16 Del. Admin. Code § 3225-9.0

Current through Register Vol. 28, No. 3, September 1, 2024

Section 3225-9.0 - Infection Control

9.1 The assisted living facility shall establish written procedures to be followed in the event that a resident with a communicable disease is admitted or an episode of communicable disease occurs. It is the responsibility of the assisted living facility to see that:

9.1.1 The necessary precautions stated in the written procedures are followed; and

9.1.2 All rules of the Delaware Division of Public Health are followed so there is minimal danger of transmission to staff and residents.

9.2 Any resident found to have active tuberculosis in an infectious stage may not continue to reside in an assisted living facility.

9.3 A resident, when suspected or diagnosed as having a communicable disease, shall be placed on the appropriate isolation or precaution as recommended for that disease by the Centers for Disease Control. Those with a communicable disease which has been determined by the Director of the Division of Public Health to be a health hazard to visitors, staff, and other residents shall be placed on isolation care until they can be moved to an appropriate room or transferred.

9.4 The admission of a resident with or the occurrence of a disease or condition on the Division of Public Health List of Notifiable Diseases/Conditions within a nursing facility shall be reported to the resident's physician and the facility's medical director. The facility shall also report such an admission or occurrence to the Division of Public Health's Health Information and Epidemiology office.

9.4.1 The assisted living facility shall have policies and procedures for infection control as it pertains to staff, residents, and visitors.

9.4.2 All assisted living facility staff shall be required to use Standard Precautions.

9.5 Requirements for tuberculosis and immunizations:

9.5.1 The facility shall have on file the results of tuberculin testing performed on all newly placed residents.

9.5.2 Minimum requirements for pre-employment require all employees to have a base line two step tuberculin skin test (TST) or single Interferon Gamma Release Assay (IGRA or TB blood test) such as QuantiFeron. Any required subsequent testing according to risk category shall be in accordance with the recommendations of the Centers for Disease Control and Prevention of the U.S. Department of Health and Human Services. Should the category of risk change, which is determined by the Division of Public Health, the facility shall comply with the recommendations of the Center for Disease Control for the appropriate risk category.

9.5.2.1 No person, including volunteers, found to have active tuberculosis in an infectious stage shall be permitted to give care or service to residents.

9.5.2.2 Any person having a positive skin test but a negative X-ray shall receive an annual evaluation for signs and symptoms of active TB if they cannot provide documentation of completion of treatment for LTBI (latent TB infection).

9.5.2.3 Persons with a prior BCG vaccination are required to be tested as set forth in 9.5.2.

9.5.2.4 A report of all test results shall be kept on file at the facility of employment.

9.6 The assisted living facility shall have on file evidence of annual vaccination against influenza for all residents, as recommended by the Immunization Practice Advisory Committee of the Centers for Disease Control, unless medically contraindicated. All residents who refuse to be vaccinated against influenza must be fully informed by the facility of the health risks involved. The reason for the refusal shall be documented in the resident's medical record.

9.7 The assisted living facility shall have on file evidence of vaccination against pneumococcal pneumonia for all residents older than 65 years, or those who received the pneumococcal vaccine before they became 65 years and 5 years have elapsed, and as recommended by the Immunization Practice Advisory Committee of the Centers for Disease Control, unless medically contraindicated. All residents who refuse to be vaccinated against pneumococcal pneumonia must be fully informed by the facility of the health risks involved. The reason for the refusal shall be documented in the resident's medical record.

9.8 Specific Requirements for COVID-19:

9.8.1 Residents

9.8.1.1 All residents should be tested upon identification of another resident with symptoms consistent with COVID-19, or if facility staff have tested positive for COVID-19.

9.8.1.2 All other resident testing should be consistent with Division of Public Health guidance for the duration of the public health emergency.

9.8.1.3 All testing and test results must be documented in the resident medical record.

9.8.1.4 Facilities must report all resident testing and test results, to the Delaware Division of Public Health.

9.8.2 Staff, vendors and volunteers

9.8.2.1 Prior to their start date, all new staff, vendors and volunteers must be tested in accordance with the Delaware Division of Public Health guidance.

9.8.2.2 All staff, vendors and volunteers who test negative must be retested consistent with Division of Public Health guidance for the duration of the public health emergency.

9.8.2.3 Facilities must report all staff, vendor and volunteer testing and test results, to the Delaware Division of Public Health.

9.8.2.4 Facilities must follow recommendations of the Centers for Disease Control and Prevention of the U.S. Department of Health and Human Services and the Division of Public Health regarding the provision of care or services to residents by staff, vendor or volunteer found to be positive for COVID-19 in an infectious stage.

9.8.2.5 Facilities shall amend their policies and procedures to include:

9.8.2.5.1 Work exclusion and return to work protocols for staff tested positive for COVID-19.

9.8.2.5.2 Staff refusals to participate in COVID-19 testing.

9.8.2.5.3 Staff refusals to authorize release of their testing results to the facility.

9.8.2.5.4 Procedures to obtain staff authorizations for release of laboratory test results to the facility so as to inform infection control and prevention strategies.

9.8.2.5.5 Plans to address staffing shortages and facility demands should a COVID-19 outbreak occur.

9.9 Infection Prevention and Control Program

9.9.1 The assisted living facility shall establish an infection prevention and control program with shall be based upon Centers for Disease Control and Prevention and other nationally recognized infection prevention and control guidelines.

9.9.1.1 The infection prevention and control program must cover all services and all areas of the assisted living facilities, including provision of the appropriate personal protective equipment for all residents, staff and visitors.

9.9.2 The individual designated to lead the assisted living facility's infection prevention and control program must develop and implement a comprehensive plan that includes actions to prevent, identify, and manage infections and communicable diseases. The plan must include mechanisms that result in immediate action to take preventive or corrective measures that improve the assisted living facility's infection control outcomes.

9.9.3 All assisted living facility staff shall receive orientation at the time of employment and annual in-service education regarding the infection prevention and control program.

16 Del. Admin. Code § 3225-9.0

13 DE Reg. 1328 (04/01/10)
15 DE Reg. 81 (07/01/11)
24 DE Reg. 579(12/1/2020)
25 DE Reg. 761( 2/1/2022) (Final)