1701. Staff Practices (I).

Staff/volunteer practices shall promote conditions that prevent the spread of infectious, contagious, or
communicable diseases and provide for the proper disposal of toxic and hazardous substances. These
preventive measures/practices shall be in compliance with applicable guidelines of the Blood borne
Pathogens Standard of the Occupational Safety and Health Act (OSHA) of 1970; the Centers for Disease
Control and Prevention (CDC); and R.61-105; and other applicable Federal, State, and local laws and
regulations.

1702. Tuberculin Skin Testing (I).

A.Tuberculin skin testing is a diagnostic tool for detecting M. tuberculosis infection. A small dose (0.1
mil) of purified protein derivative (PPD) tuberculin is injected just beneath the surface of the skin (by the
intradermal Mantoux method), and the area is examined for induration (hard, dense, raised area at the site
of the TST administration) forty-eight to seventy-two (48 to 72) hours after the injection (but positive
reactions can still be measurable up to a week after administering the TST). The size of the indurated area
is measured with a millimeter ruler and the reading is recorded in millimeters, including zero (0) mm to
represent no induration. Redness/erythema is insignificant and is not measured or recorded. Authorized
healthcare providers are permitted to perform tuberculin skin testing and symptom screening.

B.All facilities shall conduct an annual tuberculosis risk assessment (See Section 101.BBB) in
accordance with CDC guidelines (See Section 102.B.16) to determine the appropriateness and frequency
of tuberculosis screening and other tuberculosis related measures to be taken.

C.The risk classification, i.e., low risk, medium risk, shall be used as part of the risk assessment to
determine the need for an ongoing TB screening program for staff/direct care volunteers and residents and
the frequency of screening. A risk classification shall be determined for the entire facility. In certain
settings, e.g., healthcare organizations that encompass multiple sites or types of services, specific areas
defined by geography, functional units, patient population, job type, or location within the setting may have
separate risk classifications.

D.Staff/Direct Care Volunteers/Private Sitters Tuberculin Skin Testing

1. Tuberculosis Status. Prior to date of hire or initial resident contact, the tuberculosis status of
staff/direct care volunteer/private sitters shall be determined in the following manner in accordance with
the applicable risk classification:

2. Low Risk:

a. Baseline two-step Tuberculin Skin Test (TST) or a single Blood Assay for Mycobacterium
tuberculosis (BAMT): All staff/direct care volunteers/private sitters (within three (3) months prior to
contact with residents) unless there is a documented TST or a BAMT result during the previous twelve (12)
months. If a newly employed staff/direct care volunteer or private sitter has had a documented negative
TST or a BAMT result within the previous twelve (12) months, a single TST (or the single BAMT) can be
administered and read to serve as the baseline prior to resident contact.

b. Periodic TST or BAMT is not required.

c. Post-exposure TST or a BAMT for staff/direct care volunteers upon unprotected exposure to M.
tuberculosis: Perform a contact investigation when unprotected exposure is identified. Administer one (1)
TST or a BAMT as soon as possible to all staff who have had unprotected exposure to an infectious TB
case/suspect. If the TST or the BAMT result is negative, administer another TST or a BAMT eight to ten
(8 to 10) weeks after that exposure to M. tuberculosis ended.

d. Post-exposure TST or a BAMT for private sitters upon unprotected exposure to M. tuberculosis:
Written evidence of a contact investigation when unprotected exposure is identified shall be provided to
the facility administrator. The private sitter shall provide documentation of a completed single TST or a
BAMT prior to resident contact. If the TST or BAMT result is negative, the private sitter shall provide
written evidence of an additional TST or BAMT eight to ten (8 to 10) weeks after that exposure to M.
tuberculosis ended. (CDC: Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in
Health-Care Settings, December 30, 2005).

e. Baseline positive with or without documentation of treatment for latent TB infection (LTBI) (See
Section 101.BB) or TB disease shall have a symptoms screen prior to employment and annually thereafter.

f. Upon hire, staff/direct care volunteers/private sitters with a newly positive test result for M.
tuberculosis infection (i.e., TST or BAMT) or signs or symptoms of tuberculosis, e.g., cough, weight loss,
night sweats, fever, shall have a chest radiograph performed immediately to exclude TB disease (or evaluate
an interpretable copy taken within the previous three (3) months). Repeat radiographs are not needed unless
symptoms or signs of TB disease develop or unless recommended by a physician. These staff
members/direct care volunteers/private sitters will be evaluated for the need for treatment of TB disease or
latent TB infection (LTBI) and will be encouraged to follow the recommendations made by a physician
with TB expertise (i.e., the Department’s TB Control program).

