Chapter 4723-20 Prevention of Disease Transmission

4723-20-01 Definitions pertaining to prevention of disease transmission and infection control.

For the purposes of this chapter, the following definitions shall apply:

(A) "Aseptic technique" means practices used to reduce or eliminate microorganisms.

(B) "Exposure-prone activity" means an activity in which there is a risk of disease transmission by virtue of any of the following:

(1) Direct contact with a disease source that includes:

(a) Airborne transmission or droplet;

(b) Eating or drinking contaminated food or water;

(c) Being bitten by an insect or other disease carrying agent;

(2) Invasive procedure;

(3) Any other direct contact with disease source, including bodily contact; or

(4) Contact with contaminated environmental surfaces.

(C) "Hand washing" as that term is used in division (K)(1) of section 4723.07 of the Revised Code is a component of hand hygiene achieved by washing and rinsing hands with non-antimicrobial soap or antimicrobial soap and water, or by using alcohol-based waterless hand sanitizers or other antimicrobial agents.

(D) "Invasive procedure" means any procedure involving manual or instrumental contact with, or entry into, any blood, body fluid, cavity, internal organ, subcutaneous tissue, mucous membrane or percutaneous wound of the human body. If percutaneous injury occurs to a licensee or certificate holder during an exposure-prone activity, the licensee's or certificate holder's blood is likely to contact the patient's body cavity, subcutaneous tissues, or mucous membranes.

(E) "Respiratory hygiene" is an element of standard precautions that requires the licensee or certificate holder to engage in source control practices to control the spread of respiratory infection, including but not limited to:

(1) Covering coughs or sneezes, promptly disposing of used tissues, and performing hand hygiene;

(2) Source control measures, including but not limited to using masks on a coughing patient when tolerated and appropriate; or

(3) Spatial separation of patients and other persons with respiratory infections in common waiting areas when possible.

(F) "Universal and standard precautions" are infection prevention practices that apply to all patients, regardless of suspected or confirmed infection status, in any setting in which healthcare is delivered, and include but are not limited to the following:

(1) Practices used to mitigate exposure to disease-causing agents when exposure-prone activity occurs;

(2) Hand hygiene;

(3) Disinfection and sterilization of equipment;

(4) Appropriate handling and disposal of needles and other sharp instruments; and

(5) Appropriate use of personal protective equipment, including wearing and disposal of gloves and other protective barriers or devices.

Effective: 02/01/2014
R.C. 119.032 review dates: 10/17/2013 and 10/15/2018
Promulgated Under: 119.03
Statutory Authority: 4723.07(L)
Rule Amplifies: 4723.07(L)
Prior Effective Dates: 10/01/1993, 04/01/1999, 02/01/2001, 2/1/04, 02/01/2009

4723-20-02 Practices to control infection and minimize exposure to disease.

During the delivery of healthcare, licensees and certificate holders shall be familiar with, observe, and rigorously adhere to the acceptable and prevailing standard precautions to minimize exposure to disease causing agents and prevent infection, including at least the following:

(A) Appropriate use of hand hygiene;

(B) Appropriate use of respiratory hygiene;

(C) Effective disinfection and sterilization of equipment;

(D) Safe injection practices;

(E) Safe handling and disposal of needles and other sharp instruments;

(F) Safe handling and disposal of blood and body fluid; and

(G) Appropriate use of personal protective equipment, including wearing and disposal of gloves and other protective garments and devices.

Replaces: Replaces former 4723-20-02

R.C. 119.032 review dates: 10/17/2013 and 10/17/2018
Promulgated Under: 119.03
Statutory Authority: 4723.07(L)
Rule Amplifies: 4723.07(L)
Prior Effective Dates: 10/01/1993, 04/01/1999, 02/01/2001, 02/01/2009

4723-20-03 Hand hygiene.

During the delivery of healthcare, licensees and certificate holders shall follow acceptable and prevailing standard precautions for hand hygiene, including but not limited to the following:

(A) Appropriate handwashing prior to performing or participating in an exposure-prone activity and after performing or participating in an exposure-prone activity;

(B) Washing the hands and other skin surfaces immediately and thoroughly when hands have had contact with mucous membranes, blood or body fluids, secretions or excretions, or after touching contaminated items; and

(C) Washing the hands immediately after the gloves are removed; and

(D) For the purposes of this chapter, hand washing may include the use of alcohol-based waterless hand sanitizers or other antimicrobial agents. If contact with spores, such as C. difficile or bacillus anthracis, has likely occurred, the physical action of washing and rinsing hands with antimicrobial soap and water is the recommended standard precaution.

