Infection Control 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 establishes how Sample Agency, LLC (the "Agency") prevents the spread of infection between clients, staff and households when care is given in clients' homes, and how it handles communicable disease in staff and clients. It implements 10A NCAC 13J .1003(a) and the North Carolina communicable disease control rules that apply to home care agencies.

This policy applies to all services the Agency provides in clients' homes and to every worker who provides them: in-home aides, companions, sitters, respite workers, homemakers and registered nurses.

For the purposes of this policy:

The Agency establishes and implements written policies on infection control and exposure to communicable diseases consistent with North Carolina's communicable disease control rules, including provisions for compliance with 29 CFR Part 1910 (10A NCAC 13J .1003(a)). North Carolina incorporates 29 CFR Part 1910 by reference in 13 NCAC 07F .0101, and the N.C. Department of Labor enforces it.

10A NCAC 13J .1003(a) refers to "Subchapter 19A of Title 15A". The North Carolina communicable disease control rules are now codified at 10A NCAC 41A (Communicable Disease Control), and the Agency follows the current rules there. Under them, "Health care workers and emergency responders shall, with all patients, follow Centers for Disease Control and Prevention Guidelines on blood and body fluid precautions incorporated by reference in 10A NCAC 41A .0201." (10A NCAC 41A .0206(d)) Every worker uses standard precautions with every client.

DHSR expects "Infection control policies with Employee risk categories identified {.1003 (a)}" (DHSR Home Care Initial Survey Checklist). The registered nurse supervisor keeps Form NC-HC-IC-01-A, which places every job classification in one of the categories in Table 1, made without regard to the use of protective equipment (29 CFR §1910.1030(c)(2)(ii)). The form is reviewed every year and whenever a position or task changes.

• Hand hygiene before and after contact with the client, before putting on and after taking off gloves, before preparing food or helping the client eat, after helping with toileting or touching soiled items, after cleaning, and before leaving the home. Hands that are visibly dirty are washed with soap and running water. Each worker carries alcohol-based hand rub and paper towels the Agency supplies, for homes without a clean sink or towel (29 CFR §1910.1030(d)(2)(iv)).
• Gloves for any contact with blood, body fluids, secretions, excretions, broken skin or mucous membranes, and for handling items soiled with them. Gloves are changed between tasks on the same client when moving from a dirty to a clean task, never washed or reused, and removed before touching clean surfaces.
• A gown or apron when clothing may be soiled, and a mask and eye protection when splashing or spraying may occur (Policy NC-HC-IC-02).
• Respiratory hygiene: covering coughs and sneezes, a mask for a worker with a mild cough who has been cleared to work, and offering a mask to a coughing client where the client will wear one.
• Workers do not wear artificial nails or long nails during hands-on care, keep their own cuts covered, and follow 10A NCAC 41A .0206(e): "Health care workers who have exudative lesions or weeping dermatitis shall refrain from handling patient care equipment and devices used in performing invasive procedures and from all direct patient care that involves the potential for contact of the patient, equipment, or devices with the lesion or dermatitis until the condition resolves."
• Workers do not share a client's personal care items (razors, toothbrushes, towels) with anyone else, and do not carry items from one client's home to another without cleaning them.

• Surfaces soiled with blood or body fluids are cleaned while wearing gloves, then disinfected with a household disinfectant used according to its label (Policy NC-HC-IC-02).
• Equipment the worker uses for the client (for example a shower chair, commode or gait belt) is cleaned after use as the manufacturer directs. A gait belt or other item the worker carries between homes is cleaned and disinfected after each client.
• Soiled laundry is handled with gloves, carried away from the body, not shaken, and washed promptly in the client's washer following the fabric label, kept apart from other laundry.
• Soiled briefs, dressings and gloves are placed in a plastic bag, tied and put in the household trash. Workers never handle loose needles or lancets (Policy NC-HC-IC-02).

As the Agency's own standard, workers who prepare food for clients wash their hands first, keep raw meat and ready-to-eat food apart, cook food thoroughly, refrigerate leftovers promptly, check dates, and discard spoiled food with the client's agreement. North Carolina's control measures require, for diseases transmitted by the fecal-oral route, exclusion from situations in which transmission can reasonably be expected, such as work as a paid food handler, for the duration of infectivity (10A NCAC 41A .0201(b)(3)). Because workers prepare clients' meals, a worker with such an illness does not work until cleared under Section 9.

The rules do not set work restrictions for home care workers. The restrictions below are the Agency's own standard, based on the communicable disease control principles in 10A NCAC 41A .0201(b) and current CDC guidance for health care personnel.

• A worker who has a fever, vomiting, diarrhea, a new cough with fever, flu-like illness, conjunctivitis ("pink eye"), a rash with fever, a draining wound or skin infection, or has been told by a health care provider that they have a contagious illness, calls the office before the shift and does not go to any client's home.
• The worker returns to client care only when: fever has been gone for at least 24 hours without fever-reducing medicine; vomiting and diarrhea have stopped for at least 48 hours; or the worker's health care provider, or the registered nurse supervisor after speaking with the worker, has cleared the worker in writing for other illnesses.
• A worker with symptoms of tuberculosis, such as a cough lasting more than three weeks, night sweats, fever or unexplained weight loss, is evaluated before returning to clients' homes (Policy NC-HC-HR-04).
• A worker who becomes ill during a visit makes sure the client is safe, tells the office, and leaves when a replacement or family member arrives or the registered nurse agrees.
• Work restrictions are applied consistently, and information about a worker's illness is kept confidential (Policy NC-HC-HR-04).

