A&J Assisted Living - Operational Policies and Procedures

1. The ALF Infection Control Plan conforms to CDC guidelines, AHCA, federal requirements, state and local regulations and currently accepted standards of practice.

• • The Plan meets or exceeds the standards established by the Department of health, CDC guidelines, Emergency Order (20-002), Prohibitions on visitors - Executive Order 20-52, CMS Expanded Recommendations for Limiting Visitors and Individuals.

2. The Infection Control Plan establishes and implements policies and procedures for controlling employee exposure to COVID-19. These policies/procedures include:

• • Identifies all those resident and employees at risk of exposure to COVID-19 o Establishes procedures for the evaluation of circumstances surrounding exposure incidents. 

• • Establishes a training program upon employment which:
    • Educates residents and employees in the infection control program.
    • Advises residents and employees of any revisions or when changes occur. Provides record keeping in accordance with regulations.
    • Ensures that provisions of equipment and supplies necessary to minimize the risk of infection with COVID-19 or other potentially infectious materials are available to all residents and employees at risk of exposure.
  • Establishes a process for educating residents/employees regarding infection control policies/procedures.
  • Establishes a surveillance program for infections acquired in home health care. o Reviews the program’s effectiveness systematically and revise as necessary. o Establishes policies/procedures that will reduce the spread of COVID-19 to employees and residents.
  • Monitors staff adherence to recommended policies, procedures and protective measures. When monitoring reveals a failure to follow recommended precautions:
    • Counseling, education and/or retraining will be provided.
    • If necessary, appropriate disciplinary action will be taken.
    • Screens staff as required by law and regulation for exposure to COVID-19, and/or immunity to infectious diseases that staff may come in contact with (see employee screening tool, attachment 9, Coronavirus 2019 (COVID-19) Visitor Screening Toolkit, A Resource for Long Term Care Centers, updated March 12, 2020 by the Florida Health Care Association.
    • Isolation of residents and employees who have been exposed to or who potentially have been exposed to COVID-19 and/or any other viral/infectious disease to physicians for assessment, testing, prophylaxis treatment, counseling and/or immunization as per CDC guidelines.

3. Goals for the infection control program include:

• • To reduce the risk of acquisition and transmission of COVID-19 by addressing prioritized risks.
  • To limit unprotected exposure to COVID-19 throughout the organization by implementing current CDC and OSHA guidelines o To improve hand hygiene compliance.
  • To minimize the risk of transmitting COVID-19 associated with the use of procedures, medical equipment and medical devices.
  • To improve protocol about What to do if you are sick with COVID-19).
  • Emergency operations planning for COVID-19 disease outbreak includes:
    • The ALF will be prepared to respond to an influx, or the risk of an influx, of residents/employees.
    • In order to manage an ongoing influx of potentially exposed residents/employees over, the ALF will:
      • Suspend residents’ new admissions
      • Limited the visits to the ALF, only to third party healthcare providers, such as nurses, and hospice staff.
      • Provide the residents will alternative way to communicate/interact with family, such as: phone calls, video conferences, text message, etc.
  • The ALF has established processes and procedures for information management before and during the COVID-19 outbreak, or risk of an outbreak.
  • The ALF will keep abreast of and obtain current information about COVID-19 that could cause an increased number of potentially infectious residents through communication with resources, e.g., hospitals, CDC, Federal, local and state health departments, offices of emergency management and, local media (e.g., television, radio and newspapers).
  • Critical information will be disseminated to residents, families, staff, key practitioners, physicians, and leaders through e-mail, voicemail, telephone and staff meetings.
  • The risk analysis defines the current surveillance activities and will be reviewed systematically, or whenever significant changes occur.
  • The ALF management will assign responsibility for infection control program management.
  • The assigned individual will be qualified for such responsibilities based on:
    • education, additional training and/or experience.
    • The individual coordinates all activities and assures
      • ongoing surveillance
      • data collection
      • aggregation
      • analysis and monitoring of the effectiveness of the program.
  • The individual meets regularly with leaders, managers and staff to:
    • Develop strategies.
    • Review and react (as appropriate) to surveillance data.
    • Assess successes and failures of the program.
    • Review and revise the program.
    • Perform annual infection control program evaluation.

General INformation - INfection COntrol & Standard Precautions

• Blood, body fluids and tissues of all patients are presumed infectious.
• If questions arise concerning a particular technique or policies of infection control, they should be directed to the administrator.
• Refrigerate food promptly and keep in a refrigerator separate from blood or other potentially infectious materials. Medications and biologicals are also stored separately.
• Maintain a clean resident environment with emphasis on common areas surfaces such as: countertops, handles, handrails, bathroom and kitchen cleanliness.
• Use aseptic technique, and universal precautions attending the ALF residents. Hand HygieneHand hygiene is the most important procedure in the prevention of infections. Hand-washing will be performed by all staff according to established Hand Hygiene Policy.

Methods of Disinfection

Reusable articles in the ALF 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.
• Whenever it is necessary to use equipment which must be disinfected after use and which will be used by or for a resident over a period of time, e.g., bedpans, urinals, bedside commodes, etc.
• Blood glucose monitors are cleaned when visibly soiled or according to manufacturers’ recommendations (third party provider – HHA).

