6 CCR 1009-1
DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT EPIDEMIC AND COMMUNICABLE DISEASE CONTROL 6 CCR 1009-1 [Editor’s Notes follow the text of the rules at the end of this CCR Document.] _________________________________________________________________________ Adopted by the Board of Health on March 15, 2017. Effective May 15, 2017. Regulation 1. Reportable Diseases For the purpose of these regulations, the diseases named in the Reportable Diseases Table (Appendix A) are declared to be potentially dangerous to the public health and shall be reportable in accordance with the provisions of these regulations.
The Colorado Board of Health also requires the reporting of any unusual illness, or outbreak, or epidemic of illnesses, which may be of public concern whether or not known to be, or suspected of being, communicable. Such illnesses, outbreaks, or epidemics include, but are not limited to: 1) those which may be a risk to the public and which may affect large numbers of persons such as illnesses transmitted through food, water, or from person to person; 2) cases of a newly recognized entity, including novel influenza; 3) those related to a health care setting or contaminated medical devices or products; and 4) those related to environmental contamination by any infectious agent or toxic product of such an agent. The occurrence of a single case of any unusual disease or manifestation of illness which the health care provider determines or suspects may be caused by or related to a bioterrorist agent or incident must be reported immediately by telephone to the state or local health department by the health care provider and the hospital, emergency department, clinic, health care center, and laboratory in which the person is examined, tested, and/or treated. The same immediate reporting is required for any unusual cluster of illnesses that may be caused by or related to a bioterrorist agent or incident. Bioterrorist agents include, but are not limited to, anthrax, plague, smallpox, tularemia, botulism, viral hemorrhagic fever and brucellosis.
Manner of Reporting All cases are to be reported with patient’s name, date of birth, sex, race, ethnicity, and address (including city and county) and name and address of responsible physician or other health care provider; and such other information as is needed to locate the patient for follow up. In addition, all laboratory information reported shall include specimen accession number. For animal bites by dogs, cats, bats, skunks, foxes, raccoons, coyotes, and other wild carnivores, the name and locating information of the owner of the biting animal shall be reported, if known, by the health care provider. For healthcare-associated infections, except as provided in § 25-3-601, C.R.S., facilities choosing to voluntarily participate in applied public health projects on a project by project basis shall make medical records available for review by the Department upon request within a reasonable time frame. In addition, for sexually transmitted infections, the patient’s sex at birth, gender identity and relevant treatment shall be reported. For reports from a publically funded anonymous testing site, as provided in §25-4-411, C.R.S, the patient’s name and address are not required.
See Appendix A, Reportable Diseases Table and Footnotes to determine time frame for reporting (from diagnosis or test result), who shall report, the reporting area, whether laboratory information is required for a report, and whether an isolate or clinical material must be sent to the State Laboratory. Reports on hospitalized patients may be made part of a report by the hospital as a whole. The Department shall develop systems and forms for reporting for physicians, other health care providers and hospitals. When hospitals and laboratories transmit disease reports electronically using systems and protocols developed by the department that ensure protection of confidentiality, such reporting is acceptable and is considered good faith reporting.
