{"ref":"NC-HH-IC-01","title":"Infection Prevention and Control and Communicable Disease Reporting","category":"Infection control","own":false,"summary":"Sets up the Agency’s infection prevention and control program for every patient: the written infection control policy and designated staff member North Carolina requires of a home care agency that performs invasive procedures, a yearly risk assessment with employee risk categories, standard and transmission-based precautions, cleaning, disinfection and maintenance of equipment, surveillance of infections built into QAPI, reporting of suspected reportable diseases with the patient’s physician and the local health department, control measures and outbreaks, staff health, and education for staff, patients and caregivers.","inShort":["Clean your hands when you arrive, before and after touching the patient, after taking off gloves, and before you leave.","Use standard precautions with every patient: gloves and other protective equipment for blood and body fluids, a new needle and syringe for every injection, and sharps straight into a sharps container.","Put your bag on a clean, hard surface, take out only what you need, and clean and disinfect shared equipment before it goes back in the bag.","Report signs of infection (fever, wound redness or drainage, cloudy urine, new cough, diarrhea) to the case manager the same day.","If you suspect a reportable disease such as tuberculosis or measles, tell the supervising nurse at once so the physician and the local health department are told in time.","Do not visit patients if you have a fever, vomiting, diarrhea or a weeping skin sore. Call your supervisor before your shift."],"primaryCitation":"42 CFR §484.70","citations":["10A NCAC 13J .1003(a)","10A NCAC 13J .1003(b)","10A NCAC 13J .1003(f)","10A NCAC 13J .1004(a)","10A NCAC 41A .0101","10A NCAC 41A .0102","10A NCAC 41A .0201","10A NCAC 41A .0206","10A NCAC 41A .0211","G.S. 130A-135","G.S. 130A-137","13 NCAC 07F .0101","NC Medicaid Clinical Coverage Policy 3A"],"federalCitations":["42 CFR §484.70","42 CFR §484.65","42 CFR §484.80(h)","29 CFR §1910.1030","29 CFR §1910.134","45 CFR §164.512(b)"],"surveyorAsks":["Who is your designated infection control staff member, and where is the certificate for the state-approved infection control course?","Show me your infection surveillance log and what you did about the last trend you found.","How do your staff clean a blood pressure cuff or a glucose meter between patients?","A patient is diagnosed with tuberculosis. Who reports it, to whom, and how fast?","How do you teach patients and caregivers to prevent infection at home?"],"version":"1.0","effectiveDate":"2026-10-01","reviewDate":"2027-10-01","approvedBy":"Pat Sample, Administrator","forms":[{"ref":"NC-HH-IC-01-A","title":"Infection Surveillance 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.supervisingNurse.name","text":"Robin Sample, RN"},", ",{"k":"field","name":"people.supervisingNurse.title","text":"Supervising Nurse"}]],[["Authority"],["Adopted under 10A NCAC 13J .1003(a), which requires written infection control and communicable disease exposure policies \"consistent with Subchapter 19A of Title 15A, North Carolina Administrative Code\" (those communicable disease rules are now codified at 10A NCAC 41A) and compliance with 29 CFR 1910; 13J .1003(b) (tuberculosis) and (f)(6) (pathogen training records); 10A NCAC 41A .0101 and .0102 (reportable diseases and how they are reported), .0201 and .0211 (control measures), and .0206 (infection prevention in health care settings, which applies to home care agencies); G.S. 130A-135 and 130A-137 (who reports communicable diseases); 42 CFR §484.70 (infection prevention and control) and §484.65 (QAPI); 29 CFR §1910.1030 and §1910.134, in force in North Carolina through 13 NCAC 07F .0101; 45 CFR §164.512(b) (disclosures for public health); and NC Medicaid Clinical Coverage Policy 3A. The Agency is a home health agency as defined in G.S. 131E-136(4): a licensed home care agency certified to receive Medicare and Medicaid reimbursement, and it meets 42 CFR Part 484. A licensed home care agency that is not Medicare-certified is bound by 10A NCAC 13J but not by 42 CFR Part 484, and follows the federal provisions in this policy as its own standard."]],[["Applies to"],["Every employee, contractor and student who visits patients or handles patient equipment, supplies or specimens; the supervising nurse, who leads the program; and the designated infection control staff member at each licensed premises."]],[["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 exposure control, sharps and medical waste (Policy NC-HH-IC-02). Tuberculosis screening and hepatitis B records in the personnel file (Policy NC-HH-HR-02). Infusion line care (Policy NC-HH-MED-02). Specimen collection and point-of-care testing (Policy NC-HH-CS-05). Outbreaks or pandemics that disrupt operations (Policy NC-HH-EP-01)."]],[["Review"],["Reviewed by the document owner at least every ",{"k":"field","name":"settings.reviewFrequencyMonths","text":"12"}," months, and within 30 days of any amendment to a rule cited at Section 19. The policy and administration review in the annual evaluation of the Agency’s total operation (10A NCAC 13J .1004(a) to (c)) also covers this policy. Each review is recorded at Section 22 whether or not the text changes."]],[["Amendment"],["Any change requires the approval of the governing body and the issue of a new version number. Superseded versions are retained for six years."]],[["Distribution"],["Master copy held in the policy manual at each licensed premises, where it is available for inspection by the Division of Health Service Regulation (10A NCAC 13J .1001(a)). 