DEPARTMENT OF HEALTH AND SOCIAL SERVICES
PUBLIC NOTICE
Communicable Disease Regulations
In compliance with the State’s Administrative Procedures Act (Title 29, Chapter 101 of the Delaware Code) and under the authority of Title 16, Part 1, Subchapter II, #122 Et. Seq. the Delaware Department of Health and Social Services/ Division of Public Health is amending its Communicable Disease Regulations. These regulations were last amended April 13, 1995.
A summary of the content of the revisions is incorporated in this notice. Anyone wishing a complete copy of the Regulations with recommended changes noted should call 302-739-3033 requesting same or write to the Division at the address listed below.
A Public Hearing will be held on Wednesday, June 23, 1999, in the third floor conference room of the Jesse Cooper Building on the corner of Federal and Water Streets from 4pm to 6pm. Persons wishing to be heard on this matter should appear in person at that time. Parties must enter by 5pm in order to be admitted.
Persons who wish to make written suggestions, compilations of data, testimony, briefs or other written materials concerning the proposed regulations must submit same to the Office of the Director, Division of Public Health, P.O., Box 637, Dover, DE 19901 by close of business June 25, 1999.
* Please note paragraph numbering and the table of contents may not be reflective of the final document. This should not, and is not meant to substantively alter the meaning of the proposed regulatory revisions.
Regulations for the Control of Communicable and Other Disease Conditions
Adopted August 2, 1984
Amended:
June 21, 1986
January 6, 1989
June 16, 1989
September 1, 1989
January 12, 1990
October 19, 1990
December 10, 1993
April 13, 1995
TABLE OF CONTENTS
PAGE
Part I
Applicable Codes 1
Part II
Definitions 1-3
Part III
Regulations 3-29
Section 1. Notifiable Diseases or Conditions
to be Reported 3
Section 2. Report of Outbreaks 4
Section 3. Reporting of Notifiable Diseases 4-6
3.1 Attending Practitioners
3.2 Others
3.3 Hospitals
3.4 Laboratories
3.5 Confidentiality
3.6 Information in Reports
Section 4. Reports by Division Director or
designee Unit Administrator to the
Section Chief 6
4.1 Surveillance/Investigation Reports
for Individual Cases
4.2 Outbreak Reports and Special Reports
4.3 Reports of Morbidity
Section 5. Investigation of Case 7-9
5.1 Action to be Taken
5.2 Suspected Source Outside County
but Within Delaware
5.3 Suspected Source in Another State
or Country
5.4 Exposed Person Outside Jurisdiction
5.5 Examination of Patient
5.6 Sensitive Situations
Section 6. Quarantine 9-10
6.1 Establishment
6.2 Requirements
6.3 Transportation
6.44 Disinfection
Section 7. Control of Specific Communicable
Diseases 10-20
7.1 Vaccine Preventable Diseases
7.2 Ophthalmia Neonatorum
7.3 Sexually Transmitted Diseases
7.4 Tuberculosis
Section 8. Preparation for Burial 21
Section 9. Disposal of Infectious Articles Remains 21
Section 10. Diseased Animals 21
10.1 Sale
10.2 Notification
Section 11. Notification of Emergency Medical
Care Providers of Exposureto
Communicable Diseases 21-28
11.1 Definitions
11.2 Universal Precautions
11.3 Communicable Diseases
11.4 Request for Notification
11.5 Notification of Exposure to
Air-borne Pathogens
11.6 Notification of Exposure when Requested
11.7 Manner of Notification
11.8 Transfer of Patients
11.9 Death of Patient
11.10 Testing of Patient for Infection
11.11 Confidentiality
Section 12. Enforcement 28-29
12.1 Authorization
12.2 Penalties
APPENDIX I Notifiable Diseases 30
APPENDIX II Drug Resistant Organisms
Required to be Reported 30
* Please note, the above page numbers refer to the original document and not to the Register.
PART I
Applicable Codes
These regulations are adopted by the Delaware State Board of Health Department of Health & Social Services pursuant to 16 Del. C. §122(1), (2), (3) (a and j), (4), (5); §128; §129; §151; §503; §504; §505; §507; §508; §702; §706 and 707. These regulations are are were originally adopted on August 2, 1984 and are effective September 1, 1984, and subsequently amended.
PART II
Definitions
When used in Parts II and III, the following terms shall mean:
1. "Carrier" - A person who harbors pathogenic organisms of communicable disease but who does not show clinical evidence of the disease and serves as a potential source of infection.
2. “Case" - A person whose body has been invaded by an infectious agent with the result that clinical symptoms have occurred.
3. "Child Care Facility" - Any organization or business created for, and having as its major purpose, the daily care and/or education of children under the age of 7 years.
4. "Communicable Disease" - An illness due to a specific infectious agent or its toxic products which arises through transmission of that agent or its products from a reservoir to a susceptible host either directly as from an infected person or animal or indirectly, through an intermediate plant or animal host, vector, or the inanimate environment.
5. "Contact" - A person or animal that has been in such association with an infected person or animal or a contaminated environment as to have had opportunity to acquire the infection.
"Designated Representative" - The person officially named by the Local Health Unit Administrator or the Section Chief to represent and to carry out the functions of the Division Director or designee Unit or the Section, respectively, in the absence of the Division Director or designee Unit Administrator or the Section Chief.
6. “Designee” - The person named by the Director of the Division of Public Health to assume a specific responsibility.
7. “Division Director” - The Director of the Division of Public Health.
8. “Directly Observed Therapy (DOT)” - an adherence-enhancing strategy in which a health care worker or other designated person watches the patient swallow each dose of medication.
9. "Epidemic" or "Outbreak" - The occurrence in persons in a community, institution, region, or other defined area of cases of an illness of similar nature clearly in excess of normal expectancy.
"Immunizations" -– DPT is diphtheria, tetanus, and pertussis, DT is diphtheria and tetanus, Td is tetanus, diphtheria toxoids, OPV is oral Polio vaccine, IPV is injectable polio vaccine
"Local Health Unit" - The main offices of the Division of Public Health which are located in Kent, Sussex and New Castle Counties.
New Castle Local Health Unit
2055 Limestone Road
Wilmington, DE 19804
995-8650
Kent Local Health Unit
805 River Road
Dover, DE 19901
736-5305
Sussex Local Health Unit
544 South Bedford Street
Georgetown, DE 19947
856-5355
"Local Health Unit Administrator" - The person officially named by the Division of Public Health Director responsible for the operations within a local health unit.
10. HIV Infection – repeatedly reactive screening tests for HIV antibody (for example, enzyme immunoassay) with specific antibody identified by the use of supplemental tests such as Western Blot or immunofluorescence assay; or direct identification of virus in host tissues by virus isolation (for example, culture); or HIV antigen detection (for example p24 antigen); or a positive result on any other highly specific licensed test for HIV.
11. "Medical Examiner" - A physician appointed pursuant to 29 Del. C. §4703 or 7903(a)(3) who is authorized to investigate the causes and circumstances of death.
12. "Nosocomial Disease" - A disease occurring in a patient in a health-care facility and in whom it was not present or incubating at the time of admission.
13. "Notifiable Disease" - A communicable disease or condition of public health significance required to be reported to the Division of Public Health in accordance with these Rules.
14. "Notification" - A written or verbal report as required by any section of these Rules.
