Current through Reg. 49, No. 38; September 20, 2024
(a) A center must establish and maintain an
infection prevention and control program (IPCP) designed to provide a safe,
sanitary, and comfortable environment by preventing the development and
transmission of disease and infection. Under the IPCP, the center must:
(1) investigate, prevent, and control
infections at the center;
(2)
decide what procedures, such as isolation, should be applied to an individual
minor;
(3) address vaccine
preventable diseases in accordance with THSC, Chapter 224;
(4) address hepatitis B vaccinations in
accordance with Occupational Safety and Health Administration;
(5) address tuberculosis requirements;
and
(6) maintain a record of
incidents and corrective actions relating to infections.
(b) A center must provide IPCP information to
employees, contractors, volunteers, parents, health care providers, other
service providers, and visitors.
(c) A center's IPCP must include written
policies and procedures for admissions and attendance of minors who are at risk
for infections or present a significant risk to other minors. The policy must
include that a minor is accepted only:
(1) as
authorized by a minor's prescribing physician:
(2) as determined by the center's medical
director's assessment of the risk;
(3) as determined by the medical and nursing
director review, on a case-by-case basis, to determine appropriateness of
admission to or attendance at the center; and
(4) in accordance with Centers for Disease
Control (CDC) guidelines.
(d) The center's IPCP must include written
policies and procedures for preventing the spread of infection.
(1) If the center determines, in accordance
with its IPCP, that a minor must be isolated to prevent the spread of
infection, the center must isolate a minor.
(A) The center must maintain an isolation
room with a glass window for observation of a minor. The isolation room must be
equipped with emergency outlets and equipment as necessary to provide care to a
minor. The isolation room must have a dedicated bathroom not accessible to the
center's other rooms if appropriate to control the spread of infectious
disease.
(B) The center must ensure
that all equipment is thoroughly cleaned and disinfected before being placed in
the isolation room and before being removed from the room.
(C) The center's procedures must address:
(i) notification to a minor's parent of the
minor's condition and the center's recommendation of isolation or removal based
on the minor's risk assessment;
(ii) the arrangement of transportation if the
minor must be removed from the center; and
(iii) the return of a minor to the center, as
determined by a reassessment conducted by a nurse that the minor no longer
poses a risk to other minors.
(2) The center must prohibit employees,
volunteers, and contractors with an infectious disease or infected skin lesions
from direct contact with minors or food, if direct contact will transmit the
disease.
(3) The center's infection
control policy must provide that staff, volunteers, and contractors wash their
hands between each treatment and care interaction with a minor.
(4) The center must immediately report the
name of any minor with a reportable disease as specified in 25 TAC Chapter 97,
Subchapter A (relating to Control of Communicable Diseases) to the city health
officer, county health officer, or health unit director having jurisdiction,
and implement appropriate infection control procedures as directed by the local
health authority or the Department of State Health Services.
(e) The center must assign a crib,
bed, or sleep mat for a minor's exclusive use each day. A center must label
cribs, beds, and sleep mats with the minor's name.
(f) A center must place liquid soap,
disposable paper towels, and trash containers at each sink.
(g) The center must adopt and enforce written
policies and procedures for the control of communicable diseases for employees,
contractors, volunteers, parents, health care providers, other service
providers, and visitors and must maintain evidence of compliance.
(h) The center must adopt and enforce written
policies and procedures for the control of an identified public health
disaster.
(1) If a center determines or
suspects that an employee, volunteer, or contractor providing services has been
exposed to, or has a positive screening for, a communicable disease, the center
must respond according to current CDC guidelines and keep documentation of the
action taken.
(2) If the center
determines that an employee, volunteer or contractor providing services has
been exposed to a communicable disease, the center must conduct and document a
reassessment of the risk classification. The center must conduct and document
subsequent screenings based upon the reassessed risk classification.
(3) If the center determines that an
employee, volunteer, or a contractor providing services at the center is
suspected of having a communicable disease, the individual must not return to
the center until the individual no longer poses a risk of transmission as
documented by a written physician's statement.
(i) The center must conduct and document an
annual review that assesses the center's current risk classification according
to the current CDC Guidelines for Preventing the Transmission of Mycobacterium
Tuberculosis in Health Care Settings and 25 TAC Chapter 97, Subchapter A.
(1) The center must have a system in place to
screen all individuals providing services at the center.
(2) The center must require employees,
volunteers, and contractors providing services to provide evidence of current
tuberculosis screening before providing services at the center. The center must
maintain evidence of compliance.
(3) Any employee, volunteer, or contractor
providing services at a center with positive results must be referred to the
person's personal physician, and if active tuberculosis is suspected or
diagnosed, the person must be excluded from work until the physician provides
written approval to return to work.
(j) A center must adopt and enforce written
policies and procedures to protect a minor from vaccine preventable diseases,
in accordance with THSC, Chapter 224.
(1) The
policy must:
(A) require an employee,
volunteer, or contractor providing direct care to receive vaccines for the
vaccine preventable diseases specified by the center based on the level of risk
the employee, volunteer, or contractor, presents to minors by the employee's,
volunteer's, or contractor's routine and direct exposure to minors;
(B) specify the vaccines an employee,
volunteer, or contractor who provides direct care is required to receive in
accordance with subsection (i) of this section;
(C) include procedures for the center to
verify that an employee, volunteer, or contractor who provides direct care has
complied with the policy;
(D)
include procedures for the center to exempt an employee, volunteer, or
contractor who provides direct care from the required vaccines for the medical
conditions identified as contraindications or precautions by the CDC;
(E) include procedures, including using
protective equipment such as gloves and masks, to protect minors from exposure
to vaccine preventable diseases, based on the level of risk the employee,
volunteer, or contractor presents to minors by the employee's, volunteer's, or
contractor's routine and direct exposure to minors;
(F) prohibit discrimination or retaliatory
action against an employee, volunteer, or contractor who provides direct care
and who is exempt from the required vaccines for the medical conditions
identified as contraindications or precautions by the CDC, except that required
use of protective medical equipment, such as gloves and masks, will not be
considered retaliatory action;
(G)
require the center to maintain a written or electronic record of each
employee's, volunteer's or contractor's compliance with or exemption from the
policy; and
(H) include
disciplinary actions the center may take against an employee, volunteer, or
contractor providing direct care who fails to comply with the policy.
(2) The center must have a written
policy describing whether it will exempt an employee, volunteer, or contractor
providing direct care:
(A) from the required
vaccines based on reasons of conscience, including a religious belief;
and
(B) prohibit an employee,
volunteer, or contractor providing direct care who is exempt from the required
vaccines from having contact with minors during a public health
disaster.
(k)
The center must adopt and enforce written policies and procedures to identify
employees, volunteers, or contractors at risk of directly contacting blood or
potentially infectious materials in accordance with Occupational Safety and
Health Administration (OSHA), 29 Code of Federal Regulations Part 1910.1030 and
Appendix A relating to Bloodborne Pathogens.
(l) A center must ensure that its employees,
volunteers, and contractors comply with:
(1)
the center's IPCP;
(2) the
Communicable Disease Prevention and Control Act, THSC Chapter 81; and
(3) THSC Chapter 85, Subchapter I, concerning
the prevention of the transmission of human immunodeficiency virus and
hepatitis B virus.
