Guidance

Fundamentals of care which help prevent infections in adult social care settings

Published 28 October 2026

This section explains the fundamentals of care that support people’s health, wellbeing, comfort and dignity. Good everyday care, including nutrition and hydration, personal cleanliness and comfort, mouth care, and encouraging movement, can help reduce the risk of infection and support people to stay safe and well.

Key summary

• good basic care helps keep people safe and reduces infections (for example urinary tract infections (UTIs), chest infections)
• eating well helps the body fight infection. Poor nutrition increases risk
• drinking enough helps prevent dehydration and UTIs
• good hygiene including continence care stops infections spreading
• healthy skin protects against infection
• oral care should be a priority care activity to prevent infections
• staying active helps lungs, circulation, and skin and reduces infection risk

Call for action

• spot problems early, follow escalation steps, and get help quickly
• do the basics every day: support eating, drinking, hygiene, and movement, and record in care plans
• monitor high‑risk people (fluids, nutrition, skin)
• only test for UTIs if there are symptoms; do not use dipsticks over 65
• ensure staff can provide good hygiene/oral care and recognise infection signs
• provide person‑centred care: respect choice, dignity, and capacity
• focus on prevention: nutrition, hydration, movement, and oral health

The fundamentals of care are core practices to ensure people get safe, compassionate, dignified, and person-centred care.

Key areas include:

• nutrition (food) and hydration (drink)
• personal cleanliness and comfort
• mouth care (oral hygiene)
• encouraging movement

Supporting these key areas helps prevent infections such as urinary tract infections (UTIs) and chest infections. 

ASC providers should ensure that adequate time is given for care and support workers to focus on these fundamentals of care, to help prevent infections.

ASC settings may want to include the fundamentals of care as part of their full assessment of care needs on admission or beginning a person’s care and after any major changes on the person’s status.

If there are any concerns about the fundamentals of care, care and support workers should follow local escalation pathways and seek clinical support as appropriate. This also includes reviewing care plans when there are any changes such as deterioration or end of life pathways started.

Safeguarding statement

In keeping with the Mental Capacity Act 2005, care and support workers must presume capacity unless assessed otherwise, provide tailored support to enable understanding, and document any capacity assessments clearly. Where a person lacks capacity, decisions or protective measures must be made in their best interests and be proportionate, necessary, and least restrictive, with involvement from relevant professionals and those close to the person wherever appropriate.

Always ensure any information sharing about a person who is infectious is done so in a compassionate but proportionate way.

Hydration (drinks or fluid intake)

Promote hydration as a positive and inclusive part of daily care. Offer regular opportunities for people accessing care and support to have a drink. Provide personalised drink choices based on individual preferences and routines. Use practical approaches such as visual prompts, hydration stations where appropriate, and social activities involving drinks.

In domiciliary care, support people to keep drinks within easy reach. Encourage regular drinking throughout the day. Involve families and carers where appropriate. Make hydration an enjoyable part of daily care, rather than a task.

Ways to promote hydration

Drinking enough fluids is important for overall health and helps prevent infections such as urinary tract infections (UTIs) and can also reduce complications of infections.

Encourage people accessing care and support to drink regularly because good hydration helps keep their mouth and throat moist and supports urinary flow, which may help reduce the risk of infections. Drinking regularly also prevents constipation, reduces delirium (sudden confusion) and the risk of falls and improves wound healing.

Fluid requirements are different depending on sex, age, health conditions, medications, activity levels, and clinical needs. Adult fluid intake ranges from 6 to 8 cups or glasses of drink per day. This is a guide, therefore and some people may need more fluids than this to stay hydrated.

Offer drinks and assist with drinking actively throughout the day, not just at mealtimes, especially during hot weather conditions.

While respecting preferences and choice, follow individual care plans, Speech and Language Therapists and/or clinical advice where applicable.

Promote hydration through foods rich in fluid content such as jelly, soup, smoothies or ice lollies.

Make drinks easy to reach and suitable to the tastes and needs of each person (hot, cold, juice, squash, thickened fluids). Provide drinks in a cup, beaker or other container that the person can use safely and comfortably. Any support needs or preferences should be assessed, recorded in the care plan and reviewed regularly.

Care and support workers should monitor for signs of dehydration, which is when there is not enough fluid in the body. Early signs of dehydration are reduced fluid intake, tiredness, headache, dizziness or passing less urine than usual. Later signs of dehydration include confusion, dry mouth, and dark urine. If a person has these signs, escalate to the care manager who will contact a health professional for a prompt assessment.

