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10.06.01.06

.06 General Control Measures.

A. Necessary Action. The Secretary or health officer shall:

(1) Take any action or measure necessary to prevent the spread of communicable disease or to control a reportable disease and condition; and

(2) Issue, when necessary, special instructions for control of a disease or condition.

B. Epidemiologic Investigations.

(1) A health officer shall respond to each reported outbreak or suspected outbreak of disease within the health officer's jurisdiction in order to collect data to assist in establishing adequate control measures.

(2) A health officer shall investigate a reported case or suspect case of a condition as requested by the Secretary.

(3) The Secretary may, in conjunction with the health officers, conduct the epidemiologic investigation for each reported case or suspected case in an outbreak involving two or more jurisdictions or states.

(4) An individual, a business, a facility, or an agency, including a health care provider, school or child care facility personnel, a master of a vessel or aircraft, or a medical laboratory director, shall make available to the Secretary or the health officer all records and information necessary to the epidemiologic response or investigation.

C. The health officer or Secretary shall order cessation of operation of a business or facility determined or suspected to be a threat to public health until the public health threat is determined by the health officer to have ceased.

D. Carrier Approval.

(1) The health officer shall grant or deny approval to a carrier of an infectious agent to work in any of the following occupations involving:

(a) Care of young children;

(b) Care of the elderly;

(c) Food handling; and

(d) Patient care.

(2) The health officer shall grant or deny approval to a carrier of an infectious agent to attend a:

(a) School; or

(b) Child care facility.

(3) The health officer shall consider the following when granting or denying approval to a carrier of an infectious agent to work in occupations or to attend settings listed under §D(1) and (2) of this regulation:

(a) The seriousness of the disease;

(b) The route or routes of transmission of the disease;

(c) The contagiousness of the disease;

(d) The behavior, neurological development and condition, and physical condition of the carrier;

(e) The susceptibility to the disease of those likely to be exposed to the carrier in the occupation or setting;

(f) The precautions that may be taken to minimize or eliminate the danger of transmission; and

(g) Precedents in the practice of public health.

E. Control of Food Handlers. A case with any of the following diseases may not serve or handle, in any manner whatsoever, food intended for public consumption:

(1) Diarrhea caused by Entamoeba histolytica (see Regulation .08 of this chapter);

(2) Cholera;

(3) Disease causing diarrhea, unless physician-certified as noninfectious;

(4) E. coli O157:H7 (see Regulation .08-2 of this chapter);

(5) Hepatitis A (see Regulation .10 of this chapter);

(6) Diarrhea caused by Salmonella (see Regulation .16 of this chapter);

(7) Shigellosis (see Regulation .19 of this chapter);

(8) Streptococcal infection caused by group A beta-hemolytic Streptococcus; and

(9) Typhoid fever or carrier of Salmonella typhi (see Regulation .22 of this chapter).

F. Control of Communicable Diseases in Schools and Child Care Facilities.

(1) The health officer shall:

(a) Maintain the right to make physical inspections of pupils, teachers, or other persons attending, employed, or volunteering in schools or child care facilities whenever, in the judgment of the health officer, the inspections are necessary to investigate a suspected communicable disease; and

(b) Determine whether enrollees, pupils, or other individuals attending schools or child care facilities have received the immunizations required under COMAR 10.06.04, 07.04.01, or 07.04.02.

(2) The principal or other person in charge of any school or child care facility shall comply with a measure or special instruction issued by the health officer under Regulation .06A of this chapter.

G. Use of Sterile Instruments or Equipment. An individual who performs a procedure that penetrates the skin or mucous membrane of another individual shall:

(1) Utilize only sterile instruments or equipment for the procedure;

(2) Discard, after a single use, in accordance with COMAR 10.06.06, 26.13.11, and 26.13.12, any instruments or equipment designed for single use; and

(3) Clean and sterilize before reuse any instruments or equipment designed for multiple use.

H. Skin-Penetrating Body Adornment Procedures—Infection Control.

(1) An individual who performs a skin-penetrating body adornment procedure shall:

(a) Disclose the risks of the procedure, obtain the client's written consent for the performance of the procedure or, in the case of a minor, the consent of the parent or guardian, and retain the consent on file for a period of 3 years and make it available to the health officer, if requested;

(b) Maintain records of the name of the customer, the date and type of procedure performed, and the technician performing the procedure for a period of 3 years and make these records available to the health officer, if requested;

(c) Perform the procedure in a separate, enclosed room that has adequate lighting, and floors, walls, and a ceiling that are constructed to be smooth, impervious, and washable;

(d) Use only sterile instruments, equipment, and bandages;

(e) Wash both hands using soap and running water and dry the hands using individual single-use towels before and after each procedure;

(f) Wear single-use disposable latex or vinyl gloves for each procedure and discard the gloves after the procedure is completed;

(g) Wear a gown and face shield, or goggles and a mask, if spattering of blood is likely to occur during the procedure;

(h) Cleanse the client's skin before and after the procedure;

(i) Discard, after a single use, in accordance with COMAR 10.06.06, 26.13.11, and 26.13.12, any instruments or equipment designed for single use or any blood-soiled article;

(j) Clean and sterilize before reuse any instruments or equipment designed for multiple use;

(k) Provide written after-care instructions to the client;

(l) Use standard precautions in all situations where exposure to blood or body fluids may occur and comply with all applicable State and federal laws and regulations regarding worker protection; and

(m) Post the following notice in a prominent place:

"NOTICE"

Any procedure that involves penetrating the skin, such as body piercing or tattooing, carries some risks.

The risks from such procedures include: pain, bleeding, swelling, infection at the site of the procedure, transmission of blood-borne infections, scarring, and nerve damage.

The technician performing your procedure should:

* Obtain written consent for the procedure.

* Properly wash his/her hands.

* Cleanse your skin.

* Use sterile instruments, equipment, and bandages.

* Use proper technique to prevent infection at the site of the procedure.

* Provide you with written instructions to tell you what to expect about healing and how you should care for the area after the procedure has been done."

(2) An individual who performs a procedure that penetrates the skin or mucous membrane may not:

(a) Perform a procedure on skin or mucous membrane that has a rash, infection, or other lesion;

(b) Perform a procedure when the person performing the procedure has an infected or bleeding lesion on the hands;

(c) Use a styptic pencil or alum block to staunch bleeding; or

(d) Reuse instruments or equipment intended for single use.

(3) The health officer may investigate complaints received regarding compliance with this section.

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