Infection Control in the Home (Including Teaching Points)

Assessment

Assess the following:

• Client's and family's ability to understand and perform necessary infection control procedures (see "Implementation")
• General environmental cleanliness
• Possibility of insect or rodent infestation
• Number and status of people living in the home
• Specific client conditions requiring special infection control techniques

Planning

Sample desired outcomes:

• No transfer of microorganisms will occur from client to others.
• No contamination of sterile and clean supplies by microorganisms will occur.

Special considerations:

• Basic infection control practices should be a basic part of instruction in healthy lifestyle, particularly in multigenerational families living in one house.
• Handwashing, environmental cleaning, and laundry may have cultural implications. Contact a resource person before proceeding with teaching.
• Be alert for the possibility that poor compliance with infection control practices may be related to insufficient funds; contact social service agencies and other community resources, if necessary. Insect or rodent infestation may be a major obstacle to infection control in the home. If needed, contact the public health department for advice and assistance.
• Prepare to teach. Gather supplies, including nonsterile gloves, gown/apron, masks, goggles, 10% bleach solution, biohazardous waste containers, rigid plastic container (e.g., detergent jug), household disinfectant, and paper towels.
• Remember that the nurse must arrange for pickup of biohazardous waste containers from the home.
• All family members and caregivers must be instructed in standard precautions if they are going to be exposed to blood or body fluids.

Implementation

1. Instruct all family members to perform handwashing before and after performing client care, after using the toilet, and whenever handling trash or biohazardous materials, including raw meats. Provide the following instruction about handwashing technique:
1. Turn on water.
2. Apply soap, using vigorous friction to all skin surfaces for at least 10 s.
3. Rinse hands under running water, and turn off faucet with paper towel.
4. Dry hands with paper towel, not cloth towel used by others.
2. Teach about general environmental cleaning:
1. Use disinfectant and/or bleach solution to clean the bathroom and kitchen.
2. Clean surfaces in client area with disinfectant (avoid strong odors if client has respiratory condition or arrange for client to be out of room until odor dissipates).
3. Vacuum and dust as needed (remove client from area until completed).
4. Remove heavy carpet and difficult-to-clean furniture from client area, if possible.
5. All family members must use their own towel, washcloth, and toothbrush.
3. Instruct family and client regarding avoidance of bloodborne transmission:
1. Wash garments, linens, and towels soiled with blood and body fluids:
• Wear gloves.
• Rinse all items in cold water.
• Wash separately from family laundry in washer with hot water and bleach.
2. To dispose of used dressings soiled with blood or body fluids:
• Wear gloves.
• Wear other personal protective equipment if splashing is anticipated.
• Place soiled dressings in an approved biohazardous waste container.
3. If needles are being used, use sharps container (heavy plastic jug with lid):
• Place small amount of bleach solution in jug.
• Place all used sharps in jug and replace lid each time.
• Discard jug when two-thirds full.

Note: If a sharps container exchange program is available in the community, instruct caregivers in how to access this resource.

4. Teach about maintenance of supplies if sterile or clean supplies are to be left in the home for client use:
1. Place supplies in a clean, protected storage area that may be used for supplies only.
2. Cover supplies with clean plastic or towel.

Documentation

In the visit note, include the infection control instructions given and to whom, special circumstances in the home, and activities taken to address them.