902 KAR 20:275.
Mobile health services.
RELATES TO: KRS
216B.010-216B.131, 216B.990
STATUTORY AUTHORITY:
KRS 216B.042, 314.011(8), EO 96-862
NECESSITY, FUNCTION,
AND CONFORMITY: The administrative regulation establishing standards for mobile
health services, 902 KAR 20:270, was found deficient by the Interim Joint
Committee on Health and Welfare at its November 15, 1995, meeting. The finding
of deficiency resulted from the lack of guidelines to coordinate the
relationship between home IV therapy service and home health agencies.
Legislation to establish such guidelines was not enacted during the 1996
Regular Session of the General Assembly. Therefore, pursuant to KRS 13A.333(1),
902 KAR 20:270 expired. KRS 216B.042 requires the cabinet to establish standards
for health facilities and services, and authorizes it to promulgate
administrative regulations. Without an administrative regulation establishing
standards for mobile health services, the cabinet would be in violation of the
legislative mandate expressed in KRS 216B.042. KRS 13A.333(6) prohibits an
administrative body from promulgating an administrative regulation that is
identical to or substantially the same as an administrative regulation that has
expired. This administrative regulation is not identical to or substantially
the same as 902 KAR 20:270, because:
(1) Only the lack of
guidelines to coordinate the relationship between home IV therapy services and
home health services was found deficient;
(2) This
administrative regulation includes guidelines to coordinate the relationship
between home IV therapy service and home health agencies; and
(3) It is required
by the legislative mandate of KRS 216B.042.
Executive Order
96-862, effective July 2, 1996, reorganizes the Cabinet for Human Resources and
places the Office of Inspector General and its programs under the Cabinet for
Health Services.
Section 1.
Definitions. (1) "Certified radiation operator" means a person who
has been certified pursuant to KRS 211.870 and 902 KAR 105:010 to 105:070 as an
operator of sources or radiation.
(2) "Computed
tomography (CT) scanning" means a radiological diagnostic imaging
procedure that shows cross sectional images of internal body structures.
(3) "Governing
authority" or "licensee" means the individual, agency,
partnership, or corporation, in which the ultimate responsibility and authority
for the conduct of the institution is vested.
(4) "IV
therapy" means the administration, by a registered nurse under the
supervision of a licensed physician, of various pharmaceutical and nutritional
products by intravenous, subcutaneous or epidural routes.
(5) "IV therapy
service" means pharmaceutical and nursing services, including direct
hands-on care, limited to and necessary for the:
(a) Preparation,
dispensing and delivery of pharmaceutical and nutritional products and
equipment; and
(b) Related clinical
consultation, training, and assessment or care incidental to initial start-up
of IV therapy.
(6)
"License" means an authorization issued by the cabinet for the purpose
of operating mobile health services.
(7)
"Lithotripter" means a noninvasive treatment technique that utilizes
shock waves to shatter kidney stones.
(8) "Magnetic
resonance imaging (MRI)" means a diagnostic imaging modality which
utilizes magnetic resonance, an interaction between atoms and electromagnetic
fields, to project images of internal body structures.
(9) "Other
diagnostic and treatment services" means those health services which are
determined to require licensure pursuant to KRS 216B.042 as a mobile health
service.
(10) "Qualified
anesthesiologist" means a person who is a doctor of medicine or a doctor
of osteopathy licensed to practice medicine and surgery and who is board
certified or in the process of being certified by the American Board of
Anesthesiology or the American Osteopathic Board of Surgery and who otherwise
meets the criteria established by the mobile health service's governing
authority.
(11) "Qualified
urologist" means a person who is a doctor of medicine or a doctor of osteopathy
licensed to practice medicine and surgery and who is board certified or is in
the process of being certified by the American Board of Urology or the American
Osteopathic Board of Surgery and who otherwise meets criteria established by
the mobile health service's governing authority.
(12)
"Registered nurse" means a nurse who is licensed to engage in
registered nursing practice pursuant to KRS 314.041.
Section 2. Scope of
Operation and Services. Mobile health services provide medical services in various
locations and in some instances utilize a specially equipped vehicle such as a
van, trailer or mobile home. These services include mobile diagnostic imaging
and examination services, mobile treatment services, and any other medical or
dental services provided through the use of a mobile vehicle or performed at
various locations.
Section 3.
Administration. (1) Licensee.
(a) The licensee
shall be legally responsible for the service and for compliance with federal,
state and local laws and regulations pertaining to the operation of the
service, limited to the scope of the service's certificate of need.
