OAR 333-019-0052: Other Disease Specific Provisions: Communication During Transfer of Patients with MDROs, C. difficile, or Any Organism Requiring Transmission-Based Precautions

(1) As used in this rule: (a) “Facility” means: (A) A healthcare facility as that term is defined in ORS 442.015; (B) An infirmary (for example, in a jail or prison); (C) A residential facility or assisted living facility as those terms are defined in ORS 443.400; (D) An adult foster home as that term is defined in ORS 443.705; (E) A hospice program as that term is defined in ORS 443.850; and (F) Any other facility that provides 24-hour patient care. (b) “Multidrug-resistant organism” (MDRO) means an organism causing human disease which has acquired antibiotic resistance, as listed and defined in the Centers for Disease Control and Prevention’s Antibiotic Resistance Threats in the United States, 2013 (Atlanta, GA; 2013). MDROs include but are not limited to: (A) Methicillin-resistant Staphylococcus aureus (MRSA); (B) Vancomycin-resistant Enterococcus (VRE); (C) Carbapenem-resistant Enterobacteriaceae (CRE), as that term is defined in OAR 333-017-0000 sections (10) and (24); (D) Multidrug-resistant Acinetobacter baumannii; (E) Multidrug-resistant Pseudomonas aeruginosa; (F) Drug-resistant Streptococcus pneumoniae; (G) Other Gram-negative bacteria producing extended-spectrum beta-lactamases (ESBL); and (H) Toxin-producing Clostridium difficile. (c) “Receiving facility” means the facility receiving or admitting the case patient into their care from another facility’s care. (d) “Referring facility” means the facility transferring or discharging the case patient out of its care and into another facility’s care. (e) “Standard Precautions” means the minimum infection prevention measures that apply to all patient care, regardless of suspected or confirmed infection status of the patient, in any setting where healthcare is delivered. Standard Precautions include: (A) Hand hygiene; (B) Use of personal protective equipment (for example, gloves, gowns, facemasks), depending on the anticipated exposure; (C) Respiratory hygiene and cough etiquette; (D) Safe injection practices; and (E) Safe handling of potentially contaminated equipment or surfaces in the patient environment. (f) “Transmission Based Precautions” means infection control practices that are implemented in addition to Standard Precautions in patients with known or suspected colonization or infection of highly transmissible or epidemiologically important infectious pathogens (for example, CRE, norovirus, Neisseria meningitidis) or syndromes (for example, diarrhea) when there is strong evidence that the pathogen or syndrome may be transmitted from person to person via droplet, contact, or airborne routes in healthcare or non-healthcare settings (Siegel JD, Rhinehart E, Jackson M, Chiarello L, and the Healthcare Infection Control Practices Advisory Committee. Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings, 2007). (2) When a referring facility transfers or discharges a patient who is infected or colonized with a multidrug-resistant organism (MDRO) or pathogen which warrants Transmission Based Precautions, it must include written notification of the infection or colonization to the receiving facility in transfer documents. The referring facility must ensure that the documentation is readily accessible to all parties involved in patient transfer (for example, referring facility, medical transport, emergency department, receiving facility). (3) When a facility becomes aware that it received in transfer one or more patients with an MDRO or pathogen that warrants Transmission Based Precautions, and that was isolated from a patient specimen collected within 48 hours after transfer, it must notify the referring facility. (4) When a facility becomes aware that it transferred or discharged one or more patients who have an MDRO or pathogen that warrants Transmission Based Precautions, the referring facility must notify the receiving facility. (5) If a facility transfers or discharges a patient with laboratory-confirmed, carbapenemase-producing Enterobacteriaceae, the facility must notify the local health department communicable disease staff within one working day of the date and destination of the transfer or discharge.