HIV AIDS Resource Guide/HIV-AIDS Resource Guide.iso/STAT/STATE/MT-AD-1.ASC

Text File | 1993-01-14 | 44KB | 1,412 lines

/* The MONTANA ADMINISTRATIVE CODE concerns communicable disease
control, and exposure of emergency medical services personnel. */



COMMUNICABLE DISEASE CONTROL

16.28.202

16.28.202 REPORTABLE DISEASES.  Reportable communicable diseases
include:

(1) Category A diseases:

Botulism, including Infant Botulism

Cholera

Diphtheria

Measles

Plague

Poliomyelitis, paralytic

Poliomyelitis, non-paralytic

Rabies, Human

Relapsing Fever (louse-borne)

Smallpox

Typhus (louse-borne)

Yellow Fever

Category A diseases also include an undiagnosed febrile illness
in a person recently returning from a foreign country such as
Ebola Hemorrhagic Fever, Lassa Fever, or Marburg Virus disease.

(a) A Category A disease must be reported within 6 hours of
diagnosis to a local health officer followed by a written report
submitted within 48 hours.  The report must include the name,
address, and telephone number of the infected person; the name,
address, and telephone number of the reporter; and the name of
the disease.

(2) Category B diseases:

Anthrax

Amebiasis

Brucellosis (Undulent Fever)

Chancroid

Encephalitis or Encephalomyelitis (post-infectious, arthropod-
borne, other or unspecified)

Giardiasis

Gonococcal disease (including gonorrhea)

Granuloma inguinale

Hepatitis, Type A (Infectious), Type B (Serum), Unspecified

Legionnaires' Disease

Leprosy

Leptospirosis

Lymphogranuloma venereum

Malaria

Meningitis, Aseptic (viral)

Meningococcal Disease (Meningococcemia, Meningococcal meningitis,
or other illness)

Mumps

Ornithosis (Psittacosis)

Rabies, animal (species, county, date)

Rocky Mountain Spotted Fever (Tick-borne Typhus)

Rubella (German Measles)

Rubella, Congenital

Salmonellosis

Shigellosis (bacillary dysentery)

Syphilis

Tetanus

Trichinosis

Tuberculosis (including non-pulmonary and atypical)

Tularemia

Typhoid and Paratyphoid Fever

Whooping Cough-like illness (Pertussis)

(a) A Category B disease must be reported within 24 hours of
diagnosis to a local health officer.  The report must include the
name of the infected person, the reporter, and the disease.

(3) Category C diseases:

Chickenpox

Epidemic Gastroenteritis

Epidemic Kerato-conjunctivitis

Food-borne

Influenza

Nosocomial

Pediculosis (lice)

Ringworm (Dermatophytosis)

Scabies

Streptococcal Infections (including Scarlet Fever and "Strep
Throat")

Suspected non-polio enteroviral infections

Swimmer's Itch (cutaneous larva migrans)

Water-borne

(a) Only an epidemic of a Category C disease must be reported to
a local health officer.  A report may be made by mail or
telephone without identification of an infected person.  The
department may request further information.

(4) Category D diseases:

Animal Bites

Bacterial Meningitis (other than meningococcal)

Colorado Tick Fever

Guillain-Barre Syndrome

Heavy metal poisoning (lead, cadmium, arsenic, phosphorus,
mercury, other)

Helminth infestations

Q-Fever

Reye's Syndrome

Rheumatic Fever (acute)

Subacute Sclerosing Panencephalitis (SSPE)

Typhus, murine

Viral exanthum in pregnant women

Exotic diseases (including but not limited to melidosis,
histoplasmosis, echinococcosis, coccidioidomycosis, and
cryptococcus)

(a)  A Category D disease must be reported within 24 hours of
diagnosis to a local health officer.  The report must include the
name of the infected person, the reporter, and the disease.

(5)(a) Category E diseases and conditions are:

(i)  Acquired immune deficiency syndrome (AIDS);

(ii) Potential AIDS, as indicated by the presence of the human T-
lymphotropic virus type III antibody.

(b)  A category E disease or condition must be reported to the
department and, in the case of AIDS, to the local health officer
of the county from which the report is made, by 5:00 p.m.  Friday
of the week in which the diagnosis of AIDS is made or the test
showing potential AIDS is performed.

(c)  The report for AIDS must include the information required by
the department's communicable disease confidential case report
form available from the department.

(d)  The report of potential AIDS must include:

(i)  the date the test identifying the antibody was performed;'

(ii) the name and address of the reporter; and

(iii) the initials of the person tested or any other identifier
such as a number, assigned by the reporter which does not reveal
the name of the person tested.

(e)  The name of any category E case and the name and street
address of the reporter of-any such case are confidential and not
open to public inspection.





