Texas Administrative Code
Title 26 - HEALTH AND HUMAN SERVICES
Part 1 - HEALTH AND HUMAN SERVICES COMMISSION
Chapter 554 - NURSING FACILITY REQUIREMENTS FOR LICENSURE AND MEDICAID CERTIFICATION
Subchapter Q - INFECTION CONTROL
Section 554.1601 - Infection Control
Universal Citation: 26 TX Admin Code ยง 554.1601
Current through Reg. 49, No. 38; September 20, 2024
(a) General. The facility must establish and maintain an infection prevention and control program designed to provide a safe, sanitary, and comfortable environment and to help prevent the development and transmission of communicable diseases and infections.
(b) Infection prevention and control program (IPCP). The facility must establish an IPCP and conduct an annual review, effective November 28, 2019, of the IPCP and update the program, as necessary. The Quality Assessment and Assurance Committee, as described in § 554.1917 of this chapter (relating to Quality Assessment and Assurance) monitors the IPCP. The IPCP must include:
(1) a system for preventing, identifying,
reporting, investigating, and controlling infections and communicable diseases
for all residents, staff, volunteers, visitors, and other individuals providing
services under a contractual arrangement based upon the facility assessment
conducted according to § 554.1931 of this chapter (relating to Facility
Assessment), and following accepted national standards;
(2) written standards, policies, and
procedures for the program, which must include:
(A) a system of surveillance designed to
identify possible communicable diseases or infections, including
multidrug-resistant organisms, before they can spread to other persons in the
facility;
(B) when and to whom
possible incidents of communicable diseases or infections should be
reported;
(C) standard and
transmission-based precautions to be followed to prevent spread of
infections;
(D) when and how
isolation should be used for a resident; including:
(i) the type and duration of the isolation,
depending upon the infectious agent or organism involved; and
(ii) a requirement that the isolation should
be the least restrictive possible for the resident under the
circumstances;
(E) the
circumstances under which the facility must prohibit employees with a
communicable disease or infected skin lesions from direct contact with a
resident or a resident's food, if direct contact will transmit the disease;
and
(F) the hand hygiene procedures
to be followed by staff involved in direct resident contact;
(3) an antibiotic stewardship
program that includes antibiotic use protocols and a system to monitor
antibiotic use;
(4) procedures for
making rapid influenza diagnostic tests available to facility
residents;
(5) a system for
recording incidents identified under the facility's IPCP and the corrective
actions taken by the facility; and
(6) acceptable accommodations for a resident
with a communicable disease according to current practices and policies for
infection control.
(c) Infection preventionist. Effective November 28, 2019, the facility must designate one or more individuals as the infection preventionist (IP) who is responsible for the facility's IPCP. The individual designated as the IP, or at least one of the individuals if there is more than one IP, must be a member of the facility's Quality Assessment and Assurance Committee and report to the committee on the IPCP on a regular basis. The IP must:
(1) have primary professional training in
nursing, medical technology, microbiology, epidemiology, or other related
field;
(2) be qualified by
education, training, experience or certification;
(3) work at least part-time at the facility;
and
(4) have completed specialized
training in infection prevention and control.
(d) Communicable Diseases.
(1) Policies. The facility must have and
implement written policies for the control of communicable diseases in
employees and residents and must maintain evidence of compliance with local and
state health codes and ordinances regarding employee and resident health
status.
(2) Reporting. The name of
any resident with a reportable disease as specified in Title 25, Chapter 97,
Subchapter A (relating to Control of Communicable Diseases), must be reported
immediately to the city health officer, county health officer, or health unit
director having jurisdiction, and appropriate infection control procedures must
be implemented as directed by the local health authority.
(3) Tuberculosis.
(A) The facility must conduct and document an
annual review that assesses the facility's current risk classification
according to the current CDC Guidelines for Preventing the Transmission of
Mycobacterium Tuberculosis in Health Care Settings.
(B) The facility must screen all employees
before providing services in the facility, according to CDC guidelines. The
facility must require all persons providing services under an outside resource
contract to provide evidence of a current tuberculosis screening prior to
providing services in the facility. The facility must document or keep a copy
of the evidence provided.
(C) If
the facility determines or suspects that an employee or person providing
services under an outside resource contract has been exposed to or has a
positive screening for a communicable disease, the facility must respond
according to the current CDC guidelines and keep documentation of the action
taken.
(D) If the facility
determines that an employee or a person providing services under an outside
resource contract has been exposed to a communicable disease, the facility must
conduct and document a reassessment of the risk classification. The facility
must conduct and document subsequent screening based upon the reassessed risk
classification.
(E) The facility
must screen all residents at admission in accordance with the attending
physician's recommendations and current CDC guidelines. If the facility
determines or suspects that a resident has been exposed to a communicable
disease or has a positive screening, the facility must respond according to the
current CDC guidelines and attending physician's recommendations, and keep
documentation of the response.
(e) Vaccinations.
(1) A facility must develop and implement a
written policy to protect a resident from vaccine preventable diseases in
accordance with Texas Health and Safety Code, Chapter 224.
