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Core Infection Prevention and Control Practices for
Safe Healthcare Delivery in All Settings –
Recommendations of the Healthcare Infection
Control Practices Advisory Committee
Preface
The Healthcare Infection Control Practices Advisory Committee (HICPAC) is a federal advisory
committee chartered in 1991 to provide advice and guidance to the Centers for Disease Control and
Prevention (CDC) and the Secretary of the Department of Health and Human Services (HHS) regarding
the practice of infection control and strategies for surveillance, prevention, and control of healthcare-
associated infections, antimicrobial resistance and related events in United States healthcare settings.
CDC has been developing recommendations for healthcare infection control to prevent infections in
patients and healthcare personnel since the 1970’s. These recommendations continue to evolve over
time as evidence bases are built and serve as a foundation for healthcare safety across settings, a
basis for quality improvement efforts, and part of the process that identifies important research gaps.
Guideline development methods have since moved beyond expert opinion alone and incorporated
systematic approaches to evidence analysis. A number of core practices are recommended by CDC
and considered standards of care and/or accepted practices (e.g., aseptic technique, hand hygiene
before patient contact) to prevent infection in healthcare settings. These widely agreed upon
practices are elements of care that are not expected to change based on additional research, either
because of an overwhelming preponderance of evidence (e.g., hand hygiene requirements), or in
some cases due to ethical concerns (e.g., randomizing patients to procedures performed by trained
versus untrained personnel). Therefore, these accepted practices are categorized as strong
recommendations, even when high-quality randomized controlled trials are not available to support
them. In an effort to streamline and systematize the process for updating existing guidelines without
recreating the analytic process for each of these accepted/core practices, in March 2013, CDC
charged HICPAC to review existing CDC guidelines and identify all recommendations that warrant
inclusion as core practices. A HICPAC workgroup was formed that was led by HICPAC members and
contained representatives from the following stakeholder organizations: America’s Essential
Hospitals, the Association for Professionals in Infection Control and Epidemiology (APIC), the Council
of State and Territorial Epidemiologists (CSTE), the Public Health Agency of Canada (PHAC), the
Society for Healthcare Epidemiology of America (SHEA), and the Society of Hospital Medicine (SHM).
The Workgroup provided updates and obtained HICPAC input at the June 2013, November 2013, April
2014, and July 2014 public meetings. HICPAC voted to finalize the recommendations at the July 2014

Core Infection Prevention and Control Practices for Safe Healthcare Delivery in All Settings
Recommendations of the HICPAC
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meeting. Additional information about HICPAC is available at the HICPAC website
(www.cdc.gov/hicpac).
Introduction
Adherence to infection prevention and control practices is essential to providing safe and high-
quality patient care across all settings where healthcare is delivered. Substantial attention has been
focused in recent years on improving infection prevention practices within acute care hospitals to
optimize patient safety; many of these practices also need to be applied across multiple aspects of
patient care. In addition, changes in healthcare during the past decade, driven at least in part by
efforts to contain costs, have resulted in an increasing proportion and range of healthcare services
being delivered outside of the acute care setting.1,2 These ambulatory and community-based
healthcare encounters also can lead to infectious complications that can be prevented using those
same infection prevention and control practices.
This document concisely describes a core set of infection prevention and control practices that
are required in all healthcare settings, regardless of the type of healthcare provided. The practices
were selected from among existing CDC recommendations and are the subset that HICPAC and its
Core Practices Working Group determined were fundamental standards of care that are not expected
to change based on emerging evidence or to be regularly altered by changes in technology or
practices, and are applicable across the continuum of healthcare settings. This document also is
intended to improve consistency of language, reduce redundancy across guidelines, and provide a
convenient reference wherein these recommendations are maintained. A review of existing CDC
guidelines demonstrated many examples of similar recommendations in multiple guidelines with
variability in language. The recommendations outlined in this document are intended to serve as a
standard reference and reduce the need to repeatedly evaluate practices that are considered basic
and accepted as standards of medical care. Readers are urged to consult the full text of CDC
guidelines (see references) for additional background and rationale related to the core practice
recommendations captured here.
Scope
The core practices in this document should be implemented in all settings where healthcare is
delivered. These venues include both inpatient settings (e.g., acute, long-term care, rehabilitation,
behavioral health) and outpatient settings (e.g., physician and nurse practitioner offices, clinics,
urgent care, ambulatory surgical centers, imaging centers, dialysis centers, physical therapy and
rehabilitation centers, alternative medicine clinics). In addition, these practices apply to healthcare
delivered in settings other than traditional healthcare facilities, such as homes, pharmacies, and
health fairs.
Healthcare personnel (HCP) referred to in this document include all persons, paid and unpaid, in
the healthcare setting having direct patient contact and/or potential for exposure to patients and/or
to infectious materials (e.g., body substances, used medical supplies and equipment, soiled
environmental surfaces). This also includes persons not directly involved in patient care (e.g., clerical