Regulation 2. Reporting by Individuals Where Reporter = ‘P’ in the Appendix A Reportable Diseases Table, cases of diseases shall be reported by the physician or other health care provider and by other persons either treating or having knowledge of a reportable disease, including, but not limited to coroners, persons in charge of hospitals or other institutions licensed by the Colorado Department of Public Health and Environment, (or their designees), persons in charge of schools (including school nursing staff), licensed day care centers, or any other person providing testing and/or counseling to a person with a sexually transmitted infection. Regulation 3. Laboratory Reporting Where Reporter = ‘L’ in the Appendix A Reportable Diseases Table, cases of diseases shall be reported with the information required in Regulation 1 by the laboratory that performs the test, whether or not associated with a hospital. The following laboratories shall also report: 1) out of state laboratories that maintain an office or collection facility in Colorado or arrange for collection of specimens in Colorado; and 2) in-state laboratories that send specimens to out-of-state referral laboratories. The case shall be reported by a laboratory when a result diagnostic of or highly correlated with clinical illness is found. Laboratory assays which demonstrate only immunity should not be reported (for example, a single elevated rubella antibody titer obtained during routine prenatal screening should not be reported). For organisms so noted in Appendix A, Reportable Diseases Table, testing laboratories shall routinely submit bacterial culture isolates or patient clinical material that yields positive findings to the CDPHE Laboratory Services Division. Clinical material is defined as: (i) A culture isolate containing the infectious organism for which submission of material is required, or (ii) If an isolate is not available, material containing the infectious organism for which submission of material is required, in the following order of preference: (A) a patient specimen; (B) nucleic acid; or (C) other laboratory material. All specimens shall be accompanied by the following information: (a) Patient's name, date of birth, sex, race, ethnicity, and address (b) Name and address of responsible physician or other health care provider (c) Name of disease or condition (d) Laboratory information - test name, collection date and specimen type. Laboratories should make an effort to report all test results electronically, whenever possible. Regulation 4 Treatment and Control of Tuberculosis The emergence of multiple drug-resistant tuberculosis in this country and state dictates a coherent and consistent strategy in order to protect the public health from this grave threat. The underlying principles of disease control expressed in the following rules are as follows: use of the most rapid and modern diagnostic methods by laboratories, rapid reporting, full patient compliance with medical treatment, and prevention of spread of tuberculosis in health care settings. The tuberculosis statute (C.R.S. 25-4-501 et seq.) covers subject matters not included in these regulations.
A. All confirmed or suspected cases of active tuberculosis disease, regardless of whether confirmed by laboratory tests, shall be reported to the state or local health department or health agency within 24 hours by physicians, health care providers, hospitals, other similar private or public institutions, or any other person providing treatment to the confirmed or suspected case. The reports shall include the following information: the patient’s name, date of birth, sex, race, ethnicity, address (including city and county), name and address of the reporting physician or agency; and such other information as is needed to locate the patient for follow-up. If reported by a physician, the physician shall also give the evidence upon which the diagnosis of tuberculosis was made, the part of the body affected, and the stage of disease.
B. Physicians, health care providers, and health care facilities shall report within 7 calendar days the following tuberculin skin test (TST) or Interferon-Gamma Release Assay (IGRA) result if it occurs in a health care worker, correctional facility worker, or detention facility worker: a positive TST (defined as = 5 mm in duration) or positive IGRA test (based on manufacturer’s interpretation criteria) if the worker has had prolonged or frequent face-to-face contact with an infectious tuberculosis case.
C. Laboratories shall report within 24 hours any result diagnostic of or highly correlated with active tuberculosis disease, including cultures positive for Mycobacterium tuberculosis and sputum smears positive for acid fast bacilli, and shall report the results of tests for antimicrobial susceptibility performed on positive cultures for tuberculosis.
D. Results must be reported by the laboratory which performs the test, but an in-state laboratory which sends specimens to an out-of-state referral laboratory is also responsible for reporting the results.
E. A laboratory may fulfill its requirement to report (in parts C and D of this regulation) by submitting a sputum specimen from the patient to either the State Public Health Laboratory, or for facilities located in Boulder, Broomfield, Denver, Adams, Douglas, Arapahoe, and Jefferson counties, to the Denver Public Health laboratory. The reporting requirement is not fulfilled if the laboratory submits an isolate from a culture to either of the public health laboratories or if the laboratory delays sending the sputum specimen for more than 2 calendar days after collection of the specimen.
F. When a laboratory performs a culture that is positive for Mycobacterium tuberculosis, the laboratory shall store the isolate until it receives a request from the state or local health department for the isolate. In lieu of such storage, the laboratory may fulfill this requirement by submitting the isolate to the state public health laboratory.
G. The State or local health department is authorized to perform evaluations of the timeliness of laboratory diagnostic processes. The data collected in an evaluation may include the mean, median, and range for the following indices: the length of time from specimen collection to isolation; the length of time from isolation of an organism to identification of the organism as Mycobacterium tuberculosis; and the length of time from isolation until susceptibility test results are finalized. The state or local health department shall provide the laboratory and hospital the results of its evaluation, including comparison of the laboratory indices to norms for other similar laboratories.
H. The Board of Health determines that to prevent the emergence of multiple drug- resistant tuberculosis, it is necessary and appropriate and good medical practice that persons with active tuberculosis disease receive directly observed treatment for their disease. All medical providers and health care organizations are required to provide directly observed therapy for patients with active tuberculosis disease for the full course of therapy, unless a variance for a particular patient from this requirement is approved by the tuberculosis control program of the State Department of Public Health and Environment or Denver Public Health. Directly observed therapy is not required for patients with extrapulmonary tuberculosis disease provided that the presence of pulmonary tuberculosis has been investigated and excluded. In applicable situations, a variance shall be granted in accordance with C.R.S. 25-4-506(3).
