Home Healthcare Safety Manual

What Should a Home Healthcare Safety Manual Include?

The contents of a Home Healthcare Safety Manual should reflect the services employees provide and the hazards they may encounter.

A skilled nursing agency may require a different combination of programs than a personal care provider, therapy service, home infusion provider, hospice organization, or agency primarily providing assistance with activities of daily living.

Depending on operations, the manual may address:

• Home healthcare safety responsibilities.
• Pre-visit hazard assessment.
• Home safety assessment.
• Working alone.
• Workplace violence prevention.
• Safe patient handling and mobility.
• Patient transfers and repositioning.
• Bloodborne Pathogens.
• Needlestick and sharps safety.
• Infectious disease exposure control.
• Respiratory protection.
• Personal Protective Equipment.
• Hazard Communication.
• Hazardous drugs.
• Oxygen and compressed gases.
• Medical equipment.
• Slips, trips and falls.
• Pets and animals.
• Unsanitary home conditions.
• Bedbugs and pests.
• Vehicle safety.
• Severe weather.
• Emergency communication.

Programs should be selected according to the services performed, employee exposures, equipment used, and workplace hazards actually present.

Home Healthcare Safety Program

An effective Home Healthcare Safety Program establishes responsibilities and procedures for evaluating patient homes, protecting employees who work alone, preventing workplace violence, reducing patient-handling injuries, controlling blood and infectious-disease exposures, and addressing hazards employees may encounter while traveling between homes.

Management should provide employees with the training, equipment, PPE, communication systems, procedures, and other resources necessary to perform assigned work safely.

Managers, supervisors, and other designated personnel should:

• Identify occupational hazards.
• Evaluate home-visit risks.
• Maintain applicable written safety programs.
• Establish pre-visit screening procedures.
• Maintain working-alone procedures.
• Maintain workplace-violence prevention procedures.
• Evaluate patient-handling hazards.
• Provide appropriate assistive equipment when feasible.
• Maintain Bloodborne Pathogens procedures where applicable.
• Provide required PPE.
• Maintain emergency communication procedures.
• Evaluate transportation hazards.
• Investigate injuries and exposure incidents.
• Correct or address reported hazards.
• Provide employee training.
• Maintain applicable records.

Employees should follow established procedures, evaluate conditions before and during each visit, use required PPE and assistive devices, report unsafe conditions, and promptly report injuries, needlesticks, violent incidents, and other occupational exposures.

Home Healthcare Hazard Assessments

Home healthcare employers should evaluate the types of hazards employees may encounter while providing services in private residences.

Hazard assessments may consider:

• Patient mobility.
• Patient weight and assistance needs.
• Transfer requirements.
• Blood and body-fluid exposure.
• Sharps.
• Infectious diseases.
• Respiratory hazards.
• Hazardous drugs.
• Oxygen.
• Medical equipment.
• Home layout.
• Stairs.
• Clutter.
• Lighting.
• Pets.
• Weapons.
• Drug activity.
• Violence history.
• Smoking.
• Sanitation.
• Pests.
• Parking.
• Neighborhood conditions.
• Driving.

Hazard assessments should be reviewed when patient conditions, services, locations, equipment, or known risks change significantly.

Pre-Visit Hazard Assessment

Information known before an employee enters a patient’s home should be used to identify foreseeable hazards.

Pre-visit information may include:

• Patient mobility and transfer needs.
• Known infectious conditions.
• Sharps use.
• Oxygen use.
• Medical equipment.
• History of aggressive behavior.
• Known weapons.
• Substance-use concerns.
• Aggressive pets.
• Unsafe neighborhood conditions.
• Previous employee incidents.
• Access or parking concerns.
• Need for a second employee or other assistance.

Employees should receive relevant safety information before the visit when practicable.

Home Safety Assessment

Employees should evaluate the home environment upon arrival and throughout the visit.

Potential concerns include:

• Poor lighting.
• Blocked walkways.
• Loose rugs.
• Electrical cords.
• Stairs.
• Broken steps.
• Wet floors.
• Clutter.
• Inadequate workspace.
• Unsafe furniture.
• Pets.
• Smoke.
• Excessive heat or cold.
• Unsanitary conditions.
• Weapons.
• Illegal drugs or paraphernalia.
• Aggressive occupants.

Conditions can change between visits, so a prior safe visit does not guarantee that the next visit will be safe.

