Infection prevention and control in hospital

• Infection prevention and control (IPC) is a set of routine practices that stop infections being passed between patients, staff and the hospital environment. They are applied to every patient, all the time. ^[5]
• The foundation is standard precautions: hand hygiene, appropriate PPE, safe handling of equipment and laundry, safe injection practice, and respiratory/cough etiquette.
• Transmission-based precautions (contact, droplet, airborne) are added on top, based on how a specific germ travels, and always in addition to standard precautions.
• Most healthcare-associated infections are prevented by getting the routine basics right: clean hands, the right PPE, safe sharps handling, and device-care bundles.
• Infection control also means reducing unnecessary antibiotics, because antibiotics drive antimicrobial resistance, which makes infections harder to treat.

By the end of this page you should be able to:

1. Explain why routine infection prevention and control matters and state the size of the healthcare-associated infection problem.
2. List the elements of standard precautions and choose appropriate PPE for a given interaction.
3. Decide when contact, droplet and airborne precautions are needed and what each requires.
4. Perform hand hygiene correctly, at the right moments, and choose correctly between alcohol handrub and soap and water.
5. Isolate or cohort a patient safely and describe the airborne infection isolation room requirements.
6. Manage a sharps injury (immediate care, post-exposure prophylaxis, follow-up).
7. Describe the elements of the main healthcare-associated infection prevention bundles.
8. Explain how infection prevention links to antimicrobial stewardship and how stewardship is organised.

Infection prevention and control (IPC) is the discipline of preventing infections that are acquired in healthcare settings, and of stopping any infection (including non-healthcare infections) being spread from person to person while people are being cared for. It is not a specialist activity reserved for outbreaks: it is the background conditions under which all clinical care is delivered. Hospitals concentrate vulnerable people, invasive procedures, and microorganisms in one place, so without deliberate control, infection spreads along any route it is given.

Healthcare-associated infections (HAIs) also called nosocomial infections are infections that a patient acquires while receiving care and that were not present on admission. They include surgical site infection, catheter-related bloodstream infection, catheter-associated urinary tract infection, ventilator-associated pneumonia, and infections caused by resistant organisms such as MRSA, VRE and resistant Gram-negative bacteria. The burden is substantial: at any one time, up to 7% of patients in developed countries and 10% in developing countries will acquire at least one healthcare-associated infection.^[2]

A large fraction of these infections is preventable. Many are the result of routine processes failing rather than of unavoidable risk: a hand not cleaned, a catheter left in, a bundle step skipped.

IPC works at every level of organisation. The World Health Organization's framework for IPC programmes has two levels.^[2] At the national level, the need is a national IPC programme, written guidelines, training, monitoring of practices, surveillance of healthcare-associated infections, and linkages to water, sanitation and hygiene. At the acute facility level, the need is an IPC professional and a multidisciplinary team, practical written procedures, ongoing training, monitoring with feedback, and integration with antimicrobial stewardship and other safety programmes.

At a national level, the major guidelines a student should recognise are:

• WHO: the Guidelines on Hand Hygiene in Health Care (2009) and the core components guidelines (2016), plus the global report on IPC (2024).
• CDC / HICPAC: the Guideline for Isolation Precautions (2007, web content reviewed and updated into 2023/2024), the Guideline for Hand Hygiene in Health-Care Settings (2002), and the CDC Core Elements of Hospital Antibiotic Stewardship Programs.
• NICE (UK): clinical guideline CG139, Healthcare-associated infections: prevention and control in primary and community care (published 2012, last updated 2017).

A note on regional differences: the principles (hand hygiene, appropriate PPE, safe injection) are universal; the specific product, duration, and process details differ by region and by guideline. Where numbers below come from a particular guideline, that guideline is named.