Sub-Chapter 1

General Provisions

l6.28-101 DEFINITIONS Unless otherwise indicated, the following
definitions apply throughout this chapter.

(1)  'Blood and body fluid precautions mean the following
requirements to prevent spread of disease through contact with
infective blood or body fluids:

(a)  If soiling with blood or body fluids is likely, gowns must
be used to cover clothes, worn only once, and laundered.

(b)  Single-use gloves must be used if blood or body fluids,
mucous membranes, or non-intact skin will be touched, items or
surfaces soiled with blood or body fluids handled, and for
Performing vascular access Procedures other than venipuncture;
the gloves must be changed before touching another person and
discarded in a manner preventing contact with them thereafter.
(It is recommended, though not required, that single-use gloves
coupled with proper aseptic procedures also be used for
performing venipuncture.)

(c)  Hands must be washed immediately after gloves are removed or
if they are potentially contaminated with blood or body fluids
and before touching another person.

(d)  Articles contaminated with blood or body fluids must be
discarded or disinfected.

(e)  Injuries from needles or other sharp devices must be
avoided; used needles must not be recapped, bent, or broken by
hand, removed from disposable syringes, or otherwise manipulated
by hand; after use, disposable syringes and needles, scalpel
blades, and other sharp items must be placed in a prominently
labeled, puncture-resistant container for disposal, located as
closely as practicable to the use area; large-bore reusable
needles must be placed in such a container for transport to the
reprocessing area.

(f)  If a needle-stick injury occurs, the injured person must be
evaluated to determine if hepatitis prophylaxis is needed or
human immunodeficiency virus is a concern.

(g)  Any blood spills must be cleaned up promptly with a solution
of 5.25% sodium hypochlorite (for example, regular Chlorox or
Purex bleach) diluted 1:10 with water.

(h)  A case must be restricted to a private room if his/ her
hygiene is poor, i.e.  s/he does not wash hands after touching
infective material, contaminates the environment with infective
material, or shares contaminated articles with other individuals
who as yet have not contracted the disease in question; such a
person may share a room with anyone else infected with the same
organism.

(i)          Masks and protective eyewear or face shields must be
worn during procedures that are likely to generate droplets of
blood or other body fluids.

(j)  In areas where resuscitation is likely to be practiced (e.g.
emergency rooms), mouthpieces, resuscitation bags, or other
ventilation devices must be available.

(k)  No one who has an exudative lesion or weeping dermatitis in
an area to be touched may directly care for a patient or handle
patient-care equipment.

(2)  "Carrier" means a person or animal who harbors a specific
infectious agent without discernible illness and serves as a
potential source of infection.  A carrier may be "incubatory"
(just before onset), "convalescent" (after clinical recovery), or
"healthy" (no apparent illness at any time).  The carrier state
may be temporary or permanent.

(3)  "Case" means a person who is confirmed or suspected to have
a reportable disease.

(4)  "Clean" means to remove from surfaces, by scrubbing and
washing, as with hot water and soap or detergent, infectious
agents and organic matter on which and in which infectious agents
may be able to live and remain virulent.

(5)  "Communicable disease" means an illness due or suspected to
be due to a specific infectious agent or its toxic products,
which results from transmission of that agent or its products to
a susceptible host, directly or indirectly.

(6)  "Concurrent disinfection" means the use of a method which
will destroy any harmful infectious agents present immediately
after the discharge of infectious material from he body of an
infected person, or after the soiling of articles with such
infectious discharges before there is opportunity for any other
contact with them.

(7)  "Contact" means a person or animal that has had opportunity
to acquire an infection due to its association with an infected
person or animal or a contaminated environment.

(8)  "Contamination" means the presence of a disease-causing
agent upon a living body surface or within or upon any inanimate
article or substance.

(9)  "Department" means the department of health and en
vironmental sciences.

(10) "Drainage and secretion precautions" mean the following
requirements to prevent spread of disease through contact with
purulent material from an infected body site:

(a)  If soiling by the infective material is likely, gowns must
be worn, used only once, and laundered.

(b)  Single-use gloves must be used if infective material will be
touched, and discarded in a manner preventing contact with them
thereafter.

(c)  Anyone touching the case or potentially contaminated
articles must wash his/her hands immediately afterward and before
touching another person.

(d)  Any article contaminated with infective material must be
discarded or disinfected in a manner which prevents contact with
the material thereafter.

(11) "Enteric precautions" mean the following requirements to
prevent spread of disease through feces:

(a)  Gowns must be used to cover clothes if soiling is likely,
worn only once, and laundered.

(b)  Single-use gloves must be used if infective material will be
touched, and discarded in a manner preventing contact with them
thereafter.