15. "Outbreak" - Refer to definition of "Epidemic".
16. “Post-Secondary Institution” - Means and includes state universities, private colleges, technical and community colleges, vocational technical schools and hospital nursing schools.
17. "Quarantine" - An official order that limits the freedom of movement and actions of persons or animals in order to prevent the spread of notifiable disease or other disease condition. The Division Director or designee The Local Health Unit Administrator or the Section Chief shall determine which persons or animals are subject to quarantine and shall issue appropriate instructions.
18. “Resistant Organism” - Any organism which traditionally was inactivated or killed by a drug but has, over time, developed mechanisms to render that drug ineffective.
“Section” – The Health Monitoring and Program Consultation Section of the Division of Public Health
“Section Chief” – The Chief of the Health Monitoring and Program Consultation Section, Division of Public Health.
19. "Sensitive Situation" - A setting, as judged by the Director of the Division of Public Health or his designate designee in which the presence of a person or animal infected with or suspected of being infected with a notifiable or other communicable disease or condition which may affect the public health would increase significantly the probability of spread of such disease and would, therefore, constitute a public health hazard. Sensitive situations may include, but are not limited to, schools, child-care facilities, hospitals, and other patient-care facilities, food storage, food processing establishments or food outlets.
20. "Source of Infection" - The person, animal, object or substance from which an infectious agent passes directly to the host.
21. "Suspect" - A person or animal whose medical history and symptoms suggest that he or it may have or may be developing a communicable disease condition.
PART III
Regulations
Section 1. Notifiable Diseases or Conditions to be Reported
The list of notifiable diseases or conditions (notifiable diseases) specified in the Appendix Appendices to these regulations are declared as dangerous to the public health. The occurrence or suspected occurrence of these diseases, including those who at the time of death were so affected identified after death, shall be reported as defined in Section 3 to the Local Health Unit Administrator Division of Public Health. Such reports shall be made within 48 hours of recognition except as otherwise provided in these regulations. Reports shall be made by telephone or in writing except for certain specified diseases as indicated by a (T) which shall be reported immediately by telephone. Certain diseases are reportable in number only and are indicated by an (N). The Section Division of Public Health may list additional diseases and conditions on its reporting forms for which reporting is encouraged but not required.
Section 2. Report of Outbreaks
Any person having knowledge of any outbreak of any notifiable disease or clusters of any illness which may be of public concern, shall report such outbreaks within 24 hours to the Local Health Unit Administrator Division Director or designee.
Section 3. Reporting of Notifiable Diseases
3.1 Attending Practitioners
Reports required by Sections 1 and 2 shall be made to the Division Director or designee Local Health Unit Administrator by any attending practitioner, licensed or otherwise permitted in Delaware to practice medicine, osteopathic medicine, chiropractic, naturopathy, or veterinary medicine, who diagnoses or suspects the existence of any disease on the notifiable disease list or by the medical examiner in cases of unattended deaths.
3.2 Others
In addition to those who are required to report notifiable diseases, the following are requested to notify the Division Director or designee Local Health Unit Administrator of the name and address of any person in his or her family, care, employ, class, jurisdiction, custody of control, who is suspected of being afflicted with a notifiable disease although no practitioner, as in Section 3.1 above, has been consulted: every parent, guardian, householder; every nurse, every dentist, every midwife, every superintendent, principal, teacher or counselor of a public or private school; every administrator of a public or private institution of higher learning; owner, operator, or teacher of a child-care facility; owner or manager of a dairy, restaurant, or food storage, food-processing establishment or food outlet; superintendent or manager of a public or private camp, home or institution; director or supervisor of a military installation; military or Veterans Administration Hospital, jail, or juvenile detention center.
3.3 Hospitals
3.3.1 The chief administrative officer of each civilian hospital, long-term care facility, or other patient-care facility shall (and the United States military and Veterans Administration Hospitals are requested to) appoint an individual from the staff, hereinafter referred to as "reporting officer," who shall be responsible for reporting cases or suspect cases of diseases on the notifiable disease list in persons admitted to, attended to, or residing in the facility.
3.3.2 Such case reports shall be made to the Division Director or designee Local Health Unit Administrator within 48 hours of recognition or suspicion, except as otherwise provided in these regulations.
3.3.3 Reporting of a case or suspect case of notifiable disease by a hospital fulfills the requirements of the attending practitioner to report; however, it is the responsibility of the attending practitioner to ensure that the report is made pursuant to Section 3.1.
3.3.4 The hospital reporting officer shall also report to the Division Director or designee Local Health Unit Administrator communicable diseases not specified in Section 1, should the disease occur in a nosocomial disease outbreak situation which may significantly impact the public health.
3.4 Laboratories
3.4.1 All laboratories Any person in charge of a clinical or hospital laboratory, or other facility in which a laboratory examination of any specimen derived from a human body and submitted for microbiological examination shall report results of laboratory examinations of specimens indicating or suggesting the existence of a notifiable disease to the Division of Public Health Local Health Unit Administrator within 48 hours of when the results were obtained or as soon as possible, except as otherwise provided in these regulations.
3.4.2 The Director or designee Local Health Unit or Section personnel may contact the patient or the potential contacts so identified from laboratory reports only after consulting with the attending practitioner, when the practitioner is known and when said consultation will not delay the timely control of the a communicable disease. See Section 7.42 regarding similar requirements for sexually transmitted diseases.
3.4.3 Laboratories identifying salmonella or shigella organisms in the stool specimens shall forward cultures of these organisms or the stool specimens themselves to the Public Health Laboratory for confirmation and serotyping.
3.4.4 Reporting of antibiotic resistant organisms
Any person in charge of a clinical or hospital laboratory, or other facility in which a laboratory examination of any specimen derived from a human body and submitted for microbiologic examination yields a non-susceptible species of microorganism as listed in Appendix II, will report the infected person’s name, address, date of birth, race, sex, site of isolation, date of isolation and MIC/Zone diameter to the Division of Public Health. In addition, the number of susceptible and non-susceptible isolates of any of these organisms shall be reported monthly to the Division of Public Health.
3.5 Confidentiality
Information identifying persons or institutions submitted in reports required in Sections 3.1 - 3.4 shall be held confidential to the extent permitted by law.
3.6 Information in Reports
Information included in reports required in Sections 3.1-3.4 shall contain sufficient information to contact the patient and/or the patient's attending physician. When available, the name, address, telephone number, age date of birth, race, gender, and disease of the person ill or infected; the date of onset of illness; the name, address, and telephone number of the attending physician; and any pertinent laboratory information, shall be
provided.
Section 4. Reports by Division Director or designee Unit Administrator to the Section Chief
4.1 Surveillance/Investigation Case Reports for Individual Cases
Each Division Director or designee Unit Administrator shall submit a surveillance/investigation case report to the Section Chief for each individual case of those diseases on the notifiable disease list when requested by the Section. Surveillance/Investigation case reports shall be submitted promptly as soon as the case investigation is complete. Such reports shall be made on the required forms provided through the Section.
4.2 Outbreak Reports and Special Reports
If investigation or reports by the Division Director or designee Unit Administrator confirms an outbreak or an epidemic of a notifiable disease or other disease condition or if the Division Director or designee Unit Administrator is informed of the occurrence or suspicion of the occurrence of any single case of a notifiable disease which has significant epidemic potential, the Local Health Unit Administrator shall report such occurrence or suspicion immediately by telephone to the Section Chief. The Local Health Unit Administrator, Section Chief, or either of their designated representatives may ask for an investigation involving several disciplines within the Division of Public Health.
