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. CMPs up to $25,000 per day per CoP deficiency. 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.

Real enforcement examples

Anonymized from public FMCSA enforcement summaries. Penalty amounts reflect assessed and final settled values where disclosed.

Frequently asked questions

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