216 R.I. Code R. 216-RICR-20-15-7.6

Current through December 26, 2024

Section 216-RICR-20-15-7.6 - Minimum Standards for Immunization and Communicable Disease Testing for Health Care Workers

A. A pre-employment health screening shall be required for each healthcare worker involved in direct patient contact. Acceptable evidence shall be provided by the healthcare worker that testing and/or immunization for the communicable diseases listed in these Regulations for pre-employment health screening have been completed.

B. The healthcare facility shall document, in written or electronic form, that said acceptable evidence has been provided by the healthcare worker and validated by the practitioner as being acceptable in accordance with § 7.7 of this Part. Copies of said acceptable evidence shall be maintained in the healthcare worker's file.

C. A practitioner shall have responsibility for performance of the pre-employment health screening. Such a practitioner may be an employee of the facility where employment is sought or may be an independent non-employee, contracted practitioner.

D. A healthcare worker who is not in compliance with these requirements shall be excluded from attending patients in a healthcare facility until the requirements are met.

7.6.1Immunization and Testing Requirements

A. In accordance with the guidelines set forth in § 7.3(B) of this Part, evidence of immunity is required for all healthcare workers (except for healthcare workers who receive a medical exemption) against:

1. Measles, Mumps and Rubella

a. Pre Employment: Two (2) doses of MMR (measles-mumps-rubella) vaccine. Alternatively, two (2) doses of a live measles-containing vaccine, two (2) doses of a live mumps-containing vaccine and one (1) dose of a rubella vaccine. The first (1^st) dose of vaccine must have been administered on or after the first (1^st) birthday. The second (2^nd) dose of a measles or mumps containing vaccine must be administered at least four (4) weeks after the first (1^st) dose. or

b. Laboratory evidence of immunity or laboratory confirmation of disease (i.e., laboratory report of positive IgG titers for measles, and mumps and rubella). An equivocal laboratory result for measles, mumps and/or rubella are considered negative and vaccination is required.

c. Current Healthcare Workers. For unvaccinated health care workers born before 1957 who lack laboratory evidence of measles immunity or laboratory confirmation of disease, two (2) doses of MMR vaccine is recommended.

d. Outbreak Control. For unvaccinated healthcare workers born before 1957 who lack laboratory evidence of measles immunity or laboratory confirmation of disease, health-care facilities shall require two (2) doses of MMR vaccine during an outbreak of measles.

2. Varicella (Chickenpox)

a. Two (2) doses of varicella vaccine. The second (2^nd) dose of varicella vaccine must be administered at least four (4) weeks after the first (1^st) dose; or

b. Laboratory evidence of immunity or laboratory confirmation of disease; or

c. A healthcare provider diagnosis of varicella or healthcare provider verification of history of varicella disease; or

d. History of herpes zoster based on healthcare provider diagnosis.

3. Tetanus, Diphtheria and Pertussis (Whooping Cough)

a. Pre-employment: One (1) single dose of Tdap (tetanus-diphtheria-pertussis) vaccine is required for all healthcare workers who have not previously received a dose of Tdap vaccine.

b. Effective 1 January 2014: This requirement shall apply to current employees, as well as new employees.

4. Annual Seasonal Influenza

a. Annual influenza vaccination is required for all healthcare workers, subject to § 7.8(F) of this Part.

b. Each healthcare facility shall develop a specific plan to require annual influenza vaccination of all health care workers in a timely manner in keeping with ACIP guidelines, and at no cost to the health care worker.

c. Each healthcare facility shall maintain an active surveillance program to track and record influenza vaccination levels among healthcare workers, including vaccinations obtained outside of the formal healthcare facility program.

d. Each healthcare facility shall be responsible for reporting to the Department:

(1) The number of healthcare workers who are eligible for vaccination;

(2) The number of healthcare workers who received vaccination; and

(3) The number of healthcare workers who decline annual influenza vaccination for medical or personal reasons, reported by each of the two (2) categories.

(4) Such reporting shall occur according to procedures and format required by the Department.

5. Tuberculosis (TB)

a. Pre-employment: Evidence that the healthcare worker is free of active tuberculosis based upon the results of a negative two (2) step tuberculin skin test shall be required.

(1) If documented evidence is provided by the healthcare worker that a two (2) step tuberculin skin test, performed within the most recent twelve (12) months prior to hire, was negative, the requirements of this section shall be met. For healthcare workers who can present documentation of serial tuberculin testing with negative results in the prior two (2) years (or more), a single baseline negative tuberculin test result is sufficient evidence of absence of TB infection.