Unsafe Home Conditions

Employees should not be expected to perform work under conditions that create an unacceptable risk of injury or illness.

When unsafe conditions are identified, procedures should address:

• Immediate hazard avoidance.
• Contacting the supervisor.
• Requesting correction of the condition.
• Delaying or modifying the visit.
• Obtaining additional assistance.
• Ending the visit when necessary.
• Documenting the hazard.

Employees should not attempt to personally correct conditions outside their training, authority, or reasonable capability.

When a Visit Cannot Be Performed Safely

An employee should have a clear method for reporting that a visit cannot safely continue.

Conditions that may require delaying, modifying, or ending a visit can include:

• Threats or violence.
• Weapons creating concern.
• Illegal drug activity.
• Aggressive animals.
• Severe environmental hazards.
• Uncontrolled infectious exposure.
• Unsafe patient-handling requirements.
• Fire or electrical hazards.
• Severe infestation.
• Other immediately dangerous conditions.

Employee safety should not be sacrificed solely to complete a scheduled visit.

Working Alone

Home healthcare employees frequently work alone without immediate access to coworkers, security personnel, maintenance staff, or other support available in institutional healthcare settings.

The employer should evaluate lone-worker hazards and establish appropriate procedures.

These may include:

• Scheduled check-ins.
• Electronic visit tracking.
• Reliable cell-phone communication.
• Emergency contacts.
• Missed check-in procedures.
• High-risk visit protocols.
• Two-person visits.
• Security assistance where appropriate.

Employees should know how to obtain assistance if conditions deteriorate during a visit.

Employee Check-In Procedures

Check-in procedures may be appropriate for employees working alone, particularly during higher-risk visits.

Procedures may include:

• Confirming arrival.
• Confirming departure.
• Scheduled status updates.
• Electronic applications.
• Phone or text contact.
• Escalation procedures when contact is missed.

The system should be practical enough that employees can reliably use it during normal operations.

Missed Check-In Procedures

The employer should establish procedures for situations in which an employee fails to complete an expected check-in.

Escalation may include:

• Attempting to contact the employee.
• Contacting the patient’s location.
• Contacting a supervisor.
• Requesting a welfare check when warranted.
• Contacting emergency services when necessary.

Employees should understand how the system functions before beginning lone work.

High-Risk Visits

Certain visits may require additional precautions because of known or suspected hazards.

Potential controls include:

• Two-person visits.
• Security escorts.
• Daylight scheduling.
• Supervisor involvement.
• Modified services.
• Increased communication.
• Law-enforcement assistance where appropriate.

Risk controls should reflect actual conditions rather than relying on a single approach for every visit.

Workplace Violence Prevention

Home healthcare employees can face workplace violence from patients, family members, visitors, neighbors, or other individuals.

Risk can be increased because employees often work alone in unfamiliar and uncontrolled environments.

A Home Healthcare Workplace Violence Prevention Program may address:

• Pre-visit risk screening.
• Previous violent incidents.
• Threats.
• Weapons.
• Substance use.
• Aggressive behavior.
• Family conflicts.
• Neighborhood crime.
• Escape routes.
• Employee check-ins.
• High-risk visit procedures.
• Incident reporting.

Employees should understand that personal safety takes priority over continuing a visit during a threatening situation.

Pre-Visit Security Assessment

Known safety concerns should be communicated before employees enter a home when practicable.

Factors may include:

• Prior violence.
• Threats.
• Aggressive family members.
• Known weapons.
• Illegal drug activity.
• Domestic violence concerns.
• Unsafe neighborhoods.
• Aggressive animals.
• Previous employee experiences.

A prior incident should be considered when planning future visits.

Weapons in the Home

Employees may encounter firearms, knives, or other weapons during home visits.

The employer should establish procedures for responding when weapons create an employee-safety concern.

Employees should not handle or secure weapons unless that activity is specifically within their assigned duties and they are trained and authorized to do so.

If the presence or use of a weapon creates a threat, the employee should follow established withdrawal and emergency procedures.

Drug and Alcohol Activity

Employees may encounter patients or occupants who are intoxicated or using illegal drugs.

Drug activity can increase the risk of:

• Violence.
• Needlesticks.
• Unpredictable behavior.
• Unsafe environmental conditions.
• Criminal activity.

Employees should report these conditions according to established procedures and leave when necessary for personal safety.

