some exposure prone procedures, eg orthopaedic and gynaecological operations, when attending major trauma incidents or as part of additional precautions for high consequence infectious disease management.

Further information can be found in the gloves literature review.

Aprons must be:

Full body gowns or fluid-resistant coveralls must be:

Further information can be found in the aprons/gowns literature review.

Eye or face protection (including full-face visors) must:

Further information can be found in the eye/face protection literature review.

Surgical face masks are required:

FRSM must be:

Further information can be found in the surgical face masks literature review.

Footwear must be:

Further information can be found in the footwear literature review.

Headwear is not routinely required in clinical areas unless part of theatre attire or to prevent contamination of the environment such as in clean rooms.

Headwear must be:

NB Headwear worn for religious reasons such as turbans, kippot veils, headscarves must not compromise patient care and safety. These must be washed and/or changed daily or immediately if contaminated and comply with additional attire requirements, for example, in theatres.

Further information can be found in the headwear literature review.

For the recommended method of putting on and removing PPE, see UK Health Security Agency guides.

Care equipment is easily contaminated with blood, other body fluids, secretions, excretions and infectious agents. Consequently, it is easy to transfer infectious agents from communal care equipment during care delivery.

Care equipment is classified as either:

NB Needles and syringes are single use devices, they should never be used more than once or reused to draw up additional medication. Never administer medications from a single-dose vial or intravenous (IV) bag to multiple patients.

Before using any sterile equipment check that:

Decontamination of reusable non-invasive care equipment must be undertaken:

If providing domiciliary care, equipment should be transported safely and decontaminated as above before leaving the patient's home.

Always adhere to Control of Substances Hazardous to Health (COSHH) risk assessments and manufacturers’ guidance for use and decontamination of all care equipment.

For how to decontaminate reusable non-invasive care equipment see Appendix 7.

For decontamination of surgical instruments see HTM01-01 decontamination of surgical instruments.

Further information can be found in the management of patient care equipment literature review.

The care environment must be:

Always adhere to COSHH risk assessments for product use and processes for decontamination of the care environment.

Further information can be found in the safe management of the care environment literature review.

Healthcare laundry must be managed and segregated in accordance with HTM 01-04 which categorises laundry as follows:

Infectious linen includes linen that has been used by a patient who is known or suspected to be infectious and/or linen that is contaminated with blood and/or other body fluids, eg faeces:

Linen used during patient transfer, eg, blankets, should be categorised at the point of destination.

Further information can be found in the safe management of linen literature review.

For how to manage linen at care area level see Appendix 8.

Spillages of blood and other body fluids may transmit blood borne viruses.

Spillages must be treated immediately by staff trained to undertake this safely.

Responsibilities for the management of blood/body fluid spills must be clear within each area/care setting.

For management of blood and body fluid spillages see Appendix 9.

If an organisation locally approves a product for use in the management of blood and body fluid spills, the organisation is responsible for ensuring safe systems of work, including the completion of a risk assessment approved through local governance procedures. Organisations must confirm the efficacy and suitability of the product (i.e., that it conforms with the relevant standards and is appropriate for the intended use) with the product manufacturer.

A locally approved product which conforms to: EN17126, EN13727, EN14348, EN14476, EN13697, EN14885, EN13706, EN1650, EN1276 and EN13624 may be used for the management of blood and body fluid spills.

Further information can be found in the management of blood and body fluid literature review.

Healthcare providers should ensure that any polymer gel for non-patient use (eg spill kits, controlled drug destruction, use by cleaning staff) is kept secure and away from patients. See National Patient Safety Alert – National Patient Safety Alert – Superabsorbent polymer gel granules (2019) NatPSA/2019/002/NHSPS.

Health Technical Memorandum (HTM 07-01) contains the regulatory waste management guidance for all health and care settings (NHS and non-NHS) in England and Wales including waste classification, segregation, storage, packaging, transport, treatment and disposal.

Health and Safety (Sharp Instruments in Healthcare) Regulations 2013 outline the regulatory requirements for employers and contractors in the healthcare sector in relation to the safe disposal of sharps.

Healthcare (including clinical) waste:

Clinical waste means waste from a healthcare activity (including veterinary healthcare) that:

Offensive waste is waste that:

Table 1: Categories of waste and segregation at source

Safe waste disposal at care area level:

Always dispose of waste:

Sharps containers (for safety devices, refer to section 1.10)

Sharps containers must:

Further information can be found in the Health Technical Memorandum (HTM 07-01).

The Health and Safety (Sharp Instruments in Healthcare) Regulations 2013 outline the regulatory requirements for employers and contractors in the healthcare sector in relation to: arrangements for the safe use and disposal of sharps; provision of information and training to employees; investigations and actions required in response to work related sharps injuries.

There is a potential risk of transmission of a BBV (blood bourne virus) from a significant occupational exposure and staff must understand the actions they should take when a significant occupational exposure incident takes place. There is a legal requirement to report all sharps injuries and near misses to line managers/employers.

A significant occupational exposure is:

For the management of an occupational exposure incident see Appendix 10.

Health and Safety (Sharp Instruments in Healthcare) Regulations 2013 are concerned with reducing and eliminating the number of ‘sharps’ related injuries which occur within healthcare. Its basic guidance is:

Sharps handling must be assessed, kept to a minimum and eliminated, if possible, with the use of approved safety devices.

When transporting sharps boxes for community use these must be transported safely with the use of temporary closures.

Further information can be found in occupational exposure management (incl. sharps) literature review.