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TITLE 26HEALTH AND HUMAN SERVICES
PART 1HEALTH AND HUMAN SERVICES COMMISSION
CHAPTER 550LICENSING STANDARDS FOR PRESCRIBED PEDIATRIC EXTENDED CARE CENTERS
SUBCHAPTER CGENERAL PROVISIONS
DIVISION 1OPERATIONS AND SAFETY PROVISIONS
RULE §550.211Infection Prevention and Control Program and Vaccinations Requirements

(a) A center must establish and maintain an infection prevention and control program (IPCP) designed to provide a safe, sanitary, and comfortable environment by preventing the development and transmission of disease and infection. Under the IPCP, the center must:

  (1) investigate, prevent, and control infections at the center;

  (2) decide what procedures, such as isolation, should be applied to an individual minor;

  (3) address vaccine preventable diseases in accordance with THSC, Chapter 224;

  (4) address hepatitis B vaccinations in accordance with Occupational Safety and Health Administration;

  (5) address tuberculosis requirements; and

  (6) maintain a record of incidents and corrective actions relating to infections.

(b) A center must provide IPCP information to employees, contractors, volunteers, parents, health care providers, other service providers, and visitors.

(c) A center's IPCP must include written policies and procedures for admissions and attendance of minors who are at risk for infections or present a significant risk to other minors. The policy must include that a minor is accepted only:

  (1) as authorized by a minor's prescribing physician:

  (2) as determined by the center's medical director's assessment of the risk;

  (3) as determined by the medical and nursing director review, on a case-by-case basis, to determine appropriateness of admission to or attendance at the center; and

  (4) in accordance with Centers for Disease Control (CDC) guidelines.

(d) The center's IPCP must include written policies and procedures for preventing the spread of infection.

  (1) If the center determines, in accordance with its IPCP, that a minor must be isolated to prevent the spread of infection, the center must isolate a minor.

    (A) The center must maintain an isolation room with a glass window for observation of a minor. The isolation room must be equipped with emergency outlets and equipment as necessary to provide care to a minor. The isolation room must have a dedicated bathroom not accessible to the center's other rooms if appropriate to control the spread of infectious disease.

    (B) The center must ensure that all equipment is thoroughly cleaned and disinfected before being placed in the isolation room and before being removed from the room.

    (C) The center's procedures must address:

      (i) notification to a minor's parent of the minor's condition and the center's recommendation of isolation or removal based on the minor's risk assessment;

      (ii) the arrangement of transportation if the minor must be removed from the center; and

      (iii) the return of a minor to the center, as determined by a reassessment conducted by a nurse that the minor no longer poses a risk to other minors.

  (2) The center must prohibit employees, volunteers, and contractors with an infectious disease or infected skin lesions from direct contact with minors or food, if direct contact will transmit the disease.

  (3) The center's infection control policy must provide that staff, volunteers, and contractors wash their hands between each treatment and care interaction with a minor.

  (4) The center must immediately report the name of any minor with a reportable disease as specified in 25 TAC Chapter 97, Subchapter A (relating to Control of Communicable Diseases) to the city health officer, county health officer, or health unit director having jurisdiction, and implement appropriate infection control procedures as directed by the local health authority or the Department of State Health Services.

(e) The center must assign a crib, bed, or sleep mat for a minor's exclusive use each day. A center must label cribs, beds, and sleep mats with the minor's name.

(f) A center must place liquid soap, disposable paper towels, and trash containers at each sink.

(g) The center must adopt and enforce written policies and procedures for the control of communicable diseases for employees, contractors, volunteers, parents, health care providers, other service providers, and visitors and must maintain evidence of compliance.

(h) The center must adopt and enforce written policies and procedures for the control of an identified public health disaster.

  (1) If a center determines or suspects that an employee, volunteer, or contractor providing services has been exposed to, or has a positive screening for, a communicable disease, the center must respond according to current CDC guidelines and keep documentation of the action taken.