I. All hospitals and health care facilities providing in-patient treatment to persons with active tuberculosis disease shall notify the state or local health department immediately after plans are made to discharge the patient from the facility. The notification is intended to discuss the treatment plan for the patient and to assure adequate follow-up and coordination among providers so that the standard of directly observed treatment is met.
J. All licensed hospitals and nursing home facilities shall maintain a register of the TST and/or IGRA test results of health care workers in their facility, including physicians and physician extenders who are not employees of the facility but provide care to or have face-to-face contact with patients in the facility. The facility shall maintain such TST and IGRA test results as confidential medical information. Pursuant to C.R.S. 25-4-508, authorized personnel of the department of public health and environment may inspect and have access to such register in the course of an investigation intended to identify sources and contacts of a case of active tuberculosis disease and to control tuberculosis.
K.
Regulation 5. Investigations to Confirm the Diagnosis, Treatment, and Causes of Epidemic and Communicable Diseases and to Determine Appropriate Methods of Epidemic and Communicable Disease Control Investigations may be conducted to confirm the diagnosis, treatment, and causes of reportable conditions and shall be considered official duties of the health department or health agency. Such investigations may include, but are not limited to:
These requirements shall not apply if the State and local health agencies mutually agree not to share information on reported cases.
Sharing of medical information on persons with reportable diseases between authorized personnel of State and local health departments shall be restricted to information necessary for the treatment, control, investigation, and prevention of epidemic and communicable diseases dangerous to the public health. Regulation 7. Food Handling and Infected Persons No person, while infected with a disease in a communicable form which can be transmitted by foods or who is afflicted by a boil, or an infected wound,shall work in a food processing, milk producing, milk processing or food service setting in any capacity in which there is a likelihood of such person contaminating food or food contact surfaces with pathogenic organisms or transmitting diseases to other persons. The employer is responsible for ensuring the absence from work of an employee with an infectious disease for which there is evidence of transmission to persons in a food service, food processing, milk producing, or milk processing setting, as determined by the State Department of Health. Regulation 8. Reporting of Diseases Among Animals and Waiver Process for Rabies Inoculation A. Every veterinarian, livestock owner, veterinary diagnostic laboratory director, or other person having the care of, or knowledge of, the existence of animals having or suspected of having any disease which may endanger the public health such as rabies, anthrax, plague, tularemia, encephalitis, bovine spongioform encephalopathy, etc., shall promptly report the facts to the local health department or health agency or the State Department of Health.
B. Pursuant to C.R.S. § 25-4-607 (2), a veterinarian licensed in Colorado may issue a written waiver as provided in this section exempting an animal from a rabies vaccination order if the veterinarian, in his or her professional opinion, determines the rabies inoculation is contraindicated due to the animal’s medical condition. The terms “waiver” and “exemption” as used in this section are interchangeable. A veterinarian may issue a waiver if:
C. A waiver may not exceed a period of three years from the date of issuance. If the medical condition persists beyond a three year period and, in the professional opinion of a veterinarian licensed in the State of Colorado, the exemption continues to be appropriate, a new waiver may be issued.
D. Upon receiving a complaint regarding the validity of a rabies inoculation exemption, the executive director or his/her designee(s) may review Exemption from Rabies Vaccination forms and examine the veterinary records pertaining to the medical condition to determine if the medical condition legitimately contraindicates rabies inoculation. if appropriate, the executive director or his/her designee(s) may refer the case to the State Board of Veterinary Medicine. Regulation 9. Confidentiality All personal medical records and reports held or viewed by the state health department or local public health agency in compliance with these regulations shall be confidential information subject to C.R.S. 25- 1-122(4) AND C.R.S. 25-4-406(1). Reasonable efforts shall be made by the department to consult with the responsible physician, other healthcare provider, or medical facility caring for the patient prior to any further follow-up by state health department or local public health agencies. Regulation 10. Use of Sterile Needles, and Cleaning and Disinfection of Other Instruments, Probes, and Devices Used by Practitioners of Acupuncture and Adjunctive Therapies (promulgated by the Executive Director)
This regulation is promulgated pursuant to C.R.S. Section 12-29.5-111, which states that the Department shall promulgate rules relating to the proper cleaning and sterilization of needles used in the practice of acupuncture and the sanitation of acupuncture offices.
