Both regulations and science impact infection control practice. Whichever is stricter must be followed. Regulation is often more specific than science.
Law is a broad term that refers to legally binding rules of conduct adopted by a legislative or other government body at the international, federal, state, or local level. The most common laws are statutes enacted by a legislature. A regulation is an official policy issued by an agency of the executive branch in response to statutory authority. Regulations have binding legal force and are intended to implement the administrative policies of an agency. Regulations govern professional conduct and establish acceptable conduct for those regulated by the agency.
Legal issues first began to impact IC practices at the beginning of the AIDS epidemic in the early 1980s. The need to protect healthcare workers from bloodborne exposures resulted in the publication of the Bloodborne Pathogens Standard by the Occupational Safety and Health Administration (OSHA) in 1991 (OSHA, n.d.). The OSHA Standard requires employers whose employees have exposure to blood to provide safe work practices, education, and barriers to exposure. The standards were later amended to cover the safe use of sharps.
Part of the OSHA Bloodborne Pathogens Standard is the requirement that every healthcare worker who may have contact with body fluids on the job must receive specific annual education. This education includes instruction in the basics of infection control and prevention, bloodborne pathogens training, and instruction in modes of transmission, needlestick precautions, and contact precautions.
Other laws and regulations have been enacted, some at the federal and some at the state level. The Conditions of Participation, published by the CMS, is an important source of legal guidance for the infection control community. The Conditions of Participation must be met for a hospital to receive Medicare funding, which is typically about half their income for most facilities (CMS.gov, 2020a). Inspection for compliance with the Conditions of Participation is generally carried out by survey teams from either the Joint Commission or the American Osteopathic Association (AOA). Validation surveys may also be made by state health department staff.
In most jurisdictions healthcare facilities are responsible for establishing and maintaining written infection control policies and procedures and implementing them according to published guidelines. They must ensure that these policies and procedures are reviewed and updated regularly and that staff members are familiar with them.
In many cases state laws and national and state professional associations require standards of professional conduct that specify requirements and actions for healthcare workers regarding healthcare associated infections or infectious material handling. Such laws and codes may also define professional misconduct and punishment for incidents of misconduct. It is important to familiarize yourself with state and local laws and regulations and applicable codes of professional conduct that apply to your practice area.
In 2012 New York State listed scientifically accepted infection prevention techniques to include:
- Wear appropriate protective gloves at all times when touching blood, saliva, other body fluids or secretions, mucous membranes, non-intact skin, blood-soiled items or bodily fluid-soiled items, contaminated surfaces, and sterile body areas, and during instrument cleaning and decontamination procedures
- Discard gloves used following treatment of a patient and change to new gloves if torn or damaged during treatment of a patient; wash hands and don new gloves prior to performing services for another patient; and wash hands and other skin surfaces immediately if contaminated with blood or other body fluids
- Wear appropriate masks, gowns, or aprons, and protective eyewear or chin-length plastic face shields whenever splashing or spattering of blood or other body fluids is likely to occur
- Sterilize equipment and devices that enter the patient's vascular system or other normally sterile areas of the body
- Sterilize equipment and devices that touch intact mucous membranes but do not penetrate the patient's body, or use high-level disinfection for equipment and devices that cannot be sterilized prior to use for a patient
- Use appropriate agents, including but not limited to detergents, for cleaning all equipment and devices prior a sterilization or disinfection
- Clean, by the use of appropriate agents, including but not limited to detergents, equipment and devices which do not touch the patient or that only touch the intact skin of the patient
- Maintain equipment and devices used for sterilization according to the manufacturer's instructions
- Adequately monitor the performance of all personnel, licensed or unlicensed, for whom the licensee is responsible regarding infection control techniques
- Place disposable used syringes, needles, scalpel blades, and other sharp instruments in appropriate puncture-resistant containers for disposal; and place reusable needles, scalpel blades, and other sharp instruments in appropriate puncture-resistant containers until appropriately cleaned and sterilized
- Maintain appropriate ventilation devices to minimize the need for emergency mouth-to-mouth resuscitation
- Refrain from all direct patient care and handling of patient care equipment when the healthcare professional has exudative lesions or weeping dermatitis and the condition has not been medically evaluated and determined to be safe or capable of being safely protected against in providing direct patient care or in handling patient care equipment
- Place all specimens of blood and bodily fluids in well-constructed containers with secure lids to prevent leaking; and clean any spill of blood or other bodily fluid with an appropriate detergent and appropriate chemical germicide (NYSED, 2011.)