Infection Control, Universal Precautions, and Communicable Disease

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 participants and staff from infection: it sets the precautions workers use in every home, keeps employees with a communicable condition away from participants, and makes sure reportable diseases are reported. Missouri does not license non-medical in-home services; these duties come from the MO HealthNet Personal Care Program rule (13 CSR 70-91.010(3)(C), (H)1), the in-home service standards (19 CSR 15-7.021(20)(E), (F)) and the communicable disease reporting rule (19 CSR 20-20.020).

This policy applies in every participant's home and in the Agency's office, to every employee, volunteer and contracted worker who has contact with participants, and to every participant, family member or employee who has, or may have, a communicable disease.

For the purposes of this policy:

"The provider agency must be available to provide care in accordance with the personal care plan, utilizing universal precaution procedures as defined by the Centers for Disease Control and Prevention." (13 CSR 70-91.010(3)(C))

The Agency's registered nurse and administrative supervisor "Establish, implement, and enforce a policy governing communicable diseases that prohibits provider staff contact with participants when the employee has a communicable condition including colds or flu" (19 CSR 15-7.021(20)(E); 13 CSR 70-91.010(3)(H)1), and assure compliance with the reporting requirements for communicable diseases, including hepatitis and tuberculosis, set by DHSS in 19 CSR 20-20.020 (19 CSR 15-7.021(20)(F)). The Agency complies with OSHA rules, "including the provision of medical supplies to ensure universal precautions, including, but not limited to, gloves" (MMAC In-Home Services Assurances item 20).

Workers use these precautions with every participant, whether or not the participant is known to have an infection. They are the Agency's own standards, following current CDC guidance, unless a rule is cited.

• Clean your hands when you arrive and before you leave; before and after touching the participant; before preparing food or helping with eating; after toileting or incontinence care; after touching anything soiled; and after removing gloves (29 CFR §1910.1030(d)(2)(v)).
• Wash with soap and running water, scrubbing all surfaces for at least 20 seconds, whenever your hands are visibly dirty or after contact with blood or body fluids. Otherwise you may use the alcohol-based hand rub in your kit.
• Keep nails short, and cover any cut or broken skin on your hands with a waterproof dressing before work.

• Wear gloves when you may touch blood, body fluids, mucous membranes or broken skin, and when handling soiled items, linens or surfaces: for example, perineal and incontinence care, oral and denture care, shaving, and cleaning bathrooms (29 CFR §1910.1030(d)(3)(ix)).
• Change gloves between tasks and between dirty and clean areas, and never wash or reuse disposable gloves.
• Wear a gown or apron, mask and eye protection when splashing or spraying of body fluids is likely (Policy MO-HC-IC-02).
• Wear a mask when the participant has a respiratory infection, or when the registered nurse or public health guidance says to.

• Clean surfaces soiled with blood or body fluids promptly, wearing gloves, using an EPA-registered disinfectant or a fresh bleach solution mixed as the label directs.
• Clean shared equipment, such as commodes, shower chairs and wheelchair arms, after each use if it is soiled.
• Never mix cleaning products. Open a window when using strong products.

• Handle soiled linen and clothing as little as possible, holding it away from your body, and put it straight into the washer or a bag.
• Wash the participant's soiled laundry separately in the warmest water the fabric allows, and wash your hands afterward.

• Bag soiled dressings, pads and gloves, tie the bag, and put it in the household trash.
• Participants manage their own lancets, pen needles and syringes. Workers do not handle used sharps. If a sharp is left out, the worker leaves it where it is, keeps others away, and tells the participant and the office. The registered nurse advises the participant on a puncture-resistant container (Policy MO-HC-IC-02).

When preparing meals, workers wash their hands first, keep raw meat apart from other food, cook and reheat food thoroughly, refrigerate leftovers promptly, and throw away food that is spoiled or past its date with the participant's permission. Basic sanitation practices are taught in orientation Session J (Policy MO-HC-HR-05).

Cover coughs and sneezes with a tissue or your elbow, throw tissues away, and clean your hands. Help a participant who coughs to do the same.

The Agency gives every worker the supplies needed for universal precautions, at no cost to the worker (MMAC In-Home Services Assurances item 20; 29 CFR §1910.1030(d)(3)(i)).

• Each worker receives a kit at orientation with disposable gloves (with latex-free gloves for anyone who needs them), alcohol-based hand rub, masks, a gown or apron, eye protection and disinfectant wipes (Agency standard).
• Workers ask the office for more supplies before they run low; the office restocks them within two business days (Agency standard).
• Workers never use the participant's own gloves or supplies in place of the Agency's unless there is no other choice, and then tell the office so the supplies can be replaced (Agency standard).

This is the Agency's communicable disease policy. No employee has contact with a participant while the employee has a communicable condition, including a cold or flu (19 CSR 15-7.021(20)(E); 13 CSR 70-91.010(3)(H)1; PC Manual §2.2).

