Background: Worldwide, there is an urgent need for reducing dissemination of infections associated with healthcare. This includes the prevention of infections in general practice, where the prevalence of MRSA and other multiresistant bacteria is increasing.
Objectives:The Dutch College of General Practitioners aimed to update the 2004 guideline on infection prevention in general practice and bring it in line with other (hospital) guidelines on this subject in 2015.
Methods: We composed a multidisciplinary guideline development group consisting of general practitioners, microbiologists and an expert on infection prevention in the hospital. We carried out literature searches on the most important questions. We made evidence-based recommendations or, in case there was no evidence, recommendations based on consensus within the guideline group. However, general practitioners and microbiologists in clinical practice had major critical as well as contradictary comments on our concept, which resulted in a controversy. In order to achieve consensus among all stakeholders, we organised an invitational conference, including the Dutch Health Care Inspectorate.
Results: At the invitational conference, barriers for general practitioners were discussed, such as the feasibility of the recommendations in general practice, the lack of evidence for most recommendations, little sense of urgency for following the guideline and the fear of being judged by the Health Care Inspectorate. The invitational conference led to consensus on a set of minimum requirements for infection prevention in general practice, which can be used as standard for monitoring by the Health Care Inspectorate.
Conclusions: Developing a guideline on infection prevention for general practice is a challenge due to lack of evidence and differing opinions. Recommendations for hospital care need to be adapted to ensure acceptability and feasibility of the guideline in primary care. A set of minimum requirements can help to set a standard for quality improvement.