Universal Precautions, Infection Control, and Employee Health

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 workers from infection by setting the precautions every worker uses in every home, keeping sick workers away from clients, and making sure signs of illness and possible outbreaks are reported quickly.

This policy applies to every client and every worker of Sample Agency, LLC, in every home and community setting where services are given.

For the purposes of this policy:

The Agency has, implements and follows a written policy on universal precautions, approved by the owner or governing body. (LAC 48:I.5029.B.11) Its personnel policies are, at a minimum, consistent with Office of Public Health guidelines for the services provided. (LAC 48:I.5029.C.3) Every direct care worker is trained in universal precautions, and in detecting signs of illness or impairment that warrant medical or nursing intervention, before providing direct care (LAC 48:I.5055.H.1.g, k; Policy LA-HC-TRN-01).

Every worker, with every client, every visit:

• treats all blood and body fluids as if infectious;
• cleans hands as Section 6 requires;
• wears gloves whenever touching blood, body fluids, mucous membranes, non-intact skin, or soiled items or surfaces, and other PPE when splashing is possible (Section 7);
• covers the worker's own cuts or broken skin with a waterproof dressing before the visit;
• handles soiled linens and clothing as little as possible (Section 8);
• never recaps, bends or breaks a needle and never handles a sharp by hand (Policy LA-HC-IC-02); and
• cleans surfaces and reusable equipment that become soiled (Section 8).

These are the Agency's own standards, consistent with CDC guidance.

• Workers clean their hands on arrival and before leaving; before and after hands-on care; before preparing food or helping a client eat; after toileting, incontinence care or touching soiled items; after removing gloves; and after coughing, sneezing or blowing the nose.
• Hands are washed with soap and running water for at least 20 seconds when visibly soiled and after caring for a client with diarrhea. Otherwise an alcohol-based hand rub may be used.
• Employees wash their hands immediately or as soon as feasible after removal of gloves or other PPE (29 CFR §1910.1030(d)(2)(v)). Where a sink is not available, workers use an antiseptic hand cleanser with clean cloth or paper towels, or antiseptic towelettes, and wash with soap and running water as soon as feasible (29 CFR §1910.1030(d)(2)(iv)).
• Workers keep nails short and do not wear artificial nails while giving hands-on care.

• The Agency provides gloves, alcohol-based hand rub, gowns or aprons, masks and eye protection, and a CPR barrier, at no cost to the worker (29 CFR §1910.1030(d)(3)(i)). Hypoallergenic gloves are available for workers who are allergic to the gloves normally provided (§1910.1030(d)(3)(iii)).
• Disposable gloves are changed between tasks and between clients, replaced when torn, and never washed or reused (§1910.1030(d)(3)(ix)(A), (B)).
• A gown or apron is worn when clothing may be soiled, and a mask with eye protection when splashes, spray or droplets of blood or body fluids may reach the face (§1910.1030(d)(3)(x), (xi)).
• As the Agency's own standard, a worker caring for a client with a respiratory infection, or during a declared outbreak, wears a mask, and follows any additional precautions the client's physician, the Office of Public Health or the Agency directs.
• PPE is removed before leaving the client's home and thrown away in the household trash in a closed bag, unless Policy LA-HC-IC-02 requires otherwise.

These are the Agency's own standards for infection prevention during the tasks workers do most.

Chapter 50 does not set an employee health or tuberculosis testing schedule for HCBS providers. The employee health program below is the Agency's own standard, written to be consistent with Office of Public Health and CDC guidance for health care personnel (LAC 48:I.5029.C.3). It is recorded on Form LA-HC-IC-01-A, which is kept in a confidential employee health file separate from the personnel file.

• After a conditional job offer and before client contact, each direct care worker completes a health questionnaire about the ability to perform the essential functions of the job, with or without reasonable accommodation. Medical information is collected and kept as 29 CFR §1630.14 allows: on separate forms, in separate medical files, and treated as confidential.
• The same questions are asked of every new direct care worker.

As the Agency's own standard, consistent with the 2019 CDC and National Tuberculosis Controllers Association recommendations for health care personnel:

• Before client contact, each direct care worker completes an individual tuberculosis risk assessment and symptom evaluation, and a tuberculosis test (a blood test or a skin test) unless the worker has documented prior tuberculosis disease or latent infection.
• A worker with a positive test or symptoms has a medical evaluation, including a chest X-ray, and does not have client contact until a health care provider states in writing that the worker does not have infectious tuberculosis.
• Workers are not retested every year unless there is a known exposure or ongoing transmission. A worker exposed to tuberculosis is tested as the Office of Public Health or the worker's health care provider directs.
• A worker with untreated latent tuberculosis infection completes a symptom screen every year and is encouraged to take treatment.
• Every direct care worker receives tuberculosis education every year (Policy LA-HC-TRN-02).

