Download Infection Control - Professional Pediatric Home Care

Table of Contents
Infection Control
POLICIES
Infection Tracking System ...................................................................................................... 3.1
Infection Control Plan ............................................................................................................. 3.2
Exposure Control Plan: OSHA Regulations ........................................................................... 3.3
Specific Procedures for Employee and Patient Infection Control Training ........................... 3.4
Standard Precautions ............................................................................................................... 3.5
Hand Hygiene / Hand Washing / Hand Cleansing.................................................................. 3.6
Housekeeping Requirements for Bloodborne Pathogens ....................................................... 3.7
Employee Infectious Diseases ................................................................................................ 3.8
Employee Epidemiological Illnesses ...................................................................................... 3.9
Reporting of Epidemiological Illnesses .................................................................................. 3.10
Bloodborne Pathogens Standard ............................................................................................. 3.11
Airborne Pathogens Standard ................................................................................................. 3.12
Supply Maintenance................................................................................................................ 3.13
Occupational Exposure to Tuberculosis/Prevention of Transmission of TB Plan ................. 3.14
Patient Education of Infection Precautions and Infection Control Practices .......................... 3.15
Influenza Immunization of Home Healthcare Workers .......................................................... 3.16
Appropriate Safeguards to Prevent Drug Contamination ....................................................... 3.17
Fingernails............................................................................................................................... 3.18
FORMS/ATTACHMENTS
Infection Log: Patients ............................................................................................................ 3.1A
Infection Log: Employees ....................................................................................................... 3.1B
Infection Log Annual Data Aggregation and Analysis:
Patients and Employees ..................................................................................................... 3.1C
Annual Infection Control Program Evaluation ...................................................................... 3.2A
Employee Infection Control Training ..................................................................................... 3.3A
Health Guidelines for Employees with Infectious Diseases ................................................... 3.8A
Communicable Diseases: Definitions and Modes of Transmission ........................................ 3.10A
Communicable/Infectious Disease Information Table............................................................ 3.10B
Colorado Department of Health Conditions Reportable ........................................................ 3.10C
Employee Information Sheet: Hepatitis B and Hepatitis B Vaccine....................................... 3.11A
Hepatitis B Vaccination Waiver Form ................................................................................... 3.11B
Personal Protective Equipment .............................................................................................. 3.11C
Recommendations for Follow-Up after Significant Exposure ................................................ 3.11D
Employee TB Screening .......................................................................................................... 3.14A
State Tuberculosis Cases by County ....................................................................................... 3.14B
Employee Information Sheet: Influenza Immunization .......................................................... 3.16A
Influenza Vaccination Consent/Waiver Form ......................................................................... 3.16B
Professional Pediatric Home Care
December 2012
Contents – Chapter 3
ACHC Standard HH7-1A.01
Infection Tracking System
______________________
POLICY
The Agency will implement an infection tracking system for patients and staff. The definition of
infections is based on the most common infections prevalent to Agency’s services that are high
volume, frequent infectious complications and/or have an increased risk for negative patient
outcomes.
______________________
PURPOSE
To define infection tracking system for patients and staff.
______________________
REFERENCE
Health Facilities and Emergency Medical Services Division, 6 CCR 1011-1, Standards for
Hospitals and Health Facilities, Chapter 26 – Home Care Agencies
______________________
RELATED DOCUMENTS
“Infection Log: Patients,” “Infection Log: Employees,” and “Infection Log Annual Data
Aggregation and Analysis: Patients and Employees” forms
______________________
PROCEDURE
1.
The Agency will provide an infection and safety risk management control program that
meets the CDC, Health Department, APIC (Association for Professionals in Infection
Control Epidemiology) and OSHA standards addressing:
 General infection control measures appropriate for care/service provided
 Hand washing.
 Use of standard precautions and personal protective equipment.
 Needle-stick prevention and sharps safety.
 Appropriate cleaning/disinfecting procedures.
 Infection surveillance, monitoring and reporting of employees and patients.
 Disposal and transportation of regulated waste, if applicable.
 Precautions to protect immune-compromised patients.
 Employee health conditions limiting their activities.
 Assessment and utilization of data obtained about infections and the infection control
program.
 Protocols for addressing patient care issues and prevention of infection related to
infusion therapy, urinary tract care, respiratory tract care, and wound care.
 Guidelines on caring for patients with multi-drug resistant organisms.
Professional Pediatric Home Care
December 2012
3.1
ACHC Standard HH7-1A.01



Policies on protecting patients and personnel from blood borne or airborne pathogens.
Monitoring staff for compliance with HHA policies and procedures related to
infection control.
Protocols for educating patient and personnel in standard precautions and the
prevention and control of infection.
2.
Agency will track targeted infections as follows:
 Patient infections to be reported at time of admission: chicken pox, german measles,
hepatitis B, MRSA, VRE, small pox, TB, or any reportable communicable disease (as
defined by local health department).
 Patient infections to be reported while patient is on service: wound infections that
develop 30 days or greater after admission which require an antibiotic or identified by
lab test or MD that may or may not require an antibiotic; IV site infections that
develop 10 days after admission or at any time if IV cannula was inserted by Agency
staff; device related infections such as urinary catheters; and all infections that are
identified as infections to be reported at admission.
 Employee infections to be reported if an employee develops or has a known exposure
to: conjunctivitis, MRSA, VRE, boils, jaundice, infected wounds, vomiting, diarrhea,
acute respiratory infections and any reportable communicable disease as defined by
the local health department.
3.
Written reporting of infections will occur through documentation on the infection log.
4.
At least quarterly, the Administrator/Director of Clinical Services and infection control
and PI committees will review and assess the infection log. Data will be aggregated and
analyzed on the Infection Log Annual Data Aggregation and Analysis: Patients and
Employees form.
5.
Problems and/or undesirable trends in infections will be identified, including potential
significant Agency acquired and/or community acquired infections. If such problems or
undesirable trends are identified, the Administrator/Director of Clinical Services and
infection control and PI committees will identify any common factors that could have led
to the transmission of the infection(s).
6.
The committees will make recommendations for and implement improvement activities.
Professional Pediatric Home Care
December 2012
3.1
ACHC Standard HH7-1A.01
INFECTION LOG: PATIENTS
Date
Pt ID#
Infection
MD Notified
Antibiotic Tx
Community
Acquired
Agency
Acquired
Infections to be Reported upon Admission:
Infections to be Reported while on Service:
1. Chicken pox
2. German measles
3. Hepatitis B
4. MRSA
5. VRE
6. Small pox
7. TB
8. Any other reportable communicable disease as
defined by the local health department.
1. Wound infections that develop 30 days or greater after
admission which require an antibiotic or identified by
lab test or MD that may or may not require antibiotic.
2. IV site infections that develop 10 days or greater after
admission or at any time if IV cannula was inserted
by Agency staff.
3. Device related infections such as urinary catheters.
4. All infections identified on the “Infections to be reported
upon Admission” listing.
Professional Pediatric Home Care
December 2012
3.1A
ACHC Standard HH7-1A.01
INFECTION LOG: EMPLOYEES
Date
Pt ID#
Infections to be Reported:
1. Chicken pox
2. German measles
3. Hepatitis B
4. MRSA
5. VRE
6. Small pox
7. TB
Professional Pediatric Home Care
Infection
MD Notified
Antibiotic Tx
Community
Acquired
8. Boils
9. Jaundice
10. Infected wounds
11. Vomiting
12. Diarrhea
13. Acute respiratory infections
14. Any other reportable communicable disease as
defined by the local health department.
December 2012
3.1B
Agency
Acquired
ACHC Standard HH7-1A.01
INFECTION LOG ANNUAL DATA
AGGREGATION AND ANALYSIS:
Patients and Employees
Quarter: _______________________
I.
Date reported to PI Committee:
Patient Infections:
A. Total number infections reported:
B. Types of infections:
# Wound Infections _________/ per 1000 wound days.
# IV Site Infections _________/ per 1000 device days.
Other Infections:
C. Number of Community Acquired: _______ Number of Agency Acquired:
D. Trends:
YES _____
NO _____
If YES, describe:
E. PI committee recommendations for improvement opportunities:
II.
Employee Infections:
A. Total number infections and/or exposures reported:
B. Types of infections/exposures:
C. Number of Community Acquired: _______ Number of Agency Acquired:
D. Volume (#) of Alcohol-Based Hand Rubs Used _______/_______ visits/month.
E. Clinical staff adhering to artificial nail policy: YES _____ No _____
If No, recommendations:
F. Trends in findings:
YES _____
NO _____
If, YES, describe:
G. PI committee recommendations for improvement opportunities:
_________________________________________________
Signature/Title
Professional Pediatric Home Care
December 2012
3.1C
Date
ACHC Standard HH7-1A.01
Infection Control Plan
______________________
POLICY
The Agency has developed, and implemented infection control practices that conform to OSHA
regulations, CDC guidelines, state and local regulations and currently accepted standards of
practice.
______________________
PURPOSE
To prevent or decrease the exposure of patients and employees to communicable diseases.
______________________
REFERENCE
Health Facilities and Emergency Medical Services Division, 6 CCR 1011-1, Standards for
Hospitals and Health Facilities, Chapter 26 – Home Care Agencies
______________________
RELATED DOCUMENTS
“Communicable Diseases: Definitions and Modes of Transmission” form
______________________
PROCEDURE
1.
The Agency Infection Control Plan conforms to OSHA regulations, CDC guidelines, the
state and local regulations and currently accepted standards of practice.
2.
The Plan meets or exceeds the standards established by the Department of Labor
Occupational Safety and Health Administration (OSHA) (1910.1020) on bloodborne
pathogens, including HIV and HBV.
3.
The Infection Control Plan establishes and implements policies and procedures for
controlling employee exposure to fluids, tissues or other potentially infectious material.
These policies/procedures include:
 Identifies all those employees at risk of exposure to communicable diseases.
 Establishes procedures for the evaluation of circumstances surrounding exposure
incidents.
 Makes provision for Hepatitis B vaccine to be administered to all employees at risk in
accordance with standard medical practice.
 Establishes a training program upon employment which:
o Educates employees in the infection control program.
o Advises employees of any revisions or when changes occur.
 Provides record keeping in accordance with regulations.
Professional Pediatric Home Care
December 2012
3.2
ACHC Standard HH7-1A.01
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
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


