42 CFR § 484.70

What does 42 CFR § 484.70 require?

42 CFR 484.70 is the Infection Prevention and Control Condition of Participation. Every certified HHA must have a documented program covering surveillance (tracking infections), prevention (hand hygiene, PPE, standard precautions), and control (transmission-based precautions, isolation when home-care permits). Required: infection control program written and followed; competency-based education for ALL staff (employed and contracted); surveillance data fed into the HHA's QAPI program; documentation of education, surveillance findings, and corrective actions. Surveyors check for: vaccination tracking, hand hygiene policies, PPE use, and incident logs. Common citation pattern: 'staff trained but no documentation of competency' or 'infection data collected but never analyzed for QAPI.'

Who must comply with 42 CFR § 484.70?

All Medicare/Medicaid certified HHAs. The program must cover ALL personnel providing patient care: employed clinicians, aides, and contracted therapy or nursing services. The HHA cannot outsource infection control obligations; contracted personnel must be educated under the HHA's program.

What happens if you violate 42 CFR § 484.70?

Standard or condition-level CMS deficiency. Civil money penalties under 42 CFR 488.845 run from $500 to $10,000 per day or $1,000 to $10,000 per instance, before the annual adjustment under 45 CFR part 102. Infection control deficiencies often rise to immediate jeopardy when patient harm is documented (e.g., HHA-acquired infection traced to staff hand hygiene failure or undiagnosed communicable disease exposure). COVID-era guidance elevated infection control to a top-five HHA citation category.

How to comply (implementation checklist)

1. 1Establish written infection prevention and control program: surveillance, prevention, control, education.
2. 2Adopt CDC standard precautions and transmission-based precautions as the foundation.
3. 3Document competency-based education at hire and annually for all HHA staff (employed + contracted).
4. 4Track hand hygiene compliance: observation logs or self-attestation with periodic audit.
5. 5Maintain staff vaccination + TB screening records (influenza, hepatitis B offers, TB baseline + annual).
6. 6Log all HHA-identified infections (patient + staff); analyze for trends quarterly.
7. 7Feed infection surveillance data into the QAPI program (42 CFR 484.65), at least one PIP per year may target infection control if data warrants.
8. 8Provide patient + caregiver infection control education at start of care: document delivery.
9. 9Train staff on PPE use, sharps safety, bloodborne pathogens, and exposure response.
10. 10Maintain exposure incident log: track all needlestick / body-fluid exposures with follow-up documentation.

Common misinterpretations

• Misinterpretation: 'Annual training is enough.' Reality: 42 CFR 484.70(c) requires COMPETENCY-based education, not just training. Documentation must show the staff member can demonstrate the skill (hand hygiene, PPE donning/doffing), not just that they attended a session.
• Misinterpretation: 'Contract therapists follow their own infection control program.' Reality: The HHA's program governs all personnel providing patient care, including contracted PT/OT/SLP. The HHA must document that contracted personnel received education under the HHA's program.
• Misinterpretation: 'Surveillance means counting infections.' Reality: Surveillance requires identification, analysis, and action. Counting alone without analysis or feedback into QAPI is a citable deficiency under 42 CFR 484.70(a)(1).
• Misinterpretation: 'Vaccination tracking is optional.' Reality: While there is no universal CMS HHA staff-vaccination mandate, the infection control program must document staff health screening relevant to communicable disease prevention. Influenza and TB screening documentation is commonly requested by surveyors. CDC-recommended HHA staff vaccinations should be tracked.

Frequently asked questions

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