1. Before the shift: an employee who has symptoms of a communicable condition calls the office before going to any participant's home, and does not go. Symptoms include fever or chills; a new cough, sore throat, or runny or stuffy nose with other cold or flu symptoms; vomiting or diarrhea; a rash with fever; a draining wound or skin infection; red, discharging eyes; or yellowing of the skin or eyes. An employee who has been diagnosed with a communicable disease, such as influenza, COVID-19, tuberculosis disease or hepatitis A, also calls before the shift (Agency standard list).
2. The administrative supervisor removes the employee from participant contact, records the call on Form MO-HC-IC-01-A, and arranges a replacement worker so that authorized services continue (Policy MO-HC-SVC-01).
3. During a visit: an employee who becomes ill makes the participant safe, puts on a mask, and calls the office. The administrative supervisor decides whether the employee leaves at once or stays until a replacement or family member arrives, so that no participant who needs supervision is left alone.
4. Return to work: the administrative supervisor, with the registered nurse's advice, decides when the employee may return, and records the decision. As the Agency's own standard, following current CDC guidance, an employee with a respiratory illness returns only when symptoms are improving and he or she has been free of fever for at least 24 hours without fever-reducing medication; an employee with vomiting or diarrhea returns when symptoms have stopped; and an employee with a diagnosed reportable disease returns only when the local health authority or the employee's health care provider has cleared him or her, where that is required.
5. No penalty: as the Agency's own standard, no employee is disciplined for staying away from participants because of a communicable condition, and absence for this reason is handled under the Agency's leave policies.
6. Information about an employee's illness is kept confidential and filed apart from the general personnel file (Agency standard).

19 CSR 20-20.020 lists the diseases and findings that must be reported to the local health authority or to DHSS, and how fast. "A physician, physician's assistant, nurse, hospital, clinic, or other private or public institution providing diagnostic testing, screening or care to any person with any disease, condition, or finding listed in sections (1)-(4) of this rule or who is suspected of having any of these diseases, conditions, or findings, shall make a case report to the local health authority or the Department of Health and Senior Services, or cause a case report to be made by their designee, within the specified time." (19 CSR 20-20.020(6))

• When any employee learns that a participant, a household member who has contact with workers, or an employee has, or may have, a disease listed in 19 CSR 20-20.020, the employee tells the registered nurse at once (Agency standard).
• The registered nurse checks the current list in 19 CSR 20-20.020, decides whether a report is required, and, where the participant's physician, hospital or laboratory has not already reported it, makes the case report or causes it to be made within the time in Table 1 (19 CSR 15-7.021(20)(F)).
• A case report includes the information in 19 CSR 20-20.020(7), such as the person's name, home address with zip code, date of birth, age, sex, race, home telephone number, the disease or finding diagnosed or suspected, the date of onset, the treating facility and attending physician, any laboratory results, the name and address of the reporter, and the date of the report. Disclosures required by law are permitted under the Agency's privacy policy (Policy MO-HC-PRV-01).
• The registered nurse records the report (date, time, person reported to and method) on Form MO-HC-IC-01-A and on Form MO-HC-SUP-03-A, and follows any instruction from the health authority.

The examples in Table 1 are taken from the rule text in effect on October 30, 2026 (amended effective February 28, 2023). The list changes from time to time; the registered nurse always checks the current rule.

Services continue for a participant who has an infection, with extra precautions where needed (Agency standards).

• When the Agency learns that a participant has an infection such as influenza, COVID-19, tuberculosis under treatment, MRSA, C. difficile, scabies or lice, the registered nurse gives the assigned workers written instructions on the precautions and protective equipment to use, and the office supplies them.
• The administrative supervisor tells DSDS and the participant's physician if the infection changes the participant's needs (Policy MO-HC-SP-02).
• Workers are told only what they need to know to protect themselves and the participant (Policy MO-HC-PRV-01).

Hepatitis B vaccination is offered to every employee with occupational exposure (Policy MO-HC-IC-02). As the Agency's own standard, the Agency encourages every employee who has contact with participants to receive seasonal influenza vaccine and the vaccines current public health guidance recommends.

No Missouri rule requires tuberculosis testing of in-home services workers; 19 CSR 20-20.100 applies to long-term care facilities and state correctional centers. The Agency does not require routine tuberculosis testing. As the Agency's own standard, the registered nurse requires an employee with symptoms of tuberculosis, or a known exposure, to be evaluated by a health care provider before returning to participant contact.

Accountability under this policy is allocated as follows.

Forms MO-HC-IC-01-A, records of reports made under 19 CSR 20-20.020, supply records, and training records are kept for the period in Policy MO-HC-REC-01; employee health information is kept confidentially and apart from the general personnel file. As the Agency's own standard, the registered nurse reviews all exclusions and reports each quarter for patterns, and the annual on-site evaluation observes each aide's hand hygiene and glove use (Policy MO-HC-SUP-02).

Workers are trained in infection control and universal precaution procedures as defined by the CDC, and in the communicable disease policy, in orientation Session D before their first participant contact, and again at in-service each year (PC Manual §2.4; Policy MO-HC-HR-05). APC aides are also trained in universal precautions in APC training (13 CSR 70-91.010(5)(E)4.L; Policy MO-HC-TRN-01). Nurses receive infection control and universal precautions in their general orientation (PC Manual §2.6).

This policy implements the following authorities.

• 13 CSR 70-91.010(3)(C), (3)(H)1, (5)(E)4.L (amended effective August 30, 2023)
• 19 CSR 15-7.021(20)(E), (F) (amended effective August 30, 2023)
• 19 CSR 20-20.020(1) to (4), (6), (7) (amended effective February 28, 2023); 19 CSR 20-20.100
• 29 CFR §1910.1030(b), (d)(2)(v), (d)(3)(i), (d)(3)(ix)
• MMAC In-Home Services Assurances item 20
• MO HealthNet Personal Care Provider Manual §§2.2, 2.3, 2.4, 2.6 (published August 10, 2026)

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 14 is amended, the amendment is recorded in this table and a new version of this policy is issued.