Aggressive or Threatening Behavior

Employees should be trained to recognize behavior that may indicate escalating risk.

Warning signs may include:

• Verbal threats.
• Yelling.
• Aggressive body language.
• Pacing.
• Blocking exits.
• Property destruction.
• Threatening gestures.
• Displaying a weapon.

Employees should maintain access to an exit whenever possible and avoid allowing themselves to become trapped.

De-Escalation

Employees may use appropriate verbal de-escalation techniques when it is safe and consistent with their training.

Employees should:

• Remain calm.
• Maintain appropriate distance.
• Avoid unnecessary arguing.
• Avoid threatening gestures.
• Keep an exit available.
• Seek assistance.
• Leave if the situation cannot be safely controlled.

De-escalation should not be treated as a requirement to remain in an unsafe environment.

Escape and Egress

Employees should identify a practical path of exit when entering a home, particularly when there are known violence concerns.

Employees should avoid positioning themselves where another person, furniture, pets, or equipment can block their exit.

When a threat develops, leaving the residence may be the safest response.

Violence Incident Reporting

Threats, assaults, harassment, and near misses should be reported according to established procedures.

Reported incidents should be reviewed to identify:

• Contributing factors.
• Recurrent locations.
• Patient or household risk factors.
• Need for additional controls.
• Whether future visits require modification.

Employees should not be discouraged from reporting violence because no physical injury occurred.

Safe Patient Handling and Mobility

Patient handling is a major source of musculoskeletal injuries in healthcare.

Home healthcare can create additional challenges because employees may work in tight spaces, without adjustable hospital beds, mechanical lifting equipment, or immediate assistance from another employee.

The employer should evaluate patient-handling requirements before assigning employees to tasks that involve significant lifting, transferring, or repositioning.

Patient Handling Assessment

Before attempting a transfer or lift, employees should consider:

• Patient weight.
• Patient mobility.
• Ability to bear weight.
• Ability to follow instructions.
• Medical condition.
• Fall risk.
• Available equipment.
• Available assistance.
• Space around the patient.
• Floor conditions.
• Furniture arrangement.

Employees should not attempt a transfer they cannot safely perform.

Patient Transfers

Patient-transfer procedures should reflect the patient’s physical abilities and the equipment available.

Transfers may include:

• Bed to chair.
• Chair to bed.
• Toilet transfers.
• Shower or bathing transfers.
• Vehicle transfers.
• Repositioning.

Assistive devices should be used when appropriate.

Repositioning Patients

Repositioning can create significant back, shoulder, and upper-extremity stress.

Employees should avoid unnecessary manual lifting and use appropriate techniques, equipment, and assistance.

The patient’s bed height and available working space should be considered before beginning the task.

Mechanical Lifting Equipment — When Available

Mechanical lifts and other assistive devices can reduce manual patient-handling exposures.

Where equipment is provided, employees should receive appropriate training before use.

Equipment should be:

• Appropriate for the patient.
• Maintained in safe condition.
• Used according to manufacturer instructions.
• Available when needed.

Employees should report missing, damaged, or unsuitable equipment.

Transfer Belts and Assistive Devices

Transfer belts, slide sheets, transfer boards, gait devices, and other assistive equipment may reduce physical strain when appropriate for the patient and task.

Employees should receive instruction before using unfamiliar equipment.

Assistive devices should not be used when contraindicated by the patient’s condition.

Two-Person Assistance

Some transfers or repositioning tasks may require more than one employee.

When two-person assistance is necessary, the employer should plan how the second qualified person will be available.

Employees should not substitute an untrained family member for required trained assistance when doing so creates additional risk.

Restricted Working Spaces

Home environments may provide insufficient space around beds, chairs, or medical equipment.

Employees should evaluate whether adequate room exists to perform the task safely.

Where feasible, the work area may be modified by:

• Moving nonessential furniture.
• Repositioning equipment.
• Improving lighting.
• Creating a clear pathway.

Employees should not manually move heavy furniture when doing so creates additional injury risk.

Ergonomics

Home healthcare employees may experience ergonomic stress from:

• Patient lifting.
• Reaching.
• Bending.
• Kneeling.
• Carrying equipment.
• Working from low furniture.
• Driving.
• Repetitive documentation.
• Awkward treatment positions.

Work practices and equipment should be evaluated to reduce unnecessary musculoskeletal stress.