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":"(919) 555-0100"}," or ",{"k":"field","name":"agency.email","text":"office@example.com"},"."]]]},"edited":false},{"heading":"1. Purpose","body":["This policy sets out the infection prevention and control program of ",{"k":"field","name":"agency.name","text":"Sample Agency, LLC"},". Its goal, in the words of the federal rule, is \"the prevention and control of infections and communicable diseases\" among patients, caregivers and staff. With Policy NC-HH-IC-02 it is the written infection control policy North Carolina requires of a home care agency."],"edited":false},{"heading":"2. Scope","body":["This policy covers program leadership and the designated infection control staff member, the yearly infection risk assessment, standard precautions, bag technique and the cleaning, disinfection and maintenance of equipment, transmission-based precautions and respiratory protection, surveillance and investigation, reporting of communicable diseases, control measures and outbreaks, staff health, education, and monitoring of compliance. It applies on every visit, in every vehicle used for work, and at every licensed premises."],"edited":false},{"heading":"3. Definitions","body":["For the purposes of this policy, the following terms have the meanings below. 10A NCAC 13J and the Home Care Clients’ Bill of Rights (G.S. 131E-144.1 to 131E-144.7) say \"client\"; 42 CFR Part 484 says \"patient\". This policy says \"patient\", and the two words mean the same person here."],"table":{"caption":null,"headers":[["Term"],["Meaning"]],"rows":[[["Standard precautions"],["The infection prevention practices used with every patient on every visit, whatever the diagnosis: hand hygiene; gloves, gowns, masks and eye protection chosen for the expected exposure; respiratory hygiene and cough etiquette; safe injection practices; safe handling of sharps; and cleaning and disinfection of equipment and surfaces. They include the blood and body fluid precautions 10A NCAC 41A .0206(d) requires and the universal precautions in 29 CFR §1910.1030(d)(1)."]],[["Transmission-based precautions"],["Added precautions (contact, droplet or airborne) used, together with standard precautions, for a patient known or suspected to have an infection spread by that route."]],[["Invasive procedure"],["As 10A NCAC 41A .0206(a)(2) defines it: \"entry into tissues, cavities, or organs or repair of traumatic injuries. The term includes the use of needles to puncture skin, vaginal and cesarean deliveries, surgery, and dental procedures during which bleeding occurs or the potential for bleeding exists.\" Agency nurses perform invasive procedures when they give injections, draw blood, check blood glucose by fingerstick, or start or access an intravenous line."]],[["Health care organization"],["Under 10A NCAC 41A .0206(a)(1) the term includes a \"home care agency\". The Agency is a health care organization for the purposes of that rule."]],[["Designated infection control staff member"],["The on-site staff member the Agency designates for each licensed premises that is not physically connected to another, to direct the infection control activities in Section 5 (10A NCAC 41A .0206(b)). He or she completes an infection control course approved by the North Carolina Department of Health and Human Services."]],[["Supervising nurse"],["The registered nurse designated under 10A NCAC 13J .1001(c) to supervise nursing and home health aide services, who is also the clinical manager under 42 CFR §484.105(c): currently ",{"k":"field","name":"people.supervisingNurse.name","text":"Robin Sample, RN"},", ",{"k":"field","name":"people.supervisingNurse.title","text":"Supervising Nurse"},", with ",{"k":"field","name":"people.alternateSupervisingNurse.name","text":"Casey Sample, RN"},", ",{"k":"field","name":"people.alternateSupervisingNurse.title","text":"Alternate Supervising Nurse"}," as the alternate."]],[["Surveillance"],["The ongoing collection, review and analysis of information on infections among patients, so that problems are found and acted on (42 CFR §484.70(b))."]],[["Agency-associated infection"],["An infection that appears to have begun while the patient was receiving Agency services and may be linked to that care, such as a urinary tract infection in a patient with an Agency-managed catheter, a bloodstream infection in a patient with a central line, or an infection in a wound the Agency treats."]],[["Reportable disease"],["A communicable disease or communicable condition on the list in 10A NCAC 41A .0101(a), each of which \"shall be reported within the time period specified after the disease or condition is reasonably suspected to exist\"."]],[["Local health director"],["The director of the local health department for the county or district. Reports of communicable diseases are made to the local health director (G.S. 130A-135; 10A NCAC 41A .0102(a))."]],[["Outbreak"],["For this policy, two or more patients or staff with the same infection linked by time, place, staff member, procedure or supply, or any situation the local health department treats as an outbreak, as the Agency’s own working definition."]]]