PURPOSE: This rule defines terminology used
throughout this chapter and defines terms related to infectious
(1) Administrator is
the person in charge of an institution, such as the chief executive officer,
chairperson of the board, administrator, clinician in charge, or any equivalent
distress syndrome (ARDS) is a syndrome with the following simultaneous
(A) Hypoxemia due to
intrapulmonary shunting of blood;
(B) Increased lung stiffness; and
(C) Chest x ray evidencing diffuse
is the State Board of Health.
Carrier is a person who harbors a specific infectious agent in the absence of
discernible clinical disease and serves as a potential source or reservoir of
infection for man.
(5) Case, as
distinct from a carrier, is a person in whose tissues the etiologic agent of a
communicable disease is present and which usually produces signs or symptoms of
disease. Evidence of the presence of a communicable disease also may be
revealed by routine laboratory findings.
(6) Cluster is a group of individuals who
manifest the same or similar signs and symptoms of disease.
(7) Communicable disease is an illness due to
an infectious agent or its toxic products and transmitted, directly or
indirectly, to a susceptible host from an infected person, animal or arthropod,
or through the agency of an intermediate host or a vector, or through the
is a person or animal that has been in association with an infected person or
animal and through that association has had the opportunity to acquire the
representative is any person or group of persons appointed by the director of
the Department of Health and Senior Services to act on behalf of the director
or the State Board of Health.
Director is the state Department of Health and Senior Services
Disinfection is the
killing of pathogenic agents outside the body by chemical or physical means,
(A) Concurrent disinfection
is disinfection immediately after the discharge of infectious material from the
body of an infected person or after the soiling of articles with the infectious
disinfection is the process of rendering the personal clothing and immediate
physical environment of a patient free from the possibility of conveying the
infection to others after the patient has left the premises or after the
patient has ceased to be a source of infection or after isolation practices
have been discontinued.
(12) Environmental and occupational diseases
are illnesses or adverse human health effects resulting from exposure to a
chemical, radiological or physical agent.
(13) Exposure is defined as contact with,
absorption, ingestion or inhalation of chemical, biologic, radiologic, or other
physical agents by a human that results in biochemical, physiological or
(14) Food is
any raw, cooked or processed edible substance, ice, beverage or ingredient used
or intended for use in whole or in part for human consumption.
(15) Heat exhaustion means a reaction to
excessive heat marked by prostration, weakness and collapse resulting from
(16) Heat stroke means
a severe illness caused by exposure to excessively high temperatures and
characterized by severe headache; high fever with a dry, hot skin; tachycardia;
and in serious cases, collapse, coma or death.
(17) Hyperthermia means a physician-diagnosed
case of heat exhaustion or heat stroke.
(18) Hypothermia means a physician-diagnosed
case of cold injury associated with a fall of body temperature to less than
ninety-four and one-tenth degrees Fahrenheit
(94.1oF) and resulting from exposure to a cold
reportable diseases are those diseases or findings listed in
and shall be
reported at once, without delay and with a sense of urgency by means of rapid
communication to the Missouri Department of Health and Senior Services or to
the local public health agency, regardless of the day or hour.
(20) Immunization is a treatment which
renders an individual less susceptible to the pathologic effects of a disease
or provides a measure of protection against the disease.
Infectious waste is waste capable of
producing an infectious disease. For a waste to be infectious, it must contain
pathogens with sufficient virulence and quantity so that exposure to the waste
by a susceptible host could result in an infectious disease. Infectious waste
generated by small quantity generators shall include the following categories:
(A) Sharps-all discarded sharps including
hypodermic needles, syringes and scalpel blades. Broken glass or other sharp
items that have come in contact with material defined as infectious are
(B) Cultures and stocks
of infectious agents and associated biologicals-included in this category are
all cultures and stocks of infectious organisms as well as culture dishes and
devices used to transfer, inoculate and mix cultures; and
(C) Other wastes-those wastes designated by
the medical authority responsible (physician, podiatrist, dentist,
veterinarian) for the care of the patient which may be capable of producing an
Institution is any public or private hospital, nursing home, clinic, mental
health facility, home health agency, or medical or professional corporation
composed of health care workers.
Invasive disease is caused by a pathogen
that invades the bloodstream and/or normally sterile bodily fluids and has the
potential to cause severe morbidity and/or mortality. Culturing organisms from
blood, cerebrospinal fluid, joint fluid, or pleural fluid identifies invasive
diseases. Examples of conditions caused by invasive organisms include:
influenzae-meningitis, occult febrile bacteremia, epiglottitis, septic
arthritis, pericarditis, abscesses, empyema, and osteomyelitis;
pneumoniae-bacteremia, and meningitis;
meningitidis-meningitis with or without meningococcemia, septicemia
(purpura fulminans), bacteremia, pericarditis, myocarditis, arthritis, and
Streptococcus pyogenes (group A)- bacteremia associated with
cutaneous infection, deep soft tissue infection (necrotizing fasciitis),
meningitis, peritonitis, osteomyelitis, septic arthritis, postpartum sepsis,
neonatal sepsis, and non-focal bacteremia.
(24) Isolation is the separation for the
period of communicability of infected individuals and animals from other
individuals and animals, in places and under conditions as will prevent the
direct or indirect transmission of the infectious agent from infected
individuals or animals to other individuals or animals who are susceptible or
who may spread the agent to others.