Home Healthcare Bag Safety

Employees may carry medications, PPE, dressings, instruments, documentation supplies, and other equipment from home to home.

Procedures should address:

• Appropriate bag placement.
• Clean and contaminated supplies.
• Sharps.
• Preventing cross-contamination.
• Weight of the bag.
• Ergonomic access.

Where feasible, the bag should be placed on a clean, stable, elevated surface rather than requiring repeated bending to the floor.

Bloodborne Pathogens

Employees whose duties create reasonably anticipated occupational exposure to human blood or other potentially infectious materials should be protected according to applicable Bloodborne Pathogens requirements.

The employer should maintain an appropriate Exposure Control Plan when the standard applies.

The program may address:

• Exposure determination.
• Universal Precautions.
• Engineering controls.
• Work-practice controls.
• PPE.
• Sharps safety.
• Hepatitis B vaccination.
• Exposure incidents.
• Post-exposure evaluation.
• Training.
• Recordkeeping.

Exposure Determination

The employer should identify job classifications and tasks in which occupational exposure to blood or other potentially infectious materials is reasonably anticipated.

Exposure determination should reflect assigned duties rather than job title alone.

Home healthcare employees who perform injections, wound care, blood glucose testing, specimen handling, or other procedures involving blood may have occupational exposure.

Universal Precautions

Human blood and other applicable potentially infectious materials should be treated in accordance with Universal Precautions.

Employees should use appropriate engineering controls, work practices, and PPE during tasks with anticipated exposure.

Engineering and Work-Practice Controls

Controls should be used to eliminate or minimize occupational exposure.

Examples may include:

• Safety-engineered sharps.
• Sharps containers.
• Needleless systems.
• Safe handling procedures.
• Hand hygiene.
• Appropriate disposal methods.

The home environment may require advance planning to ensure controls are available where the employee performs the procedure.

Needlestick and Sharps Safety

Needlestick and sharps injuries are a significant home healthcare concern.

Potential causes include:

• Poor lighting.
• Tight workspaces.
• Unexpected patient movement.
• Interruptions.
• Pets.
• Family members.
• Improperly discarded sharps.
• Inadequate sharps containers.

Employees should use approved safer devices when required and follow established sharps-safety procedures.

Sharps Containers in Patient Homes

Appropriate sharps containers should be available when employees perform procedures requiring disposal of contaminated sharps.

Containers should be:

• Closable.
• Puncture resistant.
• Leak resistant as appropriate.
• Accessible during procedures.
• Maintained in an upright position.
• Replaced before overfilling.

Employees should not carry loose contaminated sharps from a residence for later disposal.

Sharps Found in the Home

Employees may encounter sharps that were used by patients, family members, or other care providers.

Employees should not:

• Reach blindly into trash.
• Pick up loose needles with bare hands.
• Manually compress waste bags.
• Attempt unsafe recapping.

Improperly discarded sharps should be reported and handled according to established procedures.

Exposure Incidents

Needlesticks, cuts, splashes to mucous membranes, and other potential occupational exposures should be reported immediately.

Applicable post-exposure procedures should be initiated promptly.

Employees should know whom to contact after normal business hours.

Hepatitis B Vaccination

Where required under the Bloodborne Pathogens Standard, eligible employees should be offered Hepatitis B vaccination according to applicable requirements.

Appropriate documentation should be maintained.

Infectious Disease Exposure Control

Home healthcare employees may provide care to patients with communicable diseases.

The employer should evaluate anticipated exposures and establish procedures appropriate to:

• Route of transmission.
• Patient condition.
• Services performed.
• Home environment.
• Available controls.

Controls may include PPE, hand hygiene, cleaning and disinfection, respiratory protection, and visit modifications.

Hand Hygiene

Employees should perform hand hygiene at appropriate times, including:

• Before and after patient care.
• After contact with blood or body fluids.
• After removing gloves.
• After contact with contaminated surfaces.
• Before eating or drinking.

When appropriate handwashing facilities are unavailable, the employer should provide suitable alternatives and procedures.

Respiratory Infections

Employees may be exposed to respiratory infections during close patient contact.

Procedures should address appropriate:

• Source control.
• Employee PPE.
• Respiratory protection where required.
• Ventilation considerations.
• Patient placement during care.
• Hand hygiene.
• Cleaning.
• Exposure reporting.