Ensures that provisions of equipment and supplies necessary to minimize the risk of
infection with bloodborne pathogens or other potentially infectious materials are
available to all employees at risk of exposure.
Establishes a process for educating patient/caregivers/families regarding infection
control policies/ procedures.
Establishes a tracking system for infections acquired in home health care.
Reviews the program’s effectiveness annually and revises as necessary.
Establishes policies/procedures that will reduce the spread of infections to employees
and patients.
Monitors staff adherence to recommended policies, procedures and protective
measures. When monitoring reveals a failure to follow recommended precautions:
o Counseling, education and/or retraining will be provided.
o If necessary, appropriate disciplinary action will be taken.
Screens staff for exposure and/or immunity to infectious diseases that staff may come
in contact with.
Refers staff who are exposed to or who potentially have an infectious disease to
physicians for assessment, testing, prophylaxis treatment, counseling and/or
immunization.
4.
Goals for the infection control program include:
 To reduce the risk of acquisition and transmission of infections.
 To limit unprotected exposure to pathogens throughout the organization by
implementing current CDC and OSHA guidelines.
 To enhance hand hygiene.
 To minimize the risk of transmitting infections associated with the use of procedures,
medical equipment and medical devices.
5.
Emergency management planning for infectious disease outbreak includes:
 The agency will be prepared to respond to an influx, or the risk of an influx, of
infectious patients. Such planning includes implementation of the emergency
management plan phases of preparation and response (see plan). Depending on the
severity and potential numbers of infectious patients, existing patients may be
prioritized and services rendered to the highest priority patients.
 In order to manage an ongoing influx of potentially infectious patients over an
extended time, the Agency will consider suspension of patient admissions and early
discharge of existing stable patients after physician consultation.
 The Agency has established processes and procedures for information management
during an infectious disease outbreak.
o The Agency will keep abreast of current information through communication with
hospitals, local and state health departments, offices of emergency management
and departments of homeland security, and local media (e.g., television, radio and
newspapers).
o Critical information will be disseminated to staff, key practitioners and leaders
through e-mail, voicemail, telephone and staff meetings.
o Community resources for obtaining additional information include local and state
health departments, offices of emergency management and departments of
homeland security as well as local hospitals.
Professional Pediatric Home Care
December 2012
3.2
ACHC Standard HH7-1A.01
6.
The Agency will perform a risk analysis to identify risks for the transmission and
acquisition of infectious agents based on:
 Geographic location and community served.
 Results of analysis of infection prevention and control data.
 Care provided.
7.
The risk analysis defines the current surveillance activities and will be reviewed annually
or whenever significant changes occur.
8.
The Agency formally evaluates the infection control program and goals annually or
whenever risks significantly change.
9.
The Director of Clinical Services is responsible for infection control program
management, unless another staff member is assigned by the Administrator/DCS.
 The assigned individual will be qualified for such responsibilities based on education,
additional training and/or experience.
 The individual coordinates all activities and assures appropriate data collection,
aggregation, analysis, monitoring of the effectiveness of the program and staff
education.
 The individual meets regularly with leaders, managers and staff (as appropriate) to:
o Develop strategies.
o Review and react (as appropriate) to data.
o Assess successes and failures of program.
o Review and revise program.
o Perform annual infection control program evaluation.
Professional Pediatric Home Care
December 2012
3.2
ACHC Standard HH7-1A.01
Annual Infection Control Program Evaluation
Area of Review
Yes
No
Describe
1. Goals reviewed and are relevant.
2. New services or sites have been
introduced with resulting changes in
the scope of the program.
3. Risk analysis has changed.
4. Emerging and/or reemerging
problems in the health care
community that potentially affected
our organization occurred.
5. Describe successes or failures of interventions in preventing or controlling infections:
a. _____________________________________________________________________
b. _____________________________________________________________________
c. _____________________________________________________________________
d. _____________________________________________________________________
6. Describe responses to concerns raised by leadership and others within organization:
a. _____________________________________________________________________
b. _____________________________________________________________________
c. _____________________________________________________________________
7. Describe evolution of relevant infection prevention and control guidelines that are based
on evidence or, in the absence of evidence, expert consensus:
a. _____________________________________________________________________
b. _____________________________________________________________________
c. _____________________________________________________________________
d. _____________________________________________________________________
_____________________________________________
Signature
Professional Pediatric Home Care
December 2012
3.2A
________________________
Date
ACHC Standard HH6-6A.01, HH7-1A.01, HH7-6A.01, HH7-7A.01
Exposure Control Plan:
OSHA Regulations
______________________
POLICY
The Agency will develop, implement and maintain infection control policies and procedures for
patients diagnosed with infections and/or contagious diseases and for the protection of
employees caring for such patients. Policies and procedures will reflect OSHA regulations and
accepted standards of care along with state and federal guidelines.
______________________
PURPOSE
To prevent and control the exposure of home care staff and patient/caregivers to infections and
hazardous products.
______________________
RELATED DOCUMENTS
“Employee Infection Control Training” and “Employee TB Screening” forms
______________________
PROCEDURE
General Information – Infection Control and Standard Precautions
1.
The use of standard precautions in the workplace is considered effective preventive
methodology in the care of patients with suspected or diagnosed bloodborne pathogen
infections and/or immuno-compromised patients and caregivers. Standard precautions
should be implemented as outlined in “Standard Precautions” (see Policy 3.5).
 As applicable, isolation precautions will be implemented on as-needed basis for
protection of immuno-compromised patients and caregivers. The attending physician
will be consulted as applicable for additional guidelines.
2.
The use of combined interventions will be practiced in the care of patient’s diagnosed
with infection by multidrug resistant organisms (MDRO). These include hand hygiene,
use of Contact Precautions until patients are culture-negative for a target MDRO, active
surveillance cultures, education, enhanced environmental cleaning, and improvements in
communication about patients with MDROs within and between healthcare facilities.
3.
Blood, body fluids and tissues of all patients are presumed infectious.
4.
If questions arise concerning a particular technique or policies of infection control, they
should be directed to the Administrator/Director of Clinical Services.
5.
Refrigerate food promptly and keep in a refrigerator separate from medications and
biologicals. Medications and biologicals are also stored separately.
Professional Pediatric Home Care
December 2012
3.3
ACHC Standard HH6-6A.01, HH7-1A.01, HH7-6A.01, HH7-7A.01
6.
Maintain a clean patient environment with emphasis on the bathroom and kitchen
cleanliness.
7.
Keep supplies off the floor and out of reach of children.
8.
Eating, drinking, smoking, applying cosmetics or lip balm and handling contact lenses
are prohibited in the work environment where there is a chance of occupational exposure.
9.
Use aseptic technique for all invasive procedures including, but not limited to:
 Urinary catheterization.
 Gastrostomy tube changes.
 Tracheostomy tube care.
 Nasotracheal suction.
 Venipuncture.
 Injections.
 Care of intravenous devices.
 Wound care.
Hand washing
Hand washing is the most important procedure in the prevention of infections. Hand washing
will be performed by all staff according to established Hand Hygiene / Hand washing / Hand
Cleansing Policy.
Disposal of Infectious Waste
1.
Infectious waste may include soiled dressings, used disposable instruments, used internal
devices such as urinary catheters, gastrostomy tubes, and suction catheters, vaccines, and
intravenous equipment. Contaminated sharps, e.g., needles and lancets, will not be
recapped:
 Agency provides in all devices for staff use.
 Contaminated sharps will not be bent, broken, or removed from disposable syringes.
 Immediately after use, contaminated sharps will be dropped into a rigid, puncture
resistant container. Puncture resistant containers are available and include:
o Rigid plastic sharps containers: Agency will provide for staff use. Staff will return
rigid plastic sharps containers to Agency for disposal.
o Patient/caregivers will be educated to dispose of sharps by placing in:
- Metal cans with reinforced lid to improve the puncture resistance.
- Hard plastic jugs.
- All containers will be located close to the work area. When the container is ¾
full, it will be securely sealed and placed in household trash, unless Agency
provided sharps container (which will be picked up by staff for proper
disposal when ¾ full).
 Materials without the risk of puncturing, e.g., gauze dressings, catheters, tubing,
gloves, etc., will be placed in leak-proof plastic bags, then securely fastened and
disposed of in the patient’s household trash.
Professional Pediatric Home Care
December 2012
3.3
ACHC Standard HH6-6A.01, HH7-1A.01, HH7-6A.01, HH7-7A.01
Nurse and other Staff Bags
1.
Bags used by nurses and other staff which contain equipment, e.g., a thermometer,
stethoscope, blood pressure cuff, etc., and are brought into the home are classified as
clean on the inside. The outside of the bag, because it is exposed to all environments, is
considered “soiled.”
 The inside and outside of the bag will be cleaned when visibly soiled.
 A barrier under the bag is not required but may be used if needed to protect the
patient’s environment or equipment bag.
Methods of Disinfection
1.
Reusable articles in the patient’s home contaminated with blood or body fluids, e.g.,
feces, pus, mucous or other organic matter, will be washed with soap and water.
 If a danger of contamination of body parts or adjacent areas exists, items will be
washed in a specific container for that purpose and the subsequent solution discarded
into the toilet bowl.
 Full strength disinfectant will be used to clean toilet bowl and seat.
2.
Whenever it is necessary to use equipment which must be disinfected after use and which
will be used by or for a patient over a period of time, e.g., bedpans, urinals, bedside
commodes, etc., the nurse will instruct the family to provide this equipment or will assist
them in obtaining it.
3.
Blood glucose monitors are cleaned when visibly soiled or according to manufacturers’
recommendations.
4.
All solutions will be checked for expiration date prior to patient use.
 When the patient no longer needs the treatment, all opened solutions and supplies will
be discarded.
 Other disposable supplies, e.g., irrigation trays, syringes, suture removal sets, solution
containers, etc., will be discarded after use.
5.
Thermometers will be wiped with alcohol pad after each use. The effectiveness of this
technique is dependent on vigorous friction. Allow to air dry. Thermometers with
disposable shields are to be cleaned with alcohol pad after disposal of shield.
6.
Stethoscopes and blood pressure cuffs not provided by the patient/family will be cleaned
when visibly soiled by the employee who has possession of the equipment. The chance of
transmission of infection through use of blood pressure cuff or stethoscope is small,
therefore wiping with disinfectant when visibly soiled is adequate.
7.
All patient dirty laundry is to be handled minimally and not shaken or placed against the
employee’s clothing or body. Laundry will be placed immediately in the patient’s laundry
area or washing machine to minimize employee and family exposure.
8.
Broken glassware, e.g., contaminated blood collection tubes, will not be picked up
directly by hand.
Professional Pediatric Home Care
December 2012
3.3
ACHC Standard HH6-6A.01, HH7-1A.01, HH7-6A.01, HH7-7A.01
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Use the contents of the spill kit by sprinkling the spill with the absorbent material.
Wear gloves to scoop up the absorbed spill and broken glass.
Dispose in container and place container into a contaminated garbage bag.
Wear gloves to scoop up the absorbed spill and broken glass.
Dispose in container and place container into a contaminated garbage bag.
Nursing Bag Technique
1.
Before entering the home, make sure the bag is stocked with bacteriostatic foam/
liquid/wipes and plastic trash bags (preferable in a side pocket).
2.
Upon entering the home, place the bag on a clean surface; paper towels or plastic bag
may be used to create a clean area if indicated. Open the bag near the care area and, if
possible, near the water supply.
 Wash hands thoroughly with bacteriostatic foam/liquid/wipes.
 Remove all items which will be needed for the visit.
o Place items on a firm clean surface. Close the bag and give the patient care.
o If additional items are needed after care has started, wash hands before re-entering
bag.
o Clean any visibly soiled items, which will be returned to the bag.
o Wash hands and return equipment to the bag; close bag.
o Tidy up the work area disposing of wastes.
Professional Pediatric Home Care
December 2012
3.3
ACHC Standard HH7-1A.01
EMPLOYEE INFECTION CONTROL TRAINING
Employees will receive education and training during orientation and at least annually (see
Specific Procedures for Employee and Patient Infection Control Training).
1. Standard Precautions
 Hand washing
 Gloves
 Gowns/aprons
 Masks
 Protective eyewear and shoe covers
 CPR resusci-masks
 Disinfection
 Linens
 Eating utensils
 Needles, scalpels and other sharp instruments or devices: disposal
2. Employee Health Requirements
 Pre-employment physical evaluations are not required. Pre-employment physical
evaluations may be required on a case-by-case basis per Administrator/Director of
Clinical Services discretion.
 TB test – chest x-ray, per CDC guidelines
 HBV vaccine or declination
 Infections or illness to be reported to supervisor.
3. Hygiene
 Personal hygiene (handwashing)
 Agency uniform requirements
4. List of Reportable Communicable Diseases
 Disease information
 Disease/infection mode of transmission
 Vaccine availability: signs and symptoms
5. Transmitted Infections
 Wound infections
 IV site infections
 Hepatitis, AIDS
 MRSA, VRE
 Other reportable communicable diseases
6. Infectious Waste Disposal
7. Cleaning and Disinfection of Equipment
 Thermometer
 Stethoscope
Professional Pediatric Home Care
December 2012
3.3A
ACHC Standard HH7-1A.01



Sphygmomanometer
Clinician bag
Ultrasound (head)
8. OSHA Regulations
 Exposure Control Plan
 Standard Precautions
 Engineering controls
 Work practice controls
 Personal protective equipment (PPE)
 Orientation and training
 Labels and signs
 Hepatitis B Vaccination
 Post-exposure plans
 TB/Airborne Exposure Control Plan
9. Procedures Requiring Special Techniques
 Dressing changes
 Wound or decubitus care
 Intravenous therapy
 Respiratory care
 Urinary care
 Foot care
 Other aseptic procedures
Employees will be evaluated for compliance with agency infection control policies and
procedures during periodic infection control in-service training and by direct observation during
supervised home visits.
Professional Pediatric Home Care
December 2012
3.3A
ACHC Standard HH7-1A.01
Specific Procedures for Employee and
Patient Infection Control Training
______________________
POLICY
To ensure that all Agency staff are educated and understand specific procedures regarding
infection control.
______________________
PURPOSE
All Agency employees are educated and understand proper infection control precautions.
______________________
RELATED DOCUMENTS
“Incident/Occurrence Report: Patient or Employee” form
______________________
PROCEDURE
Staff
1.
All employees who come into contact with blood, body fluids, tissue, solids or any moist
body part or substance of any patient will use the following specific procedures in
compliance with Standard Precautions procedures:
 Apply gloves before contact with any moist body site, fluids or solids, including
mucous membranes, e.g., when providing personal care for patients with bleeding or
open lesions, large abrasions or dermatitis, and when handling items soiled with body
fluids or substances.
 Wear gloves for all patient care if employee’s hands are chapped or if employee has
any open skin areas on hands.
 Wear gloves when changing soiled linens.
 Wash hands before and after wearing gloves.
 Change gloves and wash hands between patients.
2.
Wear an apron or gown and protective eyewear if danger of body fluid splash is present.
Bag all soiled dressings in plastic and close the bag securely before placing into the
patient’s trash container.
3.
Any piece of disposable equipment which has been in contact with blood/body fluids or
moist body substances must be disposed of in a plastic bag. Place the plastic bag in the
patient’s covered trash receptacle.
4.
Handle all lab specimens, body secretions/tissue, lab tubes and syringes used in specimen
collection as if contaminated.
 Label blood specimen tubes.
 After venipuncture, place tubes in plastic bag with biohazard label.
Professional Pediatric Home Care
December 2012
3.4
ACHC Standard HH7-1A.01

