The quality statement: infection prevention and control

Why is this important?

Preventing and controlling healthcare-associated infections (HCAIs) is a strategic priority for population health and patient safety. As a result of reducing avoidable demands on the system, patient outcomes are improved, people’s experiences are enhanced, the principles of high-quality care and clinical governance are upheld, and system resilience is strengthened. 

Addressing the individual harm and healthcare cost associated with HCAIs is crucial for optimising patient safety, informing public health decisions and guiding prudent resource allocation. Understanding the full human and system impact of these infections is essential for developing effective prevention strategies and minimising the burden on individuals, healthcare organisations, and society.

Preventing avoidable HCAIs reduces harm, builds trust and supports the delivery of safe, dignified care that truly meets the needs of individuals and communities.  

Embedding high quality Infection Prevention and Control (IPC) measures, alongside responsible stewardship of environmental resources, contributes to environmental sustainability by reducing unnecessary antimicrobial use, minimising waste, and supporting the decarbonisation of healthcare services.  

The Code of Practice of the Prevention and Control of HCAI (2026) will set out the Welsh Government’s commitment to eliminating preventable HCAIs. It will emphasise that everyone has a responsibility and that the strong evidence supporting effective IPC must drive health and social care services, today and for the future.

People, their families and carers have a fundamental right to receive care in environments that are consistently safe, clean, well-maintained and well-managed. They expect care to be delivered by competent, confident professionals who are well-educated and demonstrate leadership and accountability in always applying robust IPC practices.

Supporting staff to deliver safe care is essential to maintaining workforce well-being, reducing avoidable harm, and sustaining public trust in health and social care services. Staff have the right to work in settings where their safety is protected through access to high-quality education and training, appropriate equipment and information and environments designed to minimise infection risk. Where environmental controls are not possible (for example, in a person’s home), a hierarchy of controls should be in place to mitigate risk.

How does this fit with wider policy?

This quality statement builds on the work of the Code of Practice and supersedes the Welsh Government strategy “Commitment to Purpose: Eliminating preventable healthcare associated infections (HCAIs): A Framework of Actions for Healthcare Organisations in Wales” (2011). It sets out expectations aligned with the Health and Care Quality Standards, including its domains and enablers.

The Health and Social Care (Quality and Engagement) (Wales) Act 2020 outlines with Duty of Quality, which requires organisations to evidence the delivery of quality care through a Quality Management System (QMS), which ensures all aspects of quality are considered: planning, assurance, control and improvement. This quality statement supports the development and commissioning of a robust QMS for HCAIs prevention and the assurance around improvement across the standards. 

The act also establishes a statutory Duty of Candour, placing a legal obligation on all NHS organisations in Wales to act transparently when care results in unintended or unexpected outcomes. Specifically, this duty requires organisations to formally notify and apologise to individuals when there is evidence that moderate harm, severe harm, or death has occurred as a consequence of care or treatment.

This quality statement reflects the principles of the Well-being of Future Generations (Wales) Act 2015 by supporting a long-term, preventative approach to health and care. It aims to reduce avoidable harm, improve population health outcomes, and promote sustainable healthcare delivery. Through strong IPC, antimicrobial stewardship (AMS), education and continuous quality improvement, the vision outlined in this quality statement contributes to a healthier, more resilient, and globally responsible Wales, ensuring that today’s actions protect and enhance the well-being of future generations.

This work also aligns with the NHS Wales Decarbonisation Strategic Delivery Plan, recognising that the prevention of infection and responsible use of resources are mutually reinforcing public health goals.

UK policy drivers also support this direction and ambition of this quality statement for Wales. These include the UK 20-year vision for antimicrobial resistance - (GOV.UK) and the UK 5-year National Action plan (NAP) for antimicrobial resistance. 

How has this document been developed?

This document has been generated through the office of the Chief Nursing Officer, Public Health Wales and NHS Wales Performance and Improvement. It is based on national and UK policy and has been shaped in partnership with multi-professional IPC experts from across Wales. Robust engagement was led by a national task and finish group with contributions from health board and trust leaders and operational leads from across NHS Wales and the third sector.

Whilst a whole system approach is essential for transformational change, the scope of this quality statement is specific to IPC. IPC is the responsibility of everyone working in the NHS, and this quality statement must not be viewed in isolation. Broader prevention strategies such as vaccination, antimicrobial stewardship, A Healthier Wales, and other specific quality statements relating to key specialities are important adjuncts to this document.

The quality attributes are shaped around the 12 Health and Care Quality Standards, which are intended to provide a clear framework to plan, deliver and monitor healthcare services in Wales.

