Infection prevention and control (IPC) is one of the most fundamental aspects of working in health and social care. Every day, care workers come into close contact with people who may be vulnerable to infection — elderly residents, patients with chronic conditions, individuals with weakened immune systems, and people recovering from surgery or illness.
Without proper infection control practices, healthcare-associated infections (HCAIs) can spread rapidly through care settings, causing serious illness and, in the most vulnerable individuals, death. The COVID-19 pandemic brought infection control into sharp public focus, but the principles have always been central to safe, high-quality care.
This guide covers everything care workers need to know about infection control — from the legal framework and the chain of infection to hand hygiene, PPE, waste management, and outbreak procedures.
The Legal Framework
Infection control in health and social care settings is governed by several pieces of legislation and guidance.
Health and Social Care Act 2008 (Regulated Activities) Regulations 2014
The Care Quality Commission (CQC) regulates health and social care services in England under the Health and Social Care Act 2008. Regulation 12 (Safe care and treatment) requires registered providers to assess and manage the risks of infection. This includes:
- Having effective systems in place to prevent, detect, and control the spread of infection
- Maintaining a clean and appropriate environment
- Providing suitable personal protective equipment
- Ensuring staff are trained in infection prevention and control
Failure to comply with these regulations can result in enforcement action from the CQC, including warning notices, conditions on registration, or in the most serious cases, cancellation of registration.
The Code of Practice on the Prevention and Control of Infections (2022)
The Health and Social Care Act 2008 Code of Practice (often called the Hygiene Code) sets out 10 criteria that health and social care providers must meet to ensure compliance with infection prevention and control requirements. These criteria cover:
- Systems to manage and monitor the prevention and control of infection
- Provision of suitable and accurate information on infections to service users, visitors, and staff
- Systems to ensure antimicrobial stewardship
- Provision of suitable, accurate information to any person concerned with providing care
- Infection risk management in the built environment
- Adequate isolation facilities
- Laboratory support for infection control
- Policies for the prevention and control of infection
- Staff compliance with infection prevention policies
- A programme of IPC education and training
Criterion 10 is particularly relevant — it places a clear expectation on providers to ensure that all staff receive appropriate infection control training.
Other Relevant Legislation
- The Health and Safety at Work Act 1974 — places a general duty on employers to ensure the health and safety of employees and others who may be affected by their work activities
- The Control of Substances Hazardous to Health Regulations 2002 (COSHH) — relevant to the use of cleaning chemicals and disinfectants
- The Environmental Protection Act 1990 — governs the safe disposal of clinical and hazardous waste
- The Personal Protective Equipment at Work Regulations 1992 — requires employers to provide suitable PPE where risks cannot be adequately controlled by other means
The Chain of Infection
Understanding the chain of infection is essential for anyone working in infection control. The chain describes the six links that must all be present for an infection to spread. Breaking any single link in the chain can prevent transmission.
1. Infectious Agent
The infectious agent is the pathogen that causes disease. This can be a bacterium (such as MRSA, C. difficile, or E. coli), a virus (such as norovirus, influenza, or COVID-19), a fungus (such as Candida), or a parasite (such as scabies).
2. Reservoir
The reservoir is the place where the infectious agent lives and multiplies. In care settings, common reservoirs include:
- Infected or colonised patients/residents
- Contaminated surfaces, equipment, and furnishings
- Water systems (such as Legionella in water tanks and pipes)
- Food (if improperly stored or prepared)
3. Portal of Exit
The portal of exit is the route by which the infectious agent leaves the reservoir. Common portals of exit include the respiratory tract (coughing, sneezing), the gastrointestinal tract (vomiting, diarrhoea), broken skin (wounds, sores), blood, and mucous membranes.
4. Mode of Transmission
This is how the infection travels from the reservoir to a new host. The main modes of transmission in care settings are:
- Contact transmission — the most common route, either direct (person-to-person) or indirect (via contaminated surfaces, equipment, or hands)
- Droplet transmission — large respiratory droplets produced by coughing, sneezing, or talking, which travel short distances
- Airborne transmission — smaller particles (aerosols) that can remain suspended in the air for longer periods and travel further
- Faecal-oral transmission — ingestion of pathogens from contaminated hands, food, or water
5. Portal of Entry
The portal of entry is the route by which the infectious agent enters the new host. This can include the respiratory tract (inhalation), the gastrointestinal tract (ingestion), broken skin (wounds, cannulation sites, catheter sites), and mucous membranes (eyes, nose, mouth).
