Md. Code Regs. 10.07.02.33 – Infection Prevention and Control Program.

A. Infection Prevention and Control Program. The nursing home shall establish, implement, and maintain an effective infection prevention and control program that:
1. (1) Investigates, controls, and prevents infections in a timely manner through a system that enables the facility to:
  1. (a) Analyze patterns of infected individuals;
  2. (b) Analyze changes in prevalent organisms;
  3. (c) Analyze increases in the rate of infection; and
  4. (d) Obtain surveillance data for the prevention and control of additional cases;
2. (2) Determines the procedures, such as appropriate precautions, that are to be applied to an individual resident;
3. (3) Maintains a record of infections in the nursing home and the corrective actions that were taken related to infections; and
4. (4) Monitors and evaluates the:
  1. (a) Effectiveness of the infection prevention and control program by surveying rates of infection, especially infection rates that are significantly higher than usual; and
  2. (b) Effective implementation of the policies and procedures that are outlined in §E(1) of this regulation.
B. Infection Preventionist.
1. (1) The nursing home shall assign at least one infection preventionist that has attended training in infection surveillance, prevention, and control to actively manage the nursing home’s infection prevention and control program.
2. (2) The infection preventionist shall attend or have attended a basic infection prevention and control training course that is approved by the:
  1. (a) Office of Health Care Quality; and
  2. (b) Office of Infectious Disease Epidemiology and Outbreak Response for the Department.
3. (3) This position shall be staffed at a ratio of 1.0 Full Time Equivalents for every 200 beds.
C. The nursing home shall have mechanisms for communicating the results of infection control activities to employees and to the individual or individuals who are responsible for improving the nursing home’s performance.
D. The nursing home’s communication mechanism shall ensure that the administrator, director of nursing, and the medical director receive and address reports of infection prevention and control findings and recommendations in a timely manner.
E. Infection Prevention and Control Policies and Procedures.
1. (1) The infection prevention and control program shall establish written policies and procedures to identify, investigate, control, and prevent infections in the nursing home, including policies and procedures to:
  1. (a) Identify health care-associated infections and communicable diseases in accordance with COMAR 10.06.01;
  2. (b) Report occurrences of certain infectious diseases and outbreaks of infectious diseases to the local health department in a timely manner in accordance with COMAR 10.06.01 and Health-General Article, §18-202, Annotated Code of Maryland;
  3. (c) Institute appropriate control measures when an infection or outbreak of infections is suspected or identified in order to control infection and prevent spread to other residents;
  4. (d) Perform surveillance for health care-associated and community-associated infections of residents and employees using definitions and methods approved by the infection prevention and control oversight committee to monitor and investigate causes of infection, and the manner in which the infection is spread;
  5. (e) Train employees about infection prevention and control, including:
    1. (i) Standard precautions and hand hygiene;
    2. (ii) Respiratory hygiene and cough etiquette;
    3. (iii) Soiled laundry and linen processing;
    4. (iv) Safe handling of needles and sharps and safe injection techniques;
    5. (v) Special medical waste handling and disposal;
    6. (vi) Appropriate use of antiseptics and disinfectants;
    7. (vii) Blood-borne pathogens, including hepatitis B and C and human immunodeficiency virus;
    8. (viii) Tuberculosis exposure; and
    9. (ix) Proper use and wearing of personal protective equipment, such as gloves, gowns, and eye protection;
  6. (f) Train and perform compliance monitoring of employee application of infection prevention and control activities, such as hand hygiene and personal protective equipment used for isolation precautions;
  7. (g) Review the infection prevention and control program elements at least annually and revise as necessary; and
  8. (h) Obtain annual approval of infection prevention and control program activities by the infection prevention and control oversight committee.
2. (2) The nursing home shall provide information concerning the infectious disease status of any resident being transferred or discharged to any other nursing home, including a funeral home.
3. (3) The nursing home shall obtain information concerning the infectious disease status of any resident being transferred or admitted to the nursing home from elsewhere.
F. Preventing Spread of Infection.
1. (1) The facility shall assess any residents with signs and symptoms of an infectious illness for the possibility of transmission to another resident or employee.
2. (2) The nursing home shall take appropriate infection prevention and control measures to prevent the transmission of an infectious disease to residents, employees, and visitors as outlined in the following guidelines:
  1. (a) 2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings; and
  2. (b) Guideline for Infection Control in Health Care Personnel.
3. (3) The nursing home shall prohibit employees with an infectious disease or with infected skin lesions from having direct contact with residents or their food if direct contact could transmit the disease.
4. (4) The nursing home shall require employees to perform hand hygiene before and after each direct resident contact for which hand hygiene is indicated by accepted professional practice.
5. (5) The facility shall handle, store, process, and transport linens so as to prevent the spread of infection.

