{"ref":"DC-HH-IC-01","title":"Infection Prevention and Control and Employee Communicable Disease Screening","category":"Infection control","own":false,"summary":"Sets out the Agency’s infection prevention and control program: standard and transmission-based precautions in the home, bag technique, surveillance of infections in patients and staff, outbreak response and communicable disease reporting, education for staff, patients, and caregivers, and the communicable disease screening of every employee at hire and every year, with rules on working while ill.","inShort":["Clean your hands when you arrive, before and after touching the patient, after removing gloves, and before you leave.","Use gloves and other protective equipment whenever you may touch blood, body fluids, or broken skin.","If you have a fever, vomiting, diarrhea, a new cough, or a rash, call your supervisor before your next visit and do not see patients.","You must be screened for communicable disease before you start and every year.","Report signs of infection in a patient to the nurse so it can be logged and treated."],"primaryCitation":"22-B DCMR §3905.2(h)","citations":["22-B DCMR §3905.2","22-B DCMR §3907.6","22-B DCMR §3907.7","22-B DCMR §3907.8","22-B DCMR §3911.2","22-B DCMR §3915.10","22-B DCMR §3915.11","22-B DCMR §3920.5","22-B DCMR §3999.1","29 DCMR §4222.9","29 DCMR §4222.10","29 DCMR §5006.7","29 DCMR §5009.1"],"federalCitations":["42 CFR §484.70","29 CFR §1910.1030","29 CFR §1910.134"],"surveyorAsks":["Show me your infection control policy and your infection surveillance log for the last quarter.","How do you know staff follow hand hygiene and standard precautions in the home?","Show me the communicable disease screening for this employee at hire and this year.","An aide calls in with a fever and a cough. What happens to her visits, and when may she return?","What infection control teaching did this patient and caregiver receive?"],"version":"1.0","effectiveDate":"2026-10-01","reviewDate":"2027-10-01","approvedBy":"Pat Sample, Administrator","forms":[{"ref":"DC-HH-IC-01-A","title":"Infection Surveillance and Employee Screening Log"}],"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.administrator.name","text":"Pat Sample"},", ",{"k":"field","name":"people.administrator.title","text":"Administrator"}]],[["Authority"],["Adopted under 22-B DCMR §3905.2(h) (written infection control policy), §3907.6 to §3907.8 (employee communicable disease screening and fitness for duty), §3915.10(h) and §3915.11(h) (aide infection control duties), and §3920.5(e) (intravenous therapy). If the Agency is enrolled with DC Medicaid, also under 29 DCMR §5006.7(k), §5009.1(b), and §4222.9 to §4222.10. If the Agency is Medicare-certified, also under 42 CFR §484.70."]],[["Applies to"],["All staff who enter patients’ homes or handle patient equipment, specimens, or supplies; the supervising nurse, who leads the program; the Director; and office staff who track employee screening."]],[["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"],["Bloodborne pathogens, hepatitis B vaccination, and exposure incidents (Policy DC-HH-IC-02). Sharps, medical waste, and equipment cleaning (Policy DC-HH-IC-03). Personnel health records (Policy DC-HH-HR-02)."]],[["Review"],["Reviewed by the document owner at least every ",{"k":"field","name":"settings.reviewFrequencyMonths","text":"12"}," months and, in any case, as part of the governing body’s annual review and evaluation of all Agency policies under 22-B DCMR §3903.2(c), and within 30 days of any amendment to a rule cited at Section 18. Each review is recorded at Section 21 whether or not the text changes."]],[["Amendment"],["Any change requires the approval of the governing body (22-B DCMR §3905.1) and the issue of a new version number. Superseded versions are retained for at least ten years."]],[["Distribution"],["Master copy held in the policy manual at the Agency’s operating office in the District of Columbia (22-B DCMR §3900.6), readily available to staff at all times (§3905.3), and available to patients, prospective patients, and their representatives on request (§3905.4). Staff named in the Applies to row receive it at orientation and when it changes."]],[["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":["This policy protects patients, families, and staff of ",{"k":"field","name":"agency.name","text":"Sample Agency, LLC"}," from infections and communicable diseases, and gives the Agency the written infection control policy that 22-B DCMR §3905.2(h) requires."],"edited":false},{"heading":"2. Scope","body":["This policy covers the infection prevention and control program, standard and transmission-based precautions, bag technique, surveillance, outbreaks and reporting, employee screening, working while ill, staff vaccination, and education."],"edited":false},{"heading":"3. Definitions","body":["For the purposes of this policy, the following terms have the meanings below. 