Infection prevention and control (IPC) continues to be cited as one of the top areas of deficiency for home health agencies. Surveyors observe a wide range of unsafe practices amongst staff in the unpredictable home environment. Leaders are tasked with getting their team to autonomously adhere to the basic principles of IPC in the context of the rapidly growing industry that is often short staffed, time crunched and financially strained.

Agencies can have a thorough IPC program in place, but current studies suggest compliance rates are low amongst home health workers all over the country. The Community Health Accreditation Partner (CHAP) continue to echo this finding in their 2025 Top Ten Home Health Deficiencies list in which two IPC regulations were identified. These included improper hand hygiene and bag techniques for transmitting infections from home to home. How can agency leaders close the discrepancy between IPC policy and practice?

Identify Risk Areas

The first step to improve staff compliance to IPC compliance is increasing awareness of current practices. Reviewing survey deficiencies from the last three to five years and ranking the top concerns creates a place to start a deeper dive. Ensure your agency has a home care software system in place that allows easy workflow for performing chart audits, documenting visit reports and communicating findings with caregivers. Co visit or staff performance evaluations should be further reviewed for extrapolation of the specific findings related to these deficiencies for areas of improvement. If there has been significant turnover in the agency since the last evaluations, consider re-evaluating staff for insight into current practices.

Infection control concerns are often in plain sight and can include:

• improper cleaning of equipment,
• improper donning/doffing or usage of personal protective equipment (PPE),
• missed opportunities for performing hand hygiene before or after touching a patient,
• placing equipment bags on dirty surfaces, reaching into them with dirty hands, not separating reusable from disposable equipment and
• improper or no glove usage for tasks that require it,
• poor adherence to sharps safety or injection practices,
• improper wound care techniques or
• breaking sterile or aseptic techniques as needed for urinary catheters or vascular access devices

Tips for Improved Compliance

Resources are widely available surrounding the topic of infection control and prevention, though it can be difficult to find resources specifically tailored to home health since most available evidence is focused on improvements in hospital settings. Look to the Centers for Disease Control and  Prevention (CDC) for free tools and resources such as modifiable IPC assessments and checklists for evaluations, training on the safe handling of sharps, infographics for the appropriately use of PPE and more. Advanced preparation for Survey or to boost agency knowledge of how to best implement IPC programs are available from CHAP via webinar, workshops, and consultation. Many CHAP resources are aimed specifically at the home health setting.

How agency leaders decide to implement strategies to improve compliance matters. Boost buy in with delivering education that makes an impact. The message needs to be clear that the agency values IPC adherence and staff should value it as well. Adults need to understand how the application of the information applies directly to their daily work. Simply explaining policy information verbally or by email is not enough. Some proven ideas for improving compliance include:

• Sharing IPC deficiencies and concerns identified within the agency from survey or performance reviews staff meetings and include mitigation strategies,
• Brainstorm with staff ideas and tips for IPC practices to overcome the challenging home environment such as limited space, pets, clutter and limited resources.
• Hold staff training sessions in person, break into small groups and have staff work on case studies or home care scenarios to identify IPC problems on their own to improve their ability to identify where their personal shortfalls may be.
• Provide staff with small, laminated bag tags with tips, steps or visual reminders from the CDCs Clean Hands Count campaign or clinical safety training materials on sharps and appropriate glove use.
• Normalize evaluations, audits and peer coaching. Staff should feel they are not being evaluated to “get in trouble”, rather, it provides the agency with a barometer of how well the agency is doing as a whole for IPC compliance. Contrary to historical belief, current practices for remediation include removing blame culture, evaluating barriers, identifying learning opportunities and giving staff member(s) time to improve.
• Ensure leadership and peer trainers set the tone for new staff. Stress the agency values and expectations surrounding IPC compliance, connecting individual actions to the organizational culture.

No matter how agencies decide to share information on IPC, follow up is integral to know if outcomes are being met. Anonymously survey staff at set intervals to determine if the knowledge of IPC practice has improved. Request feedback on training sessions on whether staff find the training helpful and learned something new they can apply to their daily work and regularly evaluate staff in person for compliance. Celebrate wins to continue positive momentum and create a sense of shared accountability.

IPC work can be easily overlooked until deficiencies arise due to the many competing day-to-day operational functions within home health organizations. Setting in motion a solid plan to incorporate proven techniques for IPC compliance and regular follow up can create a foundation for daily practices that the agency can rely on to reduce deficiencies.  

Resources:

Barriers and facilitators to infection prevention article

Top Ten Home Health Deficiencies -CHAP

Article – Improvements in hospital settings

CDC aritcle – infection control tools and resources

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