|INFECTION CONTROL - HOME HEALTH
In every home we visit, there’s a war going on against infection. Today, this enemy is mounting new offensives due
to viruses such as HIV; due to tuberculosis in multi-drug resistant forms; due to antibody- resistant organisms. In
addition, hospital patients are going home sooner and sicker than ever before, sometimes with infections that have
gone undetected. We can protect our clients and ourselves against this enemy by following infection control
practices in each home.
KNOW THE ENEMY
Infection occurs when an infectious agent is transmitted to a susceptible host.
• INFECTIOUS AGENTS – such as viruses, bacteria and fungi can be found in blood and other body fluids, in feces
and on body surfaces – especially the hands. They also thrive on objects and in areas prone to contamination
such as floor or medical equipment.
• HOSTS – are persons in a condition especially susceptible to an infection, such as:
- Elderly patients
- People with weak immune systems
- People with multiple health problems or chronic disease
- Patients with incisions, catheters, breathing tubes, IVs or other invasive devices.
• TRANSMISSION – occurs when an infectious agent spreads from its source into a host’s body through inhalation,
through openings in the body such as the mouth, eyes, nose and breaks in the skin, and by contaminated needles
or other sharp objects. There are various routes of transmission.
Contact transmission – happens when the infection is physically transferred either directly from body surface to
body surface, or indirectly, when the infection first contaminates an object and then comes in contact with the hose.
Droplet transmission – occurs when infectious droplets become airborne after the source person coughs, sneezes
or talks. The droplets are then propelled a short distance and land in a host’s eyes, nose or mouth.
Airborne transmission – takes place over greater distances than droplet transmissions, in the form of infectious
microscopic droplets or dust particles that stay suspended in air for long periods.
Common vehicle transmission – carries infectious agents via contaminated food, water, medications or equipment.
Vector-borne transmission – occurs when fleas, mosquitoes, flies, rats or other vermin transmit microorganisms.
KNOW THE BATTLE PLAN – INFECTION CONTROL POLILCY
Know your agency’s Infection Control Program. This battle plan includes the Occupational Safety and Health
Administration’s (OSHA’s) bloodborne pathogen standards, OSHA’s tuberculosis control guidelines, and isolations
precautions recommended by the Centers for Disease Control and Prevention (CDC).
In compliance with the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), your Infection
Control Program includes: surveillance of infection trends; identification of types and sources of infections;
prevention of infections; control measures to discourage spread of infection; and reporting of any infections to the
SCOUT THE TERRAIN – SURVELLANCE IDENTIFICATION REPORTING
Assess homes and clients for potential risks of infection such as:
- Persons especially susceptible to infection
- Lack of training in infection control measures
- No running water, flush toilets, heat or electricity
- Improper disposal of garbage, trash or contaminated products
- Insects and rodents
- Poor food handling or storage techniques
- Crowded living or sleeping arrangements.
Be pm the lookout for infections typically seen in home care such as infections of wounds, urinary tract,
bloodstream, skin and soft tissue, GI tract, eye, ear, nose, throat and mouth as well as pneumonia. Be alert for
signs and symptoms of infection such as:
- Skin changes, including rashes, redness, heat, swelling, weeping and drainage
- Green or yellow wound drainage
- Fever, chills or sweating
- Sore throat and cough
- Nausea, vomiting or diarrhea
- Burning or painful urination and clouds or particulates in a catheter bag.
- Tenderness in a body part, stiff neck or headache
- Rapid pulse, and changes in mental status.
Follow your agency’s surveillance procedures.
Report and document all potential risk to infection as well as ongoing infections to your Supervisor.
ARM YOURSELF AND YOUR CLIENTS – METHODS OF INFECTION CONTROL
Your Infection Control Plan provides two levels of precautions to guide your daily practice, as recommended by the
CDC: Standard Precautions and Transmission-Based Precautions.
STANDARD PRECAUTIONS - require you to treat all patients as though they may be infectious and are to be used
every day, with every patient, in every home. Standard Precautions protect you from contact with infectious
substances such as blood, all body fluids, secretions and excretions, non-intact skin, and mucous membranes, as
well as from contact with potentially contaminated objects and surfaces.
TRANSMISSION-BASED PRECAUTIONS – must be used in addition to Standard Precautions with patients who
have certain highly infectious or drug-resistant organisms. Use these principles in your everyday practice.