(c)  Hands must be washed after touching the case or potentially
contaminated articles and before touching another person.

(d)  Articles contaminated with infective material must be either
thoroughly disinfected before they are removed from the infected
person's room, or bagged, labeled, and burned or decontaminated.

(e)  A case must be restricted to a private room if his/ her
hygiene is poor, i.e.  s/he does not wash hands after touching
infective material, contaminates the environment with infective
material, or shares contaminated articles with other individuals
who as yet have not contracted the disease in question; such a
person may share a room with anyone else infected with the same
organism.

(12) "Epidemic" is an incidence of a disease or infection
significantly exceeding the incidence normally observed in a
specified population of people over a specific period of time.
An "outbreak" is the same as an "epidemic".

(13) "Health care facility" is a facility defined in section 50-5-
101, MCA.

(14) "Household contact" is a person or animal living within the
household of an infected person.

(15) "Infected person" means a person who harbors an infectious
agent and who has either manifest disease or in apparent
infection.

(16) "Infection" means the entry and development or mul
tiplication of an infectious agent in the body of man or animals.
Infection is not synonymous with infectious disease; the result
may be in apparent or manifest.  The presence of living
infectious agents on the exterior surface of the body or upon
articles of apparel or soiled articles is not infection, but
contamination of such surfaces and articles.

(17) "Infectious agent" means an organism, chiefly a mi
croorganism, but including helminths, that is capable of pro
ducing an infection or infectious disease.

(18) "Infectious disease" means a clinically manifest disease of
man or animals resulting from an infection.

(19) "Infectious person" means a person from whom another person
may acquire an infectious agent by touch or proximity.

(20) "Isolation" means separation during the period of
communicability of an infected or probably infected person from
other persons, in places and under conditions approved by the
department or local health officer and preventing the direct or
indirect conveyance of the infectious agent to persons who are
susceptible to the infectious agent in question or who may convey
the infection to others.  Isolation may be either modified or
strict, as defined below:

(a)  "Modified isolation" means instruction by either the
department, a local health officer, or an attending physician,
directed to the infected person, any members of his/her family,
and any other close contacts, in accordance with "Guidelines for
Isolation Precautions in Hospitals" published by the Government
Printing Office, July, 1983, setting restrictions on the
movements of and contacts with the infected person and specifying
whichever of the following are also appropriate:

(i)  tuberculosis isolation;

(ii) respiratory isolation;

(iii)     enteric precautions;

(iv) drainage and secretion precautions;

(v)  blood and body fluid precautions;

(b)  "Strict isolation" includes the following measures:

(i)  An infected person must be isolated behind a closed door in
a separate bed in a room protected from potential vectors.

(ii) A person caring for an infected person must avoid coming
into contact with any other person until every precaution
required has been taken to prevent the spread of infectious
material.

(iii) Each person caring for an infected person must wear a
washable outer garment, mask, and gloves, and must thoroughly
wash his/her hands with soap and hot water after handling an
infected person or an    object an infected person may have
contaminated.  Before leaving the room of an infected person, a
person caring for an infected person must remove the washable
outer garment and hang it in the infected person's room until the
garment and room are disinfected.

(iv) An object which may have been contaminated by an infected
person must be either thoroughly disinfected before it is removed
from the infected person 5 room or bagged, labeled, and burned or
decontaminated.

(v)  Disposal of feces and urine of an infected person must be
made by flushing them down a toilet attached to a municipal or
other sewage System approved by the department.

(21) "Laboratorian" means any person who supervises or works in a
laboratory.

(22) "Physician" means a person licensed to practice medicine in
any jurisdiction in the United States or Canada.

(23)     "Potential AIDS" means the condition in which an in
dividual's blood contains the antibody to the human
immunodeficiency virus (HIV).

(24) "Potential epidemic" means the presence or suspected
presence of a communicable disease in a population where the
number of susceptible persons and the cc of transmission of the
disease may cause further spread of that disease.

(25) "quarantine" means those measures required by a local h~-~~h
officer or the department to prevent transmission of disease to
or by those individuals who have been or are otherwise likely to
be in contact with an individual with a communicable disease.

(26) "Reportable disease" means any disease, the occurrence or
suspected occurrence of which is required by ARM 16.28.202 to be
reported.

(27) "Respiratory isolation" means:

(a)  the patient must be in a private room;

(b)  any person in close contact with the patient must wear a
mask;

(c)  any person caring for the patient must thoroughly wash
his/her hands after touching the patient or contaminated articles
and before touching another person; and

(d)  articles contaminated with infective material must be
discarded or bagged, labelled for decontamination, and decon
taminated.

(28) "Sensitive occupation" means employment in direct care of
children, the elderly, or individuals who are otherwise at a high
risk for disease or where disease spread could occur due to the
nature of his/her work.