},"edited":false},{"heading":"4. Policy Statement (42 CFR §484.70; 10A NCAC 13J .1003(a); 10A NCAC 41A .0206)","body":["\"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 Agency \"must follow accepted standards of practice, including the use of standard precautions, to prevent the transmission of infections and communicable diseases\" (§484.70(a)); \"must maintain a coordinated agency-wide program for the surveillance, identification, prevention, control, and investigation of infectious and communicable diseases that is an integral part of the HHA's quality assessment and performance improvement (QAPI) program\", which includes a method for identifying infectious and communicable disease problems and a plan for the appropriate actions expected to result in improvement and disease prevention (§484.70(b)); and \"must provide infection control education to staff, patients, and caregiver(s)\" (§484.70(c)). NC Medicaid Clinical Coverage Policy 3A carries the same requirements for NC Medicaid home health providers.\n\nUnder North Carolina rules, \"Written policies shall be established and implemented by the agency regarding infection control and exposure to communicable diseases consistent with Subchapter 19A of Title 15A, North Carolina Administrative Code. These policies shall include provisions for compliance with 29 CFR 1910 (Occupational Safety and Health Standards) which is incorporated by reference including subsequent amendments.\" (10A NCAC 13J .1003(a)). The communicable disease rules of that subchapter are now 10A NCAC 41A, which provides: \"In order to prevent transmission of HIV, hepatitis B, hepatitis C and other bloodborne pathogens each health care organization that performs invasive procedures shall implement a written infection control policy.\" (10A NCAC 41A .0206(b)). This policy, with Policy NC-HH-IC-02, is that written policy. The Agency applies it to every patient, whatever the payer."],"edited":false},{"heading":"5. Program Leadership and the Designated Infection Control Staff Member","body":[],"list":[["The supervising nurse, ",{"k":"field","name":"people.supervisingNurse.name","text":"Robin Sample, RN"},", leads the program and is the designated infection control staff member for the main licensed premises. The alternate supervising nurse, ",{"k":"field","name":"people.alternateSupervisingNurse.name","text":"Casey Sample, RN"},", acts in his or her absence."],["The Agency must \"designate one on-site staff member for each noncontiguous facility to direct these activities. The designated staff member in each health care facility shall complete a course in infection control approved by the Department.\" (10A NCAC 41A .0206(b)). For each other licensed premises that is not physically connected to the main premises, ",{"k":"field","name":"people.administrator.name","text":"Pat Sample"}," designates an on-site registered nurse in writing. The designations are kept with this policy."],["Each designated staff member completes a Department-approved infection control course and the certificate is kept in his or her personnel record. The approved course addresses the eight subjects listed in 41A .0206(b): epidemiologic principles of infectious disease; principles and practice of asepsis; sterilization, disinfection and sanitation; universal blood and body fluid precautions; safe injection practices; engineering controls to reduce the risk of sharp injuries; disposal of sharps; and techniques that reduce the risk of sharp injuries to health care workers."],["When a designated staff member leaves the role, the administrator names a replacement at once, and the replacement enrolls in the next available approved course, as the Agency’s own standard. Until the course is complete, the supervising nurse also directs the activities at that premises."],["Under the same rule the Agency ensures that its health care workers \"are trained in the principles of infection control and the practices required by the policy\", requires and monitors compliance (Sections 14 and 15), and updates the policy as needed (10A NCAC 41A .0206(b)). The supervising nurse checks current guidance from the Centers for Disease Control and Prevention (CDC) and the North Carolina Division of Public Health at least quarterly and on any public health alert, as the Agency’s own standard."],["The supervising nurse reports infection data and actions to each QAPI meeting (Policy NC-HH-QA-02) and reviews the whole program each year with the administrator as part of the annual evaluation of the Agency’s total operation (10A NCAC 13J .1004(a); Policy NC-HH-QA-01)."]],"ordered":false,"edited":false},{"heading":"6. Yearly Infection Risk Assessment and Employee Risk Categories","body":["Each year, and when the Agency adds a service or the local disease picture changes, the supervising nurse completes a written infection risk assessment, as the Agency’s own standard. It considers the services and invasive procedures the Agency provides; the patients it serves (for example, patients with wounds, urinary catheters, central lines or weakened immunity); the previous year’s surveillance data and staff exposure incidents; and information from the local health departments in the counties the Agency serves (",{"k":"field","name":"agency.counties","text":"Wake and Durham Counties"},"). It produces three results: the employee risk categories in Table 1, which match the exposure determination in Policy NC-HH-IC-02; the list of staff to be retested for tuberculosis, because \"Employees identified by agency risk assessment, to be at risk for exposure shall be subsequently tested at intervals prescribed by OSHA standards.