Standard precautions are the set of practices used for every patient, regardless of whether an infection is known or suspected. ^[3] They are based on the principle that blood, body fluids, secretions, excretions except sweat, non-intact skin, and mucous membranes may all contain transmissible organisms. ^[3]

The elements are:^[3][4][8]

• Hand hygiene: before and after patient contact, after body fluid exposure, after contact with the patient's surroundings, and after removal of gloves.
• PPE chosen by risk: gloves, gown or apron, mask, eye protection or face shield.
• Respiratory hygiene and cough etiquette: source control for coughing patients; spatial separation; masks and tissues in waiting areas.
• Patient placement: use a single room for a patient who is likely to contaminate the environment or has symptoms of a transmissible infection.
• Safe handling and decontamination of patient-care equipment and environment, including textiles and laundry.
• Safe injection practices: single needle and syringe for each injection, single-dose vials where possible, no recapping of needles, never using one syringe for multiple patients.
• Protection from occupationally acquired infection (sharps safety, lumbar puncture masks, occupational health follow-up).
• Training and education for all staff and for patients and carers.

PPE is not "put on everything for everyone"; it is selected by the anticipated exposure. ^[4] A risk-based selection looks like this:

"bare below the elbows" and good grooming (short clean nails, no nail polish or jewellery worn, cuts covered with waterproof dressings) is how staff keep their hands decontaminable during a shift.^[4]

When standard precautions alone do not completely interrupt the way a germ travels, transmission-based precautions are added on top of them, never replacing them. ^[3] They are used while the infectious cause is still being investigated (an empirical, syndromic approach) and then adjusted once the organism is identified or ruled out. ^[3]

There are three categories:^[3]

• Contact precautions for organisms spread by direct or indirect contact with the patient or their environment.
• Droplet precautions for organisms spread by close respiratory or mucous membrane contact with respiratory secretions.
• Airborne precautions for organisms that remain infectious when suspended in air over long distances.

Whenever these are used, standard precautions always go with them.

There is also the protective environment (not a routine precaution): a positive-pressure room with HEPA filtration, at least 12 air changes per hour, used for allogeneic stem-cell transplant recipients to reduce fungal spores. ^[3]

Hand hygiene is the single most effective practice in IPC. ^[1] It is done at five key moments derived from the care episode: before touching a patient; before a clean or aseptic procedure; after exposure to body fluids; after touching a patient; and after touching the patient's surroundings. The NICE wording is to decontaminate hands immediately before and after every episode of direct patient contact or care (including aseptic procedures), after any exposure to body fluids, after any contact with the patient's surroundings that might contaminate the hands, and after removal of gloves. ^[4]

Alcohol handrub, conforming to national standards, is the preferred method when hands are not visibly soiled; it is quick and effective against most organisms. ^[4] Rub it over all surfaces of the hands, including fingertips, thumbs and between the fingers, until the rub has evaporated and the hands are dry.

Soap and water must be used when hands are visibly soiled or potentially contaminated with body fluids, and in situations with potential spread of alcohol-resistant organisms such as Clostridioides difficile. ^[4] An effective hand wash takes three stages: preparation (wet under tepid running water, apply liquid soap), washing (rub vigorously, with all surfaces contacted, for at least 10 to 15 seconds, concentrating on fingertips, thumbs and between fingers), and rinsing and drying with good quality paper towels. ^[4]

• Keep hands bare below the elbow during direct patient care, with short clean nails, no nail polish and no wristwatch or stoned rings; cover cuts with waterproof dressings. ^[4]
• Apply emollient hand cream regularly to protect the skin from the drying effects of frequent decontamination; seek occupational health input if a product irritates. ^[4]
• Hands cannot be decontaminated at all if they are full of dirt or organic material; wash first, then rub.

