Infection prevention and control for healthcare providers

The Hygiene Code: 10 criteria

The Hygiene Code sets out 10 criteria that CQC-registered providers must meet. CQC uses these criteria as the benchmark when assessing IPC compliance:

1. Systems to manage and monitor the prevention and control of infection, including designation of an IPC lead
2. Provide and maintain a clean and appropriate environment that facilitates the prevention and control of infections
3. Ensure appropriate antimicrobial use to optimise patient outcomes and reduce the risk of adverse events and antimicrobial resistance
4. Provide suitable information on infections to service users, their visitors and anyone concerned with providing further support or nursing/medical care
5. Ensure prompt identification of people who have or are at risk of developing an infection so they receive timely and appropriate treatment and reduce the risk of transmission
6. Systems to ensure all workers (including contractors and volunteers) are aware of and discharge their IPC responsibilities
7. Provide or secure adequate isolation facilities
8. Secure adequate access to laboratory support
9. Have and adhere to policies for the individual's care and provider organisations that will help prevent and control infections
10. Ensure, so far as reasonably practicable, that care workers are free of and are protected from exposure to communicable infections during the course of their duties

Standard infection prevention precautions

Standard precautions are the minimum IPC measures that apply to all patient care, regardless of suspected or confirmed infection status. Your IPC policy must cover all of the following.

Hand hygiene

Hand hygiene is the single most effective measure to prevent healthcare-associated infections. Follow the WHO 5 Moments for Hand Hygiene:

1. Before touching a patient
2. Before a clean or aseptic procedure
3. After body fluid exposure risk
4. After touching a patient
5. After touching patient surroundings

Alcohol-based hand rub is the preferred method for routine decontamination. Soap and water must be used when hands are visibly soiled, after caring for patients with vomiting or diarrhoeal illness (including suspected or confirmed norovirus or Clostridioides difficile), and after using the toilet.

Conduct regular hand hygiene audits using direct observation or electronic monitoring. CQC inspectors will review audit results and observe hand hygiene practice during inspections.

Personal protective equipment (PPE)

Select PPE based on a risk assessment of the task and the likely exposure:

• Gloves - Single use, for contact with blood, body fluids, non-intact skin, or mucous membranes. Change between patients and between tasks on the same patient
• Disposable aprons - When there is a risk of clothing contamination with blood or body fluids
• Fluid-resistant surgical masks - When there is a risk of splashing to the face, or when caring for patients with respiratory infections
• Eye or face protection - For procedures with risk of splash or spray of blood, body fluids, or chemicals
• FFP3 respirators - For aerosol-generating procedures on patients with suspected or confirmed airborne infections

Respiratory hygiene and cough etiquette

Promote respiratory hygiene among staff, patients, and visitors. Provide tissues and hand hygiene facilities at entry points. Patients with respiratory symptoms should be identified early and appropriate precautions applied.

Environmental cleaning

A clean environment is fundamental to IPC. Your cleaning arrangements must be systematic and auditable.

Colour-coded cleaning equipment

Use the National Patient Safety Agency (NPSA) colour-coding system to prevent cross-contamination between areas:

• Red - Bathrooms, washrooms, showers, toilets, basins, and bathroom floors
• Blue - General areas including wards, departments, and offices
• Green - Catering departments, kitchens, and ward kitchen areas
• Yellow - Isolation areas and areas with infection risk

Equipment must not be shared between colour-coded zones. Replace or decontaminate mop heads and cloths between each use session.

Cleaning schedules and standards

Maintain documented cleaning schedules that specify:

• What is cleaned, how often, and by whom
• Which cleaning products and concentrations to use
• Frequencies for routine cleaning and enhanced cleaning
• Touch-point cleaning (door handles, bed rails, call bells, light switches)

Terminal and deep cleaning

Terminal cleaning is required after a patient with a known or suspected infection is discharged, transferred, or isolation is discontinued. This involves thorough cleaning and disinfection of all surfaces, equipment, and soft furnishings in the room.

Schedule deep cleans periodically for all clinical areas, in addition to routine cleaning. Use hydrogen peroxide vapour (HPV) or ultraviolet (UV) decontamination for areas with persistent environmental contamination.

Outbreak management

You must have an outbreak management plan that can be activated quickly. Key steps when an outbreak is suspected:

1. Recognition - Identify when the number of infections exceeds the expected baseline. Two or more linked cases of the same infection should trigger investigation
2. Immediate actions - Implement enhanced IPC precautions, isolate or cohort affected patients, restrict admissions and transfers if necessary
3. Reporting - Notify the UK Health Security Agency (UKHSA, formerly PHE) Health Protection Team. CQC must also be notified of outbreaks as a statutory notification under Regulation 18
4. Investigation - Identify the source and mode of transmission. Conduct environmental sampling if indicated
5. Enhanced cleaning - Increase cleaning frequency, use appropriate disinfectants (e.g. chlorine-based for norovirus, sporicidal for C. difficile)
6. Communication - Inform affected service users and their families. Keep staff briefed on the situation and required precautions
7. Review and learning - Conduct a post-outbreak review to identify learning and update IPC policies where necessary

Antimicrobial stewardship

Criterion 3 of the Hygiene Code requires providers to ensure appropriate antimicrobial use. Antimicrobial resistance (AMR) is a significant public health threat, and healthcare providers have a direct role in reducing it.

Follow the Start Smart Then Focus approach endorsed by NHS England:

• Start Smart - Do not start antibiotics unless there is a clinical indication. Document the indication, drug, dose, route, and review date on the prescription and in the clinical notes
• Then Focus - Review antibiotics at 48-72 hours. Determine whether to stop, switch from intravenous to oral, change the antibiotic based on microbiology results, or continue and document the reason

Appoint an antimicrobial stewardship lead. Monitor antimicrobial prescribing data and benchmark against national data. Restrict broad-spectrum antibiotics and ensure compliance with local antimicrobial formularies.

CQC assessment of IPC

CQC assesses IPC at every inspection under the Safe key question. Inspectors will examine:

• Whether you have a designated IPC lead with sufficient authority, training, and dedicated time
• Your IPC policy and whether it is up to date and reflects the Hygiene Code criteria
• Your IPC audit programme - including hand hygiene audits, environmental cleaning audits, and antimicrobial stewardship audits
• Staff training - Whether all staff receive IPC training at induction and annual updates
• Surveillance data - How you monitor and report healthcare-associated infections
• Outbreak records - Evidence of appropriate management and learning from outbreaks
• Environmental cleanliness - Direct observation during the inspection

Failure to meet IPC standards can result in CQC taking enforcement action, including requirement notices, conditions on registration, or in serious cases, prosecution. IPC deficiencies are also likely to limit your overall CQC rating to Requires Improvement or Inadequate.

What to do next

To establish or improve your IPC arrangements:

• Appoint an IPC lead who has completed a recognised IPC qualification or training programme
• Develop your IPC policy covering all 10 Hygiene Code criteria
• Set up an audit programme for hand hygiene, environmental cleanliness, and antimicrobial prescribing
• Establish a training programme - IPC induction for all new staff and annual refresher training
• Review your outbreak plan and ensure staff know how to activate it
• Engage with your local UKHSA Health Protection Team for advice on local infection risks and outbreak support