4.3 Reports of Morbidity
The Local Health Unit Administrator shall forward all individual reports of disease containing the information specified in Section 3.6 to the Section. Such reports shall be made in a manner and on forms specified by the Section.
Section 5. Investigation of Case
5.1 Action to Be Taken
Upon being notified of a case or suspected case of a notifiable disease or an outbreak of a notifiable disease or other disease condition in persons or animals, the Local Health Unit Administrator Director of the Division or designee shall may take action as required permitted in these Rules, and additionally as he deems deemed necessary to protect the public health. If the nature of the disease and the circumstances warrant, he the Director of the Division or designee shall may make or cause to be made an examination of the patient to verify the diagnosis, make an investigation to determine the source of infection, and take other appropriate action to prevent or control the spread of the disease. These actions may include, but shall not be limited to, confinement on a temporary basis until the patient is no longer infectious, and obligatory medical treatment in order to prevent the spread of disease in the community.
5.2 Suspected Source Outside County but Within Delaware
If the disease is one in which identification of the source of infection is important, and if the source of the infection is thought to be outside the county in which the case is reported but within Delaware, the Local Health Unit Administrator shall notify within 24 hours by telephone or in writing the Local Health Unit Administrator in whose county it is thought the source of infection is located.
5.3 Suspected Source in Another State or Country
5.3.1 If the source of infection is thought to be outside Delaware, the Local Health Unit Administrator shall notify the Section Chief. The Section Chief shall notify within 24 hours by telephone or in writing the Director of the State Health Agency in whose jurisdiction it is thought the source of the infection is located.
5.3.2 If the source of infection is thought to be in another country, the report shall be made to the Section Chief for transmittal to the Centers for Disease Control (CDC).
5.4 Exposed Persons Outside Jurisdiction
Notification as described in Sections 5.2 and 5.3 shall be given if there are believed to be exposed persons requiring identification and follow-up outside the jurisdiction of the Local Health Unit Administrator in which the case was reported.
5.5 5.2 Examination of Patient
Any person suspected of being afflicted with any notifiable disease shall be subject to physical examination and inspection by any designated representative of the Division of Public Health, except that a duly authorized warrant or court order shall be presented to show just cause in instances where the suspect refuses such examination and inspection. Such examination shall include the submission of bodily specimens when deemed necessary by the Local Health Unit Administrator, the Section Chief, or their designated representatives Division Director or designee.
5.6 5.3 Sensitive Situations
5.6.1 5.3.1 No person known to be infected with a communicable disease or suspected of being infected with a communicable disease shall engage in sensitive situations as defined in Part II of these regulations until determined judged by the Local Health Unit Administrator, the Section Chief, or either of their designated representatives Division Director or designee to be either free of such disease or that the public health is no longer a threat to public health. incapable of transmitting the infection. Such action shall be in accord with accepted public health practice and reasonably calculated to abate the potential public health risk.
5.6.2 5.3.2 When, pursuant to Section 5.6.1 5.3.1, it is necessary to require that a person not engage in a sensitive situation because that person is infected or suspected of being infected with a communicable disease, the Local Health Unit Administrator or his designated representative Division Director or designee shall provide, in writing, instructions specifying the nature of the restrictions and conditions necessary to terminate the restrictions. These written instructions shall be provided to the person infected or suspected of being infected with a communicable disease and to that person's employer or other such individual responsible for the sensitive situation.
5.6.3 5.3.3 The Local Health Unit Administrator Division Director or designee shall have the authority to exclude from attendance in a child care facility any child or employee suspected of being infected with a communicable disease that, in the opinion of the Local Health Unit Administrator, Division Director or designee significantly threatens the public health. In addition, no person shall attend or be employed in a child care facility who has the following symptoms:
(a) unusual diarrhea, severe coughing, difficult or rapid breathing, yellowish skin or eyes, pinkeye, or an untreated louse or scabies infestation;
(b) fever (100°F by oral thermometer or 101°F by rectal thermometer or higher) accompanied by one of the following: unusual spots or rashes, sore throat or trouble swallowing, infected skin patches, unusually dark tea-colored urine, gray or white stool, headache and stiff neck, vomiting, unusually cranky behavior, or loss of appetite.
(c) any other symptoms which, in the opinion of the Local Health Unit Administrator or his designated representative, Division Director or designee suggest the presence of a communicable disease that significantly threatens the public health. Exclusion from a childcare facility in this case shall be effective upon written notification pursuant to Section 5.6.2.
Section 6. Quarantine
6.1 Establishment
When quarantine of humans is required for the control of any notifiable disease or other disease or condition, the Division Director or designee or the Director of Public Health or their designated representatives shall have the authority to initiate procedures to establish a quarantine.
6.2 Requirements
6.2.1 The Local Health Unit Administrator Division Director or designee shall ensure that provisions are made for proper observations of such quarantined persons as frequently as necessary during the quarantine period.
6.2.2 Quarantine orders shall be in effect for a time period in accord with accepted public health practice.
6.3 Transportation
6.3.1 Transportation or removal of quarantined persons may be made only with prior approval of the appropriate Division Director or designee Local Health Unit Administrator, the Section Chief, or either of their designated representatives.
6.3.2 Transportation or removal of quarantined persons shall be made in accordance with orders issued by the Division Director or designee Local Health Unit Administrator, the Section Chief, or either of their designated representatives.
6.3.3 Quarantine shall be resumed immediately upon arrival of quarantined person at point of destination for the period of time in accord with accepted public health practices.
6.4 Disinfection
6.4.1 Concurrent disinfection is required of infectious or potentially infectious secretions or excretions of any quarantined person or animal or of objects contaminated by such secretions or excretions. The collection, storage and disposal, of such contaminated matter and disinfection procedures shall be approved by the Division Director or designee Local Health Unit Administrator, the Section Chief or either of their designated representatives.
6.4.2 Disinfection shall also be carried out at the termination of the period of quarantine and shall be applied to the quarter vacated. The disinfection procedures shall be as approved by the Division Director or designee Local Health Unit Administrator, the Section Chief, or either of their designated representatives.
Section 7. Control of Specific Communicable Diseases
7.1 Vaccine Preventable Diseases
7.l.l All preschool children who are enrolled in a child care facility must be age-appropriately vaccinated against diseases prescribed by the Division Director. For those diseases so prescribed, the most current recommendations of the federal Center’s for Disease Control and Prevention’s Advisory Committee on Immunization Practices’ (ACIP) shall determine the vaccines and vaccination schedules acceptable for compliance with this regulation. have attained 18 months of age who are enrolled in a child care facility must have documented proof of receiving a minimum of:4 doses of Diphtheria, Tetanus, Pertussis (DTP) or Diphtheria, Tetanus (DT) Vaccine; and 3 doses of Oral Polio Vaccine (TOPV) or 3 doses of Inactivated Polio Vaccine (IPV); and, 1 dose each of Measles, Mumps and Rubella Vaccines given after the age of 15months (Measles, Mumps & Rubella (MMR) is the preferred vaccine to meet this requirement); and Hib Conjugate Vaccine (HbCV) in a schedule determined by the American Immunization Practices Advisory Committee.
