Guideline for Isolation Precautions in Hospitals; Julia S. Garner and the Hospital Infection Control Practices Advisory Committee; (American Journal of Infection Control), which has been incorporated by reference in COMAR 10.07.02.01-1, is incorporated by reference in this chapter. In this chapter, the following terms have the meanings indicated. Terms Defined. “Deadly agent” means: Anthrax, ebola, plague, smallpox, tularemia, or other bacterial, fungal, rickettsial, or viral agent, biological toxin, or other biological agent capable of causing extensive loss of life or serious disability; Mustard gas, nerve gas, or other chemical agent capable of causing extensive loss of life or serious disability; or Radiation at levels capable of causing extensive loss of life or serious disability. “Department” means the Maryland Department of Health. “Health care facility” has the meaning stated in Health-General Article, §19-114, Annotated Code of Maryland. “Health officer” means the health officer of each of the 23 counties and the Commissioner of Health in Baltimore City, the duly designated representative of the health officer, or both. “Isolation” means the separation or restriction of movement of an individual who is ill and has an infectious illness or who is ill and is suspected of having an infectious illness from those who are not ill or infected for the purpose of stopping the spread of the infectious illness. “Quarantine” means the separation or restriction of movement of an individual who, though not ill, has been or may have been exposed to an infectious agent, to prevent the spread of infectious illness that may be transmitted to other individuals before illness develops or is recognized. “Secretary” means the Secretary of Health or the Secretary's designee. As set forth in Health-General Article, §18-905, Annotated Code of Maryland, in investigating actual or potential exposures to a deadly agent, the Secretary may order isolation or quarantine of an individual or a group of individuals, including those individuals who refuse to be vaccinated, medically examined, treated, or tested. An individual who does not comply with an isolation or quarantine order of the Secretary is guilty of a misdemeanor and on conviction is subject to a fine and imprisonment pursuant to Health-General Article, §18-907(a), Annotated Code of Maryland. If the Secretary issues an order in compliance with Health-General Article, §18-905(b), Annotated Code of Maryland, the Secretary may order an individual into isolation or quarantine at: A health care facility; The individual's home; or A nonhealth care facility. Place of Quarantine or Isolation other than the Individual's Home. If the Secretary has determined that it is necessary to issue an isolation or quarantine order for an individual to a facility other than the individual's home, the health officer, in consultation with other public health professionals, shall recommend to the Secretary a suitable place for isolation or quarantine. The health officer shall base the recommendation for a place for isolation or quarantine on the following: The seriousness of the disease; The route or routes of transmission of the disease; The contagiousness of the disease; Precedents in the practice of public health; The behavior, neurological development and condition, and physical condition of the individual being isolated or quarantined; and The access to needed support services at the site. The health officer, with assistance from local emergency management services, law enforcement personnel, or both, as needed, shall arrange for and provide, if needed, transportation for an individual to be isolated or quarantined. The health officer, with assistance from the local law enforcement agency as needed, shall monitor an isolated or quarantined individual by phone call, home visit, or other means, to ensure that the isolated or quarantined individual stays in the designated facility at all times during the period of isolation or quarantine, except in an emergency such as fire, natural disaster, or evacuation of the area by a county, State, or federal agency for any other reason. If evacuation from the site occurs in an emergency, an isolated or quarantined individual shall notify the health officer immediately by a phone call or any other means possible and follow instructions given by the health officer. Unless not available in the community due to a general state of emergency, the health officer, the administrator of a health care facility, or an individual in charge of an isolation or quarantine facility set forth in Regulation .07B of this chapter, with assistance from staff at local health care facilities, local law enforcement agencies, local social service agencies, local county agencies, or other agencies, shall ensure that an isolation or quarantine facility has, at a minimum: Electricity; Hot and cold potable (fit to drink) water; Hand-washing facilities; Toilets; Heat; Telephone access; and Means for discarding trash and waste. If an isolated or quarantined individual is in a health care facility, the administrator of the health care facility, and otherwise the health officer, with assistance from staff at local health care facilities, local law enforcement agencies, local social service agencies, local county agencies, or other agencies, shall ensure that an individual in isolation or quarantine has access to, at a minimum: Food; Medical supplies; Medications; and Medical care, including psychological care. To the extent feasible, the health officer shall provide information to an isolated or quarantined individual, without compromising the health of the isolated or quarantined individual or the people caring for the isolated or quarantined individual, by: Assessing the language needs of the isolated or quarantined individual; Translating both oral and written communications and documentation; and Monitoring to assure that the isolated or quarantined individual is not treated in a discriminatory manner. If an isolated or