The nursing home’s infection prevention and control program shall monitor the relevant health status of all employees, as it relates to infection prevention and control. The nursing home shall refer to the following guidelines in implementing its employee health program: Guideline for Infection Control in Health Care Personnel; Immunization of Health Care Personnel: Recommendations of the Advisory Committee on Immunization Practices (ACIP) and the Hospital Infection Control Practices Advisory Committee (HICPAC); and COMAR 09.12.31. Tuberculosis Exposure Control. The infection control program shall include a risk assessment program, including monitoring for tuberculosis infection for employees that is in accordance with the Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health-Care Settings. The nursing home shall ensure that employees may not provide services that require direct access to residents without documented evidence that the employee is free from communicable tuberculosis. A new employee shall be assessed for risk of tuberculosis through: A two-step tuberculin skin testing at the time of hire following guidelines referenced in the Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health-Care Settings; or An interferon-gamma release assay (IGRA) blood test. The nursing home shall maintain written documentation of the following: Results of tuberculin skin tests, recorded in millimeters of induration with dates of administration, dates of reading, results of test, and the manufacturer and lot number of the purified protein derivative (PPD) solution used; and Any previous tuberculin skin tests, chest x-ray, or blood test results, chemotherapy, and chemoprophylaxis that are the basis for certifying that the individual is free from tuberculosis in a communicable form. Measles, Mumps, Rubella, and Varicella. The nursing home shall screen and maintain written documentation of each employee’s proof of immunity to common childhood infections including measles, mumps, rubella, and chickenpox (varicella). Proof of immunity to these diseases shall be verified by: Documented evidence of administration of vaccine; or Laboratory evidence of immunity. The nursing home shall require that employees who are not immune to measles, mumps, rubella, and varicella receive immunization for measles, mumps, rubella, or varicella, unless medically contraindicated or against the employee’s religious beliefs. If the employee refuses to be immunized, the nursing home shall document the refusal and the reason for it. Hepatitis B. The nursing home shall require that all new employees receive immunization for Hepatitis B, unless medically contraindicated, against the employee’s religious beliefs, or after being fully informed of the health risks of not being immunized. The nursing home shall inform all new and current employees of the health risks of not being immunized. If the employee refuses to be immunized, the nursing home shall document the refusal and the reason for the refusal. Influenza. The nursing home shall require that all employees receive annual immunization for influenza, unless: Medically contraindicated; Against the employee’s religious beliefs; or After being fully informed of the health risks associated with not receiving a vaccine, the employee refuses the immunization. The nursing home shall: Comply with Health-General Article, §18-404, Annotated Code of Maryland, regarding immunizations of employees; Inform all new and current employees of the health risks of not being immunized; Document refusals; and Require that any employee who is not vaccinated with the current influenza vaccine wear a mask when: Within 6 feet of a resident; and During the influenza season as specified by the State’s Prevention and Health Promotion Administration, based on influenza activity in Maryland. Pertussis. The nursing home shall: Require that each new employee receive a one-dose booster immunization for pertussis, unless medically contraindicated or against the employee’s religious beliefs; Inform all new and current employees of the health risks of not being immunized; Document any refusals of immunization; and Ensure that the immunization is given in the form of Tdap (tetanus, diphtheria, acellular pertussis) vaccine, in accordance with the guidelines prescribed in Immunization of Health-Care Personnel: Recommendations of the Advisory Committee on Immunization Practices (ACIP) and the Health Care Infection Control Practices Advisory Committee (HICPAC).