{"ref":"DC-HC-IC-01","title":"Infection Control and Universal Precautions","category":"Infection control","own":false,"summary":"Sets out the infection control practices every staff member follows in every client's home: hand hygiene, gloves and other protective equipment, respiratory hygiene, cleaning, laundry, waste and food safety; extra precautions when a client has an infection; when staff must not work; outbreaks; client education; and how practice is checked.","inShort":["Clean your hands when you arrive, before and after care, after removing gloves, and before you leave.","Wear gloves for body fluids, broken skin or soiled items, and change them between tasks.","Bag soiled items, clean spills at once, and never pick up a used needle.","Tell the nurse the same day about fever, cough, diarrhea or other signs of infection in a client.","If you are sick, call before your shift and do not go to the client's home."],"primaryCitation":"22-B DCMR §9908.2(k)","citations":["22-B DCMR §9908.2(k)","22-B DCMR §9918.4(i)","22-B DCMR §9909.6","22-B DCMR §9909.7","22-B DCMR §9909.8(b)","22-B DCMR §9914.2(q)","22-B DCMR §9916.2(j)","22-B DCMR §9999.1"],"federalCitations":["29 CFR §1910.1030"],"surveyorAsks":["Show me your written infection control policy (22-B DCMR §9908.2(k)).","How do your aides implement universal precautions in a client's home (§9918.4(i))?","What supplies do aides carry, and who pays for them?","What does an aide do if a client has diarrhea, a fever or a contagious illness?","How do you check that aides follow infection control practices?"],"version":"1.0","effectiveDate":"2026-10-01","reviewDate":"2027-10-01","approvedBy":"Pat Sample, Administrator","forms":[{"ref":"DC-HC-IC-01-A","title":"Infection Control Practice Observation"}],"sections":[{"heading":"Terms of Reference","body":["This section sets out the standing under which this policy is issued, who owns it, who is bound by it, and how it is kept current. It is not itself a procedure. The obligations begin at Section 1."],"table":{"caption":null,"headers":[["Item"],["Detail"]],"rows":[[["Issued by"],["The governing body of ",{"k":"field","name":"agency.name","text":"Sample Agency, LLC"}]],[["Document owner"],[{"k":"field","name":"people.supervisingNurse.name","text":"Robin Sample, RN"},", ",{"k":"field","name":"people.supervisingNurse.title","text":"Supervising Nurse"}]],[["Authority"],["Adopted under 22-B DCMR §9908.2(k), which requires written policies and procedures governing \"Infection control\", and §9918.4(i), under which personal care services include \"Implementation of universal precautions to ensure infection control\"."]],[["Applies to"],["The Director, the Client Service Coordinator, every registered nurse, every home health aide, and any other employee who enters a client's home."]],[["Status"],["Mandatory. Adherence is a condition of employment and of any contract for services. No provision may be waived, shortened, or varied by any employee."]],[["Not covered here"],["Employee health screening, tuberculosis screening and hepatitis B vaccination (Policy DC-HC-HR-04). The exposure control plan for blood and other potentially infectious materials, and what to do after an exposure (Policy DC-HC-IC-02). Continuity of services in a public health emergency (Policy DC-HC-EP-01)."]],[["Review"],["Reviewed by the document owner at least annually, as part of the governing body's annual review and evaluation of all policies and procedures required by 22-B DCMR §9906.2(c), and within 30 days of any amendment to a rule cited at Section 15 (the 30-day period is the Agency's own standard). Each review is recorded at Section 18 whether or not the text changes."]],[["Amendment"],["Any change requires the approval of the governing body (22-B DCMR §9908.1) and the issue of a new version number. Superseded versions are retained for at least six years, as the Agency's own standard."]],[["Distribution"],["Master copy held in the policy manual at the operating office at ",{"k":"field","name":"agency.address","text":"100 Example Street NW, Suite 100, Washington, DC 20001"},", where it is readily available to staff at all times (22-B DCMR §9908.3). Available to clients, prospective clients and client representatives on request (22-B DCMR §9908.4)."]],[["Questions"],["Direct to the document owner on ",{"k":"field","name":"agency.phone","text":"(202) 555-0100"}," or ",{"k":"field","name":"agency.email","text":"office@example.com"},"."]]]},"edited":false},{"heading":"1. Purpose","body":["Many clients are older or have chronic illnesses that make infections more dangerous, and aides move between homes. This policy protects clients, their households and staff from the spread of infection. It implements 22-B DCMR §9908.2(k), §9918.4(i) and §9909.8(b)."],"edited":false},{"heading":"2. Scope","body":["This policy applies in every client's home and wherever staff of ",{"k":"field","name":"agency.name","text":"Sample Agency, LLC"}," give care, at every visit and for every client, whether or not the client is known to have an infection."],"edited":false},{"heading":"3. Definitions","body":["For the purposes of this policy:"],"table":{"caption":null,"headers":[["Term"],["Meaning"]],"rows":[[["Universal precautions"],["\"Universal Precautions is an approach to infection control. According to the concept of Universal Precautions, all human blood and certain human body fluids are treated as if known to be infectious for HIV, HBV, and other bloodborne pathogens.