Infection Prevention and Control Program

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.

Hospice patients are often frail and at high risk of infection, and staff move from home to home. This policy protects patients, families, visitors and staff of Sample Agency, LLC (the "Agency") by preventing and controlling infections and communicable diseases.

This policy covers infection prevention and control in patients' homes, in facilities where patients live, in any inpatient hospice facility the Agency operates, in the office and in staff vehicles.

The following terms have the meanings given below when used in this policy.

The Agency "must maintain and document an effective infection control program that protects patients, families, visitors, and hospice personnel by preventing and controlling infections and communicable diseases" (42 CFR §418.60). The Agency follows accepted standards of practice to prevent the transmission of infections and communicable diseases, including standard precautions (42 CFR §418.60(a)); maintains a coordinated agency-wide program for the surveillance, identification, prevention, control and investigation of infectious and communicable diseases that is an integral part of its QAPI program (42 CFR §418.60(b)); and provides infection control education to employees, contracted providers, patients, family members and other caregivers (42 CFR §418.60(c)). The Agency also has the written plan for screening staff and volunteers for communicable diseases and the work restriction policies OAC 3701-19-09(B)(4) requires (Policy OH-HSP-HR-05).

• Hand hygiene with alcohol-based hand rub or soap and water before and after patient contact, before clean or aseptic tasks, after contact with body fluids, after removing gloves, and after touching the patient's surroundings. Soap and water are used when hands are visibly soiled and after caring for a patient with diarrhea suspected to be Clostridioides difficile or norovirus.
• PPE (gloves, gowns, masks, eye protection) is worn according to the expected exposure, and is supplied by the Agency at no cost to staff (Policy OH-HSP-IC-02).
• Respiratory hygiene: staff with respiratory symptoms follow Policy OH-HSP-HR-05; masks are offered to coughing patients and family members during care.
• Safe injection practices: one needle and one syringe, one time; single-dose vials used for one patient only.
• Sharps go into a puncture-resistant sharps container at the point of use; containers are sealed when three-quarters full and disposed of as Section 11 describes.

• The nursing bag is placed on a clean, dry surface or a barrier, never on the floor or bed. Hands are cleaned before reaching into the bag. Only items needed are taken into the home.
• Reusable equipment (stethoscopes, blood pressure cuffs, thermometers, pulse oximeters) is cleaned and disinfected with an EPA-registered disinfectant after each patient, following the product's contact time; equipment used for a patient on contact precautions is left in the home where possible.
• Soiled items never go back into the bag. Supplies left in a home are not taken to another patient.
• Staff vehicles are kept with a clean area for clean supplies and a separate area for waste and soiled items.
• Durable medical equipment is cleaned by the supplier between patients (Policy OH-HSP-DME-01).

When a patient has, or is suspected of having, an infection that needs added precautions (for example C. difficile, MRSA in a draining wound, scabies, influenza, COVID-19 or tuberculosis), the RN case manager adds the precautions to the plan of care and the aide's written instructions, schedules the patient as the last visit of the day where practical, and teaches the family. Staff caring for a patient with suspected or confirmed airborne infection wear a fit-tested N95 respirator (Policy OH-HSP-HR-05). In an inpatient hospice facility the Agency operates, patients with infectious diseases are isolated as needed and linens are handled, stored, processed and transported in a way that prevents the spread of infection (OAC 3701-19-08(E)(4)-(5); OAC 3701-19-22(F)(5)).

The program identifies infectious and communicable disease problems and plans actions expected to lead to improvement and disease prevention (42 CFR §418.60(b)(2)).

• Every nurse who identifies a new infection in a patient (diagnosed by a practitioner or suspected from signs and symptoms) records it in the visit note and reports it to the infection control lead within one business day, who enters it in the infection surveillance log, Form OH-HSP-IC-01-A (Agency standard).
• The log records the patient, onset date, type and site of infection, organism if known, related devices (catheter, line, wound), whether it may be care-related, the treatment and the precautions taken.
• Staff illnesses and exposures are tracked under Policies OH-HSP-HR-05 and OH-HSP-IC-02 and reviewed with the log.
• Each month the infection control lead reviews the log for clusters, trends, care-related infections and staff practice problems, and investigates any cluster (two or more related cases).
• Findings and actions are reported to the QAPI program at least quarterly, and the program is evaluated each year as part of the annual QAPI evaluation (42 CFR §418.60(b)(1); 42 CFR §418.58; OAC 3701-19-06(D)-(F)).

Under OAC 3701-3-03(A), a health care provider with knowledge of a case or suspect case of a disease in classes A, B or C under OAC 3701-3-02 must report it. Class A diseases are reported immediately by telephone, and other classes in the time OAC 3701-3-02 sets (OAC 3701-3-02, text effective August 1, 2019). When an Agency nurse learns of a case or suspect case of a reportable disease, the nurse tells the infection control lead the same day. The infection control lead confirms whether the attending practitioner, hospital or laboratory has reported it and, if not, reports it to the local health department for the patient's area in the time the rule sets, and records the report (Agency procedure). Outbreaks are reported in the same way.

• Staff and contractors: infection control at orientation and at least yearly, including hand hygiene, PPE, bag technique, equipment cleaning, transmission-based precautions and this policy (42 CFR §418.60(c); Policy OH-HSP-HR-01). Aides are assessed on compliance with infection control procedures at supervisory visits (42 CFR §418.76(h)(3)(iv)).
• Patients, families and caregivers: hand hygiene, catheter and wound care as needed, safe disposal of sharps and dressings, cleaning, laundry, and when to call the nurse about signs of infection. Teaching and the family's understanding are recorded in the clinical record (42 CFR §418.60(c)).
• Volunteers: hand hygiene, respiratory hygiene and when not to visit (Policy OH-HSP-VOL-01).

Sharps containers, soiled dressings and other waste from care in the home are disposed of as Ohio and local solid waste and infectious waste requirements allow; the Agency's procedure manual states the current method for each county served, which the infection control lead confirms each year (Agency procedure). Families are taught to wash soiled linen separately in hot water with detergent and to wear gloves when handling it.

Each role named below carries the duties shown.

The infection surveillance log, monthly reviews, public health reports and education records are kept for at least six years (Agency standard). Each quarter the QAPI program reviews infection rates, care-related infections and the results of hand hygiene and bag technique observations made during supervisory visits (Policy OH-HSP-QA-01).

All staff learn Sections 5 to 7 at orientation and show hand hygiene, PPE use and bag technique before working alone. Annual training covers this policy and the year's surveillance findings (Policy OH-HSP-HR-01).

This policy implements the following authorities.

• 42 CFR §418.60, infection control; §418.58, QAPI; §418.76(h)(3)(iv), aide compliance with infection control
• OAC 3701-19-09(B)(4), employee health policies; OAC 3701-19-06(D)-(F), QAPI
• OAC 3701-19-08(E)(4)-(5) and OAC 3701-19-22(F)(5), linens, isolation and infection control in inpatient facilities
• OAC Chapter 3701-3, including OAC 3701-3-02 and 3701-3-03, Ohio communicable disease reporting
• 29 CFR §1910.1030, bloodborne pathogens (Policy OH-HSP-IC-02)
• CDC guidance on standard and transmission-based precautions and hand hygiene in health care settings (guidance, not rule)

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