Respiratory Protection — When Required

When respirators are necessary to protect employees from occupational respiratory hazards, the employer should maintain an appropriate Respiratory Protection Program.

Applicable requirements may include:

• Hazard evaluation.
• Respirator selection.
• Medical evaluation.
• Fit testing.
• Training.
• Inspection.
• Maintenance.
• Program evaluation.

A surgical or procedure mask should not automatically be treated as equivalent to a respirator required for a particular hazard.

Personal Protective Equipment

PPE should be selected according to anticipated exposure.

Depending on assigned duties, PPE may include:

• Examination gloves.
• Chemical-resistant gloves.
• Safety glasses.
• Goggles.
• Face shields.
• Protective clothing.
• Respiratory protection.
• Protective footwear.

Employees should carry or have access to the PPE required for foreseeable tasks during the visit.

Eye and Face Protection

Eye or face protection should be used when splashes, sprays, droplets, or other hazards may expose the eyes or face.

Potential tasks may include:

• Wound irrigation.
• Suctioning.
• Handling body fluids.
• Cleaning.
• Chemical use.

Protection should be selected according to the anticipated exposure.

Hazard Communication

Home healthcare employees may use disinfectants, cleaning products, medications, oxygen-related products, and other hazardous chemicals.

Where applicable, the employer should maintain an appropriate Hazard Communication Program addressing:

• Safety Data Sheets.
• Labels.
• Employee training.
• Chemical hazards.
• Non-routine tasks.

Employees should understand the hazards of chemicals they are expected to use in patient homes.

Cleaning and Disinfecting Chemicals

Employees should use disinfectants and cleaning products according to manufacturer instructions.

Employees should:

• Use required PPE.
• Maintain product labels.
• Avoid unauthorized chemical mixing.
• Follow dilution requirements.
• Provide ventilation where appropriate.
• Report exposures.

Household chemicals belonging to the patient should not automatically be substituted for employer-approved products.

Hazardous Drugs — When Applicable

Some home healthcare employees may administer or otherwise handle hazardous drugs.

Potential exposures may occur during:

• Drug administration.
• Infusion.
• Spill cleanup.
• Handling contaminated equipment.
• Handling patient body fluids following treatment.
• Waste disposal.

Where applicable, appropriate hazardous-drug controls should be established.

Hazardous Drug Spill Response — When Applicable

Employees assigned to administer hazardous drugs should have appropriate instructions and spill-response supplies when necessary.

Employees should not attempt cleanup beyond their training and available PPE.

Significant exposures or spills should be promptly reported.

Oxygen Safety

Patients may use supplemental oxygen within the home.

Oxygen can accelerate combustion and increase fire severity.

Employees should evaluate and report unsafe conditions involving:

• Smoking.
• Open flames.
• Damaged equipment.
• Improper cylinder storage.
• Heat sources.
• Electrical hazards.

Employees should follow established procedures when oxygen is present in an unsafe environment.

Home Oxygen and Smoking

Smoking around oxygen can create a severe fire hazard.

Employees should not knowingly participate in unsafe oxygen use.

If a patient or household member refuses to follow necessary safety precautions, the employee should follow agency escalation procedures.

Compressed Gas Cylinders — When Applicable

Compressed oxygen or other medical gases should be appropriately secured and protected from damage.

Employees assigned to handle cylinders should understand safe:

• Transport.
• Storage.
• Valve protection.
• Regulator use.
• Emergency procedures.

Employees should not attempt unauthorized repair of compressed-gas equipment.

Medical Equipment Safety

Home healthcare employees may use or encounter:

• Oxygen concentrators.
• Infusion pumps.
• Suction equipment.
• Hospital beds.
• Patient lifts.
• Nebulizers.
• Monitoring devices.
• Other electrically powered equipment.

Equipment should be used according to manufacturer instructions and agency procedures.

Damaged or malfunctioning equipment should be reported.

Electrical Safety

Employees should evaluate electrical conditions before connecting employer-provided medical equipment where visible hazards are present.

Potential concerns include:

• Damaged receptacles.
• Overloaded outlets.
• Extension cords.
• Damaged electrical cords.
• Exposed wiring.
• Water near equipment.
• Inadequate grounding.
• Improvised wiring.

Employees should not attempt electrical repairs unless qualified and authorized.

Power Failure

Patients may depend on electrically powered medical equipment.

The agency should identify foreseeable power-loss hazards related to the services it provides and establish appropriate contingency procedures.