quarantined individual is in a health care facility, the administrator of the health care facility, and otherwise the health officer, shall, to the extent feasible: Determine whether the individual has any cultural or religious beliefs that would interfere with medical care during quarantine or isolation; and Make arrangements to accommodate these beliefs, without compromising the health of: The isolated or quarantined individual; or The people caring for the isolated or quarantined individual. An individual in isolation or quarantine shall: Follow all written and verbal instructions provided by the Department and the local health department; Notify and receive approval from the local health officer in advance of relocation to a new isolation or quarantine site, except in an emergency such as fire, natural disaster, or evacuation of the area by a county, State, or federal agency for any other reason; and Notify the health officer immediately upon relocation to a new location, in the event of an emergency such as fire, natural disaster, or evacuation of the area by a county, State, or federal agency for any other reason. An individual in isolation or quarantine may not leave the isolation or quarantine site without notification of the health officer, except in an emergency such as fire, natural disaster, or evacuation of the area by a county, State, or federal agency for any other reason. Parent or Guardian of an Isolated or Quarantined Minor. If the Secretary orders a minor into isolation or quarantine, the minor's parent or guardian may accompany the minor into isolation or quarantine. If the Secretary orders a minor into isolation or quarantine and the minor's parent or guardian is unavailable, the minor shall be isolated or quarantined in a facility where adequate care and supervision are available for the minor. The health officer shall follow the requirements of §I of this regulation in regard to the parent or guardian. The health officer, in consultation with local health care providers, shall: Recommend to the Secretary when an individual can be released from isolation or quarantine; and Notify the individual who is isolated or quarantined of the date and time of release from isolation or quarantine, as decided by the Secretary. The administrator of a health care facility shall ensure that isolation of an individual is done using one or more of the following types of isolation precautions and procedures, as defined and prescribed in Guideline for Isolation Precautions in Hospitals: Standard precautions; Airborne precautions; Droplet precautions; or Contact precautions. The administrator of a health care facility shall, at a minimum: Ensure the adequacy of isolation capacity and isolation practices by following the health care facility's isolation procedures; Post a notice at the entrance of an area or a room to inform visitors and staff that the area or room in a health care facility is an isolation site; and Consult with and receive approval from the Secretary before transferring the patient to another site or discharging the patient from the health care facility. The Secretary may quarantine an individual in a health care facility due to a preexisting medical condition of the individual being quarantined or if a health care facility is more appropriate than the individual's home because of medical conditions of family members residing in the individual's home. The administrator of a health care facility shall: Follow the health care facility's procedures and protocol for quarantine; and Consult with and receive approval from the Secretary before transferring the patient to another site or discharging the patient from the health care facility. The Secretary, with assistance from staff at a local health department, local health care facilities, local law enforcement agencies, local social service agencies, or any other local county agencies as needed, may isolate or quarantine in the individual's home an individual who does not require hospitalization or other highly skilled medical care. The health officer shall: Ensure that appropriate supplies, such as surgical masks, gloves, thermometers, and hand hygiene material, are available to an isolated or quarantined individual; and Depending on the kind of illness of an isolated individual or the suspected illness of a quarantined individual, recommend to the Secretary that the Secretary issue further quarantine orders to ensure that other members of the house are quarantined either at the house as set forth in this regulation or at a nonhealth care facility as set forth in Regulation .07 of this chapter and are provided, at a minimum, with the following: Written or oral information, or both, about the: Infection for which the individual is being isolated or quarantined; and Precautionary measures the individuals living in the house should exercise while staying in the house where the individual is being isolated or quarantined; Supplies, such as surgical masks, hand hygiene material, thermometers, and gloves, if appropriate; The local health department phone number; and Other information and supplies determined by the health officer as necessary. The health officer, in collaboration with local health care practitioners, shall ensure the monitoring of the health of an isolated or quarantined individual, as needed. The Secretary may order an individual, who cannot be accommodated in either a health care facility or the individual's home, into isolation or quarantine in one of the sites listed under §B of this regulation. A health officer may recommend to the Secretary the following sites for isolation and quarantine: A school; A hotel; A motel; A dormitory; or Another site determined to be appropriate by the local health officer because the site meets the minimum standards for isolation or quarantine as set forth in Regulation .03H of this chapter. Health General Article, §§18-904—18-907, Annotated Code of Maryland;Ch. 1, Section 4, Acts of 2002 Effective date: June 19, 2006 (33:12 Md. R. 998)