\" (10A NCAC 13J .1003(b); Policy NC-HH-HR-02); and the year’s priorities (the infections to track, the practices to audit, and the education topics)."],"table":{"caption":["Table 1. Employee risk categories (Agency standard)"],"headers":[["Category"],["Who"],["What follows"]],"rows":[[["1. Exposure on every visit"],["Registered nurses, licensed practical nurses, home health aides, physical therapists and physical therapist assistants, occupational therapists and occupational therapy assistants"],["Infection control and bloodborne pathogens training at hire and every year; hepatitis B vaccine offered; protective equipment in every visit bag; tuberculosis screening as Policy NC-HH-HR-02 requires"]],[["2. Exposure in some tasks"],["Speech-language pathologists, medical social workers, supervisors and others who sometimes make home visits, and office staff who receive returned sharps containers, specimens or soiled equipment"],["The same training and vaccine offer; protective equipment for the tasks listed in the exposure determination"]],[["3. No reasonably anticipated exposure"],["Office staff who do not visit patients or handle specimens, sharps or soiled items"],["General infection control and hand hygiene education; tuberculosis screening only if the risk assessment calls for it"]]]},"note":["The risk assessment is signed by the supervising nurse and the administrator and kept with the program records. The Division of Health Service Regulation’s survey checklist looks for employee risk categories in the infection control policy."],"edited":false},{"heading":"7. Standard Precautions on Every Visit","body":["\"Health care workers and emergency responders shall, with all patients, follow Centers for Disease Control and Prevention Guidelines on blood and body fluid precautions incorporated by reference in 10A NCAC 41A .0201.\" (10A NCAC 41A .0206(d)). On every visit, staff follow these practices."],"list":[["Hand hygiene. Clean hands with alcohol-based hand rub, or with soap and running water when hands are visibly soiled or after caring for a patient with diarrhea that may be infectious: on entering the home, before and after touching the patient, before a clean or aseptic task, after contact with blood, body fluids or contaminated items, after removing gloves, after touching the patient’s surroundings, and before leaving. Where there is no suitable sink, use the antiseptic hand cleanser or towelettes the Agency supplies and wash with soap and running water as soon as feasible (29 CFR §1910.1030(d)(2)(iv)). Use paper towels, not the household’s cloth towels."],["Protective equipment. Wear gloves for contact with blood, body fluids, mucous membranes, non-intact skin or contaminated items, and add a gown, mask and eye protection where splashing or spraying is likely. Put on and take off protective equipment in the order taught at orientation, discard it before leaving the care area, and clean hands (Policy NC-HH-IC-02)."],["Respiratory hygiene. Staff with symptoms of a respiratory infection do not make visits (Section 13). Offer a mask to a coughing patient or household member who can tolerate one, and keep a distance where possible."],["Safe injection practices. Use a new sterile needle and syringe for every injection; never reuse a syringe, even to change the needle; never use a single-dose vial for more than one dose; keep a multi-dose vial for one patient only and date it when opened; never carry a medication or vial from one home to another."],["Sharps. Use the safety-engineered device the Agency supplies, activate the safety feature at once, never recap by hand, and discard the sharp at once into a container that meets Policy NC-HH-IC-02."],["Aseptic technique. Use sterile technique for sterile procedures (for example, urinary catheter insertion, central line care and some wound care) as the Agency’s clinical procedures set out (Policy NC-HH-MED-02 for infusion lines)."],["Spills. Clean up blood or body fluids promptly with gloves, absorbent material and an EPA-registered disinfectant, following the product’s contact time (Policy NC-HH-IC-02)."]],"ordered":false,"edited":false},{"heading":"8. Bag Technique, Equipment and Supplies","body":["Staff carry supplies and equipment from home to home, so the visit bag and shared equipment are handled in a way that keeps them clean."],"edited":false},{"heading":"8.1 Bag technique","body":[],"list":[["Place the bag on a clean, dry, hard surface or a clean barrier, never on the floor or the bed. Clean hands before opening it."],["Take out only what the visit needs. Unused supplies taken into the care area are left with the patient or discarded, never returned to the bag."],["Keep patient-specific supplies in the patient’s home in a clean container. Never take supplies from one patient for another."],["Clean and disinfect equipment before it goes back into the bag. Never put soiled items in the bag; bag them separately."]],"ordered":false,"edited":false},{"heading":"8.2 Cleaning, disinfection and maintenance","body":["10A NCAC 41A .0206(c) requires the infection control policy to address sterilization and disinfection, \"including a schedule for maintenance and microbiologic monitoring of equipment\", with documentation of maintenance and monitoring; sanitation of rooms and equipment, \"including cleaning procedures, agents, and schedules\"; the accessibility of infection control devices and supplies; and the procedures to be