(b) The licensee
shall establish lines of authority and designate an administrator who will be
principally responsible for the daily operation of the service. In the case of
a service whose governing authority is comprised of more than one (1) licensed
hospital, a separate administrator may be designated from each hospital to
serve as the administrator of the service when it is being provided at the hospital
where the designee is employed.
(2) Policies. There
shall be written administrative policies which the service follows covering all
aspects of operation, including:
(a) A description of
organizational structure, staffing and allocation of responsibility and
accountability;
(b) A description of
linkages with inpatient facilities and other providers;
(c) Policies and
procedures for the guidance and control of personnel performances;
(d) A written
program narrative describing in detail the service(s) offered, methods and
protocols for service delivery, qualifications of personnel involved in the
delivery of the services, and goals of the service(s);
(e) A description of
the administrative and patient care records and reports; and
(f) Procedures to be
followed in the storage, handling and administration of drugs and biologicals.
(3) Personnel.
(a) Medical
director. The service shall have a medical director. The medical director shall
be a licensed physician or dentist with specialized training and experience in,
and responsibility for, all medical aspects of the service. In the case of a
service whose governing authority is comprised of more than one (1) licensed hospital,
a separate medical director may be designated from each hospital's medical staff
to serve as the medical director of the service when it is being provided at
the hospital where the physician is on staff. If a service operates only
diagnostic examination equipment, and if the service is offered only to
licensed hospitals, and if the employees of the service makes no medical assessment
of the diagnostic patient data collected, then the service shall be exempt from
the requirements of this paragraph.
(b) The service
shall employ, or provide for through a written contractual agreement,
sufficient number of qualified personnel to provide effective patient care and
all other related services. The licensee shall provide written personnel
policies which shall be available to all employees, reviewed on an annual
basis, and revised as necessary. If the staff-to-patient ratio does not meet
the needs of the patients, the Division of Licensing and Regulation shall
determine and inform the program administrator in writing how many additional
personnel are to be added and of what job classification, and shall give the
basis for this determination.
(c) There shall be a
written job description for each position which shall be reviewed and revised
as necessary.
(d) There shall be
an employee health program for mutual protection of employees and patients
including provisions for preemployment and periodic health examination,
tuberculin test, and other appropriate tests.
(e) Current
personnel records shall be maintained for each employee which include the
following:
1. Name, address and
Social Security number;
2. Evidence of
current registration, certification or licensure of personnel;
3. Records of
training and experience; and
4. Records of
performance evaluation.
(4) In-service
training. All personnel shall participate in ongoing in-service training
programs relating to their respective job activities including thorough job
orientation for new employees.
(5) Medical records.
(a) The service
shall maintain medical records which contain at least the following:
1. Medical and
social history relevant to the service(s) provided, including data obtainable
from other providers;
2. Names of
referring physician, if any, and physician's orders for special diagnostic
services such as x-ray or CT scans;
3. Description of
each medical visit or contact, to include condition or reason necessitating
visit or contact, assessment diagnosis, services provided, medications and
treatments prescribed, and disposition made;
4. Reports of all
physical examinations, laboratory, x-ray, and other test findings relevant to
the service(s) provided; and
5. Documentation of
all referrals made, including reason for referral, to whom patient was
referred, and any information obtained from referral source.
(b) Confidentiality
of all patient records shall be maintained at all times.
(c) Transfer of
records. The service shall establish systematic procedures to assist in
continuity of care where the patient moves to another source of care, and the
service shall, upon proper release, transfer medical records or an abstract
thereof when requested.
(d) Retention of
records. After patient's death or discharge the completed medical record shall
be placed in an inactive file and retained for five (5) years or in case of a
minor, three (3) years after the patient reaches the age of majority under
state law, whichever is longer. Mammography and other radiology records shall
be retained in accordance with federal requirements.
(e) A specific
location shall be designated by the mobile health service for the maintenance
and storage of the service's medical records.
(f) Provisions for
storage of medical records in the event the mobile health service ceases to
operate because of disaster, or for any other reason. The licensee shall
safeguard the record and its content against loss, defacement and tampering.
Section 4. Vehicle
Requirements. (1) All vehicles used in the provision of a health service, as
provided by the service's certificate of need, shall be kept, in optimum order
with clean interiors and equipment.
(2) The following
standards shall apply only to those vehicles which the patient enters.
(a) There shall be
adequate heating and air-conditioning capability in both the driver and patient
compartments.