22-B DCMR Chapter 39 and 42 CFR Part 484 both say \"patient\". The District of Columbia Medicaid rules (29 DCMR Chapters 42 and 50) say \"beneficiary\". In this policy these words mean the same person: someone receiving home care services from the Agency."],"table":{"caption":null,"headers":[["Term"],["Meaning"]],"rows":[[["Communicable disease"],["Under 22-B DCMR §3999.1, \"any disease denominated a communicable disease, including, without limitation, any illness due to an infectious agent or its toxic product, which is transmitted directly or indirectly to a well person from an infected person, animal, or ectoparasite\", and also any disease occurring as an outbreak of illness or toxic conditions in an identifiable group of people."]],[["Standard precautions"],["The infection prevention practices used for every patient, whatever the diagnosis: hand hygiene, personal protective equipment based on expected exposure, respiratory hygiene and cough etiquette, safe injection practices, safe handling of sharps, and cleaning of equipment and surfaces. They include the \"universal precautions\" named in the DC Medicaid rules and in 29 CFR §1910.1030."]],[["Transmission-based precautions"],["Extra precautions (contact, droplet, or airborne) used for a patient known or suspected to have an infection spread in those ways, as current CDC guidance describes."]],[["Home care-associated infection"],["For surveillance, an infection that was not present or incubating at the start of care and develops while the patient is receiving the Agency’s services (for example, a urinary tract infection with a catheter, a wound infection, a line infection, or pneumonia)."]],[["Bag technique"],["The way a clinician carries and uses the nursing bag in the home so that it does not carry germs from one home to another."]],[["Outbreak"],["More cases of an infection than expected among the Agency’s patients or staff in a period, or two or more linked cases of the same unusual infection."]],[["Supervising nurse"],["The registered nurse licensed in the District of Columbia who supervises skilled nursing, licensed practical nurses, and aides, named in this policy as ",{"k":"field","name":"people.supervisingNurse.name","text":"Robin Sample, RN"},", ",{"k":"field","name":"people.supervisingNurse.title","text":"Supervising Nurse"},". The alternate supervising nurse is ",{"k":"field","name":"people.alternateSupervisingNurse.name","text":"Casey Sample, RN"},", ",{"k":"field","name":"people.alternateSupervisingNurse.title","text":"Alternate Supervising Nurse"},". If the Agency is Medicare-certified, this person normally also serves as the clinical manager described in 42 CFR §484.105(c)."]],[["DC Health"],["The District of Columbia Department of Health, called \"the Department of Health\" in 22-B DCMR Chapter 39. Home care agencies are licensed and inspected by ",{"k":"field","name":"fixed.licensingAgency","text":"DC Health (District of Columbia Department of Health), Health Systems and Preparedness Administration, Office of Health Facilities, Intermediate Care Facilities Division"},"."]],[["Director"],["The person the governing body appoints under 22-B DCMR §3904.1 to manage and direct the Agency’s operations, named in this policy as ",{"k":"field","name":"people.administrator.name","text":"Pat Sample"},", ",{"k":"field","name":"people.administrator.title","text":"Administrator"},". If the Agency is Medicare-certified, the Director is also the administrator described in 42 CFR §484.105(b)."]],[["Medicare-certified"],["Certified by CMS to take part in Medicare as a home health agency under 42 CFR Part 484, with DC Health acting as the State Survey Agency. Where this policy says a duty applies \"if the Agency is Medicare-certified\", the duty is a federal Condition of Participation. A home care agency must be Medicare-enrolled to be paid by DC Medicaid for personal care aide services (29 DCMR §5001.1(b))."]]]},"edited":false},{"heading":"4. Policy Statement (22-B DCMR §3905.2(h); §3907.6 to §3907.8)","body":["Under 22-B DCMR §3905.2, the Agency’s written policies cover, at a minimum, \"(h) Infection control\". \"At the time of initial employment of each employee, the home care agency shall verify that the employee, within the six months immediately preceding the date of hire, has been screened for and is free of communicable disease\" (§3907.6). \"Each employee shall be screened for communicable disease annually, according to the guidelines issued by the federal Centers for Disease Control, and shall be certified free of communicable disease\" (§3907.7). No employee may provide home care services, and the Agency may not knowingly permit an employee to provide them, if the employee \"(b) Has a communicable disease which poses a confirmed health risk to patients\" (§3907.8).