All parts of the premises of an acupuncture establishment shall be kept in a clean, sanitary, neat, and orderly condition at all times. All surfaces (e.g., tables, counters, chairs) used in connection with procedures involving equipment items shall be cleaned and disinfected with a disinfectant registered by the U.S. Environmental Protection Agency for use in health care settings according to labeled instructions. Equipment items shall be defined as any needle, instrument, probe, or device utilized by practitioners of acupuncture that punctures the skin or enters tissue of any patient/client. Prior to and after each treatment of acupuncture, the practitioner shall perform hand hygiene by either washing his/her hands with soap and water or using an alcohol-based hand sanitizer. Needles and other equipment items that puncture the skin or enter the tissues of any patient/client shall be disposable single-use items that are appropriately discarded immediately after use in an appropriate sharps container, and shall never be used on more than one patient. Equipment items that are vehicles for needles and other puncturing devices shall either be disposable, single-use items (preferred), or thoroughly cleaned and disinfected between each patient use according to the manufacturers’ instructions. If there are no manufacturers’ instructions for how to clean and disinfect the device, the device shall not be used on more than one patient.
Regulation 11. Sexually Transmitted Infections The Colorado Board of Health recognizes that non-sexual transmission may occur for some of these infections, and that in individual cases, based on clinical and epidemiologic information, the responsible physician or other healthcare provider may conclude the patient’s infection was not sexually acquired. Information concerning testing, treatment, causes, or the prevention of sexually transmitted infections shall be shared, to the minimum extent necessary to achieve the public health purpose, between the appropriate local public health agency, contracted agency, Ryan White-funded agency, other health agency or person providing direct services related to sexually transmitted infection and the state department of health, as provided by C.R.S. 25-4-406(1)(b). With respect to Regulation 5, investigations related to sexually transmitted infections will be limited to the information necessary to confirm the diagnosis, treatment, source of infection, and identification of measures that may be used to prevent additional sexually transmitted infections. The department shall destroy personal identifying information on all persons with CD4 or viral load results if investigation subsequent to the report finds no evidence of a sexually transmitted infection. C.R.S. 25-4-411 (1)(a) requires the state department of health to conduct an anonymous counseling and testing program for persons considered to be at high risk for infection with human immunodeficiency virus (HIV). The provision of confidential counseling and testing for HIV is the preferred screening service for detection of HIV infection. Local boards of health who provide HIV counseling and testing through a contractual agreement with the state department of health shall consider the need for an anonymous HIV testing option in their jurisdiction, upon petition. The consideration of this option must provide an opportunity for public comment in a public forum, including anonymous testimony presented in writing or through an organization. Local boards of health electing to provide confidential HIV testing with an anonymous option must do so in conjunction with publicly funded HIV testing and counseling projects. Operational Standards A. All persons providing HIV testing and counseling at a publicly funded HIV testing and counseling project in a non health-care setting will have completed an HIV testing and counseling course approved by the state department of health.
B. All persons performing partner services will have completed courses concerning introduction to sexually transmitted disease interviewing and partner notification, and other related courses as specified by the state department of health.
C. Of all HIV tests performed at a publicly funded HIV testing and counseling project, 99% of those persons testing HIV positive will receive test results and appropriate post-test counseling related to those test results. Publicly funded HIV testing sites shall make a good faith effort to inform all persons of their test results and shall provide pertinent HIV prevention counseling and referrals.
D. All persons newly diagnosed with HIV will be referred for partner services. A minimum of 75% of those offered partner services will receive an interview and appropriate referrals. Partner services standards will be determined by the best practices guidance and code of conduct standards for sexually transmitted infection prevention providers developed by the state department of health. These standards shall be made publicly accessible.
E. Operational and evaluation standards for HIV testing and counseling sites will be determined by the best practices guidance developed by the state department of health.
F. In accordance with C.R.S 25-4-404(2), the state department of health shall create and maintain guidelines, subject to approval by the state board of health, concerning the public health procedures described in C.R.S. 25-4-412 and C.R.S. 25-4-413. These guidelines will include code of conduct standards for the delivery of partner services and clients’ rights, responsibilities and protections.