Employees should understand how to communicate power-related concerns and obtain assistance.

Pets and Animals in Patient Homes

Pets can create bite, scratch, trip, allergy, contamination, and distraction hazards.

Before care begins, animals that could interfere with safe work should be appropriately controlled.

Employees should not be expected to provide care while an aggressive or uncontrolled animal creates an unsafe condition.

Aggressive Animals

Employees should not attempt to restrain an aggressive animal unless doing so is part of their assigned duties and they are trained to perform the task.

The patient or responsible household member should secure animals when necessary.

If an animal cannot be adequately controlled, the visit may need to be delayed or ended.

Animal Bites and Scratches

Animal bites and scratches should be promptly reported.

Employees should follow established procedures for:

• Wound cleaning.
• Medical evaluation.
• Incident reporting.
• Rabies concerns where appropriate.

Even minor injuries should not be ignored.

Animal Waste and Allergens

Employees may encounter animal urine, feces, dander, fur, or contaminated surfaces.

Employees should use appropriate hygiene and PPE and avoid unnecessary contact.

Significant sanitation or allergen concerns should be reported to the agency.

Slips, Trips and Falls in Patient Homes

Home environments may contain hazards not normally permitted in controlled healthcare facilities.

Examples include:

• Loose rugs.
• Electrical cords.
• Clutter.
• Pets.
• Medical tubing.
• Wet floors.
• Broken steps.
• Poor lighting.
• Uneven exterior surfaces.

Employees should identify and avoid these hazards where possible.

Stairs

Employees should use additional caution when carrying supplies or assisting patients on stairs.

Stairs should have sufficient lighting and a usable walking surface.

Employees should not attempt to support a patient on unsafe stairs when the task exceeds their ability or available assistance.

Exterior Walkways

Driveways, sidewalks, porches, stairs, ramps, and other exterior access areas may create hazards from:

• Ice.
• Snow.
• Water.
• Uneven pavement.
• Poor lighting.
• Debris.
• Missing handrails.

Unsafe access conditions should be reported.

Poor Lighting

Adequate lighting is necessary for patient care, sharps use, medication handling, walking, and other tasks.

Where possible, lighting should be improved before performing tasks that require good visibility.

Employees should not perform precision or hazardous procedures when visibility is inadequate.

Unsanitary or Hazardous Home Conditions

Employees may encounter:

• Human or animal waste.
• Mold.
• Sewage.
• Excessive garbage.
• Insects.
• Rodents.
• Bedbugs.
• No running water.
• Contaminated surfaces.
• Severe clutter.

Employees should report conditions that create occupational hazards.

The agency should determine whether the visit can proceed safely and what controls are necessary.

Bedbugs and Pest Exposure

Employees may enter homes with bedbugs, fleas, roaches, rodents, or other pests.

Procedures may address:

• Recognizing signs of infestation.
• Placement of employee bags and clothing.
• Use of protective equipment when appropriate.
• Reporting.
• Cleaning or containment after exposure.
• Preventing transport of pests to other homes or the employee’s vehicle.

Employees should not use pesticides unless their duties, training, and procedures authorize them to do so.

Smoking and Secondhand Smoke

Employees may be exposed to tobacco or other smoke during home visits.

Smoking may also create additional hazards when oxygen or flammable materials are present.

The employer should establish procedures for addressing smoke exposure when it interferes with employee safety or required patient care.

Ventilation and Indoor Air Quality

Unlike institutional healthcare settings, residential ventilation may be poor or unreliable.

Employees may encounter:

• Smoke.
• Mold.
• Chemical vapors.
• Dust.
• Pet allergens.
• Extreme humidity.
• Excessive heat.

Conditions creating significant occupational exposure should be reported and evaluated.

Vehicle Safety

Driving between patient homes is an integral part of many home healthcare operations.

Vehicle-safety procedures should address:

• Authorized drivers.
• Seat-belt use.
• Distracted driving.
• Fatigue.
• Vehicle condition.
• Weather.
• Route planning.
• Accident reporting.
• Transport of equipment and supplies.

Employees should not use handheld devices while driving.

Driving Between Patient Visits

Schedules should allow reasonable travel time.

Employees should not be encouraged to speed or drive unsafely to meet unrealistic visit schedules.

Route planning should consider:

• Traffic.
• Weather.
• Parking.
• Road conditions.
• Distance between visits.

