Current through Register Vol. 49, No. 18, September 16, 2024
PURPOSE: This rule establishes an inquiry and notice
procedure to be followed by receiving medical facility personnel concerning the
possibility of exposure to communicable diseases by emergency response
personnel and good samaritans.
(1) The following definitions shall be used
in the interpretation of this rule:
(A)
Aerosols mean tiny invisible particles or droplet nuclei usually less than ten
(10) micrometers in diameter, which float on air currents and are capable of
being suspended in air for a considerable period of time and are not to be
confused with droplet as defined in subsection (1)(F) of this rule;
(B) Airborne transmission means
person-to-person transmission of infectious organisms through the air by means
of droplet nuclei;
(C) Bloodborne
transmission means person-to-person transmission of an infectious agent through
contact with an infected person's blood or other body fluids;
(D) Communicable disease means an infectious
disease transmitted by a significant exposure as defined in subsections (2)(A)-
(E) of this rule, and examples of likely communicable diseases for
investigation for possible significant exposures are-
1. Airborne diseases-pulmonary tuberculosis
(Mycobacterium tuberculosis) and measles;
2. Bloodborne diseases-Hepatitis B and C and
human immunodeficiency virus (HIV) infection including acquired
immunodeficiency syndrome (AIDS);
3. Droplet spread diseases-rubella,
Corynebacterium diphtheriae, and Neisseria
meningitides; and
4.
Uncommon or rare diseases-hemor-rhagic fevers including Lassa, Marburg, Ebola
and Congo-Crimean; plague (Yersinia pestis); and
rabies;
(E) Designated
officer means a city or county health department officer, or his/her designee,
appointed by the director of the Department of Health or his/her designee. The
designated officer's designee may be, at local option, a person associated with
an ambulance service, fire department or other enforcement agency; the
designated officer may appoint multiple designees as needed;
(F) Droplets mean large particles of moisture
that rapidly settle out on horizontal surfaces and originate from talking,
sneezing or coughing;
(G) Droplet
spread means brief passage of an infectious agent through the air, usually
within three feet (3') of the source;
(H) Emergency means a sudden or unforeseen
situation or occurrence that requires immediate action to save life or to
prevent suffering or disability; the determination of the existence of the
emergency can be made either by the patient/victim or by any emergency response
personnel (ERP) or good samaritan on the scene;
(I) Emergency response personnel (ERP) means
firefighters, law enforcement officers, paramedics, emergency medical
technicians, first responders and other persons including employees of legally
organized and recognized volunteer organizations-regardless of whether the
individuals receive compensation-who, in the course of professional duties,
respond to emergencies;
(J)
Exposure or significant exposure means an ERP or good samaritan has experienced
a possible risk of becoming infected with a communicable disease(s) including
those identified in paragraphs (1)(D)1.-4. of this rule by a means identified
in subsections (2)(A)-(E) of this rule;
(K) Good samaritans mean individuals that are
not ERPs that provide emergency medical assistance or aid until ERPs
arrive;
(L) Medical facility means
a health care facility licensed under Chapter 197, RSMo or a state medical
facility;
(M) Pathogen means any
disease-producing microorganism;
(N) Patient means the victim of an emergency
who has been aided by an ERP or good samaritan;
(O) Potentially life-threatening communicable
disease means an infectious disease which can cause death in a susceptible
host; and
(P) Universal precautions
means an approach to infection prevention and control that requires all human
blood and certain human body fluids to be treated as if infectious for HIV,
hepatitis B virus (HBV), and other bloodborne pathogens.