(29) "Sexually transmitted disease" means AIDS, syphilis,
gonococcal infection, chancroid, lymphogranuloma venereum,
granuloma inguinale, or chlamydial genital infections.

(30) "Surveillance" means scrutiny of all aspects of occurrence
and spread of a disease that are pertinent to effective control.

(31) "Susceptible" means having insufficient resistance against a
disease and consequently liable to contract the disease if
exposed.

(32) "Tuberculosis isolation" means:

(a)  the patient must be in a private room which has ventilation
to the outside and away from an enclosed area;

(b)  if the infective organism can be spread by cough, a mask
must be worn by anyone entering the patient's room; if the
organism can be spread by fluid, a gown and gloves must be worn;

(c)  any person caring for the patient must wash his/her hands
after touching the patient or potentially contaminated articles
and before touching another person; and

(d)  all potentially contaminated articles must be cleaned,
disinfected, or discarded.

(33) The department hereby adopts and incorporates by reference
the "Guidelines for Isolation Precautions in Hospitals" published
by the Government Printing Office July, 1983, which specifies
precautions that should be taken to prevent transmission of
communicable diseases.  A copy of the "Guidelines" may be
obtained from the National Technical Information Service, U.S.
Department of Commerce, 5285 Port Royal Road, Springfield,
Virginia 22161 (phone [phone]).



16.28.102 LOCAL BOARD RULES (1) A local board of health may adopt
rules for the control of communicable diseases, if such rules are
as stringent as and do not conflict with the requirements of this
chapter.



Sub-chapter 2

Reporting Requirements

16.28.201 REPORTERS (1) Any person, including but not limited to
a physician, dentist, nurse, medical examiner, other health care
practitioner, administrator of a health care facility, public or
private school administrator, city health officer, or
laboratorian who knows or has reason to believe that a case
exists shall immediately report:

(a)  the information specified in ARM 16.28.204(2) 0 the
department alone, in the case of potential AIDS;

(b)  the information specified in ARM 16.28.204(1)(a)-(e) to the
county, city-county, or district health officer in every case
other than those listed in ARM 16.28.203(3); or

(c)  if the disease in question is listed in ARM 16.28.203(3),
the fact that a case has occurred to the county, city-county, or
district health officer.

(2)  A county, city-county, or district health officer must
submit to the department, on the schedule noted in ARM 16.28.203,
the information specified in ARM 16.28.204 concerning each
confirmed or suspected case of which s/he is informed.

(3)  A laboratorian performing a blood test which shows the
presence of the antibody to the human immunodeficiency virus
(HIV) must submit to the department, in addition to the report
required by ARM 16.28.203(4), the report required by ARM
16.28.203(6) as well.



16.28.202 REPORTABLE DISEASES (1) The following communicable
diseases are reportable:

Acquired immune deficiency syndrome (AIDS), as defined by the
centers for disease control, or potential AIDS, as indicated by
the presence of the human immunodeficiency virus antibody

Amebiasis

Anthrax

Botulism (including infant botulism)

Brucellosis

Campylobacter enteritis

Chancroid

Chickenpox

Chlamydial genital infection

Cholera

Colorado tick fever

Conjunctivitis epidemic

Cytomegaloviral illness

Diarrheal disease outbreak

Diphtheria

Encephalitis

Gastroenteritis epidemic

Giardiasis

Gonococcal infection

Gonococcal ophthalmia neonatorum

Granuloma inguinale

Haemophilus influenzae B invasive disease (meningitis,
epiglottitis, pneumonia, and septicemia)

Hansen's disease (leprosy)

Hepatitis A, B, non-A non-B, or unspecified

Kawasaki disease

Influenza

Legionellosis

Listeriesis

Lyme disease

Lymphogranuloma venereum

Malaria

Measles (rubeola)

Meningitis, bacterial or viral

Mumps

Ornithosis (psittacosis)

Pertussis (whooping cough)

Plague

Poliomyelitis, paralytic or non-paralytic

Q- fever

Rabies or rabies exposure (human)

Reye's syndrome

Rocky Mountain spotted fever

Rubella (including congenital)

Salmonellosis

Shigellosis

Smallpox (including vaccinia)

Staphylococcal epidemic

Streptococcal epidemic

Swimmer's itch (cutaneous larva migrans)

Syphilis

Tetanus

Trichinosis

Tuberculosis

Tularemia

Typhoid fever

Typhus

Yellow fever

Yersiniosis

Illness occurring in a traveler from a foreign country

An unusual outbreak of any communicable disease in Control of
Communicable Diseases in Man, An Official Report of the American
Public Health Association, 14th Edition, 1985.

