NAC449.98453. Program required to include policies and procedures for prevention of exposure to blood-borne and other potentially infectious pathogens.

Each program for the prevention and control of infections and communicable diseases must include policies and procedures to prevent exposure to blood-borne and other potentially infectious pathogens, including, without limitation, policies and procedures relating to:

     1. Hand hygiene, including provisions regarding the time and procedure for handwashing with soap and water or use of an alcohol-based hand rub.

     2. The proper use of medical gloves. Those policies and procedures must, at a minimum, provide that each person who works at the ambulatory surgical center must wear medical gloves when the person:

     (a) Anticipates coming in contact with blood or bodily fluids;

     (b) Handles contaminated instruments, items and equipment;

     (c) Handles biohazardous waste;

     (d) Handles linens potentially contaminated with biohazardous waste; and

     (e) Performs housekeeping activities or cleans contaminated surfaces.

     3. Safe injection practices to prevent the contamination of equipment used for injections and medication. Those policies and procedures must provide that a new sterile needle and new sterile syringe must be used for each patient and may not be used for more than one patient.

     4. The proper handling of sharp instruments and the disposal of sharp instruments. Those policies and procedures must be consistent with the standards developed by the Occupational Safety and Health Administration for the handling and disposal of such instruments.

     5. Techniques for accessing a vial of medication. Those policies and procedures must comply with the requirements set forth in NAC 449.98454.

     6. The infusion of intravenous medications. Those policies and procedures must provide that intravenous tubing and fluid bags or bottles must not be used for more than one patient.

     7. The proper sterilization and disinfection of all medical equipment, instruments and devices. Those policies and procedures must, at a minimum, require an ambulatory surgical center to:

     (a) Sterilize or ascertain the sterility of items that enter sterile tissue or the vascular system, including, without limitation, surgical instruments, endoscopes, endoscopic accessories, catheters, needles and probes used for ultrasounds;

     (b) Perform high-level disinfection of reusable items that come in contact with nonintact skin or mucus membranes, including, without limitation, respiratory therapy equipment, anesthesia equipment, bronchoscopes and gastrointestinal endoscopes; and

     (c) Perform low-level disinfection of reusable items that come in contact with only intact skin, including, without limitation, tourniquets, blood pressure cuffs, linens, stands that are used to hold medical instruments and other furnishings.

     8. The proper handling of equipment, instruments and devices. Those policies and procedures must, at a minimum, require an ambulatory surgical center to:

     (a) Sterilize and disinfect reusable items as described in subsection 7;

     (b) Properly dispose of single-use equipment, instruments and devices after use, if the ambulatory surgical center has decided not to have the equipment, instruments or devices reprocessed; and

     (c) Ensure that:

          (1) All equipment, instruments and devices that may be reprocessed are reprocessed only by a third-party processor approved by the United States Food and Drug Administration; and

          (2) No equipment, instruments or devices that may be reprocessed are reprocessed at the ambulatory surgical center.

     9. The proper handling and disposal of medical waste and specimens.

     10. The proper cleaning and disinfection of all areas in which patient care is provided.

     11. The proper maintenance of a clean and sanitary environment.

     12. The identification and reporting of the development and transmission of infections and communicable diseases. Those policies and procedures must include the method by which the ambulatory surgical center must:

     (a) Track and document the development and transmission of infections and communicable diseases which are related to the medical procedures performed at the ambulatory surgical center;

     (b) Report the development and transmission of infections and communicable diseases as required by federal, state and local laws; and

     (c) Identify and address trends in such developments and transmissions of infections and communicable diseases.

     13. The care of patients with a communicable disease, including, without limitation, patients who are known to have a communicable disease at the time of arrival at the ambulatory surgical center and patients who are found to have a communicable disease during the course of treatment at the ambulatory surgical center.

     14. The screening for communicable diseases as described in NAC 441A.375 of all employees and of all persons under contract with the ambulatory surgical center who work at the center and have exposure to patients at the center.

     (Added to NAC by Bd. of Health by R096-08, 8-26-2008, eff. 10-25-2008)