Isolation is a clinical decision made for the patient's safety and that of others, not a punishment. Good practice reduces the psychological harms (anxiety, low mood, reduced contact with staff) that isolation causes. ^[3]

Principles:

• Single room preferred when transmission-based precautions are needed. ^[3]
• If no single room exists, infection control advice decides risk-balanced options: cohorting patients with the same organism, or sharing with a current roommate after risk assessment. ^[3]
• At least 3 feet of spatial separation between beds in multi-bed rooms, with curtains drawn, for droplet or contact precautions. ^[3]
• Post the precaution type and required PPE on visible signage outside the isolation area, so cleaning and other staff know what to do.
• Droplet precautions: mask the patient if they must be moved (for example to radiology) so they do not disperse secretions.
• Airborne precautions: use an airborne infection isolation room. These are single rooms with special ventilation: monitored negative pressure relative to the corridor, 12 air changes per hour for new construction and renovation, 6 air changes per hour for existing facilities, with air exhausted directly outside or passed through HEPA filtration before recirculation. Staff put on an N95 (or higher) respirator before entering. ^[3]
• Protective environment as described above, for allogeneic stem-cell transplant patients.

For most conditions precautions are discontinued when the risk of transmission has passed or the illness has resolved. ^[3] For some (for example respiratory viruses in immunocompromised patients) shedding continues for weeks to months and precautions must be prolonged. For multidrug-resistant organisms, carriage can persist for many months, especially with invasive devices, recurrent antibiotics, or severe illness; many units therefore manage known carriers with ongoing contact precautions, or reculture only after a long antibiotic-free and hospitalisation-free interval. ^[3] Local policy and the isolation guideline should be followed.

Unsafe injection practice is one of the better-documented routes of bloodborne virus transmission in healthcare. ^[3] The core rules:

• use a sterile, single-use, disposable needle and syringe for every injection; never re-use a syringe on a second patient; never re-enter a multiple-dose vial with a used needle. ^[3]
• prefer single-dose vials over multiple-dose vials, especially when a medication is given to several patients. ^[3]
• never pass sharps hand to hand; handle as little as possible; never bend or break needles before disposal (bending is allowed only as part of an approved safety device). ^[4]
• do not recap needles, except in dentistry where recapping cannot be avoided and then only with a risk assessment and appropriate safety device. ^[4]
• discard used sharps immediately into a puncture-resistant container meeting current standards; do not fill above the fill line, close it when not in use, and dispose of it when the fill line is reached; never use it for any other waste. ^[4]
• use sharps safety devices when a risk assessment shows they give a safer system, and train and assess everyone in correct use and disposal. ^[4]
• wear a surgical mask when performing lumbar punctures and spinal or epidural procedures, because of droplet transmission of oropharyngeal flora. ^[3]

A sharps injury or splash of blood or body fluid onto mucous membrane or non-intact skin demands prompt, protocol-driven action. Those exposed need teaching on it before it happens so no time is lost. ^[6]

• Puncture or small wound: wash with soap and water for about 15 minutes. ^[6]
• Laceration: apply direct pressure to control bleeding, then seek medical attention. ^[6]
• Mouth splash: rinse several times with water. ^[6]
• Eye splash: remove contact lenses; flush the eyes for about 15 minutes (eye wash station, sterile saline, or tepid running water), keeping the eyes open and rotating the eyeballs. ^[6]
• Report it immediately: post-exposure management (including source testing) depends on prompt notification. ^[6]

Bloodborne exposure risk comes from percutaneous injury, mucous membrane exposure, non-intact skin exposure, and bites leading to blood exposure to either person, from blood and certain body fluids. ^[6]

• Hepatitis B: give hepatitis B PEP as soon as possible, preferably within 24 hours. It may be given to pregnant women. It is not needed if the exposed person is already immune. ^[6]
• Hepatitis C: no post-exposure prophylaxis is recommended. ^[6]
• HIV: initiate PEP as soon as possible, within hours of exposure. Seek expert consultation if resistance is suspected; give for 4 weeks if tolerated. ^[6] PEP can be given to pregnant women, with pregnancy testing offered to women of childbearing age. ^[6]

• Hepatitis B: test for response 1 to 2 months after the last vaccine dose if only vaccination was given. ^[6]
• Hepatitis C: test for anti-HCV and ALT 4 to 6 months later, with optional HCV RNA at 4 to 6 weeks if earlier diagnosis is wanted; repeatedly reactive tests are confirmed. ^[6]
• HIV: evaluate the exposed person within 72 hours, monitor for drug toxicity for at least 2 weeks, and test HIV antibody for at least 6 months (for example at 6 weeks, 3 months and 6 months), plus testing if an illness compatible with acute retroviral syndrome occurs. ^[6]
• Advise the exposed person to use precautions to prevent secondary transmission during the follow-up period. ^[6]