6. Susceptible Host
The susceptible host is a person who is vulnerable to infection. In care settings, many individuals are at increased risk due to age, underlying health conditions, immunosuppression, invasive devices (catheters, cannulae), malnutrition, or recent surgery.
Effective infection control focuses on breaking the chain at multiple points — through hand hygiene (interrupting the mode of transmission), PPE (protecting portals of entry and exit), environmental cleaning (eliminating reservoirs), and safe waste disposal (managing portals of exit).
Standard Precautions
Standard precautions are the basic infection control practices that should be applied in the care of all individuals, regardless of their known or suspected infection status. They form the foundation of safe practice in any care setting.
Hand Hygiene
Hand hygiene is widely recognised as the single most important measure for preventing the spread of infection. Hands should be cleaned:
- Before and after every episode of direct patient or resident contact
- Before putting on and after removing gloves or other PPE
- After contact with blood, body fluids, or contaminated surfaces
- Before handling food, medication, or sterile equipment
- After using the toilet or blowing your nose
There are two primary methods of hand hygiene:
Handwashing with soap and water — the preferred method when hands are visibly soiled or contaminated with body fluids, and after caring for individuals with certain infections (such as C. difficile or norovirus, where alcohol-based products are less effective). Effective handwashing takes at least 20 seconds and should follow the WHO’s six-step technique, covering palms, backs of hands, between fingers, backs of fingers, thumbs, and fingertips.
Alcohol-based hand rub (ABHR) — suitable when hands are not visibly soiled. ABHR is quick and convenient, making it a practical option between care episodes. However, it is not effective against all pathogens — notably C. difficile spores and norovirus — so it should not replace handwashing when soap and water are needed.
Personal Protective Equipment (PPE)
PPE creates a barrier between the care worker and potential sources of infection. The type of PPE required depends on the task being performed and the level of risk. The key principle is that PPE should be based on a risk assessment of the activity, not assumed based on the individual’s diagnosis alone.
Gloves — wear disposable gloves when there is a risk of exposure to blood, body fluids, mucous membranes, or broken skin. Change gloves between tasks and between individuals. Never wash or reuse disposable gloves.
Aprons and gowns — wear a disposable apron when there is a risk of contamination to clothing. Use a fluid-resistant gown when there is a risk of extensive splashing.
Face masks and eye protection — wear a fluid-resistant surgical mask and eye protection (visor or goggles) when there is a risk of splashing or spraying of blood or body fluids. For airborne infections, a higher-grade respirator (such as an FFP3 mask) may be required.
The correct sequence for putting on (donning) and removing (doffing) PPE is critical to avoiding contamination. Training should include practical demonstrations of donning and doffing procedures.
Safe Handling and Disposal of Sharps
Needlestick injuries and sharps injuries are a significant risk in care settings. Safe practices include:
- Never recapping, bending, or breaking used needles
- Disposing of sharps immediately into a designated sharps container at the point of use
- Never overfilling sharps containers beyond the marked fill line
- Reporting all sharps injuries immediately, following your organisation’s needlestick injury protocol
Respiratory Hygiene and Cough Etiquette
Encourage individuals with respiratory symptoms to cover their nose and mouth when coughing or sneezing (using a tissue or the crook of their elbow), dispose of tissues promptly, and perform hand hygiene afterwards. Provide tissues and hand hygiene facilities in waiting areas and communal spaces.
Environmental Cleaning
A clean environment is fundamental to infection prevention. Surfaces that are frequently touched — door handles, bed rails, call bells, light switches, toilet flush handles, and taps — are common points of transmission and require regular cleaning.
Routine Cleaning
All care environments should have a documented cleaning schedule that specifies what is to be cleaned, how often, and with what products. Cleaning should follow the principle of cleaning from the least contaminated area to the most contaminated, and from high surfaces to low surfaces.
Enhanced Cleaning
Enhanced cleaning is required during outbreaks or when caring for individuals with specific infections. This may involve increased frequency of cleaning, the use of different or stronger disinfectants (such as chlorine-based products for C. difficile or norovirus), and targeted cleaning of the affected individual’s immediate environment.
Decontamination of Equipment
Reusable equipment (commodes, hoists, blood pressure cuffs, thermometers) must be cleaned and decontaminated between uses according to the manufacturer’s instructions and local policies. Single-use items must never be reused.