followed after an exposure. Table 2 sets out how the Agency meets the first three items. Exposure procedures are in Policy NC-HH-IC-02."],"table":{"caption":["Table 2. Equipment, cleaning and supplies"],"headers":[["10A NCAC 41A .0206(c) item"],["How the Agency meets it"]],"rows":[[["Sterilization"],["The Agency does not sterilize or reprocess instruments. Items that must be sterile (dressing sets, catheter kits, syringes, needles, irrigation sets) are bought sterile and single-use, checked for an intact, in-date package, used once and discarded, as the Agency’s own standard. Because nothing is sterilized, sterilizer monitoring does not arise; if the Agency ever reprocesses an item, the supervising nurse writes the procedure, the maintenance schedule and the microbiologic monitoring before it starts."]],[["Disinfection of reusable equipment"],["Reusable non-critical equipment (stethoscope, blood pressure cuff, thermometer, pulse oximeter, scale, gait belt) is cleaned and disinfected after each patient with an EPA-registered disinfectant wipe, following the label contact time, before it goes back into the bag. Glucose meters are cleaned and disinfected as the manufacturer instructs (Policy NC-HH-CS-05). Where possible, a patient on transmission-based precautions keeps dedicated equipment in the home."]],[["Maintenance schedule"],["Agency-owned clinical equipment (for example, scales, glucose meters and any suction unit the Agency owns) is listed on an equipment log with the maintenance, cleaning and calibration schedule the manufacturer sets. Checks and repairs are recorded. Equipment that fails a check is tagged and removed from use. Equipment a supplier provides to the patient is maintained by the supplier (Policy NC-HH-CS-04)."]],[["Sanitation of rooms and equipment"],["At each licensed premises clean and soiled items are stored apart; clean supplies are stored off the floor in a closed area; the supply room is cleaned at least weekly; and surfaces where returned equipment is handled are disinfected after each use with the agents on the Agency’s cleaning list, as the Agency’s own standard. In vehicles, clean and soiled items are kept in separate containers and soiled items are bagged."]],[["Accessibility of devices and supplies"],["Every clinical staff member carries a stocked visit bag: alcohol-based hand rub, gloves in the right size (non-latex for anyone with a latex allergy), gowns, masks, eye protection, an N95 respirator for fit-tested staff, disinfectant wipes, a puncture-resistant sharps container, biohazard bags, specimen transport bags and, for nurses, a resuscitation mask with a one-way valve. Supplies are restocked at the office at no cost to staff, and the designated staff member checks stock levels each month, as the Agency’s own standard."]]]},"edited":false},{"heading":"9. Transmission-Based Precautions and Respiratory Protection","body":[],"list":[["When a patient is known or suspected to have an infection spread by contact (for example, Clostridioides difficile, MRSA in a draining wound, scabies, Candida auris or a carbapenemase-producing organism), by droplets (for example, influenza or whooping cough) or through the air (for example, active pulmonary tuberculosis, measles or chickenpox), the case manager records the precautions in the plan of care and on the aide care plan (Form NC-HH-AID-02-A) and tells every staff member before the next visit."],["Staff use the protective equipment the precautions require and follow CDC guidance for that infection. Where possible, a patient on precautions is the last visit of the day and keeps dedicated equipment in the home."],["For airborne precautions, staff wear an N95 or more protective respirator. An employee who must wear a tight-fitting respirator is covered by the Agency’s written respiratory protection program under 29 CFR §1910.134: a medical evaluation \"before the employee is fit tested or required to use the respirator in the workplace\" (§1910.134(e)(1)); a fit test \"prior to initial use of the respirator, whenever a different respirator facepiece (size, style, model or make) is used, and at least annually thereafter\" (§1910.134(f)(2)); and training that recurs every year (§1910.134(k)). Staff who are not fit-tested do not visit a patient on airborne precautions."],["A staff member who is pregnant or has weakened immunity may tell the supervising nurse, who may assign another staff member to a patient with an infection such as chickenpox, as the Agency’s own standard. The information is kept confidential."],["The patient and caregivers are taught how to limit spread in the home: hand hygiene, cleaning of high-touch surfaces, handling of laundry and waste, and when to wear a mask."],["Precautions end when the physician, CDC guidance or the local health department says so, and the change is recorded in the plan of care."]],"ordered":false,"edited":false},{"heading":"10. Surveillance and Investigation","body":[],"list":[["Any staff member who notices possible signs of infection (fever; new or increased wound redness, swelling or drainage; cloudy or foul-smelling urine or pain on urination; new cough or shortness of breath; redness or drainage at a line site; diarrhea; new confusion) reports them to the case manager the same day, and at once if the patient seems acutely ill."],["The case manager tells the physician, records the report and any orders, and follows up the result."],["When an infection is confirmed or treated, the case manager enters