<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".06" citation="COMAR 10.06.01.06" title_num="10" subtitle_num="06" chapter_num="01" heading="General Control Measures.">
  <paragraph num="A.">
    <text>Necessary Action. The Secretary or health officer shall:</text>
    <paragraph num="(1)">
      <text>Take any action or measure necessary to prevent the spread of communicable disease or to control a reportable disease and condition; and</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Issue, when necessary, special instructions for control of a disease or condition.</text>
    </paragraph>
  </paragraph>
  <paragraph num="B.">
    <text>Epidemiologic Investigations.</text>
    <paragraph num="(1)">
      <text>A health officer shall respond to each reported outbreak or suspected outbreak of disease within the health officer's jurisdiction in order to collect data to assist in establishing adequate control measures.</text>
    </paragraph>
    <paragraph num="(2)">
      <text>A health officer shall investigate a reported case or suspect case of a condition as requested by the Secretary.</text>
    </paragraph>
    <paragraph num="(3)">
      <text>The Secretary may, in conjunction with the health officers, conduct the epidemiologic investigation for each reported case or suspected case in an outbreak involving two or more jurisdictions or states.</text>
    </paragraph>
    <paragraph num="(4)">
      <text>An individual, a business, a facility, or an agency, including a health care provider, school or child care facility personnel, a master of a vessel or aircraft, or a medical laboratory director, shall make available to the Secretary or a health officer all records and information necessary to the epidemiologic response or investigation.</text>
    </paragraph>
  </paragraph>
  <paragraph num="C.">
    <text>A health officer or the Secretary shall order cessation of operation of a business or facility determined or suspected to be a threat to public health until the public health threat is determined by the health officer to have ceased.</text>
  </paragraph>
  <paragraph num="D.">
    <text>Carrier Approval.</text>
    <paragraph num="(1)">
      <text>A health officer shall grant or deny approval to a carrier of an infectious agent to work in any of the following occupations involving:</text>
      <paragraph num="(a)">
        <text>Care of young children;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Care of the elderly;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Food handling; and</text>
      </paragraph>
      <paragraph num="(d)">
        <text>Patient care.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(2)">
      <text>A health officer shall grant or deny approval to a carrier of an infectious agent to attend a:</text>
      <paragraph num="(a)">
        <text>School; or</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Child care facility.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(3)">
      <text>A health officer shall consider the following when granting or denying approval to a carrier of an infectious agent to work in occupations or to attend settings listed under §D(1) and (2) of this regulation:</text>
      <paragraph num="(a)">
        <text>The seriousness of the disease;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>The route or routes of transmission of the disease;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>The contagiousness of the disease;</text>
      </paragraph>
      <paragraph num="(d)">
        <text>The behavior, neurological development and condition, and physical condition of the carrier;</text>
      </paragraph>
      <paragraph num="(e)">
        <text>The susceptibility to the disease of those likely to be exposed to the carrier in the occupation or setting;</text>
      </paragraph>
      <paragraph num="(f)">
        <text>The precautions that may be taken to minimize or eliminate the danger of transmission; and</text>
      </paragraph>
      <paragraph num="(g)">
        <text>Precedents in the practice of public health.</text>
      </paragraph>
    </paragraph>
  </paragraph>
  <paragraph num="E.">
    <text>Control of Food Handlers. A case with any of the following diseases may not serve or handle, in any manner whatsoever, food intended for public consumption:</text>
    <paragraph num="(1)">
      <text>Disease causing diarrhea, unless physician-certified as noninfectious;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Cholera;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Escherichia coli O157:H7 and other Shiga-Like Toxin Producing Escherichia coli (STEC), as discussed in Regulation .08-3 of this chapter;</text>
    </paragraph>
    <paragraph num="(4)">
      <text>Hepatitis A, as discussed in Regulation .10 of this chapter;</text>
    </paragraph>
    <paragraph num="(5)">
      <text>Salmonellosis, as discussed in Regulation .16 of this chapter;</text>
    </paragraph>
    <paragraph num="(6)">
      <text>Shigellosis, as discussed in Regulation .19 of this chapter; and</text>
    </paragraph>
    <paragraph num="(7)">
      <text>Typhoid or Paratyphoid fever or carrier of Salmonella Typhi or Paratyphi, as discussed in Regulation .21 of this chapter.</text>
    </paragraph>
  </paragraph>
  <paragraph num="F.">
    <text>Control of Communicable Diseases in Schools and Child Care Facilities.</text>