\n\nIf the Agency is Medicare-certified: \"The HHA must maintain and document an infection control program which has as its goal the prevention and control of infections and communicable diseases\" (42 CFR §484.70). \"The HHA must follow accepted standards of practice, including the use of standard precautions, to prevent the transmission of infections and communicable diseases\" (§484.70(a)). The program is \"an integral part of the HHA's quality assessment and performance improvement (QAPI) program\" (§484.70(b)), and \"The HHA must provide infection control education to staff, patients, and caregiver(s)\" (§484.70(c)). The Agency runs one program that meets these requirements for every patient."],"edited":false},{"heading":"5. The Program","body":[],"list":[["The supervising nurse, ",{"k":"field","name":"people.supervisingNurse.name","text":"Robin Sample, RN"},", leads the infection prevention and control program, as the Agency’s own standard, with the alternate supervising nurse as back-up."],["The program follows current CDC guidance for health care settings applied to the home, and the Agency’s policies on bloodborne pathogens (Policy DC-HH-IC-02) and sharps, waste, and equipment (Policy DC-HH-IC-03)."],["It has five parts: prevention (Sections 6 to 8), surveillance (Section 9), outbreak response and reporting (Section 10), staff health (Sections 11 to 13), and education (Section 14)."],["Results are reported to the quality program each quarter (Policy DC-HH-QA-01). The program and this policy are reviewed each year."]],"ordered":false,"edited":false},{"heading":"6. Standard Precautions in the Home","body":["Every staff member uses standard precautions with every patient. Aide duties include \"(h) Infection control\" (22-B DCMR §3915.10, §3915.11), and, for DC Medicaid beneficiaries, \"Implementing universal precautions to ensure infection control\" (29 DCMR §5006.7(k))."],"list":[["Hand hygiene with alcohol-based hand rub or soap and water on arrival, before and after touching the patient, before a clean or aseptic task, after contact with body fluids, after removing gloves, and before leaving. Soap and water is used when hands are visibly soiled and when caring for a patient with diarrhea or a known spore-forming infection."],["Gloves for contact with blood, body fluids, mucous membranes, or broken skin; a gown, mask, and eye protection when splashes are likely. Personal protective equipment is supplied at no cost (Policy DC-HH-IC-02)."],["Respiratory hygiene: staff with a cough do not visit (Section 12); patients and family with a cough are offered a mask and tissues."],["Safe injection practices: one needle, one syringe, one time; single-dose vials for one patient only."],["Sharps go straight into a sharps container (Policy DC-HH-IC-03)."],["Soiled linen is handled as little as possible, held away from the body, and bagged where it is used."]],"ordered":false,"edited":false},{"heading":"7. Transmission-Based Precautions","body":[],"list":[["When a patient is known or suspected to have an infection spread by contact, droplets, or the air (for example, a multidrug-resistant organism, Clostridioides difficile, influenza, COVID-19, or tuberculosis), the nurse adds the precautions current CDC guidance recommends and writes them into the plan of care and the aide instructions."],["Where practical, the patient is visited last in the day and equipment such as a stethoscope and blood pressure cuff is left in the home, as the Agency’s own standard."],["Respirators are used only by staff who have been medically cleared, trained, and fit-tested under the OSHA respiratory protection standard (29 CFR §1910.134)."],["The family is taught the precautions they need and how to clean the home."]],"ordered":false,"edited":false},{"heading":"8. Bag Technique","body":[],"list":[["The bag is placed on a clean, dry surface on a barrier, never on the floor, and away from children and pets."],["Hands are cleaned before going into the bag. Only items needed are taken out; items taken out and used are cleaned before going back in, or discarded."],["Clean and dirty items are kept apart. The bag and its contents are cleaned on a schedule and whenever soiled."],["For a patient on contact precautions, the bag stays outside the home or in the car, and only the supplies needed are taken in."]],"ordered":false,"edited":false},{"heading":"9. Surveillance","body":["If the Agency is Medicare-certified, the program includes \"(1) A method for identifying infectious and communicable disease problems; and (2) A plan for the appropriate actions that are expected to result in improvement and disease prevention\" (42 CFR §484.70(b)). The Agency’s method, applied to every patient:"],"list":[["Clinicians record each new infection in a patient (and any infection present on admission) on Form