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California OT Infection Control

Proper Hand Hygiene

Avoid unnecessary touching of face, nose and surfaces in close proximity to the patient to prevent both contamination of clean hands from environmental surfaces and transmission of pathogens from contaminated hands to surfaces, during the delivery of healthcare.

When hands are visibly soiled, hands shall be washed with soap and water for a twenty (20) second scrub and ten (10) second rinse or an antimicrobial hand wash.

If hands are not visibly soiled, an acceptable alternative of hand decontamination is with an alcohol-based hand rub.

Hands shall be washed or decontaminated as follows:

    • Before having direct contact with any patient/client.
    • After contact with blood, body fluids or excretions, mucous membranes, non-intact skin, or wound dressings.
    • After contact with a patient's/client's intact skin (e.g., when assisting with bathing/dressing or lifting a patient).
    • If hands will be moving from a contaminated-body site to a clean-body site during patient/client care.
    • After contact with inanimate objects (including medical equipment) in the immediate vicinity of the patient/client.
    • After removing gloves.

Artificial Nails

Artificial fingernails or extenders shall not be worn if duties include direct contact with patients at high risk for infection and associated adverse outcomes (e.g., those in ICUs or special care units).

Contact with Spores

After each patient/client session ends, a practitioner shall wash hands with soap and water or an antimicrobial hand wash if contact with spores (e.g., C. difficile or Bacillus anthracis) is likely to have occurred. The physical action of washing and rinsing hands under such circumstances is required because alcohols, chlorhexidine, iodophors, and other antiseptic agents have poor activity against spores.

Use of Personal Protective Equipment

The use of personal protective equipment (PPE) includes observing the following principles of use at all times:

    • Wear gloves, gowns and mouth/nose/eye protection when the nature of the anticipated patient/client interaction indicates that contact with blood, body fluids, secretions or excretions may occur. Select masks, goggles, face shields and combinations of each according to the need anticipated by the task performed.
    • Prevent contamination of clothing and skin during the process of removing PPE.
    • Before leaving the patient's/client's room or service area, remove and discard PPE.

Gloves

PPE includes the use of disposable medical examination gloves, which must be worn when it can be reasonably anticipated that contact with blood or other potentially infectious materials, mucus membranes, non-intact skin, or potentially contaminated intact skin (e.g. of a patient/client incontinent of stool or urine) could occur.

    • Non-sterile gloves may be used for all non-surgical procedures.
    • Wear disposable gloves for cleaning the environment or equipment.
    • Wear gloves with fit and durability appropriate to the task.
    • Remove gloves after contact with a patient/client or the surrounding environment (including equipment) using proper technique to prevent hand contamination.
    • Do not wear the same pair of gloves for the care of more than one patient/client.
    • Do not wash gloves for the purpose of reuse since this practice has been associated with the transmission of pathogens.
    • Change gloves during patient/client care if the hands will move from a contaminated body-site to a clean body-site.

Gowns

PPE includes wearing a gown that is appropriate to the task to protect skin and prevent soiling or contamination of clothing during procedures and patient/client-care activities when contact with blood, body fluids, secretions, excretions is anticipated. Proper use of a gown includes the following:

    • Remove gown and perform hand hygiene before leaving the patient's/client's environment. Place gown in an appropriately-designated area or container for storage, washing, decontamination or disposal.
    • Do not reuse gowns, even for repeated contacts with the same patient.
    • Routine donning of gowns upon entrance into high risk units (e.g. ICU, NICU) is not indicated.

Personal protective equipment does not include lab coats or uniforms, including scrubs. Lab coats and uniforms shall be changed or washed at least daily, or more frequently if visibly soiled.

Face Masks and Shields

During an aerosol-generating procedure (e.g. suctioning of the respiratory tract if not using in-line suction catheters) in a patient who is not suspected of being infected with an agent for which respiratory protection is otherwise recommended (e.g. M. tuberculosis, SARS or hemorrhagic fever viruses), wear one of the following: a face shield that fully covers the front and sides of the face, a mask with an attached shield, or a mask and goggles, in addition to gloves and a gown.

Face shields and protective eyewear must be washed and disinfected between each patient or when visibly soiled.

Respiratory Hygiene/Cough Etiquette

Measures shall be implemented to contain respiratory secretions and to prevent droplet and fomites transmission of respiratory pathogens, especially during seasonal outbreaks of viral respiratory infections such as influenza, RSV, adenovirus, or parainfluenza virus.

    • A practitioner shall provide tissues and, where practical, use no-touch receptacles (e.g. foot-pedal operated lid or open plastic-lined waste basket) for disposal of tissues.
    • A practitioner shall wear a mask during all patient/client interactions if the practitioner has any symptoms of respiratory infection.

Patient/Client Care Equipment, Instruments, Devices, and Environment of Care

Equipment, instruments, and devices include, but are not limited to: toys and play equipment, shared craft supplies, computers, multi-use electronic equipment, transfer belts, bandage scissors, debridement utensils, patient lifting and/or transporting devices, commode chairs, bath/shower chairs and benches, and dressing equipment.

A practitioner shall follow employer-established policies and procedures for containing, transporting, handling and cleaning patient/client-care equipment and instruments/devices that may be contaminated with blood or body fluids.

In the absence of employer-established policies and procedures for containing, transporting, handling and cleaning patient/client-care equipment and instruments/devices that may be contaminated with blood or body fluids, practitioners are responsible for establishing and following policies and procedures for containing, transporting, handling and cleaning patient/client-care equipment and instruments/devices that may be contaminated with blood or body fluids. Such policies and procedures must include the use of PPE (e.g. gloves and gowns and masks, worn according to the level of anticipated contamination.

A Practitioner shall follow employer-established policies and procedures for routine and targeted cleaning of environmental surfaces as indicated by the service-delivery setting, the level of patient/client contact and degree of soiling.

In the absence of employer-established policies and procedures for routine and targeted cleaning of environmental surfaces as indicated by the service-delivery setting, the level of patient/client contact and degree of soiling, practitioners are responsible for establishing and following said policies and procedures for routine and targeted cleaning of environmental surfaces.

A Practitioner shall clean and disinfect surfaces that are likely to be contaminated with pathogens, especially those in close proximity to the patient and frequently touched surfaces in the patient care environment. The practitioner is personally responsible for cleaning of shared items and shared surfaces in the occupational therapy setting such as treatment tables, toys, bandage scissors, shared bathing and toileting equipment, and wound care areas, in the absence of an organization-wide housekeeping or environmental cleaning organization.

Select equipment that can be easily cleaned and disinfected. Do not use fabric-based equipment (e.g. chairs, stuffed toys, furry toys, transfer belts) if it will likely be contaminated by body fluids.

Practitioners shall comply with all minimum standards for infection control practices and comply with local, state, or federal recommendations, issued in response to an emergency health and safety situation.

Citation

Cal. Code Regs., tit. 16 ยง 4175

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