7.1.2 All preschool children less than 18 months of age who are enrolled in child care facilities must have documented proof of being immunized according to the following schedule.
Age Immunizations Received
2 months 1 dose each of DTP, (or DT), and
TOPV (or IPV)
4 months 2nd dose of DTP, (or DT), and
TOPV (or IPV)
6 months 3rd dose of DTP (or DT), TOPV
not required-
15 months 4th dose of DTP, (or DT), 3rd dose
of TOPV (or 3rd dose of IPV), 1 dose
each of Measles, Mumps and Rubella
Vaccine (MMR is the preferred vaccine to
meet this requirement), Hib Conjugate
Vaccine (HbCV) in a schedule determined
by the American Immunization Practices
Advisory Committee.
Any child entering private school must have documented proof of receiving be age-appropriately vaccinated against diseases prescribed by the Division Director.a minimum of the following vaccines, appropriate for their age, prior to enrolling in school. For those diseases so prescribed, the most current recommendations of the federal Center’s for Disease Control and Prevention’s Advisory Committee on Immunization Practices’ (ACIP) shall determine the vaccines and vaccination schedules acceptable for compliance with this regulation. This provision pertains to all children between the ages of 2 months and 21 18 years entering or being admitted to a Delaware private school for the first time including, but not limited to, foreign exchange students, immigrants, students from other states and territories and children entering from public schools. 4 doses of DTP, DT (or Td vaccine), of which the first dose should be given at 6 weeks of age and the second and third dose given 4-8 weeks after the preceding dose. A fourth dose is given at 15 months along with MMR and TOPV. Although the regulations require four doses of DTP, the following exceptions apply: (1) a child who received a fourth dose prior to the fourth birthday must have a fifth dose; (2) a child who received the first dose of Td(Adult) at or after age seven may meet this regulation with only three doses of Td(Adult).
4 doses of TOPV (or 4 doses of IPV); of which the first dose should be given at 6 weeks of age and the second dose given 4-8 weeks after the preceding dose. A third dose is given at 15 months along with MMR and DTP. Although the regulation requires four doses of TOPV (or 4 doses of IPV), if the third primary dose of TOPV or IPV is administered on or after the fourth birthday, a fourth dose is not required.
2 doses of Measles vaccine. The first dose should be given at 15 months of age or older. The second dose should be administered between four and six years of age. MMR can be provided to meet this requirement.
1 dose of Mumps and Rubella Vaccine given after the age of 15 months. MMR can be provided to meet this requirement.
Until September 1, 1991, the above requirements shall apply except that only 1 dose of measles vaccine given after the age of 15 months shall be required.
7.1.3 Acceptable documentation of the receipt of immunization vaccination as required by Sections 7.1.1-7.1.2 shall include either only a medical record signed by a physician, or a valid immunization record issued by the State of Delaware or another State, which specifies the vaccine given and the date of administration.
7.1.4 Immunization requirements for children attending public school can be found in Title 14, Section 131 of the Delaware code.
7.1.4 Immunization requirements pursuant to sections 7.1.1-7.1.2 shall be waived for:
(a) children whose physicians have submitted, in writing, that a specific immunizing agent would be detrimental harmful to that child; and,
(b) children whose parents or guardians present a notarized document that immunization is against their religious beliefs.
7.1.5 Child care facilities and private schools (grades K-12) shall maintain on file an immunization record for each child. The facility will also be responsible to report to the Division Director or designee on an annual basis the immunization status of its enrollees.
7.1.6 Parents whose children present immunization records which show that immunizations are lacking will be allowed l4 (or such time as may be appropriate for a particular vaccination) to complete the required age-appropriate doses of vaccine for their children. In which to obtain the required doses of vaccine for their children. In instances where more than l4 days will be necessary to complete the age-appropriate immunization schedule, an extension those days, upon certification by a physician, may be allowed in order to obtain the required immunizations. Extension of the 14-day allowance because of missed appointments to receive needed immunizations shall not be permitted.
7.1.7 When a child's records are lost and the parent states that the child has completed his/her series of immunizations, or a child has been refused admission or continued attendance at a child care facility or private school for lack of acceptable evidence of immunization as specified in this regulation, a written certification must be provided by a health care provider who has administered the necessary age-appropriate immunizations to the child according to the current ACIP immunization schedule. licensed physician, nurse practitioner or public health official that the child has received at least one (1) dose of DTP DT (or Td vaccine), one dose of TOPV (or IPV), one dose of Measles, Mumps, and Rubella vaccines, along with Hib Conjugate vaccine, if required by the child's age.
7.1.8 It is the responsibility of the child care facility or private school to exclude a child prior to admission or from continued attendance who has failed to document required immunizations pursuant to this section 7.1.1 - 7.1.3 and 7.1.8 - 7.1.9.
7.1.9 Upon the occurrence of a case or suspect case of one of the vaccine preventable diseases specified in section 7.1.10, any child not immunized against that disease shall be excluded from the premises, until the Local Health Unit Administrator or his designated representative Division Director or designee has determined that the disease risk to the unimmunized child has passed. Such exclusion shall apply to all those in the facility who are admitted under either medical or religious exemption as well as to those previously admitted who have not yet received vaccine against the disease which has occurred. If, in the judgment of the Local Health Unit Administrator Division Director or designee, the continued operation of the facility presents a risk of the spread of disease to the public at large, he/she shall have the authority to close the facility until the risk of disease occurrence has passed.
7.1.10 All full-time students of post-secondary educational institutions and all full and part-time students in such educational institutions if engaged in patient-care related curriculums (included but not limited to nursing, dentistry and medical laboratory technician technology), shall be required to show evidence of immunity to measles, rubella and mumps prior to enrollment starting September 1, 1991 by the following criteria:
1. Measles immunity:
(a) persons born prior to before January 1, 1957; or
(b) physician documented history of measles disease; or
(c) serological confirmation of measles immunity; or
(d) a documented receipt from a physician or health facility that two doses of measles vaccine were administered after 12 months of age. with at least one immunization after 15 months of age.
2. Rubella immunity:
(a) persons born prior to before January 1, 1957; except women who could become pregnant; or
(b) laboratory evidence of antibodies to rubella virus; or
(c) a documented receipt from a physician or health facility that rubella vaccine was administered on or after 12 months of age.
3. Mumps immunity:
(a) persons born prior to before January 1, 1957; or
(b) physician diagnosed history of mumps disease; or
(c) laboratory evidence of immunity; or
(d) a documented receipt from a physician or health facility that mumps vaccine was administered on or after 12 months of age.
7.1.11 Immunization requirements pursuant to section 7.1.10 shall be waived for:
(a) A student whose licensed physician certifies that such immunization may be detrimental to the student’s health;
(b) A student who presents a notarized document that immunization is against their religious beliefs.
(a) A student who presents a notarized document that immunization is against their religious beliefs;
(b) A licensed physician who certifies that such immunization may be detrimental to the student's health.
7.1.12 The student health service, the admissions office and the office of the university or college registrar are jointly responsible for implementing Section 7.1.10 through student notification of immunization requirements, the collection and verification of documented vaccine histories, identification and notification of students not in compliance and imposition of sanctions for non-compliance.
