Infection Control, Standard Precautions, and Facial Coverings

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.

This policy protects clients and staff of Sample Agency, LLC (the "Agency") from infection, using practices that fit care in a private home, and keeps the Agency within Florida's laws on facial coverings and vaccination.

This policy applies to all staff under both a home health agency license (NSHHA) and a homemaker and companion registration (HMC), in clients' homes, in vehicles and at the Agency's office.

For the purposes of this policy:

Every staff member uses the practices in this policy on every visit. Rule 59A-8.0095(2)(b)-(c), F.A.C., which requires a director of nursing to set infection control and biomedical waste policies, applies to agencies that provide nursing and therapy and have a director of nursing; this Agency is not required to have one ("An agency that does not provide skilled care is not required to have a director of nursing.", Rule 59A-8.0095(2)(i)). As its own standard, the Agency follows CDC standard precautions, and it meets the OSHA bloodborne pathogens standard as an employer (Policy FL-HC-IC-02). The Agency does not require anyone to wear a facial covering unless it has first adopted and published a facial covering policy under Section 14.

Clean your hands:

• When you arrive and before you leave each home.
• Before and after touching the client, before preparing food, and before helping with eating or medication.
• After touching blood, body fluids, soiled linen, briefs or waste, after cleaning the bathroom, and after taking off gloves: "Employers shall ensure that employees wash their hands immediately or as soon as feasible after removal of gloves or other personal protective equipment." (29 CFR §1910.1030(d)(2)(v))
• After using the toilet, blowing your nose, coughing or sneezing.

Use soap and running water when hands are visibly dirty, after contact with blood or body fluids, and after caring for a client with diarrhea; otherwise an alcohol-based hand sanitizer may be used. Where soap and running water are not available, use the Agency-supplied antiseptic hand cleanser or towelettes and wash with soap and water as soon as feasible (29 CFR §1910.1030(d)(2)(iv)). The CDC recommends washing for at least 20 seconds and using a sanitizer with at least 60 percent alcohol; the Agency adopts both as its own standard. Keep nails short; as the Agency's own standard, direct care staff do not wear artificial nails.

• The Agency gives staff, free of charge, the gloves and other PPE their tasks need, in the right sizes, including non-latex gloves for anyone allergic (29 CFR §1910.1030(d)(3)(i), (iii)). Staff carry a supply to every visit.
• Wear gloves for any contact with blood, body fluids, mucous membranes, broken skin, briefs, soiled linen or waste, and for cleaning bathrooms and commodes.
• Change gloves between tasks (for example after toileting care and before helping with a meal), wash hands, and never reuse or wash disposable gloves.
• Wear a gown or apron when clothing may be soiled, and a mask and eye protection when splashing of blood or body fluids may happen.
• Take off PPE before leaving the work area, bag it, and put it in the household trash; remove any garment soaked by blood as soon as possible (29 CFR §1910.1030(d)(3)(vi)-(vii)).

As the Agency's own standard, staff who carry equipment (for example a blood pressure cuff, thermometer, gait belt or supply bag):

• Place the bag on a clean, dry, hard surface on a paper towel or other barrier, never on the floor or the bed.
• Clean hands before reaching into the bag, take out only what is needed, and never put a used item back in the bag until it is cleaned.
• Clean and disinfect reusable equipment after each client with an EPA-registered disinfectant wipe, following the label contact time, before putting it back in the bag.
• Use the client's own equipment where the client has it, and do not take a client's equipment to another home.

• Clean surfaces that are touched often (bathroom fixtures, commode, bed rails, light switches, tables) as the task plan or assignment directs (Rule 59A-8.0095(5)(l)2, (12)(a)1, F.A.C.).
• Clean up blood or body fluids at once: wear gloves, absorb with paper towels, clean the surface, then disinfect it with a product labeled for the purpose, and put the waste in a sealed bag (29 CFR §1910.1030(d)(4)(ii)). A homemaker or companion who has not been trained for this tells the office (Policy FL-HC-IC-02).
• Use only products the client supplies or the Agency provides, as labeled, and never mix bleach with ammonia or other cleaners (Agency's own standard).

