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The Oregon Administrative Rules contain OARs filed through July 15, 2014
 
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OREGON HEALTH AUTHORITY,
PUBLIC HEALTH DIVISION

 

DIVISION 19

INVESTIGATION AND CONTROL OF DISEASES:
GENERAL POWERS AND RESPONSIBILITIES

333-019-0000

Responsibility of Public Health Authorities to Investigate Reportable Diseases

(1) The local public health administrator shall use all reasonable means to investigate in a timely manner all reports of reportable diseases, infections, or conditions. To identify possible sources of infection and to carry out appropriate control measures, the local public health administrator shall investigate each report following procedures outlined in the Authority's Investigative Guidelines or other procedures approved by the Authority. The Authority may provide assistance in these investigations.

(2) Investigations of outbreaks involving residents of multiple states or counties or exposures in multiple states of counties may be supervised by the Authority.

(3) Investigations by the Authority or public health administrator shall be conducted in accordance with ORS 433.004.

[Publications: Publications referenced are available from the agency.]

Stat. Auth.: ORS 413.042, 431.110, 433.004, 437.010, 616.010 & 624.005
Stats. Implemented: ORS 433.004 & 437.030
Hist.: HD 15-1981, f. 8-13-81, ef. 8-15-81; HD 4-1987, f. 6-12-87, ef. 6-19-87; HD 29-1994, f. & cert. ef. 12-2-94; OHD 4-2002, f. & cert. ef. 3-4-02; PH 7-2011, f. & cert. ef. 8-19-11

333-019-0002

Cooperation with Public Health Authorities

(1) Health care providers, health care facilities, and licensed laboratories shall cooperate with local public health administrators and the Authority in the investigation and control of reportable diseases and conditions.

(2) Every health care provider attending a person with a reportable disease, infection, or condition shall instruct the person in measures appropriate to controlling the spread of the disease.

Stat. Auth.: ORS 413.042, 431.110, 433.004, 437.010, 616.010 & 624.005
Stats. Implemented: ORS 433.004, 433.106 & 433.130
Hist.: OHD 4-2002, f. & cert. ef. 3-4-02; PH 11-2005, f. 6-30-05, cert. ef. 7-5-05; PH 7-2011, f. & cert. ef. 8-19-11

333-019-0003

Providing Information to the Oregon Health Authority or Local Public Health Administrator

(1) The Authority or local public health administrator (LPHA) may, as necessary to investigate a case of a reportable disease, disease outbreak or epidemic, require a health care provider, public or private entity, or an individual to permit the inspection or provide copies of information necessary to the investigation.

(2) Information that may be inspected or provided to the Authority or LPHA includes but is not limited to:

(a) Individually identifiable health information and contact information related to:

(A) The case;

(B) An individual who may be the potential source of exposure or infection;

(C) An individual who has been or may have been exposed to or affected by the disease; or

(D) A control.

(b) Policies, practices, systems or structures that may have affected the likelihood of disease transmission.

(c) Factors that may influence an individual's susceptibility to the disease or likelihood of being diagnosed with the disease.

(3) In addition to requesting information the Authority or LPHA may inspect, sample or test real or personal property. The Authority or LPHA will request permission to inspect, sample or test real or personal property prior to taking any action. If an individual or entity refuses to allow access to real or personal property for this purpose, the Authority or LPHA may seek an administrative warrant in order to obtain access.

(4) The Authority or LPHA shall request the information required to be submitted orally or in writing and shall inform the individual or entity from whom the information is sought when the information is required to be submitted. In lieu of requesting that information be provided to the Authority or LPHA, the Authority or LPHA may request access to the information at the location where the information is located.

(5) A person who provides information in accordance with these rules is immune from civil or criminal liability that might otherwise be incurred or imposed with respect to providing information under this section.

(6) Pursuant to ORS 433.008, all information obtained by the Authority or LPHA in the course of an investigation is confidential, may only be released in accordance with ORS 433.008(2) through (6), and except as required for the administration of public health laws or rules, a state or local public health official or employee may not be examined in any administrative or judicial proceeding about the existence or contents of a reportable disease report or other information received by the Authority or LPHA in the course of an investigation of a reportable disease or disease outbreak.

