<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".08-3" citation="COMAR 10.06.01.08-3" title_num="10" subtitle_num="06" chapter_num="01" heading="Escherichia coli O157:H7 and Other Shiga-Like Toxin Producing Escherichia coli (STEC).">
  <paragraph num="A.">
    <text>Control of a Case.</text>
    <paragraph num="(1)">
      <text>A case may not attend a child care facility until:</text>
      <paragraph num="(a)">
        <text>The case’s fecal cultures or stool Shiga-like toxin tests are free of E. coli O157:H7 and other Shiga-Like Toxin Producing Escherichia coli (STEC) on two consecutive specimens collected not less than 24 hours apart and not sooner than 48 hours following discontinuation of antibiotics, if antibiotics have been given; or</text>
      </paragraph>
      <paragraph num="(b)">
        <text>A health officer approves readmission based on the low likelihood of disease transmission.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(2)">
      <text>A case, with or without diarrhea, may not participate in occupations involving food handling, patient care, or care of young children or the elderly until:</text>
      <paragraph num="(a)">
        <text>The case’s fecal cultures or stool Shiga-like toxin tests are free of E. coli O157:H7 and other Shiga-Like Toxin Producing Escherichia coli (STEC) on two consecutive specimens collected not less than 24 hours apart and not sooner than 48 hours following discontinuation of antibiotics, if antibiotics have been given; or</text>
      </paragraph>
      <paragraph num="(b)">
        <text>A health officer approves resumption of occupational duties based on the low likelihood of disease transmission.</text>
      </paragraph>
    </paragraph>
  </paragraph>
  <paragraph num="B.">
    <text>Control of Contacts.</text>
    <paragraph num="(1)">
      <text>A health officer shall require a culture of feces or stool Shiga-like toxin test only from a household member or other close contact who attends a child care facility or whose occupation involves food handling, patient care, or care of young children or the elderly.</text>
    </paragraph>
    <paragraph num="(2)">
      <text>A household member or other close contact shall submit for examination two fecal specimens taken at an interval of not less than 24 hours apart.</text>
    </paragraph>
    <paragraph num="(3)">
      <text>If either of the specimens submitted pursuant to §B(2) of this regulation is positive for E. coli O157:H7, other Shiga-Like Toxin Producing Escherichia coli (STEC), or Shiga-like toxin, a health officer shall consider the contact to be a case, and the control measures specified in §A of this regulation apply.</text>
    </paragraph>
    <paragraph num="(4)">
      <text>A household member or other close contact who currently has diarrhea or who has had an onset of diarrhea in the past 3 weeks may not attend a child care facility until:</text>
      <paragraph num="(a)">
        <text>The household member or other close contact is without diarrhea for at least 24 hours and fecal cultures or Shiga-like toxin tests are free of E. coli O157:H7 and other Shiga-Like Toxin Producing Escherichia coli (STEC) on two consecutive specimens collected not less than 24 hours apart and not sooner than 48 hours following discontinuation of antibiotics, if antibiotics have been given; or</text>
      </paragraph>
      <paragraph num="(b)">
        <text>A health officer approves readmission based on the low likelihood of disease transmission.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(5)">
      <text>A contact who currently has diarrhea or who has had an onset of diarrhea within the past week may not participate in occupations involving food handling, patient care, or care of young children or the elderly until:</text>
      <paragraph num="(a)">
        <text>The contact is without diarrhea for at least 24 hours and fecal cultures or Shiga-like toxin tests are free of E. coli O157:H7 and other Shiga-Like Toxin Producing Escherichia coli (STEC) on two consecutive specimens collected not less than 24 hours apart and not sooner than 48 hours following discontinuation of antibiotics, if antibiotics have been given; or</text>
      </paragraph>
      <paragraph num="(b)">
        <text>A health officer approves resumption of occupational duties based on the low likelihood of disease transmission.</text>
      </paragraph>
    </paragraph>
  </paragraph>
  <paragraph num="C.">
    <text>Infection Control. A health care provider shall practice standard precautions.</text>
  </paragraph>
</regulation>