Infection Prevention and Standard Precautions

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, who are often older or medically fragile, and staff from infections passed during care in the home, by making standard precautions part of every visit.

This policy applies to every visit by Sample Agency, LLC staff to a client's home, and to Agency equipment, supplies and offices.

For the purposes of this policy, the following terms have the meanings below. Ohio Revised Code Chapter 3740 and Ohio Administrative Code Chapter 3701-60 call the person served a "patient", and the Ohio Department of Aging and Ohio Department of Medicaid rules call that person an "individual". In this manual the person served is the "client"; the three words mean the same person.

Every staff member uses standard precautions with every client at every visit. The Agency supplies gloves, alcohol-based hand rub and other PPE free of charge, trains every aide in infection prevention before the first client visit and every year, and checks each aide's hand hygiene and PPE skills on Form OH-HC-IC-01-A. These requirements are the Agency's own standard except where this policy cites a rule.

Hand hygiene is the most important way to prevent infection. Staff clean their hands:

• on arrival, before touching the client or the client's belongings;
• before preparing food, feeding the client, or helping with medication;
• before putting on gloves and immediately after taking them off;
• after contact with blood, body fluids, bodily waste, broken skin, soiled linen or trash;
• after toileting or continence care, even if gloves were worn;
• after using the toilet, blowing the nose, coughing or sneezing; and
• before leaving the home.

Use soap and running water when hands are visibly soiled, after helping with toileting or continence care, after contact with a client who has diarrhea, and before handling food. Otherwise an alcohol-based hand rub containing at least 60 percent alcohol may be used, as CDC recommends. If a home has no running water, staff use hand rub or antiseptic towelettes and wash with soap and water as soon as feasible (29 CFR §1910.1030(d)(2)(iv) where blood may be present). Nails are kept short, and staff do not wear artificial nails when giving hands-on care, as the Agency's own standard.

• Wear disposable gloves for any contact, or expected contact, with blood, body fluids, bodily waste, mucous membranes, broken skin, or soiled items and surfaces, including toileting, continence care, perineal and catheter care, oral care and cleaning bathrooms.
• Change gloves between tasks on the same client (for example after toileting and before oral care), when torn, and when moving from a dirty to a clean task. Never wash or reuse disposable gloves.
• Wear a disposable gown or apron when clothing may be splashed or soiled, and a mask and eye protection when splashes to the face are possible.
• Wear a mask when the aide has respiratory symptoms but has been cleared to work (Policy OH-HC-HR-03), when the client has respiratory symptoms, and when public health guidance or the supervisor directs.
• Remove PPE before leaving the client's home, put it in a plastic bag in the client's trash, and clean hands.
• The Agency provides PPE, in the sizes staff need and in latex-free versions, at no cost to staff (29 CFR §1910.1030(d)(3)(i), (iii); 29 CFR §1910.132). Supervisors check that every aide has enough supplies at each supervisory visit.

• Cover coughs and sneezes with a tissue or the inside of the elbow, throw tissues away, and clean hands.
• Offer a mask and tissues to a client who is coughing, if the client is willing.
• Keep at a distance where possible when the client or a household member has respiratory symptoms, and open windows if the client agrees and the weather allows.
• Vaccination of staff against influenza and other diseases CDC recommends for health care personnel is encouraged and recorded under Policy OH-HC-HR-03.

• Clean surfaces used for care (bathroom fixtures, commodes, bed rails, tables, door handles) as the activity plan says, using the client's household cleaner or a disinfectant the Agency supplies, following the label.
• Clean shared equipment such as shower chairs, commodes, walkers and gait belts after use when soiled.
• Clean any blood or body fluid spill at once, wearing gloves, using an appropriate disinfectant, as set out in Policy OH-HC-IC-02.
• Aides carry only the supplies they need into the home, keep them in a clean bag placed on a clean, dry surface, and do not carry items from one client's home to another without cleaning them.

• Handle soiled linen and clothing as little as possible, hold it away from the body, and do not shake it. Wear gloves. Wash it separately in the hottest water the fabric allows, with detergent.
• Flush urine, stool and vomit down the toilet, then clean and disinfect the commode or bedpan.
• Put briefs, pads, wipes, gloves and other soiled disposable items in a plastic bag, tie it and place it in the household trash. This is the standard precaution for "the disposal of bodily waste" covered at orientation (OAC 173-39-02.11(C)(3)(b)(vii)).
• Aides do not handle used needles or lancets. The client's sharps are kept in a puncture-resistant container (Policy OH-HC-IC-02).

