AURORA VISITING NURSE ASSOCIATION OF WISCONSIN
FIELD SERVICE POLICIES
Policy No.:
Effective:
Revisions:
406
11/91
11/91, 12/94, 12/97, 9/01, 11/04, 9/06, 9/07, 10/07,
8/09, 12/10
Last Review: 9/05
Intended Users: All field staff
INFECTION CONTROL RESPONSIBILITIES OF FIELD STAFF
I. Policy
The Aurora Visiting Nurse Association of Wisconsin (VNA) field staff have the responsibility to
prevent infections in the care/service of patients. Staff should follow the infection control procedures
outlined here and in nursing/clinical procedure manuals to significantly reduce the potential for the
transmission and development of preventable infections in the home.
II. Purpose
To prevent the development of organization acquired infection in patients.
III. Procedure
A. Good hand hygiene is the single most important practice for preventing infection.
Hands are to be cleansed prior to providing care, between procedures, and after the completion of
care. Hands must always be washed with soap and water when visibly soiled. Keep nails
medium/short and well groomed. Jewelry and rings should be conservative and kept to a
minimum. HR Policy #12 (Appearance Policy) prohibits artificial nails or extenders for direct care
staff. Natural nail tips must be kept less than ¼ inch long. Nail polish must be a conservative
color, intact and not chipped. (See HR #12 for more detail.)
B. The home environment should be assessed for potential sources of infection. Always consider the
floor to be contaminated; clean, disinfect, sterilize, or discard any items that fall onto the floor.
Work surfaces and patient care areas should be kept clean and clear of clutter. Avoid raising dust,
which carries organisms; use vacuum cleaners, and dampened/treated cloths to dust. Keep linens
and used supplies and equipment away from your uniform/clothing. Do not shake linens. Patients
who have problems with rodents and/or insects should be advised of resources to help resolve the
problem. Social Service referral may be appropriate in instances of noncompliance or significant
infestation.
C. Patient food preparation should be such that it is not a contributing factor to infections. Always
cleanse hands before handling food.
D. Patients with poor personal hygiene should be taught the importance of personal hygiene as it
relates to the development of infections. Education and any noncompliance should be documented.
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E. Clinical field staff should adhere to bag technique per VNA procedure. It is expected that all field
staff will bring a bag into the home for all visits unless there is infestation, or it is medically
contraindicated, e.g. a drug resistant organism. Isolation precautions should be discontinued per
CDC guidelines for the respective organism/infectious disease.
F. Those field staff who use a laptop computer should make sure it is kept on a clean surface during
the visit and:
 After touching the patient, perform hand hygiene before using the laptop, OR
 Wipe down the “high touch” surfaces, i.e., the keyboard, at the end of the visit using a
manufacturer-approved cleaner
G. Patient health care solutions may only be used according to these guidelines:
1. Do not use any solution past its expiration date, even if unopened.
2. Original solutions of alcohol, hydrogen peroxide, and betadine may be used up to one month
after opening. Date bottle when opened; if not dated, must be discarded.
3. Sterile irrigating solutions, e.g. sterile water or sterile saline, may be used up to one week after
opening. Date bottle when opened; if not dated, must be discarded.
4. Pharmacy mixed solutions, e.g. Dakins or Domeboro’s, may be used up until the expiration
date printed on the label.
5. Employee mixed solutions, e.g. 1:10 bleach water or ½ NS: ½H2O2, may be used up to 24
hours. Label and date container when mixed.
H. All staff will adhere to Standard Precautions at all times. Treat all bodily fluids as if potentially
infectious. (See clinical procedure manual.) In addition, double gloving may be followed when
handling sharps and working with known HIV positive patients.
I.
J.
To alert delivery staff of the need to observe precautions (contact, respiratory, etc.) in the home,
agency defined codes will be entered onto the delivery ticket (Dezine and CHIP systems). These
codes are as follows:
DRO:
Drug Resistant Organism - contact precautions
CD:
C. Diff positive – special hand washing precautions and equipment cleaning
precautions in addition to contact precautions.
RD:
“Red Dot” - blood and body fluid precautions
RI:
Respiratory Isolation - respiratory precautions
TP:
Transplant Precautions - reverse precautions.
The following precautions will be taken whenever there is knowledge that the patient has a
drug resistant organism (DRO), or is either suspected of, or diagnosed with Creutzfeldt-Jakob
Disease, or Gertsmann-Straussler-Scheinter Syndrome.