Stat. Auth.: ORS 433.004
Stat. Implemented: ORS 433.004
Hist.: PH 7-2011, f. & cert. ef. 8-19-11

333-019-0005

Conduct of Special Studies by the Oregon Health Authority

The Authority may conduct special studies concerning the causes and prevention of diseases and other significant health conditions. Special studies include any collection of information about the health status or potential health risk factors of individuals or groups of individuals, other than the routine collection of birth, death, and marriage information, and are not restricted to reportable diseases, infections, or conditions. The Authority may collaborate with local public health authorities, other institutions, or other individuals in the conduct of these studies.

Stat. Auth.: ORS 413.042, 431.110, 433.004, 437.010, 616.010 & 624.005
Stats. Implemented: ORS 433.006 & 433.065
Hist.: HD 15-1981, f. 8-13-81, ef. 8-15-81; HD 4-1987, f. 6-12-87, ef. 6-19-87; HD 9-1997, f. & cert. ef. 6-26-97; OHD 4-2002, f. & cert. ef. 3-4-02; PH 11-2005, f. 6-30-05, cert. ef. 7-5-05; PH 7-2011, f. & cert. ef. 8-19-11

Disease-Related School, Child Care, and Worksite Restrictions

333-019-0010

Imposition of Restrictions

(1) To protect the public health, persons who attend or work at schools or child care facilities or who work at health care facilities or food service facilities shall not attend or work at these facilities whilst in a communicable stage of any restrictable diseases unless authorized to do so as hereunder specified.

(2) At all such facilities, restrictable diseases include: diphtheria, measles, Salmonella enterica serotype Typhi infection, shigellosis, Shiga-toxigenic Escherichia coli (STEC) infection, hepatitis A, tuberculosis, open or draining skin lesions infected with Staphylococcus aureus or Streptococcus pyogenes, and any illness accompanied by diarrhea or vomiting.

(3) At schools, child care, and health care facilities, such restrictable diseases shall also include: chickenpox, mumps, pertussis, rubella, and scabies. Children in the communicable stages of hepatitis B infection may be excluded from attending school or child care if, in the opinion of the local health officer, the child poses an unusually high risk to other children (for example, exhibits uncontrollable biting or spitting).

(4) At the discretion of local school authorities or the local public health authority, pediculosis may be considered a school-restrictable condition.

(5) Nothing in these rules prohibits the adoption of more stringent rules regarding exclusion from schools or child care facilities. Such additional restrictions shall require formal certification that the disease or condition in question presents a significant public health risk in that setting. For schools, this action may be taken by the local public health authority or the local school governing body. For child care facilities, this action may be taken by the local public health authority.

(6) The infection control committee at all health care facilities shall adopt policies to restrict the work of employees with restrictable diseases in accordance with recognized principles of infection control. Nothing in these rules prohibits health care facilities or the local public health authority from adopting additional or more stringent rules for exclusion from these facilities.

Stat. Auth.: ORS 413.042, 431.110, 433.004, 433.329, 433.332, 616.750, & 624.005
Stats. Implemented: ORS 433.260, 433.407, 433.411 & 433.419
Hist.: HD 15-1981, f. 8-13-81, ef. 8-15-81; OHD 4-2002, f. & cert. ef. 3-4-02; PH 11-2005, f. 6-30-05, cert. ef. 7-5-05; PH 7-2011, f. & cert. ef. 8-19-11; PH 16-2013, f. 12-26-13, cert. ef. 1-1-14

333-019-0014

Removal of Restrictions

(1) Worksite, child care, and school restrictions can be removed by statement of the local public health administrator that the disease is no longer communicable to others or that adequate precautions have been taken to minimize the risk of transmission.

(2) School or child care restrictions for chickenpox, scabies, staphylococcal skin infections, streptococcal infections, diarrhea, or vomiting may also be removed by a school nurse or health care provider.