Core Infection Prevention and Control Practices for Safe Healthcare Delivery in All Settings
Recommendations of the HICPAC
Last updated: March 15, 2017 Page 3 of 15
staff, environmental services, volunteers) who could be exposed to infectious material in a healthcare
setting.
Methods
CDC healthcare infection control guidelines3-19 were reviewed, and recommendations included in
more than one guideline were grouped into core infection prevention practice domains (e.g.,
education and training of HCP on infection prevention, injection and medication safety). Additional
CDC materials aimed at providing general infection prevention guidance outside of the acute care
setting20-22 were also reviewed. HICPAC formed a workgroup led by HICPAC members and including
representatives of professional organizations (see Contributors for full list). The workgroup reviewed
and discussed all of the practices, further refined the selection and description of the core practices,
and presented drafts to HICPAC at public meetings in June 2013, November 2013, April 2014, and July
2014 to inform HICPAC’s final recommendations. The recommendations (see Table) were approved
by the full Committee in July 2014.
Conclusions
Adherence to basic infection prevention and control practices are essential, not only in acute care
hospitals but also in settings with limited infection prevention infrastructure. The frequency of
infectious outbreaks stemming from errors in infection control across settings (e.g., reuse of syringes
between patients leading to transmission of viral hepatitis23-25) underscores the critical importance of
adherence to these core infection prevention practices wherever healthcare is provided.
Recommendations highlighted in this document represent minimum expectations, and healthcare
personnel and facilities will need to supplement them according to their settings, procedures
performed, and patient populations.
Readers should consult the full texts of CDC healthcare infection control guidelines for
background, rationale, and related infection prevention recommendations for more comprehensive
information. We encourage professional associations and societies and the research community to
develop tools to facilitate implementation and maintenance of these core infection prevention
practices across the continuum of healthcare.
Text References
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program, June 2016 [PDF - 4.1 MB] (http://www.medpac.gov/docs/default-source/data-
book/june-2016-data-book-health-care-spending-and-the-medicare-program.pdf?sfvrsn=0).
3. Bolyard EA. Tablan OC, Williams WW, Pearson ML, Shapiro CN, Deitchmann SD. Guideline for
Infection Control in Healthcare Personnel, 1998 (https://stacks.cdc.gov/view/cdc/7250). Hospital
Infection Control Practices Advisory Committee. Infect Control Hosp Epidemiol. 1998 Jun;
19(6):407-63.

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Recommendations of the HICPAC
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Control, 2007 Dec 35 (10 Suppl 2):S165-93.
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(https://wwwdev.cdc.gov/infectioncontrol/pdf/guidelines/isolation-guidelines.pdf). Am J Infect
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12. Division of Viral Disease, National Center for Immunization and Respiratory Diseases, Centers for
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Recommendations of the HICPAC
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(https://www.cdc.gov/mmwr/pdf/rr/rr6007.pdf). MMWR Recomm Rep. 2011 Nov 25:60(RR-7):1-45.
18. U.S. Public Health Service Working Group on Occupational Postexposure Prophylaxis, Kuhar DT,
Henderson DK, et. al., https://stacks.cdc.gov/view/cdc/20711. September, 2013.
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(https://www.cdc.gov/mmwr/preview/mmwrhtml/rr5005a1.htm). MMWR. April 27,
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oncology office practice in New Jersey, 2009. Am J Infect Control. 2011;39:663-670.
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virus transmission: United States, 1998–2008. Ann Intern Med 2009;150:33-39.