An infection control policy sets out how your agency stops infections from spreading between clients, staff and families in the home. It should cover hand hygiene and standard precautions, protective equipment, equipment and supplies, sharps and waste, staff health and tuberculosis screening, what to do after a needlestick or other exposure, reporting diseases to public health, tracking infections, and training. Home health agencies and hospices must meet federal infection control rules, any employer whose staff may be exposed to blood needs a written exposure control plan under OSHA, and states add rules of their own.
What to include
- Standard precautions for every client: hand hygiene before and after each contact and after removing gloves, and gloves for any contact with blood, body fluids or broken skin.
- Protective equipment: when staff wear gowns, masks and eye protection, for example when splashing is likely or someone has respiratory symptoms, and how staff get more supplies.
- Extra precautions when a client has a known or suspected infection that spreads by contact, droplets or the air.
- Equipment and supplies: cleaning reusable equipment between clients, and how staff carry supplies from home to home.
- Sharps and waste: sharps containers, and disposal under your state's medical waste rules.
- Staff health: tuberculosis screening, hepatitis B vaccination for staff exposed to blood, and when a sick staff member stays away from clients.
- Exposures: what a staff member does after a needlestick or splash, and the confidential medical follow-up.
- Reporting: which diseases are reported to the local health department, and what staff do in an outbreak.
- Tracking: logging infections among clients and staff, and acting on what the log shows.
- Training: for staff at hire and on a regular schedule, and teaching for clients and families.
What federal rules require
- Home health (42 CFR §484.70) and hospice (42 CFR §418.60): follow accepted standards of practice, including standard precautions; keep an agency-wide program to identify, prevent, control and investigate infections, as an integral part of the QAPI program; and give infection control education to staff, patients and caregivers.
- Bloodborne pathogens (29 CFR §1910.1030), for any employer whose staff may be exposed to blood or other potentially infectious materials: a written exposure control plan, reviewed and updated at least once a year; hepatitis B vaccination offered at no cost within 10 working days of initial assignment; a confidential medical evaluation and follow-up straight after an exposure; and training at the start and at least once a year after that.
- California and Michigan run their own versions of the bloodborne pathogens standard (8 CCR §5193 and Mich. Admin. Code R 325.70001 to R 325.70018).
What some state rules add
| State | What the rule adds | Rule |
|---|---|---|
| Texas, all licensed agencies | Written infection control policies that follow the state's communicable disease law, the OSHA bloodborne pathogens standard and the state law on preventing HIV and hepatitis B transmission, and a record of any infection a client says they acquired while receiving services | 26 TAC §558.285 |
| California, home care | Each home care aide is examined for tuberculosis within 90 days before or 7 days after starting, with documentation before working with clients, and again at least every two years after a negative test | Cal. Health & Safety Code §1796.45 |
| Georgia, private home care | A health screening program for staff who work with clients, tuberculosis screening under CDC guidance before starting work, and no client contact for staff exposed to or diagnosed with tuberculosis or hepatitis until they are found not to be contagious | Rule 111-8-65-.09(4)(c)4 and -.10(2) |
| Pennsylvania, home care | Before client contact, documentation of tuberculosis screening dated no more than a year before the start date, updated at least every 12 months | 28 Pa. Code §611.56 |
| North Carolina, home care | A baseline tuberculosis skin test for hands-on care staff, proof of noninfectious status before assignment for anyone who tests positive, and a yearly symptom check for anyone who has tested positive before | 10A NCAC 13J .1003(b) |
Each state's manual sets out the infection control, screening and disease reporting rules for that license: see the policy manuals by state.
Questions a surveyor may ask
- Show me your written exposure control plan and the date it was last reviewed.
- Show me the tuberculosis screening record for a caregiver hired this year.
- How do your staff clean their hands in a client's home if there is no soap or running water?
- How do you identify infections in your clients, and what did you do about the last trend you found?
- Who reports communicable diseases to the health department, and how fast?
Surveyors also ask staff directly, for example when they wear gloves or what they do if a client has a new cough and fever, so train staff on the policy and have them read and sign it. See how read-and-sign works.
Next step
Every Cura Core manual includes an infection control policy and a bloodborne pathogens exposure control plan, written to your state's rules. Pick your state and license on the policy manuals by state page and read three of its policies free.