it on the infection surveillance log (Form NC-HH-IC-01-A) within one week, as the Agency’s own standard, with the date found, the patient, the type and site of infection, the organism if known, any device or procedure involved (catheter, central line, wound), the treatment, whether it appears Agency-associated, and whether it is a reportable disease."],["Each month the supervising nurse reviews the log, counts infections by type, works out rates using a stated denominator (for example, urinary tract infections per 1,000 catheter days, or central line infections per 1,000 line days), compares them with earlier months, and looks for clusters and for links to a staff member, procedure, device or supply, as the Agency’s own standard."],["Where a problem is found, the supervising nurse investigates, records the findings, and puts in place a plan for the appropriate actions expected to bring improvement and prevent disease (42 CFR §484.70(b)(1), (2)), such as retraining, a change of supply or procedure, or closer supervision. Results are tracked until the problem is resolved."],["Infection data, investigations and actions are part of the QAPI program (42 CFR §484.65; Policy NC-HH-QA-02) and feed the 90-day client record review and the annual evaluation (Policy NC-HH-QA-01). Staff exposure incidents are tracked separately and confidentially under Policy NC-HH-IC-02."]],"ordered":false,"edited":false},{"heading":"11. Reporting Communicable Diseases","body":["In North Carolina the duty to report falls first on the physician: \"A physician licensed to practice medicine who has reason to suspect that a person about whom the physician has been consulted professionally has a communicable disease or communicable condition declared by the Commission to be reported, shall report information required by the Commission to the local health director of the county or district in which the physician is consulted.\" (G.S. 130A-135). A medical facility in which there is a patient reasonably suspected of having a reportable disease may also report to the local health director (G.S. 130A-137). For a disease reportable within 24 hours, the first report is made by telephone and the written report follows within seven days on the communicable disease report card or the electronic format the Division of Public Health provides (10A NCAC 41A .0102(a)(1), (2)). The reportable diseases and the time for each report are listed in 10A NCAC 41A .0101(a); Table 3 shows some that home health staff may meet."],"table":{"caption":["Table 3. Examples from the reportable disease list (10A NCAC 41A .0101(a), last amended November 1, 2024)"],"headers":[["Disease or condition"],["Time to report after it is reasonably suspected"]],"rows":[[["Measles (rubeola)"],["Immediately"]],[["Novel coronavirus infection; novel influenza virus infection"],["Immediately"]],[["Tuberculosis"],["24 hours"]],[["Hepatitis A; hepatitis B"],["24 hours"]],[["Candida auris; carbapenemase-producing organisms (CPO)"],["24 hours"]],[["Staphylococcus aureus with reduced susceptibility to vancomycin"],["24 hours"]],[["Influenza virus infection causing death"],["24 hours"]],[["Mpox; varicella; whooping cough"],["24 hours"]],[["Legionellosis"],["7 days"]],[["Streptococcal infection, Group A, invasive disease"],["7 days"]]]},"edited":false},{"heading":"11.1 What staff and the supervising nurse do","body":[],"list":[["A staff member who suspects a reportable disease, or learns that a patient has one, tells the supervising nurse at once."],["The supervising nurse makes sure the patient’s attending physician knows and asks whether the physician has reported it. The call, the answer and the time are recorded in the clinical record."],["If the physician cannot be reached in time for a disease reportable immediately or within 24 hours, or the supervising nurse cannot confirm that a report has been made, the supervising nurse calls the local health department for the county where the patient lives, as the Agency’s own standard, and records the call. HIPAA permits this disclosure to a public health authority (45 CFR §164.512(b)(1)(i); Policy NC-HH-PRV-01)."],["For clinical questions at any hour, the supervising nurse may call the NCDHHS communicable disease line, ",{"k":"field","name":"fixed.communicableDiseaseLine","text":"919-733-3419 (24 hours a day, 7 days a week; NCDHHS assistance for clinicians and laboratories with communicable disease questions)"},"."],["An unusual cluster of illness, or an illness that may be caused by an act of bioterrorism, is reported to the supervising nurse and the administrator at once, and the supervising nurse calls the local health department the same day, as the Agency’s own standard."],["The list of reportable diseases changes. The supervising nurse keeps the current list from the Office of Administrative Hearings website with this policy and checks it at each review and on any public health notice."],["Information about a patient’s communicable disease is confidential. It is shared only with public health officials, the patient’s physicians, the staff who need it for care, and as Policy NC-HH-PRV-01 allows."]],"ordered":false,"edited":false},{"heading":"12. Control Measures and Outbreaks","body":[],"list":[["The control measures North Carolina requires for each communicable disease are the recommendations in the American Public Health Association’s Control of Communicable Diseases Manual, with guidelines of the Centers for Disease Control and Prevention taking