Employees should safely park before using phones or completing documentation.

Parking and Arrival Safety

Employees may arrive in unfamiliar neighborhoods or locations.

Before leaving the vehicle, employees should evaluate:

• Lighting.
• Nearby activity.
• Parking location.
• Access to the home.
• Animals.
• Severe weather.
• Other security concerns.

Employees should avoid parking in locations that unnecessarily block rapid departure during higher-risk visits.

Transporting Equipment and Supplies

Medical bags, PPE, oxygen, documentation, and other supplies should be secured during vehicle travel.

Heavy or frequently used items should be positioned to reduce awkward lifting.

Contaminated materials should be separated from clean supplies where required.

Severe Weather

Employees may travel or provide care during:

• Snow.
• Ice.
• Thunderstorms.
• Flooding.
• Extreme heat.
• Extreme cold.
• Wildfire smoke.
• Other severe weather.

The employer should establish procedures for modifying, delaying, or canceling visits when travel or environmental conditions create unacceptable risk.

Heat Stress — When Applicable

Employees may encounter poorly cooled homes or perform work outdoors during hot weather.

Potential controls may include:

• Drinking water.
• Rest.
• Cooling.
• Appropriate clothing.
• Acclimatization.
• Emergency procedures.

Employees should report conditions that prevent safe work.

Cold Stress — When Applicable

Employees may encounter unheated homes, outdoor exposure, snow, or cold vehicles.

Appropriate clothing and work practices should reflect the exposure.

Severe cold conditions may require postponing or modifying a visit.

Emergency Communication

Employees should have reliable means to summon assistance while working in the field.

Procedures should address:

• Medical emergencies.
• Workplace violence.
• Vehicle crashes.
• Fire.
• Chemical exposure.
• Needlestick injuries.
• Unsafe home conditions.
• Other serious incidents.

Employees should know both agency emergency contacts and when to contact public emergency services directly.

Medical Emergencies

Home healthcare employees may encounter patient emergencies in addition to employee emergencies.

Employees should understand the scope of their assigned clinical responsibilities and procedures for obtaining emergency medical assistance.

Employee safety should be considered before entering or remaining in a hazardous emergency scene.

Fire Prevention

Home healthcare employees may encounter fire hazards involving:

• Oxygen.
• Smoking.
• Cooking.
• Space heaters.
• Electrical equipment.
• Candles.
• Overloaded outlets.
• Damaged wiring.

Employees should report significant fire hazards and should not place themselves at risk attempting to correct conditions outside their responsibilities.

Emergency Action Procedures

Because employees work in many different residences, emergency procedures should emphasize adaptable principles rather than relying on a single building-specific evacuation plan.

Employees should consider:

• Available exits.
• Emergency communication.
• Patient mobility.
• Fire.
• Violence.
• Severe weather.
• Medical emergencies.
• Hazardous conditions.

Employees should not delay personal evacuation when conditions become dangerous.

First Aid and Employee Injuries

Employees should know how to obtain prompt medical evaluation following occupational injuries and exposures.

Particular attention should be given to:

• Needlesticks.
• Blood exposure.
• Animal bites.
• Patient-handling injuries.
• Falls.
• Vehicle crashes.
• Chemical exposure.
• Workplace violence.

Employees should promptly report occupational injuries even when immediate symptoms appear minor.

Incident Reporting

Home healthcare employers should maintain procedures for reporting:

• Employee injuries.
• Exposure incidents.
• Needlesticks.
• Workplace violence.
• Threats.
• Near misses.
• Vehicle crashes.
• Unsafe patient homes.
• Animal incidents.
• Other occupational hazards.

Reported information should be reviewed for trends and opportunities for corrective action.

Contractor and Third-Party Coordination

Home healthcare employees may interact with durable-medical-equipment suppliers, delivery personnel, other healthcare providers, family caregivers, maintenance workers, and other third parties.

Where appropriate, activities should be coordinated so that one party’s work does not create unnecessary hazards for another.

Home Healthcare Safety Training

Safety training should reflect employees’ assigned duties and field exposures.

Depending on operations, training may address:

• Home hazard assessment.
• Working alone.
• Workplace violence.
• Patient handling.
• Ergonomics.
• Bloodborne Pathogens.
• Needlestick prevention.
• Infectious diseases.
• PPE.
• Respiratory protection.
• Chemical safety.
• Oxygen.
• Pets and animals.
• Bedbugs and pests.
• Vehicle safety.
• Emergency procedures.