PROTECTIVE WORK PRACTICES
Decrease the spread of infection with these safe work practices.
Protect yourself with immunizations. Immunizations are powerful weapons – they prevent infection. The CDC
recommends that you be immunized against hepatitis B, influenza, measles, mumps, rubella and chicken pox.
Wash Your Hands
Handwashing is the single most important precaution against the spread of infection. If no handwashing facilities
are available, come prepared with a waterless handwashing agent.
If not visibly soiled, decontaminate the hands using an alcohol-based hand rub for routine clinical situations. That
includes between patients and after removing gloves. Apply recommended amount of product to the palm of one
hand and rub hands together, covering all surfaces of hands and fingers until hands are dry.
Hand hygiene also means intact skin and trimmed nails. Apply an approved hand lotion to clean hands as often as
necessary to prevent skin breakdown. Remember to keep your nail tips shorter than one-quarter inch and never
wear artificial nails or extenders.
Always wash hands:
• On arrival, before going into your equipment bag.
• After bathing your client or performing other client care.
• After touching blood, body fluids, secretions or excretions such as feces, vomit, wound drainage or saliva and
contaminated surfaces – whether or not gloves are worn.
• Every time you remove your gloves.
• Just before you leave the client’s home.
Follow these handwashing procedures:
• Use an approved antiseptic agent rather than the home’s used bar soap. Germs can live on its surface.
• Lather and rub vigorously. Rinse thoroughly.
• Dry with a clean paper towel, rather than the home’s cloth towels. Turn off faucets with a paper towel.
• The CDC recommends use of an alcohol antiseptic hand rub if your hands are not visibly
soiled. Apply the product to the palm of one hand, rub your hands together covering all hand surfaces and fingers
until hands are dry.
Practice good hygiene:
• Avoid splashes or spatters of body fluids and other potentially infectious materials.
• Do not eat, drink, smoke, apply cosmetics or lip balms or handle contact lenses where there is a reasonable
chance you might be exposed to blood or body fluids.
• Do not transport or store food and drink near blood, urine, or other potentially infectious materials.
Handle sharps with care:
Be careful to prevent injuries from needles and other sharp instruments. More than a half a million sharp-related
injuries occur each year, according to OSHA. Safety devices now include needleless systems and engineered
protective devices for needles and other sharps. Studies show that sharps safety devices may significantly reduce
your risk of injury during procedures such joining IV lines, drawing blood, injecting medications and suturing during
surgery. The FDA and OSHA now recommend use of breakage-resistant blood capillary tubes to decrease
Never bend, recap or break needles after use. Immediately after use, dispose of contaminated sharps in the
puncture-resistant container you carry with you.
PERSONAL PROTECTIVE EQUIPMENT
Personal protective equipment (PPE) provides you with a barrier against infectious materials. PPE includes such
items as gloves, gowns, protective eyewear, masks and ventilation devices. Keep them in your vehicle and bring in
specific items you anticipate needing. Always have disposable ventilator tasks available for emergency
PPE must fit properly ad be appropriate for the task you are doing. Follow your agency’s policies regarding its use,
maintenance, replacement, and disposal.
Gloves are the PPE you will use most often. Before putting them on, wash hands thoroughly. Bandage any cuts in
case a glove leaks or tears. When removing contaminated gloves, be careful not to touch the outside. Always
wash your hands after removing them and dispose opf them appropriately.
PATIENT CARE PROCEDURES
Study your agency’s Infection Control Program before performing any patient care procedure. Use aseptic
technique when necessary. Be alert during invasive procedures such phlebotomies, urinary catheterizations and
• Wound care – For proper wound care, use aseptic technique and follow your agency’s stated procedures as to
use of clean and/or sterile gloves. Store sterile solutions for wound care in a clean place in the patient’s home.
Dispose of wound dressings according to your agency’s policies.
• Medications and supplies – Store medications in a clean area of the home or refrigerate if necessary. Discard
medication if outdated or if contamination is visible or suspected. Discard single-use vials immediately after use.
Once a box of exam gloves is opened for use on a patient with a potential infection, dedicate it
to that patient and leave it in the home.
HOME HEALTH CLEANUP
• Wear gloves when handling or cleaning soiled items.
• Contaminated linens should not be shaken, held against you, placed on the floor or mixed in with family laundry.
They should be washed as quickly as possible in hot water, with detergent.