(b) There shall be a
minimum of two (2) potential power sources for the vehicle. To insure an
immediately available source of power in the event of a power failure, one (1)
must be self-contained on the vehicle. The other source must be an exterior
source of power hookup.
(c) The vehicle
shall be accessible to users with disabilities either through the use of a
wheelchair lift or a ramp which complies with applicable American National
Standards Institute (ANSI) requirements.
(d) The vehicle
shall have adequate and safe space for staff and examination procedures, as
determined by the cabinet.
(e) Equipment.
Vehicles used in the provision of a health service, as provided by the
service's certificate of need, shall have the following essential equipment:
1. One (1) five (5)
pound dry chemical fire extinguisher;
2. One (1) first aid
kit;
3. Suction
apparatus;
4. Oxygen equipment
(portable) including:
a. One (1)
"D" size oxygen cylinder;
b. One (1) pressure
gauge and flow rate regulator;
c. Adaptor and
tubing; and
d. Transparent masks
for adults and children. Nasal cannulas may be substituted.
(f) Personnel. Each
mobile health service vehicle shall at a minimum be staffed by one (1) person,
who may also be the driver of the vehicle, who shall have the following
qualifications:
1. Red Cross
Advanced and Emergency Care Certification, each with supplemental CPR
instruction certified by the American Red Cross or the American Heart
Association; or
2. EMT-first
responder certification; or
3. EMT-A
certification; or
4. Licensure as a
registered nurse, physician or dentist.
Section 5.
Requirements for Provision of Services. A licensed mobile health service shall
comply with the requirements listed in Sections 3, 4, and 6 of this
administrative regulation, the service's program narrative, and the additional
requirements of this section which relate to the particular service(s) offered
by the licensee.
(1) Diagnostic
services. Diagnostic services are those services which are performed to
ascertain and assess an individual's physical health condition.
(a) Diagnostic
services, except for mammography services, shall be performed only on the order
of a physician or advanced practice registered nurse as authorized in KRS
314.011(8).
(b) The service
shall prepare a record for each patient to include the date of the procedure,
name of the patient, description of the procedures ordered and performed, the
referring physician, the name of the person performing the procedure, the date
and the name of the physician to whom the results were sent.
(c) Diagnostic
imaging services.
1. Diagnostic imaging
services are those services which produce an image, either through film or
computer generated video, of the internal structures of a patient. These
services include:
a. X-ray;
b. MRI;
c. CT scanning;
d. Ultrasound;
e. Mammography;
f. Fluoroscopy; and
g. Other modalities
using directed energy to gain statistical, physiological or biological
diagnostic imaging information.
2. Any mobile health
service which provides diagnostic imaging services shall comply with the
following:
a. Equipment used
for direct patient care shall be fully approved by the Federal Food and Drug
Administration (FDA) for clinical use;
b. There shall be a
written preventive maintenance program which the service follows to ensure that
imaging equipment is operative, properly calibrated, and shielded to protect
the operator, patient, environment, and the integrity of the images produced.
Recalibration of radiation producing and nonradiation producing instrumentation
shall occur at least every six (6) months by biomedical service personnel and
radiation producing instrumentation shall be recalibrated annually by a
consulting health physicist.
c. Diagnostic
imaging services shall be provided under the supervision of a physician who is
qualified by advanced training and experience in the use of the specific
imaging technique for diagnostic purposes;
d. Imaging services
shall have a current license or registration pursuant to applicable Kentucky
statutes and any administrative regulations promulgated thereunder;
e. All Personnel
engaged in the operation of imaging equipment shall be currently licensed or
certified in accordance with applicable Kentucky statutes and administrative
regulations;
f. There shall be a
written training plan for personnel in the safe and proper usage of the mobile
imaging equipment and system;
g. There shall be a
physician's signed order which specifies the reason the procedure is required,
the area of the body to be examined, and a statement concerning the condition
of the patient which indicates why mobile imaging services are necessary; and
h. There shall be
sufficiently trained on-duty personnel with adequate equipment to provide
emergency resuscitation services in the event of a patient emergency.
(d) Other diagnostic
services.
1. Other diagnostic
services are those services which are provided through the use of diagnostic
equipment, and physical examination. These services include:
a. Electrocardiogram
services;
b.
Electroencephalogram services;
c. Holter monitor
services;
d. Disability determination
services;
e. Pulmonary
function services;
f. Aphresis
services;
g. Blood gas
analysis services;
h. Echosonogrophy
services; and
i. Doppler services.