Authority: Health-General Article, §§19-308, 19-308.1, 19-323, and 19-1401 et seq.;
Public Safety Article, §14-110.1; Annotated Code of Maryland

Effective date: June 30, 1978 (5:13 Md. R. 1053)

This chapter is a compilation and revision of prior regulations contained in COMAR 10.07.02, Nursing Homes—Extended Care, and COMAR 10.07.05, Intermediate Care Facilities—Long-term Care (Type A). COMAR 10.07.02 was effective January 1, 1967; amended effective March 27, 1973 and April 16, 1975 (2:8 Md. R. 565). COMAR 10.07.05 was effective July 1, 1969 and amended effective March 27, 1973.

Regulation .01B amended effective January 7, 1991 (17:26 Md. R. 2975); June 22, 1992 (19:12 Md. R. 1134); January 17, 1994 (21:1 Md. R. 33); August 15, 1994 (21:16 Md. R. 1383); June 30, 1997 (24:13 Md. R. 931); June 1, 1998 (25:11 Md. R. 821)

Regulation .01B amended as an emergency provision effective January 1, 2001 (28:4 Md. R. 414); amended permanently effective May 14, 2001 (28:9 Md. R. 885)

Regulation .01B amended effective September 16, 2002 (29:18 Md. R. 1442); March 3, 2003 (30:4 Md. R. 316); September 13, 2004 (31:18 Md. R. 1350)

Regulation .01I-1, L-1, O-1, GG-1 adopted effective January 13, 1986 (13:1 Md. R. 16)

Regulation .01GG-1, KK-1 adopted effective August 3, 1981 (8:15 Md. R. 1306)

Regulation .01II-1 adopted effective January 26, 1987 (14:2 Md. R. 128)

Regulation .01-1 adopted effective June 1, 1998 (25:11 Md. R. 821)

Regulation .01-1 amended effective January 6, 2005 (31:26 Md. R. 1862)

Regulation .02 amended effective January 14, 1988 (15:1 Md. R. 20)

Regulation .02 repealed and new Regulation .02 adopted effective May 10, 1993 (20:9 Md. R. 778)

Regulation .02 amended effective August 24, 2009 (36:17 Md. R. 1312)

Regulation .02F amended effective April 8, 1996 (23:7 Md. R. 551)

Regulation .02G adopted effective September 16, 2002 (29:18 Md. R. 1442)

Regulation .03 amended effective May 10, 1993 (20:9 Md. R. 778); August 27, 2007 (34:17 Md. R. 1507); August 24, 2009 (36:17 Md. R. 1312); August 29, 2016 (43:17 Md. R. 953)

Regulation .03A amended effective May 24, 1982 (9:10 Md. R. 1021); June 22, 1992 (19:12 Md. R. 1134)

Regulation .03B amended effective August 1, 1994 (21:15 Md. R. 1304)

Regulation .03-1 adopted effective May 10, 1993 (20:9 Md. R. 778)

Regulation .04B amended effective December 7, 1992 (19:24 Md. R. 2125)