Appendix A. Reportable Disease Table Carbapenem-resistant Acinetobacter Acinetobacter baumannii, baumannii (including Acinetobacter Sterile 30 days L carbapenem-resistant (CRAB)5, 4-Metro baumannii complex and Acinetobacter sites, urine baumannii-calcoaceticus complex)
Acute flaccid myelitis 4 days P Animal bites by dogs, cats, bats, skunks, foxes, raccoons, coyotes, or other wild 24 hrs P carnivores 6,7 Animal bites by mammals not listed 4 days P above6 Anthrax6 Bacillus anthracis Immed L & P All Required Eastern equine encephalitis, LaCrosse encephalitis virus, California encephalitis Arboviral Disease 4 days L All serogroup, St. Louis encephalitis virus and Western equine encephalitis virus Botulism6 Clostridium botulinum Immed L & P All Brucellosis6 Brucella species 4 days L & P All Required Campylobacteriosis Campylobacter species 4 days L & P All Candidemia Candida species 30 days L Blood Requested Chancroid Haemophilus ducreyi 4 days L & P All Chikungunya Chikungunya virus 4 days L All Chlamydia Chlamydia trachomatis 4 days L & P All Cholera6 Vibrio cholerae Immed L & P All Required CJD and other transmissible 4 days P spongiform encephalopathies (TSEs)6 Clostridium difficile infection 4-Metro Clostridium difficile 30 days L All Requested8 Colorado tick fever Colorado tick fever virus 4 days L All Cryptosporidiosis Cryptosporidium species 4 days L & P All Cyclosporiasis Cyclospora species 4 days L & P All Dengue Dengue virus 4 days L All Diphtheria6 Corynebacterium diphtheriae Immed L & P All Required Encephalitis6 4 days P All Enterobacteriaceae, carbapenem- Carbapenem-resistant Escherichia coli, 4 days L All Requested8 resistant (CRE)9 Klebsiella species, Enterobacter species Escherichia coli O157:H7 and Shiga Shiga toxin-producing Escherichia coli10 4 days L & P All Required toxin-producing Escherichia coli10 Giardiasis Giardia lamblia 4 days L & P All Gonorrhea, any site Neisseria gonorrhoeae 4 days L & P All Group A streptococci11, 4-Metro Streptococcus pyogenes 4 days L Sterile only Required12 Group B streptococci 4-Metro Streptococcus agalactiae 30 days L Sterile only Required12 1 working Haemophilus influenzae Haemophilus influenzae L & P Sterile only Required day Hantavirus disease6 Hantavirus 4 days L & P All Healthcare-associated infections13 4 days P Hemolytic uremic syndrome if ≤ 18 4 days P years6 1 working Hepatitis A6 Hepatitis A virus (+IgM anti-HAV ) L & P All day Hepatitis B virus (+HBsAg, +IgM anti- Hepatitis B 4 days L & P All HBc, +HBeAg, or +HBV DNA)
Hepatitis, other viral 4 days P Human immunodeficiency virus L & P Human immunodeficiency virus (HIV)/ CD4 counts (any value) L & P 4 days acquired immunodeficiency syndrome HIV viral load (any value) L & P All (AIDS) HIV genotype L Influenza-associated death if < 18 4 days P years Influenza-associated hospitalization 4 days P Japanese encephalitis Japanese Encephalitis virus 4 days L All Legionellosis Legionella species 4 days L & P All Leprosy (Hansen's Disease) 4 days P Listeriosis Listeria monocytogenes 4 days L & P All Required Lyme disease Borrelia burgdorferi 4 days L & P All Lymphogranuloma venereum (LGV) Chlamydia trachomatis 4 days L & P All Malaria6 Plasmodium species 4 days L & P All Measles (rubeola)6 Measles virus Immed L & P All Neisseria meningitidis or gram-negative Meningococcal Disease6 Immed L & P Sterile only Required diplococci Mumps6 Mumps virus (acute infection) 4 days L & P All Outbreaks - known or suspected of all types including those transmitted from food, Immed P water, person-to-person, and related to a health care setting6 1 working Pertussis (whooping cough)6 Bordatella pertussis L & P All Requested8 day Plague6 Yersinia pestis Immed L & P All Required Poliomyelitis6 Poliovirus Immed L & P All Powassan virus disease Powassan virus 4 days L All Pseudomonas, carbapenem- Pseudomonas aeruginosa 4 days L All Requested8 resistant14 Psittacosis Chlamydia psittaci 4 days L & P All Q fever6 Coxiella burnetii 4 days L & P All Rabies: human (suspected)6 Rabies virus (Lyssavirus) Immed L & P All Rickettsia species, including Rocky Mtn Rickettsiosis 4 days L & P All spotted fever and typhus groups 1 working Rubella (acute infection)6 Rubella virus L & P All day Rubella, congenital6 Rubella virus 4 days L & P All Salmonellosis Salmonella species 4 days L & P All Required Severe acute respiratory syndrome coronavirus (SARS-CoV), Middle East Severe or novel coronavirus Immed L & P All respiratory syndrome coronavirus (MERS-CoV)