A "bundle" is a small (three to five) set of evidence-based steps that together reliably prevent a specific device-associated infection; when all bundle elements are performed together, they reduce infection. Bundles convert guideline recommendations into a bedside checklist and apply to central lines, urinary catheters, ventilators and surgery. ^{[4] [7]}

A teaching central line-associated bloodstream infection (CLABSI) bundle contains the familiar elements from contemporary practice: perform hand hygiene before insertion; use maximal sterile barrier precautions; prepare the skin with an appropriate antiseptic; avoid the femoral site when possible in adults; and review the line daily, removing it as soon as it is not essential. ^{[4] [7]} NICE adds the device-specific details: decontaminate the insertion site with chlorhexidine gluconate in 70% alcohol, use sterile transparent semipermeable dressings changed every 7 days (or sooner if soiled), decontaminate hubs before and after access, use administration sets for up to 72 hours of continuous use, change blood component tubing every 12 hours and total parenteral nutrition sets generally every 24 hours, and avoid multidose vials. ^[4]

For catheter-associated urinary tract infection (CAUTI): insert urinary catheters only when necessary, use a sterile closed drainage system, perform hand hygiene before handling, keep the drainage bag below bladder level and off the floor, secure the catheter, review and remove as soon as possible, and perform daily perineal hygiene with soap and water. ^[4]

For ventilator-associated events (including ventilator-associated pneumonia): elevate the head of the bed, provide oral care as advised, minimise sedation and assess daily readiness to extubate, use a closed suction system where appropriate, and manage cuffs to prevent microaspiration. Follow local bundles.

For surgical site infection (SSI): appropriate hair removal without razors (clip if necessary), chlorhexidine skin preparation, normothermia, glucose control, timely perioperative antibiotics within the required window, and maintenance of sterility in the operating field.

For skin decolonisation and MDRO control, see organism-specific guidance. The principles (hand hygiene, PPE, isolation, cleaning, antimicrobial stewardship) are the same across all.

The exact bundle membership and duration thresholds above should be aligned with the current local bundle card and the newest compendium version.

Preventing infection and controlling its spread is only one half of IPC. The other half is ensuring that when antibiotics are needed, they are used appropriately: overuse drives antimicrobial resistance, and resistant organisms make every healthcare-associated infection harder to treat. ^[7] Infection prevention and antimicrobial stewardship are therefore run together in almost every hospital's quality-and-safety structure.

The Centers for Disease Control and Prevention's Core Elements of Hospital Antibiotic Stewardship Programs (released 2014, updated 2019, web page updated 15 September 2025) sets out seven structural elements that a hospital should have. ^[7]

Practical links for the reader are the dedicated MedGrasp page on antimicrobial resistance and stewardship, on sepsis, on pneumonia, on urinary tract infection and its organisms, and on wound healing and surgical site infection. These topics carry drug, dose and regimen detail that belongs with those diseases rather than with IPC.

Clean clinical environments are a core part of IPC. ^[8] Standard precautions require safe handling and decontamination of equipment, instruments and the environment, plus safe textile and laundry handling. ^{[3] [8]} Isolation rooms (especially for organisms like C. difficile and norovirus) are cleaned after non-isolation areas, with detergent or disinfectant appropriate to the organism, and PPE matched to the precautions posted. ^[3] Waste is segregated immediately by the person producing it into appropriate colour-coded bags or containers in line with national legislation and local policy; sharps are never placed in general waste. ^[4] Equipment used on a patient with transmission-based precautions is dedicated or disposed of accordingly.

