Volunteers, Contract Workers, and Other Nonemployees Who Interact with Patients

Sue Sebazco, RN, MBA, CIC Director of Infection Control and Employee Health & Education

Texas Health
Arlington, TX

October 3, 2014


Many individuals who are not employees of the healthcare facility may come into contact with patients. For the purpose of this chapter, these nonemployees are individuals who do not receive compensation from the healthcare facility or appointment recognition or have direct care student status in the hospital environment but do have a relationship with the organization to perform specific services.

As with the volunteer or contract worker, a nonemployed individual will provide services at the request and with the approval of the healthcare facility. This designation indicates that the facility is aware of and has approved their activities. Therefore, the healthcare facility has the responsibility to establish safe practice policies and procedures for these groups. This difference is in contrast to others such as a patient’s own spiritual leader or a friend who stays with a patient and assists the patient or provides support at the patient’s request or invitation. Thus, family members and friends of the patient are not included in the status of nonemployed individuals.

Healthcare industry representatives, contracted sitters, contract construction workers, volunteer community clergy, pet therapists, and volunteers are examples of nonemployee individuals who may interact directly or indirectly with patients during their inpatient stay. These individuals provide a variety of necessary services, such as delivering mail, flowers, or personal care items to the patients’ bedsides; transporting patients within the facility; providing spiritual support or comfort; providing education or observation; and staffing the gift shop and visitor waiting areas.

All nonemployee individuals permitted to function at the facility who have direct contact with patients and visitors must understand the transmission and prevention of disease within the framework of their duties to reduce the risk for exposure to potential pathogens. Each facility should establish a plan for protecting approved nonemployee individuals that includes a list of allowed and prohibited duties; evidence of an initial two-step tuberculosis skin test and annual tuberculin skin test guided by the facility’s annual tuberculosis risk assessment and individual state laws; a health history that includes immunization status; education about Standard Precautions, infection prevention practices in specific areas such as the operating room, tuberculosis, and bloodborne pathogens; and the risks of exposure to communicable diseases and prevention.