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.

This policy makes sure that Sample Agency, LLC prevents and controls infections and communicable diseases among patients, caregivers and staff, finds and acts on infection problems early, and reports diseases to public health as Pennsylvania law requires.

This policy covers program leadership, standard precautions, bag technique and equipment, transmission-based precautions, surveillance and documentation of infections, reporting of reportable diseases and outbreaks, staff illness and work restrictions, and education.

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

The Agency maintains and documents an infection control program which has as its goal the prevention and control of infections and communicable diseases (42 CFR §484.70). Staff follow accepted standards of practice, including the use of standard precautions, to prevent the transmission of infections and communicable diseases (§484.70(a)). The Agency 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 quality assessment and performance improvement program, with a method for identifying infectious and communicable disease problems and a plan for the appropriate actions that are expected to result in improvement and disease prevention (§484.70(b)), and provides infection control education to staff, patients and caregivers (§484.70(c)). These are federal Conditions of Participation if the Agency is Medicare-certified, and the Agency’s own standard for every patient.

The Agency complies with 28 Pa. Code Chapter 27 (28 Pa. Code §601.3(b)). As a health care facility, the Agency reports a case of a reportable disease, infection or condition when it treats or examines a person who has, or who it suspects because of symptoms or appearance of having, the disease, within the time §27.21a(b) sets (24 hours after being identified for the conditions in §27.21a(b)(1); 5 work days for those in §27.21a(b)(2)), reports an outbreak within 24 hours (§27.3(a)), and reports through the Department’s electronic disease surveillance system as §27.4 requires.

No Pennsylvania home health rule requires a named infection preventionist. The program is led by the supervising nurse or the person the Administrator designates in writing.

• The supervising nurse, Robin Sample, RN, leads the infection control program, with the alternate supervising nurse acting in the supervising nurse’s absence, unless the Administrator designates another qualified RN in writing. As the Agency’s own standard, the program lead completes infection prevention training each year.
• The program lead reviews surveillance data each month, reports infection data and actions to each quality program meeting (Policy PA-HH-QA-01), and reviews this program each year with the Administrator.
• The program follows current guidance from the Centers for Disease Control and Prevention (CDC) and the Pennsylvania Department of Health. The program lead checks for new guidance at least quarterly and whenever there is a health alert.

• Hand hygiene. Clean hands with alcohol-based hand rub, or soap and water when hands are visibly soiled or the patient may have infectious diarrhea: on entering the home, before and after patient contact, before a clean or aseptic procedure, after removing gloves, after contact with the patient’s surroundings, and before leaving.
• Gloves and other protective equipment. Wear gloves for contact with blood, body fluids, mucous membranes, non-intact skin or contaminated items; add a gown, mask or eye protection where splashing or spraying is likely; remove and discard protective equipment before leaving the patient area, then clean hands (Policy PA-HH-IC-02).
• Respiratory hygiene. Offer a mask to a coughing patient where tolerated, and keep a distance where possible. Staff with respiratory illness follow Section 11.
• Safe injection practices. Use a new sterile needle and syringe for every injection, never reuse single-dose vials, and use multi-dose vials for one patient only.
• Sharps. Use safety-engineered devices, never recap by hand, and discard sharps at once into a sharps container (Policy PA-HH-IC-03).
• Aseptic technique. Use sterile technique for sterile procedures, such as central line care and urinary catheter insertion. LPNs prepare equipment and materials for treatments observing aseptic technique as required (28 Pa. Code §601.32(c)).

• The supply bag is placed on a clean, dry, hard surface or a barrier, never on the floor or the bed, and opened only after hand hygiene.
• Only the supplies needed for the visit are taken out. Unused supplies taken into the work area are left with the patient or discarded, never returned to the bag.
• Reusable equipment (stethoscope, blood pressure cuff, thermometer, pulse oximeter, scale) is cleaned and disinfected with an EPA-registered disinfectant, following the contact time on the label, after each patient. Equipment is left in the home for a patient on transmission-based precautions where possible.
• Clean and dirty items are kept apart in the vehicle, and soiled items are bagged.
• Glucose meters and other point-of-care devices follow Policy PA-HH-CS-04.

• When a patient is known or suspected to have an infection spread by contact (for example, MRSA in a draining wound, C. difficile, scabies), droplet (for example, influenza) or airborne routes (for example, active tuberculosis), the case manager records the precautions in the plan of treatment and the aide care plan and tells every staff member before the next visit.
• Staff use the protective equipment the precautions require. For airborne precautions, staff wear a fit-tested N95 or higher respirator under the Agency’s respiratory protection program, which follows the OSHA respiratory protection standard.
• A patient with suspected or confirmed infectious tuberculosis who is isolated at home is taught to cover the mouth and nose when coughing and sneezing and to handle and dispose of sputum carefully (28 Pa. Code §27.161(a)(1)). The case manager cooperates with the Department or local health authority on the isolation and contact testing they direct.
• Where possible, a patient on precautions is scheduled as the last visit of the day.
• The patient and caregivers are taught how to prevent spread in the home, including hand hygiene, laundry, cleaning and waste disposal.

