| (a) General. The facility must establish and maintain
an infection prevention and control program designed to provide a
safe, sanitary, and comfortable environment and to help prevent the
development and transmission of communicable diseases and infections.
(b) Infection prevention and control program (IPCP).
The facility must establish an IPCP and conduct an annual review,
effective November 28, 2019, of the IPCP and update the program, as
necessary. The Quality Assessment and Assurance Committee, as described
in §554.1917 of this chapter (relating to Quality Assessment
and Assurance) monitors the IPCP. The IPCP must include:
(1) a system for preventing, identifying, reporting,
investigating, and controlling infections and communicable diseases
for all residents, staff, volunteers, visitors, and other individuals
providing services under a contractual arrangement based upon the
facility assessment conducted according to §554.1931 of this
chapter (relating to Facility Assessment), and following accepted
national standards;
(2) written standards, policies, and procedures for
the program, which must include:
(A) a system of surveillance designed to identify possible
communicable diseases or infections, including multidrug-resistant
organisms, before they can spread to other persons in the facility;
(B) when and to whom possible incidents of communicable
diseases or infections should be reported;
(C) standard and transmission-based precautions to
be followed to prevent spread of infections;
(D) when and how isolation should be used for a resident;
including:
(i) the type and duration of the isolation, depending
upon the infectious agent or organism involved; and
(ii) a requirement that the isolation should be the
least restrictive possible for the resident under the circumstances;
(E) the circumstances under which the facility must
prohibit employees with a communicable disease or infected skin lesions
from direct contact with a resident or a resident's food, if direct
contact will transmit the disease; and
(F) the hand hygiene procedures to be followed by staff
involved in direct resident contact;
(3) an antibiotic stewardship program that includes
antibiotic use protocols and a system to monitor antibiotic use;
(4) procedures for making rapid influenza diagnostic
tests available to facility residents;
(5) a system for recording incidents identified under
the facility's IPCP and the corrective actions taken by the facility;
and
(6) acceptable accommodations for a resident with a
communicable disease according to current practices and policies for
infection control.
(c) Infection preventionist. Effective November 28,
2019, the facility must designate one or more individuals as the infection
preventionist (IP) who is responsible for the facility's IPCP. The
individual designated as the IP, or at least one of the individuals
if there is more than one IP, must be a member of the facility's Quality
Assessment and Assurance Committee and report to the committee on
the IPCP on a regular basis. The IP must:
(1) have primary professional training in nursing,
medical technology, microbiology, epidemiology, or other related field;
(2) be qualified by education, training, experience
or certification;
(3) work at least part-time at the facility; and
(4) have completed specialized training in infection
prevention and control.
(d) Communicable Diseases.
(1) Policies. The facility must have and implement
written policies for the control of communicable diseases in employees
and residents and must maintain evidence of compliance with local
and state health codes and ordinances regarding employee and resident
health status.
(2) Reporting. The name of any resident with a reportable
disease as specified in Title 25, Chapter 97, Subchapter A (relating
to Control of Communicable Diseases), must be reported immediately
to the city health officer, county health officer, or health unit
director having jurisdiction, and appropriate infection control procedures
must be implemented as directed by the local health authority.
(3) Tuberculosis.
(A) The facility must conduct and document an annual
review that assesses the facility's current risk classification according
to the current CDC Guidelines for Preventing the Transmission of Mycobacterium
Tuberculosis in Health Care Settings.
(B) The facility must screen all employees before providing
services in the facility, according to CDC guidelines. The facility
must require all persons providing services under an outside resource
contract to provide evidence of a current tuberculosis screening prior
to providing services in the facility. The facility must document
or keep a copy of the evidence provided.
(C) If the facility determines or suspects that an
employee or person providing services under an outside resource contract
has been exposed to or has a positive screening for a communicable
disease, the facility must respond according to the current CDC guidelines
and keep documentation of the action taken.
(D) If the facility determines that an employee or
a person providing services under an outside resource contract has
been exposed to a communicable disease, the facility must conduct
and document a reassessment of the risk classification. The facility
must conduct and document subsequent screening based upon the reassessed
risk classification.
(E) The facility must screen all residents at admission
in accordance with the attending physician's recommendations and current
CDC guidelines. If the facility determines or suspects that a resident
has been exposed to a communicable disease or has a positive screening,
the facility must respond according to the current CDC guidelines
and attending physician's recommendations, and keep documentation
of the response.
(e) Vaccinations.
(1) A facility must develop and implement a written
policy to protect a resident from vaccine preventable diseases in
accordance with Texas Health and Safety Code, Chapter 224.
(A) The policy must:
(i) require an employee, contractor, or other individual
with privileges providing direct care to a resident to receive vaccines
for the vaccine preventable diseases specified by the facility based
on the level of risk the employee, contractor, or other individual
presents to residents by the employee's, contractor's, or other individual's
routine and direct exposure to residents;
(ii) specify the vaccines an employee, contractor,
or other individual with privileges to provide direct resident care
is required to receive in accordance with clause (i) of this subparagraph;
(iii) include procedures for the facility to verify
that an employee, contractor, or other individual with privileges
to provide direct resident care has complied with the policy;
(iv) include procedures for the facility to exempt
an employee, contractor, or other individual with privileges to provide
direct resident care from the required vaccines for the medical conditions
identified as contraindications or precautions by the CDC;
(v) for an employee, contractor, or other individual
with privileges to provide direct resident care who is exempt from
the required vaccines, include procedures the employee, contractor,
or other individual must follow to protect residents from exposure
to vaccine preventable diseases, such as the use of protective equipment,
such as gloves and masks, based on the level of risk the employee,
contractor, or other individual presents to residents by the employee's,
contractor's, or other individual's routine and direct exposure to
residents;
(vi) prohibit discrimination or retaliatory action
against an employee, contractor, or other individual with privileges
to provide direct resident care 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, may not be considered retaliatory action;
(vii) require the facility to maintain a written or
electronic record of each employee's, contractor's, or other individual's
compliance with or exemption from the policy; and
(viii) include disciplinary actions the facility may
take against an employee, contractor, or other individual with privileges
to provide direct resident care who fails to comply with the policy.
(B) The policy may:
(i) include procedures for an employee, contractor,
or other individual with privileges to provide direct resident care
to be exempt from the required vaccines based on reasons of conscience,
including religious beliefs; and
Cont'd... |
