Ohio Admin. Code 3701-16-12 - Changes in residents' health status; incidents; infection control; tuberculosis control plan

(A) In the event of a significant adverse change in residents' health status, the residential care facility shall is obligated to do all of the following:

(1) Take immediate and proper steps to see that the resident receives necessary intervention including, if needed, medical attention or transfer to an appropriate medical facility;

(2) Make a notation of the change in health status and any intervention taken in the resident's record;

(3) Provide pertinent resident information to the person providing the intervention as soon as possible; and

(4) Notify the sponsor unless the resident refuses or requests otherwise.

(B) As used in this paragraph, "incident" means any accident or episode involving a resident, staff member, or other individual in a residential care facility which presents a risk to the health, safety, or well-being of a resident. In the event of an incident, the facility shall is obligated to do both of the following:

(1) Take immediate and proper steps to see that the resident or residents involved receive necessary intervention including, if needed, medical attention or transfer to an appropriate medical facility; and

(2) Investigate the incident and document the incident and the investigation and include information that will enable staff to identify to the director upon request, the resident involved in an incident. The facility shall is obligated to maintain an incident log separate from the resident record which shall is be accessible to the director and shall contain contains the time, place, and date of the occurrence; a general description of the incident; and the care provided or action taken. The facility shall is obligated to maintain a notation document about the incident in the resident's record.

(C) Each residential care facility shall will establish and implement appropriate written policies and procedures to control assure a safe, sanitary, and comfortable environment for the residents and to control the development and transmission of infections and diseases. Each residential care facility is obligated to establish an infection prevention and control program to monitor compliance with the home's infection prevention and control policies and procedures, to prevent, investigate, and control infections in the home, to institute appropriate interventions, and ensure all staff are appropriately trained on the home's infection prevention and control protocol. which, at minimum, shall provide for the following An effective infection control program includes:

(1) Each residential care facility is obligated to designate one or more individuals as the infection prevention and control designee and provide that individuals name and contact information, including an electronic mail address, on an electronic system prescribed by the director no later than ten days after hiring or appointing the individual and no later than ten days after the individual's contact information changes or the designated individual is replaced. The infection control designee is responsible for the facility's infection prevention and control program. The infection prevention and control designee will have:

(a) Completed post-secondary education in a health-related field including but not limited to medicine, nursing, medical technology, laboratory technology, public health, epidemiology, or biology;

(b) Have education, training, or experience in infection control; and

(c) Work at least part-time at the facility or hold a contract to provide infection prevention and control at least part-time at the facility.

A residential care facility located in the same building as a nursing home, or on the same lot as a nursing home, both of which are owned and operated by the same entity, will be considered to have met this requirement if the nursing home has an infection prevention and control designee who is responsible for both the residential care facility and nursing home.

(2) A tuberculosis control plan that meets the standards set forth in rule 3701-15-03 of the Administrative Code.

(3) A written surveillance plan outlining the activities for monitoring/tracking infections based on nationally-recognized surveillance criteria such as McGeer criteria and:

(a) Includes a surveillance system that includes a data collection tool;

(b) Uses surveillance data to:

(i) Implement timely corrective action when a greater than expected number healthcare-associated infections are detected; and

(ii) Implement timely corrective actions when transmission of targeted MDROs (e.g., CRE, Candida auris) are detected.

(4) Written standards, policies, and procedures for the program, which must include, but are not limited to:

(a) Standard and transmission-based precautions to be followed to prevent spread of infections;

(b) When and to whom possible incidents of communicable disease or infections should be reported;

(c) When and how isolation should be used for a resident; including but not limited to:

(i) The type and duration of the isolation, depending upon the infectious agent or organism involved, and (B) A requirement; and

(ii) A requirement that the isolation should be the least restrictive possible for the resident under the circumstances.

(5) Written standards, policies, and procedures under which the facility will prohibit employees with a communicable disease or infected skin lesions from direct contact with residents or their food, if direct contact will transmit the disease;

(6) The hand hygiene procedures to be followed by staff involved in direct resident contact, including, but not limited to:

(a) Washing hands for twenty seconds with soap and water; or

(b) Cleaning of hands with an alcohol-based product used according to manufacturer's directions or other alternative methods accepted by the United States Centers for Disease Control and Prevention or US Food and Drug Administration, as being an effective alternative, or handwashing with soap and water.