Laboratory means a facility for the
biological, microbiological, serological, chemical, immuno-hematological,
biophysical, cytological, pathological, or other examination of materials
derived from the human body for the purpose of providing information for the
diagnosis, prevention, or treatment of any disease or impairment of, or the
assessment of the health of a human. These examinations also include procedures
to determine, measure, or otherwise describe the presence or absence of various
substances or organisms in the body. Facilities only collecting or preparing
specimens (or both) or only serving as a mailing service and not performing
testing are not considered laboratories. Laboratory includes hand-held testing
equipment. All testing laboratories must be certified under the Clinical
Laboratories Improvement Amendment of 1988 (CLIA- 42 CFR part 493
(26) Local health authority is the city or
county health officer, director of an organized health department or of a local
board of health within a given jurisdiction. In those counties where a local
health authority does not exist, the health officer or administrator of the
Department of Health and Senior Services district in which the county is
located shall serve as a local health authority.
(27) Local public health agency is a legally
constituted body provided by a city, county or group of counties to protect the
public health of the city, county or group of counties.
(MRSA), vancomycin-resistant enterococci
(VRE), and nosocomial infection are:
shall be defined as S. aureus strains that are resistant to oxacillin,
nafcillin and methicillin; historically termed MRSA. These organisms are
resistant to all [BETA]-lactam agents, including cephalosporins and
carbapenems. (NOTE: MRSA isolates are often resistant to other multiple,
commonly used classes of antimicrobial agents, including erythromycin,
clindamycin, and tetracycline.)
VRE shall be defined as enterococci that possess intrinsic or acquired
resistance to vancomycin. Several genes, including vanA,
vanB, vanC, vanD, and
vanE, contribute to resistance to vancomycin in
infection shall be defined by the national Centers for Disease Control and
Prevention and applied to infections within hospitals, ambulatory surgical
centers, and other facilities.
(29) Outbreak or epidemic is the occurrence
in a community or region of an illness(es) similar in nature, clearly in excess
of normal expectancy and derived from a common or a propagated
(30) Period of
communicability is the period of time during which an etiologic agent may be
transferred, directly or indirectly, from an infected person to another person
or from an infected animal to a person.
(31) Person is any individual, partnership,
corporation, association, institution, city, county, other political
subdivision authority, state agency or institution or federal agency or
poisoning means human disturbance of function, damage to structure or illness
which results from the inhalation, absorption or ingestion of any
(33) Poisoning means
injury, illness or death caused by chemical means.
Quarantine is a restriction of movement
of persons or animals that have been exposed to a communicable disease, but
have not yet developed disease. The period of quarantine will not be longer
than the entire incubation period of the disease. The purpose of quarantine is
to prevent effective contact with the general population.
(A) Complete quarantine is a limitation of
freedom of movement of persons or animals exposed to a reportable disease, for
a period of time not longer than the entire incubation period of the disease,
in order to prevent effective contact with the general population.
(B) Modified quarantine is a selective,
partial limitation of freedom of movement of persons or animals determined on
the basis of differences in susceptibility or danger of disease transmission.
Modified quarantine is designed to meet particular situations and includes, but
is not limited to, the exclusion of children from school, the closure of
schools and places of public or private assembly and the prohibition or
restriction of those exposed to a communicable disease from engaging in a
(35) Reportable disease is any disease or
condition for which an official report is required. Any unusual expression of
illness in a group of individuals which may be of public health concern is
reportable and shall be reported to the local health department, local health
authority or the Department of Health and Senior Services by the quickest
(36) Small quantity
generator of infectious waste is any person generating one hundred kilograms
(100 kg) or less of infectious waste per month and as regulated in 10 CSR
(37) Statewide pandemic is an
outbreak of a particularly dangerous disease affecting a high proportion of the
population, appearing in three (3) or more counties, as declared by the
director of the Department of Health and Senior Services.
Terrorist event is the unlawful use of
force or violence committed by a group or individual against persons or
property to intimidate or coerce a government, the civilian population, or any
segment thereof, in furtherance of political or social objectives. Terrorist
attacks are classified as chemical, biological, or radiological.
(A) Chemical means any weapon that is
designed or intended to cause widespread death or serious bodily injury through
the release, dissemination, or impact of toxic or poisonous chemicals or
precursors of toxic or poisonous chemicals.
(B) Biological means any microorganism,
virus, infectious substance, or biological product that may be engineered as a
result of biotechnology, or any naturally occurring or bioengineered component
of any such microorganism, virus, infectious substance, or biological
(C) Radiological means any
weapon that is designed to release radiation or radioactivity at a level
dangerous to human life.
(39) Toxic substance is any substance,
including any raw materials, intermediate products, catalysts, final products
or by-products of any manufacturing operation conducted in a commercial
establishment that has the capacity through its physical, chemical or
biological properties to pose a substantial risk of death or impairment, either
immediately or later, to the normal functions of humans, aquatic organisms or
any other animal.
diseases-Examples include, but are not limited to, the following:
(A) Diseases uncommon to a geographic area,
age group, or anatomic site;
Cases of violent illness resulting in respiratory failure;
(C) Absence of a competent natural vector for
a disease; or
(D) Occurrence of
Unusual manifestation of
illness-Examples include, but are not limited to, the following:
(A) Multiple persons presenting with a
similar clinical syndrome at a steady or increasing rate;
(B) Large numbers of rapidly fatal cases,
with or without recognizable signs and symptoms;
(C) Two (2) or more persons, without a
previous medical history, presenting with convulsions;
(D) Persons presenting with grayish colored
tissue damage; or
(E) Adults under
the age of fifty (50) years, without previous medical history, presenting with
adult respiratory distress syndrome (ARDS).
Varicella (Chickenpox) severity of
illness shall include the following categories:
(A) Mild-less than fifty (50) lesions (able
to count lesions within thirty (30) seconds);
(B) Moderate-fifty to five hundred (50-500)
lesions (anything in between mild and severe); and
(C) Severe-more than five hundred (500)
lesions (difficult to see the skin) or lesions with complications.