16 Del. Admin. Code § 4202-11.0

Current through Register Vol. 28, No. 7, January 1, 2025

Section 4202-11.0 - Notification of Emergency Medical Care Providers of Exposure to Communicable Diseases

11.1 For the purposes of Section 11.0 of this regulation, the following definitions shall apply.

"Emergency medical care provider" means a fire fighter, law enforcement officer, paramedic, emergency medical technician, correctional officer, ambulance attendant, or other person who serves as employee or volunteer of an ambulance service or provides prehospital emergency medical service.

"Receiving medical facility" means a hospital or similar facility that receives a patient attended by an emergency medical care provider for the purposes of continued medical care.

"Standard precautions" means those precautions, including the appropriate use of hand washing, protective barriers, and care in the use and disposal of needles and other sharp instruments, that minimize the risk of transmission of communicable diseases between patients and health care providers. Standard precautions require that all care providers use appropriate barrier precautions to prevent exposure to blood and body fluids, secretions, and excretions of all patients at all times.

11.2 Standard Precautions

11.2.1 Didactic Instruction

11.2.1.1 Education and training with respect to standard precautions shall be a mandatory component of any required training and any required continuing education for all emergency medical care providers who have patient contact. Training shall be appropriately tailored to the needs and educational background of the emergency medical care providers being trained. Training shall include the following:

11.2.1.1.1 Mechanisms and routes of transmission of viral, bacterial, rickettsial, fungal, and mycoplasmal human pathogens.

11.2.1.1.2 Proper techniques of hand washing, including the theory supporting the effectiveness of hand washing, and guidelines for waterless hand cleansing in the field.

11.2.1.1.3 Proper techniques and circumstances under which barrier methods of protection (personal protective equipment) from contamination by microbial pathogens are to be implemented. The instruction is to include the theory supporting the benefits of these techniques.

11.2.1.1.4 Proper techniques of disinfection and cleanup of spills of infectious material. This instruction is to include the use of absorbent, liquid, and chemical disinfectants.

11.2.1.1.5 Instruction regarding the reporting and documentation of exposures to infectious agents and the requirement for employers to have an exposure control plan.

11.2.1.1.6 Proper disposal of contaminated needles and other sharps. The instruction is to include information about recapping needles and using puncture-resistant, leak-resistant containers, and safety sharps.

11.2.1.1.7 First aid and immediate care of wounds that may be incurred by an emergency medical care provider.

11.2.2 Practical or Laboratory Instruction

11.2.2.1 Practical sessions addressing the field application of the above didactic instruction must be part of the curriculum. The practical sessions shall provide a means of hands-on experience and training in the following:

11.2.2.1.1 The proper use of personal protective equipment, hand-washing disinfection, cleanup of infectious spills, handling and disposal of contaminated sharps, and the proper completion of reporting forms.

11.2.3 Approval of Curricula. Any provider of mandatory education and training and continuing education pursuant to this section must submit a curriculum for approval by the Division of Public Health and shall not utilize curricula that are not regarded by the Division of Public Health to be in substantial compliance with subsections 11.2.1 and 11.2.2.

11.3 Communicable Diseases

11.3.1 Communicable Disease Defined. For the purposes of Section 11.0 only, exposure to patients infected with the following communicable disease agents shall warrant notification to an emergency medical care provider pursuant to this section:

11.3.1.1 Human Immunodeficiency Virus (HIV)

11.3.1.2 Hepatitis B Virus

11.3.1.3 Hepatitis C Virus

11.3.1.4 Meningococcal disease

11.3.1.5Haemophilus influenzae

11.3.1.6 Measles

11.3.1.7 Tuberculosis

11.3.1.8 Uncommon or rare pathogens

11.3.2 Infection Defined. For the purposes of Section 11.0 only, a patient shall be considered infected with a communicable disease when the following conditions are satisfied:

11.3.2.1 Blood-borne pathogens

11.3.2.1.1 HIV: ELISA and western blot (or other confirmatory test accepted by prevailing medical opinion) tests must be positive.