precedence where they differ (10A NCAC 41A .0201(a)). Staff follow these, and any control measures the local health director gives for a patient, and teach them to the patient and household."],["When the local health director tells the Agency, as an employer, about an employee with a reportable disease, the Agency requires the employee to follow the control measures the local health director gives to prevent transmission (10A NCAC 41A .0211(b)). The information is kept confidential."],["A suspected outbreak among patients or staff is reported to the supervising nurse and the administrator at once. The supervising nurse contacts the local health department, follows its instructions, cooperates with any investigation, and records each step. If the outbreak affects staffing or operations, the emergency preparedness plan is activated (Policy NC-HH-EP-01)."],["During an outbreak or a pandemic, the supervising nurse may add screening of staff and patients before visits, change protective equipment, limit visits to essential care, and use telephone contact where the plan of care allows, as CDC and North Carolina public health guidance direct."]],"ordered":false,"edited":false},{"heading":"13. Staff Health","body":[],"list":[["Staff who have a fever, vomiting, diarrhea, a draining or weeping skin lesion, conjunctivitis, or a respiratory illness with fever do not make visits. They tell their supervisor before the shift and return when the supervising nurse, following CDC guidance, clears them, as the Agency’s own standard."],["\"Health care workers who have exudative lesions or weeping dermatitis shall refrain from handling patient care equipment and devices used in performing invasive procedures and from all direct patient care that involves the potential for contact of the patient, equipment, or devices with the lesion or dermatitis until the condition resolves.\" (10A NCAC 41A .0206(e))."],["Every hands-on care employee completes tuberculosis screening before assignment to a patient’s home, as 10A NCAC 13J .1003(b) requires and Policy NC-HH-HR-02 sets out. Staff the yearly risk assessment identifies as at risk are retested (Section 6)."],["The Agency offers hepatitis B vaccination under Policy NC-HH-IC-02 and encourages yearly influenza vaccination and the other vaccinations the CDC recommends for health care personnel. Vaccination and screening records are kept in the confidential employee medical file (Policy NC-HH-HR-02)."],["A staff member with a work-related exposure to blood or body fluids follows Policy NC-HH-IC-02 at once."],["A staff member who develops a reportable disease is handled under Section 12 and the instructions of the local health director. The supervising nurse clears the return to work."]],"ordered":false,"edited":false},{"heading":"14. Education of Staff, Patients and Caregivers","body":[],"list":[["Staff receive infection control education at orientation, before the first visit, and at least every year (42 CFR §484.70(c); 10A NCAC 41A .0206(b)). It covers this policy, hand hygiene, protective equipment, bag technique and equipment cleaning, standard and transmission-based precautions, respiratory protection, safe injection practices, recognizing and reporting infection, reportable diseases, staff health, and the bloodborne pathogens plan (Policy NC-HH-IC-02)."],["Each hands-on care employee’s personnel record shows \"airborne and bloodborne pathogen training for hands on care employees, including annual updates, in compliance with 29 CFR 1910 and in accordance with the agency's exposure control plan\" (10A NCAC 13J .1003(f)(6))."],["Home health aides learn basic infection prevention and control procedures in their training and competency evaluation (42 CFR §484.80(b)(3); Policy NC-HH-AID-01). Their compliance with infection prevention and control policies and procedures is checked at every aide supervisory visit (42 CFR §484.80(h)(4); Policy NC-HH-AID-02)."],["Patients and caregivers are taught at the start of care and as needed: hand hygiene; care of wounds, catheters, lines and other devices; signs of infection to report and whom to call; safe handling and disposal of sharps and soiled dressings (Policy NC-HH-IC-02); cleaning in the home; and vaccinations to discuss with their physician. The teaching and the patient’s understanding are recorded in the clinical record."],["Teaching uses plain language and the patient’s preferred language, with an interpreter where needed (Policy NC-HH-PR-04)."]],"ordered":false,"edited":false},{"heading":"15. Monitoring Compliance","body":["The Agency must \"require and monitor compliance with the policy\" (10A NCAC 41A .0206(b)). The supervising nurse and the designated staff members do so as follows, as the Agency’s own standard."],"list":[["Hand hygiene, protective equipment and bag technique are observed at every aide supervisory visit (Form NC-HH-AID-02-B) and at least once a year for every nurse and therapist during a joint visit."],["A sample of visit bags is checked each quarter for stock, cleanliness and expired supplies."],["The equipment log and cleaning records are checked each quarter."],["Results, with any retraining or corrective action, are reported to QAPI. Repeated failures are handled through the personnel process (Policy NC-HH-HR-01)."]],"ordered":false,"edited":false},{"heading":"16. 