(2) The department hereby adopts and incorporates by reference
"Control of Communicable Diseases in Man, An official Report of
the American Public Health Association", 14th edition, 1985,
which lists and specifies control measures for communicable
diseases.  A copy of "Control of Communicable Diseases in Man"
may be obtained from the American Public Health Association, 1015
- 15th Street NW, Washington, D.C.  20005.



16.28.203 REPORTS AND REP0RT DEADLINES (1) A county, city-county,
or district health officer or his/her authorized representative
must immediately report to the department by telephone the
information cited in ARM 16.28.204(1) whenever a case of one of
the following diseases is suspected or confirmed:

Anthrax

Botulism (including infant botulism) Diphtheria Measles (rubeola)
Plague Rabies or rabies exposure (human) Smallpox (including
vaccinia) Typhoid fever

(2) A county, city-county, or district health officer or his/her
authorized representative must mail to the department the
information required by ARM 16.28.204(1) for each suspected or
confirmed case of one of the following diseases, within the time
limit noted for each:

(a) On the same day information about a case of one of the
following diseases is received by the county, city-county, or
district health officer:

Chancroid

Cholera

Diarrheal disease outbreak

Gastroenteritis epidemic

Gonococcal infection

Gonococcal ophthalmia neonatorum

Granuloma inguinale

Haemophilus influenzae B invasive disease (meningitis,
epiglottitis, pneumonia, and septicemia)

Listeriosis

Lymphogranuloma venereum

Meningitis, bacterial or viral

Pertussis (whooping cough)

Poliomyelitis, paralytic or non-paralytic

Rubella (including congenital)

Syphilis

Tetanus

Typhus

Yellow fever

Illness occurring in a traveler from a foreign country

An unusual outbreak of any communicable disease in Control of
Communicable Diseases in Man, An Official Report of the American
Public Health Association, 14th Edition, 1985.

(b)  Within 7 calendar days after the date information about a
case of one of the following diseases is received by the county,
city-county, or district health officer:

Acquired immune deficiency syndrome (AIDS)

Amebiasis

Brucellosis

Campylobacter enteritis

Chlamydial genital infection

Cytomegaloviral illness

Encephalitis

Giardiasis

Hansen's disease (leprosy)

Hepatitis, A, B, non-A non-B, or unspecified

Kawasaki disease

Legionellosis

Lyme disease

Malaria

Mumps

Ornithosis (Psittacosis)

Q- fever

Reye's syndrome

Rocky Mountain spotted fever

Salmonellosis

Shigellosis

Trichinosis

Tuberculosis

Tularemia

Yersiniosis

(3)  By Friday of each week during which a suspected or confirmed
case of one of the diseases listed below is reported to the
county, city-county, or district health officer, that officer or
his/her authorized representative must mail to the department the
total number of the cases of each such disease reported that
week:

Chickenpox

Colorado tick fever

Conjunctivitis epidemic

Influenza

Staphylococcal epidemic

Streptococcal epidemic

Swimmer's itch (cutaneous larva migrans)

(4)  Anyone, other than the local health officer, who reports a
case of AIDS or potential AIDS must submit the report by 5:00
p.m.  Friday of the week in which the diagnosis of AIDS is made
or the test showing potential AIDS is performed.

(5)  A laboratorian must submit to the department by the 15th day
following each quarter a report on a form supplied by the
department indicating the number of tests with negative or
positive results which were done that quarter for tuberculosis or
a sexually transmitted disease.

(6)  A laboratorian in a laboratory in which a test of blood is
made to determine whether the antibody to the human
immunodeficiency virus (HIV) is present must submit to the de
partment by the 15th day following the month in which the test
was performed a report on a form supplied by the department in
dicating the number of tests with negative results for that
antibody which were done during that month.

(7)  The department hereby adopts and incorporates by reference
"Control of Communicable Diseases in Man, An Official Report of
the American Public Health Association", 14th edition, 1985,
which lists and specifies control measures for communicable
diseases.  A copy of "Control of Communicable Diseases In Man"
may be obtained from the American Public Health Association, 1015
- 15th Street NW, Washington, D.C.  20005.



16.28.204 REPORT CONTENTS (1) A report of a case of reportable
disease which is required by ARM 16.28.203(1) or (2) must
include, if available:

(a)  name and age of case;

(b)  dates of onset of disease and date disease reported to
health officer;

(c)  whether or not the case is suspected or confirmed;

(d)  name and address of case's physician; and

(e)  name of reporter or other person the department can contact
for further information regarding the case.

(2)  A report of potential AIDS must include:

(a)  the date the test identifying the antibody was performed, if
it is available to the reporter;

(b)  the name and address of the reporter; and

(c)  the initials of the person tested or any other identifier,
such as a number, assigned by the reporter which does not reveal
the name of the person tested.