Effective: 02/01/2014
R.C. 119.032 review dates: 10/17/2013 and 10/15/2018
Promulgated Under: 119.03
Statutory Authority: 4723.07(L)
Rule Amplifies: 4723.07(L)
Prior Effective Dates: 10/01/1993, 04/01/1999, 02/01/2001, 02/01/2004, 02/01/2009

4723-20-04 Disinfection and sterilization.

An instrument or other reusable equipment used by a licensee or certificate holder who performs or participates in an exposure-prone activity shall be appropriately disinfected and sterilized according to acceptable and prevailing standards for disinfection and sterilization which shall include at least the following:

(A) Equipment and devices that enter a normally sterile area of the body shall be sterilized before being used for each client; and

(B) Equipment and devices that touch an intact mucous membrane but do not penetrate the client's body surfaces shall be sterilized when possible, or undergo high-level disinfection if the equipment or device cannot be sterilized before being used for each client.

(C) A licensee or certificate holder shall use aseptic technique, as appropriate.

R.C. 119.032 review dates: 10/17/2013 and 10/17/2018
Promulgated Under: 119.03
Statutory Authority: 4723.07(L)
Rule Amplifies: 4723.07(L)
Prior Effective Dates: 10/01/1993, 04/01/1999, 02/01/2001, 02/01/2004, 02/01/2009

4723-20-05 Handling and disposal of a sharp or waste.

(A) To prevent injury, a licensee or certificate holder performing or participating in an exposure-prone activity shall not recap a needle, or purposely bend or break a needle or other sharp instrument or item by hand.

(B) After a licensee or certificate holder, who is performing or participating in an exposure-prone activity, uses a disposable needle, syringe, scalpel blade or other sharp item, the licensee or certificate holder shall place the disposable sharp item used in a puncture-resistant container for disposal. The puncture-resistant container shall be located as close as practicable to the use area.

(C) In addition to the requirements of this rule, any sharp instrument, needle or contaminated waste shall be handled and disposed in accordance with all requirements established by the licensee or certificate holder's employer, facilities or organizations in which the licensee or certificate holder is providing care, and requirements established for independent providers by the Ohio department of job and family services for the delivery of home care.

R.C. 119.032 review dates: 10/17/2013 and 10/17/2018
Promulgated Under: 119.03
Statutory Authority: 4723.07(L)
Rule Amplifies: 4723.07(L)
Prior Effective Dates: 10/01/1993, 04/01/1999, 02/01/2001, 02/01/2009

4723-20-06 Personal protective equipment.

During the delivery of healthcare, licensees and certificate holders shall follow acceptable and prevailing standards precautions regarding the use of personal protective equipment, including at least the following:

(A) Gloves:

(1) A licensee or certificate holder shall wear disposable gloves when performing or participating in an exposure-prone invasive procedure;

(2) The licensee's or certificate holder's hands shall be washed when gloves are removed;

(3) Before performing or participating in an exposure-prone invasive procedure on another client, the licensee or certificate holder shall wash hands and reglove with another pair of disposable gloves;

(4) If a glove is torn or a needlestick or other injury occurs, the glove shall be removed and a new glove put on as promptly as client safety permits. The needle or instrument involved in the incident shall be removed from the sterile field;

(B) Masks and protective eyewear. A licensee or certificate holder shall use personal protective equipment such as masks and protective eyewear during patient procedures and activities that are likely to generate splashes or sprays of blood, body fluids and excretions; and

(C) Gowns or aprons. A gown or apron made of material that provides an effective barrier shall be worn by a licensee or certificate holder who is performing or participating in an exposure-prone activity if during the procedure there is a possibility of spattering or splashing of blood or other body fluid.

Replaces: Replaces former 4723-20-06

R.C. 119.032 review dates: 10/17/2013 and 10/17/2018
Promulgated Under: 119.03
Statutory Authority: 4723.07(L)
Rule Amplifies: 4723.07
Prior Effective Dates: 10/01/1993, 04/01/1999, 02/01/2001, 02/01/2009

4723-20-07 Failure to use universal and standard precautions.

During the delivery of healthcare, a licensee or certificate holder who fails to follow universal and standard precautions when engaging in exposure-prone activity, as set forth in rules 4723-20-01 to 4723-20-06 of the Administrative Code, may be subject to disciplinary action according to section 4723.28 of the Revised Code.

Effective: 02/01/2014
R.C. 119.032 review dates: 10/17/2013 and 10/15/2018
Promulgated Under: 119.03
Statutory Authority: 4723.07(L)
Rule Amplifies: 4723.28(B)(18)
Prior Effective Dates: 10/01/1993, 04/01/1999, 02/01/2001, 02/01/2009