Waste Management
Healthcare waste must be segregated, handled, and disposed of in accordance with the Department of Health’s Health Technical Memorandum 07-01 (Safe Management of Healthcare Waste). The colour-coded waste segregation system ensures that different types of waste are handled appropriately:
- Orange bags — infectious clinical waste for treatment (autoclaving or incineration)
- Yellow bags — clinical waste requiring incineration (such as anatomical waste or chemically contaminated waste)
- Yellow with black stripe bags — offensive/hygiene waste (non-infectious, includes incontinence pads, nappies, and sanitary waste)
- Black bags — domestic waste (non-clinical)
- Yellow sharps containers — for needles, blades, and other sharp clinical waste
- Purple-lidded sharps containers — for cytotoxic or cytostatic sharps waste
Staff must be trained to segregate waste correctly at the point of production. Incorrect segregation can lead to environmental contamination, injury, and regulatory breaches.
Outbreak Management
Despite the best preventive measures, outbreaks can and do occur in care settings. Common outbreaks in care homes and hospitals include norovirus (winter vomiting bug), influenza, COVID-19, and C. difficile.
Effective outbreak management depends on rapid recognition and response:
Recognising an Outbreak
An outbreak should be suspected when two or more individuals in the same setting develop similar symptoms within a short timeframe. Early signs include clusters of diarrhoea and vomiting, respiratory symptoms, or unexplained febrile illness.
Immediate Actions
- Report the suspected outbreak to the person in charge and to Public Health England (now the UK Health Security Agency) or the local health protection team
- Isolate affected individuals where possible to prevent further spread
- Increase cleaning — implement enhanced cleaning protocols, paying particular attention to frequently touched surfaces and bathrooms
- Review PPE — ensure all staff are using appropriate PPE for the suspected pathogen
- Restrict movement — consider restricting visitors and transfers to and from the setting during the outbreak
- Collect specimens — obtain stool or respiratory samples as appropriate for laboratory testing
- Communicate — keep staff, residents, families, and relevant external agencies informed
After the Outbreak
Once the outbreak is declared over (typically after a defined period with no new cases), conduct a review to identify lessons learned and update your IPC policies and practices accordingly.
How to Get Trained
Infection control training is a mandatory requirement for all care workers and is a key expectation of the CQC and other regulators. Chefs Bay Academy offers a comprehensive Infection Control course that covers all the topics outlined in this guide.
The course is suitable for care assistants, support workers, nurses, domiciliary care workers, and anyone working in health and social care settings. It covers the chain of infection, standard precautions, hand hygiene, PPE, environmental cleaning, waste management, and outbreak procedures.
Here is how to get started:
- Buy a licence for £29 — this gives each learner access to the Infection Control course and 130+ other courses in the library
- Start learning — the course is self-paced and works on any device, so staff can complete it around their shifts
- Complete the assessment — pass the end-of-course assessment to confirm your knowledge
- Download your certificate — a CPD accredited certificate is available immediately
The £29 licence also includes other courses essential for care workers, including health and social care courses, manual handling, safeguarding, mental health awareness, and fire safety — everything your team needs in one package.
Frequently Asked Questions
Is infection control training mandatory for care workers?
Yes. The CQC expects all staff working in regulated health and social care settings to receive infection prevention and control training as part of their induction and on an ongoing basis. The Health and Social Care Act 2008 Code of Practice (Criterion 10) specifically requires providers to have a programme of IPC education and training. Failure to provide adequate training can result in enforcement action.
How often should infection control training be refreshed?
Best practice is to refresh infection control training annually. This ensures that staff remain up to date with current best practices, any changes in guidance, and lessons learned from recent outbreaks. Many CQC inspectors will specifically check that IPC training is current when assessing services.
What is the difference between cleaning and disinfection?
Cleaning is the physical removal of dirt, dust, and organic matter from surfaces using water and detergent. Disinfection is the use of chemical agents to destroy or inactivate microorganisms on surfaces. Effective infection control requires both — cleaning must be performed before disinfection, as organic matter can prevent disinfectants from working properly.
Does infection control training only apply to clinical staff?
No. Infection control applies to everyone working in a care setting, including domestic and catering staff, maintenance workers, administrative staff who enter clinical areas, and volunteers. Anyone who enters a care environment has a role to play in preventing the spread of infection.
Related Guides
If you found this guide helpful, you might also want to read:
- COSHH Awareness: Understanding Hazardous Substances — cleaning chemicals and disinfectants used in infection control are regulated under COSHH
- First Aid at Work: Requirements, Regulations and Training Options — first aid and infection control go hand-in-hand in care settings
- Safeguarding Training: Who Needs It and What It Covers — infection control is part of your duty of care to vulnerable individuals
All these courses are included in your Chefs Bay Academy licence — £29 for instant access to 130+ courses.