(3)  The information required by sections (1) and (2) of this
rule must be supplemented by any other information in the
possession of the reporter which the department requests and
which is related to case management, excepting, in the case of
those who are HIV-positive, the name or any other information
from which the individual in question might be identified.

(4)  The laboratory reports required by ARM 16.28.203(5) and (6)
and the numerical report required by ARM 16.28.203(3) need
contain only the information specified in those sections.

(5)  The name of any case of AIDS or potential AIDS and the name
and address of the reporter of any such case are confidential and
not open to public inspection.



Sub-Chapter 3

General Control Measures

16.28.301 SENSITIVE OCCUPATIONS (1) A local health officer or the
department may restrict a person employed in direct care of
children, the elderly, or individuals who are otherwise at a high
risk for disease from practicing an occupation while infected by
a reportable disease if, given the means of transmission of the
disease in question, the nature of the person 5 work would tend
to spread the disease.

(2)  No infectious person may engage in any occupation involving
the preparation, serving, or handling of food, including milk, to
be consumed by others than his/her immediate family, until a
local health officer determines him/her to be free of the
infectious agent or unlikely to transmit the infectious agent due
to the nature of his/her particular work.



16.28.302 FUNERALS (1) A funeral service for a person who died of
a reportable disease must be conducted in accordance with
instructions of a local health officer.

(2)  If a person dies from a disease requiring quarantine of
contacts, a funeral service for that person may be open to the
public only if the casket remains closed and those contacts
subject to the quarantine who attend the funeral are segregated
from the rest of those attending, unless the contacts have been
determined by a local health officer to be incapable of trans
mitting the infection or disease which caused the death.

(3)  Transportation of dead human bodies must be in accord with
ARM 16.29.103.



16.28.303 TRANSPORTATION OF COMMUNICABLE DISEASE CASES

(1)  Neither an infected person with a communicable disease for
which subchapter 6 of this chapter prescribes isolation nor a
contact made subject to quarantine by that subchapter may travel
or be transported from one location to another without the
permission of the local health officers with jurisdiction over
the places of departure and arrival, except if, in the case of an
infected person:

(a)  the infected person is to be admitted directly to a hospital
for the treatment of the communicable disease, and

(b)  both local health officers are satisfied that adequate
precautions are taken to prevent dissemination of the disease by
the infected person en route to the hospital.



16.28.304 IMPORTATION OF DISEASE (1) No person who has a
reportable disease for which subchapter 6 of this chapter
prescribes isolation may be         brought within the boundaries
of the state without prior    notice to the department and
approval of measures to be taken within Montana to prevent
disease transmission.

(2)  Whenever a person knows or has reason to believe that

an infected person, whether or not infectious, has been brought
within the boundaries of the state, s/he shall report the name
and location of the infected person to the department, with the
exception of those individuals who are HIV-positive; in the
latter case, only the information described in ARM 16.28.204(2)
must be provided to the department.



16.28.305 CONFIRMATION OF DISEASE (l)(a) Subject to the
limitation in (b) below, if a local health officer receives
information about a case of any of the following diseases, s/he
or his/her authorized representative must ensure that a specimen
from the case is submitted to the department, which specimen will
be analyzed to confirm the existence or absence of the disease in
question:

Amebiasis

Anthrax

Botulism (including infant botulism)

Brucellosis

Chancroid

Cholera

Diarrheal disease epidemic

Diphtheria

Encephalitis

Gonococcal infection in a person less than 14 years of age

Granuloma inguinale

Hansen's disease (leprosy)

Influenza

Lymphogranuloma venereum

Measles (rubeola)

Ornithosis (Psittacosis)

Pertussis (whooping cough)

Plague

Polio, paralytic or non-paralytic

Rabies (human)

Rubella (including congenital)

Shigellosis

Smallpox (including vaccinia)

Syphilis

Tetanus

Trichinosis

Tuberculosis

Tularemia

Typhoid fever

Typhus

Illness occurring in a traveler from a foreign country

(b)  In the event of an outbreak of diarrheal disease, influenza,
or measles, analysis of specimens from each case is unnecessary
after the disease organism is determined by the department.

(2)  A laboratorian or any other person in possession of a
specimen from a case of a disease listed in (1) above must submit
it to the local health officer upon request.

(3)  If no specimen from the case is otherwise available and the
case refuses to allow a specimen to be taken for purposes of (1)
above, the case will be assumed to be infected and must comply
with whatever control measures are imposed by the department or
local health officer.

(4)  A Physician or laboratorian Performing a blood test which
shows the presence of the antibody to the human Immunodeficiency
virus (HIV) must submit to the department laboratory a blood
specimen from the Person tested in order to confirm the test
results.



