Infection Control

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 Home Care Agency, LLC (the "Agency") prevents and controls infection among its clients and staff. Texas requires every home and community support services agency to adopt and enforce written policies addressing infection control, including the prevention of the spread of infectious and communicable disease, that ensure compliance with Texas Health and Safety Code Chapter 81, the OSHA Bloodborne Pathogens Standard (29 CFR §1910.1030 and its Appendix A), and Texas Health and Safety Code Chapter 85, Subchapter I, and that require documentation of infections a client acquires while receiving services (26 TAC §558.285). The Agency also follows current guidance from the Centers for Disease Control and Prevention as its own standard. As an employer whose staff may be exposed to blood or other potentially infectious materials, the Agency must also maintain a written exposure control plan under the OSHA Bloodborne Pathogens Standard (29 CFR §1910.1030). This policy meets both requirements in one document that a field attendant can read and follow.

This policy applies to every employee, contractor, and volunteer of the Agency, in the Agency office and in every client home, and to every client. It covers standard precautions, hand hygiene, personal protective equipment, staff health and tuberculosis screening, the exposure control plan, handling of contaminated items and laundry, cleaning of equipment, reporting of communicable disease, and surveillance. Disposal of sharps and other special waste is governed by Policy TX-IC-02.

For the purposes of this policy:

• Standard precautions means the infection prevention practices recommended by the CDC for the care of all clients regardless of diagnosis, including hand hygiene, use of personal protective equipment based on anticipated exposure, respiratory hygiene, safe handling of sharps, and cleaning of equipment and surfaces.
• Occupational exposure means reasonably anticipated skin, eye, mucous membrane, or parenteral contact with blood or other potentially infectious materials that may result from the performance of an employee’s duties (29 CFR §1910.1030).
• Exposure incident means a specific contact with blood or other potentially infectious materials through the eye, mouth, other mucous membrane, non-intact skin, or a needlestick or other puncture, that results from the performance of duties.
• Personal protective equipment (PPE) means gloves, gowns, masks, respirators, and eye protection provided by the Agency at no cost to staff.
• Health care personnel, for tuberculosis screening, means every employee, contractor, and volunteer who has direct contact with clients.

The Agency applies standard precautions to every client contact and maintains an infection control program that meets 26 TAC §558.285 and follows current CDC guidelines as the Agency’s own standard. Hand hygiene with soap and water or an alcohol-based hand rub is performed before and after every client contact, after removing gloves, after contact with body fluids or contaminated surfaces, and before handling food or medication. Gloves are worn for any contact with blood, body fluids, non-intact skin, mucous membranes, or contaminated items, and for all personal care involving toileting, incontinence care, and wound proximity. Gowns, masks, and eye protection are worn whenever splashing or spraying is anticipated, and a mask is worn when the client or the staff member has respiratory symptoms.

The Agency maintains a written exposure control plan that identifies the job classifications and tasks with occupational exposure, offers hepatitis B vaccination to each exposed employee within 10 working days of initial assignment at no cost, provides training at hire and at least annually, sets out engineering and work practice controls and the procedure for evaluating an exposure incident, and is reviewed and updated at least annually and whenever a task or procedure changes (29 CFR §1910.1030).

Every member of health care personnel is screened for tuberculosis before client contact and thereafter in accordance with the current CDC and National Tuberculosis Controllers Association recommendations for health care personnel, which the Agency has adopted as its own standard: a baseline individual risk assessment, symptom evaluation, and test on hire; annual TB education; and further testing where a risk assessment or a known exposure indicates it. A staff member with symptoms of active tuberculosis or another communicable disease is removed from client contact until cleared by a licensed practitioner.

The Agency reports notifiable conditions to the local health authority or the Department of State Health Services as required by Tex. Health & Safety Code ch. 81 and 25 TAC ch. 97, and follows the direction of public health authorities during an outbreak. When a client tells a staff member about an infection the client acquired while receiving services, the staff member reports it to the office the same day, and the Agency documents the date the infection was disclosed to the Agency employee, the client’s name, and the treatment as disclosed by the client (26 TAC §558.285(2)(B)). The Agency complies with Texas Health and Safety Code Chapter 85, Subchapter I, on preventing the transmission of HIV and hepatitis B virus (26 TAC §558.285(1)(C)).

The following procedures apply. Timeframes drawn from 29 CFR §1910.1030 are marked; the others are Agency standards.