5.
Place the biohazard bag with the blood specimen tubes in a rigid, impervious
container for transport to lab.
When a needlestick or body fluid splash/exposure occurs, wash the area thoroughly and
report the incident to the Administrator/Director of Clinical Services. Complete an
Incident/Occurrence Report: Patient or Employee.
Patient Education
1.
Instruct in all basic principles of Standard Precautions and any other procedures as
applicable to the patient’s care.
2.
Instruct in modes of transmission of all possible contaminants and specific organisms, if
known.
3.
Instruct regarding disposal of all infectious wastes.
4.
Instruct to report any contaminated needlestick or exposure to a physician immediately.
5.
Instruct to make a 10% bleach solution for cleaning equipment and decontamination.
 Add 9 parts of water to 1 part of household bleach.
 Once mixed, the solution must be discarded after 24 hours.
 Instruct to clean contaminated surfaces with the bleach solution.
6.
Instruct to run one (1) cup of bleach through the washing machine for laundering
contaminated linens and clothing.
7.
Patients who have Hepatitis, Staph, TB, MRSA, VRE or enterobacterium should use
separate dishes.
 Wash first in a plastic basin and rinse in 10% bleach solution followed by a cold
rinse.
 Rinse the basin with bleach solution after use.
8.
Food leftovers from infectious patients should be bagged before discarding.
9.
Bathrooms should be cleaned with a 10% bleach solution.
10.
Instruct patient/caregivers to cover the nose and mouth when coughing or sneezing.
11.
Contact infection control specialists at a local hospital or the local health department for
procedures regarding specific organisms, when known.
12.
The patient/caregiver should demonstrate understanding following teaching.
 Evaluate and record patient/caregiver compliance in the nurses’ notes periodically.
Professional Pediatric Home Care
December 2012
3.4
ACHC Standard HH7-1A.01
Standard Precautions
______________________
POLICY
Blood and body fluid precautions will be followed for all patients.
______________________
PURPOSE
To prevent transmission of communicable diseases.
______________________
PROCEDURE
1.
The concept of body substance isolation encompasses all the principles of Standard
Precautions/blood and body fluid precaution, and extends to all moist body parts/tissues/
surfaces, including fluids, solids, tissue and moist areas, e.g., mucous membranes.
2.
The principles of Standard Precautions are to be followed by all employees when
contacting any such substances or areas. Standard Precautions include the following
procedures:
 All health care workers will routinely use appropriate barrier precautions to prevent
skin and mucous membrane exposure when contact with blood or other body fluids of
any patient is anticipated.
o Gloves will be worn before touching blood and body fluids, mucous membranes
or non-intact skin of all patients; for handling items or surfaces soiled with blood
or body fluids; and for performing venipuncture and other vascular access
procedures.
o Gloves will be changed and hands washed after contact with each patient.
o Masks and protective eyewear or face shields will be worn during procedures that
are likely to generate droplets of blood or other body fluids to prevent exposure of
mucous membranes of the mouth, nose and eyes.
o Gowns or aprons and shoe covers will be worn during procedures that are likely
to generate splashes of blood or other body fluids.
o CPR resusci-masks will be used when rendering resuscitation. For the staff that is
CPR certified, the masks are to be carried at all times while rendering care.
3.
Hands and other skin surfaces will be washed immediately and thoroughly if
contaminated with blood or other body fluids.
4.
All health care workers will take precautions to prevent injuries caused:
 Needles, scalpels, and other sharp instruments or devices during procedures.
 When cleaning used equipment.
 During disposal of used needles.
 When handling sharp instruments after procedures.
5.
To prevent needlestick injuries, contaminated needles will not be recapped, purposely
bent or broken by hand, removed from disposable syringes or otherwise manipulated by
hand. The Agency provides all safe devices for staff use.
Professional Pediatric Home Care
December 2012
3.5
ACHC Standard HH7-1A.01
6.
After use, disposable syringes and needles, scalpel blades, and other sharp items will be
placed in puncture-resistant containers. These containers should be:
 Practical to the use area.
 Be leak-proof on the sides and bottom.
 Be kept closed.
 Not overfilled.
7.
Standard Precautions will be followed for all patients. Isolation precautions will be used
as necessary if specific conditions, e.g., infectious diarrhea or tuberculosis, are diagnosed
or suspected.
Professional Pediatric Home Care
December 2012
3.5
ACHC Standard HH7-1A.01
Hand Hygiene / Hand Washing / Hand Cleansing
______________________
POLICY
Hand Hygiene / Hand Washing / Hand Cleansing will be done by all employees to reduce the
transfer of microbes to patients and to prevent the growth of microorganisms on the nails, hands
and forearms.
______________________
PURPOSE
To prevent transfer of germs and transmission of infections to patients and caregivers.
______________________
REFERENCE
Health Facilities and Emergency Medical Services Division, 6 CCR 1011-1, Standards for
Hospitals and Health Facilities, Chapter 26 – Home Care Agencies
______________________
EQUIPMENT
 Alcohol based gel.
 Sink with running water.
 Soap – preferably liquid.
 Paper Towels.
 Disposable plastic bag or waste can.
______________________
PROCEDURE
1.
Indications for Hand Hygiene / Hand Washing / Hand Cleansing are:
 Before and after direct patient care.
 Before and after each procedure.
 After using the bathroom.
 After blowing or wiping the nose.
 Before and after eating and drinking.
 Before and after collecting specimen.
 When hands are soiled.
 After any contact with contaminated materials.
 Before entering clinician’s bag or patient’s clean supplies.
2.
All employees are responsible for implementing Hand Hygiene / Hand Washing / Hand
Cleansing procedures in an on-going attempt to prevent and/or contain infectious
processes and communicable diseases.
3.
Alcohol based gels are the preferable Hand Hygiene / Hand Washing / Hand Cleansing
method. When using alcohol based gel, the procedure is a follows:
 Place adequate amount of foam or liquid on hands.
Professional Pediatric Home Care
December 2012
3.6
ACHC Standard HH7-1A.01



Using friction, clean between fingers, around and under nails, palms and backs of
hands.
Apply friction to hands until the foam or liquid has dried on the skin surface.
Alcohol based gels are not to be used for hand hygiene when hands are visibly soiled,
in this instance hand washing with soap and water is required.
4.
The proper procedure for hand washing when using soap and water is as follows:
 Turn water to a comfortable warm temperature.
 Hold hands under running water so they get completely wet.
 Lather hands well with soap: use friction for a minimum of 15 seconds; wash between
fingers, wash area around and under nails.
 Using a clean, dry towel, dry hands thoroughly.
 Turn off water faucet using clean, dry towel.
 Discard paper towels in a disposable bag or waste can.
5.
Staff competence with use of alcohol based gel and hand washing will be evaluated at
time of hire and annually.
Professional Pediatric Home Care
December 2012
3.6
ACHC Standard HH7-1A.01
Housekeeping Requirements for Bloodborne Pathogens
______________________
POLICY
The Agency will encourage employees to use good housekeeping techniques in both the patients’
homes and the Agency office.
______________________
PURPOSE
To maintain a clean and sanitary working environment.
______________________
PROCEDURE
1.
All equipment, environmental and working surfaces will be cleaned and decontaminated
after contact with blood or other potentially infectious materials. Work surfaces will be
decontaminated with an appropriate disinfectant:
 After completion of care.
 Immediately, or as soon as feasible, when surfaces are overtly contaminated.
 After any spill of blood or other potentially infectious materials.
2.
Protective covers used to cover equipment and environmental surfaces, e.g., plastic wrap,
aluminum foil or imperviously backed absorbent paper, will be removed and replaced as
soon as possible when they become overtly contaminated.
3.
All bins, pails, cans and similar receptacles intended for reuse which have a reasonable
likelihood of becoming contaminated with blood or other potentially infectious materials
will be inspected and decontaminated immediately, or as soon as feasible upon visible
contamination.
4.
Broken glassware which may be contaminated will not be picked up directly with the
hands. It will be cleaned by using mechanical means such as a brush, dust pan, tongs or
forceps.
5.
When moving containers of contaminated sharps from the area, the container will be:
 Closeable.
 Constructed to contain all contents and prevent leakage during handling, storage,
transport or shipping.
 Closed prior to removal to prevent spillage.
 Labeled and color coded as biohazardous waste.
6.
Disposal of all regulated waste will be in accordance with applicable laws/regulations,
both state and federal. Regulated waste will be placed in containers which are:
 Closeable.
 Constructed to contain all contents and prevent leakage of fluids during handling,
storage, transport or shipping.
Professional Pediatric Home Care
December 2012
3.7
ACHC Standard HH7-1A.01


