Infection Prevention and Control Program

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 the patients and staff of Sample Agency, LLC from infections that can spread during home visits, and makes sure infection risks are found early, acted on, and used to improve care.

This policy covers the infection control program and its policies, standard and transmission-based precautions, hand hygiene, personal protective equipment, bag technique, cleaning and disinfection of reusable equipment, supplies, staff illness, surveillance, outbreak investigation, education, and program review.

For the purposes of this policy, the following terms have the meanings below. In this policy "the Agency" means Sample Agency, LLC, and the state Agency for Health Care Administration is called "AHCA". Part III of chapter 400, Florida Statutes, chapter 59A-8, Florida Administrative Code, and 42 CFR Part 484 all use the word "patient" for a person who receives home health services (s. 400.462(26), F.S.; Rule 59A-8.002(20), F.A.C.). Chapter 408, Part II, F.S. uses "client" for anyone a licensee serves (s. 408.803(6), F.S.); where a Florida text says "client", it means the same person.

The director of nursing establishes "policies and procedures that are consistent with recommended Centers for Disease Control (CDC) and Occupational Safety and Health Agency (OSHA) guidelines for safety, universal precautions and infection control procedures" (Rule 59A-8.0095(2)(c)1., F.A.C.). Aide training includes basic infection control procedures such as hand hygiene, personal protective equipment, bag technique, and equipment disinfection (Rule 59A-8.0095(5)(c)4., F.A.C.), and aides perform hand hygiene consistent with current CDC guidance before administering medication (Rule 59A-8.0219(2)(e), F.A.C.). Every staff member follows standard precautions with every patient.

If 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). It follows accepted standards of practice, including standard precautions; maintains a coordinated agency-wide program for the surveillance, identification, prevention, control, and investigation of infectious and communicable diseases that is an integral part of its quality assessment and performance improvement (QAPI) program, with a method for identifying problems and a plan for actions expected to result in improvement and disease prevention; and provides infection control education to staff, patients, and caregivers (42 CFR §484.70(a)-(c)). The Agency applies these elements to all patients, as the Agency's own standard.

The director of nursing leads the program, as the Agency's own standard, and:

• Keeps this policy and the procedures under it (hand hygiene, PPE, bag technique, equipment cleaning, transmission-based precautions, specimen handling, and the Policy FL-HH-IC-02 exposure control plan) consistent with current CDC and OSHA guidance, and checks that guidance at each review.
• Makes sure PPE, hand sanitizer, disinfectant wipes approved for the equipment, and sharps containers are always stocked and given to field staff.
• Runs the surveillance in Section 13 and the outbreak response in Section 14.
• Reports infection control findings to the quality assurance program each quarter (Rule 59A-8.0095(2)(e), F.A.C.; Policy FL-HH-QA-01) and, if the Agency is Medicare-certified, to QAPI (Policy FL-HH-QA-02).

• Staff clean their hands on arrival, before and after touching the patient, before any clean or aseptic task (including medication administration and wound care), after any contact with body fluids, after removing gloves, after touching the patient's surroundings, and before leaving the home.
• Alcohol-based hand rub is used unless hands are visibly soiled, or the patient has a known or suspected infection for which current CDC guidance calls for soap and water; then staff wash with soap and running water and dry with paper towels they bring.
• Staff keep nails short and do not wear artificial nails during patient care, as the Agency's own standard.

• Gloves are worn when contact with blood, body fluids, mucous membranes, non-intact skin, or contaminated items is expected, and are changed between tasks and removed before touching clean items.
• Gowns, masks, and eye protection or face shields are worn when splashes or sprays are likely.
• When a patient is on droplet or airborne precautions, staff use the mask or respirator current CDC guidance calls for. A respirator such as an N95 is worn only by staff who have been medically evaluated and fit-tested under the respiratory protection program required by 29 CFR §1910.134 (Policy FL-HH-IC-03).
• PPE is put on before entering the care area and removed in the order the training teaches, followed by hand hygiene, and discarded in the home in a sealed bag or as Policy FL-HH-IC-02 requires.

1. Place the bag on a clean, dry, hard surface, on a barrier (such as a paper towel or clean pad), away from children and pets. Never place it on the floor or the bed.
2. Clean hands before opening the bag and before taking anything out.
3. Take out only what is needed for the visit and keep it on the barrier. Items that have been taken out and are not used are not returned to the bag unless they are clean and sealed.
4. Clean hands again before returning to the bag during the visit.
5. For a patient on contact precautions, leave the bag outside the care area or in the car and bring in only what is needed, or use disposable equipment that stays in the home.
6. Clean the outside of the bag when it is soiled, and the inside at least monthly, as the Agency's own standard.

• Reusable items such as stethoscopes, blood pressure cuffs, thermometers, pulse oximeters, and scales are cleaned and disinfected after each patient with an EPA-registered disinfectant used as the label directs (including the wet contact time), before they go back in the bag.
• For a patient on transmission-based precautions, dedicated or disposable equipment stays in the home where possible.
• Equipment owned by the patient or a supplier is cleaned according to the manufacturer's instructions, and the patient and caregiver are taught how.

