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 sets out the infection prevention and control program of Sample Home Health Agency, LLC (the "Agency"), which has as its goal the prevention and control of infections and communicable diseases among patients, caregivers, and staff. It meets 26 TAC §558.285 and, for a Medicare-certified agency, 42 CFR §484.70.

The program covers prevention practices on every visit, surveillance and documentation of infections, investigation and control of infectious and communicable disease problems, reporting to public health authorities, staff health, and education of staff, patients, and caregivers.

For the purposes of this policy, the following terms have the meanings below. 26 TAC Chapter 558 says "client" and 42 CFR Part 484 says "patient"; in this policy the two words mean the same person.

The Agency maintains and documents an infection control program with the goal of preventing and controlling infections and communicable diseases (42 CFR §484.70). All staff follow accepted standards of practice, including standard precautions, on every visit (42 CFR §484.70(a)). The Agency’s policies ensure that the Agency, its employees, and its contractors comply with Texas Health and Safety Code Chapter 81 (communicable diseases), the OSHA bloodborne pathogens standard at 29 CFR §1910.1030 and its Appendix A, and Texas Health and Safety Code Chapter 85, Subchapter I (prevention of the transmission of HIV and hepatitis B virus) (26 TAC §558.285(1)).

The Agency documents every infection a patient acquires while receiving services from the Agency, including "the date that the infection was detected, the client's name, primary diagnosis, signs and symptoms, type of infection, pathogens identified, and treatment" (26 TAC §558.285(2)(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 QAPI 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 (42 CFR §484.70(b)). It provides infection control education to staff, patients, and caregivers (42 CFR §484.70(c)). The Agency applies these federal standards to all patients.

• The supervising nurse, Robin Sample, RN, leads the infection control program, with the alternate supervising nurse acting in the supervising nurse’s absence. As the Agency’s own standard, the supervising nurse completes infection prevention training each year.
• The supervising nurse reviews surveillance data each month, reports infection data and actions to each QAPI meeting (Policy TX-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 Texas Department of State Health Services. The supervising nurse checks for new guidance at least quarterly and whenever there is a public health alert.

• Hand hygiene. Clean hands with alcohol-based hand rub, or soap and water when hands are visibly soiled, after contact with body fluids, and where the patient has diarrhea that may be infectious: 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’s room or home, then clean hands (29 CFR §1910.1030; Policy TX-HH-IC-02).
• Respiratory hygiene. Staff with respiratory symptoms do not make visits (Section 11). Offer a mask to a coughing patient where tolerated, and keep a distance where possible.
• 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 where available, never recap by hand, and discard sharps at once into a puncture-resistant container (Policy TX-HH-IC-03).
• Aseptic technique. Use sterile technique for sterile procedures, such as central line care and urinary catheter insertion, as the clinical procedure manual sets out.

• The supply bag is placed on a clean, dry, hard surface or a barrier, never on the floor or the bed, and is opened only after hand hygiene.
• Only the supplies needed for the visit are taken out. Unused supplies that went into the work area are left with the patient or discarded, never returned to the bag.
• Reusable equipment, such as a stethoscope, blood pressure cuff, thermometer, pulse oximeter, or scale, is cleaned and disinfected with an EPA-registered disinfectant, following the product’s contact time, after each patient. Where possible, equipment is left in the home for a patient on transmission-based precautions.
• Patient-specific supplies stay in the patient’s home. 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 TX-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, or scabies), droplet (for example, influenza), or airborne (for example, active tuberculosis) routes, the case manager records the precautions in the plan of care 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 procedure.
• Where possible, the 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.

1. Any staff member who notices signs or symptoms of a possible infection, such as fever, new or increased wound drainage or redness, painful or cloudy urine, new cough, or diarrhea, reports them to the case manager the same day.
2. The case manager notifies the practitioner, records any orders, and follows up the result.
3. When an infection is confirmed or treated, the case manager records it on the infection surveillance log (Form TX-HH-IC-01-A) and in the clinical record with the date the infection was detected, the patient’s name, primary diagnosis, signs and symptoms, type of infection, pathogens identified, and treatment (26 TAC §558.285(2)(A)).
4. The supervising nurse 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), and looks for clusters, trends, and links to a staff member, procedure, or device.
5. Where a problem is identified, the supervising nurse investigates, records the findings, and puts in place an action plan (42 CFR §484.70(b)(2)). Actions and their results are reported to the QAPI program (Policy TX-HH-QA-01).

• Where a patient is diagnosed with a notifiable condition, the supervising nurse confirms whether the practitioner or laboratory has reported it and, where Texas Health and Safety Code Chapter 81 and the Department of State Health Services rules require the Agency to report, reports it to the local health authority within the time those rules set for that condition. The current list of notifiable conditions and time frames is kept with this policy and checked at each review.
• The supervising nurse cooperates with the local health authority in any investigation and follows its instructions.
• A suspected outbreak, such as two or more patients or staff with the same infection linked in time and place, is reported to the Administrator at once, and the emergency preparedness plan is used if needed (Policy TX-HH-EP-01).

• 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. They return when the supervising nurse, following CDC guidance, clears them.
• Staff are screened for tuberculosis at hire, and after a known exposure, as current CDC guidance for health care personnel recommends. No Texas or federal home health rule sets a screening interval.
• The Agency offers hepatitis B vaccination under Policy TX-HH-IC-02 and encourages annual influenza vaccination and other vaccinations CDC recommends for health care personnel. Records are kept in the confidential employee health file.
• Staff with a work-related exposure follow Policy TX-HH-IC-02.

• 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)). Hand hygiene and protective equipment use are observed during supervisory visits.
• Home health aides comply with infection prevention and control policies and procedures, and this is checked at every aide supervisory visit (42 CFR §484.80(h)(4)(iv); Policy TX-HH-AID-02).
• Patients and caregivers are taught at the start of care, and as needed, about hand hygiene, care of wounds, catheters, and devices, signs of infection to report, safe disposal of sharps (Policy TX-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 TX-HH-IC-01-A), infection details in each clinical record, monthly surveillance reviews and investigations, public health reports, QAPI minutes showing infection data and actions, staff education records, observation results from supervisory visits, and confidential employee health records.

The supervising nurse reports infection rates and the status of action plans to the QAPI program at each meeting (Policy TX-HH-QA-01). Each year, as the Agency’s own standard, the supervising nurse audits hand hygiene and bag technique on a sample of observed visits for each discipline.

All staff complete infection control training at orientation and each year, as described in Section 12. The supervising nurse completes infection prevention training each year as the Agency’s own standard.

This policy implements the following authorities.

• 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
• Texas Health and Safety Code Chapter 81, Communicable Diseases
• Texas Health and Safety Code Chapter 85, Subchapter I, Prevention of Transmission of HIV and Hepatitis B Virus
• 22 Texas Administrative Code §217.11(1)(O), Standards of Nursing Practice
• 42 CFR §484.70, Infection Prevention and Control
• 42 CFR §484.80(h)(4)(iv), Aide Compliance with Infection Control Policies
• 29 CFR §1910.1030, Bloodborne Pathogens
• Centers for Disease Control and Prevention, Core Infection Prevention and Control Practices for Safe Healthcare Delivery in All Settings

The following documents are read together with this policy.

This policy is adopted by the governing body of Sample Home Health 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.