PURPOSE:

The purpose of this advisory is to provide guidelines for effective infection control programs to assure a safe and healthful environment for all individuals Such programs shall include prevention activities, control and monitoring of communicable diseases, and education and training for individuals and staff.

APPLICATION:

This advisory applies to individuals who receive day and/or residential supports or services regardless of the facility, program or region in which they are served.

The department recognizes the special need to work with facilities which it does not fund or license to ensure the thorough understanding and implementation of medical advisories.

DISCUSSION:

I. Introduction

The Department of Developmental Services recognizes that individuals who receive supports or services may at any given time be exposed to, exhibit symptoms of, or transmit various communicable diseases. Therefore, it is essential that each service provider develop and maintain effective infection control systems that maximize prevention; provide processes to identify, investigate, and address concerns and/or control communicable disease outbreaks; monitor compliance with federal and state law and regulation; and provide education for individuals, families, staff and others. Agencies funded by the department shall adopt this guideline and recommendations or develop systems that are substantively similar to those outlines in this advisory.

II. Infection Control Programs

In DDS regions and training school, effective infection control programs shall be the responsibility of an infection control committee. The department strongly recommends that infection control committees be an essential component of a larger regional or training school focus such as safety and/or quality assurance programs.

A. Committee membership shall include persons whose collective knowledge, skills and administrative authority will ensure development, implementation and monitoring of infection control programs. The regional health service director/training school medical director or designee shall coordinate the infection control committee.

1. Core committee membership shall include the following:

   1. Health service /nursing director or designee
   2. STS medical director
   3. Regional director or designee at the level of Assistant Director
   4. Appropriate program representative from residential services
   5. Appropriate program representative from day services
   6. Facilities manager or designee
   7. Nurse Clinical Instructor

2. Ad Hoc consultants may be included as follows:

   1. Physician
   2. Dentist or designee
   3. Pharmacist
   4. Infection control specialist
   5. Dietitian and/or food service supervisor where applicable
   6. Health service director (if not on committee)
   7. Program Nurse
   8. Physical/Occupational Therapist, Speech/Language Pathologist as appropriate
   9. Representative from Respite/Leisure Services
   10. Others as needed

3. Each infection control committee shall develop operational guidelines and procedures to ensure implementation of infection control programs.

4. Infection control committees shall meet at least quarterly and the minutes of each meeting shall be shared with all appropriate staff.

5. Duties of the committee shall include but are not limited to the following:

   1. Develop guidelines and procedures that incorporate national standards (e.g.. OSHA, Centers of Disease Control, CT Department of Public Health, etc.) to address prevention and control of communicable disease
      1. Immunization (e.g. Hepatitis, pneumonia) and screening (e.g., Tuberculosis)
      2. Methicillin Resistant Staphylococcus aureus (Med Adv. #98-1)
      3. Vancomycin Resistant enterococci (Med. Adv. #98-2)
      4. Proper handling, storage and disposal of food, medications, laundry, hazardous materials including needles & syringes, cleaning products, etc.
      5. Environmental and seasonal precautions (e.g., proper clothing; personal hygiene; ventilation, insect/rodent control)
      6. Cleaning and sanitation of equipment, environment, etc. (e.g., humidifiers, suction machines, oxygen equipment)
      7. Food handling and sanitation procedures
      8. Use of Universal Precautions

   2. Develop guidelines and procedures to address investigation and control of communicable disease outbreaks (e.g., pneumonia, upper respiratory infections, tuberculosis, hepatitis, AIDS). Such guidelines shall address confidentiality and reporting as required by state and federal law.

   3. Develop guidelines and procedures for disease surveillance as appropriate (see medical advisories #98-1; 98-2)

   4. Monitor infection control practices including quarterly inspections of each residential and day program using quality assurance audits.

   5. Compile and analyze data and make recommendations to the regional director

   6. Act as resource to IDTs in the resolution of infection control issues

B. DDS health service or nursing directors/STS medical director responsibilities include but are not limited to the following:

1. Participate in the infection control committee meetings (if not the chair)

2. Develop procedures that require immediate notification of communicable disease outbreaks in public and private programs or facilities

3. Participate in the development of operational guidelines and procedures relative to infection control

4. Ensure that communicable disease reporting is done according to state and federal law

5. Consult with communicable disease experts as appropriate

6. Identify training needs and assist with the development and implementation of educational programs as appropriate

7. Analyze data, report to appropriate regional/STS management (e.g. safety committees, quality assurance, etc.), and make recommendations to the regional director as needed.

III. Consultative Services and Reporting Requirements

1. DDS Operated Facilities/Programs
   1. The infection control coordinator, when other than the health service/nursing director or medical director, shall report all uncorrected conditions relating to communicable disease to the regional/STS health service/nursing director or STS medical director.
   2. The health service/nursing director or STS medical director shall ensure that all reporting procedure required by state and federal law are followed
2. Private Agencies Funded or Licensed by DDS
   1. As previously stated, private agency policies and procedures shall develop and implement infection control systems that are substantively similar to those outlined in this advisory. These systems shall include procedures that will ensure required reporting per federal and state law.
   2. Private agencies shall report the following to the DDS regional health service director:
      1. Each new occurrence of MRSA or VRE infection (see Medical Advisory, #98-1 and #98-2)
      2. Serious, unresolved outbreaks of communicable disease

3. DDS regional health service/nursing directors and STS medical director shall notify the central office director of health and clinical services as appropriate.

4. The central office director of health and clinical services shall inform the Commissioner and others as appropriate.

5. DDS service/nursing directors and medical director shall provide consultative services as appropriate and/or may assist agencies in accessing community resources.