• Handle soiled linen and clothing with gloves, as little as possible, holding it away from your body; do not shake it (29 CFR §1910.1030(d)(4)(iv)(A)). Carry it to the washer in a bag or basket.
• Wash as the fabric label directs, using detergent and the warmest suitable water, and dry completely (Agency's own standard).
• Wash dishes in hot, soapy water or the dishwasher, and let them air dry.

Staff never give injections (Policy FL-HC-SVC-05). Some clients use their own lancets, pen needles or syringes. Staff:

• Never recap, bend, break or remove a needle (29 CFR §1910.1030(d)(2)(vii)).
• Place a used lancet or needle the client hands over, or one used during glucometer assistance, straight into the client's puncture-resistant sharps container. If the client has none, the staff member tells the office, and the RN supervisor or Administrator talks with the client or family about getting one.
• Never pick up a loose needle with bare hands; use tongs or another tool, or leave it and tell the client and the office.
• Report any needlestick at once and follow Policy FL-HC-IC-02.

Gloves, briefs, pads and used wipes go into a plastic bag that is tied shut and placed in the household trash, unless the client's provider has given other instructions. As a non-skilled agency, the Agency does not generate the biomedical waste addressed by the biomedical waste policy Rule 59A-8.0095(2)(b), F.A.C., requires of agencies providing nursing and physical therapy. An item soaked with blood is double-bagged and the staff member tells the office, and the Administrator decides how it is handled.

• Cover coughs and sneezes with a tissue or your sleeve, throw the tissue away, and clean your hands.
• Staff do not work while they have the illnesses listed in Policy FL-HC-HR-05, Section 7, and call the office as early as possible so the visit can be covered (Policy FL-HC-SVC-01).
• If a client has signs of a contagious illness (fever with cough, vomiting, diarrhea, a new rash), tell the office. The RN supervisor (licensed agency) or Administrator decides what extra precautions staff use, and tells each staff member who serves the client before the next visit.
• Any staff member may choose to wear a mask at any time.

As the Agency's own standard, when two or more clients or staff have the same contagious illness, or the Florida Department of Health or the county health department issues a public health notice that affects home care, the Administrator: tells the staff and clients affected what precautions to take; asks the county health department for advice where needed; and records the actions taken. During a declared emergency or epidemic, the emergency management plan applies (Policy FL-HC-EP-01).

Florida restricts when anyone may be required to wear a facial covering. Sections 14.1 to 14.3 set out the law, the Agency's standing position, and what the Agency must do before it requires a facial covering in any case.

Florida law bars a business from requiring a person to wear a facial covering (s. 381.00316(5)(a), F.S.), except a health care provider "in compliance with" s. 408.824, F.S., and except where a facial covering "is required safety equipment consistent with occupational or laboratory safety requirements" (s. 381.00316(5)(b)). Under s. 408.824(3), a health care provider that "requires any individual to wear a facial covering for any reason" must have facial covering policies and procedures that comply with the standards in Rule 59A-35.125, F.A.C., and that "must be accessible from the home page of such health care practitioner's or health care provider's website or conspicuously displayed in the lobby of its health care service setting or settings."

Unless the governing body has adopted a facial covering policy under Section 14.3, which is then posted as Section 14.3 requires:

• The Agency does not require any client, visitor or staff member to wear a facial covering, and does not deny service to, or treat differently, anyone who does not wear one.
• Any client or staff member may choose to wear one, and the Agency supplies masks to staff who want them.
• A client may ask that staff wear a mask in the home. The Agency passes on the request; a staff member who chooses not to wear one is not disciplined, and the Agency may offer the client another staff member who is willing.
• Protective equipment that the OSHA bloodborne pathogens standard requires for a task (for example a mask and eye protection where splashing of blood is likely) is required safety equipment, and staff wear it (s. 381.00316(5)(b)2; 29 CFR §1910.1030(d)(3)).