1. Hire (Administrator, before first client contact). Complete the exposure determination for the role, provide infection control and bloodborne pathogen training, offer hepatitis B vaccination and file the acceptance or signed declination (within 10 working days of assignment, 29 CFR §1910.1030), and complete baseline TB screening. File the records in the personnel record (26 TAC §558.246).
2. Equip (office staff, on hire and on request). Issue each attendant a supply of gloves, masks, alcohol-based hand rub, and a spill kit, and replenish supplies without charge. Gowns and eye protection are issued when a client’s care requires them.
3. Practice standard precautions (all field staff, every visit). Follow Section 4 for hand hygiene and PPE. Clean and disinfect reusable equipment, such as blood pressure cuffs, gait belts, and thermometers, between clients with an EPA-registered disinfectant. Handle soiled linen with gloves, hold it away from the body, and wash it separately in hot water. Never eat, drink, or apply cosmetics during personal care.
4. Screen clients (attendant, every visit; Administrator, on referral). Observe for new fever, cough, rash, diarrhea, wound drainage, or a reported diagnosis of a communicable disease, report it to the office the same day, and record it in the visit note. The Administrator determines any additional precautions and informs every staff member assigned to that client.
5. Respond to an exposure incident (exposed staff member, immediately; Administrator, the same day). Wash the area with soap and water or flush mucous membranes with water, report to the Administrator at once, and go to the designated occupational health provider or emergency department for confidential post-exposure evaluation and follow-up at the Agency’s expense. The Administrator documents the route and circumstances of exposure, identifies the source individual where permitted by law, and provides the written opinion of the evaluating practitioner to the employee within 15 days of the evaluation (29 CFR §1910.1030).
6. Report communicable disease (Administrator, within the timeframe set for the condition by 25 TAC ch. 97). Report a notifiable condition in a client or staff member to the local health authority and cooperate with contact investigation.
7. Train (Administrator, at orientation and at least annually under 29 CFR §1910.1030). Deliver training on this policy, standard precautions, PPE use, the exposure control plan, and TB education, and keep the training record with the date, content, trainer, and attendees.
8. Surveil and review (Administrator, monthly; QAPI Committee, every meeting). Enter each client infection, staff exposure incident, staff illness with work restriction, and hand hygiene observation in the infection control log, and report the data to the QAPI Committee, which reviews it at least twice a year (26 TAC §558.287). Review this policy and the exposure control plan at least annually.

Accountability under this policy is allocated as follows.

Every employee, contractor, and volunteer is trained on Sections 4 and 5 at orientation, before first client contact, and at least once a year after that, as 29 CFR §1910.1030(g)(2) requires for staff with occupational exposure.

The Agency keeps the following: the written exposure control plan with the date of each annual review; the exposure determination by job classification; each employee’s hepatitis B vaccination record or signed declination; TB screening records; training records, retained for three years from the training date (29 CFR §1910.1030); exposure incident reports and post-exposure evaluation records, kept as confidential medical records for the duration of employment plus 30 years (29 CFR §1910.1020); the sharps injury log where the Agency has 11 or more employees; the infection control log; communicable disease reports; and QAPI Committee minutes. Personnel health records are filed in the confidential section of the personnel record (26 TAC §558.246). Client infection information is recorded in the client record.

Each quarter, as the Agency’s own standard, the Administrator reviews the infection control log, confirms that each client infection disclosed to staff was documented with the items 26 TAC §558.285(2)(B) requires, and checks staff tuberculosis screening and hepatitis B vaccination records for currency. Findings are reported to the QAPI Committee under Policy TX-QA-01.

• 26 Texas Administrative Code §558.285, Infection Control
• 26 Texas Administrative Code §558.286, Disposal of Special or Medical Waste
• 26 Texas Administrative Code §558.287, Quality Assessment and Performance Improvement
• 26 Texas Administrative Code §558.246, Personnel Records
• Texas Health and Safety Code, Chapter 81, Control of Communicable Diseases
• 25 Texas Administrative Code, Chapter 97, Communicable Diseases
• 29 CFR §1910.1030, Bloodborne Pathogens
• 29 CFR §1910.1020, Access to Employee Exposure and Medical Records
• 29 CFR §1910.1200, Hazard Communication
• CDC and National Tuberculosis Controllers Association, Tuberculosis Screening, Testing, and Treatment of U.S. Health Care Personnel (2019)
• CDC Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings
• 42 CFR §484.70, Infection Prevention and Control (applies when Medicare-certified)

This policy is adopted by the governing body of Sample Home Care 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 8 is amended, the amendment is recorded in this table and a new version of this policy is issued.