    <paragraph num="(1)">
      <text>A health officer shall:</text>
      <paragraph num="(a)">
        <text>Maintain the right to make physical inspections of pupils, teachers, or other persons attending, employed, or volunteering in schools or child care facilities whenever, in the judgment of the health officer, the inspections are necessary to investigate a suspected communicable disease; and</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Determine whether enrollees, pupils, or other individuals attending schools or child care facilities have received the immunizations required under COMAR 10.06.04, 13A.15.03.02, or 13A.16.03.04.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(2)">
      <text>The principal or other person in charge of any school or child care facility shall comply with a measure or special instruction issued by the Secretary or a health officer under Regulation .06A of this chapter.</text>
    </paragraph>
  </paragraph>
  <paragraph num="G.">
    <text>Use of Sterile Instruments or Equipment. An individual who performs a procedure that penetrates the skin or mucous membrane of another individual shall:</text>
    <paragraph num="(1)">
      <text>Utilize only sterile instruments or equipment for the procedure;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Discard, after a single use, in accordance with COMAR 10.06.06, 26.13.11, and 26.13.12, any instruments or equipment designed for single use; and</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Clean and sterilize before reuse any instruments or equipment designed for multiple use.</text>
    </paragraph>
  </paragraph>
  <paragraph num="H.">
    <text>Skin-Penetrating Body Adornment Procedures — Infection Control.</text>
    <paragraph num="(1)">
      <text>An individual who performs a skin-penetrating body adornment procedure shall:</text>
      <paragraph num="(a)">
        <text>Disclose the risks of the procedure, obtain the client's written consent for the performance of the procedure or, in the case of a minor, the consent of the parent or guardian, and retain the consent on file for a period of 3 years and make it available to the health officer, if requested;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Maintain records of the name of the customer, the date and type of procedure performed, and the technician performing the procedure for a period of 3 years and make these records available to the health officer, if requested;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Perform the procedure in a separate, enclosed room that has adequate lighting, and floors, walls, and a ceiling that are constructed to be smooth, impervious, and washable;</text>
      </paragraph>
      <paragraph num="(d)">
        <text>Use only sterile instruments, equipment, and bandages;</text>
      </paragraph>
      <paragraph num="(e)">
        <text>Wash both hands using soap and running water and dry the hands using individual single-use towels before and after each procedure;</text>
      </paragraph>
      <paragraph num="(f)">
        <text>Wear single-use disposable latex or vinyl gloves for each procedure and discard the gloves after the procedure is completed;</text>
      </paragraph>
      <paragraph num="(g)">
        <text>Wear a gown and face shield, or goggles and a mask, if spattering of blood is likely to occur during the procedure;</text>
      </paragraph>
      <paragraph num="(h)">
        <text>Cleanse the client's skin before and after the procedure;</text>
      </paragraph>
      <paragraph num="(i)">
        <text>Discard, after a single use, in accordance with COMAR 10.06.06, 26.13.11, and 26.13.12, any instruments or equipment designed for single use or any blood-soiled article;</text>
      </paragraph>
      <paragraph num="(j)">
        <text>Clean and sterilize before reuse any instruments or equipment designed for multiple use;</text>
      </paragraph>
      <paragraph num="(k)">
        <text>Provide written after-care instructions to the client;</text>
      </paragraph>
      <paragraph num="(l)">
        <text>Use standard precautions in all situations where exposure to blood or body fluids may occur and comply with all applicable State and federal laws and regulations regarding worker protection; and</text>
      </paragraph>
      <paragraph num="(m)">
        <text>Post the following notice in a prominent place:</text>
      </paragraph>
    </paragraph>
    <paragraph num="(2)">
      <text>An individual who performs a procedure that penetrates the skin or mucous membrane may not:</text>
      <paragraph num="(a)">
        <text>Perform a procedure on skin or mucous membrane that has a rash, infection, or other lesion;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Perform a procedure when the person performing the procedure has an infected or bleeding lesion on the hands;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Use a styptic pencil or alum block to staunch bleeding; or</text>
      </paragraph>
      <paragraph num="(d)">
        <text>Reuse instruments or equipment intended for single use.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(3)">
      <text>A health officer may investigate complaints received regarding compliance with this section.</text>
    </paragraph>
  </paragraph>
</regulation>