Good IPC is measurable. Programmes monitor healthcare-associated infection rates using standard definitions, monitor hand hygiene compliance, monitor cleaning, and feed results back to clinical teams. ^[2] An outbreak is suspected when cases exceed the expected number and triggers an investigation (case finding, mapping, possible molecular typing, control measures). ^[2] Education, audit with feedback and leadership are the engine that keeps a programme running: without monitoring, standard precautions drift back to habit rather than policy. ^{[2] [7]}

Lower-resource settings are where most healthcare-associated infections occur and where the 10% prevalence figure applies. ^[2] WHO's approach is a minimum layering that any facility can meet: a trained IPC focal person; clean water, basic toilets and hygiene materials; reliable hand hygiene supplies at every point of care; waste management; and one trained person per large facility. Water, sanitation and hygiene (WASH) is inseparable from IPC: hand hygiene requires water or alcohol, and safe sharps disposal requires containers.

Adaptations that keep care safe when resources are short:

• No single rooms: cohort patients with the same organism and use physical separation and curtains; prioritise the most transmissible (airborne, then droplet) and the most vulnerable for any available isolation space.
• No N95 respirators or negative pressure rooms: mask the patient, close the door, and protect staff with the best available mask, following the measles and tuberculosis interim guidance.
• No sinks: alcohol handrub (even where water is unreliable) is the pragmatic fallback; teach rub-until-dry technique.
• No sterilisation capacity: use disposable consumables when available, prioritise sterilisation for invasive instruments, and use standardised low-level disinfection correctly.
• No microbiology: at minimum, clinical syndromic precautions at admission and careful isolation; surveillance at ward level with simple tallies.
• No on-site IPC nurse: train one staff member (often a nurse) part-time as an IPC link; use WHO open-access training and the WHO IPC handbook.

Cleaning, hand hygiene, and sharps safety cost little and prevent most infections; they remain the right focus when budgets do not allow the capital items. ^[2]

• Infection prevention and control is routine, applied to every patient, everywhere care is delivered.
• Standard precautions are the foundation: hand hygiene, risk-based PPE, respiratory and cough etiquette, patient placement, equipment and environmental control, textiles, safe injection, sharps safety and training. ^{[3] [8]}
• Standard precautions are never replaced; transmission-based precautions are added on top. ^[3]
• Three transmission-based categories: contact, droplet and airborne, with corresponding room and PPE requirements. ^[3]
• Hand hygiene is the single most effective practice; alcohol handrub when hands are clean-looking, soap and water when visibly soiled or when there is risk of alcohol-resistant organisms, with at least 10 to 15 seconds of rubbing. ^{[1] [4]}
• Gloves are single-use and do not replace hand hygiene. ^[4]
• Isolation and patient placement (single room preferred, at least 3 feet separation, airborne isolation room with 12 and 6 air changes per hour) protect others. ^[3]
• A sharps injury needs immediate washing (about 15 minutes), immediate reporting, risk-appropriate post-exposure prophylaxis, and structured follow-up. ^[6]
• Infection prevention bundles turn guideline evidence into bedside checklists for central lines, urinary catheters, ventilation and surgery. ^{[4] [7]}
• NICE CG139 sets hand washing at 10 to 15 seconds minimum, chlorhexidine gluconate in 70% alcohol skin preparation, 7-day central line dressings, 72-hour administration-set changes, 12-hour blood tubing and 24-hour parenteral nutrition sets. ^[4]
• Infection prevention is coupled to antimicrobial stewardship; the CDC core elements are leadership commitment, accountability, pharmacy expertise, action, tracking, reporting and education. ^[7]
• WHO figures: up to 7% of patients in developed and 10% in developing countries acquire at least one healthcare-associated infection at any one time. ^[2]
• Lower-resource adaptations make the basics possible: hand hygiene, safe sharps disposal, isolation by cohorting, alcohol rub, and one trained IPC link per facility.

Infection prevention connects to the dedicated MedGrasp page on antimicrobial resistance and stewardship, to sepsis and to the device and infection topics such as pneumonia, urinary tract infection and its organisms, and wound healing and surgical site infection. Within the hospital, it also underpins management of infections such as meningitis, infectious diarrhoea and Clostridioides difficile infection.