(3) Restrictions at health care facilities for chickenpox, scabies, staphylococcal skin infections, streptococcal infections, diarrhea, or vomiting may also be removed by the facility's infection control committee when sufficient measures have been taken to prevent or minimize the transmission of disease, in accordance with written procedures approved by the committee.

(4) In general, restrictions on persons diagnosed with shigellosis or Shiga-toxigenic Escherichia coli (STEC) infection, including E. coli O157 infection shall not be lifted until no pathogens are identified by a licensed laboratory in two consecutive approved fecal specimens collected not less than 24 hours apart. Such restrictions may be waived or modified at the discretion of the local public health administrator.

(5) Individuals infected with Salmonella enterica serotype Typhi (with or without symptoms), hereinafter referred to as "typhoid cases," must, before having a restriction removed, submit fecal specimens and one urine specimen to a licensed laboratory for testing on a schedule specified by the local public health administrator.

(6) A restriction on a typhoid case who is not a chronic carrier must be lifted by the local public health administrator when Salmonella enterica serotype Typhi is not identified by a licensed laboratory in any of four successive approved fecal specimens, collected at least 24 hours apart and not earlier than one month after illness onset, and one urine specimen.

(7) A “chronic carrier” is an individual who has fecal specimens test positive for Salmonella enterica serotype Typhi more than one year after onset or first diagnosis or on two occasions at least one year apart. A restriction on a chronic carrier may only be removed when Salmonella enterica serotype Typhi is not identified by a licensed laboratory in any of six successive approved fecal specimens, collected at least 72 hours apart, and one urine specimen.

Stat. Auth.: ORS 413.042, 431.110, 433.004, 616.010 & 624.005
Stats. Implemented: ORS 433.004, 433.260 & 433.273
Hist.: OHD 4-2002, f. & cert. ef. 3-4-02; PH 7-2011, f. & cert. ef. 8-19-11; PH 16-2013, f. 12-26-13, cert. ef. 1-1-14

Pet Licensing, Animal Bites, and Rabies

333-019-0017

Rabies Vaccination for Animals

(1) Except where specifically exempt, all dogs at least three months old shall be immunized against rabies by the age of six months. The following are exempt:

(a) Dogs brought temporarily into the state for periods of less than 30 days and kept under strict supervision by their owners;

(b) Dogs for which rabies immunization is contraindicated for health reasons, as determined by a licensed veterinarian subsequent to an examination. The reasons for the exemption and a specific description of the dog, including name, age, sex, breed, and color, shall be recorded by the examining veterinarian on a Rabies Vaccination Certificate, which shall bear the owner's name and address. The veterinarian shall also record whether the exemption is permanent, and if it is not, the date the exemption ends;

(c) Dogs that are owned by dealers, breeders, or exhibitors exclusively for sale or exhibition purposes and that are confined to kennels except for transportation under strict supervision to and from dog shows or fairs.

(2) Vaccination of an animal against rabies is valid only when performed:

(a) By a licensed veterinarian as specified by ORS 686.350 through 686.370 and OAR 875-010-0006;

(b) By a veterinary technician (certified according to OAR 875-030-0010) under the direct supervision of a licensed veterinarian; or

(c) In the case of a need to vaccinate and the lack of an available veterinarian, by another person approved for this purpose by the State Public Health Veterinarian.

(3) To be considered immunized against rabies, dogs and cats must be vaccinated according to guidelines published by the U.S. Centers for Disease Control and Prevention in the Compendium of animal rabies prevention and control, MMWR April 18, 2008; 57 (No. RR-2).

(4) A Rabies Vaccination Certificate shall be completed and signed by a licensed veterinarian; electronic signatures are acceptable. That individual shall give the original and one copy to the dog's owner and retain one copy for the period for which the vaccination is in force. The Certificate must include at least the following information: owner's name and address; dog description by age, sex, color, breed; date of vaccination; due date for revaccination; type and lot number of vaccine used; and name and address of vaccinator.

[Publications: Publications referenced are available from the agency.]