Be sensitive and provide practical support if someone limits fluids or drinks because they fear incontinence (passing urine accidentally). For example, reassure people that staying hydrated will not make their incontinence worse, review their continence care plan, and ensure timely access to toileting facilities, and if required continence aids, ensuring dignity and respect.

Care and support workers should use fluid intake charts for people at risk of dehydration (such as those with a raised temperature, who are frail, have dementia, have swallowing difficulties, or rely on others for drinks) to help ensure they drink enough fluids each day.

In domiciliary care, care and support workers will usually support with encouraging drink intake, contribute to monitoring, observing and escalating any hydration concerns using their usual escalation process. 

Hydration should be considered in staff induction, preceptorship (during training in a new role), and ongoing mandatory training.

More information to support hydration is available:

• Supporting vulnerable people before and during hot weather: social care managers - GOV.UK
• Regulation 14 of the Health and Social Care Act 2008: Meeting nutritional and hydration needs.

Nutrition (food)

Good nutrition (eating well) helps prevent infections by supporting the immune system and keeping the body working properly. When the body doesn’t get the right amount of nutrients (too little or too much) it is called malnutrition, which can increase vulnerability to infectious diseases.

Good nutrition means eating a healthy, balanced diet to support the brain, muscles, skin, and immune system.

Care and support workers should support and encourage people to eat a diet rich in essential nutrients.

Importance of good nutrition

A well-balanced diet rich in essential nutrients is important for the reasons below:

Energy and vitality

Nutrient-rich foods like fruits, vegetables, whole grains, and lean meats and other proteins give sustained energy for daily activities.

Immune function

A balanced diet strengthens the immune system. Vitamins C, D and Zinc are especially important.  

Mental well-being

Healthy diets can improve mood, while diets high in processed foods and sugar may increase depression and anxiety.

Long-term health

Eating a diet that is low in saturated fat, sugar, salt, and high in fibre and vitamins reduces risks of chronic diseases and infections.

More information on nutrition can be found here:

• NHS Information and guidance about eating a healthy, balanced diet.
• Eatwell Guide poster that shows proportions of food groups for a healthy diet
• CQC Regulation 14 for service providers and managers on meeting nutritional and hydration needs

Personal cleanliness and comfort and continence care

Good personal cleanliness (including hand hygiene) helps reduce the spread of infections like colds, flu, skin infections, and diarrhoea.

Good personal hygiene helps reduce the spread of infections and prevent UTIs when people:

• are encouraged and supported with daily washing or showering, especially if they have incontinence, or if mental health difficulties affect their ability to maintain personal hygiene independently
• use incontinence pads that soak up the right amount, so people feel comfortable and confident to drink more
• change or are supported to change pads when necessary (for example in line with the indicator strip) and immediately if soiled with faeces
• wipe or are supported to wipe from front to back after using the toilet
• keep the genital area clean and dry
• follow appropriate hand hygiene before and after care
• avoid scented soaps or gels that may irritate the genital area and use a pH balanced product (products that are pH balanced are made to be close to the body’s natural levels) - this can help prevent dryness, irritation, and discomfort and helps protect the body’s natural balance
• promptly escalate where there are signs of discomfort, deterioration or suspected infection

These steps help keep the genital area clean and stop bacteria from moving from the bowel to the bladder, which can cause infections.

Encourage and support people accessing care and support to wear clean clothing.

Skin care

Skin is the first barrier to prevent infections entering the body.

Good skin care is essential for everyone. Ensuring the skin is clean, hydrated and properly moisturised helps prevent infection.

Skin assessments are important and should be carried out routinely as part of care assessments.

To support prompt identification and treatment of skin breakdown, care and support workers should report any changes through local escalation processes if skin is:

• dry
• itchy
• flaky
• discoloured
• shows signs of pressure damage
• shows any other changes, or a worsening skin condition

People in ASC settings requiring shaving that are not able to do so by themselves should be supported to do so safely. Razors should be for individual use only and should never be shared. After use, dispose of razors in a designated sharps container to prevent the risk of bloodborne virus transmission.

In domiciliary care, store the person’s razor safely and follow ASC provider process for disposal. Use sharps containers only where these are already in place.

Any cuts on the skin should be cleaned and covered as needed.

Support people to maintain good foot hygiene by keeping feet clean, dry, and regularly checked for signs of damage, infection, or skin changes, and seek referral to a podiatrist or other appropriate healthcare professional if concerns are identified.

More information on skin care and assessments:

• Quality statement 4: Skin assessment - Pressure ulcers - Quality standards NICE
• SSKIN Assessment tool

Mouth care (oral hygiene)

Mouth care is important and should always be part of personal care. Good nutrition and hydration helps improve oral health.