Labeled and color coded as biohazardous waste.
Closed prior to removal to prevent spillage.
7.
If outside contamination of waste containers occurs, the container will be placed in a
second container. The second container will be:
 Closeable.
 Constructed to contain all contents and prevent leakage during handling, storage,
transport or shipping.
 Labeled and color coded as biohazardous waste.
 Closed prior to removal to prevent spillage or protrusion of contents.
8.
Blood spills will be wiped up and decontaminated with diluted bleach solution or
commercial germicide. A spill kit will be used, as appropriate.
9.
Transportation of hazardous waste:
 Hazardous waste shall be transported off site by a biomedical waste transporter. (This
does not include the transport of the sharps containers back to the Agency from the
patient’s home.)
 Hazardous waste shall be contained in an onsite storage area prior to offsite transport
in such a manner that no discharge or release of any waste may occur.
 Storage of hazardous waste shall not exceed 30 days beginning on the day the waste
is collected.
 All packages containing hazardous waste shall be visibly identified with the
international biological hazard symbol sign and a “Biomedical Waste” sign.
 Outer container/off site transported container shall be labeled with transporter’s
name, address, registration number, and 24 hour telephone number.
 All labels must be legible, written in indelible ink and securely attached or
permanently printed on each bag.
 Hazardous waste containers/packages shall be transferred in a manner that does not
impair the integrity of the packaging.
 Packages shall not be compacted.
 Bags shall be prepared for offsite transport by enclosing in a rigid type container.
 The Agency will contract with a hazardous waste management company.
 Contractor responsibilities include the transportation and treatment of all Agency
hazardous wastes.
 In the event the contractor is unable to fulfill the contracted duties/responsibilities, the
Agency will contact another hazardous waste management company as soon as the
Agency becomes aware of the problem.
Professional Pediatric Home Care
December 2012
3.7
ACHC Standard HH7-1A.01
Employee Infectious Diseases
______________________
POLICY
The Agency will determine the work status of an employee diagnosed with certain infectious
diseases.
______________________
PURPOSE
To prevent the spread of infectious diseases to patients and other employees.
______________________
REFERENCE
Health Facilities and Emergency Medical Services Division, 6 CCR 1011-1, Standards for
Hospitals and Health Facilities, Chapter 26 – Home Care Agencies
CDC Personnel Health Guideline
______________________
RELATED DOCUMENTS
“Health Guidelines for Employees with Infectious Diseases”
______________________
PROCEDURE
1.
Work status of employees with infectious diseases will be determined by consultation
with the Administrator/Director of Clinical Services or Supervisor and the employee’s
physician, if applicable.
2.
Recommendations will be based on guidelines from CDC, current practice and state law.
Professional Pediatric Home Care
December 2012
3.8
ACHC Standard HH7-1A.01
HEALTH GUIDELINES FOR EMPLOYEES WITH
INFECTIOUS DISEASES
The following guidelines are to be followed regarding the work status and any restrictions for
employees with infectious diseases.
Illness/Disease
Abscesses, boils or lesionsdraining
AIDS, HIV Positive, ARC
Disease
Work Status
No direct patient care contact
Restrictions
Until drainage stops
May work unless other
infections prohibit from work
Conjunctivitis
Diarrhea or enteric infections
May not work
May not work
Fungus: hands
German Measles (Rubella)
May not work
May not work
Gonorrhea
Hepatitis - A, B, and non A,
non B
Herpes Simplex:
May work
May not work
Not to provide care to
immune suppressed or
severely ill patient
Until symptoms subside
Until symptoms resolve
- See MD if severe or
persistent. No care for
immune suppressed or
severely ill patients
Until lesions are healed
Until rash is cleared –
minimum 5 days
None
Until MD permits to work
a. Genital
May work
b. Oral/facial
May work
Herpes Zoster
Impetigo
Influenza
Jaundice
May not work
May not work
May not work
May work
Lice
May not work
Meningitis – active
Meningocele
Meningitis exposure
May not work
Professional Pediatric Home Care
May work
December 2012
3.8A
Use good handwashing
technique
No contacts with immune
suppressed or severely ill
patients
Until lesions have crusted
Until lesions have crusted
Until acute symptoms resolve
Limit physical exertion,
allow frequent rest periods
Until MD permits return to
work
Until MD permits return to
work
None
ACHC Standard HH7-1A.01
Illness/Disease
Mononucleosis Infectious
Work Status
May not work
Mumps – active
May not work
Pertussis
May not work
PPD – positive conversion
May not work
Salmonella,
Shigella
No direct patient care
Scabies
May not work
Strep Throat by culture
May not work
Upper Respiratory Infection
with coughing & sneezing
Varicella - active (Chicken
Pox)
Vomiting
No direct patient care
Wound Infection
May work
May not work
May not work
Restrictions
Until MD permits return to
work
Until 9 days after onset of
parotitis
Until 7 days after start of
treatment
Until MD permits return to
work
May not return to direct
patient care until 48 hrs after
anti-microbials are D/C'd & 2
successive negative cultures
from fecal samples or rectal
swabs & MD permits return
to work
Until MD permits return to
work
Until 24 hours after adequate
treatment started
Until coughing & sneezing
subside; should be afebrile
Until MD permits return to
work
Until acute symptoms resolve
- See MD if severe or
persistent. No care for
immune suppressed or
severely ill patients
Wound must be receiving
adequate treatment, wound
must be covered with intact,
waterproof dressing
**NOTE: For any other infectious illnesses and/or communicable diseases not listed, the
employee's physician will be consulted regarding work status and any work restrictions and
durations.
Professional Pediatric Home Care
December 2012
3.8A
ACHC Standard HH7-1A.01
Employee Epidemiological Illnesses
______________________
POLICY
Any employee who has an exposure to or is diagnosed with a reportable communicable disease
will not be allowed to work. Notification will be made of exposure or diagnosis to all contacts.
The patient’s physician will be notified, as appropriate.
______________________
PURPOSE
To establish a procedure when an employee is exposed to or diagnosed with a reportable
communicable disease that could possibly be transmitted to other staff or patients.
______________________
PROCEDURE
1.
If an employee is diagnosed with or has an exposure to a reportable communicable
disease, the employee will be suspended from work. The employee will be required to
report to his/her physician.
2.
To return to work, the employee must present a written statement from employee’s
physician indicating physician’s permission to return to work with no restrictions.
3.
Reportable communicable diseases are defined by local health departments.
Professional Pediatric Home Care
December 2012
3.9
ACHC Standard HH7-1A.01
Reporting of Epidemiological Illnesses
______________________
POLICY
Unless previously reported, patients and employees with known or suspected reportable
communicable diseases will be reported to the Colorado Department of Public Health and
Environment.
______________________
PURPOSE
To comply with state and federal regulations regarding reporting requirements applicable to
communicable diseases.
______________________
RELATED DOCUMENTS
“Communicable Diseases: Definitions and Modes of Transmission,” “Communicable/Infectious
Disease Information Table,” and “Colorado Department of Health Conditions Reportable”
forms
______________________
PROCEDURE
1.
All reportable communicable diseases will be reported to the state department of health,
according to guidelines established by the Colorado Department of Public Health and
Environment.
2.
Patients will be encouraged to report any reportable communicable diseases to the office
and to the Colorado Department of Public Health and Environment.
3.
Records will be kept to identify any patterns or trends of communicable diseases. Data
regarding communicable diseases will be reviewed and analyzed on an ongoing basis to
identify any trends.
Professional Pediatric Home Care
December 2012
3.10
ACHC Standard HH7-1A.01
COMMUNICABLE DISEASES:
DEFINITIONS AND MODES OF TRANSMISSION
Definitions:
An infectious disease results from the invasion of a host by disease-producing organisms, such
as bacteria, viruses, fungi or parasites.
Example: Salmonella is a highly infectious disease usually transmitted from poorly prepared
foods contaminated with salmonella bacteria and is not contagious.
A communicable (or contagious) disease is one that can be transmitted from one person to
another. Not all infectious diseases are communicable.
Example: chickenpox is an infectious disease which is also communicable and can be easily
transmitted from one person to another.
Modes of Transmission:
Communicable disease can be spread through contact, droplet, or airborne routes. .
Contact transmission, includes direct and indirect transmission, and includes bloodborne
transmission.
Direct transmission occurs through direct contact with the blood or other body substances of an
infected individual.
Indirect transmission occurs without person-to-person contact. The disease-producing organism
passes from the infected individual to an inanimate object. (Person comes into contact with a
contaminated object and comes down with the disease.)
Bloodborne diseases are spread by direct contact with the blood or other body substances of an
infected person. (Bloodborne diseases of most concern include Human Immunodeficiency Virus
[HIV], Hepatitis B and Hepatitis.)
Droplet transmission occurs when respiratory droplets carrying infectious pathogens make
contact with the mucosal surfaces of the recipient, generally over short distances. This can be
caused by a productive cough, sneeze, or talking. Influenza, SARS, group A streptococcus,
adenovirus, and Mycoplasma pnuemoniae can be transmitted by this route.
Airborne transmission occurs by dissemination of either airborne droplet nuclei or small
particles that contain infectious agents that remain infective over time and distance (e.g.,
Aspergillus, Mycobacterium tuberculosis.)
Exposure to Bloodborne Pathogens:
Human “exposure” is defined as contact with blood or other body fluids to which Standard
Precautions apply. Exposure can occur via percutaneous inoculation (needlestick, laceration or
bite), contact with an open wound, non-intact skin or mucous membrane (ocular or permucosal)
during the performance of normal job duties.
Professional Pediatric Home Care
December 2012
3.10A
ACHC Standard HH7-1A.01
Body Fluids Exposure:
“Body fluids” exposures are those identified by the CDC to which Standard Precautions apply
including, without limitation, the following body fluids: blood, semen, vaginal secretions, CSF,
synovial fluid, pleural fluid, peritoneal fluid, pericardial fluid, and amniotic fluid, laboratory
specimens that contain HIV or other body fluids which contain visible blood, such as vomitus or
urine.
Professional Pediatric Home Care
December 2012
3.10A
ACHC Standard HH7-1A.01
COMMUNICABLE/INFECTIOUS
DISEASE INFORMATION TABLE
Disease/
Infection
Mode of
Transmission
Is Vaccine
Available?
AIDS/HIV
(Human Immunodeficiency
Virus)
Needlesticks, blood splashes into
mucous membranes (e.g., eye or
mouth) or blood contact with
open wounds
Cutaneous: spores enter open
areas
Pulmonary: inhalation of spores
NO
Fever, night sweats,
weight loss, cough
YES
Anthrax
Signs and
Symptoms
Respiratory secretions and contact
with moist vesicles
Fecal/oral
YES
NO
Cutaneous: pustules,
lesions, edema
Pulmonary: fever, fatigue,
headache, rapid onset of
acute respiratory distress
Fever, rash, cutaneous
vesicles (blisters)
Loose, watery stools
Respiratory droplets & contact
with respiratory secretions
Fecal/oral
YES
Fever, rash
YES
Needlestick, blood splashes into
mucous membranes (e.g., eye or
mouth) or blood contact with
open wound
Possible exposure during mouthto-mouth resuscitation
Same as Hepatitis B
Same as Hepatitis B; dependent
on HBV (past or present) to cause
infection
YES
Fever, loss of appetite,
fatigue, jaundice.
Incubation period is 15-50
days (avg of 28)
Fever, fatigue, loss of
appetite, nausea, headache,
jaundice. Incubation
period is 45-160 days
(avg of 120)
Other non-A, non-B
Hepatitis
Several viruses with different
modes of transmission
(These are called “non-A, non-B”
because there are no specific tests
to identify them)
NO
Herpes Simplex
(Cold Sores)
Contact of mucous membrane
with moist lesions
Fingers are at particular risk for
becoming infected
Contact with moist lesions
NO
Skin lesions located
around the mouth area
NO
Skin lesions
Airborne
YES
Fever, fatigue, loss of
appetite, nausea, headache
Chickenpox
Diarrhea:
Campylobactor,
Cryptosporidium, Giardia
Salmonella, Shigella
Viral, Yersinia
German Measles (Rubella)
Hepatitis A
(Infectious Hepatitis)
Hepatitis B
(Serum Hepatitis)
Hepatitis C
Hepatitis D
Herpes Zoster (Shingles)
localized disseminated (See
Chickenpox)
Influenza
Professional Pediatric Home Care
December 2012
3.10B
NO
NO
Same as Hepatitis B
A complication of HBV
infection & can increase
the severity of HBV
infection
Fever, headache, fatigue,
jaundice
ACHC Standard HH7-1A.01
Disease/
Infection
Mode of
Transmission
Is Vaccine
Available?
Signs and
Symptoms
Lice: Head, Body, Pubic
Close head to head contact. Both
body & pubic lice require
intimate contact (usually sexual)
or sharing of intimate clothing
NO
Measles
Respiratory droplets & contact
with nasal or throat secretions
Highly communicable
Contact with respiratory
secretions
YES
Severe itching and
scratching, often with
secondary infection. Scalp
& hairy portions of body
may be affected. Eggs of
head lice (nits) attach to
hairs as small, round, gray
lumps
Fever, rash, bronchitis
NO
Fever, severe headache,
stiff neck, sore throat
Hemophilus
Influenza
Contact with respiratory
secretions
YES
(Same)
Viral Meningitis
NO
(Same)
NO
Fever, sore throat, fatigue
Mumps
(infectious parotitis)
Salmonellosis
Contact with respiratory
secretions
Contact with respiratory
secretions or saliva, such as with
mouth-to-mouth resuscitation
Respiratory droplets & contact
with saliva
Foodborne
YES
Scabies
Close body contact
NO
Small Pox
Respiratory droplets & contact
with nasal or throat secretions
Direct contact with pustules
Highly communicable
YES
Syphilis
Primarily sexual contact; rarely
through blood transfusion
NO
Tuberculosis, pulmonary
Airborne
NO
Whooping cough
(pertussis)
Airborne, direct contact with oral
secretions
YES
Fever, swelling of salivary
glands (parotid)
Sudden onset of fever,
abdominal pain, diarrhea,
nausea & frequent
vomiting
Itching, tiny linear
burrows or “tracks,”
vesicles – particularly
around fingers, wrists,
elbows & skin folds
Severe headache, chills,
high fever, vomiting,
convulsions, rash of small
red pustules that become
blisters
Genital & cutaneous
lesions, nerve
degeneration (late)
Fever, night sweats,
weight loss, cough
Violent cough at night,
whooping sound when
cough subsides
Meningitis:
Meningococcal
Mononucleosis
NO
*NOTE: Obtain list and guidelines from local health department for other state-specific
reportable, communicable diseases.
Professional Pediatric Home Care
December 2012
3.10B
ACHC Standard HH7-1A.01
COLORADO BOARD OF HEALTH
CONDITIONS REPORTABLE BY
ALL PHYSICIANS AND HEALTH CARE PROVIDERS
IN COLORADO
The list below applies to physicians and health care providers. Laboratories have separate reporting requirements. A case must be reported to the state
or local health department following diagnosis within the timeframe indicated.
The State Health Department recommends reporting all suspected cases, whether or not supporting laboratory data are available.
24 - Hour Reportables
Animal bites by dogs, cats, bats,
skunks or other wild carnivores
Anthrax
Botulism
Cholera
Diphtheria
Group Outbreaks - known or suspected
of all types: including foodborne,
waterborne or other illness
Vaccine-Preventable Diseases
Influenza - associated death if <18
years (7d)
Mumps (7d)
Foodborne and Enteric Diseases
Giardiasis (7d)
Hemolytic uremic syndrome if <18
years (7d)
Listeriosis (7d)
Hepatitis B (7d)
Influenza - associated
hospitalization (7d)
Campylobacteriosis (7d)
Cryptosporidiosis (7d)
Cyclospora (7d)
E. coli 0157:H7 & shiga toxin
producing E. coli (7d)
Sexually Transmitted Diseases
Gonorrhea, any site (7d)
AIDS and HIV infection (7d)
Chancroid (7d)
Zoonotic Diseases
Psittacosis (7d)
Q Fever (7d)
Relapsing Fever (7d)
Meningitis/Encephalitis & Invasive Disease
Aseptic meningitis (7d)
Brucellosis (7d)
Hantavirus (7d)
Lyme Disease (7d)
Encephalitis (7d)
encephalopathy (7d)
Hepatitis C, acute (7d)
Hepatitis, other viral (7d)
Kawasaki Syndrome (7d)
Haemophilus influenzae invasive disease
Hepatitis A
Human Rabies (suspected)
Measles
Neisseria meningitidis invasive disease
Pertussis
Plague
Poliomyelitis
Rubella
SARS
Smallpox
Syphilis, early (1o, 2o, early latent)
Tuberculosis (active disease)
Typhoid Fever
Rubella, congenital (7d)
Tetanus (7d)
Varicella (7d)
Salmonellosis (7d)
Shigellosis (7d)
Trichinosis (7d)
Lymphogranuloma venereum (7d)
Rocky Mountain Spotted Fever (7d)
Tularemia (7d)
Transmissible spongiform
Other Important Reportable Diseases
Legionellosis (7d)
Toxic Shock Syndrome (7d)
Leprosy (7d)
Positive TB skin test in workers
Malaria (7d)
exposed to active disease (7d)
Environmental, Occupational, and Chronic Conditions
Fetal Alcohol Syndrome if <10 years
Muscular Dystrophy (120d)+
old (30d)
Spinal cord injuries (120d)+
Head injuries (hospitalized
or fatal) (120d)+
Autism spectrum disorders <10 years
old (30d)+
Birth defects, developmental disabilities
and risk factors (pregnancy to 3rd
birthday) (120d)+
(+) only hospitals required to report
~ Immediate reporting by phone is required of any illness suspected to be caused by biologic, chemical, or radioactive terrorism ~
ALL REPORTS MUST INCLUDE:
TO REPORT A CASE / REQUEST FORMS, CONTACT:
1. The disease or condition being reported
The Local Health Department or
2. Patient's name, date of birth, sex, race,
Colorado Department of Public Health and Environment
ethnicity, address (including city,
Division of Disease Control & Environmental Epidemiology
county, and phone number)
4300 Cherry Creek Drive South, A3
3. Physician's name, address and
Denver, Colorado 80246-1530
www.cdphe.state.co.us/dc/index.html
telephone number
Denver Metro Telephone: 303-692-2700
Denver Metro Fax: (303) 782-0338
Outside Denver / Toll Free Telephone: 1-800-866-2759 Outside Denver / Toll Free Fax: 1-800-811-7263
For a Rapid Response / 24-Hour Reportable Conditions call:
303-370-9395 (after hours and weekends)
Professional Pediatric Home Care
December 2012
3.10C
ACHC Standard HH4-2D.01, HH7-1A.01
Bloodborne Pathogens Standard
______________________
POLICY
Current OSHA standards are followed to reduce the risk of occupational exposure to bloodborne
pathogens.
______________________
PURPOSE
To follow procedures established in the OSHA standards to reduce the risk of occupational
exposure to bloodborne pathogens.
______________________
RELATED DOCUMENTS
“OSHA Directive No. CPL 02-02-069 (November 27, 2001), Enforcement Procedures for the
Occupational Exposure to Bloodborne Pathogens,” “Employee Information Sheet: Hepatitis B
and Hepatitis B Vaccine,” “Hepatitis B Vaccination Form,” and “Personal Protective
Equipment”
______________________
DEFINITIONS
Bloodborne pathogens are those that are transmitted through blood, semen, vaginal secretions,
tissues, cerebrospinal fluid, pleural fluid, synovial fluid, peritoneal fluid, pericardial fluid,
amniotic fluid and any other body fluids that can reasonably be expected to contain visible blood.
Nasal secretions, sputum, and vomitus are included in this category if they contain visible blood.
Parenteral (needlestick/mucous membrane) exposure is defined as exposure to blood, body
fluids or tissue involving puncture wound, splash, spill, etc., or cutaneous (skin contact) exposure
involving large amounts of blood/body fluids or prolonged contact with blood/body fluids.
______________________
PROCEDURE
1.
Any employee who will be in direct patient contact and accepts employment with
Agency is required upon employment to be notified of the Hepatitis B vaccination that is
offered to the employee by the Agency. An information sheet will be given to all new
employees. The employee can either accept the vaccine or decline and sign the waiver
form that will be placed in the employee’s health file. If at any time during employment
an employee is exposed to Hepatitis B, the employer will offer the vaccine. Employees
must sign a declination statement for the Hepatitis B vaccination within 10 days of
employment it they chose not to become vaccinated.
2.
Agency will provide to the employees at no cost the following engineering and work
place controls:
 All safe devices for needles.
 Puncture-resistant containers for used needles.
Professional Pediatric Home Care
December 2012
3.11
ACHC Standard HH4-2D.01, HH7-1A.01









