Infection Prevention and Standard Precautions 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 protects clients and workers of Sample Agency, LLC (the "Agency") from infections that can spread during care in the home. Michigan does not license non-medical home care agencies, so no state licensing rule sets infection control requirements for them. This policy follows the MI Choice Waiver chapter of the Michigan Medicaid Provider Manual, the Michigan occupational safety and health rules that bind every employer whose workers may contact blood or body fluids, CDC guidance, and the Agency's own standards, for every client and payer.

This policy applies to every visit to every client, in the client's home and in the community, and to every task a worker performs.

For the purposes of this policy:

"Each waiver agency and direct service provider must evaluate the occupational exposure of employees to blood or other potentially infectious materials that may result from the employee's performance of duties. Each waiver agency and direct service provider must establish appropriate standard precautions based upon the potential exposure to blood or infectious materials. Each waiver agency and direct service provider with employees who may experience occupational exposure must also develop an exposure control plan that complies with the Federal regulations implementing the Occupational Safety and Health Act." (MPM MI Choice Waiver §9.20.F) Michigan administers its own occupational safety and health plan; for Michigan employers the bloodborne pathogens standard is MIOSHA Part 554 (Policy MI-HC-IC-02).

"Universal precautions shall be observed to prevent contact with blood and other potentially infectious materials. If differentiation between body fluid types is difficult or impossible, all body fluids shall be considered potentially infectious materials." (Mich. Admin. Code R 325.70005)

Every worker uses standard precautions with every client, for every program, and the Agency supplies the protective equipment and hand hygiene products workers need at no cost to them.

• Clean your hands before and after contact with the client, before putting on and after taking off gloves, before handling food, after using the bathroom, and after touching anything soiled.
• Wear gloves whenever you may touch blood, body fluids, mucous membranes or broken skin, or items soiled with them (Section 7).
• Treat all blood and body fluids as potentially infectious (Mich. Admin. Code R 325.70005).
• Cover your own cuts and broken skin with a waterproof bandage before work.
• Cover coughs and sneezes, and follow Section 8 if you or the client has signs of a respiratory infection.
• Clean and disinfect surfaces and equipment as Section 9 describes; handle soiled laundry, waste and sharps as Sections 10 and 11 describe.
• Never eat, drink, smoke, apply cosmetics or lip balm, or handle contact lenses while doing a task where you may contact blood or body fluids (Mich. Admin. Code R 325.70007(g)).

• Wash with soap and running water when your hands are visibly dirty or soiled, after helping with toileting or incontinence care, and before handling food. CDC guidance is to scrub hands for at least 20 seconds and dry them with a clean towel.
• When hands are not visibly soiled, an alcohol-based hand sanitizer may be used. The Agency supplies sanitizer that meets current CDC guidance (at least 60 percent alcohol).
• "Employers shall ensure that employees wash their hands immediately or as soon as feasible after removal of gloves or other personal protective equipment." (Mich. Admin. Code R 325.70007(d))
• Wash hands and any other skin with soap and water, or flush mucous membranes with water, "immediately or as soon as feasible following contact of such body areas with blood or other potentially infectious materials" (Mich. Admin. Code R 325.70007(e)), and report the contact under Section 13.
• "When provision of handwashing facilities is not feasible, the employer shall provide either an appropriate antiseptic hand cleanser in conjunction with clean cloth/paper towels or antiseptic towelettes. When antiseptic hand cleansers or towelettes are used, employees shall wash hands with soap and running water as soon as feasible." (Mich. Admin. Code R 325.70007(c)) Workers carry Agency-supplied sanitizer and paper towels to every visit.

• When there is occupational exposure, the employer must provide appropriate PPE "at no cost to the employee" and assure that the employee uses it (Mich. Admin. Code R 325.70008(a)). The Agency supplies disposable gloves in each worker's size, and masks, eye protection, gowns or aprons as tasks require. "Hypoallergenic gloves, glove liners, powderless gloves, or other similar alternatives shall be readily accessible to employees who are allergic to the gloves normally provided." (Mich. Admin. Code R 325.70008(c))
• Wear gloves when there is "a reasonable anticipation of direct skin contact with blood, other potentially infectious material, mucous membranes, or nonintact skin" and when handling items or surfaces soiled with them (Mich. Admin. Code R 325.70008(f)). As the Agency's own standard, gloves are always worn for toileting and incontinence care, perineal care, oral care, shaving, catheter and ostomy care, wound and skin care, and cleaning bathrooms.
• "Disposable gloves shall not be washed or decontaminated for reuse." (Mich. Admin. Code R 325.70008(f)) Change gloves between tasks and between clean and dirty parts of the same task, and replace them at once if they tear.
• Wear a mask and eye protection, or a face shield, when splashes or sprays of blood or body fluids may occur (Mich. Admin. Code R 325.70008(h)), and a gown or apron when clothing may be soiled (Mich. Admin. Code R 325.70008(i)).
• "If a garment is penetrated by blood or other potentially infectious materials, the garment shall be removed immediately or as soon as feasible." (Mich. Admin. Code R 325.70007(b)) Take off PPE before leaving the work area and discard it in a closed bag (Mich. Admin. Code R 325.70007(a)).
• A worker who runs low on supplies tells the office before the next visit. A worker who has no gloves for a task that needs them does not do the task and calls the office.