11.3.2.1.2 Hepatitis B: Positive for Hepatitis B surface antigen.

11.3.2.1.3 Hepatitis C: Hepatitis C antibody screening test and more specific supplemental test positive.

11.3.2.2 Airborne and droplet-spread pathogens

11.3.2.2.1 Meningococcal disease: Compatible clinical findings and laboratory confirmation through isolation of Neisseria meningitidis from a normally sterile site.

11.3.2.2.2Haemophilus influenzae: Compatible clinical findings of epiglottitis or meningitis and laboratory confirmation through isolation of Haemophilus influenzae from a normally sterile site or from the epiglottis.

11.3.2.2.3 Measles: Compatible clinical findings with or without laboratory confirmation by one of the following methods:

11.3.2.2.3.1 Presence of the measles virus from a clinical specimen;

11.3.2.2.3.2 Four-fold rise in measles antibody level by any standard serologic assay; or

11.3.2.2.3.3 Positive serologic test for measles IgM antibody.

11.3.2.2.4 Tuberculosis: Compatible clinical findings of pulmonary disease and identification of either acid-fast bacilli in sputum or the pathogen by culture.

11.3.2.3 Uncommon or rare pathogens. Infection with uncommon or rare pathogens determined by the Division of Public Health on a case-by-case basis.

11.3.3 Exposure Defined

11.3.3.1 Blood-borne pathogens. Exposure of an emergency medical care provider to a patient infected with a blood-borne pathogen as defined in subsection 11.3.2.1 shall include a needle-stick or other penetrating injury with an item contaminated by a patient's blood, plasma, pleural fluid, peritoneal fluid, tissue, cerebrospinal fluid, synovial fluid, peritoneal fluid, pericardial fluid, amniotic fluid, or any other body fluid or drainage that contains blood or plasma. Contact of these fluids with mucous membranes or non-intact skin of the emergency medical care provider or extensive contact with intact skin shall also constitute exposure.

11.3.3.2 Airborne and droplet-spread pathogens. Exposure of an emergency medical care provider to a patient infected with an airborne or droplet-spread pathogen as defined in subsection 11.3.2.2 shall be as follows:

11.3.3.2.1 Meningococcal disease and Haemophilus influenza: Close contact with an infected patient's oral secretions or sharing the same air space with an infected patient for one hour or longer without the use of an effective barrier such as a mask.

11.3.3.2.2 Measles: Sharing confined air space with an infected patient, regardless of contact time.

11.3.3.2.3 Tuberculosis: Sharing confined air space with an infected patient, regardless of contact time.

11.3.3.3 Uncommon or rare pathogens. The Division of Public Health shall determine definition of exposure to an uncommon or rare pathogen on a case-by-case basis.

11.3.3.4 Ruling on infection and exposure. When requested by the emergency medical care provider or receiving medical facility, the Division of Public Health shall investigate and issue judgment on any differences of opinion regarding infection and exposure as otherwise defined in subsection 11.3.

11.4 Request for Notification

11.4.1 Every employer of an emergency medical care provider and every organization which supervises volunteer emergency medical care providers must register the name or names of a designated officer who shall perform the following duties. The designated officer shall delegate these duties as may be necessary to ensure compliance with this regulation.

11.4.1.1 Receive requests for notification from emergency medical care providers;

11.4.1.2 Collect facts relating to the circumstances under which the emergency medical care provider may have been exposed;

11.4.1.3 Forward requests for notification to receiving medical facilities;

11.4.1.4 Report to the emergency medical care provider findings provided by the receiving medical facility; and

11.4.1.5 Assist the emergency medical care provider to take medically appropriate action if necessary.

11.4.2 Receiving medical facilities must register with the Division of Public Health the name or office to whom notification requests should be sent by an emergency medical care provider and who is responsible for ensuring compliance with this section.

11.4.3 If an emergency medical care provider desires to be notified under this regulation, the officer designated pursuant to subsection 11.4.1 shall notify the receiving medical facility within 24 hours after the patient is admitted to or treated by the facility on a form that is prescribed or approved by the State Board of Health.

11.5 Notification of Exposure to Airborne and Droplet-Spread Pathogens

11.5.1 Notwithstanding any requirement of subsection 11.4.3, a receiving medical facility must make notification when an emergency medical care provider has been exposed to an airborne or droplet-spread communicable disease pursuant to subsections 11.3.2.2 and 11.3.3.2. Such notification shall occur as soon as possible but not more than 48 hours after the exposure has been determined and shall apply to any patient upon whom such a determination has been made within 30 days after the patient is admitted to or treated by the receiving medical facility.