Shigellosis Shigella species 4 days L & P All Required Smallpox6 Variola virus (Orthopox virus) Immed L & P All Staphylococcus aureus, Vancomycin- Vancomycin-resistant Staphylococcus 4 days L All Required resistant aureus Streptococcal toxic shock syndrome Streptococcus pyogenes 4 days P All Required12 Streptococcus pneumoniae Streptococcus pneumoniae 4 days L Sterile only Required12 1 working Syphilis 6 Treponema pallidum L & P All day Tetanus6 Clostridium tetani 4 days P All Tick-borne relapsing fever6 Borrelia species 4 days L & P All Toxic shock syndrome (non- 4 days P streptococcal)
Trichinosis6 Trichinella species 4 days P All 1 working Tuberculosis disease (active)6 Mycobacterium tuberculosis15 L & P All See Reg 4F day 1 working Tularemia6 Francisella tularensis L & P All Required day 1 working Typhoid fever6 Salmonella Typhi L & P All Required day Varicella (chicken pox)6 Varicella virus 4 days L & P All Vibriosis Vibrio species, non-cholera 4 days L All Required Crimean-Congo hemorrhagic virus, Ebola virus , Lassa fever virus, Lujo Viral hemorrhagic fever Immed L & P All Required virus, Marburg virus, Guanarito virus, Junin virus, Machupo virus, Sabia virus West Nile virus (acute infection, IgM+) West Nile virus 4 days L All Yellow fever Yellow fever virus 4 days L All Yersiniosis 4-Seven Yersinia non-pestis species 4 days L All Required Zika virus Zika virus 4 days L All All cases are to be reported with patient's name, date of birth, sex, race, ethnicity, and address (including city and county) and name and address of responsible physician or other health care provider; and such other information as is needed in order to locate the patient for follow up. In addition, all laboratory information reported shall include specimen accession number. *Time: 1) “Immed” = by phone, within 4 hours of suspected diagnosis. 2) Unless the term “working day” is specified, “days” refers to calendar days.
1 Reporter: The party responsible for reporting is indicated by one of the following: L = Laboratory (whether or not associated with a hospital; by out-of-state laboratories that maintain an office or collection facility in Colorado; and by in-state laboratories which send specimens to an out-of- state laboratory referral laboratory), P = health care provider or other person knowing of or suspecting a case (including but not limited to coroners, persons in charge of hospitals or other institutions licensed by CDPHE (or their designees), persons in charge of schools (including nursing staff) and licensed day care centers), L & P = Both 2 Specimen sources: A condition is reportable when the pathogen is isolated or detected from any specimen source unless where otherwise indicated. A normally “sterile site” is defined as blood, CSF, pleural fluid (includes chest fluid, thoracentesis fluid), peritoneal fluid (includes abdominal fluid, ascites), pericardial fluid, bone (includes bone marrow), joint or synovial fluid, needle aspirate or culture of any specific joint, internal body sites (sterilely obtained from biopsy/tissue/abscess/aspirate/fluid/swab from lymph node, brain, heart, liver, spleen, vitreous fluid, kidney, pancreas, vascular tissue, or ovary). Skin and skin abscesses are not considered sterile sites.
3 Testing laboratories shall routinely submit bacterial culture isolates or patient clinical material that yields positive findings to the CDPHE Laboratory Services Division. The isolate or clinical material shall be received at the CDPHE Laboratory Services Division no later than one working day after the observation of positive findings.