Biohazardous waste containers for disposal of biohazardous waste.
Hand washing capability with alcohol based gel to reduce contamination.
Gloves when contact with blood, body fluid, mucous membranes or non-intact skin of
patients is anticipated and/or when contact with contaminated surfaces is anticipated.
Gowns or plastic aprons if blood splattering is likely.
Masks and protective eyewear and shoe covers if aerosolization or splattering is likely
to occur.
CPR resusci-masks for those employees who are CPR certified and may be required
to render CPR.
Biohazard-labeled plastic bags and rigid, impervious containers for transportation of
lab specimens.
Employee infection control policies and procedures.
Cleaning procedures for all equipment and work surfaces.
3.
The following Job Classification/Tasks Performed positions are defined as Category I
employees who are exposed occupationally to blood and body secretions:
 Nurses (RN/LPN): dressing changes, wound care, foley catheter changes,
venipuncture, IV administration, IV access devices, enema administration, medication
administration, personal care (bathing, etc.), patient assessment, suctioning,
tracheostomy care and all direct (hands-on) patient care.
 Therapists (Physical/Speech Language/Occupational): dysphagia teaching,
ambulation/gait training, ADL's, ultrasound, paraffin treatments and all direct (handson) patient care procedures.
4.
The following employee positions are defined as Category II positions that are
occasionally exposed to blood and body secretions:
 Social Workers: Usually provide no direct (hands-on) patient care, but may be
occupationally exposed by virtue of performing home visits.
5.
The Agency provides orientation to each of its employees at the time of initial
employment and annual training thereafter.
 Additional training will be provided when there is a modification in tasks or
procedures or with the institution of new tasks or procedures.
 Each employee will receive the Employee Information Sheet: Hepatitis B and
Hepatitis B Vaccine as part of the training program (information sheet contains
materials appropriate in content and vocabulary to education level, literacy and
language of employees).
6.
The program consists of identification of modes of transmission; knowledge of the
exposure control plan; understanding of engineering controls and work practices to
safeguard the employees; the importance of personal protective equipment; an
understanding by the employee of hazards associated with bloodborne disease; and
understanding of CDC's Standard Precautions.
7.
Each employee will inform the Agency of his/her individual status regarding the HBV
vaccine. Agency will make the HBV vaccination series available to all employees who
have occupational exposure (Category I and Category II employees) after those
employees have received appropriate training.
Professional Pediatric Home Care
December 2012
3.11
ACHC Standard HH4-2D.01, HH7-1A.01




If employee does not want to receive the vaccine, the Hepatitis B Vaccination Waiver
Form must be signed.
The recommended dosage and administration of Hepatitis B vaccine is a series of
three 1ml doses (initial injection, one month and six months) given intramuscularly in
the deltoid muscle.
The Agency will make provision for Hepatitis B vaccine to be administered.
The vaccine will be administered unless the employee has previously received the
complete Hepatitis B vaccination series, antibody testing has revealed that the
employee is immune, employee refuses (signs waiver) or the vaccine is
contraindicated for medical reasons.
8.
The Administrator/Director of Clinical Services is responsible for: development,
implementation and overall management of the infection control plan; staff education;
record keeping; evaluation of exposure incidents; annually reviewing the plan; updating
the plan whenever changes in the work environment or job task assignments so dictate;
etc.
9.
The Agency will make available post-exposure follow up for all employees with an
occupational exposure incident at no cost to the employee.
 All medical evaluations and procedures will be performed by or under the supervision
of a licensed physician at no cost to the employee.
 Agency will provide all necessary personal protective equipment to employees whose
tasks, procedures and/or positions may lead to an occupational bloodborne exposure.
10.
Each employee has the responsibility to report any contaminated needlesticks or any
direct blood or body fluid exposures to eyes, skin, mouth, nose, open wound or abrasion.
 Employee must notify Administrator, Director of Clinical Services or Supervisor of
any open wounds or abrasions that might allow disease transmission before initiating
work activities involving bloodborne pathogens.
 Employee will properly wear all personal protective equipment as described in this
plan. Failure to comply with Standard Precautions is a serious violation and will be
treated as such.
 Employee will report to the Administrator, Director of Clinical Services or Supervisor
immediately all accidents, incidents or near occurrences.
11.
Employee records are confidential and will be kept for the following durations:
 Inservice (training) records will be maintained for a minimum of three (3) years from
the date of the training.
 Medical records for any employee with an occupational exposure will be kept for the
duration of his/her employment plus thirty years and will be kept confidential.
 Health records for exposed employees will contain a copy of their Hepatitis B
vaccination status, results of examination, medical testing and follow-up procedures.
 Each health record will include the name and social security number of each
employee.
- A copy of each employee's Hepatitis B vaccination record will be maintained in
the employee's health record.
- A copy of the Hepatitis B Vaccination Waiver Form will be maintained in each
employee's health record that does not elect to receive the HBV vaccine.
Professional Pediatric Home Care
December 2012
3.11
ACHC Standard HH4-2D.01, HH7-1A.01


All records will be made available upon request to the Assistant Secretary and
Director of OSHA for examination and copying.
Employee inservice records will be provided upon request for examination to
employees, employee representatives and the Assistant Secretary of OSHA.
Employee health records and inservice records relevant to the Bloodborne Pathogen
Standards will be provided upon request for examination and copying to the subject
employee, to anyone having written consent of the subject employee and to the
Assistant Secretary of OSHA.
12.
If the Agency ceases to do business and there is no successor, the Agency will notify the
Director of OSHA at least three months prior to ceasing business to transmit records, if
required by the Director of OSHA and to do so during that three month period.
13.
Transmission of Hepatitis B virus and HIV virus occur through contact with infected
blood and/or body fluids. It is not always possible to know the HBV or HIV status of a
patient. For the safety and/or protection of employees, work-related tasks may require the
use of appropriate precautions. As defined by the Department of Labor, work related
tasks may be divided into three exposure categories:
 Category I: Tasks that involve exposure to blood, body fluids or tissues.
 Category II: Tasks that involve no exposure to blood, body fluids or tissues, but
employee's job may require performing unplanned Category I tasks.
 Category III: Tasks that involve no exposure to blood, body fluids or tissues, and
Category I tasks are not a condition of employment, e.g., secretarial and billing staff.
14.
Staff will utilize appropriate precautions (Standard Precautions) for all unanticipated
blood/body fluid exposures utilizing CDC guidelines for Standard Precautions and
incorporating barriers. Patient care staff will have readily available barriers at all times
for potential blood/body fluid exposures, such as handwashing, gloves, masks, gowns and
goggles.
15.
The following items will be readily available and utilized for the Category I and II tasks:
 Gloves: Disposable gloves are to be worn with any anticipated exposure to blood,
body fluids or when providing direct care for a patient with an open wound/lesions,
fecal or urinary incontinence, vomiting or any other type of drainage of bodily fluids.
 Masks: Masks will be worn when the splattering of blood and/or body fluids is likely
to occur. For those employees who are required to be CPR certified as a condition of
job assignment, these employees will carry a CPR resusci-mask with them at all times
while performing home visits and will use the mask when rendering CPR.
 Goggles: Goggles will be worn when the splattering of blood or body fluids is likely
to occur.
 Gowns and Shoe Covers: Gowns and shoe covers will be worn if the soiling of an
employee's clothing or shoes with blood or body fluids is likely to occur.
16.
If an exposure should occur, the Agency will file an Incident/Occurrence Report: Patient
or Employee and make it available to the affected employee. The report will contain:
 Documentation of the routes of exposure including source individual(s), if known,
and the circumstances surrounding the event.
Professional Pediatric Home Care
December 2012
3.11
ACHC Standard HH4-2D.01, HH7-1A.01



Results from the collection of and testing of source patient blood (if determined and
permission given) to determine the presence of HBV and/or HIV infection.
Results from antibody or antigen testing of victim's blood or serum sample (sample to
be collected as soon as possible after the exposure).
Follow up results on the testing, counseling, illness reported and post exposure
prophylaxis.
17.
The Agency will provide the following information to the evaluating physician:
 A description of the affected employee's duties as they relate to the occupational
exposure.
 Documentation of the routes of exposure and circumstances under which the
exposure occurred.
 Results of the source individual's blood testing, if available.
 All medical records relevant to the appropriate treatment of the employee including
vaccination status.
18.
The Agency will obtain and provide the employee with a copy of the evaluating
physician's opinion within 15 working days of the completion of the evaluation.
19.
When an exposure occurs, the employee will immediately notify the Administrator,
Director of Clinical Services or Supervisor for instructions for post-exposure health care.
The affected area will be cleansed immediately by flushing area(s) under a steady stream
of running hot water and soap. Treatment should minimally consist of the taking of a
baseline serum or blood sample and a HBV booster or equivalent as soon as feasible.
20.
The affected employee and the Administrator, Director of Clinical Services or Supervisor
will file an initial incident report detailing the circumstances of the incident. The report
will include:
 The name of the individual affected.
 The date and time of the incident.
 Task being performed at the time of the incident.
 Suspected cause of the incident.
 Any mitigating circumstances surrounding the incident.
 The immediate responses and actions of all individuals involved in the incident
(including patient, caregivers, bystanders, witnesses, etc.).
21.
A copy of the report will be filed in the employee's health record and the original sent to
the Administrator/Director of Clinical Services for review.
22.
The exposed employee will be tested as follows:
 Initial tests: HBV and HIV.
 6 weeks post-exposure: HBV and HIV.
 3 months post-exposure: HIV.
 6 months post-exposure: HIV.
 12 months post-exposure: HIV.
Professional Pediatric Home Care
December 2012
3.11
ACHC Standard HH4-2D.01, HH7-1A.01
INFORMATION SHEET
Hepatitis B and Hepatitis B Vaccine
Hepatitis B, a viral infection of the liver, is caused by the Hepatitis B virus (HBV). In the United
States, some 300,000 persons are newly infected with HBV each year. Occupational work related
acquisition of HBV occurs through a needlestick, mucous membrane or non-intact skin exposure
to blood and other body fluids containing the HBV. The risk of contracting Hepatitis B from a
single contaminated needlestick ranges from 6% to 30%. Each year approximately 12,000
healthcare workers (HCW) contract work-related Hepatitis B. Three hundred of these will
ultimately die from Hepatitis B related complications.
Healthcare workers are 20 times more likely to contract HBV infection than the general public.
There is a 15% to 30% prevalence of Hepatitis B markers in physicians and HCWs indicating
prior exposure to the virus. Since 1970, 20 reported cases of HBV infection from HCWs to
patients have been reported.
Although HBV is an unpredictable disease that may incapacitate a person for weeks or months
and lead to complications, most people develop antibody to the virus and recover completely.
However, 5% to 10% of infected persons become chronic carriers of HBV and never develop
antibodies.
One in 200 persons in the United States is chronic HBV carriers. It is estimated that 1% to 2% of
all hospital admissions are Hepatitis B antigen positive. A carrier is infectious to others and has
an increased risk of developing long-term complications, such as chronic active hepatitis,
cirrhosis of the liver and primary carcinoma of the liver. Carriers have a risk 273 times greater
than that of the general population of contracting liver cancer.
A vaccine is available for the prevention of Hepatitis B infection. It is a non-infectious
genetically engineered recombinant DNA vaccine. No substances of human origin are used in its
manufacture. The vaccine is administered in the deltoid area in a series of 3 doses over a 6month period. The second dose is given one month after the first and the third dose 5 months
after the second or 6 months after the first dose. Protective antibody titers are achieved in 95% of
those vaccinated.
The incidence of side effects, both local and general, has been minimal among recipients of the
vaccine. Broad use of the vaccine could have adverse reactions not observed during clinical trails.
The most common adverse reaction is local soreness at the injection site. Less common reactions
include erythema, swelling and warmth or induration of the injection site which is generally well
tolerated and usually subsides within 48 hours. Low grade fever (101) occurs occasionally; fever
over 102 is uncommon. Systemic complaints, including fatigue, malaise, nausea, vomiting, headache,
myalgia and arthralgia are infrequent. Rash has rarely been reported. There has been no cause and
effect relationship established between the vaccine and neurological disorders.
This vaccine is contraindicated in persons allergic to yeast. HBV vaccine would not be expected
to be harmful to a developing fetus; however, its safety for the fetus has not yet been
demonstrated. Accordingly, HBV vaccine is not generally recommended for pregnant women or
nursing mothers.
If you have a medical condition, allergies, are pregnant or breastfeeding, please consult your
physician for direction prior to receiving the vaccine.
Professional Pediatric Home Care
December 2012
3.11A
ACHC Standard HH4-2D.01, HH7-1A.01
HEPATITIS B VACCINATION WAIVER FORM
I understand that due to my occupational exposure to blood or other potentially infectious
material, I am at risk of acquiring HBV (Hepatitis B Virus) infection. I have read the Information
Sheet: Hepatitis B and Hepatitis B Vaccine and have had an opportunity to ask questions and
understand the risks and benefits of the HBV vaccine.
I have been given the opportunity to be vaccinated at no charge to myself.
Having been so informed, I decline to take the HBV vaccine at this time. I understand that by
declining the vaccine, I continue to be at risk of acquiring hepatitis. If in the future I continue to
have occupational exposure to blood or other potentially infectious materials and want to be
vaccinated, I can receive the vaccination series at no charge to me.
NAME (Print): ________________________________________________________________
SS#: ________________________ AGENCY: ______________________________________
EMPLOYEE SIGNATURE: _________________________________ DATE: ______________
SUPERVISOR: ___________________________________________ DATE: ______________
Professional Pediatric Home Care
December 2012
3.11B
ACHC Standard HH7-1A.01
PERSONAL PROTECTIVE EQUIPMENT
Procedures that may Involve Exposure to Blood or
Other Potentially Infectious Materials
Key:
X = Required
O = Use if soiling or splattering likely
Procedures
Gloves
Venipuncture
Fingerstick Blood Sample
Dressing Change
Wound Irrigation
Cleaning Equipment
Suctioning
Enemas
Vaginal Douche
Sputum Collection/ Aerosol Admin
Foley Catheter Insertion
Foley Catheter Care
Foley Catheter Removal
Condom Catheter Applica/Care
IM, SQ, Intradermal Injection
CPR
NG Tube Insertion
Tube Feeding
Bath
Oral Care
Colostomy Care
Assist with Toileting
Changing Soiled Linens
Disposal of Soiled Trash
Handling Specimens
Administration of Suppository
Taking Rectal Temperature
Specimen Collection
Nail Clipping
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
Professional Pediatric Home Care
December 2012
3.11C
Gowns
Faceshield
Eye Cover
O
O
O
O
O
O
O
O
O
O
O
O + TB mask
Pocket
ResusciMask
X
O
O
O
O
O
O
ACHC Standard HH4-2D.01, HH7-1A.01
RECOMMENDATIONS FOR FOLLOW-UP AFTER
SIGNIFICANT EXPOSURE
Treatment when source patient is found to be:
Exposed Person
Obtain baseline and f/u HIV
titers *4, *5.
HIV Status Unknown or
Source Patient Unknown
Request to obtain HIV testing
on source patient *6.
Offer AZT or current
medication per protocol
Offer AZT or current
education per protocol
HIV Positive
Employee
Obtain baseline and f/u HIV
titers on employee *4, *5.
*4
*5
*6
Obtain employee f/u titers at 6 weeks, 3 months & 6 months.
Employee may elect to have blood stored for 90 days if he declines immediate
testing.
If source patient refuses HIV testing, employee must have HIV testing or provide
proof of negative results done within the last 6 months. Any blood on hold in the
lab from the source patient may then be tested for HIV.
Chickenpox (Varicella)
 If the history is questionable, or the exposed employee has never had chickenpox or shingles,
a titer should be drawn with the results documented in the employee’s file.
 Exposed susceptible employees will be placed on work restrictions as indicated.
Hepatitis A (Post-Exposure or Acute Disease)
 Hepatitis A is primarily transmitted by person-to-person contact, generally through fecal
contamination or oral ingestion. Employees who have had direct exposure to Viral Hepatitis,
Type A, should report to Agency office and to their physician to be given immune serum
globulin (IgG) intramuscularly, if indicated. The recommended dose if 0.02 ml/kg of body
weight. Refer to insert in product package. IgG should be given as soon as possible after last
exposure (Giving IgG more than two weeks after exposure is not indicated.)
 Transmission of Hepatitis A is primarily through oral/fecal route. Good personal hygiene and
practicing good handwashing at all times is strongly recommended.
 Employees who have had Hepatitis A (or Hepatitis B) and are in the convalescent state will
not be allowed to return to duty until blood levels are:
Total Bilirubin
not above 3 mg/ml
AST
not above 150 units
ALT
not above 150 units
 Any employee who has been released by his/her private physician following illness of
Hepatitis A or B must present current laboratory reports as listed above. The laboratory
results will be reviewed by the Administrator/Director of Clinical Services. If results are not
within acceptable levels, the employee will not be allowed to return until the standard is met.
Professional Pediatric Home Care
December 2012
3.11D
ACHC Standard HH4-2D.01, HH7-1A.01