Stat. Auth.: ORS 413.042 & 433.365
Stats. Implemented: ORS 433.365
Hist.: OHD 4-2002, f. & cert. ef. 3-4-02; PH 6-2003, f. & cert. ef. 5-22-03; PH 11-2005, f. 6-30-05, cert. ef. 7-5-05; PH 5-2010, f. & cert. ef. 3-11-10

333-019-0019

Dog Licensing

(1) Each dog shall be licensed by the local animal control agency in whose jurisdiction its owner resides.

(2) No dog shall be licensed until the owner of a vaccinated dog presents, in person or by mail, the original Rabies Vaccination Certificate to the County Clerk or designated animal control officer serving that jurisdiction.

(3) Upon receipt of applicable fees (if any, pursuant to ORS 433.380), the local animal control agency shall issue a serially numbered tag legibly identifying an expiration date that may not exceed the vaccine coverage expiration date by more than two months. The tag shall be attached to a collar or harness that shall be worn by the dog at all times when off the premises of the owner.

(4) The local animal control agency may request and file the Rabies Vaccination Certificate, cross-referenced to the tag number.

(5) An unexpired tag shall be honored throughout Oregon.

(6) A dog's rabies vaccination tag may, at the discretion of the local animal control agency, serve as the dog license, but not for more than two months beyond the immunity expiration date.

(7) Nothing in these rules shall be construed to limit the power of any jurisdiction to enact more stringent requirements to regulate and control dogs.

Stat. Auth.: ORS 413.042, 431.110, 433.004, 433.340
Stats. Implemented: ORS 433.380
Hist.: OHD 4-2002, f. & cert. ef. 3-4-02

333-019-0022

Wolf-Dog Hybrids

For the purposes of dog licensing, immunization, and response to bites, wolf-dog hybrids shall be considered wild animals and not dogs. The status of an animal as a dog or as a wolf-dog hybrid shall be determined by a Licensed Veterinarian. Such determinations may consider descriptions of the animal in medical records and prior claims made by the owner, and shall be subject to review by the State Public Health Veterinarian or designee.

Stat. Auth.: ORS 413.042, 431.001, 433.004, 433.340, 686.010 & 686.020
Stats. Implemented: ORS 433.004 & 433.380
Hist.: OHD 4-2002, f. & cert. ef. 3-4-02

333-019-0024

Management of Animal Bites

(1) The circumstances surrounding bites of humans by mammals shall be investigated by the local public health administrator in accordance with the Investigative Guidelines published by the Authority.

(2) Except as provided in section (3) of this rule, any dog, cat, or ferret that has bitten a person shall be held for observation until the 10th day following the bite. This observation shall be under the supervision of a licensed veterinarian or other person designated by the local public health administrator. Animals shall be held within an enclosure or with restraints deemed adequate by the local public health administrator to prevent contact with any person or other animals. At the discretion of the local public health administrator, properly vaccinated dogs used by public law enforcement agencies may be exempted from the observation period requirement; however, any law enforcement agency shall notify the local public health administrator immediately should any exempted dog develop abnormal behavior within 10 days of biting a person.

(3) The local public health administrator may order the euthanasia and rabies testing of animals that have bitten humans when these animals are:

(a) Inadequately vaccinated dogs, cats, or ferrets that have inflicted an unprovoked bite to the face, head, or neck of a person; or

(b) Any other mammal suspected of having rabies or that has been in contact with an animal suspected of having rabies.

(4) Because it is preferable to hold such animals for observation, no person shall either euthanize any dog, cat, or ferret that has bitten a human or destroy the head of any mammal that has bitten a person without authorization by the local public health administrator.

[Publications: Publications referenced are available from the agency.]

Stat. Auth.: ORS 413.042, 431.110, 433.004, 433.340, 433.350
Stats. Implemented: ORS 433.345, 433.350
Hist.: OHD 4-2002, f. & cert. ef. 3-4-02; PH 7-2011, f. & cert. ef. 8-19-11

333-019-0027

Management of Possibly Rabid Animals

(1) An animal is considered to have been in close contact with an animal suspected of having rabies when, within the past 180 days, it has been bitten, mouthed, mauled by, or closely confined with a rabid animal or any mammal suspected of having rabies.