• Wash hands before handling food. Keep raw meat away from ready-to-eat food, and use separate cutting boards or wash them between uses.
• Cook food thoroughly, refrigerate leftovers promptly, and throw away food that is past its date or shows spoilage, with the client's agreement.
• Clean counters, dishes and utensils after meal preparation.
• Aides do not eat the client's food or drink without the client's offer and consent (OAC 5160-44-31(E)(11) for ODM waiver clients, and as the Agency's own standard for all clients).

1. An aide who notices signs of infection (fever, new cough, diarrhea or vomiting, a red, warm or draining wound, burning on urination, or new confusion) tells the supervisor the same day (Policy OH-HC-SVC-02).
2. The supervisor finds out from the client, the client's representative or the client's health care provider what precautions are needed, and writes them into the activity plan.
3. For a client with diarrhea or a known contact-spread infection, staff wear gloves and a gown or apron for hands-on care, wash hands with soap and water (not hand rub alone) after care, and clean the bathroom and commode with a disinfectant that is effective for the organism, as the label shows.
4. For a client with a respiratory infection, staff wear a mask, and the supervisor follows CDC and Ohio Department of Health guidance current at the time on any higher level of protection.
5. The Agency does not refuse or end services because a client has an infection. It provides the training and PPE staff need, or helps the client find other care if the client's needs cannot be met safely (Policy OH-HC-DC-01).
6. Information about a client's infection is shared only with staff who need it to provide care (Policy OH-HC-PRV-01).

Staff do not visit clients while they have symptoms of a contagious illness. They call the scheduler as early as possible so that a replacement can be found. The illness, exclusion and return-to-work rules are in Policy OH-HC-HR-03. For an ODM waiver client, a provider may not deliver services when "medically, physically or emotionally unfit" (OAC 5160-44-31(E)(7)).

• Staff report symptoms of infection in clients and in themselves to the supervisor. The Agency follows any instruction from the local health department or the Ohio Department of Health on communicable disease reporting and control, and cooperates fully with any public health investigation.
• If two or more clients or staff develop similar symptoms close together, the supervisor tells the Administrator, who seeks advice from the local health department and decides on extra precautions, as the Agency's own standard.
• During a declared public health emergency, the Administrator follows Ohio Department of Health and CDC guidance, ODA and ODM notices, and the continuity plan in Policy OH-HC-EP-01, and keeps a supply of PPE to cover at least 30 days of normal use, as the Agency's own standard.

A supervisor observes each aide performing hand hygiene and putting on and removing gloves, gown and mask, and records the result on Form OH-HC-IC-01-A: at orientation before the first client visit, once a year, and whenever a supervisor sees a lapse, as the Agency's own standard. An aide who does not pass is retrained and checked again before the next visit.

Accountability under this policy is allocated as follows.

Forms OH-HC-IC-01-A are kept in the personnel file for the duration of employment plus six years, as the Agency's own standard (Policy OH-HC-HR-04). Supply orders and outbreak notes are kept for three years. Each quarter the Administrator reviews infection-related reports, staff illness absences and competency results, as the Agency's own standard, and reports trends to the quality improvement program (Policy OH-HC-QA-01).

Every aide is trained on standard precautions, including hand washing and the disposal of bodily waste, at orientation before any client contact (OAC 173-39-02.11(C)(3)(b)(vii); Policy OH-HC-HR-05), and again each year in in-service training, as the Agency's own standard. Training uses CDC materials and is given in the language the aide understands best.

This policy implements the following authorities.

• OAC 173-39-02.11(C)(3)(a)(v)(b)(iv), (C)(3)(b)(vii) and 173-39-02.8(B)(5)(c)(i)(h) (effective July 1, 2024)
• OAC 5160-44-31(E)(7), (E)(11); OAC 5160-46-04(A)(8)(a)(i)(c) (training content for non-agency Ohio Home Care Waiver aides, used as a benchmark) (effective January 1, 2024)
• 29 CFR §1910.132 (personal protective equipment); 29 CFR §1910.1030 (bloodborne pathogens)
• Centers for Disease Control and Prevention, standard precautions and hand hygiene guidance for health care settings, as current at the time of each review

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