2. Equipment used
for direct patient care shall comply with the following:
a. The licensee
shall establish and follow a written preventive maintenance program to ensure
that equipment shall be operative and properly calibrated;
b. All Personnel
engaged in the operation of diagnostic equipment shall have adequate training
and be currently licensed or certified in accordance with applicable Kentucky
statutes and administrative regulations; and
c. There shall be a
written training plan for the adequate training of personnel in the safe and
proper usage of the equipment.
3. Physical
examination services shall be nonabusive and provided in a manner which ensures
the greatest amount of safety and security for the patient.
a. Protocols for
diagnostic examinations shall be developed by the medical director.
b. Personnel
performing physical examinations shall have adequate training and be currently
licensed or certified in accordance with applicable Kentucky statutes and
administrative regulations.
c. Personnel
performing physical examinations shall be limited by the relevant scope of
practice of Kentucky licensure.
(2) Treatment
services. Treatment services are those services provided to an individual who,
because of a physical health condition, is in need of medical assistance for
the attainment of their maximum level of physical function.
(a) Mobile health
clinic. A mobile health clinic is a health service providing both diagnostic
and treatment services through the use of a mobile vehicle. A mobile health
clinic may provide a wide range of diagnostic and treatment services on an
outpatient basis for a variety of physical health conditions.
1. Policies. The
licensee shall develop patient care policies with the advice of a group of
professional personnel that includes one (1) or more physicians and one (1) or
more advanced practice registered nurses. At least one (1) member shall not be
a member of the mobile health clinic staff. The policies shall include:
a. A description of
the services the mobile health clinic provides directly and those provided
through agreement;
b. Guidelines for
the medical management of health problems which include the conditions
requiring medical consultation and/or patient referral, and the maintenance of
health records; and
c. Procedures for
review and evaluation of the services provided by the clinic at least annually.
2. Personnel. The
mobile health clinic shall have a staff that includes at least one (1)
physician and at least one (1) advanced practice registered nurse. The clinic
shall employ such other staff or ancillary personnel that are necessary to
provide the services essential to the clinic's operation.
a. The physician
shall:
(i) Be responsible
for all medical aspects of the clinic and shall provide direct medical services
in accordance with the Medical Practice Act, KRS Chapter 311. In addition, the
physician shall provide medical direction, supervision, and consultation to the
staff;
(ii) In conjunction
with the advanced practice registered nurse(s), participate in developing,
executing, and periodically reviewing the mobile health clinic's written policies
and services;
(iii) Periodically
review the mobile health clinic's patient records, provide medical orders, and
provide medical care services to patients of the mobile health clinic; and
(iv) Be present for
consultation weekly, and be available within one (1) hour, through direct
telecommunication for consultation, assistance with medical emergencies, or
patient referral.
b. The advanced
practice registered nurse shall:
(i) Participate in
the development, execution and periodic review of the written policies
governing the services the mobile health clinic provides;
(ii) Participate
with the physician in periodic review of patient health records;
(iii) Provide
services in accordance with mobile health clinic policies, established
protocols, the Nurse Practice Act (KRS Chapter 314), and with administrative
regulations promulgated thereunder;
(iv) Arrange for, or
refer patients to needed services not provided at the mobile health clinic; and
(v) Assure that
adequate patient health records are maintained and transferred when patients
are referred.
3. The mobile health
clinic shall have linkage agreements or arrangements with each of the
following:
a. Inpatient
hospital care;
b. Physician
services in a hospital, patient's home, or long-term care facility;
c. Additional and
specialized diagnostic and laboratory services that are not available at the
mobile health clinic;
d. Home health
agency;
e. Emergency medical
services;
f. Pharmacy
services; and
g. Local health
department.
4. The mobile health
clinic shall carry out, or arrange for an annual evaluation of its total
program, shall consider the findings of the evaluation, and take corrective
action, if necessary. The evaluation shall include:
a. The utilization
of clinic services including at least the number of patients served and the
volume of services;
b. A representative
sample of both active and closed clinical records; and
c. The mobile health
clinic's health care policies.
5. The mobile health
clinic shall develop and maintain written protocols, i.e., standing orders,
rules of practice, and medical directives, which apply to services provided by
the clinic and which explicitly direct the step-by-step collection of
subjective and objective data from the patient. The protocols shall further
direct data analysis, direct explicit medical action depending upon the data collected,
and include rationale for each decision made. The protocols shall be signed by
the staff physician.
6. The Mobile health
clinic staff shall furnish those diagnostic and therapeutic services and
supplies that are commonly furnished in a physician's office or at the entry
point into the health care delivery system. These include medical history,
physical examination, assessment of health status, and treatment for a variety
of medical conditions.