1. Do not take your visit bag or any reusable equipment or supplies into the home.
2. The admitting professional is responsible for securing a Drug Resistant Organism
Admission Kit and any disposable medical supplies to be taken to the home. Contents of
the kit remain in the home.
3. Cleanse hands with antibacterial hand gel or soap and water. Practice hand hygiene upon
entering the home, after gloves are removed, between procedures, and prior to exiting the
home. Dry hands with paper towel to avoid cross-contamination.
4. Gloves and gowns are worn whenever treating a patient with a DRO who is incontinent of
stool or urine; or whose wound exudate cannot be contained; or when contact with blood or
body fluids is anticipated. Both are always worn when caring for a bed-bound patient.
Gloves may be worn alone when doing environmental cleaning in the patient’s home.
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5. The patient should be advised to clean and disinfect the toilet and/or sink that they
personally use daily, IF they share this toilet/sink with others AND depending upon where
their DRO has been cultured as positive.
6. Masks should be worn when in close proximity to the patient when there is a possibility that
any body fluids will become aerosolized (i.e. coughing through a trach tube), or when a
patient is known to be colonized with a DRO in the throat or lungs or infected with a DRO
in the nares, throat, or lungs.
7. Linens soiled with blood or body fluids should be laundered separately; see Disinfection of
Linen in the Home.
8. In the event of transfer from the VNA to another health care facility, notify the receiving
staff of the patient’s actual or suspected DRO/diagnosis.
K.
Isolation Precaution - CONTACT
1. Contact Precautions are used when germs can be spread from touching the patient or things
in their environment.
2. Examples:
a. Patients with DRO such as MRSA or VRE
b. Uncontained drainage from wounds
c. Diarrhea – NOTE: for patients with clostridium difficile (c-diff) special hand washing
guidelines apply: first wash hands with liquid soap and water, then when hands are dry,
use approved, alcohol-based hand gel. In addition, all surface cleaning (i.e., equipment)
must be done with a 1:10 bleach solution.
d. Disposable gloves and gowns are worn for Contact Precautions
e. Put on Personal Protective Equipment (PPE) in this order:
i. Disposable gown (tie at neck and waist)
ii. Gloves (should cover the cuffs of the gown)
f. Remove PPE in this order:
i. Before leaving the room/patient care area/home
ii. Remove gloves and discard
iii. Remove gown – untie back of gown and remove, do not touch outside front of
gown – double bag.
iv. Use alcohol hand gel to clean hands or wash with soap and water.
L. Isolation Precaution – DROPLET
1. Droplet Precautions are used when the germs are spread by large droplets from the
respiratory tract that travel only about three feet. This infection can be spread by droplets
that occur with sneezing or coughing
2. Examples:
a. Meningitis
b. Some Pneumonias
c. Influenza
3. Masks are worn or Droplet Precautions
a. Put on PPE (mask)
b. Remove PPE in this order:
i. Before leaving the room
ii. Remove mask in room and discard
iii. Use alcohol hand gel to clean hands or wash with soap and water
c. Then exit the patient environment
M. Isolation Precautions – AIRBORNE
1. Airborne precautions are used when the germs are spread long distances on tiny particles in
the air
2. Examples:
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a.
b.
c.
d.
e.
Measles
Chicken Pox
Active or Suspended Tuberculosis (TB)
Disseminated Shingles (herpes zoster)
SARS
3. An N95 Respirator Mask or a PAPR (Powered Air Purifying Respirator) is worn for
Airborne Precautions.
a. Put on PPE (N95 respirator mask or PAPR) Note: N95 mask must be fit tested for each
employee
b. Remove PPE in this order:
i. Before leaving the patient room
ii. Use alcohol hand gel to clean hands or wash with liquid soap and water
c. When leaving the room:
i. Exit the room and close the door
ii. Remove and discard N95 respirator mask or PAPR
iii. Use alcohol hand gel to clean hands or wash with liquid soap and water.
NOTE: For suspected or confirmed Novel H1N1 Influenza:
a. Contact Precautions PLUS N95 mask
b. Airborne Precautions (negative pressure not required; sign is for N95 mask)
c. Eye protection (goggles or faceshield) at all times (Note: fogging can occur while wearing goggles),
must be cleaned with bleach wipes if reused. Faceshield is worn over the N95 mask
d. Door signage (At AZFH) that can be printed from the H1N1 Resource Center. Door closed at all
times
Suspect Case: Isolation precautions until a negative result is finalized
Confirmed Case: Consult with Infection Control prior to discontinuing isolation
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