7.1.13 Students who cannot show evidence of immunity to measles pursuant to 7.1.10 and who cannot show documented receipt of ever having received measles vaccine shall be permitted to enroll on the condition that 2 doses be administered within 45 days or at the resolution of an existing medical contraindication. However, measles vaccine shall not be given closer than 30 days apart. Students who cannot show evidence of immunity to rubella and/or mumps or who have had only 1 dose of measles vaccine shall be permitted to enroll on the condition that required measles, mumps and rubella immunizations be obtained within 14 days or at the resolution of an existing medical contraindication.
7.1.12.4 The term post-secondary institution means and includes states universities, private colleges, technical and community colleges, vocational technical schools and hospital nursing schools.
7.1.14 The Division Director may maintain a registry of the immunization status of persons vaccinated against any vaccine preventable diseases (hereafter called an “immunization registry”).
7.1.14.1 Physicians and other health care providers who give immunizations shall report information about the immunization and the person to whom it was given for addition to the immunization registry in a manner prescribed by the Division Director or designee.
7.1.14.2 The Division Director or designee may disclose information from the immunization registry without a patient’s, parent’s, or guardian’s written release authorizing such disclosure to the following:
(a) The person immunized, or a parent or legal guardian of the person immunized, or persons delegated in writing by same.
(b) Employees of public agencies or research institutions, however only when it can be shown that the intended use of the information is consistent with the purposes of this section.
(c) Health records staff of school districts and child care facilities.
(d) Persons who are other than public employees who are entrusted with the regular care of those under the care and custody of a state agency including but not limited to operators of day care facilities, group, residential care facilities and adoptive or foster parents.
(e) Health insurers, however only when the person immunized is a client of the health insurer.
(f) Health care professionals or their authorized employees who have been given responsibility for the care of the person immunized.
7.1.14.3 If any person authorized in subsection 7.1.14.2 discloses information from the immunization registry for any other purpose, it is an unauthorized release and such person may be subject to civil and criminal penalty.
7.2 Ophthalmia Neonatorum
See 16 Del. C. §803 and the State Board of Health Department of Health and Social Services regulations promulgated thereunder entitled "Regulations Governing Treatment of the Eyes of Newborns".
7.3 Sexually Transmitted Diseases (STDs)
7.3.1 The following diseases Appendix I lists STDs regarded to cause significant morbidity and mortality, can be screened, diagnosed and treated, or are of major public health concerns such that surveillance of the disease occurrence is in the public interest, and therefore shall be designated as sexually transmitted and reportable pursuant to Title 16 Del. Code, Chapter 7. For the purposes of this section, a suspect is any person (a) having positive or clinical findings of a STD; or (b) in whom epidemiologic evidence indicates an STD may exist, or is identified as a sexual contact of an STD case, and is provided treatment for the STD on that basis.
7.3.1.1 Class A: STDs or suspected STDs or laboratory evidence suggestive of STDs to be reported individually.
Acquired Immune Deficiency Syndrome (AIDS), (only if satisfying the case definitionn of the federal Centers for Disase Control)
Chancroid
Chlamydia trachomatis infections
Chlamydia trachomatis infections of newborns
Neisseria gonorrhea infections (gonorrhea and related conditions)
Granuloma inguinale
Hepatitis B
Herpes (congenital only)
Lymphogranuloma venereum
Pelvic Inflammatory Disease (only gonococcal and/or chlamydial)
Syphilis
7.3.1.2 Class B: STDs or suspected STDs or laboratory evidence suggestive of STDs to be reported by number only in demographic categories (for example, age and sex) or methods prescribed and furnished by the Division of Public Health, and from health care professionals or health facilities specified by the Section
Herpes (genital)
Human Immunodeficiency virus (HIV)*
Human papillomavirus (genital warts)
*Tests which employ an ELISA technique to detect antibodies shall be reported only if confirmed with a Western Blot or other confirmatory test.
7.3.1.3 Class C: STDs or suspected STDs or laboratory evidence suggestive of STDs to be reported immediately by telephone or other rapid means of communication.
Congenital syphilis
7.3.2 Reporting of STDs
7.3.2.1 A physician or any other health care professional who diagnoses, suspects or treats a Class A or Class C reportable STD and every administrator of a health facility or state, county, or city prison in which there is a case of a Class A or Class C reportable STD shall report such case to the Division of Public Health specifying. Unless reportable in number only as specified in Appendix I, reports of Class A and Class C provided under this rule shall specify the infected person's name, address, age date of birth, gender and race as well as the date of onset, name and stage of disease, type and amount of treatment given and the name and address of the submitting health professional. Reports of Class A diseases shall be placed into the United States mail, telephoned, or otherwise routed to the appropriate agency of the Division of Public Health within one working day of diagnosis, suspicion or treatment. Reports of Class C disease shall be telephoned within one working day of diagnosis, suspicion or treatment.
7.3.2.2 Any person who is in charge of a clinical or hospital laboratory, blood bank, mobile unit, or other facility in which a laboratory examination of any specimen derived from a human body yields microscopic, cultural, serological, or other evidence suggestive of a Class A or Class C reportable STD shall notify the Division of Public Health. Unless reportable in number only as specified in Appendix I, reports provided under this rule shall specify Reports of Class A diseases shall be placed in the United States mail, telephoned, or otherwise routed to the appropriate agency of the Division of Public Health within one working day of identification of evidence suggestive of a STD. Reports shall include the name, age date of birth, race, gender and address of the persons from whom the specimen was obtained, laboratory findings, and the name and address of the physician and that of the processing clinical laboratory.
7.3.2.3 All facilities obtaining blood from human donors for the purpose of transfusion or manufacture of blood products shall report Human Immunodeficiency Virus (HIV) as a Class A STD .consistent with 7.3.2.2 Tests which employ an ELISA technique to detect antibodies shall be reported only if confirmed with a Western Blot or other confirmatory test.
7.3.2.4 Reports required by this Section for STD’s designated with the letter “T” in Appendix I shall be made by telephone, fax, or other rapid electronic means. Reports required by this Section for STD’s designated with the letter “N” in Appendix I shall be made at the request of the Division of Public Health, in number only, and in demographic categories specified by the Division of Public Health. All other reports required by this Section for STD’s listed in Appendix I shall be placed into the United States mail, faxed, telephoned, or otherwise routed to the Division of Public Health within one working day of diagnosis, suspicion, or treatment.
7.3.2.5 Reports of HIV infection shall be reportable by mail only in special double envelopes which will be provided by the Division of Public Health or by another method approved by the Division of Public Health, which assures the confidentiality of the information reported.
7.3.2.6 All reports and notification made pursuant to this section are confidential and protected from release except under the provisions of Title 16 Del. Code, §710,and §711 and §1203. From information received from laboratory notifications, the Division of Public Health may contact attending physicians. The Division of Public Health shall inform the attending physician, if the notification indicates the person has an attending physician, before contacting a person from whom a specimen was obtained. However, if delays resulting from informing the physician may enhance the spread of the STD, or otherwise endanger the health of either individuals or the public, the Division of Public Health may contact the person without first informing the attending physician.
7.3.2.7 Any laboratory that examines specimens for the purpose of finding evidence of an STD shall permit the Division of Public Health to examine the records of said laboratory in order to evaluate compliance with this section.