• Hepatitis B vaccination is offered to every worker with occupational exposure as Policy LA-HC-IC-02 requires.
• As the Agency's own standard, the Agency encourages and helps workers get an influenza vaccine each year and other vaccines CDC recommends for health care personnel, and records what workers choose to share on Form LA-HC-IC-01-A.
• No vaccine other than one required by law is a condition of employment unless the governing body decides so in writing after legal advice, and any such rule allows the exemptions the law requires.

These are the Agency's own standards.

• A worker who has a fever, vomiting, diarrhea, a new rash, draining sores, or a new cough with fever calls the supervisor before the shift and does not go to any client's home. The supervisor sends a back-up worker (Policy LA-HC-SP-02).
• The worker may return when free of fever for at least 24 hours without fever-reducing medicine and free of vomiting and diarrhea for at least 48 hours, or sooner if a health care provider clears the worker in writing, and follows any return-to-work instruction from the Office of Public Health for a reportable disease.
• No worker is disciplined for staying home because of a contagious illness and reporting it as this section requires.

Workers watch for signs of illness or impairment that warrant medical or nursing intervention (LAC 48:I.5055.H.1.k), such as fever, chills, a new cough or shortness of breath, burning or cloudy urine, new confusion, diarrhea or vomiting, a red, warm or draining wound, or skin breakdown.

• The worker reports any change in the client's condition to the supervisor immediately upon discovery (LAC 48:I.5055.G.3). The Agency ensures an observable significant change is immediately reported so that the client receives needed medical attention by a licensed medical practitioner in a timely manner (LAC 48:I.5039.B.6; Policy LA-HC-SP-03).
• If the client is in danger, the worker calls 911 first (Policy LA-HC-SAF-02).
• The worker records what was seen and reported in the progress note (Policy LA-HC-REC-02).

The Louisiana Sanitary Code places the duty to report reportable diseases and conditions on physicians (LAC 51:II.105.A) and on nurses, social workers and "any other health care professional" who has examined, evaluated, is attending or has knowledge of a case (LAC 51:II.105.C). Class A conditions, which include outbreaks of any infectious disease, are reported to the Office of Public Health no later than 24 hours from recognition (LAC 51:II.105.D.1).

• Direct care workers are not named reporters. A worker who learns that a client, household member or co-worker has a contagious disease, or sees several people in a home or on the worker's schedule with the same illness, tells the supervisor the same day.
• A licensed health care professional on the Agency's staff, such as a registered nurse or social worker, meets that professional's own reporting duty under LAC 51:II.105.C. The route is: Louisiana Department of Health, Office of Public Health, Infectious Disease Epidemiology: the regional epidemiologist during business hours (section phone 504-568-8313); the on-call epidemiologist at 1-800-256-2748 during non-business hours, weekends and holidays.
• The Administrator cooperates with the Office of Public Health, follows its instructions on precautions, exclusion of workers and notice to clients, and shares only the information public health needs (Policy LA-HC-PRV-01).
• A widespread infectious disease emergency is managed under the all-hazards plan (Policy LA-HC-EP-01).

• Each direct care worker receives a kit with gloves in the right size, alcohol-based hand rub, masks, a gown or apron, eye protection, a CPR barrier and waterproof dressings at no cost, and gets more from the office or the supervisor when needed.
• Supervisors check the kit at supervisory visits (Policy LA-HC-SUP-01).

Accountability under this policy is allocated as follows.

Form LA-HC-IC-01-A and health screening records are kept in the confidential employee health file. As the Agency's own standard, supervisors record hand hygiene and glove use on each supervisory visit (Form LA-HC-SUP-01-A), and each quarter the Administrator reviews reported infections, worker illnesses and supply problems with the quality enhancement committee (Policy LA-HC-QE-01).

Universal precautions and detecting signs of illness are part of the 16 hours of training before providing care (LAC 48:I.5055.H.1.g, k; Policy LA-HC-TRN-01). Tuberculosis education and an infection prevention refresher are given every year (Policy LA-HC-TRN-02).

This policy implements the following authorities.

• LAC 48:I.5029.B.11, C.3, Policy and Procedures
• LAC 48:I.5039.B.3, B.6, General Provisions (assessment; changes in status)
• LAC 48:I.5055.G.3, H.1.g, H.1.k, Core Staffing Requirements
• LAC 51:II.105, Reportable Diseases and Conditions (Louisiana Sanitary Code)
• 29 CFR §1910.1030, Bloodborne pathogens (definitions; hand hygiene; PPE; housekeeping; laundry)
• 29 CFR §1630.14, Medical examinations and inquiries (Americans with Disabilities Act)
• Tuberculosis Screening, Testing, and Treatment of U.S. Health Care Personnel: Recommendations from the National Tuberculosis Controllers Association and CDC, 2019 (MMWR 2019;68(19))

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.