When a patient has, or is suspected to have, an infection that spreads by contact, droplet, or air, the case manager adds the precautions to the plan of care and the aide assignment, tells every discipline before the next visit, schedules the patient's visits last in the day where possible, as the Agency's own standard, and teaches the household how to limit spread. Any suspected tuberculosis, measles, or other airborne disease is reported to the director of nursing the same day.

• A staff member with fever, vomiting, diarrhea, a new rash, a draining wound, conjunctivitis, or symptoms of a respiratory infection does not make patient visits and calls the scheduler before the first visit, as the Agency's own standard.
• The director of nursing decides when the staff member may return, following current CDC guidance for health care personnel, and may require a note from a health care provider.
• Staff tell the director of nursing of any diagnosis of a communicable disease that could put patients at risk; the information is kept confidential (Policy FL-HH-HR-05).

• Sterile and clean supplies are stored in the office in a clean, dry area off the floor, rotated by expiry date, and carried in the car in a closed clean container.
• Supplies left in a patient's home are used only for that patient.
• Specimens are collected as ordered, labeled at the bedside, placed in a sealed leak-proof bag, and taken to the laboratory as the laboratory directs, kept apart from clean supplies.

The director of nursing keeps the Infection Surveillance and Outbreak Log (Form FL-HH-IC-01-A), as the Agency's own standard:

• Clinicians report to the director of nursing any infection that a patient appears to develop during the Agency's care, including wound, urinary tract, catheter, intravenous line, and respiratory infections and any hospitalization for infection.
• Staff report any infection they may have acquired at work, and any exposure (Policy FL-HH-IC-02).
• Each month, the director of nursing reviews the log for patterns by type, discipline, staff member, and device, and looks for a cause in care practice.
• Each quarter, results and actions go to the quality assurance program (Policy FL-HH-QA-01).

1. The director of nursing confirms the cases, lists the patients and staff involved, and identifies any staff member who visited more than one case.
2. The director of nursing tells the Administrator and seeks advice from the county health department, and the Agency makes any report Florida law requires of it.
3. Control measures are put in place at once (for example, transmission-based precautions, staff restriction, dedicated staff, extra cleaning, and refresher training), and the patients' practitioners are told.
4. The director of nursing records the investigation and actions on Form FL-HH-IC-01-A and reviews the outbreak in quality assurance once it is over.

• Staff: infection control at orientation and at least once a year, including hand hygiene, PPE, bag technique, cleaning, and the exposure control plan (Policies FL-HH-HR-02, FL-HH-IC-02). Aides receive it in the 40-hour training (Rule 59A-8.0095(5)(c)4., F.A.C.). Each employee completes the one-time HIV and AIDS course within 30 days of employment (Rule 59A-8.0095(5)(r), F.A.C.; s. 381.0035, F.S.).
• Patients and caregivers: at admission and when a risk arises, the clinician teaches hand hygiene, care of any wound, catheter, line, or device, signs of infection and when to call, safe disposal of the patient's own sharps and waste (Policy FL-HH-IC-02), and cleaning of equipment in the home, and records the teaching in the clinical record.
• Supervisors check infection control practice at supervisory visits (Policy FL-HH-AID-02; 42 CFR §484.80(h)(4)(iv)).

Accountability under this policy is allocated as follows.

The director of nursing keeps the surveillance and outbreak log (Form FL-HH-IC-01-A), outbreak investigations, and the quarterly infection control reports. Patient teaching and precautions are recorded in the clinical record (Policy FL-HH-REC-01). Training records are kept in personnel files (Policy FL-HH-HR-04). Infection data are kept with the quality assurance records (Policy FL-HH-QA-01).

All field staff are trained in this policy at orientation and each year, with a hand hygiene and bag technique demonstration observed by a registered nurse, as the Agency's own standard. Office staff are trained in Section 11.

This policy implements the following authorities.

• s. 381.0035, Florida Statutes, Educational course on HIV and AIDS
• Rule 59A-8.0095(2)(c) and (e), F.A.C., Director of Nursing: infection control policies; quality assurance
• Rule 59A-8.0095(5)(c)4. and (r), F.A.C., Aide training in infection control; HIV and AIDS education
• Rule 59A-8.0219(2)(e), F.A.C., Medication Administration: hand hygiene
• 29 CFR §1910.134, Respiratory protection
• 42 CFR §484.70, Infection prevention and control
• 42 CFR §484.80(h)(4), Supervision of home health aides: infection prevention and control
• Centers for Disease Control and Prevention, current guidelines for standard and transmission-based precautions, hand hygiene, and infection control in health care personnel

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 rule cited in Section 19 is amended, the amendment is recorded in this table and a new version of this policy is issued.