7.3.3 Reporting the Identity of Sexual or Needle Sharing Partners of STD Infected Patients Privilege to Disclose the Identity of HIV Infected Patients and Their Partners
7.3.3.1 Any physician, or any other licensed health care personnel acting on the orders of a physician, (hereafter referred to as provider), diagnosing or caring for an HIV STD infected patient may shall disclose the identity of the patient or the patient's sexual or needle-sharing partner(s) to the Division of Public Health so that the partner(s) may be notified of his or her risk of infection, provided that:
a. The patient is reasonably suspected of being infected with an STD and
b. The provider does not know that the partner has been adequately informed of the risk, been offered testing, or advised of the risk management practices appropriate to the disease.
a. The patient's condition satisfies the Centers for Disease Control definition of AIDS, or has an HIV infection as evidenced by a positive antibody test which is confirmed by Western Blot, or based upon other tests accepted by prevailing medical opinion, the patient is considered to be infected with HIV;
b. The provider knows of an identifiable partner at risk of infection; and
c. The provider believes there is a significant risk of harm to the partner; and
d. The provider believes that the partner does not suspect that he or she is at risk; and
e. Reasonable efforts have been made to counsel the patient pursuant to 16 Del. C. Section 1202(e), urging the patient to notify the partner, and the patient has refused or is considered to be unlikely to notify the partner; and
f. The provider has made reasonable efforts to inform the patient of the intended disclosure and to give the patient the opportunity to express a preference as to whether the partner be notified by the provider, the patient, or the Division.
7.3.3.2 Any provider diagnosing or caring for an HIV infected patient may also disclose the identity of the patient or the patient's sexual or needle-sharing partner to the Division so that the partner may be notified of his or her risk of infection, when:
a. The patient requests the provider to make such notification for the purposes of obtaining assistance in the notification of a partner; or
b. The patient does not pose a threat to an identifiable partner but, in the professional judgment of the provider based upon stated intended acts, the patient may be dangerous to the general population. In this instance the conditions specified in Sections 7.3.3.1(a), 7.3.3.1(e) and 7.3.3.1(f) shall apply. Disclosure shall be for the purpose of providing appropriate counseling to the patient.
7.3.3.3 Procedures for disclosing information pursuant to this section shall be specified by the Division. Such procedures shall (a) include the requirement that, prior to the Division identifying and notifying a partner, reasonable efforts be made by the Division to counsel the patient and urge the patient's voluntary notification of a partner; (b) specify Division employees permitted to receive the disclosed information; and (c) describe the manner in which partners will be notified pursuant to these regulations.
7.3.3.4 The provider will prepare and maintain contemporaneous records of compliance with each element of these regulations.
7.3.3.5 Nothing in this section shall constitute a duty upon the provider to disclose the identity of the patient or the patient's sexual or needle-sharing partner to the Division for the purpose of notifying a partner of the risk of HIV infection. A cause of action shall not arise under this section for the failure to make such disclosure.
7.4 Tuberculosis
7.4.1 Any persons suspected of having infectious tuberculosis shall have a tuberculin skin test, an X-ray examination or laboratory examinations of sputum, gastric contents or other body discharges as may be required by the Local Health Unit Administrator, the Section Chief or either of their designated representatives to determine whether said patient represents an infectious case of tuberculosis.
7.4.1 Any person afflicted with or suspected of being afflicted with tuberculosis disease and in need of hospitalization and unable to pay the cost, shall be hospitalized at public expense wherever and whenever facilities are available and provided that private or third party funds are not available for this purpose.
7.4.2 Reporting Tuberculosis
7.4.2.1 Physicians, pharmacists, nurses, hospital administrators, medical examiners, morticians, laboratory administrators, and others who provide health care services to a person with diagnosed, suspected or treated tuberculosis (TB) shall report such a case to the Division of Public Health specifying the infected person’s name, address, date of birth, race, gender, date of onset, site of disease, prescribed anti-TB medications, and, in the case of laboratory administrators, the name and address of the submitting health professional. A report shall be telephoned into the Division of Public Health within two working days of the provision of service or laboratory finding.
7.4.2.2 Any person who is in charge of a clinical or hospital laboratory or other facility in which a laboratory examination of sputa, gastric contents, or any other specimen derived from a human body yields microscopic, cultural, serological or other evidence suggestive of tubercle bacilli shall notify the Division of Public Health by telephone within two working days of the occurrence.
7.4.2.3 Any provider who has knowledge about a person with multiple drug-resistant tuberculosis (MDR-TB), even if the confirmed or suspected TB cases had been previously reported, shall report the occurrence to the Division of Public Health within two days of the occurrence.
7.4.2.4 Persons with TB who have demonstrated an inability or an unwillingness to adhere to a prescribed treatment regimen, who refuse medication, or who show other evidence of not taking anti-TB medications as prescribed, shall be reported to the Division of Public Health within two days of the occurrence.
7.4.3 Diagnostic Examinations
7.4.3.1 Any persons suspected of having infectious tuberculosis shall have a Mantoux tuberculin skin test, a chest radiograph, and laboratory examinations of sputum, gastric contents or other body discharges as may be required by the Division Director or designee to determine whether said patient represents an infectious case of tuberculosis.
7.4.3.2 The Division Director or designee shall determine the names of household and other contacts who may be infected with tuberculosis and cause them to be examined for the presence of tuberculosis disease.
7.4.4 The Local Health Unit Administrator, the Section Chief or either of their designated representatives shall determine the names of household and other contacts who may be infected with tuberculosis and shall encourage them to be examined for the presence of tuberculosis infection.
7.4.4 Clinical Management
7.4.4.1 In addition to fulfilling the reporting requirements of 7.4.1, providers shall manage persons with active TB disease by following one of three courses of action:
a. they shall immediately refer the client to the Division of Public Health for comprehensive medical and case management services; or
b. they shall provide comprehensive assessment, treatment, and follow-up services (including patient education, directly observed therapy and contact investigation) to the client and his/her contacts consistent with current American Thoracic Society and the Centers for Disease Control and Prevention (ATS/CDC) guidelines; or
c. they shall initiate appropriate medical treatment and refer the client to the Division of Public Health for coordination of community services and case management including directly observed therapy (DOT).
If the health care provider chooses (b) or (c) above, then the Division Director or designee may ask the health care provider for information about the care and management of the patient, and the health care provider shall assure that the requested information is communicated.
7.4.4.2 Patients with infectious tuberculosis who are dangerous to public health may be required by the State Board of Health Division Director or designee to be hospitalized, isolated, or otherwise quarantined. Whenever facilities for adequate isolation and treatment of infectious cases are available in the home and patient will accept said isolation, it shall be left to the discretion of the Division Director or designee Local Health Unit Administrator, the Section Chief, or either of their designated representatives as to whether these or other facilities shall be used.
Section 8. Preparation for Burial.
See 16 Del. C. Chapter 31 and State Board of Health Department of Health and Social Services regulations promulgated thereunder, entitled "Regulations Concerning Care and Transportation of the Dead".
Section 9. Disposal of Infectious Articles, Remains
No person shall dispose of articles, or human or animal remains known or suspected to be capable of infecting others with a communicable disease in such a manner whereby exposure to such infectious agents may occur. See also "Regulations Concerning Care and Transportation of the Dead", Section 11 ("Disposition of Amputated Parts of Human Bodies").
Section 10. Diseased Animals.