If the governing body decides to require facial coverings in any case, it first adopts a written facial covering policy that follows Rule 59A-35.125, F.A.C., and posts it on the home page of the Agency's website or displays it conspicuously in the lobby of its office (s. 408.824(3), F.S.). The policy may only require:

• A client to wear a facial covering "only when the patient is in a common area of the health care setting and is exhibiting signs or symptoms of or has a diagnosed infectious disease that can be spread through droplet or airborne transmission." (Rule 59A-35.125(2))
• A visitor to wear one only in the cases listed in Rule 59A-35.125(3)(a)-(d), for example when the visitor has signs or symptoms of such a disease, or is visiting a client whose treating practitioner has diagnosed a condition affecting the immune system and determined that facial coverings are necessary for the client's safety.
• A staff member to wear one only where the staff member cannot opt out under Rule 59A-35.125(5): conducting sterile procedures; working in a sterile area; working with a client whose treating practitioner has diagnosed or confirmed a condition affecting the immune system and determined facial coverings are necessary for the client's safety; being with a client on droplet or airborne isolation; or engaging in non-clinical potentially hazardous activities that require facial coverings under industry standards. In every other case "Health care practitioners and health care providers must allow an employee to opt out of facial covering requirements" (Rule 59A-35.125(5)).

A policy that requires a facial covering for any client must include an opt-out provision that is "in accordance with the Florida Patient Bill of Rights and Responsibilities, section 381.026, F.S." (Rule 59A-35.125(4)(a)); a policy that requires one for any visitor must include an opt-out "if an alternative method of infection control or infectious disease prevention is available" ((4)(b)). The Administrator reviews the policy before it is adopted and keeps the posted copy current.

• The Agency encourages vaccination and gives staff information about vaccines recommended for health care personnel.
• The Agency does not require any person to provide documentation of vaccination with a COVID-19 vaccine, an emergency use authorization vaccine or a messenger RNA vaccine, or of postinfection recovery from COVID-19, or require a COVID-19 test, to receive services or as a condition of hiring or continued employment (s. 381.00316(3)(a), F.S.; Policy FL-HC-HR-05, Section 8).
• The hepatitis B vaccine is offered free to staff with occupational exposure under the OSHA standard and may be declined (Policy FL-HC-IC-02).

Accountability under this policy is allocated as follows.

Supervisory visit and contact records note infection control practice (Policy FL-HC-SUP-01). Outbreak actions are recorded by the Administrator. If a facial covering policy is adopted, the governing body's approval, the policy and proof of posting are kept with this policy. As the Agency's own standard, the quality assurance program (Policy FL-HC-QA-01) reviews infection-related incidents and staff illness absences each quarter.

All staff learn this policy at orientation (Policy FL-HC-HR-06) and in annual training (Policy FL-HC-TRN-02). Home health aides learn infection control in the 40-hour course (Rule 59A-8.0095(5)(c)4). Supervisors watch hand hygiene and glove use at supervisory visits and retrain on the spot when needed.

This policy implements the following authorities.

• Rule 59A-8.0095(5)(c)4, (5)(l)2, (12)(a)1, F.A.C.
• Rule 59A-8.0095(2)(b)-(c), (i), F.A.C.
• s. 408.824, F.S., Facial covering requirements for health care practitioners and health care providers
• Rule 59A-35.125, F.A.C., Standards for the appropriate use of facial coverings for infection control
• s. 381.00316, F.S., Discrimination based on health care choices; facial coverings and vaccination
• 29 CFR §1910.1030(d), Methods of compliance
• Centers for Disease Control and Prevention, Core Infection Prevention and Control Practices for Safe Healthcare Delivery in All Settings (guidance)

The following documents are read together with this policy.

This policy is adopted by the governing body of 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.

Every version of this policy, the date it took effect, a summary of what changed, and who approved it is recorded below. Where a statute or rule cited in Section 19 is amended, the amendment is recorded in this table and a new version of this policy is issued.