What is expected of NHS Wales organisations?

It is expected that health boards, trusts and broader NHS organisations in Wales, including commissioned services, undertake a review of their status in relation to each of the quality attributes described in the quality statement. This will act as a baseline and contribute to the development of, or alignment to, existing local improvement plans and will be used to assess delivery, experience and assurance according to national expectations.

Key actions will be set by the Welsh Government and NHS Wales Performance and Improvement, underpinned by the work of the NHS Wales HCAI Delivery Group.

Support will be provided by the Public Health Wales Healthcare Associated Infection, Antimicrobial Resistance & Prescribing Programme (HARP) team, other professionals within Public Health Wales directorates and NHS Wales Performance and Improvement. Actions will be delivered in collaboration with the wider NHS, including primary care (general practitioners, dentists, pharmacists and optometrists), community services, social care partners and speciality networks across Wales.

Ongoing collaborative work will focus on developing and implementing robust, evidence-based service specifications for IPC across all levels of care. These will be informed by national clinical pathways, standards, guidance, and professional codes of practice. The development process will also consider the responsibilities of those who commission care to ensure IPC practices are embedded within commissioned services. Education, training and resources required to support effective implementation, ongoing monitoring and meaningful evaluation will also be addressed.

Safe

1. Consistent use of person-centred, evidence-based pathways of care, delivered by a skilled multiprofessional workforce and supported by robust clinical governance arrangements and escalation pathways, from point of care to executive leadership.
2. Risk is systematically assessed, communicated and escalated within the organisation as well as through national monitoring and governance systems, with appropriate measures taken to proactively mitigate and reduce the potential for harm.
3. Systematic monitoring and surveillance of incidence and prevalence data is used to inform controls and improvement actions, as well as improvement targets to enable delivery in line with agreed national standards.
4. Robust systems are established to document and verify the effective decontamination of equipment and medical devices, ensuring they are safe for reuse. This includes providing comprehensive staff education to reinforce awareness of their responsibilities and the potential consequences of inadequate decontamination.
5. Systematic monitoring of cleanliness of the clinical and non-clinical environment within new and aging estates, demonstrating compliance with the National Standards of Healthcare Cleanliness (due for publication early in 2026). Systems are in place to monitor water safety, standard and transmission-based IPC practices, laundering services, decontamination practices and environmental ventilation. Public access and traffic within healthcare settings is considered, particularly in hospitals, where IPC risks may be heightened. Drawing on learning from the pandemic, this includes optimising ward visiting practices and waiting area management.

Timely

6. Effective systems and processes, including automation, are established to facilitate multi-professional communication and escalation across the healthcare system, enabling timely responses to periods of increased incidence, outbreaks and routine infection surveillance data. This ensures that interventions are promptly implemented, and their impact is continuously monitored and evaluated.
7. Timely, robust and evidence-based assessment of compliance is undertaken for all aspects of infection control practice and interventions in line with agreed protocols, overseen by skilled and experienced professionals to enable effective decision-making and clinical prioritisation.
8. Real-time learning is actively shared across organisations and the wider health system to mitigate risks and prevent harm. This may be achieved through structured mechanisms such as incident reporting systems, learning bulletins, shared dashboards and cross-sector learning events, enabling timely dissemination of lessons learned and promoting continuous improvement across all care settings.
9. Timely and effective risk assessment and triage of patients with, or at risk of, infection is essential to ensure appropriate isolation, supporting the principle of right place, right time patient pathway and safeguarding others. The timely collection, reporting and escalation of clinical sample results facilitates accurate diagnosis and ensures appropriate treatment. In addition, prompt cleaning and disinfection is carried out to support IPC practice and policy.