\" (29 CFR §1910.1030(b))"]],[["Standard precautions"],["The basic infection prevention practices the federal Centers for Disease Control and Prevention (CDC) recommends for the care of every person: hand hygiene, protective equipment chosen for the expected contact, respiratory hygiene and cough etiquette, safe handling of equipment, cleaning, and safe handling of laundry and waste. Standard precautions include universal precautions."]],[["Transmission-based precautions"],["Extra steps, added to standard precautions, when a client has or may have an infection spread by contact, droplets or the air, as the registered nurse instructs."]],[["Hand hygiene"],["Washing hands with soap and water, or cleaning them with an alcohol-based hand sanitizer."]],[["Personal protective equipment (PPE)"],["Gloves, gowns or aprons, masks, eye protection and face shields worn to protect against contact with blood, body fluids or germs."]],[["Communicable disease"],["An infection that can be transmitted from one person to another. DC Health's response to comments on the final rule describes it as \"a transmittable infection by direct contact\" and says that following the CDC guidelines will help determine what is communicable."]],[["Agency's own standard"],["A requirement the Agency sets for itself that goes beyond, or fills a gap in, the rules. This manual labels each one so that it is never mistaken for a DC Health requirement."]]]},"edited":false},{"heading":"4. Policy Statement (22-B DCMR §9908.2(k))","body":["The Agency has and follows this written infection control policy (22-B DCMR §9908.2(k)). Aides implement universal precautions to ensure infection control (§9918.4(i)), and as the Agency's own standard every staff member follows CDC standard precautions at every visit. Every employee is screened for and free of communicable diseases at hire and is screened according to CDC guidelines (§9909.6, §9909.7; Policy DC-HC-HR-04). No employee may provide personal care services, and the Agency does not knowingly permit an employee to provide personal care services, if the employee has a communicable disease which poses a confirmed health risk to clients (§9909.8(b)). The Agency provides gloves and other protective equipment to staff at no cost (29 CFR §1910.1030(d)(3)(i); Policy DC-HC-IC-02)."],"edited":false},{"heading":"5. Hand Hygiene","body":["Hand hygiene is the most important way to stop the spread of infection. Staff clean their hands:"],"list":[["On arriving at the client's home and before leaving it."],["Before and after any physical contact with the client."],["Before preparing food and before helping the client eat."],["After toileting, incontinence care, emptying a drainage bag, or any contact with body fluids, even if gloves were worn."],["Immediately or as soon as feasible after removing gloves or other protective equipment (29 CFR §1910.1030(d)(2)(v))."],["After handling soiled laundry, trash, or the client's pets, and after using the bathroom, blowing your nose, coughing or sneezing."]],"ordered":false,"note":["How: CDC guidance is to wash with soap and water, scrubbing for at least 20 seconds, and, if soap and water are not readily available, to use a hand sanitizer with at least 60% alcohol. Use soap and water when hands are visibly dirty, after contact with blood or body fluids, and when the registered nurse says the client has an infection (such as some kinds of diarrhea) that hand sanitizer does not reliably kill. When hand sanitizer or towelettes are used because handwashing facilities are not available, hands are washed with soap and running water as soon as feasible (29 CFR §1910.1030(d)(2)(iv)). As the Agency's own standard, staff who give hands-on care keep nails short, do not wear artificial nails, and cover cuts on their hands with a waterproof dressing."],"edited":false},{"heading":"6. Gloves and Other Protective Equipment","body":["Staff choose protective equipment for the contact they expect. As the Agency's own standards, which include the federal rules cited:"],"list":[["Wear gloves when you may touch blood, body fluids, urine, stool, mucous membranes or broken skin, and when handling or touching soiled items or surfaces (29 CFR §1910.1030(d)(3)(ix))."],["Change gloves between tasks (for example, after incontinence care and before helping the client dress), and whenever they tear. Never wash or reuse disposable gloves (§1910.1030(d)(3)(ix)(A), (B))."],["Wear a disposable gown or apron when your clothes may become soiled, and a mask with eye protection or a face shield when splashes may reach your eyes, nose or mouth (§1910.1030(d)(3)(x), (xi))."],["Wear a mask when the registered nurse or current DC Health or CDC guidance says to, for example when the client or you have respiratory symptoms."],["Put on and take off equipment in the order