Regulation .05 amended effective August 1, 2016 (43:15 Md. R. 864)

Regulation .05B amended effective January 17, 1994 (21:1 Md. R. 33)

Regulation .05C amended effective January 25, 1980 (7:2 Md. R. 115)

Regulation .07 amended effective January 26, 1987 (14:2 Md. R. 128); May 20, 1996 (23:10 Md. R. 731); August 24, 2009 (36:17 Md. R. 1312)

Regulation .07A amended effective August 3, 1981 (8:15 Md. R. 1306)

Regulation .07G amended effective May 24, 1982 (9:10 Md. R. 1021); January 26, 1987 (14:2 Md. R. 128); March 3, 2003 (30:4 Md. R. 316)

Regulation .07-1 adopted effective January 1, 2007 (33:26 Md. R. 1996)

Regulation .08 amended effective June 22, 1992 (19:12 Md. R. 1134)

Regulation .08A, B, D amended effective January 26, 1987 (14:2 Md. R. 128)

Regulation .08A, E amended effective January 13, 1986 (13:1 Md. R. 16)

Regulation .08-1 adopted effective September 16, 2002 (29:18 Md. R. 1442)

Regulation .09A amended effective November 8, 1982 (9:22 Md. R. 2196); January 13, 1986 (13:1 Md. R. 16); January 17, 1994 (21:1 Md. R. 33)

Regulation .09B-1 adopted effective August 3, 1981 (8:15 Md. R. 1306)

Regulation .09C, D amended effective August 24, 2009 (36:17 Md. R. 1312)

Regulation .10 amended effective January 26, 1987 (14:2 Md. R. 128); June 30, 1997 (24:13 Md. R. 931)

Regulation .10E amended effective November 8, 1982 (9:22 Md. R. 2196)

Regulation .10H amended effective May 24, 1982 (9:10 Md. R. 1021)

Regulation .10 repealed and new Regulation .10 adopted effective August 6, 2001 (28:15 Md. R. 1396)

Regulation .11 amended effective January 26, 1987 (14:2 Md. R. 128)

Regulation .11O amended effective November 8, 1982 (9:22 Md. R. 2196)

Regulation .11 repealed and new Regulation .11 adopted effective August 6, 2001 (28:15 Md. R. 1396)

Regulation .11-1 adopted effective August 6, 2001 (28:15 Md. R. 1396)

Regulation .11-2 adopted effective August 6, 2001 (28:15 Md. R. 1396)

Regulations .12, .13, .18—.21 amended effective January 13, 1986 (13:1 Md. R. 16)

Regulation .12 amended effective January 26, 1987 (14:2 Md. R. 128)

Regulation .13 amended effective January 26, 1987 (14:2 Md. R. 128)

Regulation .14-1 adopted effective August 15, 1994 (21:16 Md. R. 1383)

Regulation .14-2 adopted effective August 15, 1994 (21:16 Md. R. 1383)

Regulation .15 amended effective January 26, 1987 (14:2 Md. R. 128); September 22, 2008 (35:19 Md. R. 1716)

Regulation .15B amended effective March 16, 1992 (19:5 Md. R. 577); June 5, 1995 (22:11 Md. R. 820)

Regulation .17 amended effective January 26, 1987 (14:2 Md. R. 128)

Regulation .18B amended effective January 26, 1987 (14:2 Md. R. 128)

Regulation .19A, B amended effective January 26, 1987 (14:2 Md. R. 128)

Regulation .20 amended effective January 26, 1987 (14:2 Md. R. 128)

Regulation .21 amended effective June 1, 1998 (25:11 Md. R. 821)

Regulation .21 repealed and new Regulation .21 adopted effective January 6, 2005 (31:26 Md. R. 1862)

Regulation .21E amended effective November 8, 1982 (9:22 Md. R. 2196)

Regulation .21-1 adopted effective January 17, 1994 (21:1 Md. R. 33)