Effective

10. Standardised reporting and multiprofessional investigation of adverse events and incidents, including outbreaks, are conducted consistently. Effective local and national processes are established to share learning, implement necessary changes, and mitigate the risk of future harm. Openness and transparency are demonstrated in line with the duty of candour, and people, their families and carers are involved throughout the investigation process. 
11. Robust population health strategies are in place and communicated effectively to promote health and well-being with a focus on infection prevention, supported by processes for providing guidance, advice and support for well-being and self-care. 
12. IPC policies and standards are evidence-based and aligned with national guidance (National Infection Prevention and Control Manual (NIPCM)). They are supported by comprehensive education, training, and implementation plans, which are monitored for effectiveness. Locally tailored programmes monitor adherence to best practices through audit and the use of care bundles, which contribute to national reporting and continuous improvement.
13. New healthcare buildings and improvements to existing facilities are designed with appropriate consultation. The design facilitates effective IPC practices by incorporating high-quality finishes and fittings that support safe operational systems. These include cleaning, decontamination, ventilation and water safety to ensure that maintenance and monitoring take place. Designed-in IPC means that designers, architects, engineers, facilities managers and planners work in collaborative partnership with IPC teams, health and social care staff and service users to deliver facilities in which IPC needs have been anticipated, planned for and met. This input continues up to, into and beyond the final building stage and meets the regulatory requirements set out in the relevant Welsh Health Technical Memoranda (WHTMs) and Health Technical Memoranda (HTM).
14. Antimicrobial stewardship (AMS) is clearly established, promoting the responsible and effective use of antimicrobials to reduce the risk of antimicrobial resistance, and the risk of opportunistic infections such as Clostridioides difficile infection (CDI). Advancements in electronic Prescribing and Medication Administration (ePMA) support prescriber decision-making in accordance with local prescribing guidelines.
15. AMS is supported by evidence-based guidance, behaviour change strategies and tailored education and learning. The development of an All-Wales CDI Learning Collaborative will provide opportunities for teams, services and organisations to share current good practice, learn and apply behavioural science principles, test quality improvement approaches, and optimise the QMS approach to managing HCAIs. Opportunities to integrate and use synergies between AMS and IPC approaches should be embraced where these will improve clinical outcomes (for example, when promoting the route switch of antimicrobials from intravenous to oral).
16. Local and national audit processes are embedded to identify areas of concern or variation in IPC practices. These audits are responsive and used to drive learning, inform improvement and ensure that care delivery aligns with best practice.
17. Effective IPC and AMS are embedded into all service delivery to improve outcomes that matter to people, their families, and carers. These include enhanced patient safety, reduced complications and readmissions and a positive experience for people who use NHS Wales services. These practices also minimise unwarranted variation in care and ensure that healthcare resources are used efficiently and sustainably, in line with the Value in Health ethos.

Efficient

18. Available resources are used efficiently and sustainably with a view to minimising environmental impact and waste, moving towards net zero whilst maintaining a clear focus on delivering person-centred care to maximise outcomes and experiences.
19. Value-based principles are applied to diagnostics to avoid unnecessary interventions, such as unwarranted or unnecessary repeat clinical sampling.
20. Organisations have a defined approach to optimising antimicrobial prescribing, in the form of a co-ordinated AMS programme. This includes adherence to local and national antimicrobial stewardship policies and infection management guidelines which draw on national evidence-based guidance, such as National Institute for Health and Care Excellence (NICE) guidance which also takes account of local antimicrobial resistance patterns. This is supported by national and local surveillance, data collection and monitoring of best practice including regular audit to provide assurance that key policies and practices are implemented, adhered to and periodically updated as required.

Equitable

21. Organisations recognise that achieving equitable care requires a focus on equity of outcomes. IPC and AMS interventions must be tailored to reflect the diverse needs, risks, and circumstances of individuals and communities. This ensures that care is accessible and effective in delivering fair, person-centred, and meaningful health outcomes.
22. Care and treatment are prioritised based on clinical need and delivered equitably, with a clear focus on identifying and addressing additional care requirements while minimising unnecessary variation and intervention. Equity of outcome is supported through personalised approaches that consider individual risk factors and vulnerabilities.
23. Equitable access to consistent standards of infection prevention, AMS, decontamination expertise, advice, support, facilities, testing and treatment is ensured across all geographic areas, including care provided outside a patient’s health board of residence. 
24. Protected characteristics, social and cultural backgrounds and specific care needs are recognised as essential factors in delivering accessible, equitable and person-centred IPC advice and practices. This includes adaptations for Personal Protective Equipment (for example, for sensory impairment) and cultural considerations (in line with the Workwear and Professional Appearance Policy, which is due for publication in Spring 2026.) 
25. Evidence is considered on inequalities in the social and wider determinants of health that increase vulnerability to infection, particularly in the context of pandemics or endemic disease. Populations in areas of deprivation, who may experience higher infection risk, poorer outcomes, and greater co-morbidity, are proactively supported through population health management, targeted education, and improved access to healthcare.  Equity of outcomes is actively monitored to identify disparities and inform targeted interventions to improve infection-related outcomes across communities.  
26. Patients colonised or infected with clinically significant antimicrobial-resistant organisms receive consistent, appropriate and timely care. Their infection status does not hinder timely surgery or reduce access to basic facilities (for example, showers and toilets), nor compromise their social well-being, especially when isolated in single rooms.
27. Health boards and trusts routinely analyse antimicrobial prescribing patterns in relation to demographic factors to identify key drivers and inform targeted AMS interventions. Strengthening data capture and shared learning, through collaboration with local public health teams, is essential to support this approach and enhance system-wide learning.
28. New builds, refurbishments and redesigns must increase the availability of single rooms with adequate, accessible sanitary fittings (for example, Disability Discrimination Act compliant showers and toilets), ensuring equitable care for all patients, including those with mobility needs.