(7) Written standards, policies, and procedures for laundry to ensure personnel handle, store, process, and transport linens so as to prevent the spread of infection including:

(a) Handling soiled laundry as little as possible;

(b) Placing of laundry that is wet or soiled with body substances in impervious bags that are secured to prevent spillage; and

(c) Wearing of impervious gloves and impervious gowns by individuals performing laundry services, and, if handling soiled or wet laundry on the unit, the wearing of gloves and, if appropriate, other personal protective equipment;

(1) Individuals working in the facility shall wash their hands vigorously for ten to fifteen seconds before beginning work and upon completing work, before and after eating, after using the bathroom, after covering their mouth when sneezing and coughing, before and after providing personal care services or skilled nursing care, when there has been contact with body substances, after contact with contaminated materials, before handling food, and at other appropriate times;

(2) If the residential care facility provides any laundering services, the facility shall keep clean and soiled linen separate. Soiled laundry shall be handled as little as possible. Laundry that is wet or soiled with body substances shall be placed in moisture-resistant bags which are secured or tied to prevent spillage. Laundry staff shall wear moisture-resistant gloves, suitable for sorting and handling soiled laundry, and a moisture-resistant gown or sleeved plastic apron if soiling of staff members' clothing is likely. The facility shall use laundry cycles according to the washer and detergent manufacturers' recommendations. Protective clothing shall be removed before handling clean laundry;

(3) Individuals providing personal care services or skilled nursing care that may result in exposure to body substances, shall wear disposable vinyl or latex gloves as a protective barrier and shall remove and dispose of the used gloves and wash hands before contact with another resident. If exposed to body substances, the individual who has been exposed shall wash his or her hands and other exposed skin surfaces immediately and thoroughly with soap and water. The facility shall provide follow-up consistent with the guidelines issued by the United States centers for disease control and prevention for the prevention of transmission of human immunodefiency virus and hepatitis B virus to health- care and public-safety workers in effect at the time. Individuals providing personal care services or skilled nursing care shall wash their hands before and after providing the services or care even if they used gloves;

(4) Place disposable articles, other than sharp items, contaminated with body substances in a container impervious to moisture and manage them in a fashion consistent with Chapter 3734. of the Revised Code. Reusable items contaminated with body substances shall be bagged, then sent for decontamination;

(5) Wear a moisture-resistant gown or other appropriate protective clothing if soiling of clothing with body substances is likely;

(6) Wear a mask and protective eye wear if splashing of body substances is likely or if a procedure that may create an aerosol is being performed; and

(7) Ensure that all hypodermic needles, syringes, lancets, razor blades and similar sharp wastes are disposed of by placing them in rigid, tightly closed puncture- resistant containers before they are transported off the premises of the facility, in a manner consistent with Chapter 3734. of the Revised Code. The residential care facility shall provide instructions to residents who use sharps on the proper techniques for disposing of them.

For the purposes of this paragraph, "body substance" means blood, semen, vaginal secretions, feces, urine, wound drainage, emesis, and any other body fluids that have visible blood in them.

(D) Each residential care facility will establish and implement an effective water management program to identify hazardous conditions, and take steps to manage the risk of occurrence and transmission of waterborne pathogens, including but not limited to legionella, in building water systems in accordance with guidance from the United States centers for disease control and prevention (available at https://www.cdc.gov/legionella/wmp/overview.html ) and recommendations of the United States centers for disease control and prevention healthcare infection control practices advisory committee, "Environmental Infection Control Guidelines" (2019) or its successors.

(D) Each residential care facility shall appoint an individual with knowledge of the facility's infection control plans to serve as a infection control designee and provide that individuals name and contact information, including a electronic mail address, on an electronic system prescribed by the director.

(E) If the residential care facility provides an adult day care program which is located, or shares space, within the same building as the residential care facility, shares staff between the program and the facility, or where the day care participants at any time intermingle with residents of the facility, the requirements of this rule are also applicable to participants of the adult day care program.

(E) Each residential care facility shall develop and follow a tuberculosis control plan that is based on the home's assessment of the facility. The control and annual assessment shall be consistent with the United States centers for disease control and prevention "Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health Care Settings, 2005," MMWR 2005, Volume 54, No. RR-17. The home shall retain documentation evidencing compliance with this paragraph and shall furnish such documentation to the director upon request.

Notes

Ohio Admin. Code 3701-16-12

Effective: 7/12/2024
Five Year Review (FYR) Dates: 4/25/2024 and 07/02/2029
Promulgated Under: 119.03
Statutory Authority: 3721.04
Rule Amplifies: 3721.07; 3721.01
Prior Effective Dates: 12/21/1992, 09/29/1996, 12/01/2001, 01/01/2013, 12/28/2014, 03/01/2018