Laboratory studies, Total Bilirubin, AST and ALT will be done on each employee, if deemed
necessary by the Administrator/Director of Clinical Services. Any variation in this policy
will be at the discretion of the Administrator/Director of Clinical Services.
Hepatitis B (Employee with Active, Acute or Chronic Disease or Post-Exposure)
 All employees who have a positive Hepatitis B surface antigen will be given a written
statement which reviews techniques and precautions that are to be observed. This statement
will be signed by the employee, witnessed and filed in his/her health records. Certain work
restrictions may apply.
 Follow-up lab work (AST and ALT) may be requested by the Agency on employees every
six (6) months. The Administrator/Director of Clinical Services will be responsible for
employee’s work technique and placement.
 Subsequent Hepatitis B surface antibody (HBsAB) will be done on any employee who
requests one. This test will be done one (1) month after the final injection. If HBsAB is not
present, a fourth injection will be given. Employees who decline the vaccine must sign the
Hepatitis B Vaccination Waiver Form indicating they have had three (3) doses of vaccine,
have positive antibody tests or have medical contraindications for the vaccine. Records of the
Hepatitis B immunization dates are kept by the Agency.
 For accidental percutaneous (needlestick, laceration or bite) or permucosal (ocular or mucous
membrane) exposure to blood, the decision to provide prophylaxis must consider:
1) Whether the source of the blood is available;
2) The HBsAB status of the source;
3) The Hepatitis B vaccination and vaccine response status of the exposed person.
 Once an exposure has occurred, a blood sample should be drawn and tested for HBsAB from
the exposed individual. Local laws regarding consent for testing source individuals should be
followed. CDC recommendations for Hepatitis B prophylaxis are followed.
Hepatitis B Virus Prophylaxis
CDC recommendations for Hepatitis B prophylaxis following percutaneous or permucosal
exposure are:
Exposed Person
HBsAB-Positive
HBsAB-Negative
Unvaccinated
HBIG x 1 * and indicate Initiate HB vaccine
HB vaccine +
Previously vaccinated Test exposed for HBs.
No treatment
responder
1. If adequate, no
treatment
2. If inadequate, HB
vaccine booster
dose
Known nonresponders HBIG x 2 or HBIG x *
No treatment
1 dose HB vaccine
Professional Pediatric Home Care
December 2012
3.11D
Source not tested or
unknown
Initiate HB vaccine +
No treatment
If known high-risk
source, may treat as
HBsAB-positive
ACHC Standard HH4-2D.01, HH7-1A.01
Exposed Person
Response unknown
HBsAB-Positive
Test exposed for HBs
1. If inadequate, HBIG
x 1 # Hepatitis-B
vaccine booster
dose.
2. If adequate, no
treatment.
HBsAB-Negative
No treatment
Source not tested or
unknown
Test exposed for HBs
1. If inadequate,
Hepatitis vaccine
booster dose.
2. If adequate, no
treatment.
* HBIG dose 0.06 ml/kg IM ASAP after exposure within 24 hours if possible.
+ HB vaccine dose per the recommended three (3) doses. Given IM at a separate site and can
be given simultaneously with HBIG or within seven (7) days of exposure.
# Adequate anti-HBs is >10 SRU by RIA or positive EIA.
Measles, Mumps, Rubella (MMR)
Titers will be required on exposed susceptible employees who are exposed to an active case of
MMR before proper precautions are instituted. If the titers indicate no immunity, the exposed
employee will be placed on work restriction as indicated.
Meningococcal Meningitis
A person having intimate contact, e.g., mouth-to-mouth resuscitation, with a patient who has
meningitis prior to 24 hours of subsequent treatment with effective antibiotics may be treated
with prophylaxis antibiotics. If this decision is made, treatment will not await laboratory
confirmation. Medication will be prescribed by the employee’s physician.
Professional Pediatric Home Care
December 2012
3.11D
ACHC Standard HH7-1A.01
Airborne Pathogens Standard
______________________
POLICY
Current CDC standards are followed to reduce the risk of occupational exposure to airborne
pathogens.
______________________
PURPOSE
To follow procedures established in the CDC standards to reduce the risk of occupational
exposure to airborne pathogens.
______________________
RELATED DOCUMENTS
CDC 2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in
Healthcare Settings
______________________
DEFINITIONS
Airborne pathogens include Mycobacterium tuberculosis, rubeola virus (measles), and varicellazoster virus (chickenpox). Additionally, consideration is given to influenza, rhinovirus and some
gastrointestinal viruses (e.g., norovirus and rotavirus).
Airborne transmission occurs by dissemination of either airborne droplet nuclei or small particles in
the respirable size range containing infectious agents that remain infective over time and distance
(e.g., spores of Aspergillus spp, and Mycobacterium tuberculosis). Microorganisms carried in this
manner may be dispersed over long distances by air currents and may be inhaled by susceptible
individuals who have not had face-to-face contact with (or been in the same room with) the
infectious individual.
______________________
PROCEDURE
1.
Standard precautions will be observed for patients with known or suspected infection with
an airborne pathogen.
2.
In settings where Airborne Isolation Precautions cannot be implemented due to limited
engineering resources (e.g., the home setting), masking the patient, placing the patient in a
private room with the door closed, and providing N95 or higher level respirators or masks
if respirators are not available for healthcare personnel will reduce the likelihood of
airborne transmission.
3.
Healthcare personnel caring for patients on Airborne Precautions will wear a mask or
respirator, depending on the disease-specific recommendations, that is donned prior to
room entry. Whenever possible, non-immune health care workers should not care for
patients with vaccine-preventable airborne diseases (e.g., measles, chickenpox, and
smallpox).
4.
Clinical staff will be educated on preventing transmission of infectious agents associated
with healthcare during orientation and during ongoing education programs. Documentation
of training will be retained for the specific staff positions.
Professional Pediatric Home Care
December 2012
3.12
ACHC Standard HH7-1A.01
Supply Maintenance
______________________
POLICY
The Agency maintains and delivers supplies according to applicable federal/state laws and
regulations.
______________________
PURPOSE
To assure that the supplies used by Agency staff and/or patients are sanitary and appropriate for
use.
______________________
PROCEDURE
At the Agency Site(s)
1. All medical supplies, especially sterile items, will be properly stored in a clean, dry area and
handled in a sanitary manner protected from potential contamination as indicated by the
manufacturer.
2. Supply packaging will remain intact while stored. If outer package is damaged or opened,
supply will be removed and discarded.
3. Supplies will be checked for expiration date prior to use. If outdated, the supplies will be
immediately removed from stock and discarded.
4. New medical supplies will be stored behind older supplies to assist in a timely rotation of
supplies.
5. Staff will inspect packages of sterile items for evidence of interruption or exposure to liquid
prior to use.
6. Staff using sterile medical supplies will handle items in a manner to protect sterility and
prevent contamination. If supplies are taken from the Agency to the patient’s environment,
staff assures appropriate and safe delivery of supplies. Supplies will be placed in a plastic or
paper bag and placed in a clean area of the car for transport.
In the Patient’s Home
1. Staff will assess the home environment for appropriate location for storage of supplies.
2. Staff will request that patient/caregiver allocate one area, e.g., shelf, drawer counter top, as
the designated area for supply storage and maintenance.
3. Staff will instruct the patient/caregiver on proper storage of medical supplies and
maintenance of an optimal clean environment for supplies.
4. Items will be stored according to vendor/manufacturer’s recommendations, e.g., refrigeration
if necessary.
5. The patient/caregiver will be instructed on principles of safe handling of clean supplies,
equipment, medication and solutions.
6. The patient/caregiver will be instructed on proper disposal and handling of utilized
supplies.
7. The Agency is responsible for obtaining and delivering only those supplies routinely
stocked in the supply room, e.g., dressings, catheter supplies.
8. The patient/caregiver is responsible for obtaining other supplies and medications with the
appropriate assistance from staff.
9. Supplies issued to a patient will not be returned from the patient’s home.
Professional Pediatric Home Care
December 2012
3.13
ACHC Standard HH4-2C.01, HH7-1A.01
Occupational Exposure to Tuberculosis/
Prevention of Transmission of TB Plan
______________________
POLICY
This Agency will comply with the current OSHA Enforcement Policy and Procedure for
Occupational Exposure to Tuberculosis (TB) as well as Centers for Disease Control (CDC)
guidelines.
______________________
PURPOSE
To protect exposed employees against TB.
______________________
PROCEDURE
1.
Responsibility for the TB infection control program is assigned to the
Administrator/Director of Clinical Services. The Administrator/Director of Clinical
Services is given the authority to implement and enforce TB infection control policies
and procedures.
2.
The Administrator/Director of Clinical Services will perform annual and ongoing risk
assessment surveillance for the Agency. According to the Annual TB Surveillance Report
for CO 2011, the overall case rate for TB is 1.4 per 100,000 (March 2012 TB
Report/CDC). There have been no documented cases of TB or suspected TB in the
PPHC client or family population in the past year. For this reason, PPHC
clients/families and care providers are considered at very low risk for TB infection
and/or transmission. Regardless of the risk level, the management of patients with
known or suspected infectious TB will not vary. Risk definitions include:
 Very low risk: Applies to an entire facility in which patients with active TB are not
admitted to inpatient areas but may receive initial assessment and diagnostic
evaluation or outpatient management in outpatient areas. Patients who may have
active TB and need inpatient care are promptly referred to an appropriate facility.
 Low risk: Areas or groups in which the PPD test conversion rate is not greater than
that for areas or groups in which occupational exposure to TB is unlikely or than
previous conversion rates for the same area or group. No clusters of PPD test
conversions have occurred. Person-to-person transmission of TB has not been
detected, and fewer than six (6) TB patients have been treated per year.
 Intermediate risk: Same as low risk, except that six (6) or more TB patients are
treated per year.
 High risk: Areas or occupational groups in which the PPD test conversion rate is
significantly greater than for areas or groups in which occupational exposure to TB is
unlikely or than previous conversion rates for the same area or group and
epidemiologic evaluation suggest nosocomial transmission. An epidemiologic
evaluation suggests nosocomial transmission of TB. Possible person-to-person
transmission of TB has been detected.
Professional Pediatric Home Care
December 2012
3.14
ACHC Standard HH4-2C.01, HH7-1A.01
3.
The occurrence of drug-resistant TB in the patient population served or a relatively high
prevalence of HIV infections among patients served or employees may increase the
concern about the transmission of TB and may influence the decision regarding which
protocol to follow, e.g., high risk classification may be selected.
4.
The Agency may have a combination of risk areas at any given time. The appropriate
protocol will be implemented for each area or group.
5.
A diagnosis of TB may be considered for any patient who has a persistent cough, e.g., a
cough lasting 3 weeks or longer, unexplained weight loss, night sweats and/or other
signs/symptoms suggestive of active TB.
The home management of those patients with suspected or confirmed infections includes:
 Implementation of precautions to prevent exposure until communicability has been
eliminated by drugs including:
o Instructing patients to cover coughs and sneezes.
o Instructing patients who are on TB medications about the importance of taking
medications as prescribed (unless adverse effects are seen).
o Employee use of NIOSH-approved high efficiency particulate air respirator (the
minimally acceptable level of respiratory protection) in the following
circumstances:
1) When employees enter the homes or rooms of individuals with suspected or
confirmed infectious TB disease.
2) When employees perform high risk procedures on individuals who have
suspected or confirmed TB disease including, but not limited to: aerosolized
medication (e.g., pentamidine), sputum induction, endotracheal procedures
and/or suctioning procedures.
 Performance of cough-inducing procedures in a well-ventilated area away from other
persons.
o A cough-inducing procedure performed on patients who have infectious TB
should not be done in the patient’s home unless absolutely necessary.
o When medically necessary to be performed in the home, procedure should be
performed in a well-ventilated area away from other persons.
o Employee should consider opening a window to improve ventilation or collecting
the specimen while outside the dwelling.
o The employee collecting the specimen must wear respiratory protection during the
procedure.
 To the extent possible, isolation of the patient away from other residents in an area
with the maximum possible ventilation.
o If agreeable with the patient, placement of a warning sign outside the room or
home:
1) “Special Respiratory Isolation” or
2) A description of the necessary precautions.
o Precautions may be discontinued when patient is no longer infectious.
6.
7.
Respiratory protective devices should meet recommended performance criteria. These
include:
 Ability to filter particles 1mm in size in the unloaded state (not loaded with dust) with
a filter efficiency of greater than or equal to 95% (NIOSH = 95 or greater).
Professional Pediatric Home Care
December 2012
3.14
ACHC Standard HH4-2C.01, HH7-1A.01