(A) The policy must:
(i) require an employee, contractor, or other
individual with privileges providing direct care to a resident to receive
vaccines for the vaccine preventable diseases specified by the facility based
on the level of risk the employee, contractor, or other individual presents to
residents by the employee's, contractor's, or other individual's routine and
direct exposure to residents;
(ii)
specify the vaccines an employee, contractor, or other individual with
privileges to provide direct resident care is required to receive in accordance
with clause (i) of this subparagraph;
(iii) include procedures for the facility to
verify that an employee, contractor, or other individual with privileges to
provide direct resident care has complied with the policy;
(iv) include procedures for the facility to
exempt an employee, contractor, or other individual with privileges to provide
direct resident care from the required vaccines for the medical conditions
identified as contraindications or precautions by the CDC;
(v) for an employee, contractor, or other
individual with privileges to provide direct resident care who is exempt from
the required vaccines, include procedures the employee, contractor, or other
individual must follow to protect residents from exposure to vaccine
preventable diseases, such as the use of protective equipment, such as gloves
and masks, based on the level of risk the employee, contractor, or other
individual presents to residents by the employee's, contractor's, or other
individual's routine and direct exposure to residents;
(vi) prohibit discrimination or retaliatory
action against an employee, contractor, or other individual with privileges to
provide direct resident care 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, may not be considered retaliatory action;
(vii) require the facility to maintain a
written or electronic record of each employee's, contractor's, or other
individual's compliance with or exemption from the policy; and
(viii) include disciplinary actions the
facility may take against an employee, contractor, or other individual with
privileges to provide direct resident care who fails to comply with the
policy.
(B) The policy
may:
(i) include procedures for an employee,
contractor, or other individual with privileges to provide direct resident care
to be exempt from the required vaccines based on reasons of conscience,
including religious beliefs; and
(ii) prohibit an employee, contractor, or
other individual with privileges to provide direct resident care who is exempt
from the required vaccines from having contact with residents during a public
health disaster, as defined in Texas Health and Safety Code, §
81.003 (relating to
Definitions).
(2) A facility must offer vaccinations to a
resident in accordance with an immunization schedule Amended by the Advisory
Committee on Immunization Practices of the CDC.
(A) Pneumococcal vaccinations for residents.
The facility must offer pneumococcal vaccination to a resident 65 years of age
or older who has not received the vaccination and to a resident younger than 65
years of age, who has not received the vaccination but is a candidate for it
because of chronic illness. A pneumococcal vaccination must be offered to a
current resident of a facility and to a new resident at the time of admission.
A vaccination must be completed unless a physician has indicated that the
vaccination is medically contraindicated or the resident refuses the
vaccination. The facility must develop and implement policies and procedures to
ensure that:
(i) before offering the
pneumococcal immunization, each resident or resident representative receives
education regarding the benefits and potential side effects of the pneumococcal
vaccination;
(ii) each resident is
offered a pneumococcal immunization, unless the immunization is medically
contraindicated or the resident has already been immunized;
(iii) the resident or the resident
representative has the opportunity to refuse immunization; and
(iv) the resident's clinical record includes
documentation that indicates:
(I) that the
resident or the resident representative was provided education regarding the
benefits and potential side effects of pneumococcal immunization;
(II) that the resident either received the
pneumococcal immunization or did not receive the pneumococcal immunization due
to medical contraindication or refusal; and
(III) the date of the receipt or refusal of
the pneumococcal vaccination.
(v) Based on an assessment and practitioner
recommendation, a second pneumococcal vaccination may be given five years after
the first pneumococcal vaccination, unless medically contraindicated or the
resident or the resident representative refuses the second
vaccination.
(B)
Influenza vaccinations for residents and employees. The facility must offer an
influenza vaccination to a resident and an employee in contact with residents,
unless the vaccination is medically contraindicated by a physician or the
employee or resident has refused the vaccination.
(i) Influenza vaccinations for all residents
and employees in contact with a resident must be completed by November 30 of
each year. Employees hired or residents admitted after this date and during the
influenza season (through March of each year) must receive influenza
vaccinations, unless medically contraindicated by a physician or the employee,
the resident, or the resident representative refuses the vaccination.
(ii) The facility must develop and implement
policies and procedures that ensure that:
(I)
before offering the influenza immunization, each resident or resident
representative receives education regarding the benefits and potential side
effects of the influenza vaccination; and
(II) the resident's clinical record includes
documentation that indicates:
(-a-) that the
resident or the resident representative was provided education regarding the
benefits and potential side effects of influenza immunization;
(-b-) that the resident either received the
influenza immunization or did not receive the influenza immunization due to
medical contraindications or refusal; and
(-c-) the date of the receipt or refusal of
the annual influenza vaccination.
(C) Hepatitis B vaccinations for employees.
The facility must develop a method to identify employees at risk of directly
contacting blood or potentially infectious materials. The facility must offer
an employee identified as being at risk of directly contacting blood or
potentially infectious materials a hepatitis B vaccine within 10 days of
employment. If the employee initially declines the hepatitis B vaccination but
at a later date, while still at risk of directly contacting blood or
potentially infectious materials, decides to accept the vaccination, the
facility must make the vaccination available within 10 days after the employee
decides to accept that vaccination.
(f) Linens. Personnel must handle, store, process, and transport linens so as to prevent the spread of infection and in accordance with § 554.325 of this chapter (relating to Linen).
(g) The Quality Assessment and Assurance Committee as described in § 554.1917 of this chapter (relating to Quality Assessment and Assurance) will monitor the Infection Prevention and Control Program.
Disclaimer: These regulations may not be the most recent version. Texas may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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