you were taught, remove it before leaving the work area (§1910.1030(d)(3)(vii)), put disposable items in a closed bag in the client's trash, and clean your hands."],["Ask the office for more supplies before you run out. Gloves in your size, and non-latex gloves for anyone who needs them, are provided (§1910.1030(d)(3)(iii))."]],"ordered":false,"edited":false},{"heading":"7. Respiratory Hygiene, Cleaning, Laundry and Waste","body":["As the Agency's own standards, staff:"],"list":[["Cover coughs and sneezes with a tissue or the inside of the elbow, throw tissues away at once, and clean hands. Offer the client tissues and help the client do the same."],["Clean surfaces the client uses for care (bathroom, kitchen counters, bedside table, commode) during each visit as the service plan says, and clean spills of blood or body fluids at once: wear gloves, soak up the spill with disposable towels, clean the area, then disinfect it with a household disinfectant used as the label directs."],["Clean reusable equipment, such as a thermometer, blood pressure cuff, scale, walker or commode, after each use as the manufacturer says. Agency equipment carried between homes is cleaned and disinfected before and after each use."],["Handle soiled linen and clothing as little as possible, hold it away from your uniform, bag it where it was used, do not shake it, and wash it as the label directs (29 CFR §1910.1030(d)(4)(iv))."],["Put used gloves, pads and protective underwear in a closed plastic bag in the client's household trash. Items soaked with blood are handled under Policy DC-HC-IC-02."],["Never pick up needles or lancets the client has used. If you find one loose, leave it, keep others away from it, and tell the registered nurse, who helps the client arrange a sharps container (Policy DC-HC-IC-02)."],["Follow the food safety steps in Policy DC-HC-SVC-05, Section 5."]],"ordered":false,"edited":false},{"heading":"8. When a Client Has or May Have an Infection","body":["Aides report possible signs of infection to the registered nurse the same day, or at once if the client is very unwell (Policy DC-HC-SVC-04): fever or chills, a new cough, vomiting or diarrhea, burning or cloudy urine, a red, warm, swollen or draining area of skin, a rash, or new confusion. The registered nurse:"],"list":[["Asks the client, or the client representative with the client's consent, what the client's physician has said, and advises the client to contact the physician where needed."],["Tells the assigned aides, before their next visit, which transmission-based precautions to use (for example, gloves and gown for all contact, soap-and-water handwashing only, or a mask), and writes them into the service plan for as long as they are needed."],["Provides the supplies needed and checks that the aides know how to use them."],["Considers whether the same aide should avoid visiting other clients who are at high risk, and adjusts the schedule with the office (Policy DC-HC-SCH-01)."],["Records the infection and the precautions in the client record, and tells the Client Service Coordinator so it can be logged (Section 13)."]],"ordered":true,"edited":false},{"heading":"9. When Staff Must Not Work","body":["No employee may provide personal care services, and the Agency does not knowingly permit it, if the employee has a communicable disease which poses a confirmed health risk to clients (22-B DCMR §9909.8(b)). Policy DC-HC-HR-04, Section 7 sets out the Agency's own standards: an employee with a fever, vomiting or diarrhea, a new cough with fever, an uncovered draining wound, a rash that may be infectious, conjunctivitis or a diagnosed communicable disease calls the office or the on-call person before the shift and does not go to the client's home; the Client Service Coordinator arranges a replacement and decides when the employee may return. An employee exposed to blood or other potentially infectious materials follows Policy DC-HC-IC-02; an employee exposed to another communicable disease at work tells the Client Service Coordinator, who arranges screening as the CDC or DC Health advises."],"edited":false},{"heading":"10. Outbreaks and Public Health Emergencies","body":["If DC Health or the CDC announces an outbreak or public health emergency, or two or more clients or staff have the same infection, the Director and the Client Service Coordinator, with the disaster coordinator ",{"k":"field","name":"people.disasterCoordinator.name","text":"Avery Sample"},", review DC Health and CDC guidance, decide on any extra precautions, supplies, screening of staff and clients before visits, and changes to visits, and tell staff in writing. The Agency follows any instruction or reporting requirement DC Health issues. Continuity of services follows Policy DC-HC-EP-01. These steps are the Agency's own standards."],"edited":false},{"heading":"11. Teaching Clients and Families","body":["Clients have the right to be educated about and trained in matters related to the services to be provided (22-B DCMR §9916.2(j)). The registered nurse and aides show clients and family caregivers hand hygiene, safe handling of soiled items, and how to keep the