Ability to be qualitatively or quantitatively fit tested in a reliable way to obtain a faceseal leakage of less than or equal to 10%.
Ability to fit different facial sizes and characteristics of employees.
Ability to be checked for face piece fit, in accordance with OSHA and good industrial
hygiene practice, by employees each time respirators are used.
CDC guidelines reference OSHA requirements for use of respiratory protective
devices which are certified by NIOSH.
8.
Respiratory protection should be used:
 By employees entering homes in which patients with known or suspected infectious
TB are living.
 Employees when performing cough-inducing or aerosol-generating procedures on
such patients.
 Where administrative and engineering controls are not likely to protect employee
from inhaling infectious airborne droplet nuclei.
9.
Patients suspected of having TB should wear surgical masks when not in TB isolation
rooms to reduce the expulsion of droplet nuclei into the air.
NOTE: These patients do not need to wear particulate respirators which are designed to
filter the air before it is inhaled by the person wearing the respirator.
10.
All employees will receive education regarding TB that is relevant to their particular
occupational group, before initial assignment and annually. The program will include the
following elements:
 Basic concepts of transmission, pathogenesis and diagnosis, including the difference
between latent and active TB infection, the signs and symptoms of TB and the
possibility of re-infection.
 Potential for occupational exposure.
 Principles and practices of infection control that reduce risk for transmission.
 Purpose of TB screening and the importance of participating in the screening
program.
 Principles of preventive therapy for latent TB.
 Employee’s responsibility to seek prompt medical evaluation if a PPD test conversion
develops or if symptoms develop that could be caused by TB.
 Principles of drug therapy for active TB.
 Importance of notifying the Agency if the employee is diagnosed with active TB.
 Responsibility of the Agency to maintain the confidentiality of the employee while
ensuring that the employee who has TB receives therapy.
 High risks associated with TB infection in persons who have HIV infection or other
causes of severely impaired cell-mediated immunity.
 Potential development of cutaneous anergy as immune functions decline.
 Information regarding the efficacy and safety of BCG vaccination and the principles
of PPD screening among BCG recipients.
 Agency’s policy on voluntary work reassignment options for immunocompromised
employees.
11.
Employees will be counseled regarding:
Professional Pediatric Home Care
December 2012
3.14
ACHC Standard HH4-2C.01, HH7-1A.01








The need to follow existing recommendations for infection control to minimize the
risk for exposure to infectious agents.
The potential risks to severely immunocompromised persons associated with caring
for patients who have some infectious diseases including TB.
Making reasonable accommodations for employees who have health conditions that
compromise cell-mediated immunity and who work in settings where they may be
exposed to Mycobacterium tuberculosis.
Immunocompromised employees will be referred to health professionals who can
individually counsel the employees regarding their risk for TB.
Agency will offer, but not compel, a work setting in which the immunocompromised
employee wound have the lowest possible risk for occupational exposure to M.
tuberculosis, including consideration of the provisions of the “Americans with
Disabilities Act of 1990.”
Immunosuppressed employees should have appropriate follow up and screening for
infectious diseases, including TB. Employees who are known to be HIV infected or
otherwise severely immunosuppressed should be tested for cutaneous anergy at the
time of PPD testing.
Consideration will be given to retesting at least every 6 months, those
immunocompromised employees who are potentially exposed to M. tuberculosis
because of the high risk for rapid progression to active TB if they become infected.
Information provided by employees regarding their immune status will be treated
confidentially. If the employee requests voluntary job reassignment, confidentiality
will be maintained.
12.
Any employee who has a persistent cough (lasting greater than or equal to 3 weeks),
especially in the presence of other signs or symptoms compatible with active TB, should
be evaluated for TB. The employee should not return to the workplace until a diagnosis
of TB has been excluded or until the employee is on therapy and a determination has
been made that the employee is noninfectious.
13.
New Employees/Contractors will produce recent (within 12 months) evidence of a
negative PPD or chest x-ray prior to working with PPHC clients.
 Employees who have a documented history of a positive PPD test, adequate treatment for
disease or adequate preventive therapy for infection will be exempt from further PPD
screening unless they develop signs of symptoms suggestive of TB.
 PPD negative employees need not obtain ongoing PPD screening, unless they have
come in contact with any of the following high risk groups:
•
•
•
•
•
•
•
•
•
•
persons with HIV infection/AIDS
recent close contacts to persons with infectious pulmonary TB disease
persons with fibrotic lesions on chest x-ray consistent with healed TB
persons who inject drugs or use other high risk substances, such as crack cocaine, and
alcoholics
persons with medical conditions which increase the risk of TB disease
residents and employees of high risk congregate settings such as correctional institutions,
long-term residential care facilities (nursing homes, mental institutions, etc.), hospitals
and other health care facilities, and homeless shelters.
health care workers and volunteers who serve high risk clients who undergo employment
screening and cannot provide documentation of a previous TST or information about
appropriate follow-up for a “positive” skin test
mycobacteriology laboratory personnel
foreign-born persons who have arrived within five years from countries that have a high
TB incidence or prevalence (most countries in Africa, Asia, Latin America, Eastern
Professional Pediatric Home Care
December 2012
3.14
ACHC Standard HH4-2C.01, HH7-1A.01
•
•
Europe, and Russia)
children less than 4 years of age, or children and adolescents exposed to adults in high
risk categories
•
adult contacts to children with TB
•
persons with a history of inadequately treated TB
(State of Colorado Rules and Regulations Pertaining to Epidemic and Communicable Disease Control {6 CCR-1009-1}.
Regulation 4: Treatment and Control of Tuberculosis)



Care Providers will receive annual education regarding signs/symptoms of exposure, high
risk groups and where to obtain screening.
Employees/Contractors will notify the Clinical Director and/or Administrator if they
believe they have been in contact with a potentially infectious client or family.
PPD test results will be filed confidentially in the individual employee health record.
14.
Employees who have positive TB screening results will be referred to their physician for
evaluation. The employee will be removed from patient contact until permission to work
is granted by the physician in writing.
 If an employee’s PPD test result converts to positive, a history of confirmed or
suspected TB exposure will be obtained in an attempt to determine the potential
source. When the source of exposure is known, the drug susceptibility of M.
tuberculosis from the source should be determined and recorded in the employee’s
health record, where it will be available if the employee subsequently develops active
TB and needs therapy.
 Employees with pulmonary or laryngeal TB will be excluded from the workplace
until they are noninfectious.
 Before the employee who has TB can return to the workplace, the Agency must have
documentation from the health care provider that the employee is receiving adequate
therapy, cough has resolved and the employee has had three consecutive negative
sputum smears collected on different days.
 After work duties are resumed and while the employee remains on therapy, Agency
must receive periodic documentation from the health care provider that the employee
is being maintained on effective drug therapy for the recommended time period and
that the sputum AFB smears continue to be negative.
 Employees with active laryngeal or pulmonary TB who discontinue treatment before
they are cured will be evaluated promptly for infectiousness. If it is determined that
they are still infectious, they will be excluded from the workplace until treatment has
been resumed, an adequate response has been documented and three or more
consecutive AFB smears collected on different days have been negative.
 Employees who have TB at sites other than the lung or larynx usually do not need to
be excluded from the workplace, if a diagnosis of concurrent pulmonary TB has been
ruled out.
 Employees receiving preventive treatment for latent TB will not be restricted from
their usual work activities.
 Employees with latent TB who cannot take or who do not accept or complete a full
course of preventive therapy will not be excluded from the workplace. They will be
counseled about the risk for developing active TB and instructed regularly to seek
prompt evaluation if signs and symptoms develop that could be caused by TB.
15.
As soon as a patient or employee is known or suspected to have active TB, the patient or
employee should be reported to the public health department so that appropriate follow
Professional Pediatric Home Care
December 2012
3.14
ACHC Standard HH4-2C.01, HH7-1A.01
up can be arranged and a community contact investigation can be performed. The public
health department will protect the confidentiality of the patient or employee in
accordance with state and local laws.
16.
The Agency and health department will coordinate their efforts to perform appropriate
contact investigations on patients and employees who have active TB.
17.
In accordance with state and local laws and regulations, results of all AFB positive
sputum smears, cultures positive for M. tuberculosis and drug susceptibility results will
be reported to the public health department as soon as these results are available.
18.
Public health department may be able to assist the Agency with planning and
implementing various aspects of a TB infection control program, e.g., surveillance,
screening activities and outbreak investigations.
19.
All reports (exposure/medical) of an employee are confidential and may be accessed
when the record is within the regulation definition.
 A record of TB skin testing results and medical evaluations and treatment is an
employee medical record within the regulation definitions.
 Records must be handled in compliance with the regulations.
20.
TB infections (positive TB Mantoux skin test or PPDs and TB disease) will be recorded
on the “Infection Log: Employees.” A positive skin test for TB, even on baseline testing
(except if positive on pre-employment screening), is recordable on the log because there
is a presumption of work-relatedness.
21.
If an employee’s TB infection which was recorded on the log progresses to TB disease
during the five year maintenance period, the original log entry must be updated to reflect
the new information. Because it is clinically difficult to determine if TB disease resulted
from the source indicated by the skin test conversion or from subsequent exposures, only
one case should be entered to avoid double counting.
Professional Pediatric Home Care
December 2012
3.14
ACHC Standard HH4-2C.01, HH7-1A.01
Employee TB Screening
1. Are you from or have you lived for two months or more in Africa, Asia, Central or South America, or
Eastern Europe? � No � Yes If yes, list countries: ________________________________________________
2. Have you been diagnosed with a chronic condition that may impair your immune system?
� No � Yes If yes, check all that apply:

� Chronic steroid use
� Gastrectomy/intestinal bypass
� Diabetes mellitus
� HIV infection
� Crohn’s disease
� Dialysis/Renal failure
� Cancer of the head or neck
� Rheumatoid arthritis
� Chronic malabsorption syndromes
� Silicosis
� Use of TNF-α antagonist
� Low body weight
� Leukemia
� Lymphoma
� Hodgkin’s Disease
� Other _______________________________________________________
3. Have you ever resided, worked or volunteered in any of the following facilities?
� No � Yes If yes, check all that apply:

