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<regulation prefix="Regulation" num=".33" citation="COMAR 10.07.02.33" title_num="10" subtitle_num="07" chapter_num="02" heading="Infection Prevention and Control Program.">
  <paragraph num="A.">
    <text>Infection Prevention and Control Program. The nursing home shall establish, implement, and maintain an effective infection prevention and control program that:</text>
    <paragraph num="(1)">
      <text>Investigates, controls, and prevents infections in a timely manner through a system that enables the facility to:</text>
      <paragraph num="(a)">
        <text>Analyze patterns of infected individuals;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Analyze changes in prevalent organisms;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Analyze increases in the rate of infection; and</text>
      </paragraph>
      <paragraph num="(d)">
        <text>Obtain surveillance data for the prevention and control of additional cases;</text>
      </paragraph>
    </paragraph>
    <paragraph num="(2)">
      <text>Determines the procedures, such as appropriate precautions, that are to be applied to an individual resident;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Maintains a record of infections in the nursing home and the corrective actions that were taken related to infections; and</text>
    </paragraph>
    <paragraph num="(4)">
      <text>Monitors and evaluates the:</text>
      <paragraph num="(a)">
        <text>Effectiveness of the infection prevention and control program by surveying rates of infection, especially infection rates that are significantly higher than usual; and</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Effective implementation of the policies and procedures that are outlined in §E(1) of this regulation.</text>
      </paragraph>
    </paragraph>
  </paragraph>
  <paragraph num="B.">
    <text>Infection Preventionist.</text>
    <paragraph num="(1)">
      <text>The nursing home shall assign at least one infection preventionist that has attended training in infection surveillance, prevention, and control to actively manage the nursing home’s infection prevention and control program.</text>
    </paragraph>
    <paragraph num="(2)">
      <text>The infection preventionist shall attend or have attended a basic infection prevention and control training course that is approved by the:</text>
      <paragraph num="(a)">
        <text>Office of Health Care Quality; and</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Office of Infectious Disease Epidemiology and Outbreak Response for the Department.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(3)">
      <text>This position shall be staffed at a ratio of 1.0 Full Time Equivalents for every 200 beds.</text>
    </paragraph>
  </paragraph>
  <paragraph num="C.">
    <text>The nursing home shall have mechanisms for communicating the results of infection control activities to employees and to the individual or individuals who are responsible for improving the nursing home’s performance.</text>
  </paragraph>
  <paragraph num="D.">
    <text>The nursing home’s communication mechanism shall ensure that the administrator, director of nursing, and the medical director receive and address reports of infection prevention and control findings and recommendations in a timely manner.</text>
  </paragraph>
  <paragraph num="E.">
    <text>Infection Prevention and Control Policies and Procedures.</text>
    <paragraph num="(1)">
      <text>The infection prevention and control program shall establish written policies and procedures to identify, investigate, control, and prevent infections in the nursing home, including policies and procedures to:</text>
      <paragraph num="(a)">
        <text>Identify health care-associated infections and communicable diseases in accordance with COMAR 10.06.01;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Report occurrences of certain infectious diseases and outbreaks of infectious diseases to the local health department in a timely manner in accordance with COMAR 10.06.01 and Health-General Article, §18-202, Annotated Code of Maryland;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Institute appropriate control measures when an infection or outbreak of infections is suspected or identified in order to control infection and prevent spread to other residents;</text>
      </paragraph>
      <paragraph num="(d)">
        <text>Perform surveillance for health care-associated and community-associated infections of residents and employees using definitions and methods approved by the infection prevention and control oversight committee to monitor and investigate causes of infection, and the manner in which the infection is spread;</text>
      </paragraph>
      <paragraph num="(e)">
        <text>Train employees about infection prevention and control, including:</text>
        <paragraph num="(i)">
          <text>Standard precautions and hand hygiene;</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>Respiratory hygiene and cough etiquette;</text>
        </paragraph>
        <paragraph num="(iii)">
          <text>Soiled laundry and linen processing;</text>
        </paragraph>
        <paragraph num="(iv)">
          <text>Safe handling of needles and sharps and safe injection techniques;</text>
        </paragraph>
        <paragraph num="(v)">
          <text>Special medical waste handling and disposal;</text>
        </paragraph>
        <paragraph num="(vi)">
          <text>Appropriate use of antiseptics and disinfectants;</text>
        </paragraph>
        <paragraph num="(vii)">
          <text>Blood-borne pathogens, including hepatitis B and C and human immunodeficiency virus;</text>
        </paragraph>
        <paragraph num="(viii)">
          <text>Tuberculosis exposure; and</text>
        </paragraph>
        <paragraph num="(ix)">
          <text>Proper use and wearing of personal protective equipment, such as gloves, gowns, and eye protection;</text>
        </paragraph>
      </paragraph>
      <paragraph num="(f)">
        <text>Train and perform compliance monitoring of employee application of infection prevention and control activities, such as hand hygiene and personal protective equipment used for isolation precautions;</text>
      </paragraph>
      <paragraph num="(g)">
        <text>Review the infection prevention and control program elements at least annually and revise as necessary; and</text>
      </paragraph>
      <paragraph num="(h)">
        <text>Obtain annual approval of infection prevention and control program activities by the infection prevention and control oversight committee.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(2)">
      <text>The nursing home shall provide information concerning the infectious disease status of any resident being transferred or discharged to any other nursing home, including a funeral home.</text>
    </paragraph>
    <paragraph num="(3)">
      <text>The nursing home shall obtain information concerning the infectious disease status of any resident being transferred or admitted to the nursing home from elsewhere.</text>
    </paragraph>
  </paragraph>
  <paragraph num="F.">
    <text>Preventing Spread of Infection.</text>
    <paragraph num="(1)">
      <text>The facility shall assess any residents with signs and symptoms of an infectious illness for the possibility of transmission to another resident or employee.</text>
    </paragraph>
    <paragraph num="(2)">
      <text>The nursing home shall take appropriate infection prevention and control measures to prevent the transmission of an infectious disease to residents, employees, and visitors as outlined in the following guidelines:</text>
      <paragraph num="(a)">
        <text>2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings; and</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Guideline for Infection Control in Health Care Personnel.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(3)">
      <text>The nursing home shall prohibit employees with an infectious disease or with infected skin lesions from having direct contact with residents or their food if direct contact could transmit the disease.</text>
    </paragraph>
    <paragraph num="(4)">
      <text>The nursing home shall require employees to perform hand hygiene before and after each direct resident contact for which hand hygiene is indicated by accepted professional practice.</text>
    </paragraph>
    <paragraph num="(5)">
      <text>The facility shall handle, store, process, and transport linens so as to prevent the spread of infection.</text>
    </paragraph>
  </paragraph>
</regulation>