QAPI vs. Infection Control: What’s the Difference in Home Health?

In home health, two major Conditions of Participation (CoPs) that often cause confusion are Quality Assessment and Performance Improvement (QAPI) and Infection Prevention and Control (IPC). While both are essential to patient safety and survey readiness, they serve distinct purposes. Agencies sometimes blur the lines between the two, but understanding their differences—and how they work together—is key to maintaining compliance and building a strong, safe program.

At SummitRidge, we help agencies untangle these requirements, set up the right systems, and prepare for surveys with confidence.

The Regulatory Framework

Let’s look at the Medicare CoPs that define each requirement:

• QAPI – §484.65

  • Requires an ongoing, data-driven program that measures, monitors, and improves quality across the agency.

  • Must focus on high-risk, high-volume, and problem-prone areas.

  • Requires documentation of Performance Improvement Projects (PIPs), governing body oversight, and measurable outcomes.

• Infection Prevention and Control – §484.70

  • Requires agencies to maintain an infection control program to prevent, identify, and manage infections.

  • Must include surveillance, education, and reporting processes.

  • Agencies must take immediate action to correct deficiencies and minimize risks of transmission.

While QAPI is broad—covering the agency’s overall quality—Infection Control is narrow, zeroing in on one of the most critical aspects of patient safety.

Purpose and Focus

• QAPI: The “big picture” improvement system for the agency. It addresses everything from patient outcomes (hospitalizations, falls, pain management) to operational processes (timeliness of visits, patient satisfaction).

• Infection Control: The specialized system for reducing infection risks for patients, staff, and caregivers. It focuses on preventing adverse events like wound infections, respiratory infections, or outbreaks.

Program Scope

• QAPI looks at the whole agency: all services, clinical outcomes, patient experiences, and operational efficiencies. Every department and process is included.

• Infection Control focuses on infection risks: hand hygiene, PPE use, wound care practices, environmental sanitation, and surveillance of infection events.

Activities and Data

QAPI Activities:

• Collecting and analyzing OASIS and HHCAHPS data.

• Tracking hospitalization and readmission rates.

• Reviewing adverse event logs.

• Launching PIPs (e.g., reducing falls or improving medication reconciliation).

Infection Control Activities:

• Conducting surveillance for infections (e.g., wound infections, catheter-associated issues).

• Logging infection-related incidents.

• Providing staff training on standard precautions, PPE, and isolation protocols.

• Reviewing infection trends in QAPI meetings.

Documentation Surveyors Want

For QAPI (§484.65):

• Written QAPI program and policies.

• Meeting minutes with data review and improvement actions.

• Reports on performance improvement projects.

• Governing body documentation of oversight.

For Infection Control (§484.70):

• Written infection control policies and procedures.

• Surveillance logs and trend reports.

• Staff education and competency records.

• Documentation of corrective actions taken after infection-related events.

How They Work Together

Although QAPI and Infection Control are separate CoPs, they overlap in practice. Infection control data (e.g., number of wound infections, hand hygiene compliance) should feed into the QAPI program. If infection trends show a problem, QAPI should launch a Performance Improvement Project to address it.

Example:

• Infection Control identifies an increase in wound infections.

• QAPI launches a PIP: “Reducing wound infection rates by 20% in 6 months.”

• The team implements new wound care protocols and tracks results.

This integration demonstrates to surveyors that your programs don’t operate in silos—they work together to improve patient outcomes.

Common Pitfalls

• Mixing them up: Agencies sometimes document infection control activities as their only QAPI activity. This leads to citations because QAPI must cover all agency operations.

• Not collecting enough data: Infection control logs that are incomplete or outdated raise red flags.

• Weak PIPs: Saying “we reviewed infection control” isn’t enough—surveyors want to see documented projects with measurable outcomes.

Best Practices

• For QAPI:

  • Run at least 2–3 PIPs per year.

  • Include interdisciplinary participation and governing body sign-off.

  • Use visuals (graphs, dashboards) to show progress.

• For Infection Control:

  • Maintain real-time infection logs.

  • Educate staff annually—and track competencies.

  • Investigate every infection-related incident and document corrective actions.

Why This Matters

Surveyors consistently cite agencies for weak QAPI or incomplete infection control programs. Understanding the distinction—and linking them together effectively—creates a stronger compliance foundation. More importantly, it leads to safer care for patients and a healthier work environment for staff.

How SummitRidge Can Help

At SummitRidge, we guide home health agencies through:

• Designing compliant QAPI and infection control programs.

• Conducting mock surveys to test documentation and staff readiness.

• Creating policies, tools, and templates that surveyors love.

• Training teams to integrate infection control data into QAPI improvement projects.

With our expertise, your agency can avoid confusion, demonstrate compliance with both §484.65 (QAPI) and §484.70 (Infection Control), and impress surveyors with a program that is seamless, efficient, and patient-centered.

QAPI is the engine of continuous improvement, while Infection Control is a critical safeguard within that system. When managed separately but connected intentionally, they work together to protect patients and strengthen your agency.

With clear documentation, proactive monitoring, and SummitRidge support, your agency can be confident it meets every regulatory expectation—and delivers safer, higher-quality care.