Poor mouth care can make a person more likely to develop infections like gum and mouth infections and aspiration pneumonia. Aspiration pneumonia is a chest infection that can happen when food, drink, saliva, or bacteria from the mouth accidentally enter the lungs instead of going into the stomach. Those at risk are often older people, people with dementia, with swallowing difficulties or requiring support with eating, drinking or oral care. Poor mouth care is also linked to heart disease, diabetes, dementia, respiratory infections, and bloodstream infections.

Poor mouth care can cause pain, difficulty eating, malnutrition (not enough nutrients), and lower quality of life.

Care and support workers should encourage and support people to clean their teeth and mouth at least twice a day. Care and support workers should report any changes in oral health using their usual escalation processes, so that the oral care assessment and care plan can be updated,

Older adults or those with dementia or disabilities may need extra support to maintain their own good mouth care.

Carrying out good mouth care

Care and support workers should be trained to support mouth care, and ASC providers should have an oral health policy in place. The policy should describe the oral health assessments and routine checks required for different care settings and the needs of people accessing care and support.

Carry out an oral health assessment when a person first joins an ASC service.

If there are any rising concerns regarding oral health these should be escalated using routine processes.

Care plans should include twice daily mouth care and more frequently if needed. People who are independent with their mouth care may also need prompting or reminding during morning and evening routines.

Record whether a person accessing care and support wears dentures. In communal or residential settings, if they do wear dentures and these are unmarked, then with the person’s permission arrange for dentures to be marked to reduce the risk of denture loss. 

Ensure people have access to oral hygiene products needed to maintain good oral health. In domiciliary care this may mean speaking to family members to help provide toothbrushes and toothpaste, and other oral hygiene products that the person needs.

Support people to access routine dental care wherever possible, taking account of their communication, cognitive, sensory, and mobility needs. This may include arranging accessible transport, providing familiar support, using clear and reassuring communication, and working with carers, families, or specialist dental services to help reduce anxiety and ensure appointments can be attended successfully.

Signs of a healthy mouth

Signs of a healthy mouth include:

• healthy-looking gums and oral tissues, with natural colour and moist lips
• clean teeth
• gums that are firm, healthy and allowing for ethnic pigmentation (gum varies from pale pink to darker coral or even brownish/black depending on skin tone)
• naturally pigmented mouth tissue (as above) that look healthy and are free from sores, swelling or unusual changes in colour
• no ulcers, bleeding or swelling
• pink tongue
• presence of saliva

Cleaning natural teeth (including implants)

To clean natural teeth:

• use toothpaste with 1350 to 1500 ppm fluoride or care products as prescribed by dental clinicians such as high fluoride toothpaste
• brush twice daily, including last thing at night
• brush all tooth surfaces and gum line to remove plaque and food
• spit, don’t rinse, to keep fluoride effective
• encourage to clean between teeth with floss or interdental brushes daily
• fluoridated mouthwash can be used in addition to brushing
• implants should be cleaned similarly to natural teeth as above, but with additional implant‑specific techniques as advised by a specialist dental clinician

Regular flossing may also reduce gum disease, tooth decay and bad breath by removing plaque that forms along the gum line. Check with the person to see if they would like to have the option to floss.

Cleaning dentures

To clean dentures:

• remove dentures overnight to rest the mouth and reduce risk of infection
• rinse dentures after meals and clean once a day
• brush all surfaces, especially fitting surfaces, using denture paste or unperfumed liquid soap (not regular toothpaste)
• soak in denture cleaner for 20 to 30 minutes following manufacturer’s instructions
• rinse and store in a dry, labelled denture pot
• if using dental adhesives, clean daily and remove any residue in the mouth

More information on mouth care is available here: 

• Oral health for adults in care homes NICE
• Smiling matters: oral health care in care homes - Care Quality Commission
• Dental and mouth care Alzheimer’s Society
• Oral health Skills for Care

Encouraging movement

Encouraging safe movement is an important part of care that helps prevent infections.

Regular movement supports lung function and circulation, reducing the risk of chest infections. It also helps prevent pressure ulcers, which can lead to skin infections, and supports blood flow to the kidney and increase urine production.

Encourage people accessing care and support to take part in activities they enjoy, both indoors and outdoors, where this is safe and appropriate. Regular movement and active leisure activities can support physical health, wellbeing and independence.

To help keep people moving:

• support people to move regularly, such as walking, gentle exercises, or assisted repositioning
• adapt activities to each person’s ability and care plan
• encourage movement throughout the day, not just during scheduled activities

See the NHS Physical activity guidelines for more information

Physical activity guidelines for older adults - NHS

Physical activity guidelines for adults aged 19 to 64 - NHS