Infection Control in Home and Facility Settings

Why Infection Control Matters in Elder Care

Older adults are among the most vulnerable people to healthcare-associated infections. Their immune systems are often less robust, and many live with chronic conditions that reduce their ability to fight off pathogens. As an elder care aide working in both home and facility settings, you are a critical link in breaking the chain of infection. Infection control is not optional — it is a core professional and legal responsibility, and it protects you just as much as it protects your clients.

The Chain of Infection

Infections spread only when six links are all present: a pathogen (the germ), a reservoir (where it lives), a portal of exit (how it leaves the reservoir), a mode of transmission (how it travels), a portal of entry (how it enters a new host), and a susceptible host. Your job is to break at least one of those links. Hand hygiene and PPE are your two most powerful tools for doing so.

Hand Hygiene: The CDC 5 Moments Framework

The CDC and World Health Organization identify five key moments when hand hygiene must be performed:

1. Before touching a client

2. Before a clean or aseptic procedure

3. After body fluid exposure risk

4. After touching a client

5. After touching a client's surroundings

In a facility these moments are straightforward. In a home setting, the same moments apply — but the environment is less controlled. You may not have a sink nearby, so carry an alcohol-based hand rub (at least 60% alcohol) in your home health bag.

Soap-and-water technique (CDC recommended, minimum 20 seconds):

Wet hands, apply soap, lather all surfaces including backs of hands, between fingers, and under nails, scrub for at least 20 seconds, rinse thoroughly under running water, and dry with a clean paper towel. Use the towel to turn off the faucet.

Alcohol-based hand rub is acceptable for most moments, but soap and water is required when hands are visibly soiled and is strongly preferred after caring for a client with Clostridioides difficile (C. diff) or norovirus, because alcohol is less effective against these pathogens.

Personal Protective Equipment (PPE): Selecting the Right Level

Not every task requires the same PPE. Your selection is guided by the anticipated exposure:

• Gloves: Wear whenever you may contact blood, body fluids, mucous membranes, non-intact skin, or contaminated surfaces.
• Gown: Wear when your clothing or skin may be contaminated during care (e.g., bathing, wound care, contact precautions).
• Surgical mask: Wear for droplet precautions or when splashing of body fluids is possible.
• N95 respirator: Required for airborne precautions (e.g., tuberculosis). N95s must be fit-tested; they are not interchangeable with surgical masks.
• Eye protection (face shield or goggles): Wear when splashes or sprays of body fluids to the eyes, nose, or mouth are possible.

Donning (Putting On) PPE — Correct Order

The order matters because it ensures cleaner items protect dirtier ones:

1. Perform hand hygiene.

2. Put on the gown — tie at neck and waist.

3. Put on the mask or respirator — secure ties or ear loops, mold nose piece.

4. Put on eye protection.

5. Put on gloves — pull cuffs over the gown cuffs.

Doffing (Removing) PPE — Correct Order

Doffing is the highest-risk step because contaminated surfaces are now being handled. The outside of your gown and gloves is considered contaminated.

1. Remove gloves first — glove-to-glove, then skin-to-skin technique to avoid touching your bare skin with a contaminated glove.

2. Perform hand hygiene.

3. Remove eye protection — handle by the clean headband or earpieces, not the front lens.

4. Remove the gown — unfasten ties, pull away from neck and shoulders touching inside only, roll it away from you, and discard.

5. Perform hand hygiene.

6. Remove the mask — handle by ear loops or ties only; do not touch the front.

7. Perform hand hygiene again.

Critical safety rule: Never touch your face, eyes, nose, or mouth while any PPE is in place or during doffing.

Infection Control in the Home Setting

Home visits present unique challenges. There is no central supply room, no biohazard bin in the kitchen, and no facility housekeeping staff. Adapt standard principles:

• Clean field: Before any procedure, lay a paper towel on a flat surface to create a clean work area. Keep clean supplies on it; never place soiled items back on it.
• Waste disposal: Contaminated dressings or gloves go into a sturdy, sealable plastic bag (double-bagged if heavily soiled) and into the household trash unless local regulations specify otherwise. Never leave biohazardous waste in the client's home without a plan.
• Improvised sharps disposal: If a sharps container is not available, use a rigid, puncture-resistant container with a lid (such as a heavy detergent bottle) labeled clearly. Check agency policy and local regulations; this is an interim measure only.
• Home health bag: Keep the bag off the floor, on a clean surface. The bag represents your clean zone.

Transmission-Based Precautions in Facilities

When a client in a skilled nursing facility (SNF) or hospital is placed on precautions, follow the posted signage precisely:

• Contact precautions (e.g., MRSA, C. diff): Gown and gloves required upon entry.
• Droplet precautions (e.g., influenza): Surgical mask required within a defined distance of the client.
• Airborne precautions (e.g., TB): Fit-tested N95 required; client in a negative-pressure room.

When in doubt, ask the charge nurse before entering.

Safety Summary

• Perform hand hygiene at every one of the 5 moments — every time.
• Match your PPE level to the actual exposure risk.
• Doff carefully; this is when most self-contamination occurs.
• In the home, improvise safely and follow agency policy.
• Scope of practice reminder: if you observe signs of infection (fever, wound changes, new confusion), report to your supervisor — assessment and diagnosis are outside your scope.