• When the registered nurse learns that a client has a communicable disease (for example influenza, COVID-19, norovirus, C. difficile, MRSA, shingles or scabies), the registered nurse writes any additional precautions on the assignment or task sheet and tells the assigned workers what they need to know to protect themselves and others, and no more (Policy NC-HC-PRV-01).
• Workers follow the additional precautions, which may include gowns and gloves for all care, a mask, dedicated equipment kept in the home, or scheduling the client last in the day.
• For lice, scabies or bed bugs, the registered nurse gives instructions on protecting the worker and avoiding carrying the problem to other homes, and refers the client and family to their health care provider or the local health department.
• If a client is reasonably suspected of having tuberculosis disease, the registered nurse contacts the client's physician and the local health department. Under 10A NCAC 41A .0205(h), a person with suspected or known infectious pulmonary or laryngeal tuberculosis is managed with airborne precautions, including respiratory isolation or isolation in the home with no new persons exposed. As the Agency's own standard, no worker enters the home until the registered nurse, after speaking with the health department, decides it is safe and the worker has any respirator required under Section 11.
• Unsanitary conditions that put the client at risk may be a sign of self-neglect and are handled under Policy NC-HC-ANE-01.

• As written, this manual does not require workers to wear respirators. If the registered nurse decides that a worker must wear a respirator (for example to care for a client with suspected infectious tuberculosis or during an outbreak), the Agency first meets 29 CFR §1910.134.
• "In any workplace where respirators are necessary to protect the health of the employee or whenever respirators are required by the employer, the employer shall establish and implement a written respiratory protection program with worksite-specific procedures." (29 CFR §1910.134(c)(1)) The program is administered by a suitably trained program administrator named by the Agency Director.
• Each worker who must wear a respirator has a medical evaluation to determine the ability to use one before being fit tested or using it (29 CFR §1910.134(e)(1)), and "is fit tested prior to initial use of the respirator, whenever a different respirator facepiece (size, style, model or make) is used, and at least annually thereafter" (29 CFR §1910.134(f)(2)).
• If workers choose to wear respirators when the Agency does not require them, the Agency gives them the information that 29 CFR §1910.134(c)(2) requires for voluntary use.

• The Agency provides hand rub, paper towels, gloves in the sizes workers need (including non-latex gloves), gowns or aprons, masks and eye protection at no cost to workers (29 CFR §1910.1030(d)(3)(i), (iii)).
• Each worker carries a supply kit, and the office restocks it on request. A worker who runs out of any item tells the office before the next visit.
• Supplies for a client with additional precautions may be kept in that client's home with the client's agreement.

• Physicians and laboratories report communicable diseases to public health. The Agency cooperates with the local health department and the State Health Director in any investigation, follows any control measures or isolation order that applies to a client or worker (10A NCAC 41A .0201(d)), and discloses information as the law allows (Policy NC-HC-PRV-01).
• The registered nurse may call the NCDHHS communicable disease telephone line, 919-733-3419 (24 hours a day, 7 days a week; NCDHHS assistance for clinicians and laboratories with communicable disease questions), or the local health department for advice on a communicable disease question.
• If the Agency ever performs invasive procedures (for example if it adds nursing services), it must meet the additional requirements of 10A NCAC 41A .0206(b) and (c), including a designated staff member who completes a Department-approved infection control course. The Agency does not perform invasive procedures under this manual.

Accountability under this policy is allocated as follows.

Form NC-HC-IC-01-A, worker illness and return-to-work records (in the confidential medical section of the personnel record), additional precaution instructions (in the client record) and any respiratory protection program records are kept as Policies NC-HC-HR-06 and NC-HC-REC-01 require.

As the Agency's own standard, the registered nurse supervisor keeps a log of worker illnesses and client infections reported to the Agency and reviews it each month to spot clusters. Infection control findings from supervisory visits, the illness log, and any exposure incidents are reviewed in the quality program (Policy NC-HC-QA-01), and this policy is reviewed each year with the exposure control plan (Policy NC-HC-IC-02).

Infection control, standard precautions and work restrictions are taught at orientation to every in-home caregiver and reviewed in annual in-service education, with the annual airborne and bloodborne pathogen update for hands-on care employees (10A NCAC 13J .1003(f)(6); Policy NC-HC-HR-05). If the Agency provides NC Medicaid personal care services, infection control training is documented in each aide's personnel record (NC Medicaid Clinical Coverage Policy 3L, §6.1.2(g)). Hand hygiene and glove use are observed at supervisory visits (Policies NC-HC-SUP-01 and NC-HC-SUP-02).

This policy implements the following authorities.

• 10A NCAC 13J .1003(a), (b), (f)(6), Personnel
• 15A NCAC 19A (as cited in 10A NCAC 13J .1003(a)); now 10A NCAC 41A, Communicable Disease Control
• 10A NCAC 41A .0201(a), (b), (d), Control Measures - General
• 10A NCAC 41A .0205(h), Control Measures - Tuberculosis
• 10A NCAC 41A .0206(a), (b), (d), (e), Infection Prevention - Health Care Settings
• 13 NCAC 07F .0101, General Industry (incorporating 29 CFR Part 1910)
• 29 CFR §1910.1030(c)(2), (d), Bloodborne pathogens
• 29 CFR §1910.134(c), (e), (f), Respiratory protection
• NC Medicaid Clinical Coverage Policy 3L, §6.1.2(g) (amended January 1, 2026)
• DHSR Home Care Initial Survey Checklist (Rev. 9/21): infection control policies with employee risk categories identified

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 or statute cited in Section 17 is amended, the amendment is recorded in this table and a new version of this policy is issued.