4 Condition reportable only among residents of a specific catchment area. Metro = Denver Metropolitan Area (Adams, Arapahoe, Denver, Douglas and Jefferson Counties); Seven = Seven- county Denver Metropolitan Area (Adams, Arapahoe, Boulder, Broomfield, Denver, Douglas and Jefferson Counties). If not specified, condition reportable in all Colorado counties. 4-Metro Condition reportable only among residents of Denver Metropolitan Area (Adams, Arapahoe, Denver, Douglas and Jefferson Counties)
4-Seven Condition reportable only among residents of seven-county Denver Metropolitan Area (Adams, Arapahoe, Boulder, Broomfield, Denver, Douglas and Jefferson Counties). 5 Acinetobacter baumannii (including Acinetobacter baumannii complex and Acinetobacter baumannii-calcoaceticus complex) that are intermediate or resistant to at least one carbapenem (including imipenem, meropenem, doripenem, or ertapenem) isolated from a normally sterile site or urine.
6 Report shall be based on the diagnosis or suspected diagnosis of the attending physician or other health care provider, whether or not supporting laboratory data are available. 7 For animal bites by dogs, cats, bats, skunks, foxes, raccoons, coyotes, and other wild carnivores, the name and locating information of the owner of the biting animal shall be reported, if known, by the health care provider Reporter.
8 Clinical material is requested from selected laboratories. 9 Escherichia coli, Klebsiella species, and Enterobacter species that are resistant to at least one carbapenem (including imipenem, meropenem, doripenem, or ertapenem); OR Escherichia coli, Klebsiella species, and Enterobacter species that test positive for production of carbapenemase (i.e., KPC, NDM, VIM, IMP, OXA-48) demonstrated by a recognized test (e.g., polymerase chain reaction, metallo-ß-lactamase test, modified-Hodge test, Carb-NP). 10 This includes any shiga-toxin test or O157 antigen test that is positive, even if no culture is performed. If the laboratory does not have the capacity to perform H (flagellar) antigen tests, then Escherichia coli O157 should be reported.
11 If Group A streptococci is isolated from a wound or surgical tissue/specimen and is accompanied by necrotizing fasciitis or streptococcal toxic shock syndrome, the case shall be reported and the isolate shall be submitted.
12 Clinical material shall be submitted from laboratories located in the seven-county Denver Metropolitan Area (Adams, Arapahoe, Boulder, Broomfield, Denver, Douglas, and Jefferson Counties) when the material is from residents of the Metro Area (Adams, Arapahoe, Denver, Douglas and Jefferson counties).
13 Reportable only by facilities that are voluntarily participating in applied public health projects. Appendix B includes a definition of healthcare-associated infections, a list of included infections, and a list of included health facility types.
14 Pseudomonas aeruginosa resistant to at least one of the following carbapenems: imipenem, meropenem, or doripenem; OR Pseudomonas aeruginosa that tests positive for production of a carbapenemase (i.e., KPC, NDM, VIM, IMP, OXA).
15 Including (+) AFB sputum smear Appendix B. Healthcare-Associated Infections Definition of a healthcare-associated infection: a localized or systemic condition that results from an adverse reaction to the presence of an infectious agent or its toxins that was not present or incubating at the time of admission to the health facility.
Healthcare-associated infections include:
Ambulatory surgical centers Birth centers Convalescent centers Dialysis treatment clinics/End-stage renal disease facilities Hospices Hospitals (general, psychiatric, rehabilitation, maternity, and long-term care) Long-term care facilities Outpatient clinics (community clinics; community clinics with emergency centers; rural health clinics; outpatient rehabilitation facilities; outpatient physical therapy, occupational therapy or speech pathology services; and private physician offices) _________________________________________________________________________ Editor’s Notes History Regulations 1, 3 eff. 05/30/2007.
Regulation 3 eff. 03/30/2008.
Regulation 8 eff. 03/02/2010.
Regulations 1, 3, 11 eff. 04/14/2010.
Regulations 1, 3, Appendix A eff. 12/30/2010.
Regulations 1, 3 eff. 11/30/2012.
Regulations 1-3, 5, 9 eff. 10/15/2014.
Regulations 1-4, 8, 10, Appendices A-B eff. 11/14/2015. Entire rule eff. 05/15/2017.