• Bedpans, urinals, and other plastic containers should be cleaned with soap and water.
• When contaminated, walkers, canes and wheelchairs should be cleaned with a disinfectant solution
• Follow agency procedures in cleaning urine collection bags.
• Disinfect weight scales before use. Clean reusable items such as blood pressure cuffs, tourniquets and
stethoscopes with an approved cleaning agent after each patient’s care.
• Follow your agency’s policy for thermometer use and cleaning.
PROPER WASTE DISPOSAL
• Most contaminated waste products can be disposed of in the trash receptacle outside the home. Soiled
dressings, gloves, diapers, wipes, paper products and other disposable supplies should be put in leak proof plastic
bags prior to placement in public trash. Items that may leak should be double bagged.
• Sharps such as needles, blood collection devices and other sharp-edged objects such as razors, glass vials and
glass capillary tubes must be discarded in designated puncture-proof containers at the point of use. When full,
these containers must be disposed of at your agency, following state regulations.
• Blood, urine, feces and other body substances should be carefully flushed in the toilet – not the sink.
• Spills of blood and other body fluids should be cleaned immediately. Wear gloves and use paper towels to
absorb any excess. Use tongs, forceps or a brush and dustpan to pick up broken glass. Then clean with an
approved disinfectant detergent – many agencies include in a spill kit. Check with your agency for further specifics
on spill cleanup.
• Carefully follow your agency’s policy regarding materials which must be disposed of in red biohazard bags.
TRANSPORT OF MEDICAL MATERIALS
Transport potentially contaminated items such as used equipment, sharps containers and lab specimens in the
dirty part of your car. Place so they cannot tip over. Remember to transport laboratory specimens in a leak proof,
puncture-resistant container labeled biohazard.
CARE FOR YOUR BAG
Your bag and everything in it should always be clean. Carry your bag in the “clean” part of your car. Once in the
home, place your bog on a table or chair, not on the floor. Always keep it in sight – and out of the reach of curious
Wash your hands before going into your bag. Have soap and paper towels handy near the top. Take out just the
equipment and supplies you need. If you need to return to your bag in mid-visit, remove gloves and wash your
hands before going into it. Do not return soiled equipment or supplies to your bag. Disinfect items such as your
stethoscope before replacing in your bag. If your bag gets contaminated, wipe with paper towels and clean with an
approved disinfectant detergent.
When caring for patients with highly infectious diseases or drug-resistant organisms, follow your agency’s detailed
Transmission-Based Precautions, which include airborne, droplet and contact precautions. Here are some general
• Airborne precautions – must be followed to protect yourself from exposure to tuberculosis (TB), as well as other
airborne diseases. Carefully follow your agency’s plan for TB protection and control. In general, assess all
patients for signs and symptoms as well as risk factors of TB. Report all such patients to their physicians and
immediately institute TB precautions, including isolation and protection methods. Wear an approved, properly fitted
respirator into the home of an infectious tuberculosis patient. Put it on prior to entering the hone and remove only
after you have left.
• Contact precautions – are used when patients have infections that are highly contagious or resistant to antibiotics.
Take in only the supplies needed for the client in that home. Before beginning care, wash hands, put on clean
gloves. Change gloves during care to prevent cross-contamination of body sites and to reduce the spread of body
sites and to reduce the spread of organisms in the home. After removing gloves, wash hands with an approved
antibacterial soap or disinfectant. Wear a disposable gown during patient care or when your clothing may come in
contact with infectious materials. Remove and dispose of gown before leaving and avoid clothing contact with
contaminated surfaces. If possible, dedicate care equipment to a single patient. Otherwise, thoroughly disinfect with
an approved disinfectant immediately after use and before returning equipment to your bag or car.
• Droplet precautions – require wearing a surgical mask when caring for patients infected by droplet spread
diseases such as pertussis or influenza. Put on your mask before entering the patient’s room and remove it only
after you have exited the room.
Know how to deal with accidental exposures to infectious material. If you are exposed to blood or body fluids,
immediately wash the affected skin with soap and water or flush affected mucous membranes with water. Then
report the incident to your immediate supervisor.
Report exposure to communicable diseases such as tuberculosis or hepatitis A. Remember to report even
potential exposures to infectious agents. Your agency has specific guidelines for any necessary medical
evaluation and follow-up. If you have a potentially communicable disease or infection, you must be cleared by a
healthcare professional before providing further direct patient care.
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