(2) A negative U.S. Food and Drug Administration (FDA)-approved blood assay for Mycobacterium tuberculosis (BAMT) may be used instead of a two (2) step tuberculin skin test. If the baseline BAMT is positive, screening should proceed as indicated below for positive PPD.

(3) Documentation shall include date and result of the tuberculin skin test (PPD), and reaction size in millimeters or an actual copy of the laboratory test result from a BAMT.

(4) If the PPD test or BAMT is positive, consistent with the most current CDC guidance, or a previous one is known to have been positive, a physician's or other licensed practitioner's (acting within his or her scope of practice) certification that the health care worker is free of active disease shall be required. Such certification shall be based on documentation of adequate chemotherapy for TB disease or chemoprophylaxis for latent TB infection in the past, and a current history of freedom from signs and symptoms of TB. In the absence of documentation of chemotherapy or chemoprophylaxis, a negative chest x-ray shall be required for certification. The chest x-ray shall have been performed at any time after the most recent positive PPD test result.

(5) A physician, certified registered nurse practitioner, or a physician assistant may certify that the healthcare worker is currently free of TB based on his or her clinical judgment for complex cases or unusual circumstances that do not fit the above criteria.

b. Current Healthcare Workers

(1) Periodic follow up testing of all healthcare workers must be based on the CDC Guidelines for Preventing the Transmission of Mycobacterium Tuberculosis in Health-Care Settings incorporated above at § 7.3(C) of this Part.

(2) Effective 1 January 2013, healthcare workers with newly detected latent TB infection (LTBI) at initial or periodic testing are required to be referred for care with intent to obtain treatment for latent TB infection. Referral of previously (prior to 1 January 2013) known LTBI for care is recommended.

(3) Effective 1 January 2013, LTBI cases detected in healthcare workers must also be reported to the RI TB Program on standard reporting forms.

6. Hepatitis B Vaccination and Testing

a. Healthcare facilities shall abide by the OSHA Blood Borne Pathogens Standard, incorporated above at § 7.3(D) of this Part including the offering of hepatitis B vaccination along with all recommendations for infection control training and provision of protective equipment to those healthcare workers at risk.

b. An exposure control plan shall be in place in all healthcare facilities licensed by the Department, pursuant to the provisions of R.I. Gen. Laws Chapter 23-17.

c. Employees at risk of exposure to blood-borne pathogens shall be offered hepatitis B vaccine within ten (10) days of employment.

(1) The hepatitis B vaccination series consists of three (3) doses of vaccine given as two (2) doses four (4) weeks apart followed by a third (3^rd) dose five (5) months after the second (2^nd) dose.

(2) It is recommended that testing for anti-HBs be performed one (1) to two (2) months after the last dose.

(3) Persons failing to develop a titer shall be offered a repeat three (3) dose series with follow up titers.

(4) Employees have the option of signing a standard OSHA declination form if they choose not to be vaccinated and should be counseled regarding risk.

d. If the healthcare worker, upon hire, has written documentation of a full hepatitis B vaccine series administered in accordance with ACIP guidelines, testing for anti-HBs shall not be necessary. If the healthcare worker has a subsequent exposure to HBV, hepatitis B immunoprophylaxis should be administered following ACIP guidelines for a person who has been vaccinated, but the immune response is not known.

B. In accordance with the guidelines set forth in § 7.3(B) of this Part, with respect to SARS-CoV-2 (COVID-19) vaccination, a healthcare worker or assisted living residence worker shall:

1. Be up to date with all CDC recommended doses of FDA approved or authorized COVID-19 vaccine (e.g., Moderna, Pfizer, or Johnson & Johnson) or have received all recommended dose(s) of another COVID-19 vaccine approved by the Department (e.g., Novavax); or

2. Wear an N95 mask at each healthcare facility or assisted living residence during where he or she is employed or volunteering, or with which he or she is compensated by a third (3^rd) party which has an agreement with the healthcare facility to provide staffing services during each direct patient contact or while in a patient care area in the performance of his or her duties when a period in which the COVID-19 prevalence rate in the State is greater than or equal to fifty (50) cases per one hundred thousand (100,000) people per week, as reported by the Department.

3. In accordance with the Center for Medicaid and Medicare Services (CMS) 86 FR 61555, all Medicare and Medicaid certified providers, suppliers, and healthcare workers are required to receive the primary series (e.g., two (2) doses of Pfizer or Moderna, or one (1) dose of Johnson & Johnson) of a COVID-19 vaccine.

216 R.I. Code R. 216-RICR-20-15-7.6

Amended effective 6/15/2022