client's area clean, and give simple written information where helpful. Documentation of training and education given to the client and the client's caregivers is kept in the client record (§9914.2(q))."],"edited":false},{"heading":"12. Responsibilities","body":["Accountability under this policy is allocated as follows."],"table":{"caption":["Who is accountable for what"],"headers":[["Role"],["Responsibility under this policy"]],"rows":[[[{"k":"field","name":"people.supervisingNurse.name","text":"Robin Sample, RN"},", ",{"k":"field","name":"people.supervisingNurse.title","text":"Supervising Nurse"}],["Owns this policy. Leads infection control for the Agency, sets precautions for clients with infections, keeps the infection log, and reviews it each quarter."]],[[{"k":"field","name":"people.administrator.name","text":"Pat Sample"},", ",{"k":"field","name":"people.administrator.title","text":"Administrator"}],["Provides supplies and protective equipment at no cost to staff, acts on outbreaks and DC Health instructions, and enforces the rule on working while ill."]],[["Registered nurses"],["Observe infection control practice at supervisory visits, act on reports of infection, and teach clients and families."]],[["Home health aides and all staff"],["Follow standard precautions at every visit, report signs of infection, and stay home when ill."]],[["Office staff"],["Keep supplies in stock, send them to staff promptly, and adjust schedules when the nurse asks."]]]},"edited":false},{"heading":"13. Records and Compliance Monitoring","body":["Forms DC-HC-IC-01-A are kept in the aide's personnel record (22-B DCMR §9909.2(l)), and infection-related notes, precautions and education are kept in the client record (§9914.2(q)) for at least five years after discharge (§9915.4).\n\nAs the Agency's own standards: a registered nurse completes Form DC-HC-IC-01-A at each direct observation visit (Policy DC-HC-SUP-01); the Client Service Coordinator keeps a log of client infections reported, staff illnesses that kept staff from work, and exposures, without unnecessary personal details, and reviews it each quarter for patterns; and supply levels are checked monthly. Results go into the annual evaluation (Policy DC-HC-QA-01)."],"edited":false},{"heading":"14. Staff Training","body":["Every employee who enters clients' homes is trained on this policy at orientation, before the first visit, and each year, including practice in hand hygiene and in putting on and taking off protective equipment (Policy DC-HC-HR-06). Bloodborne pathogens training is given under Policy DC-HC-IC-02. When DC Health or the CDC issues new guidance, the Client Service Coordinator briefs staff before they must follow it."],"edited":false},{"heading":"15. References","body":["This policy implements the following authorities."],"list":[["22-B DCMR §9908.2(k), written infection control policy"],["22-B DCMR §9909.6 to §9909.8, employee health screening and fitness to work"],["22-B DCMR §9914.2(q) and §9916.2(j), client education"],["22-B DCMR §9918.4(i), universal precautions"],["29 CFR §1910.1030 (Bloodborne Pathogens), paragraphs (b), (d)(2), (d)(3) and (d)(4)"],["CDC, standard precautions and hand hygiene guidance for health care settings (current version)"],["DC Health, response to comments on the final rule, 67 DCR 9476 (August 7, 2020)"]],"ordered":false,"edited":false},{"heading":"16. Related Policies and Forms","body":["The following documents are read together with this policy."],"table":{"caption":null,"headers":[["Reference"],["Title"]],"rows":[[["Form DC-HC-IC-01-A"],["Infection Control Practice Observation"]],[["Policy DC-HC-IC-02"],["Bloodborne Pathogens Exposure Control Plan"]],[["Policy DC-HC-HR-04"],["Employee Health Screening and Fitness for Duty"]],[["Policy DC-HC-SVC-04"],["Vital Signs, Observation, and Reporting Changes in Condition"]],[["Policy DC-HC-SVC-05"],["Homemaker, Companion, Meals, Shopping, and Accompaniment"]],[["Policy DC-HC-SUP-01"],["RN Supervision of Home Health Aides and 90-Day On-Site Visits"]],[["Policy DC-HC-EP-01"],["Emergency Preparedness and Continuity of Services"]]]},"edited":false},{"heading":"17. Approval","body":["This policy is adopted by the governing body of ",{"k":"field","name":"agency.name","text":"Sample Agency, LLC"},". The effective date, the person who approved it, and the date of approval are shown in the header block and recorded in the signature lines below."],"edited":false},{"heading":"18. Revision History","body":["Every version of this policy, the date it took effect, a summary of what changed, and who approved it is recorded below. Where a rule cited in Section 15 is amended, the amendment is recorded in this table and a new version of this policy is issued."],"edited":false}],"missing":[],"editedCount":0,"pack":"dc-hca","state":"Washington, DC","service":"Home care","guides":[{"path":"/guides/infection-control-policy/","h1":"What should a home care infection control policy include?"},{"path":"/guides/home-care-agency-policies/","h1":"What policies does a home care agency need?"}],"sample":true,"agency":{"name":"Sample Agency","legalName":"Sample Agency, LLC","logo":null}}