(2) The disposition of such animals and of animals suspected of having rabies that have not bitten humans shall be determined by the local public health authority as follows:

(a) Inadequately vaccinated dogs, cats, and ferrets shall be destroyed immediately, if the owner permits. If the owner does not agree to this, the animal shall be confined as prescribed by the local public health authority for a period of six months under the observation of a licensed veterinarian or a person designated by the local public health authority. It should be vaccinated against rabies one month before release.

(b) Dogs, cats, and ferrets that are adequately vaccinated shall be revaccinated immediately and observed in confinement for 45 days by a person designated by the local public health authority. If the owner prefers, such animals can be destroyed (in lieu of confinement) with the concurrence of the local public health authority.

(c) Unless the owner prefers to hold any unvaccinated livestock or wild animals born and raised in captivity in confinement for six months, such animals shall be destroyed.

(d) Unless otherwise specified, all other mammals shall be destroyed.

(e) For the purposes of this rule, confinement shall be within an enclosure or with restraints deemed adequate by the local public health authority to prevent contact with any member of the public or any other animal. Nothing in these rules or in OAR 333-019-0024 shall be interpreted to require any public authority to bear the costs of such confinement.

(3) Nothing in these rules is intended or shall be construed to limit the power of any city, city and county, county or district in its authority to enact more stringent requirements to regulate and control animals within its jurisdiction.

Stat. Auth.: ORS 413.042 & 433.360
Stats. Implemented: ORS 433.360
Hist.: OHD 4-2002, f. & cert. ef. 3-4-02; PH 5-2010, f. & cert. ef. 3-11-10

Other Disease-Specific Provisions

333-019-0031

Acquired Immunodeficiency Syndrome/Human Immunodeficiency Virus

Investigation of cases of HIV infection or AIDS. Investigations of HIV infection or AIDS shall be conducted to the extent that resources permit. The Authority, or the local public health administrator, will ensure that each identified case is offered prevention, care, and partner counseling and referral services.

NOTE: Specific rules regarding reporting requirements for HIV and AIDS may be found in OAR 333-018-0015. Rules regarding informed consent for HIV testing and confidentiality of HIV test results may be found in OAR 333-022-0200 through 333-022-0315.

Stat. Auth.: ORS 431.110, 433.004
Stats. Implemented: ORS 431.110, 433.004
Hist.: HD 4-1987, f. 6-12-87, ef. 6-19-87; HD 15-1988, f. 7-11-88, cert. ef. 9-1-88; HD 29-1994, f. & cert. ef. 12-2-94; OHD 13-2001, f. & cert. ef. 7-12-01, Renumbered from 333-019-0223; OHD 22-2001, f. & cert. ef. 10-19-01; OHD 4-2002, f. & cert. ef. 3-4-02; PH 7-2006, f. & cert. ef. 4-17-06; PH 7-2011, f. & cert. ef. 8-19-11; PH 16-2013, f. 12-26-13, cert. ef. 1-1-14

333-019-0036

Special Precautions Relating to Pregnancy and Childbirth

(1)(a) Blood samples drawn from women during pregnancy or at delivery pursuant to ORS 433.017 shall be submitted for standard tests for reportable infectious diseases or conditions which may affect a pregnant woman or fetus. Routine tests submitted shall include syphilis, hepatitis B, and HIV. Tests using bodily fluids other than blood that have equal or better sensitivity and specificity may be substituted for the blood test.

(b) "Consent of the patient to take a sample of blood" (as stated in ORS 433.017, section 3) or other bodily fluid, is defined as notifying the patient or her authorized representative of the tests which will be conducted on that specimen. The patient or her authorized representative shall be informed that she may decline any or all of the tests.

(c) If a patient declines any of the offered tests, documentation shall be included in the medical record.