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.
• 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.
• Stethoscopes (third care provider – HHA) and blood pressure cuffs will be cleaned after each use by the employee who has possession of the equipment.
• All resident’s 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 resident’s laundry area or washing machine to minimize employees and resident’s exposure.
• Broken glassware, e.g., contaminated blood collection tubes, will not be picked up directly by hand.
• 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. EMPLOYEE INFECTION CONTROL TRAINING

Employees will receive education and training during orientation and at least annually, or when thread of viral or bacterial exposure warrant it. (see Specific Procedures for Employee and Patient Infection Control Training).

1. Standard Precautions Hand hygiene 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 TB test – chest x-ray HBV vaccine Infections or illness to be reported to supervisor
3. Hygiene Personal hygiene (handwashing) PPE 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 COVID-19, MRSA, VRE Other reportable communicable diseases
6. Infectious Waste Disposal
7. Cleaning and Disinfection of Equipment Thermometers Stethoscope Sphygmomanometer Glucometers
8. OSHA Regulations Exposure Control Plan Standard Precautions Work practice controls Personal protective equipment (PPE) Orientation and training Labels and signs Hepatitis B Vaccination Post-exposure plans TB/Airborne Exposure Control Plan 

The Joint Commission CAMHC Standards: IC.01.05.01, IC.02.01.01, HR.5; Medicare CoP #: 484.70, 484.100; CHAP Standards: CDT.9.I.M1; ACHC Standards: HH7-1A.01, HH7-1B.01; Florida Regulations: 408.804 F.S., 408.811 F.S.

Staff

All employees who is exposed to 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 assisting residents with bathing, toileting, and meals preparations.
• Wear PPE for all residents’ care.
• Change PPE and wash hands between residents.
• 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 resident’s trash container.

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 covered trash receptacle.

 Resident Education

1. Instruct in all basic principles of Standard Precautions and any other procedures as applicable to the resident’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 on isolation needs if they were exposed to any contagious diseases.
5. Bathrooms should be cleaned with a 10% bleach solution.
6. Instruct residents to cover the nose and mouth when infected, or under investigation for possible infection.
7. Contact infection control specialists at a local hospital or the local health department for as stated in policies and procedures regarding specific organisms, when known. 

Indications for staff performing hand hygiene are:

• Before and after direct resident care.
• After using the bathroom.
• After blowing or wiping the nose.
• Before and after eating.
• When hands are soiled.
• After any contact with contaminated materials

All employees are responsible for implementing hand hygiene procedures in an ongoing attempt to prevent and/or contain infectious processes and communicable diseases.

Bacteriostatic foam/gel/liquid is the preferable hand hygiene method. When using bacteriostatic foam/gel/liquid, the procedure is a follows:

• Place adequate amount of foam or liquid on hands.
• Using friction, clean between fingers, around and under nails, palms and backs of hands until hands are completely dry. 

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 liquid, antimicrobial soap: use friction; wash between fingers, wash area around and under nails.
• Using a clean paper towel, dry hands thoroughly.
• Turn off water faucet using towel.
• Discard paper towels in a disposable bag or waste can.

The ALF has implemented an aggressive program to address hand hygiene and decrease rates of infections:

• The ALF provides bacteriostatic foam/gel/liquid to all resident care staff.
• The ALF provides a liquid, antimicrobial soap and paper towels to all resident care staff.
• Orientation and annual staff training will include hand hygiene.
• Staff compliance with use of bacteriostatic foam/gel/liquid will be monitored systematically.

The ALF has established a hand hygiene compliance goal of 90% or greater.

• Staff compliance with hand hygiene will be monitored systematically to determine compliance rate.
• Remedial individual staff education will be provided to assist ALF in meeting goal.

The Joint Commission CAMHC Standard: IC.02.01.01; Medicare CoP #: 484.70, 484.100; CHAP Standards: IPC.4.I; ACHC Standards: HH7-1A.01, HH7-9A.01: Florida Regulations: 408.804 F.S., 408.811 F.S.

• Administrator/owner will assess the home environment for appropriate location for storage of supplies.
• Staff will bed instructed on proper storage of medical supplies and maintenance of an optimal clean environment for supplies.
• Administrator/owner will supervise that the ALF keeps enough supplies to face any unexpected viral and/or infection exposures.
• Administrator/owner will have an account with a supplier to guarantee restocking of supplies when needed.
• Items will be stored according to vendor/manufacturer’s recommendations, e.g., refrigeration if necessary.
• The staff will be instructed on principles of safe handling of clean supplies, equipment, medication and solutions.
• The staff will be instructed on proper disposal and handling of utilized supplies.

The Joint Commission CAMHC Standard: IC.02.01.01; CoP #: 484.70 c; CHAP Standards: CDT.9.I,IPC.7.I; ACHC Standard: HH7-1A.01

Appropriate ALF staff members will provide to the residents/families any information/education regarding infection prevention or control precautions to be taken, such as Standard or barrier precautions. The residents/families will also be instructed regarding any observations to be reported to ALF staff.

Education will occur at time of admission and on an ongoing basis. Initial education for all residents will include:

• Hand hygiene practices.
• Respiratory hygiene practices.

Contact precautions, as applicable

The residents/families understanding of this information is evaluated and documented at admission.

As appropriate to the services which the residents is receiving, education may include such precautions as:

• Appropriate hand hygiene.
• Use of gloves and/or protective clothing.
• Dressing changes with disposal of soiled dressings.
• Personal care. o Equipment cleaning.
• Handling resident’s personal items, e.g., laundry and dishes.