New North Carolina Law Will Require Infection Control Training at Adult Care Homes

June 10, 2011

A new North Carolina law aims to improve care provided in adult care homes by increasing staff infection control training requirements and providing for annual inspections for safe infection control standards compliance.

The impetus for House Bill 474 was the occurrence of the deaths of six individuals at a Wayne County assisted living home who were infected with hepatitis from improper injection practices for diabetes treatments. According to a local news source, News Observer, an investigation by state officials was conducted when state epidemiologists were notified after the first four deaths; the investigation indicated a lack of thorough staff infection control training.

The bill was sponsored by Rep. Jennifer Weiss. The legislation passed the North Carolina General Assembly on May 26, 2011 and was signed by Governor Bev Perdue on May 31.

Approximately 30,000 medical technicians and supervisors will be subject to the infection control training requirements by the end of 2012.

The new law amends current requirements for adult care homes pertaining to medication administration standards, minimum staffing, training requirements for medication aides, and standards for professional supervision of adult care homes’ medication controls.

Adult Care Home Infection Prevention Requirements

The new law adds certain requirements to prevent the transmission of HIV, hepatitis B, hepatitis C, and other bloodborne pathogens.

Implementation of Infection Control Policy

Adult care homes are required to implement a written infection control policy that is consistent with the federal Centers for Disease Control and Prevention (CDC) guidelines on infection control. The infection control policy must address the following:

  • “Proper disposal of single-use equipment used to puncture skin, mucous membranes, and other tissues, and proper disinfection of reusable patient care items that are used for multiple residents.”
  • “Sanitation of rooms and equipment, including cleaning procedures, agents, and schedules.”
  • “Accessibility of infection control devices and supplies.”
  • “Blood and bodily fluid precautions.”
  • “Procedures to be followed when adult care home staff is exposed to blood or other body fluids of another person in a manner that poses a significant risk of transmission of HIV, hepatitis B, hepatitis C, or other bloodborne pathogens.”
  • “Procedures to prohibit adult care home staff with exudative lesions or weeping dermatitis from engaging in direct resident care that involves the potential for contact between the resident, equipment, or devices and the lesion or dermatitis until the condition resolves.”

Under the new law, adult care homes are also required to monitor compliance with the facility’s infection control policy.  It must update the infection control policy as necessary to prevent the transmission of HIV, hepatitis B, hepatitis C, and other bloodborne pathogens.

Adult Care Staff Infection Control Training

Adult care homes in North Carolina will now be required to designate one on-site staff member per each noncontiguous facility who is familiar with CDC guidelines on infection control to direct the infection control activities of the facility.  That person must also ensure that all adult care staff is trained based on the facility’s infection control policy.

Starting October 1, 2010, any non-supervisory staff member designated to direct the facility’s infection control policy must complete an infection control course developed by the North Carolina Department of Health and Human Services (department).

Reporting Suspected Communicable Disease Outbreaks

The law requires the department to develop guidelines describing how adult care homes are to report suspected communicable disease outbreaks within facilities to the local health department.

State Inspection and Monitoring for Infection Prevention and Safe Injection Practices

The new law also requires the Division of Health Service Regulation to include a review of the facilities compliance with the new law’s infection prevention requirements as part of inspections of adult care homes.  This includes an inspection of safe injection practices and any other procedures for which bleeding typically occurs.  These review requirements must be in place by January 1, 2012.

Medication Aides Training and Competency Evaluation Requirements

The law imposes significant training and competency requirements upon medication aides.  By January 1, 2010, the Division of Health Service Regulation is to develop a mandatory, annual in-service training program for adult care medication aides.  The program is to include training about infection control, safe injection practices, other procedures for which bleeding typically occurs, and glucose monitoring.

Starting on October 1, 2013, adult care homes will be prohibited from allowing staff to perform any unsupervised medication aide duties unless that person has previously worked as a medication aide during the previous 24 months in an adult care home.

As an alternative to the above requirement, the staff must have successfully completed the following:

  • A five-hour training program including training and instruction for key principles of medication administration; CDC guidelines on infection control and safe injection practices; and training for procedures for monitoring or testing where bleeding occurs or the potential for bleeding exists;
  • A clinical skills evaluation;
  • Completion of an additional 10-hour training program that includes training and instruction about the key principles of medication administration, CDC guidelines on infection control, safe injection practices, and monitoring or testing in situations where bleeding occurs or the potential for bleeding exists; and
  • An examination developed and administered by the Division of Health Service Regulation.

By October 1, 2012, the Division of health Service Regulation is required to develop and administer an examination for all persons seeking employment as a medication aide in an adult care home.

Infection Control Training Requirements for Adult Care Home Supervisors

The law requires the department to develop a mandatory, annual course for adult care home supervisors by December 1, 2011.  The course requires training on infection control CDC guidelines.

To view HB 474, visit http://www.ncga.state.nc.us/Sessions/2011/Bills/House/PDF/H474v6.pdf.

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