Employees should receive task-specific instruction before independently performing higher-hazard work.

New Employee Safety Orientation

New employees should receive appropriate safety orientation before beginning independent home visits.

Orientation may address:

• Home healthcare hazards.
• Pre-visit assessment.
• Working alone.
• Check-in procedures.
• Workplace violence.
• Patient handling.
• Bloodborne Pathogens.
• Sharps.
• PPE.
• Infectious disease.
• Driving.
• Incident reporting.
• Emergency communication.

New employees should understand when they are authorized to stop or leave a visit because of unsafe conditions.

Home Healthcare JSA/JHA

Home healthcare organizations can use JSAs/JHAs to document safe work practices for selected higher-hazard activities.

Potential Home Healthcare JSAs/JHAs include:

• Patient transfers.
• Repositioning patients.
• Bathing assistance.
• Sharps use.
• Wound care.
• Oxygen-cylinder handling.
• Hazardous-drug administration.
• Working alone.
• High-risk home visits.
• Driving between visits.

Home Healthcare Safety Meetings

Periodic safety meetings can reinforce safe work practices and address conditions employees are encountering in the field.

Potential topics include:

• Workplace violence.
• Working alone.
• Patient lifting.
• Sharps safety.
• Bloodborne Pathogens.
• Infectious diseases.
• PPE.
• Pets.
• Unsafe homes.
• Bedbugs.
• Driving.
• Severe weather.

Field employees should have opportunities to share recurring hazards and effective control measures.

Recordkeeping

Home healthcare organizations should maintain occupational safety and health records required for their operations.

Records may include:

• Employee training.
• Bloodborne Pathogens records.
• Sharps injuries.
• Workplace-violence incidents.
• Employee injuries.
• Patient-handling evaluations.
• Respirator records.
• Vehicle incidents.
• Home-hazard reports.
• Other required program records.

Confidential employee medical information should be maintained according to applicable requirements.

Additional Safety Programs

Depending on home healthcare operations, additional safety programs may be necessary for:

• Bloodborne Pathogens.
• Needlestick & Sharps Safety.
• Infectious Disease Exposure Control.
• Respiratory Protection.
• Personal Protective Equipment.
• Hazard Communication.
• Hazardous Drugs.
• Compressed Gas Cylinders.
• Ergonomics.
• Manual Lifting & Material Handling.
• Workplace Violence Prevention.
• Working Alone.
• Vehicle Safety.
• Slips, Trips & Falls.
• Electrical Safety.
• Heat Stress Prevention.
• Cold Stress.
• Fire Prevention.
• First Aid.
• Spill Prevention & Response.

These programs should be included when employee duties and exposures make them applicable rather than automatically adding procedures unrelated to the services being provided.

Building a Home Healthcare Safety Manual

A useful Home Healthcare Safety Manual should reflect the actual services employees provide and the environments in which they work rather than simply adapting a hospital or medical-office manual.

A skilled nursing agency may require a different combination of programs than a personal-care agency, physical therapy service, home infusion provider, or other organization delivering services in private residences.

The manual should consider:

• Patient mobility.
• Patient-handling requirements.
• Blood and sharps exposure.
• Infectious diseases.
• Respiratory hazards.
• Medications.
• Oxygen.
• Medical equipment.
• Working-alone conditions.
• Violence risks.
• Pets.
• Home sanitation.
• Pests.
• Travel.
• Weather.
• Emergency communication.

Selecting the appropriate programs creates a manual that is comprehensive without filling it with procedures unrelated to the agency’s work.

Customized Home Healthcare Safety Manuals

A Home Healthcare Safety Manual can be developed around the agency’s services, employee duties, patient-handling requirements, blood and sharps exposures, infectious-disease hazards, medical equipment, oxygen use, home-visit conditions, driving, workplace-violence risks, and other occupational exposures.

The finished manual may incorporate applicable programs for Bloodborne Pathogens, Needlestick and Sharps Safety, Infectious Disease Exposure Control, Respiratory Protection, PPE, Hazard Communication, Hazardous Drugs, Ergonomics, Workplace Violence Prevention, Working Alone, Vehicle Safety, Emergency Procedures, and other hazards present within the operation.

This provides home healthcare employers with a practical safety manual organized around the work employees actually perform in patients’ homes.