(2) Any health care provider attending the birth of an infant shall evaluate whether the newborn is at risk for gonococcal ophthalmia neonatorum. The primary means of assessing risk shall be review of results of prenatal testing and maternal history of risk factors for gonococcal. If the infant is determined to be at risk, or risk cannot be adequately assessed, the person attending the birth shall ensure that the newborn receives erythromycin or tetracycline ophthalmic ointment or silver nitrate 1 percent aqueous solution into each eye within two hours after delivery.

Stat. Auth.: ORS 413.042 & 433.017
Stats. Implemented: ORS 433.017, 433.006 & 433.110
Hist.: OHD 4-2002, f. & cert. ef. 3-4-02; PH 20-2005, f. 12-30-05, cert. ef. 1-1-06; PH 5-2010, f. & cert. ef. 3-11-10

333-019-0039

Sudden Infant Death Syndrome

(1) In compliance with ORS 431.120(4), the Authority will conduct an epidemiologic investigation of each instance of sudden infant death syndrome.

(2) In order to promote support of this effort, the Authority will reimburse any county health department (or other agency providing public health services in lieu of a county health department for this purpose) to the extent of $25 to help defray the cost of one home visit by a public health nurse to any family who has lost a member of the family to SIDS.

(3) In order for the home visit to be reimbursed the following procedure will be required:

(a) On receiving the death investigation report in which the cause of death is SIDS, the administrator of the local public health authority receiving the report will, if possible, assure the arrangement of a home visit to the affected family by a public health nurse at an appropriate time;

(b) The home visit will include:

(A) A nursing assessment of family needs related to the SIDS event;

(B) Grief counseling;

(C) Education regarding the state of knowledge regarding the cause of SIDS;

(D) Discussion of other support resources available to help meet family needs;

(E) Information alerting the family to expect to receive in the mail an epidemiologic investigation questionnaire, including an explanation of its purpose, of its confidentiality, and assurance of assistance in completing the form if necessary.

(4) After the home visit has been completed, the local agency will notify the Authority in writing, including the name and birth date of the deceased infant, and the family name and address, and the date of the visit. This notice should be addressed to the Public Health Division, Center for Public Health Practice, 800 NE Oregon Street, Portland, OR 97232.

(5) On receipt of this written notice, the Authority will reimburse the agency in the amount of $25. Reimbursement for repeat visits to the same family will not be available.

(6) An epidemiologic questionnaire will be mailed by the Authority to the parent(s) (guardian) of the deceased infant, with instructions as to its purpose and means of completing and a request that it be completed and returned.

(7) In the event that the completed questionnaire has not been returned in a reasonable length of time, the Authority will notify the county health department (or agency acting in lieu of the county health department) with a request for a follow-up contact with the family to ensure the highest possible rate of return and of accuracy.

(8) Completed questionnaires will be collected and tabulated and the information analyzed by the Authority. A report of the findings will be published biennially beginning in 1985.

Stat. Auth.: ORS 431.001 & 433.004
Stats. Implemented: ORS 431.001 & 433.004
Hist.: HD 3-1983, f. & ef. 3-3-83; HD 16-1991, f. & cert. ef. 10-10-91; HD 29-1994, f. & cert. ef. 12-2-94; OHD 15-2001, f. & cert. ef. 7-12-01, Renumbered from 333-018-0025; OHD 4-2002, f. & cert. ef. 3-4-02; PH 7-2011, f. & cert. ef. 8-19-11

333-019-0041

Tuberculosis

(1) Each health care facility shall formally assess the risk of tuberculosis transmission among staff (professional and volunteer), residents, and patients at least annually and shall follow tuberculosis screening recommendations outlined in "Guidelines for preventing the transmission of Mycobacterium tuberculosis in Health-Care Settings," published by the Centers for Disease Control and Prevention (Morbidity and Mortality Weekly Report, Vol. 54, Number RR-17: 1-141; December 30, 2005) or otherwise approved by the Authority. For the purposes of this rule “health care facility” has the meaning given that term in ORS 442.015.