Person centred

29. People, their families and carers have timely access to clear, up-to-date information about their care, IPC procedures and what is expected of them. Information is provided in accessible formats tailored to meet diverse needs and includes guidance on how they can stay well, prevent infection and actively contribute to their recovery.
30. Co-produced treatment plans should be developed through informed and shared decision-making, ensuring that people with HCAIs are supported to make decisions and understand the risks and benefits of treatment. Additional support is provided to those with communication, language or cognitive barriers to ensure equitable understanding and involvement.
31. IPC is fully integrated within each patient’s clinical pathway and is subject to ongoing review to ensure a truly individualised approach. By prioritising holistic, person-centred care, interventions are tailored to address the unique needs of every individual, promoting their well-being in a comprehensive and responsive way.
32. People’s experience feedback is collected, acted upon in a timely manner and triangulated with other quality metrics, including feedback from external bodies and learning from concerns, patient stories and compliments. These inform local improvement plans and support a partnership between people and the workforce when considering service design and delivery.

Leadership

33. Compassionate, inclusive and bold leadership is demonstrated at all levels, enabling transformative change in a coordinated way, from point of care to executive leadership. Clear lines of sight and communication are established to ensure that frontline staff are empowered to design and implement necessary changes in clinical care, and that critical issues can be escalated effectively.
34. Oversight at Board level is supported by a named Executive Board member responsible for IPC and a designated Independent Member. A Senior Reporting Officer (SRO) or Director of Infection Prevention and Control (DIPC) is in place at Executive level, with governance structures that enable direct reporting to the health board or trust executive team. This role provides oversight and assurance on IPC, including cleanliness, the built environment and AMS to the health board or trust.  
35. Robust succession planning is established to support current and future IPC leaders, ensuring equitable access to development opportunities. This includes opportunities for staff to develop their digital literacy and genomics knowledge.
36. IPC is a consistent agenda item at Board and sub-committees, ensuring integration, visibility, and influence across the organisation’s Quality and Safety agenda. This enables regular appraisal of organisational risks and opportunities related to IPC. Senior IPC leadership is engaged in these forums to provide expert input and ensure that IPC priorities are embedded in strategic decision-making.

Workforce

37. Skilled and adequately resourced multi-professional IPC and AMS teams are established and align with national guidance, supported through national workforce planning activities. These teams are actively engaged in evidence-based programmes that reflect the national HCAI delivery plan, support patient safety and address local risk priorities. To enable this, organisations ensure access to enhanced digital and data infrastructure to support the capture, analysis and interpretation of relevant data. They also use data insights to inform continuous improvement, guide interventions and evaluate impact across care settings.
38. The workforce participates in multi-professional education and has access to both essential and advanced continuing professional development opportunities, such as the All-Wales Infection Prevention Training and the Learning and Development Framework. This supports enhanced knowledge and expertise, promotes workforce retention, fosters career progression and builds a sustainable talent pipeline for the future.
39. There is compliance with agreed levels of mandatory IPC and Aseptic Non-Touch Technique (ANTT) training, and staff are given protected time to be released to undertake training. 
40. NHS organisations foster a culture that prioritises staff well-being, discouraging working while unwell and supporting safe, healthy working environments. Policies enable staff to take appropriate leave and access support, recognising that staff health is essential to effective IPC.

Culture

41. A positive and inclusive organisational culture is evidenced as fundamental to the successful delivery of IPC and AMS. Safety, accountability and continuous learning is embedded into everyday practice, supported by an understanding of human factors that influence behaviour and decision-making in safety critical environments. This fosters an environment where all staff and service users, regardless of role or setting and operational pressures, feel empowered and supported to prioritise IPC and AMS, and challenge poor practice without fear.
42. IPC is not seen as a standalone function but as an essential element of high-quality, person-centred care. By nurturing leadership at every level, promoting open communication and valuing the contribution of all team members, organisations create the conditions for sustained improvement and resilience in the face of emerging infection threats.
43. IPC services and leadership promote a culture which embodies compassion, empathy, kindness and allyship, with these values and behaviours actively embraced and demonstrated by all members of the workforce, people, their families and carers.
44. Robust IPC systems and processes prioritise health, well-being and safety of staff at all levels of the organisation. Psychological safety is embedded and timely support is available to understand and meet the needs of the workforce, people, their families and carers.
45. A just, learning and improvement culture around IPC practice, and escalation of risk, is fully embedded based on service and organisational values and behaviours, and staff at all levels, people, their families and carers are supported and actively encouraged to raise any concerns in line with the speaking up safely framework.