16.28.306 INVESTIGATION OF A CASE (1) Immediately after being
notified of a case or an epidemic of a reportable disease, a
local health officer must:

(a)  investigate and take whatever steps are necessary to Prevent
spread of the disease;

(b)  if s/he finds that the nature of the disease and the
circumstances of the case or epidemic warrant such action:

(i) examine or ensure that a physician examines any infected
person in order to verify the diagnosis;

(ii) make an epidemiologic investigation to determine the source
and Possible spread of infection;

(iii) take appropriate steps, as outlined in the APHA Publication
"Control of Communicable Diseases in Man, an Official Report of
the American Public Health Association", 14th edition, 1985, to
prevent or control the spread of disease; and

(iv) notify contacts (for example, emergency responders) of the
case and give them the information needed to prevent contracting
the disease.

(c)  whenever the identified source of a reportable disease or a
person infected or exposed to a reportable disease who should be
quarantined or placed under surveillance is located outside of
his/her jurisdiction:

(i)  notify the department or the local health officer of the
jurisdiction in which the source or person is located if within
Montana; or

(ii) notify the department if the source or person is located
outside of Montana.

(2)  The department hereby adopts and incorporates by reference
"Control of Communicable Diseases in Man, an Official Report of
the American Public Health Association", 14th edition, 1985,
which specifies control measures for communicable diseases.  A
copy of the report may be obtained from the American Public
Health Association, 1015 - 15th Street NW, Washington, D.  C.
20005.



16.28.307 POTENTIAL EPIDEMICS (1) Whenever a disease listed in
ARM 16.28.203(1) is confirmed or whenever any other communicable
disease listed in Control of Communicable Diseases in Man, An
Official Report of the American Public Health Association, 14th
Edition, 1985, or other communicable disease which constitutes a
threat to the health of the public becomes so Prevalent as to
endanger an area outside of the jurisdiction where it first
occurred, the local health officer of the jurisdictional area in
which the disease occurs must notify the department and cooperate
with the department's epidemiologist or his/her representative to
control the spread of the disease in question.

(2)  The department hereby adopts and incorporates by reference
"Control of Communicable Diseases in Man, An Official Report of
the American Public Health Association", 14th edition, 1985,
which lists and specifies control measures for communicable
diseases.  A copy of "Control of Communicable Diseases in Man"
may be obtained from the American Public Health Association.
1015 - 15th Street NW, Washington, D.C.  20005.



16.28.308 QUARANTINE OF CONTACTS -- NOTICE AND OBSERVATION (1) If
a communicable disease requires quarantine of contacts, a local
health officer or the department shall institute whatever
quarantine measures are necessary to prevent transmission,
specifying in writing the person or animal to be quarantined, the
place of quarantine, the frequency with which possible or known
contacts must be medically observed to determine if physiological
signs of the disease are occurring, and the duration of the
quarantine.

(2)  A local health officer or the department must ensure such
contacts are medically observed as frequently as necessary during
the quarantine period.



16.28.309 ISOLATION OF PATIENT -- NOTICE (1) When isolation of a
patient is declared, the agency declaring the isolation must
supply to the infected person in writing a description of the
place of isolation, the length of the isolation period, and the
name and title of the person declaring the isolation.

(2)  A local health officer or the department may inspect the
place of isolation during the period of isolation to determine
compliance with the isolation.



Sub-Chapter 6

Specific Control Measures

16.28.601 MINIMAL CONTROL MEASURES (1) This subchapter contains
minimal control measures to prevent the spread of disease which
must be employed by a local health officer, an attending
physician, or any other person caring for a person with a
reportable disease.

(2)  If a reportable disease is not listed in this subchapter, no
minimum control measures for the disease are required.



16.28.601A     ACQUIRED IMMUNE DEFICIENCY SYNDROME

(1)  Whenever acquired immune deficiency infection occurs, blood
and body fluid precautions must be used for the duration of the
infection.



16.28.602 AMEBIASIS (1) Whenever a case of amebiasis occurs:

(a)  Enteric precautions are required.

(b)  Feces must be disposed of by flushing down a toilet attached
to a municipal or other sewage system approved by the department.



16.28.603 ANTHRAX (1) Whenever a case of anthrax occurs:

(a)  If skin lesions exist, drainage and secretion precautions
must be used until lesions are bacteriologically free of anthrax
bacilli.

(b)  All bodily discharges must be concurrently disinfect-ed.

(2)  Strict isolation must be imposed upon each case of
inhalation anthrax.



16.28.604 BOTULISM -- INFANT BOTULISM (1) Feces must be
concurrently disinfected or flushed down a toilet attached to a
municipal or other sewage system approved by the department.