DC-HH-IC-01-A: the type of infection, the date found, the devices in use (for example, catheters or central lines), the organism if known, and the outcome."],["Staff infections that may affect patients, and exposure incidents (Policy DC-HH-IC-02), are also logged."],["Each month the supervising nurse totals the infections by type, looks for patterns (for example, by device, by staff member, or by procedure), and decides on actions such as retraining, observation of practice, or a change of supplies."],["Each quarter the results and actions go to the quality program (Policy DC-HH-QA-01). A pattern that suggests a problem may become a performance improvement project."]],"ordered":false,"edited":false},{"heading":"10. Outbreaks and Communicable Disease Reporting","body":[],"list":[["When the supervising nurse suspects an outbreak, the supervising nurse tells the Director at once, checks the cases, adds precautions, limits staff movement between affected and unaffected patients where possible, and asks DC Health for advice."],["Communicable diseases that District law requires to be reported are reported to DC Health within the time DC Health requires. The Agency confirms with the patient’s physician whether the physician or laboratory has already reported, and follows any DC Health instructions for the patient and staff."],["Each step taken is recorded, and the outbreak is reviewed in the quality program."]],"ordered":false,"edited":false},{"heading":"11. Employee Communicable Disease Screening","body":[],"list":[["Before a new employee has patient contact, the office verifies that, within the six months immediately before the date of hire, the employee was screened for and is free of communicable disease (22-B DCMR §3907.6), using the health clearance in Policy DC-HH-HR-02."],["Every employee is screened each year according to CDC guidelines and certified free of communicable disease (§3907.7). Tuberculosis screening follows current CDC recommendations for health care personnel, as decided by the screening practitioner."],["If the Agency is enrolled with DC Medicaid, each PCA also confirms, consistent with CDC published guidance, freedom from communicable diseases including tuberculosis and hepatitis, with a purified protein derivative test and hepatitis vaccine at the start and annual written and signed documentation from the examining physician (29 DCMR §5009.1(b))."],["Office staff keep each employee’s screening due date on Form DC-HH-IC-01-A and remove from the schedule anyone whose annual screening has lapsed until it is done."]],"ordered":false,"edited":false},{"heading":"12. Working While Ill and Returning to Work","body":[],"list":[["A staff member who has, or may have, a communicable disease tells the supervisor before the next visit and does not care for patients (§3907.8(b)). This includes fever, vomiting or diarrhea, a new cough or other respiratory illness, an unexplained rash, conjunctivitis, a draining wound or skin infection, or a positive test for a disease spread person to person."],["The supervising nurse decides when the staff member may return, using current CDC guidance for health care personnel and any advice from the staff member’s practitioner, and records the decision. Visits are reassigned so that no patient goes without care (Policy DC-HH-CC-02)."],["Staff use their sick leave under the District’s sick leave law and the personnel handbook and are not penalized for staying home when ill (Policy DC-HH-HR-01)."]],"ordered":false,"edited":false},{"heading":"13. Staff Vaccination","body":[],"list":[["Hepatitis B vaccination is offered to every employee with occupational exposure, at no cost (Policy DC-HH-IC-02), and acceptance or declination is recorded in the personnel record (22-B DCMR §3907.2(m))."],["The Agency encourages and helps staff to receive the vaccines CDC recommends for health care personnel, including the yearly influenza vaccine, and records the vaccines staff report, as the Agency’s own standard."],["The District has a 2022 rule on required COVID-19 vaccination for health care facilities (22-B DCMR Chapter 112). Whether and how it applies to home care agencies today has not been confirmed. The Director checks with DC Health and follows any vaccination requirement that applies."]],"ordered":false,"edited":false},{"heading":"14. Education","body":[],"list":[["Staff receive infection control training at orientation and at least once a year after that, including hand hygiene, standard and transmission-based precautions, bag technique, and cleaning (Policy DC-HH-HR-01)."],["If the Agency serves EPD Waiver beneficiaries, all staff providing direct care are \"trained in universal precautions prior to the provision of any service\" (29 DCMR §4222.9), and universal precautions training is part of annual continuing education for all staff who may encounter blood or