3. Medium Risk:

a. Baseline two-step TST or a single BAMT: All staff/direct care volunteers/private sitters (within
three (3) months prior to contact with residents) unless there is a documented TST or a BAMT result during
the previous twelve (12) months. If a newly employed staff/direct care volunteer/private sitter has had a
documented negative TST or a BAMT result within the previous twelve (12) months, a single TST (or the
single BAMT) can be administered to serve as the baseline prior to resident contact.

b. Periodic testing (with TST or BAMT): Annually, of all staff/direct care volunteers who have risk
of TB exposure and who have previously documented negative results. Instead of participating in periodic
testing, staff/direct care volunteers with documented TB infection (positive TST or BAMT) shall receive a
symptom screen annually. This screen shall be accomplished by educating the staff/direct care volunteers
who have documented TB infection about symptoms of TB disease (including the staff’s and/or direct care
volunteers’ responses concerning symptoms of TB disease), documenting the questioning of the staff/direct
care volunteers about the presence of symptoms of TB disease, and instructing the staff/direct care
volunteers to report any such symptoms immediately to the administrator. Treatment for latent TB infection
(LTBI) shall be considered in accordance with CDC and Department guidelines and, if recommended,
treatment completion shall be encouraged.

c. Periodic testing (with TST or BAMT): Annually, of all private sitters who have risk of TB
exposure and who have previously documented negative results. Instead of participating in periodic testing,
private sitters with documented TB infection (positive TST or BAMT) shall provide the facility with written
evidence of a symptom screen annually. Documentation of education about symptoms of TB disease
(including responses concerning symptoms of TB disease) and written evidence of the questioning about
the presence of symptoms of TB disease and the report of any such symptoms shall be provided
immediately to the facility administrator.

d. Post-exposure TST or a BAMT for staff/direct care volunteers upon unprotected exposure to M.
tuberculosis: Perform a contact investigation (See Section 101.M) when unprotected exposure is identified.
Administer one (1) TST or a BAMT as soon as possible to all staff/direct care volunteers/private sitters
who have had unprotected exposure to an infectious TB case/suspect. If the TST or the BAMT result is
negative, administer another TST or BAMT eight to ten (8 to 10) weeks after that exposure to M.
tuberculosis ended.

e. Post-exposure TST or a BAMT for private sitters upon unprotected exposure to M tuberculosis:
Written evidence of a contact investigation when unprotected exposure is identified shall be provided to
the facility administrator. The private sitter shall provide documentation of a completed single TST or a
BAMT prior to resident contact. If the TST or BAMT result is negative, the private sitter shall provide
written evidence of an additional TST or BAMT eight to ten (8 to 10) weeks after that exposure to M.
tuberculosis ended.

4. Baseline Positive or Newly Positive Test Result:
a. Baseline positive with or without documentation of treatment for latent TB infection (LTBI) or
TB disease shall have a symptoms screen prior to employment and annually thereafter.
b. Upon hire, staff/direct care volunteers/private sitters with a newly positive test result for
M.tuberculosis infection (i.e., TST or BAMT) or signs or symptoms of tuberculosis, e.g., cough, weight
loss, night sweats, fever, shall have a chest radiograph performed immediately to exclude TB disease (or
evaluate an interpretable copy taken within the previous three (3) months). Repeat chest radiographs are
not required unless symptoms or signs of TB disease develop or unless recommended by a physician. These
staff members/direct care volunteers/private sitters will be evaluated for the need for treatment of TB
disease or latent TB infection (LTBI) and will be encouraged to follow the recommendations made by a
physician with TB expertise (i.e., the Department’s TB Control program).
c. Staff/direct care volunteers/private sitters who are known or suspected to have TB disease shall
be excluded from work, required to undergo evaluation by a physician, and permitted to return to work only
with written approval by the Department’s TB Control program. Repeat chest radiographs are not required
unless symptoms or signs of TB disease develop or unless recommended by a physician.