Regulation .21-1 repealed and new Regulation .21-1 adopted effective January 6, 2005 (31:26 Md. R. 1862)

Regulation .21-2 adopted effective January 6, 2005 (31:26 Md. R. 1862)

Regulation .21-3 adopted effective January 6, 2005 (31:26 Md. R. 1862)

Regulation .21-4 adopted effective January 6, 2005 (31:26 Md. R. 1862)

Regulation .22B amended effective August 3, 1981 (8:15 Md. R. 1306)

Regulation .24 repealed and new Regulation .24 adopted effective April 21, 2008 (35:8 Md. R. 805)

Regulation .26F amended and .26G—H repealed effective January 17, 1983 (10:1 Md. R. 28)

Regulation .26EE amended effective October 25, 1982 (9:21 Md. R. 2106); September 16, 2002 (29:18 Md. R. 1442)

Regulation .27A, B amended effective March 3, 2003 (30:4 Md. R. 316)

Regulation .27B amended effective January 26, 1987 (14:2 Md. R. 128)

Regulation .28 amended effective January 26, 1987 (14:2 Md. R. 128); January 17, 1994 (21:1 Md. R. 33)

Regulation .28C amended effective January 14, 1988 (15:1 Md. R. 20)

Regulation .31A amended effective September 16, 2002 (29:18 Md. R. 1442)

Regulation .32F amended effective January 17, 1994 (21:1 Md. R. 33)

Regulation .32G amended effective January 26, 1987 (14:2 Md. R. 128)

Regulation .33E amended effective January 26, 1987 (14:2 Md. R. 128)

Regulations .35—.41 adopted effective January 13, 1986 (13:1 Md. R. 16)

Regulation .35 amended effective December 16, 1996 (23:25 Md. R. 1785)

Regulation .36 amended effective December 16, 1996 (23:25 Md. R. 1785); September 16, 2002 (29:18 Md. R. 1442)

Regulation .36C amended effective March 3, 2003 (30:4 Md. R. 316)

Regulation .37 amended effective December 16, 1996 (23:25 Md. R. 1785); September 16, 2002 (29:18 Md. R. 1442)

Regulation .38 amended effective December 16, 1996 (23:25 Md. R. 1785)

Regulation .39A and B amended effective October 1, 1990 (17:19 Md. R. 2320)

Regulation .39C and D repealed effective October 1, 1990 (17:19 Md. R. 2320)

Regulation .39G amended effective June 30, 1986 (13:13 Md. R. 1491)

Regulation .40A amended effective June 30, 1986 (13:13 Md. R. 1491)

Regulations .40 and .41 recodified to Regulations .43 and .44, respectively, Appendix recodified as Regulation .40 and amended, and new Regulations .41 and .42 adopted effective October 1, 1990 (17:19 Md. R. 2320)

Regulation .41 repealed and new Regulation .41 adopted effective September 13, 2004 (31:18 Md. R. 1350)

Regulation .41A amended effective August 1, 1994 (21:15 Md. R. 1304)

Regulation .41D amended effective June 30, 1986 (13:13 Md. R. 1491)

Regulation .43C adopted effective October 1, 1990 (17:19 Md. R. 2320)

Regulations .45—.51 adopted effective January 7, 1991 (17:26 Md. R. 2975)

Regulations .45—.51 repealed as an emergency provision effective January 1, 2001 (28:4 Md. R. 414); repealed permanently effective May 14, 2001 (28:9 Md. R. 885)

Regulations .45—.60 adopted as an emergency provision effective January 1, 2001 (28:4 Md. R. 414); adopted permanently effective May 14, 2001 (28:9 Md. R. 885)

Regulation .49D amended effective September 16, 2002 (29:18 Md. R. 1442)

Regulation .54D adopted effective March 3, 2003 (30:4 Md. R. 316)

Regulation .61 adopted effective August 24, 2009 (36:17 Md. R. 1312)

Chapter revised effective June 17, 2019 (46:12 Md. R. 536)