• Cover your mouth and nose with a tissue or your elbow when you cough or sneeze, throw tissues away and clean your hands.
• Do not work with a fever, vomiting, diarrhea, an uncovered draining wound or a contagious rash or illness; call the office before your shift and follow Policy MI-HC-HR-04.
• If a client has signs of a respiratory infection or a known contagious illness, call the supervisor before or at the start of the visit. The supervisor or supervising nurse tells the worker which additional precautions to use (for example a mask for the worker and, if the client is willing, for the client), following current CDC guidance, and supplies the equipment.
• As the Agency's own standard, the Agency gives workers information about the vaccines CDC recommends for health care personnel and encourages workers to be vaccinated. Hepatitis B vaccination is offered under Policy MI-HC-IC-02.

• Clean the client's bathroom, kitchen surfaces and frequently touched surfaces as the care plan directs, and clean shower chairs, commodes and other equipment after each use.
• Clean up blood or body fluid spills at once: put on gloves, absorb the spill with paper towels, clean the area, then apply a disinfectant and leave it on for the contact time on the label. Put the waste in a closed plastic bag.
• "Broken glassware that may be contaminated shall not be picked up directly with the hands." Use a brush and dust pan, tongs or similar means (Mich. Admin. Code R 325.70009(2)(e)).
• Use only cleaning and disinfecting products as the label directs; never mix products. Direct service workers must be able to "safely use cleaning and cooking products" (MPM MI Choice Waiver §9.12.E).
• Clean and disinfect any Agency equipment a worker carries from home to home (for example a gait belt or thermometer) between clients, or use single-client items.

• "Laundry that is or may be soiled with blood or other potentially infectious material or that may contain contaminated sharps shall be treated as if it were contaminated and shall be handled as little as possible with a minimum of agitation." (Mich. Admin. Code R 325.70011(1))
• Wear gloves to handle soiled linen and clothing. Carry it away from your body, do not shake it, and put it straight into a bag or the washer.
• Wash soiled items separately from other laundry, following the care labels and the detergent directions.

• Put used gloves, soiled dressings, incontinence products and other soiled items in a plastic bag, close it and put it in the client's outside trash.
• If a client uses needles or lancets, the client or family keeps a puncture-resistant sharps container. As the Agency's own standard, workers do not handle the client's used sharps except, when the care plan allows, to drop a used sharp straight into that container. Never recap, bend or break a used needle (Mich. Admin. Code R 325.70007(f)). Never reach into a sharps container.
• Report any sharps left loose in the home to the supervisor, who discusses safe disposal with the client or family.
• Waste that is regulated waste under MIOSHA Part 554 is handled under Policy MI-HC-IC-02.

CLS workers must be "confident and competent" in "food preparation including safe and sanitary food-handling procedures" before serving MI Choice participants, as applicable (MPM MI Choice Waiver §4.1.D). Every worker who prepares food for any client follows the safe food handling procedures in Policy MI-HC-SVC-02, as the Agency's own standard. "Food and drink shall not be stored in refrigerators, freezers, shelves, cabinets, or on countertops or benchtops where blood or other potentially infectious material is present" (Mich. Admin. Code R 325.70007(h)).

1. Wash the area with soap and water at once; flush eyes, nose or mouth with clean water.
2. Make sure the client is safe, then call the supervisor immediately, even outside office hours.
3. The supervisor arranges a confidential medical evaluation and follow-up the same day under Policy MI-HC-IC-02.
4. Complete an incident report by the end of the shift (Policy MI-HC-INC-01).

Accountability under this policy is allocated as follows.

Supply orders and distribution to workers are recorded by the office, as the Agency's own standard. Supervisors record infection prevention practice on Form MI-HC-SUP-01-A. Exposure incidents and infections that may have spread between clients and workers are recorded as incidents (Policy MI-HC-INC-01), and the supervising nurse reviews them each quarter, as the Agency's own standard, and reports trends to the quality management program (Policy MI-HC-QM-01).

Every direct care worker is trained on this policy at orientation, before the first client visit, and at least once a year as part of in-service training, as the Agency's own standard (Policy MI-HC-HR-05). Hand hygiene and glove use are checked by return demonstration (Policy MI-HC-CMP-01). Bloodborne pathogens training follows Policy MI-HC-IC-02.

This policy implements the following authorities.

• Michigan Medicaid Provider Manual, MI Choice Waiver chapter (October 1, 2026), Sections 4.1.D, 9.12.E and 9.20.F
• Mich. Admin. Code R 325.70002, R 325.70005, R 325.70006, R 325.70007, R 325.70008, R 325.70009 and R 325.70011 (MIOSHA Part 554, Bloodborne Infectious Diseases)
• MCL 408.1011 (Michigan Occupational Safety and Health Act, employer duties)
• Centers for Disease Control and Prevention, current guidance on hand hygiene, standard precautions and infection control 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 law, rule or manual chapter cited in Section 17 is amended, the amendment is recorded in this table and a new version of this policy is issued.