(2) Means of transmission of communicable
diseases are-
(A) Any person-to-person
contact in which a commingling of respiratory secretions (saliva and sputum)
between the patient and ERP or good samaritan may have taken place;
(B) Transmittal of the blood or bloody fluids
of the patient onto the mucous membranes (mouth, nose or eyes) of the ERP or
good samaritan or into breaks in the skin of the ERP or good
samaritan;
(C) Transmittal of other
body fluids (semen, vaginal secretions, amniotic fluids, feces, wound drainage
or cerebral spinal fluid) onto the mucous membranes or breaks in the skin of
the ERP or good samaritan;
(D) Any
nonbarrier unprotected contact of the ERP or good samaritan with mucous
membranes or nonintact skin of the patient; or
(E) Sharing of airspace by an ERP or a good
samaritan with a patient who has been determined by the treating facility to
have an infectious disease caused by airborne pathogens.
(3) The designated officer shall have the
following duties:
(A) Collecting, upon
request, facts surrounding possible exposure of an ERP or good samaritan to a
communicable disease or infection;
(B) Contacting facilities that received
patients who potentially exposed ERPs or good samaritans to ascertain if a
determination has been made as to whether the patient has a communicable
disease or infection and to ascertain the results of that
determination;
(C) Notifying the
ERP or good samaritan as to whether s/he has been exposed within forty-eight
(48) hours of receiving the patient's diagnosis report, medical information or
necessary test results and providing information regarding the exposure,
importance of appropriate medical follow-up and confidentiality; and
(D) Upon request of the receiving medical
facility or coroner/medical examiner's office, notifying the ERP or good
samaritan of potential exposure to a communicable disease.
(4) The receiving medical facility personnel
shall notify the ERP or good samaritan or the appropriate designated officer as
soon as there has been a determination that there may have been a significant
exposure-as defined in subsection (1)(J), of this rule-to communicable diseases
including those identified in paragraphs (1)(D)1.-4. of this rule, by those
means identified in subsections (2)(A)-(E) of this rule, thereby creating a
risk of infection from a patient transported or assisted during the possible
time of communicability of the particular disease. Information provided shall
include to the extent known the type of disease in question; date, time and
place of possible exposure; and recommendations regarding appropriate followup.
The receiving medical facility or coroner/medical examiner's office shall make
a commitment to faithfully implement the procedures provided for by section (4)
of this rule, to assign appropriate personnel to investigate cases that appear
to have involved a significant exposure as defined in subsection (1)(J) of this
rule to an ERP or good samaritan and to provide the notification to the ERP or
good samaritan or designated officer. If the receiving medical facility has
determined that contacting the appropriate designated officer was better than
notifying the ERP or good samaritan directly, then the designated officer shall
employ previously developed policies and procedures governing the dissemination
of information to the ERP or good samaritan and shall direct them to seek
appropriate medical care. Nothing in this section shall be construed to imply
that a medical facility has absolute knowledge as to the communicable disease
status of all its patients at all times. Neither shall this section be
construed as eliminating or reducing any preexisting duty under the common law
or sections 2681-2690 of the Public Health Service Act (PHS) in 42 U.S.C.A.
300ff - 81 - 300ff - 90 to determine the communicable disease status of any
patient.
(5) An ERP or good
samaritan may submit a request for a determination whether s/he has had a
significant exposure to a communicable disease, preferably within twenty-four
(24) hours but as soon as possible.
(A) Upon
receipt of a request from a designated officer, an ERP or good samaritan, the
medical facility or coroner/medical examiner's office shall evaluate the facts
and determine if the ERP or good samaritan may have had a significant exposure
to a communicable disease.
(B) If a
determination is made of a possibly significant exposure-as defined in
subsection (1)(J) of this rule-to a communicable disease(s) including those
identified in paragraphs (1)(D)1.-4. of this rule, by a means identified in
subsections (2)(A)-(E) of this rule, the ERP or good samaritan shall be
notified as soon as possible, but not later than forty-eight (48) hours after
receiving the patient's diagnosis report.
(C) If the information provided by the ERP,
good samaritan or designated officer is insufficient to make a determination,
the ERP, good samaritan or designated officer shall be notified in writing, by
telephone, or by electronic transmission as soon as possible but not later than
forty-eight (48) hours after receiving the initial request.