10.1 Importation and Sale
No person shall bring into this state or offer for sale domestic or wild animals infected or suspected to be infected with a disease communicable from animals to man.
10.2 Notification
It shall be the duty of persons having custody of care of animals infected or suspected to be infected with a disease transmitted from animals to man to notify the Division Director or designee Local Health Unit Administrator of the infection.
Section 11. Notification of Emergency Medical Care Providers of Exposure to Communicable Diseases.
11.1 Definitions
For the purposes of this section, the following definitions shall apply.
a. “Emergency medical care provider” - fire fighter, law enforcement officer, paramedic, emergency medical technician, correctional officer, ambulance attendant, or other person who serves as employee or volunteer of an ambulance service and/or provides pre-hospital emergency medical service.
b. “Receiving medical facility” - hospital or similar facility that receives a patient attended by an emergency medical care provider for the purposes of continued medical care.
c. “Universal precautions” - those precautions, including the appropriate use of hand washing, protective barriers, and care in the use and disposal of needles and other sharp instruments, that minimize the risk of transmission of communicable diseases between patients and health care providers. Universal precautions require that all blood, body fluids, secretions, and excretions of care providers use appropriate barrier precautions to prevent exposure to blood and body fluids of all patients at all times.
11.2 Universal Precautions
11.2.1 Didactic Instruction
Education and training with respect to universal precautions shall be a mandatory component of any required training and any required continuing education for all emergency medical care providers who have patient contact. Training shall be appropriately tailored to the needs and educational background of the person(s) being trained. Training shall include, but not be limited to, the following:
a. Mechanisms and routes of transmission of viral, bacterial, rickettsial, fungal, and mycoplasmal human pathogens.
b. Proper techniques of hand washing, including the theory supporting the effectiveness of hand washing, and guidelines for waterless hand cleansing in the field.
c. Proper techniques and circumstances under which barrier methods of protection (personal protective equipment) from contamination by microbial pathogens are to be implemented. The instruction is to include the theory supporting the benefits of these techniques.
d. The proper techniques of disinfection and clean-up of spills of infectious material. This instruction is to include the use of absorbent, liquid, and chemical disinfectants.
e. Instruction regarding the reporting and documentation of exposures to infectious agents and the requirement for employers to have an exposure control plan.
f. The proper disposal of contaminated needles and other sharps. The instruction is to include information about recapping needles and using puncture-resistant, leak-resistant containers.
g. First aid and immediate care of wounds which may be incurred by an emergency medical care provider.
11.2.2 Practical or Laboratory Instruction
Practical sessions addressing the field application of the above didactic instruction must be part of the curriculum. The practical sessions shall provide a means of hands-on experience and training in the proper use of personal protective equipment, hand-washing disinfection, clean-up of infectious spills, handling and disposal of contaminated sharps, and the proper completion of reporting forms.
11.2.3 Approval of Curricula
Any provider of mandatory education and training and continuing education pursuant to this section must submit a curriculum for approval by the Division of Public Health and shall not utilize curricula that are not regarded by the Division of Public Health to be in substantial compliance with 11.2.1 and 11.2.2.
11.3 Communicable Diseases
11.3.1 Communicable Disease Defined
Exposure to patients infected with the following communicable disease agents shall warrant notification to an emergency medical care provider pursuant to this section:
Human Immunodeficiency Virus (HIV)
Hepatitis B Virus
Hepatitis C Virus
Meningococcal disease
Haemophilus influenzae
Measles
Tuberculosis
Uncommon or rare pathogens
11.3.2 Infection Defined
A patient shall be considered infected with a communicable disease when the following conditions are satisfied:
11.3.2.1 Blood-borne pathogens
a. HIV - ELISA and western blot (or other confirmatory test accepted by prevailing medical opinion) tests must be positive.
b. Hepatitis B - positive for hepatitis B surface antigen.
c. Hepatitis C - (1) IgM anti-HAV negative, and (2) IgM anti-HBc negative or HBsAg negative, and (3) serum aminotransferase level more than two and one half times the upper limit of normal; or anti-HcB positive.
11.3.2.2 Air-borne pathogens
a. Meningococcal disease -compatible clinical findings and laboratory confirmation through isolation of Neisseria meningitides from a normally sterile site.
b. Haemophilus influenzae -compatible clinical findings of epiglottitis or meningitis and laboratory confirmation through isolation of Haemophilus influenzae from a normally sterile site or from the epiglottis.
c. Measles - compatible clinical findings with or without laboratory confirmation by one of the following methods: (1) presence of the measles virus from a clinical specimen, or (2) four-fold rise in measles antibody level by any standard serologic assay, or (3) positive serologic test for measles IgM antibody.
d. Tuberculosis - compatible clinical findings of pulmonary disease and identification of either acid-fast bacilli in sputum or the pathogen by culture.
11.3.2.3 Uncommon or rare pathogens
Infection with uncommon or rare pathogens determined by the Division of Public Health on a case-by-case basis.
11.3.3 Exposure Defined
11.3.3.1 Blood-borne pathogens
Exposure of an emergency medical care provider to a patient infected with a blood-borne pathogen as defined in 11.3.2.1 shall include a needle-stick or other penetrating injury with an item contaminated by a patient's blood, plasma, pleural fluid, peritoneal fluid, or any other body fluid or drainage that contains blood or plasma. Contact of these fluids with mucous membranes or non-intact skin of the emergency medical care provider or extensive contact with intact skin shall also constitute exposure.
11.3.3.2 Air-borne pathogens
Exposure of an emergency medical care provider to a patient infected with an air-borne pathogen as defined in 11.3.2.2 shall be as follows:
a. Meningococcal disease and haemophilus influenza - Close contact with an infected patient's oral secretions or sharing the same air space with an infected patient for one hour or longer without the use of an effective barrier such as a mask.
b. Measles - Sharing confined air space with an infected patient, regardless of contact time.
c. Tuberculosis- Sharing confined air space with an infected patient, regardless of contact time.
11.3.3.3 Uncommon or rare pathogens
The Division of Public Health shall determine definition of exposure to an uncommon or rare pathogen on a case-by-case basis.
11.3.4 Ruling on infection and exposure
When requested by the emergency medical care provider or receiving medical facility, the Division of Public Health shall investigate and issue judgment on any differences of opinion regarding infection and exposure as otherwise defined in 11.3.
11.4 Request for Notification
11.4.1 Every employer of an emergency medical care provider and every organization which supervises volunteer emergency medical care providers must register the name(s) of a designated officer who shall perform the following duties. The designated officer shall delegate these duties as may be necessary to ensure compliance with these regulations.
a. receive requests for notification from emergency medical care providers;
b. collect facts relating to the circumstances under which the emergency medical care provider may have been exposed;
c. forward requests for notification to receiving medical facilities;
d. report to the emergency medical care provider findings provided by the receiving medical facility; and
e. assist the emergency medical care provider to take medically appropriate action if necessary.
11.4.2 Receiving medical facilities must register with the Division of Public Health the name or office to whom notification requests should be sent by an emergency medical care provider and who is responsible for ensuring compliance with this section.
11.4.3 If an emergency medical care provider desires to be notified under this regulation, the officer designated pursuant to 11.4.1 shall notify the receiving medical facility within 24 hours after the patient is admitted to or treated by the facility on a form that is prescribed or approved by the State Board of Health.
