Infection Control in the Home

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 sets out how Sample Agency, LLC (the "Agency") prevents the spread of infection between clients, staff and households when care is given in the home. It applies the Centers for Disease Control and Prevention (CDC) standard precautions to home care and carries out Ga. Comp. R. & Regs. 111-8-65-.10(2) and -.09(6)(a)4.

This policy applies to every visit in every service category, and to the Agency office.

For the purposes of this policy:

Every staff member uses standard precautions with every client, in line with current CDC guidance, and uses transmission-based precautions when the supervisor tells them a client has a known or suspected infection that calls for them.

No supervisor knowingly permits an employee who has been exposed to tuberculosis or hepatitis or diagnosed with the same to provide services to clients until it is determined that the employee is not contagious (111-8-65-.10(2)). Every employee is oriented on the obligation to report known exposure to tuberculosis and hepatitis to the Agency (111-8-65-.09(6)(a)4).

• Clean hands on arrival and before leaving the home; before and after touching the client; before preparing food or helping the client eat; before putting on and after removing gloves; after contact with blood, body fluids, soiled items or surfaces; and after using the toilet.
• Wash with soap and water, rubbing all surfaces for at least 20 seconds, as CDC guidance recommends, when hands are visibly soiled, after toileting care, before handling food, and when caring for a client with diarrhea or known Clostridioides difficile (C. diff) infection.
• Otherwise use alcohol-based hand rub, rubbing until hands are dry.
• If there is no running water, use alcohol-based hand rub or antiseptic towelettes and wash hands with soap and running water as soon as feasible (29 CFR §1910.1030(d)(2)(iv)).
• Keep nails short. Artificial nails are not worn by staff who give hands-on care, as the Agency's own standard. Cover cuts on hands with a waterproof dressing.

The Agency gives every staff member a supply of PPE and alcohol-based hand rub at no cost and replaces it on request. Staff put on PPE before the task and remove it before leaving the client's room, and do not reuse disposable items.

• Cover coughs and sneezes with a tissue or the elbow, dispose of the tissue, and clean hands.
• Encourage the client to do the same, and offer tissues and a waste container.
• Follow any current public health recommendations about masks, vaccination and respiratory illness that the Administrator issues to staff.

• Clean, then disinfect, surfaces that come into contact with body fluids, using an EPA-registered disinfectant supplied by the Agency or the client, following the label's directions. Use a household bleach solution only as the product label directs.
• Clean reusable equipment, such as a shower chair, commode or blood pressure cuff, after each use as the manufacturer directs.
• Handle soiled laundry with gloves, hold it away from the body, do not shake it, and wash it in the client's machine on the hottest setting the fabric allows. Soiled laundry is not taken out of the home.
• Bag soiled incontinence products and dressings, tie the bag and place it in the household trash, unless local rules say otherwise.
• Needles and other sharps that belong to the client are disposed of in a puncture-resistant container with a lid, such as an FDA-cleared sharps container or a heavy-duty plastic household container. Staff never recap, bend or break a needle, and do not carry sharps out of the home (Policy GA-HC-IC-02).

• Clean hands, surfaces and utensils before preparing food.
• Keep raw meat, poultry, seafood and eggs apart from ready-to-eat foods, and use separate cutting boards where possible.
• Cook food to safe internal temperatures and refrigerate leftovers promptly.
• Check dates and discard spoiled food with the client's agreement, and report a client who has no safe food to the supervisor.

1. When the Agency learns that a client has an infection that may call for transmission-based precautions (for example C. diff, MRSA in a draining wound, scabies, influenza, COVID-19 or tuberculosis), the supervisor, with the RN supervisor or the client's physician, decides the precautions and records them in the service plan.
2. The supervisor tells each assigned staff member before the next visit, gives the PPE needed, and, as the Agency's own standard, schedules the client's visit last in the day where possible.
3. A staff member who is pregnant or has a weakened immune system may ask not to be assigned, and the supervisor tries to reassign.
4. Staff report new signs of infection in a client, such as fever, a new cough, a red or draining wound, or diarrhea, to the supervisor the same day (Policies GA-HC-SVC-02 and GA-HC-SVC-03).

• A staff member with fever, vomiting, diarrhea, a draining skin lesion, a rash of unknown cause, or a respiratory infection does not work and calls the office before the visit. The supervisor decides when the staff member may return under Policy GA-HC-HR-04.
• A staff member who learns of exposure to tuberculosis or hepatitis, or is diagnosed with either, reports it to the supervisor before the next visit (111-8-65-.09(6)(a)4).
• The supervisor does not permit that employee to provide services to clients until it is determined that the employee is not contagious (111-8-65-.10(2)). The determination is made under Policy GA-HC-HR-04.
• A staff member exposed to blood or other potentially infectious materials at work follows the exposure incident steps in Policy GA-HC-IC-02 at once.

Hepatitis B vaccination is offered to staff with occupational exposure to blood under Policy GA-HC-IC-02. As the Agency's own standard, the Agency gives staff information each year about influenza and other vaccines that CDC recommends for health care personnel, and where to receive them. The Agency does not require vaccination beyond what law requires, and staff vaccination records given to the Agency are kept in the confidential medical section of the personnel record (Policy GA-HC-HR-03).

Accountability under this policy is allocated as follows.

Service plans record any transmission-based precautions. Staff illness, exposure reports and return-to-work determinations are kept in the confidential medical section of the personnel record under Policy GA-HC-HR-04 (111-8-65-.09(4)(c)4). Infections in clients that staff may have spread, and clusters of illness, are recorded as unusual occurrences under Policy GA-HC-QA-02 and kept for five years (111-8-65-.09(4)(d)).

At each supervisory visit and annual competency evaluation, the supervisor observes the staff member's hand hygiene and PPE use (Policies GA-HC-SUP-01 and GA-HC-SUP-02). As the Agency's own standard, the quality improvement program reviews infection-related incidents and PPE supply each quarter (Policy GA-HC-QA-01).

Infection control in the home is part of PCA training (111-8-65-.09(5)(c)1(iv)(VII); Policy GA-HC-TRN-01) and of companion and sitter training or demonstrated competency (111-8-65-.09(5)(d)2(ii); Policy GA-HC-TRN-02). Every employee is oriented on the obligation to report known exposure to tuberculosis and hepatitis (111-8-65-.09(6)(a)4). As the Agency's own standard, infection control is reviewed in every employee's annual training (Policy GA-HC-HR-05).

This policy implements the following authorities.

• Ga. Comp. R. & Regs. 111-8-65-.10(2), Supervision of Services
• Ga. Comp. R. & Regs. 111-8-65-.09(5)(c)1(iv)(VII) and (5)(d)2(ii), infection control training
• Ga. Comp. R. & Regs. 111-8-65-.09(6)(a)4, orientation on reporting exposure
• Ga. Comp. R. & Regs. 111-8-65-.09(4)(c)4, health screening program
• 29 CFR §1910.1030, Bloodborne Pathogens
• CDC, Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings (2007, as updated), and CDC hand hygiene guidance for 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 16 is amended, the amendment is recorded in this table and a new version of this policy is issued.