11.5.2 To determine if notification is necessary pursuant to this section, a receiving medical facility must review medical records of a patient infected with an airborne or droplet-spread communicable disease to determine if care was provided by an emergency medical care provider. If medical records do not so indicate, the receiving medical facility shall assume that no notification is required.

11.6 Notification of Exposure when Requested

11.6.1 When a request for notification has been made pursuant to subsection 11.4.3, the receiving medical facility shall attempt to determine if the patient is infected with a communicable disease and if the emergency medical care provider has or has not been exposed. Information provided on the request for notification and medical records and findings in possession of the receiving medical facility shall be used to make this determination. If a determination is made within 30 days after the patient is admitted to or treated by the receiving medical facility, the receiving medical facility shall notify the officer designated pursuant to subsection 11.4.1 as soon as possible but not more than 48 hours after the determination. The following information shall be provided in the notification:

11.6.1.1 The date that the patient was attended by the emergency medical care provider;

11.6.1.2 Whether or not the emergency medical care provider was exposed; and

11.6.1.3 If the emergency medical care provider was exposed, the communicable disease involved.

11.6.2 If, after expiration of the 30-day period and because of insufficient information, the receiving medical facility has not determined that the emergency medical care provider has or has not been exposed to a communicable disease, the receiving medical care facility shall so notify the officer designated pursuant to subsection 11.4.1 as soon as possible but not more than 48 hours after expiration of the 30-day period. The following information shall be provided in the notification:

11.6.2.1 The date that the patient was attended by the emergency medical care provider; and

11.6.2.2 That there is insufficient information to determine if an exposure has occurred.

11.6.3 The receiving medical facility shall provide to the Division of Public Health a copy of each form completed pursuant to subsection 11.4 which shall include information about whether or not the patient is infected, and if the emergency medical care provider is considered by the receiving medical facility to have been exposed.

11.7 Manner of Notification.

11.7.1 A receiving medical facility must make a good faith effort, which is reasonably calculated based upon the health risks, the need to maintain confidentiality, and the urgency of intervention associated with the exposure, to expeditiously notify the officer designated pursuant to subsection 11.4.1.

11.7.2 If notification is by mail, and if, in the judgment of the receiving medical facility the circumstances warrant, the receiving medical facility shall ensure by telephone or other appropriate means that the designated officer of the emergency medical care provider has received notification.

11.8 Transfer of Patients.

11.8.1 If, within the 30-day limitation defined in subsections 11.5.1 and 11.6.1 a patient is transferred from a receiving medical facility to a second receiving medical facility, the receiving medical facility must provide the second facility with all requests for notification made by emergency medical care providers for that patient.

11.8.2 The second receiving medical facility must make notification to the officer designated pursuant to subsection 11.4.1 if the facility determines within the remaining part of the 30-day period that the patient is infected and shall otherwise comply with this regulation.

11.9 Death of Patient.

11.9.1 If, within the 30-day limitation defined in subsections 11.5.1 and 11.6.1, a patient is transferred from a receiving medical facility to a medical examiner, the receiving medical facility must provide the medical examiner with all requests for notification made by emergency medical care providers for that patient.

11.9.2 The medical examiner must make notification to the designated officer if the medical examiner determines that the patient is infected with a communicable disease and shall otherwise comply with this regulation.

11.10 Testing of Patients for Infection. Nothing in this regulation shall be construed to authorize or require a medical test of an emergency medical care provider or patient for any infectious disease.

11.11 Confidentiality. All requests and notifications made pursuant to this regulation shall be used solely for the purposes of complying with this regulation and are otherwise confidential.

16 Del. Admin. Code § 4202-11.0

9 DE Reg. 1188 (02/01/06)
17 DE Reg. 320 (9/1/2013)
22 DE Reg. 1012 (6/1/2019)
23 DE Reg. 665 (2/1/2020)
24 DE Reg. 791 (2/1/2021)
27 DE Reg. 863 (5/1/2024) (Final)