11.5 Notification of Exposure to Air-borne Pathogens
11.5.1 Notwithstanding any requirement of 11.4.3, a receiving medical facility must make notification when an emergency medical care provider has been exposed to an air-borne communicable disease pursuant to 11.3.2.2 and 11.3.3.2. Such notification shall occur as soon as possible but not more that 48 hours after the exposure has been determined and shall apply to any patient upon whom such a determination has been made within 30 days after the patient is admitted to or treated by the receiving medical facility.
11.5.2 To determine if notification is necessary pursuant to this section, a receiving medical facility must review medical records of a patient infected with an air-borne communicable disease to determine if care was provided by an emergency medical care provider. If medical records do not so indicate, the receiving medical facility shall assume that no notification is required.
11.6 Notification of Exposure when Requested
11.6.1 When a request for notification has been made pursuant to 11.4.3, the receiving medical facility shall attempt to determine if the patient is infected with a communicable disease and if the emergency medical care provider has or has not been exposed. Information provided on the request for notification and medical records and findings in possession of the receiving medical facility shall be used to make this determination. If a determination is made within 30 days after the patient is admitted to or treated by the receiving medical facility, the receiving medical facility shall notify the officer designated pursuant to 11.4.1 as soon as possible but not more than 48 hours after the determination. The following information shall be provided in the notification:
a. The date that the patient was attended by the emergency medical care provider;
b. Whether or not the emergency medical care provider was exposed;
c. If the emergency medical care provider was exposed, the communicable disease involved.
11.6.2 If, after expiration of the 30-day period and because of insufficient information, the receiving medical facility has not determined that the emergency medical care provider has or has not been exposed to a communicable disease, the receiving medical care facility shall so notify the officer designated pursuant to Section 11.4.1 as soon as possible but not more than 48 hours after expiration of the 30-day period. The following information shall be provided in the notification:
a. The date that the patient was attended by the emergency medical care provider;
b. That there is insufficient information to determine if an exposure has occurred;
11.6.3 The receiving medical facility shall provide to the Division of Public Health a copy of each form completed pursuant to 11.4 which shall include information about whether or not the patient is infected, and if the emergency medical care provider is considered by the receiving medical facility to have been exposed.
11.7 Manner of Notification
A receiving medical facility must make a good faith effort, which is reasonably calculated based upon the health risks, the need to maintain confidentiality, and the urgency of intervention associated with the exposure, to expeditiously notify the officer designated pursuant to 11.4.1. If notification is by mail, and if, in the judgment of the receiving medical facility the circumstances warrant, the receiving medical facility shall ensure by telephone or other appropriate means that the designated officer of the emergency medical care provider has received notification.
11.8 Transfer of Patients
If, within the 30-day limitation defined in 11.5.1 and 11.6.1 a patient is transferred from a receiving medical facility to a second receiving medical facility, the receiving medical facility must provide the second facility with all requests for notification made by emergency medical care providers for that patient. The second receiving medical facility must make notification to the officer designated pursuant to 11.4.1 if the facility determines within the remaining part of the 30-day period that the patient is infected and shall otherwise comply with these regulations.
11.9 Death of Patient
If, within the 30-day limitation defined in 11.5.1 and 11.6.1, a patient is transferred from a receiving medical facility to a medical examiner, the receiving medical facility must provide the medical examiner with all requests for notification made by emergency medical care providers for that patient. The medical examiner must make notification to the designated officer if the medical examiner determines that the patient is infected with a communicable disease, and shall otherwise comply with these regulations.
11.10 Testing of Patients for Infection
Nothing in this regulation shall be construed to authorize or require a medical test of an emergency medical care provider or patient for any infectious disease.
11.11 Confidentiality
All requests and notifications made pursuant to these regulations shall be used solely for the purposes of complying with these regulations and are otherwise confidential.
Section 12. Enforcement
12.1 Authorization
The Department of Health and Social Services or the Director of the Division of Public Health or their designated representatives are authorized to enforce these regulations to accomplish the following:
12.1.1 To insure compliance of persons who refuse to submit themselves or others for whom they are responsible, including their animals, to necessary inspection, examination, treatment, sacrifice of the animal, or quarantine.
12.1.2 To insure coordination of actions of individuals, local authorities, or state authorities in the control of communicable disease.
12.1.3 To insure the reporting of notifiable diseases or other disease conditions as required in these Rules.
12.2 Penalties
Except as otherwise provided by the Delaware Code or this regulation, failure to comply with the requirements of this regulation will be subject to prosecution pursuant to 16 Del. C., §107. The Department of Health and Social Services may seek to enjoin violations of this regulation.
APPENDIX 1
NOTIFIABLE DISEASES
Acquired Immune Deficiency Lymphogranuloma Venereum (S)
Syndrome (AIDS) (S)
Anthrax (T) Malaria
Amebiasis Measles (T)
Meningitis (aseptic)
Botulism (T) Meningitis (bacterial)
Brucellosis Meningitis (all types other
than menigococcal)
Campylybacteriosis Meningococcal Meningitis (T)
Chancroid (S) Meningococcal Disease (other)
Chlamydia trachomatis Mumps (T)
infection (S) Pelvic Inflammatory Disease
Cholera (N) (T) (resulting from gonococcal and/
Cryptosporidiosis or chlamydial infections) (S)
Cyclosporidiosis Pertussis (T)
Plague (T)
Diphtheria (T) Poliomyelitis (T)
Psittacosis
E. Coli 0157:H7 infection (T) Rabies (man, animal) (T)
Encephalitis Reye Syndrome
Ehrlichiosis Rocky Mountain Spotted Fever
Foodborne Disease Rubella (T)
Outbreaks (T) Rubella (congenital) (T)
Giardiasis Salmonellosis
Gonococcal Infections (S) Shigellosis
Granuloma Inguinale (S) Streptococcal disease (invasive
group A)
Hansen’s Disease (Leprosy) Streptococcal toxic shock
Hantavirus infection (T) syndrome (STSS)
Hemolytic uremic syndrome (HUS) Streptococcus pneumoniae
Hepatitis A (T) (drug-resistant invasive
Hepatitis B (S) disease)
Hepatitis C & unspecified Syphilis (S)
Herpes (congenital) (T) (S) Syphilis (congenital) (T) (S)
Herpes (genital) (N) (S) Tetanus
Histoplasmosis Toxic Shock Syndrome
Human Immunodeficiency Virus Trichinosis
(HIV) (N) (S) Tuberculosis (T)
Human papillomavirus (genital Tularemia
warts) (N) (S) Typhoid Fever (T)
Influenza (N) Vaccine Adverse Reactions
Lead Poisoning Varicella (N)
Legionnaires Disease
Leptospirosis Waterborne Disease
Lyme Disease Outbreaks (T)
Yellow Fever (T)
(T) report by rapid means.
(N) report in number only when so requested
For all diseases not marked by (T) or (N):
(S) – sexually transmitted disese, report required in 1 day
Others – report required in 2 days
APPENDIX II
DRUG RESISTANT ORGANISMS REQUIRED
TO BE REPORTED
Enterococci resistant to Vancomycin
Pseudomonas aeruginosa resistant to Amikacin,Gentamicin
and Tobramycin
Staphylococcus aureus resistant to methicillin
Staphylococcus aureus intermediate or resistance to
Vancomycin (MIC >8ug/ml)