E.Resident Tuberculosis Screening (I)
1. Tuberculosis Status. Prior to admission, the tuberculosis status of a resident shall be determined in
the following manner in accordance with the applicable risk classification:
a. For Low Risk and Medium Risk:
1. Admission/Baseline two-step TST or a single BAMT: All residents within thirty (30) days prior
to admission shall have completed the first step of the two-step tuberculin skin test followed seven to twenty-one (7 to 21)
days later by a second test unless there is a documented TST or a BAMT result during the
previous twelve (12) months. If a newly-admitted resident has had a documented negative TST or a BAMT
result within the previous twelve (12) months, a single TST (or the single BAMT) can be administered
within one (1) month prior to admission to the facility to serve as the baseline. As an exception, a resident
may be admitted with at least the first step of the TB screening process completed prior to admission and
the second step within fourteen (14) days of admission.
2. Periodic TST or BAMT is not required.
3. Post-exposure TST or a BAMT for residents upon unprotected exposure to M. tuberculosis:
Perform a contact investigation when unprotected exposure is identified. Administer one (1) TST or a
BAMT as soon as possible to all residents who have had exposure to an infectious TB case/suspect. If the
TST or the BAMT result is negative, administer another TST or a BAMT eight to ten (8 to 10) weeks after
that exposure to M. tuberculosis ended.
b. Baseline Positive or Newly Positive Test Result:
1. Residents with a baseline positive or newly positive test result for M. tuberculosis infection
(i.e., TST or BAMT) or documentation of treatment for latent TB infection (LTBI) or TB disease or signs
or symptoms of tuberculosis, e.g., cough, weight loss, night sweats, fever, shall have a chest radiograph
performed immediately to exclude TB disease (or evaluate an interpretable copy taken within the previous
three (3) months). Routine repeat chest radiographs are not required unless symptoms or signs of TB disease
develop or unless recommended by a physician. These residents shall be evaluated for the need for
treatment. If diagnosed with latent TB infection (LTBI) the resident shall be encouraged to follow the
recommendations made by a physician with TB expertise (i.e., the Department’s TB Control program). For
those residents diagnosed with TB disease, the facility shall assure that the affected residents follow the
recommendations made by a physician with TB expertise (i.e., the Department’s TB Control program).
2. Residents who are known or suspected to have TB disease shall be transferred from the facility
if the facility does not have an Airborne Infection Isolation Room (See Section 101.E), required to undergo
evaluation by a physician, and permitted to return to the facility only with written approval by the
Department’s TB Control program.
F. Individuals who have been declared in writing to be in an emergency crisis stabilization status maybe
admitted to the facility without the initial step of the two-step tuberculin skin test and/or while awaiting the
result of a BAMT. These individuals shall be placed in an area separate from the general population. This
admission to the facility may be made provided:
1. There is documentation at the facility of the declaration by Adult Protective Services of the South
Carolina Department of Social Services or the South Carolina Department of Mental Health that the
admission is, in fact, an emergency (NOTE: Only these agencies may declare these crisis stabilization
admissions to be an emergency);
2. There is written evidence of a chest x-ray within one (1) month prior to admission and a written
assessment by a physician or other authorized healthcare provider that there is no active TB and a negative
assessment for signs and/or symptoms of tuberculosis; and,
3. The resident will receive the initial step of the two-step tuberculin test within twenty-four (24) hours
of admission to the facility. The second step of the two-step tuberculin skin test must be administered within
the next seven to fourteen (7 to 14) days.

703. Housekeeping (II).
The facility and its grounds shall be clean, and free of vermin and offensive odors.
A.Interior housekeeping shall at a minimum include:
1. Cleaning each specific area of the facility;
2. Cleaning and disinfection, as needed, of equipment used and/or maintained in each area appropriate
to the area and the equipment’s purpose or use;
3. Safe storage of chemicals indicated as harmful on the product label, cleaning materials, and supplies
in cabinets or well-lighted closets/rooms, inaccessible to residents. If a physician or other authorized
the healthcare provider has determined that a resident is capable of appropriately using a cleaning product or
another hazardous agent, the facility may elect to permit the resident to use the product, provided there is a
a written statement from a physician or other authorized healthcare provider that assures that the resident is
capable of maintaining the product in a secure locked manner and that a description of product usage is
outlined in the resident’s ICP.
B.Exterior housekeeping shall at a minimum include:
1. Cleaning of all exterior areas, e.g., porches and ramps, and removal of safety impediments such as
snow and ice;
2. Keeping facility grounds free of weeds, rubbish, overgrown landscaping, and other potential
breeding sources for vermin.
3. Safe storage of chemicals indicated as harmful on the product label, equipment and supplies
inaccessible to residents.

1704. Infectious Waste (I).

Accumulated waste, including all contaminated sharps, dressings, and/or similar infectious waste, shall be
disposed of in a manner compliant with OSHA Blood-borne Pathogens Standard, and R.61- 105.
1705. Pets (II).

A.If the facility chooses to permit pets, healthy animals that are free of fleas, ticks, and intestinal parasites
and have been screened by a veterinarian prior to resident contact, have received required inoculations, if
applicable, and that present no apparent threat to the health, safety, and well-being of the residents, may be
permitted in the facility, provided they are sufficiently fed and cared for and that both the pets and their
housing are kept clean.

B.Pets shall not be allowed near residents who have allergic sensitivities to pets, or for other reasons
such as residents who do not wish to have pets near them.

C.Pets shall not be allowed in the kitchen area. Pets shall be permitted in resident dining areas only
during times when food is not being served. If the dining area is adjacent to a food preparation or storage
area, those areas shall be effectively separated by walls and closed doors while pets are present.

D.If personal pets are permitted in the facility, the housing of those pets shall be either in a resident
private room or outside the facility.

1706. Clean/Soiled Linen and Clothing (II).
A.Clean Linen/Clothing. A supply of clean, sanitary linen/clothing shall be available at all times. In order
to prevent the contamination of clean linen/clothing by dust or other airborne particles or organisms, clean
linen/clothing shall be stored and transported in a sanitary manner, e.g., enclosed and covered.
Linen/Clothing storage rooms shall be used only for the storage of linen/clothing. Clean linen/Clothing
shall be separated from storage of other purposes.
B.Soiled Linen/Clothing.
1. Soiled linen/Clothing shall neither be sorted, rinsed, nor washed outside of the laundry service area;
2. Provisions shall be made for collecting, transporting, and storing soiled linen/clothing;
3. Soiled linen/Clothing shall be kept in enclosed/covered containers;
4. Laundry operations shall not be conducted in resident rooms, dining rooms, or in locations where
food is prepared, served, or stored. Freezers/refrigerators may be stored in laundry areas, provided sanitary
conditions are maintained.