(2) Each facility specified below shall formally assess the risk of tuberculosis transmission among staff (professional and volunteer), residents, and patients at least annually and shall follow appropriate tuberculosis screening recommendations as outlined in the relevant publication or as otherwise approved by the Authority:

(a) Long Term Care Facilities for the Elderly: "Prevention and control of tuberculosis in facilities providing long-term care to the elderly. Recommendations of the Advisory Committee for Elimination of Tuberculosis," published by the Centers for Disease Control and Prevention (Morbidity and Mortality Weekly Report, Vol. 39, RR-10, pp. 7-20; July 13, 1990) and "Guidelines for preventing the transmission of Mycobacterium tuberculosis in Health-Care Settings," published by the Centers for Disease Control and Prevention (Morbidity and Mortality Weekly Report, Vol. 54, Number RR-17: 1-141; December 30, 2005).

(b) Homeless Shelters: "Prevention and control of tuberculosis among homeless persons," published by the Centers for Disease Control and Prevention (Morbidity and Mortality Weekly Report, Vol. 41, RR-5, pp. 13-23; April 17, 1992)

[Publications: Publications referenced are available from the agency.]

Stat. Auth.: ORS 431.110, 432.060, 433.001–433.035, 433.110–433.220 & 437.030
Stats. Implemented: ORS 431.150, 431.155, 431.170, 433.001–433.035, 433.110–433.220 & 437.030
Hist.: OHD 4-2002, f. & cert. ef. 3-4-02; PH 10-2005, f. 6-15-05, cert. ef. 6-21-05; PH 9-2009, f. & cert. ef. 9-22-09; PH 7-2011, f. & cert. ef. 8-19-11; PH 12-2011, f. & cert. ef. 12-14-11

333-019-0042

Tuberculosis Screening in Correctional Facilities

(1) For purposes of this rule:

(a) "Correctional facility" means a facility operated by the Oregon Department of Corrections or a local correctional facility as that is defined in ORS 169.005; and

(b) “Symptoms of TB disease” means a cough longer than 3 weeks and/or coughing up blood in conjunction with fever, fatigue, night sweats or weight loss.

(2) A correctional facility shall screen all inmates upon admission for symptoms of tuberculosis (TB) disease. This screening and any follow-up shall be documented.

(3) Any inmate suspected of having TB disease or who has TB disease shall be isolated as appropriate and provided medical care and treatment that meets accepted standards of practice.

(4) Inmates detained or confined for 15 consecutive days or more in a correctional facility shall be screened for the following TB risk factors:

(a) HIV/AIDS;

(b) Immigration within the past five years from a country that has a high incidence of TB, including but not limited to immigration from Africa, Asia, Middle East, Latin America, Eastern Europe and South Pacific regions;

(c) Close contact to a person with infectious TB disease;

(d) History of injection drug use;

(e) History of homelessness; and

(f) Taking immunosuppressive medication.

(5) Inmates screened under section (4) of this rule who have TB risk factors and no documented history of prior positive screening tests for TB shall be screened with either a TB skin test or interferon gamma release assay (IGRA). Inmates with a documented previously positive TB skin test or IGRA, or a new positive result upon testing, shall receive a chest X-ray.

(6) Exceptions:

(a) A correctional facility is not required to retest an inmate at each admission under section (5) of this rule if:

(A) There is a documented record of a negative TB skin test or negative IGRA or normal chest X-ray within the past year; or

(B) There is a documented record of adequate TB treatment or compliance with a currently prescribed TB treatment.

(b) This exception does not apply if the inmate has symptoms of TB, evidence of new exposure to a person with infectious TB disease or a diagnosis of HIV/AIDS.

(7) Nothing in these rules prohibit any correctional facility from having more stringent TB screening requirements.