• Any staff member who notices signs or symptoms of a possible infection (fever, new or increased wound drainage or redness, painful or cloudy urine, new cough, diarrhea, line site redness) reports them to the case manager the same day.
• The case manager notifies the physician, records any orders, and follows up the result.
• When an infection is confirmed or treated, the case manager records it on Form PA-HH-IC-01-A and in the clinical record: the date detected, the patient, primary diagnosis, signs and symptoms, type of infection, organism identified, treatment, devices in place, and whether it may be linked to Agency care, as the Agency’s own standard.
• The program lead reviews the log each month, calculates infection rates by type (for example, per 1,000 patient days, or per 100 patients with a urinary catheter or central line), and looks for clusters, trends, and links to a staff member, procedure or device.
• Where a problem is found, the program lead investigates, records the findings, and puts in place an action plan (42 CFR §484.70(b)). Actions and their results are reported to the quality program (Policy PA-HH-QA-01; 42 CFR §484.65).

• The program lead keeps with this policy the current list of reportable diseases, infections and conditions in 28 Pa. Code §27.21a(b), with their time frames, and checks it at each review of this policy.
• When an Agency clinician treats or examines a patient who has, or who the clinician suspects because of symptoms or appearance of having, a reportable condition, the clinician tells the program lead the same day. The program lead reports the case for the Agency unless the Agency has already reported it (28 Pa. Code §27.21a(a)(1)); a report by the patient’s physician or a laboratory does not remove the Agency’s own duty. Influenza is reported only when confirmed by laboratory evidence of the causative agent (§27.21a(a)(2)).
• Conditions in §27.21a(b)(1) (for example, measles, meningococcal invasive disease, Haemophilus influenzae invasive disease, Legionellosis and food poisoning outbreak) are reported within 24 hours after being identified by symptoms, appearance or diagnosis. Conditions in §27.21a(b)(2) (for example, tuberculosis (suspected or confirmed active disease), hepatitis, salmonellosis, shigellosis, Lyme disease and chickenpox) are reported within 5 work days.
• An outbreak is reported within 24 hours (28 Pa. Code §27.3(a)). A suspected public health emergency, including an unusual occurrence of a disease not on the list, is reported within 24 hours (§27.3(b)-(c)). A suspected outbreak among Agency patients or staff (for example, two or more with the same infection linked in time and place) is reported to the Administrator at once.
• Reports are made to the Department through the appropriate electronic disease surveillance system using the Department’s case report format. A preliminary report may be made by telephone and must be followed by the electronic report (28 Pa. Code §27.4). The Department of Health 24-hour line for immediately notifiable conditions and public health emergencies is 877-PA-HEALTH (877-724-3258).
• The program lead records each report (date, time, condition, how reported, and confirmation), cooperates with any investigation, and follows the Department’s or local health authority’s instructions. The emergency plan is used where needed (Policy PA-HH-EP-01).

• A licensed health care practitioner with amebiasis, enterohemorrhagic E. coli, shigellosis, typhoid or paratyphoid fever, hepatitis A or other viral hepatitis or jaundice of unspecified cause, or persistent diarrhea may not work in direct patient care until the conditions in 28 Pa. Code §27.155 are met (for example, negative stool specimens verified by a physician, or the stated time after onset). As the Agency’s own standard, the same restrictions apply to home health aides and every other staff member in direct care.
• As the Agency’s own standard, staff who have fever, vomiting, diarrhea, a draining skin lesion, conjunctivitis or a respiratory illness with fever do not make visits and tell their supervisor before the shift, and return when the program lead, following current CDC guidance and any physician clearance, approves.
• Staff with a work-related exposure follow Policy PA-HH-IC-02. Tuberculosis screening and vaccinations are in Policy PA-HH-IC-04.

• Staff receive infection control education at orientation, before the first visit, and each year, covering this policy, hand hygiene, protective equipment, bag technique, precautions, surveillance reporting and the bloodborne pathogens plan (42 CFR §484.70(c)). Aides are trained in procedures for maintaining a clean, healthful and pleasant environment (28 Pa. Code §601.35(a)).
• Aides’ compliance with infection prevention and control policies is checked at every aide supervisory visit (42 CFR §484.80(h)(4)(iv); Policy PA-HH-AID-02). Hand hygiene and bag technique of nurses and therapists are observed during supervisory and competency visits.
• Patients and caregivers are taught at the start of care, and as needed, about hand hygiene, care of wounds, catheters and lines, signs of infection to report, safe disposal of sharps (Policy PA-HH-IC-03) and cleaning in the home. The teaching is recorded in the clinical record.

Accountability under this policy is allocated as follows.

The Agency keeps the infection surveillance log (Form PA-HH-IC-01-A), infection details in each clinical record, monthly surveillance reviews and investigations, a record of each Chapter 27 report, quality program minutes showing infection data and actions, staff education records, observation results from supervisory visits, and confidential employee health records (Policy PA-HH-IC-04). Each year, as the Agency’s own standard, the program lead audits hand hygiene and bag technique on a sample of observed visits for each discipline and reports the results to the quality program.

Training is delivered and recorded as follows. Frequencies marked as the Agency’s own standard are not set by rule.

This policy implements the following authorities.

• 28 Pa. Code §601.3(b), Compliance with Chapter 27
• 28 Pa. Code §27.1, Definitions (case, health care facility, outbreak)
• 28 Pa. Code §27.3, Reporting outbreaks and unusual diseases; §27.4, Reporting cases
• 28 Pa. Code §27.21a, Reporting of cases by health care practitioners and health care facilities
• 28 Pa. Code §27.155, Restrictions on health care practitioners; §27.161, Special requirements for tuberculosis
• 28 Pa. Code §§601.32(c) and 601.35(a)
• 42 CFR §484.70, Infection prevention and control; §484.80(h)(4)(iv); §484.65 (if Medicare-certified)
• 29 CFR §1910.1030, Bloodborne pathogens
• Centers for Disease Control and Prevention, core infection prevention and control practices for safe health care delivery in all settings

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