(2)  The local health officer shall make an immediate in
vestigation of every case or suspected case of botulism in an
effort to establish the diagnosis and determine the source.



Sub-Chapter 8

Notification of Exposure to Infectious Disease

16.30.801 TRANSMITTABLE INFECTIOUS DISEASES (1) The following
infectious diseases are designated as having the potential of
being transmitted to emergency services providers through an
unprotected exposure described in ARM 16.30.802:

(a)  human immunodeficiency virus infection (AIDS or HIV
infection);

(b)  hepatitis B;

(c)  hepatitis, non-A non-B;

(d)  communicable pulmonary tuberculosis;

(e)  meningococcal meningitis.



16.30.802 REPORTABLE UNPROTECTED EXPOSURE (1) The types of
exposures to the infectious diseases specified in ARM 16.30.801
that may be reported to a health care facility by an emergency
services provider are:

(a)  any person to person contact in which a co-mingling of
respiratory secretion (saliva and sputum) of the patient and the
emergency services provider may have taken place;

(b)  transmittal of the blood or bloody body fluids of the
patient onto the mucous membranes of the emergency services
provider (mouth, nose, eyes) and/or into breaks in the skin of
the emergency services provider;

(c)  transmittal of other body fluids (semen, vaginal secretion,
amniotic fluid, feces, wound drainage, or cerebral spinal fluid)
onto the mucous membranes of the emergency services provider;

(d)  any non-barrier protected contact of the emergency services
provider with the mucous membranes or non-intact skin of the
patient.



16.30.803 UNPROTECTED EXPOSURE FORM (1) A report of unprotected
exposure must be filed on a form approved by the department,
entitled "Report of Unprotected Exposure", and containing the
following:

(a)  name, address, and phone number(s) of the emergency services
provider who sustained an unprotected exposure;

(b)  date and time of the unprotected exposure;

(c)  a narrative description of the events surrounding the
unprotected exposure, and a detailed description of how the
exposure took place;

(d)  the name and, if available, the date of birth of the
patient;

(e)  the name of the hospital receiving the patient;

(f)  the name of the emergency services organization with which
the individual filing the report is affiliated;

(g)  the signature of the emergency services provider filing the
report.

(2)  A copy of the required form is available from the
department's emergency medical services bureau, Cogswell Build
ing, Capitol Station, Helena, Montana 59620 [phone: 406-444-
3895].



16.30.804 RECOMMENDED MEDICAL PRECAUTIONS AND TREATMENT

(1)  At a minimum, a health care facility that notifies a person
who has filed a report of unprotected exposure that he/she in
fact has been exposed to one of the diseases listed in ARM
16.30.801 should recommend to that person the medical precautions
and treatment:

(a)  specified in Control of Communicable Diseases in Man, An
Official Report of the American Public Health Association, 14th
Edition, 1985; and

(b)  other additional medical precautions and treatment provided
to the facility by the department, if any.

(2)  Whenever changes in the standards cited in (1) above become
nationally acceptable and recommended, the department will
provide health care facilities with those changes, and those
facilities should in turn recommend the updated precautions and
treatment to persons filing reports of unprotected exposure..

(3)  The department hereby adopts and incorporates by reference
"Control of Communicable Diseases in Man, An Official Report of
the American Public Health Association", 14th

edition, 1985, which lists and specifies control measures for
communicable diseases.  A copy of "Control of Communicable
Diseases in Man" may be obtained from the American Public Health
Association, 1015 15th Street NW, Washington, D.C.  20005.



16.30.805 OTHER REQUIREMENTS (1) If an emergency services
provider has filed a report of unprotected exposure with a health
care facility, and if the patient has been transferred to another
health care facility, the initial health care facility must
forward the report of unprotected exposure to the final receiving
health care facility.

(2)  An emergency services provider wishing to file a report of
unprotected exposure with a health care facility should, but is
not required to, do so within 72 hours of the unprotected
exposure.

(3)  The unprotected exposure form shall be valid only for the
admission and health care facility stay corresponding to the
incident which generated the unprotected exposure.

(4)  Upon receipt by a health care facility of an unprotected
exposure report form, the health care facility employee initially
receiving the form must sign it and provide a copy to the
emergency services provider submitting the form.

(5)  Each health care facility must maintain a permanent record
of all unprotected exposure report forms it receives, and must
retain each form for the same period of time that it keeps
medical records.  The record must contain at least the following
information:

(a)  name of the patient;

(b)  name of the emergency services provider;

(c)  date and time the form was received;

(d)  whether the patient had one of the infectious diseases
specified in ARM 16.30.801;

(e)  if an infectious disease designated in ARM 16.30.801 was
diagnosed, the dates the emergency services provider was notified
by telephone and in writing; and

(f)  other hospitals, if any, to which the form was transferred.