Information

46. An intelligent and appropriate suite of nationally agreed IPC process, experience and outcome measures is systematically captured, monitored and routinely scrutinised by clinical, managerial and executive teams, with appropriate escalation and actions taken aligned to local and national assurance and improvement mechanisms.
47. Organisations have a clear understanding of the IPC, HCAI and AMS data they need to collate, regularly review and act upon.
48. Integrated data related to HCAIs, community infection prevalence and transmission trends, AMR data and digital clinical systems are adopted to inform a single national dataset. This enables the delivery of safe, high-quality and consistent services, including commissioned services, where data is available to support shared decision-making, inform service delivery, drive improvements and contribute to safe care by reducing nosocomial transmission and antimicrobial resistance. 
49. Wherever possible, with a degree of scrutiny and appropriate governance, surveillance and reporting data is automated, and artificial intelligence supports with content and thematic analysis to enable real-time response.
50. Organisations have an Executive Board level statement outlining collective responsibility for minimising the risks of infection and antimicrobial resistance and the controls in place to prevent these risks. This also includes a governance and accountability framework with reporting through the organisation’s IPC Committee, providing assurance in a timely manner on all aspects of IPC.

Learning, improvement and research

51. People, their families, carers and staff are encouraged and supported to participate in local, national and partnership initiatives related to IPC, AMS, HCAI surveillance and research, to advance knowledge and improve care, experiences and outcomes for future IPC practice and patient care. 
52. The workforce is actively engaged in delivering evidence-based infection control quality improvement initiatives at both local and national level. These initiatives are informed by feedback from people, their families and carers as well as insights from national bodies, data and audit programmes. A consistent approach to evaluation and shared learning ensures that improvements are meaningful, measurable and sustainable.

Whole systems approach

53. Collaborative working is embedded across professions, services, health boards, trusts, educationalists and wider agencies involved in providing advice, care and support across the system.  
54. In working towards achieving a net zero health service, the two agendas of IPC and sustainability work collaboratively. To provide collaboration and alignment, IPC is included in sustainability planning to ensure plans to reuse, reprocess and recycle do not compromise staff and patient safety.

Health boards, trusts and partners across primary and social care are expected to adopt this quality statement as a local framework for delivering high-quality, evidence-based IPC. It should be used to inform practice, support assurance and drive continuous improvement in preventing HCAIs.

Each organisation should identify an Executive Sponsor and an Independent Member with clear accountability for the delivery and oversight of this agenda.

The following actions should begin during 2026:

• Local adoption and alignment of the quality statement with existing governance, assurance and improvement structures.
• Gap analysis against the quality statement to inform local priorities and improvement plans.
• Strengthening leadership and accountability by embedding IPC responsibilities at all levels, from operational teams to Board governance.
• Embedding multi-professional collaboration and learning approaches to support system-wide improvement.
• Ensuring equity of access to IPC education, training, resources, and specialist advice across all care settings.
• Ensuring robust and competent specialist IPC and AMS services to support and ensure equity across all care settings (in line with the All Wales Education, Learning and Development Framework for Specialist Infection Prevention and Control Workforce)  
• Monitoring progress through agreed metrics and using insights from data, audits, service user feedback and national programmes to shape ongoing development using existing and new mechanisms for feedback, learning and improvement. This work will be in alignment with nationally agreed metrics developed through the Metrics and Surveillance Working Group, which sits under the HCAI Delivery Group.

AMS – Antimicrobial Stewardship
ANTT - Aseptic Non-Touch Technique
CNO – Chief Nursing Officer
CDI – Clostridioides difficile infection
DIPC - Director of Infection Prevention and Control
ePMA - electronic Prescribing and Medication Administration
HARP - Healthcare Associated Infection, Antimicrobial Resistance & Prescribing Programme
HCAI – Healthcare Associate Infection
IPC – Infection Prevention and Control
NIPCM – National Infection Prevention and Control Manual
SRO - Senior Reporting Officer