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"}],["Leads the program; is the designated infection control staff member for the main premises; completes the yearly risk assessment; reviews surveillance each month; leads investigations; makes sure reportable diseases are reported; reports to QAPI."]],[[{"k":"field","name":"people.alternateSupervisingNurse.name","text":"Casey Sample, RN"},", ",{"k":"field","name":"people.alternateSupervisingNurse.title","text":"Alternate Supervising Nurse"}],["Acts for the supervising nurse whenever he or she is unavailable."]],[["Designated infection control staff member at each other licensed premises"],["Directs infection control activities at that premises under 10A NCAC 41A .0206(b); completes the approved course; checks supplies and equipment records."]],[[{"k":"field","name":"people.administrator.name","text":"Pat Sample"},", ",{"k":"field","name":"people.administrator.title","text":"Administrator"}],["Designates the infection control staff members; provides supplies, protective equipment and training time at no cost to staff; reviews the program each year."]],[["Case managers"],["Record infections on the log; set transmission-based precautions; notify physicians; teach patients and caregivers."]],[["All visiting staff"],["Follow standard precautions and bag technique on every visit; clean equipment between patients; report signs of infection; stay home when ill."]]]},"edited":false},{"heading":"17. Records and Compliance Monitoring","body":["The infection surveillance log, monthly reviews, investigations and action plans, the yearly risk assessment, the designations of infection control staff members and their course certificates, equipment and cleaning logs, records of communicable disease reports, and the yearly program review are kept by the supervising nurse for at least six years, as the Agency’s own standard. Infection details are also recorded in each patient’s clinical record (Policy NC-HH-REC-01). Course certificates and training records are also kept in the personnel record, which 10A NCAC 13J .1003(f) requires to be kept at least one year after employment ends. Compliance monitoring results go to the QAPI program and the annual evaluation."],"edited":false},{"heading":"18. Staff Training","body":["Delivered as Section 14 describes. Designated infection control staff members complete the Department-approved course (Section 5). The supervising nurse and the alternate are also trained in surveillance methods, outbreak response, and North Carolina communicable disease reporting."],"edited":false},{"heading":"19. References","body":["This policy implements the following authorities."],"list":[["10A NCAC 13J .1003(a), (b) and (f)(6), Personnel (infection control, tuberculosis, pathogen training)"],["10A NCAC 13J .1004(a), Evaluation"],["10A NCAC 41A .0101, Reportable Diseases and Conditions; .0102, Method of Reporting"],["10A NCAC 41A .0201, Control Measures, General; .0211, Duties of Other Persons"],["10A NCAC 41A .0206, Infection Prevention, Health Care Settings"],["G.S. 130A-135, Physicians to report; G.S. 130A-137, Medical facilities may report"],["13 NCAC 07F .0101, General Industry (North Carolina adoption of 29 CFR Part 1910)"],["NC Medicaid Clinical Coverage Policy 3A, Home Health Services"],["42 CFR §484.70, Infection prevention and control"],["42 CFR §484.65, Quality assessment and performance improvement"],["42 CFR §484.80(b)(3) and (h)(4), Home health aide training and supervision"],["29 CFR §1910.1030, Bloodborne pathogens; 29 CFR §1910.134, Respiratory protection"],["45 CFR §164.512(b), Uses and disclosures for public health activities"]],"ordered":false,"edited":false},{"heading":"20. Related Policies and Forms","body":["The following documents are read together with this policy."],"table":{"caption":null,"headers":[["Reference"],["Title"]],"rows":[[["Policy NC-HH-IC-02"],["Bloodborne Pathogens Exposure Control Plan, Sharps, and Medical Waste"]],[["Policy NC-HH-HR-01"],["Personnel Policies, Job Descriptions, Qualifications, Orientation, In-Service Education, and Performance Evaluation"]],[["Policy NC-HH-HR-02"],["Personnel Records, Tuberculosis Screening, and Hepatitis B Documentation"]],[["Policy NC-HH-AID-01"],["Home Health Aide Qualifications, Training, Competency Evaluation, and Registry Listing"]],[["Policy NC-HH-AID-02"],["Home Health Aide Assignment, Care Instructions, and Supervisory Visits"]],[["Policy NC-HH-MED-02"],["Infusion Nursing and Pharmacy Services"]],[["Policy NC-HH-CS-04"],["Clinical Respiratory Services and Home Medical Equipment and Supplies"]],[["Policy NC-HH-CS-05"],["Laboratory Services and Waived Testing"]],[["Policy NC-HH-PR-04"],["Language Access, Accessibility, and Nondiscrimination"]],[["Policy NC-HH-PRV-01"],["HIPAA Privacy and Patient and Employee Confidentiality"]],[["Policy NC-HH-REC-01"],["Service Records: Content, Entries, Completion and Return, and Retention"]],[["Policy NC-HH-EP-01"],["Emergency Preparedness and Management of Emergency Care Situations in the Home"]],[["Policy NC-HH-QA-01"],["Annual Program Evaluation and 90-Day Client Record Review"]],[["Policy NC-HH-QA-02"],["Quality Assessment and Performance Improvement (QAPI)"]],[["Form NC-HH-IC-01-A"],["Infection Surveillance Log"]]]},"edited":false},{"heading":"21. 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":"22. 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 19 is amended, the amendment is recorded in this table and a new version of this policy is issued."],"edited":false}],"missing":[],"editedCount":0,"pack":"nc-hha","state":"North Carolina","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}}