� Prison
� Hospital
� Nursing home
� Homeless shelter
� Other long term treatment center _____________________________________
4. Do you currently have any of the following symptoms?
� No � Yes If yes, check all that apply:
� Cough > 3 weeks
� Productive cough
� Coughing up blood
� Unexplained fever
� Night sweats
� Unexplained wt. loss
� Chest pain
� Shortness of breath
� Fatigue
� Chills
� Loss of appetite
� Weakness
5. Have you ever had contact with a person known to have active tuberculosis?
� No � Yes
6. Have you ever used injection drugs?
� No � Yes
7. Have you had a tuberculin skin test before?
� No � Yes If yes, list where given ___________________ Date __________ (attach results)
8. Have you had a chest x-ray?
� No � Yes If yes, list where given ___________________ Date __________ (attach results)
The information above is true and complete to the best of my knowledge, and I am aware that deliberate
misrepresentation may jeopardize my health. I understand that this information is confidential and will not be
released without my knowledge and written permission.
_____________________________________________
Applicant / Employee Signature
______________________________
Date
-------------------------------------------------------------------------------A “yes” answer to 1-6 above may require the employee be referred to a provider for further evaluation, unless the
applicant/employee can provide documentation of negative skin test in the last 12 months or negative chest x-ray. If
referred, applicant/employee will be eligible to work only when cleared by physician.
Referred to MD? � No � Yes If yes, cleared to work? � No � Yes Date __________ (attach documentation)
_____________________________________________
Administrator / Supervisor Signature
Professional Pediatric Home Care
______________________________
Date
December 2012
3.14A
ACHC Standard HH7-1A.01
TB in Colorado: Cases by County and Year of Report 2002-2011
County
Adams
Alamosa
Arapahoe
Archuleta
Bent
Boulder
Broomfield
Chaffee
Clear Creek
Conejos
Costilla
Crowley
Delta
Denver
Douglas
Eagle
El Paso
Elbert
Fremont
Garfield
Grand
Gunnison
Huerfano
Jefferson
Kit Carson
La Plata
Lake
Larimer
Las Animas
Lincoln
Logan
Mesa
Moffat
Montezuma
Montrose
Morgan
Otero
Phillips
Pitkin
Pueblo
Rio Blanco
Rio Grande
Routt
Saguache
Sedgwick
Summit
Teller
Weld
Yuma
TOTAL
2002
11
0
20
0
0
5
0
0
0
0
0
0
0
38
2
1
5
0
0
1
0
0
0
4
0
1
0
3
0
0
0
2
0
0
0
1
0
0
0
6
0
0
0
0
0
0
0
4
0
104
2003
9
0
20
1
0
13
0
1
0
1
0
0
0
38
0
2
4
1
2
0
0
0
0
7
0
0
0
3
0
0
0
2
0
0
0
1
0
0
0
2
1
0
0
0
0
0
0
2
1
111
2004
13
0
18
0
0
2
0
0
0
0
0
1
0
47
3
0
9
0
0
0
2
0
0
10
0
1
0
2
0
0
0
0
0
2
0
1
0
0
0
3
1
0
0
0
1
2
0
9
0
127
2005
6
1
17
0
0
3
1
0
0
0
0
0
0
42
0
1
9
0
1
0
1
0
0
5
0
0
0
2
0
0
1
0
1
0
0
2
0
1
1
3
0
0
0
0
0
0
0
3
0
101
2006
17
0
22
0
0
7
0
0
0
1
0
0
0
40
1
0
10
0
0
2
2
0
0
5
0
0
0
4
0
0
0
0
0
0
0
0
1
0
2
2
0
0
0
0
0
1
0
5
2
124
2007
14
0
17
0
1
5
0
0
0
0
0
0
1
37
2
0
7
0
1
2
0
0
0
9
0
0
1
2
2
0
0
0
0
1
0
2
0
0
0
4
0
1
0
0
0
0
0
1
1
111
Note: Only counties reporting an active case of TB (2002-2011) are included.
Source: CDPHE Annual Tuberculosis Surveillance Report Colorado 2011
Professional Pediatric Home Care
December 2012
3.14B
2008
14
0
14
0
0
7
0
0
0
2
0
0
0
24
3
1
10
0
0
1
0
0
0
12
0
0
1
3
1
0
1
0
0
0
0
1
1
0
0
3
0
0
0
1
0
0
0
3
0
103
2009
4
0
11
0
0
3
0
0
1
0
0
0
1
29
4
2
7
0
1
2
0
2
0
8
0
0
0
2
2
0
0
1
0
0
0
1
0
0
0
1
0
0
0
0
0
0
1
2
0
85
2010
6
0
17
0
0
0
1
0
0
0
0
0
0
24
1
0
8
0
1
0
0
0
1
0
1
0
0
5
0
0
0
0
0
0
0
0
0
0
0
2
0
1
0
0
0
1
0
2
0
71
2011
10
0
5
0
0
5
0
0
0
0
0
0
0
23
2
0
7
0
0
0
0
0
0
8
0
0
0
2
0
0
0
1
0
0
0
2
0
0
0
1
0
0
0
0
0
0
0
4
0
70
ACHC Standard HH7-1A.01
Patient Education of Infection Precautions
and Infection Control Practices
______________________
POLICY
Agency will assure that patients/caregivers are informed of any infection precautions or control
precautions.
______________________
PURPOSE
The Agency will educate the patient/caregiver/family regarding any precautions to be taken to
prevent and/or control any infection.
______________________
PROCEDURE
1.
Appropriate Agency staff members will provide to the patient/caregiver/family any
information/education regarding infection prevention or control precautions to be taken,
such as Standard or barrier precautions. The patient/caregiver will also be instructed
regarding any observations to be reported to Agency staff.
2.
Education will occur at time of admission and on an ongoing basis.
3.
As appropriate to the care and services which the patient is receiving, education may
include such precautions as:
 Appropriate hand hygiene/handwashing.
 Use of gloves and/or protective clothing.
 Dressing changes with disposal of soiled dressings.
 Personal care.
 Equipment cleaning.
 Handling patient’s personal items, e.g., laundry and dishes.
Professional Pediatric Home Care
December 2012
3.15
ACHC Standard HH7-1A.01
Influenza Immunization of Home Healthcare Workers
______________________
POLICY
All employees who have direct contact with patients will be offered the influenza vaccine
annually to encourage and promote the benefits associated with vaccinations against influenza.
The Agency shall provide employees with pertinent information regarding benefits and
availability of immunization and importance of adhering to standard precautions.
______________________
PURPOSE
To follow procedures established in the CDPHE standards to reduce the risk of occupational
exposure to influenza.
______________________
REFERENCE
Health Facilities and Emergency Medical Services Division, 6 CCR 1011-1, Standards for
Hospitals and Health Facilities, Chapter 2 – General Licensure Standards, Part 10
______________________
RELATED DOCUMENTS
“Employee Information Sheet: Influenza Immunization” form
______________________
DEFINITIONS
“Influenza Season" means November 1 through March 31 of the following year, or as otherwise
defined by the CDPHE epidemiology and flu surveillance team.
"Influenza Vaccine" means a currently licensed FDA approved vaccine product.
"Proof of Immunization" means a written statement from a licensed healthcare provider who has
administered an influenza vaccine to a healthcare worker, specifying the vaccine administered
and the date it was administered or electronic entry in the Colorado Immunization Information
System (CIIS).
______________________
PROCEDURE
1.
The Agency will perform and document an initial assessment to assist in the development
of a written policy regarding influenza transmission from its healthcare workers to its
patients and/or consumers. The assessment shall, at a minimum, consider the following
criteria:
 The number of healthcare workers at the agency;
Professional Pediatric Home Care
July 2012
3.16
ACHC Standard HH7-1A.01





The number of patients and/or consumers served by the agency;
Whether the agency has an ongoing employee wellness program that offers annual
influenza vaccinations;
Whether influenza transmission from healthcare workers is addressed in the agency’s
infection control policy;
What precautions are taken to prevent the transmission of influenza from
unvaccinated healthcare workers; and
What type of educational material is utilized by the agency to promote influenza
immunization for its healthcare workers.
2.
Between October 1st and March 31st each year, the influenza vaccine shall be offered to
all Agency employees who have direct contact with patients, unless the vaccination is
medically contraindicated or the employee has already been immunized, has declined or
is exempted.
 An employee is considered exempted when they provide a medical exemption signed
by a physician, physician’s assistant, advanced practice nurse or nurse midwife
licensed in the State of Colorado stating that the influenza vaccination for that
individual is medically contraindicated as described in the product labeling approved
by the United States Food and Drug Administration.
 Agency will have the vaccine available on-site and provide to the employee at a cost
determined by the Agency to include the vaccine and supplies required for
administration.
 Employees will be permitted to obtain the vaccine elsewhere and must provide proof
of receipt of the vaccine within two (2) business days of immunization.
3.
Agency employees without proof of immunization are not required to wear surgical or
procedure masks when providing care to patients in their homes during the flu season.
 In the event Agency employees without proof of immunization provide patient care in
facilities that require the use of surgical or procedure masks (hospitals, hospital units,
ambulatory surgical centers and long-term care facilities (nursing homes)), the
Agency will coordinate with the facility and provide the required personal protective
equipment to the employee(s).
4.
Agency will maintain record of each employee’s annual immunization or declination /
exemption.
5.
Agency will track annual influenza vaccination rate for its employees through December
31st of each year and report to Department of Public Health & Environment by March
31st of following year, in the form and manner specified by CDPHE.
Professional Pediatric Home Care
July 2012
3.16
ACHC Standard HH7-1A.01
Employee Information Sheet: Influenza Immunization
Healthcare entities and healthcare workers have a shared responsibility to prevent the spread of
infection and avoid causing harm to their patients by taking reasonable precautions to prevent the
transmission of vaccine-preventable diseases. Vaccine programs are, therefore, an essential part
of infection prevention and control for slowing or stopping the transmission of seasonal
influenza viruses from adversely affecting those individuals who are most susceptible.
Influenza is primarily a community-based infection that is transmitted in households and
community settings. Each year, 5% to 20% of U.S. residents acquire an influenza virus
infection, and many will seek medical care in ambulatory healthcare. In addition, more than
200,000 persons, on average, are hospitalized each year for influenza-related complications.
Healthcare-associated influenza infections can occur in any healthcare setting and are most
common when influenza is also circulating in the community.
Uncomplicated influenza illness is characterized by the abrupt onset of constitutional and
respiratory signs and symptoms (e.g., fever, myalgia, headache, malaise, nonproductive cough,
sore throat, and rhinitis).
Preventing transmission of influenza virus and other infectious agents within healthcare settings
requires a multi-faceted approach. Spread of influenza virus can occur among patients, health
care providers, and visitors; in addition, health care providers may acquire influenza from
persons in their household or community.
The most effective strategy for preventing influenza is annual vaccination. Achieving high
influenza vaccination rates of health care providers and patients is a critical step in preventing
healthcare transmission of influenza from health care providers to patients and from patients to
health care providers. According to current national guidelines, unless contraindicated,
vaccination is recommended for all people aged 6 months and older, including health care
providers, patients and residents of long-term care facilities.
During the care of any patient, all health care providers in every healthcare setting should adhere
to standard precautions, which are the foundation for preventing transmission of infectious
agents in all healthcare settings. Standard precautions assume that every person is potentially
infected or colonized with a pathogen that could be transmitted in the healthcare setting.
Elements of standard precautions that apply to patients with respiratory infections, including
those caused by the influenza virus include, but are not limited to:
 Frequent hand hygiene, including before and after all patient contact, contact with
potentially infectious material, and before putting on and upon removal of personal
protective equipment, including gloves.
 Wearing gloves for any contact with potentially infectious material. Remove gloves after
contact, followed by hand hygiene.
 Wearing gowns for any patient-care activity when contact with potentially infectious
material (including respiratory) is anticipated. Remove gown and perform hand hygiene
before leaving the patient's environment.
 Droplet precautions should be implemented for patients with suspected or confirmed
influenza for 7 days after illness onset or until 24 hours after the resolution of fever and
Professional Pediatric Home Care
July 2012
3.16A
ACHC Standard HH7-1A.01
respiratory symptoms, whichever is longer. In some cases, agencies may choose to apply
droplet precautions for longer periods based on clinical judgment, such as in the case of
young children or severely immuno-compromised patients, who may shed influenza virus
for longer periods of time.
Health care providers at higher risk for complications from influenza infection include pregnant
women and women up to 2 weeks postpartum, persons 65 years old and older, and persons with
chronic diseases such as asthma, heart disease, diabetes, diseases that suppress the immune
system, certain other chronic medical conditions, and morbid obesity. Vaccination and early
treatment with antiviral medications are very important for HCP at higher risk for influenza
complications because they can decrease the risk of hospitalizations and deaths. HCP at higher
risk for complications should check with their healthcare provider if they become ill so that they
can receive early treatment.
The influenza vaccine has the potential to cause serious problems, such as severe allergic
reactions. The risk of the vaccine causing serious harm, or death, is extremely small. Serious
problems from influenza vaccine are very rare. The virus is inactivated, preventing transmission
of influenza from the vaccine.
 Mild reactions:
o soreness, redness, or swelling at the injection site
o fever
o aches
o If these problems occur, they usually begin soon after the shot and last 1-2 days
 Severe reactions:
o Life-threatening allergic reactions are very rare. If they do occur, it is usually within a
few minutes to a few hours after the injection.
o In 1976, a type of influenza (swine flu) vaccine was associated with Guillain-Barre
Syndrome (GBS). Since then, flu vaccines have not been clearly linked to GBS.
However, if there is a risk of GBS from current flu vaccines, it would be no more than 1
or 2 cases per million people vaccinated. This is much lower than the risk of severe
influenza, which can be prevented by vaccination.
Between October 1st and March 31st each year, the influenza vaccine is available all Agency
employees who have direct contact with patients.
If you have a medical condition, allergies, are pregnant or breastfeeding, please consult your
physician for direction prior to receiving the vaccine.
Professional Pediatric Home Care
July 2012
3.16A
ACHC Standard HH7-1A.01
INFLUENZA VACCINATION CONSENT / WAIVER FORM
Do not accept the influenza vaccine if:


You have had a previous allergic and/or serious reaction to the vaccine
You currently have moderate to severe acute illness with fever
The following information is required:
1.
2.
3.
4.
5.
6.
The date of your last influenza vaccine:
Are you allergic to eggs?
Have you ever had a serious reaction to a flu shot?
Are you sick with a fever?
Have you ever had Guillain-Barre Syndrome?
Are you pregnant or breastfeeding?
____________________
 Yes
 No
 Yes
 No
 Yes
 No
 Yes
 No
 Yes
 No

I understand that due to my occupational exposure to potentially infectious material, I am at
risk of acquiring influenza infection. I have read the Employee Information Sheet: Influenza
Immunization and have had an opportunity to ask questions which were answered to my
satisfaction. I understand the risks and benefits and have been given the opportunity to be
vaccinated.
Having been so informed:


I give my consent to receive the influenza vaccine
I have received the influenza vaccine from another provider and will provide proof of
immunization within two (2) business days of this notice
 I will be receiving the influenza vaccine from another provider and will provide proof of
immunization within two (2) business days of receipt of the vaccination
 I decline the influenza vaccine
Employee Name
Employee Signature
Date
Manufacturer:
Dose:
Lot Number:
Site:
Deltoid

Expiration Date:
Signature of administering health care professional
Professional Pediatric Home Care
December 2012
3.16B
Date administered
R

L
ACHC Standard HH7-1A.01
Appropriate Safeguards to Prevent
Drug Contamination
______________________
POLICY
Agency staff will implement appropriate safeguards in administering medications and in
teaching patients/caregivers to administer medications.
______________________
PURPOSE
To prevent drug contamination.
______________________
PROCEDURE
1.
Medications will be properly stored in the patient’s home according to any cautionary
statements included in the prescription label (e.g., “keep refrigerated”).
2.
Patients/caregivers will be educated regarding proper disposal of unused or expired
medications.
3.
Patients/caregivers will be educated regarding protecting medications from
contamination.
4.
Staff will implement appropriate aseptic technique when compounding and preparing
medications.
 Patients/caregivers will be educated regarding use of aseptic technique when
compounding and preparing medications.
5.
Staff and patients/caregivers will keep work surfaces clean for preparing medications.
6.
Medications will be prepared according to any directions.
7.
Prior to administration, medications will be visually inspected for microbial
contamination, inappropriate particulate matter and/or signs of deterioration.
8.
Medications will be prepared in the patient’s home only when the stability of such
medications is required.
Professional Pediatric Home Care
December 2012
3.17
ACHC Standard HH7-1A.01
Fingernails
______________________
POLICY
The Agency will follow CDC recommended hand hygiene guidelines for fingernails.
______________________
PURPOSE
To reduce the risk to patients of Agency acquired infections.
______________________
RELATED DOCUMENTS
CDC Media Relations: Press Release – “Fact Sheet: Hand Hygiene Guidelines Fact Sheet”
______________________
PROCEDURE
1.
Fingernails of staff should be clean and well cared for.
Professional Pediatric Home Care
December 2012
3.18