Stat. Auth.: ORS 431.110, 432.060, 433.001–433.035, 433.110–433.220 & 437.030
Stats. Implemented: ORS 431.150, 431.155, 431.170, 433.001–433.035, 433.110–433.220 & 437.030
Hist.: PH 12-2011, f. & cert. ef. 12-14-11

333-019-0052

Communication during Patient Transfer of Multidrug-Resistant Organisms

(1) As used in this rule:

(a) “Facility” means:

(A) A healthcare facility as that term is defined in ORS 442.015;

(B) An infirmary (for example, in a jail or prison);

(C) A residential facility or assisted living facility as those terms are defined in ORS 443.400;

(D) An adult foster home as that term is defined in ORS 443.705;

(E) A hospice program as that term is defined in ORS 443.850; and

(F) Any other facility that provides 24-hour patient care.

(b) “Multidrug-resistant organism” (MDRO) means an organism causing human disease which has acquired antibiotic resistance, as listed and defined in the Centers for Disease Control and Prevention’s Antibiotic Resistance Threats in the United States, 2013 (Atlanta, GA; 2013). MDROs include but are not limited to:

(A) Methicillin-resistant Staphylococcus aureus (MRSA);

(B) Vancomycin-resistant Enterococcus (VRE);

(C) Carbapenem-resistant Enterobacteriaceae (CRE), as that term is defined in OAR 333-017-0000 sections (10) and (24);

(D) Multidrug-resistant Acinetobacter baumannii;

(E) Multidrug-resistant Pseudomonas aeruginosa;

(F) Drug-resistant Streptococcus pneumoniae;

(G) Other Gram-negative bacteria producing extended-spectrum beta-lactamases (ESBL); and

(H) Toxin-producing Clostridium difficile.

(c) “Receiving facility” means the facility receiving or admitting the case patient into their care from another facility’s care.

(d) “Referring facility” means the facility transferring or discharging the case patient out of its care and into another facility’s care.

(e) “Standard Precautions” means the minimum infection prevention measures that apply to all patient care, regardless of suspected or confirmed infection status of the patient, in any setting where healthcare is delivered. Standard Precautions include:

(A) Hand hygiene;

(B) Use of personal protective equipment (for example, gloves, gowns, facemasks), depending on the anticipated exposure;

(C) Respiratory hygiene and cough etiquette;

(D) Safe injection practices; and

(E) Safe handling of potentially contaminated equipment or surfaces in the patient environment.

(f) “Transmission Based Precautions” means infection control practices that are implemented in addition to Standard Precautions in patients with known or suspected colonization or infection of highly transmissible or epidemiologically important infectious pathogens (for example, CRE, norovirus, Neisseria meningitidis) or syndromes (for example, diarrhea) when there is strong evidence that the pathogen or syndrome may be transmitted from person to person via droplet, contact, or airborne routes in healthcare or non-healthcare settings (Siegel JD, Rhinehart E, Jackson M, Chiarello L, and the Healthcare Infection Control Practices Advisory Committee. Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings, 2007).

(2) When a referring facility transfers or discharges a patient who is infected or colonized with a multidrug-resistant organism (MDRO) or pathogen which warrants Transmission Based Precautions, it must include written notification of the infection or colonization to the receiving facility in transfer documents. The referring facility must ensure that the documentation is readily accessible to all parties involved in patient transfer (for example, referring facility, medical transport, emergency department, receiving facility).

(3) When a facility becomes aware that it received in transfer one or more patients with an MDRO or pathogen that warrants Transmission Based Precautions, and that was isolated from a patient specimen collected within 48 hours after transfer, it must notify the referring facility.

(4) When a facility becomes aware that it transferred or discharged one or more patients who have an MDRO or pathogen that warrants Transmission Based Precautions, the referring facility must notify the receiving facility.

(5) If a facility transfers or discharges a patient with laboratory-confirmed, carbapenemase-producing Enterobacteriaceae, the facility must notify the local health department communicable disease staff within one working day of the date and destination of the transfer or discharge.

Stat. Auth.: ORS 413.042, 431.110, 433.004, 433.010
Stats. Implemented: ORS 433.004, 433.006, 433.010, 433.110, 442.015, 443.400, 443.705, 443.850
Hist.: PH 16-2013, f. 12-26-13, cert. ef. 1-1-14

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