Section 144-110-21 - Infection Control and Biomedical Waste21.A.Infection ControlThe facility must establish an active program for the prevention, control, and investigation of infection according to current standards and federal Center for Disease Control ("CDC") guidelines, which includes:
21.A.1. The facility's written protocols for the prevention of the spread of infections shall require consultation with the Maine Center for Disease Control and Prevention ("MeCDC") for any mandatory reportable disease as required by 10-144 CMR Ch. 258, Control of Notifiable Diseases and Conditions Rule, within 24 hours of any resident or staff person exhibiting symptoms of such a disease, and within 12 hours of any confirmed positive resident or staff person. This consultation with the MeCDC must include consideration of universal testing and resident cohorting. Facilities shall notify the DHHS Division of Licensing and Certification ("DLC") prior to implementation of universal testing and cohorting.21.A.2. A written Crisis Staffing plan that, at a minimum, includes a clear process to recruit personnel that is not reliant on National Guard or government resources as the primary or secondary sources for crisis staffing. The staffing plan should outline a progression of facility interventions to address staffing needs at various steps in the progression of a disease outbreak.21.A.3. A protocol for early identification, reporting, and monitoring of infections (nosocomial and those present on admission) that will: a. Identify residents at risk;b. Maintain a separate record of infections that identifies the resident's name, date of infection, causative agent, origin or site of infection, and cautionary measures taken;c. Prevent infections common to nursing facility residents (e.g., vaccination for influenza and pneumococcal pneumonia as appropriate);d. Analyze the clusters and/or significant increases in the rate of infection;e. Report to appropriate agencies those infections for which reporting is mandated.f. Require the facility to notify the MeCDC, all other residents and their primary family contact, staff, and DLC of a probable or confirmed case of a contagious infection in a resident or staff member within 24 hours.21.A.4. A protocol for prevention of the spread of infection that requires: a. The facility must isolate the resident when the infection control program determines that a resident needs isolation to prevent the spread of infection.b. The facility may only restrict visitation and departures consistent with CDC and MeCDC guidelines.c. The facility must establish reasonable methods and processes to allow residents to communicate in ways that maintain resident safety consistent with CDC guidelines. Such methods could include, but are not limited to, the use of electronic video conferencing and visual visitation on-site through closed windows, supplemented with telephones.d. The facility must monitor staff infections and prohibit employees with a communicable disease or infected skin lesions from direct contact with residents' food. e. During an infection outbreak, the facility must screen all individuals upon entry through a designated entrance of the facility. This screening must be done using the most current CDC screening methods.f. The facility must have PPE sufficient to last for 72 hours on hand at all times and report PPE resources to the MeCDC in the format and frequency specified by the MeCDC.g. The facility must ensure adherence to CDC guidance on the use of PPE and source control measures.h. The facility must require staff to wash their hands after each direct resident contact for which handwashing is indicated by accepted professional practice (per CDC guidelines).i. The facility must conduct cleaning and sanitation using cleaning agents and processes consistent with federal guidance.21.A.5. An active training program that provides staff and residents, as appropriate, adequate information to prevent the spread of infection. 21.A.6. Routine review of infectious disease surveillance and recommendations made by the facility's Quality Assurance Committee.21.A.7 The facility must have (employed or through contract) an Infection Preventionist whose qualifications are consistent with 42 CFR § 483.80(b), who is responsible for the facility's infection control program. The Infection Preventionist shall: a. Ensure that staff have received training and demonstrated competency in appropriate PPE selection and utilization, to include donning/doffing processes consistent with current CDC guidelines; b. Conduct random visual observations of staff use of PPE. These visual observations shall occur at least weekly. Each shift (days, evenings, nights) shall be observed at least once a month during an infection outbreak, then quarterly after there is documentation that all staff are sufficiently trained and observed competent in PPE use; and c. Take immediate corrective actions (to include applicable retraining of staff) to prevent cross-contamination.21.B.Biomedical Waste Management21.B.1. Each facility shall have policies and procedures for containment and disposal of biomedical waste. a. Identification of Biomedical Waste 1. "Biomedical Waste" means a waste that may contain human pathogens of sufficient virulence and in sufficient concentrations that exposure to it by a susceptible host could result in disease. 2. "Body Fluids", as defined by the CDC, means waste which, at the time of generation, is soaked or dripping with human blood, blood products or body fluids.3. "Sharps" means items which may cause puncture wounds or cuts including, but not limited to, hypodermic needles, syringes, scalpel blades, capillary tubes and lancets, disposable razors, Pasteur pipettes, broken glassware, I.V. tubing with needles attached and dialysis bags with needles attached.b. Disposal 1. Biomedical waste shall be incinerated (or interred) per contract with a licensed biomedical waste contractor.2. Biomedical waste (other than Sharps) shall be packaged in bags which are impervious to moisture and of sufficient strength to resist tearing or bursting. a. All bags containing biomedical waste shall be red in color and be labeled with the symbol for biomedical waste.b. Bags shall be sealed by forming a secure closure which results in a leak resistant seal.c. Red bags may not be enclosed in a bag of another color.3. Discarded sharps shall be placed directly into leak resistant, rigid, puncture resistant containers, without clipping or breaking. a. Containers shall be taped closed or tightly lidded to preclude loss or leakage of contents.10- 144 C.M.R. ch. 110, § 21