(D) If the ERP, good samaritan or designated
officer receives notice that insufficient information was provided, the ERP or
good samaritan may request the designated officer to evaluate the request and
the medical facility's or coroner/medical examiner's office response. The
designated officer shall then evaluate the request and the medical facility's
or coroner/medical examiner's response and report his/her findings to the ERP
or good samaritan as soon as possible but not later than forty-eight (48) hours
after receiving the request.
1. If the
designated officer finds the information provided is sufficient to make a
determination of exposure, s/he shall submit the report to the medical facility
or coroner/medical examiner's office.
2. If the designated officer finds the
information provided was insufficient to make a determination of exposure, s/he
shall contact the ERP or good samaritan to gather the additional needed
information, contact the medical facility or coroner/medical examiner's office,
or both, to collect any additional available relevant information. If
sufficient facts are then collected by the medical facility or coroner/medical
examiner's office, the ERP or good samaritan shall be notified of any change in
status.
3. If there was not a
significant exposure, the medical facility, coroner/medical examiner's office
or designated officer shall notify the ERP or good samaritan, or designated
officer (who shall notify the ERP or good samaritan) within forty-eight (48)
hours.
(6) If
the ERP, good samaritan, designated officer and medical facility or
coroner/medical examiner's office are unable to achieve satisfactory resolution
to questions or issues under the procedures in subsections (5)(A)-(D) of this
rule, a request may be made to the Department of Health, through its director
or the director's designee, to resolve the issues or questions, preferably
within seventy-two (72) hours, but as soon as possible.
(7) The Department of Health's Communicable
Disease Exposure Report (form MO 580-1825, 4/94) shall be used by ERPs or good
samaritans to notify medical facilities or coroners/medical examiner's office
or designated officer regarding suspected exposure. The ERP or good samaritan
shall retain a copy of the form and shall send one (1) copy to the designated
officer and one (1) copy to the receiving medical facility or coroner/medical
examiner's office.
(8) The
designated officer and the local health department shall assure that an
adequate supply of reporting forms is provided to all receiving medical
facilities or coroner/medical examiner's offices within the geographic area
served.
(9) The notification
process established by the receiving medical facility or coroner/medical
examiner's office to deal with reported exposures to ERPs or good samaritans
shall be as comprehensive as that for employees of the medical facility or
coroner/medical examiner's office.
(10) Receiving medical facilities or
coroner/medical examiner's offices and designated officers with information
regarding the significant exposure-as defined in subsection (1)(J) of this
rule-of an ERP or good samaritan to a communicable disease(s) including those
identified in paragraphs(1)(D)1.-4. of this rule by a means identified in
subsections (2)(A)-(E) of this rule, shall provide information directly to the
affected ERP. In the case of a good samaritan the designated officer or his/her
designee shall provide the information directly to the good samaritan. All
information shall be in a manner that protects the identity and confidentiality
of the possibly infected individual and the ERP or good samaritan.
(11) A sending medical facility in advance of
the transfer of a patient to another medical facility or back to the patient's
residence shall notify the ambulance personnel of the existence and nature of
any communicable disease(s) including those identified in paragraphs
(1)(D)1.-4. of this rule by those means identified in subsections (2)(A)-(E) of
this rule and appropriate precautions and procedures to follow. If the
information supplied by the sending medical facility is unclear to the
ambulance personnel, the ambulance personnel may make a specific inquiry as to
whether there are any known communicable disease(s) involving a possible
significant exposure that might occur during the transport of the patient.
Nothing in this section shall be construed to imply that a medical facility has
absolute knowledge as to the communicable disease status of all its patients at
all times, but neither shall this section be construed to imply that a medical
facility has absolute knowledge as to the communicable disease status of all
its patients at all times, but neither shall this section be construed as
eliminating or reducing any preexisting duty under the common law or sections
2681-2690 of the PHS Act in 42 U.S.C.A. 300ff - 81 - 300ff - 90 to determine
the communicable disease status of any patient.
*Original authority: 192.020, RSMo 1939, amended 1945, 1951
and 192.806, RSMo 1992, amended 1993.