  (2) If the center determines that an employee, volunteer or contractor providing services has been exposed to a communicable disease, the center must conduct and document a reassessment of the risk classification. The center must conduct and document subsequent screenings based upon the reassessed risk classification.

  (3) If the center determines that an employee, volunteer, or a contractor providing services at the center is suspected of having a communicable disease, the individual must not return to the center until the individual no longer poses a risk of transmission as documented by a written physician's statement.

(i) The center must conduct and document an annual review that assesses the center's current risk classification according to the current CDC Guidelines for Preventing the Transmission of Mycobacterium Tuberculosis in Health Care Settings and 25 TAC Chapter 97, Subchapter A.

  (1) The center must have a system in place to screen all individuals providing services at the center.

  (2) The center must require employees, volunteers, and contractors providing services to provide evidence of current tuberculosis screening before providing services at the center. The center must maintain evidence of compliance.

  (3) Any employee, volunteer, or contractor providing services at a center with positive results must be referred to the person's personal physician, and if active tuberculosis is suspected or diagnosed, the person must be excluded from work until the physician provides written approval to return to work.

(j) A center must adopt and enforce written policies and procedures to protect a minor from vaccine preventable diseases, in accordance with THSC, Chapter 224.

  (1) The policy must:

    (A) require an employee, volunteer, or contractor providing direct care to receive vaccines for the vaccine preventable diseases specified by the center based on the level of risk the employee, volunteer, or contractor, presents to minors by the employee's, volunteer's, or contractor's routine and direct exposure to minors;

    (B) specify the vaccines an employee, volunteer, or contractor who provides direct care is required to receive in accordance with subsection (i) of this section;

    (C) include procedures for the center to verify that an employee, volunteer, or contractor who provides direct care has complied with the policy;

    (D) include procedures for the center to exempt an employee, volunteer, or contractor who provides direct care from the required vaccines for the medical conditions identified as contraindications or precautions by the CDC;

    (E) include procedures, including using protective equipment such as gloves and masks, to protect minors from exposure to vaccine preventable diseases, based on the level of risk the employee, volunteer, or contractor presents to minors by the employee's, volunteer's, or contractor's routine and direct exposure to minors;

    (F) prohibit discrimination or retaliatory action against an employee, volunteer, or contractor who provides direct care and who is exempt from the required vaccines for the medical conditions identified as contraindications or precautions by the CDC, except that required use of protective medical equipment, such as gloves and masks, will not be considered retaliatory action;

    (G) require the center to maintain a written or electronic record of each employee's, volunteer's or contractor's compliance with or exemption from the policy; and

    (H) include disciplinary actions the center may take against an employee, volunteer, or contractor providing direct care who fails to comply with the policy.

  (2) The center must have a written policy describing whether it will exempt an employee, volunteer, or contractor providing direct care:

    (A) from the required vaccines based on reasons of conscience, including a religious belief; and

    (B) prohibit an employee, volunteer, or contractor providing direct care who is exempt from the required vaccines from having contact with minors during a public health disaster.

(k) The center must adopt and enforce written policies and procedures to identify employees, volunteers, or contractors at risk of directly contacting blood or potentially infectious materials in accordance with Occupational Safety and Health Administration (OSHA), 29 Code of Federal Regulations Part 1910.1030 and Appendix A relating to Bloodborne Pathogens.

(l) A center must ensure that its employees, volunteers, and contractors comply with:

  (1) the center's IPCP;

  (2) the Communicable Disease Prevention and Control Act, THSC Chapter 81; and

  (3) THSC Chapter 85, Subchapter I, concerning the prevention of the transmission of human immunodeficiency virus and hepatitis B virus.


Source Note: The provisions of this §550.211 adopted to be effective September 1, 2014, 39 TexReg 6569; transferred effective May 1, 2019, as published in the Texas Register April 12, 2019, 44 TexReg 1875

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