bodily fluids, with the training record kept for at least ten years (§4222.10)."],["Patients and caregivers are taught hand hygiene, care of any device or wound, signs of infection to report, safe disposal of sharps and dressings, and cleaning, and the teaching is recorded (22-B DCMR §3911.2(s))."],["Intravenous therapy infection control is in Policy DC-HH-CS-04 (§3920.5(e))."]],"ordered":false,"edited":false},{"heading":"15. Responsibilities","body":["Accountability under this policy is allocated as follows."],"table":{"caption":["Who is accountable for what"],"headers":[["Role"],["Responsibility under this policy"]],"rows":[[["Director (",{"k":"field","name":"people.administrator.name","text":"Pat Sample"},")"],["Provides the supplies, personal protective equipment, and time the program needs, and acts on outbreak and surveillance reports."]],[["Supervising nurse (",{"k":"field","name":"people.supervisingNurse.name","text":"Robin Sample, RN"},")"],["Leads the program, reviews surveillance each month, manages outbreaks, decides return to work, and reports to the quality program."]],[["Clinicians"],["Follow precautions and bag technique, log infections, teach patients and caregivers, and report illness before working."]],[["Aides"],["Follow standard precautions and the aide instructions, and report signs of infection and their own illness."]],[["Office staff"],["Track employee screening due dates and keep screening records."]]]},"edited":false},{"heading":"16. Records and Compliance Monitoring","body":["The infection surveillance log, monthly summaries, outbreak records, and quality program reports are kept for at least ten years, as the Agency’s own standard. Employee screening and vaccination records are kept in the confidential medical part of the personnel record (Policy DC-HH-HR-02). Each quarter the supervising nurse observes hand hygiene and bag technique on a sample of home visits and reports the results with the surveillance data to the quality program (Policy DC-HH-QA-01)."],"edited":false},{"heading":"17. Staff Training","body":["All staff are trained on this policy at orientation and each year. The supervising nurse completes training in infection prevention suited to the program lead’s role."],"edited":false},{"heading":"18. References","body":["This policy implements the following authorities."],"list":[["22-B DCMR §3905.2(h) (infection control policy); §3907.2(m), §3907.6 to §3907.8 (employee screening and fitness for duty); §3911.2(s) (patient education); §3915.10(h) and §3915.11(h) (aide duties); §3920.5(e) (intravenous therapy); §3999.1 (definition of communicable disease); 22-B DCMR Chapter 112 (COVID-19 vaccination for health care facilities; applicability not confirmed)."],["29 DCMR §5006.7(k), §5009.1(b) (DC Medicaid personal care aides) and §4222.9, §4222.10 (EPD Waiver), if the Agency is enrolled."],["42 CFR §484.70 (if the Agency is Medicare-certified)."],["29 CFR §1910.1030 (bloodborne pathogens) and §1910.134 (respiratory protection)."]],"ordered":false,"edited":false},{"heading":"19. Related Policies and Forms","body":["The following documents are read together with this policy."],"table":{"caption":null,"headers":[["Reference"],["Title"]],"rows":[[["Policy DC-HH-IC-02"],["Bloodborne Pathogens Exposure Control Plan and Hepatitis B Vaccination"]],[["Policy DC-HH-IC-03"],["Sharps, Medical Waste, and Equipment Cleaning"]],[["Policy DC-HH-HR-01"],["Personnel Policies, Position Descriptions, Orientation, In-Service Training, and Annual Evaluation"]],[["Policy DC-HH-HR-02"],["Personnel Records, Employee Health Screening, and Fitness for Duty"]],[["Policy DC-HH-CS-04"],["Intravenous Therapy and Infusion Services"]],[["Policy DC-HH-CS-05"],["Laboratory Services, Specimens, and Diagnostic Results"]],[["Policy DC-HH-CC-02"],["After-Hours Availability, On-Call, Missed Visits, and Contingency Staffing"]],[["Policy DC-HH-QA-01"],["Quality Assessment and Performance Improvement"]],[["Policy DC-HH-AID-02"],["Aide Assignment, Duties, Written Instructions, and Supervisory Visits"]],[["Form DC-HH-IC-01-A"],["Infection Surveillance and Employee Screening Log"]]]},"edited":false},{"heading":"20. 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":"21. 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 18 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-hha","state":"Washington, DC","service":"Home health","guides":[{"path":"/guides/infection-control-policy/","h1":"What should a home care infection control policy include?"},{"path":"/guides/home-health-agency-policies/","h1":"What policies and procedures are required for home health agencies?"},{"path":"/guides/home-health-conditions-of-participation/","h1":"Home health Conditions of Participation: which policies each one needs"}],"sample":true,"agency":{"name":"Sample Agency","legalName":"Sample Agency, LLC","logo":null}}