N.J. Admin. Code § 8:43G-20.2

Current through Register Vol. 56, No. 21, November 4, 2024

Section 8:43G-20.2 - Employee health services

(a) Each new employee shall receive an initial health evaluation, which includes at least a documented history, which may be performed by a registered professional nurse, physician or other qualified personnel (defined as a licensed physician assistant or a certified nurse practitioner/clinical nurse specialist), and a physical examination.

(b) Employee health records shall be maintained for each employee. Employee health records shall be confidential, and kept in the employee health office separate from personnel records.

(c) The employee health record shall include documentation of all medical screening tests performed and the results.

(d) The facility shall establish policies and procedures for the detection and control of the transmission of Mycobacterium tuberculosis that include, but are not limited to, developing a Tuberculosis Infection Exposure Control Plan (TB plan), according to the guidelines set forth in "Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health-Care Facilities, 2005." MMWR. 2005; 54(RR-17); 1-141, incorporated herein by reference, as supplemented and amended.

1. With respect to newly hired employees, the facility shall establish policies and procedures that will identify a new employee's baseline status of exposure to Mycobacterium tuberculosis. Upon employment, the facility shall either draw blood for an interferon gamma release assay (IGRA) or administer a two-step Mantoux tuberculin skin test, using five tuberculin units of purified protein derivative, to all employees. Employees are defined, for the purpose of this subsection, as full and part-time employees, volunteer staff and primary care providers who are salaried by the facility and/or who have clinical privileges to provide medical care at the facility.

i. Employees whose IGRA result is "positive" have latent TB infection. A "negative" IGRA result indicates the employee has no latent TB infection. Employees whose IGRA result is "indeterminate" shall repeat the IGRA.

ii. Employees whose initial Mantoux tuberculin skin test result is "negative" (less than 10 millimeters (mm) of induration or less than five mm of induration if the individual is immunosuppressed) shall be administered a second test in one to three weeks.

iii. Employees whose first or second IGRA result is "positive" or whose first or second Mantoux tuberculin skin test result is "positive" (greater than 10 mm of induration or greater than five mm of induration if the individual is immunosuppressed) shall be referred for a medical evaluation to determine whether there is evidence of latent tuberculosis infection or active tuberculosis disease.

(1) The medical evaluation shall include, but is not limited to, a chest X-ray.

(2) The facility shall not permit an employee whose IGRA or Mantoux tuberculin skin test result was positive to begin working unless and until the employee submits written medical clearance to the facility.

iv. Exceptions to the requirements in (d)1 above are as follows:

(1) Employees who provide documentation of negative results of a single Mantoux tuberculin skin test performed within the 12 months preceding the start of employment shall receive only one Mantoux tuberculin skin test upon hire.

(2) Employees with prior documentation of negative results of two Mantoux tuberculin skin tests performed within 12 months preceding the start of employment, and without signs and symptoms of active tuberculosis, shall not be required to be tested upon hire; however, a Mantoux tuberculin skin test shall be required within 12 months of the last Mantoux tuberculin skin test.

(3) Employees who provide documentation of positive IGRA or Mantoux tuberculin skin test results shall be exempt from screening.

(4) Employees who provide documentation of having received and completed appropriate medical treatment for active tuberculosis disease or latent tuberculosis infection shall be exempt from screening.

2. The facility shall establish policies and procedures for periodic screening of eligible personnel for Mycobacterium tuberculosis that includes, but is not limited to the following requirements:

i. The facility shall administer an IGRA or a Mantoux tuberculin skin test to all employees whose prior IGRA or Mantoux tuberculin skin test results were negative at least annually. Frequency of testing shall be determined by the level of risk assigned by the facility's TB plan;

ii. The facility shall require an employee, whose IGRA or Mantoux tuberculin skin test results are positive upon follow-up testing conducted after the employee had IGRA or Mantoux tuberculin skin test results that were negative, to undergo medical evaluation in accordance with (d)1iii(1) above; and

iii. An asymptomatic employee referred to medical evaluation may continue to work while awaiting written medical clearance. The facility shall not permit a symptomatic employee to return to work until the employee submits written medical clearance.

iv. The facility shall maintain records of the results of employee IGRA and Mantoux tuberculin skin testing.

3. Persons with questions regarding tuberculosis control may request further information from the Tuberculosis Control Program, Department of Health, Division of HIV, STD and TB Services, 50 East State Street, 3rd Floor, PO Box 363, Trenton, NJ 08625-0363. Phone: 609-826-4878. Fax: 609-826-4879.

(e) Rubella screening: Each employee, including members of the medical staff employed by the hospital, shall be given a rubella screening test using the rubella hemagglutination inhibition test or other rubella screening test. The only exceptions are employees who can document seropositivity from a previous rubella screening test or who can document inoculation with rubella vaccine, or when medically contraindicated.

1. Each new employee, including members of the medical staff employed by the hospital, shall be given a rubella screening test upon employment.

(f) Measles (Rubeola) Screening: Each employee, including members of the medical staff employed by the hospital, born in 1957 or later shall be given a measles (rubeola) screening test using the Hemagglutination inhibition test or other rubeola screening test. The only exceptions are employees who can document receipt of live measles vaccine on or after their first birthday, physician-diagnosed measles, or serologic evidence of immunity.

1. Each new employee, including members of the medical staff employed by the hospital, born in 1957 or later shall be given a rubeola screening test, upon employment.

(g) The hospital shall offer rubella and rubeola vaccination to all employees and medical staff.

(h) The hospital shall maintain a list identifying the name of each employee who is seronegative and unvaccinated.

(i) The hospital shall comply with the reporting requirements of the Department's Division of Epidemiology, Environmental and Occupational Health Services for tuberculin and rubella test results, pursuant to N.J.A.C. 8:57. Information regarding testing and reporting can be obtained from:

Department of Health

Communicable Disease Service

PO Box 369

Trenton, NJ 08625-0369

(j) The hospital shall provide initial health care for employees who become ill or have a work-related illness or injury. "Initial health care" means that the ill or injured employee shall be seen and evaluated by a physician, licensed physician assistant, or certified nurse practitioner/clinical nurse specialist and stabilized prior to referral for further treatment, as appropriate.

(k) Personnel who are absent from work because of any reportable communicable disease, infection, or exposure to infection, as defined in N.J.A.C. 8:57, shall be excluded from working in the hospital until they have been examined by a physician and certified by the physician as no longer endangering the health of patients or employees. If the absence is less than three full days, the hospital's employee health nurse may certify that the employee is able to return to work.

(l) The hospital shall have a program addressing the needs of impaired employees, which at a minimum, shall include methods or mechanisms to identify and refer impaired employees to rehabilitation programs.

N.J. Admin. Code § 8:43G-20.2

Amended by 50 N.J.R. 552(b), effective 1/16/2018