7. The mobile health
clinic shall provide basic laboratory services essential to the immediate
diagnosis and treatment of the patient, including:
a. Chemical
examinations of urine by stick or tablet methods or both (including urine
ketones);
b. Microscopic
examinations of urine sediment;
c. Hemoglobin or
hematocrit;
d. Blood sugar;
e. Gram stain;
f. Examination of
stool specimens for occult blood;
g. Pregnancy tests;
h. Primary culturing
for transmittal to a hospital laboratory or licensed laboratory; and
i. Test for
pinworms.
8. The mobile health
clinic shall provide medical emergency procedures as a first response to common
life-threatening injuries and acute illness, and have available the drugs and
biologicals commonly used in lifesaving procedures, such as analgesics, anesthetics
(local), antibiotics, anticonvulsants, antidotes and emetics, serums and
toxoids.
9. The clinic shall
post in a conspicuous area at the entrance, visible from the outside of the
clinic, the hours that emergency medical services will be available in the
clinic, the clinic's next scheduled visit, and where emergency medical services
not provided by the clinic can be obtained during and after the clinic's
regular scheduled visits and hours of operation.
(b) Mobile dental
clinic. A mobile dental clinic is a health service providing both diagnostic
and dental treatment services at different locations through the use of a
mobile vehicle or equipment.
1. Policies. The
licensee shall develop patient care policies with the advice of a group of
professional personnel that includes at least one (1) licensed dentist. These
policies shall include:
a. Guidelines which
identify the dental problems which may not be performed in the mobile unit, and
provisions for patient referral;
b. Guidelines for
the review and evaluation of the services provided by the clinic at least
annually; and
c. Guidelines for
procedures to be followed in the event a patient has a medical emergency.
2. Personnel. The
mobile dental clinic shall have a staff that includes at least one (1) licensed
dentist and at least one (1) dental assistant.
a. The dentist
shall:
(i) Be responsible
for all aspects of patient care in accordance with KRS Chapter 313 and any
administrative regulations promulgated thereunder;
(ii) Be present in
the clinic at all times that a patient is receiving dental care; and
(iii) Provide direct
supervision to all staff involved in the delivery of services.
b. The dental
assistant shall:
(i) Provide services
in accordance with the mobile dental clinic policies and established protocols,
KRS Chapter 313, and any administrative regulations promulgated thereunder; and
(ii) Provide
services only under the direct supervision of a licensed dentist.
3. Equipment. The
mobile dental clinics shall have the following equipment:
a. X-ray units;
b. Sterilizer;
c. High-speed
suction;
d. Dental lights;
and
e. Emergency kit
with the following drug types:
(i) Antiallergenic;
(ii) Vasodilators;
(iii) Anticonvulsives;
and
(iv) Vasopressors.
(c) Mobile
lithotripter service. A mobile lithotripter service is a health service which
provides for a noninvasive technique for removing kidney or ureteral stones
through the use of a lithotripter at various hospital locations.
1. Mobile
lithotripter services may only be delivered on the grounds of the hospital
utilizing the mobile lithotripter service.
2. Lithotripsy
services shall be performed only on the order of a physician.
3. Lithotripsy
services shall be provided under the supervision of a physician who is
qualified by advanced training and experience in the use of lithotripsy
treatment.
4. The service shall
prepare a record for each patient to include the date of the procedure, name of
the patient, description of the procedures ordered and performed, the referring
physician, and the name of the person performing the procedure.
5. There shall be a
physician’s signed order which specifies the reason the procedure is required,
the area of the body to be exposed, and the anticipated outcome of treatment.
6. Policies. A
mobile lithotripter service shall develop patient care policies with the advice
of a group of professional personnel that includes at least one (1) qualified
urologist and one (1) qualified anesthetist. At least one (1) member shall not
be a member of the mobile lithotripter service staff. The policies shall
include:
a. A description of
how a patient will be transported between the hospital and the mobile
lithotripter service;
b. Procedures to be
followed in the event a patient has a medical emergency;
c. Guidelines for
the review and evaluation of the service on an annual basis; and
d. Policies and
protocols governing the utilization and responsibilities of hospital staff in
the delivery of lithotripter services.
7. Personnel. The
mobile lithotripter service shall employ at least one (1) lithotripter
technician, and shall employ or make arrangements with the hospital utilizing
the service for at least one (1) registered nurse, one (1) qualified urologist
to be present in the unit during the delivery of lithotripsy services, and one
(1) qualified anesthetist to be available for procedures requiring anesthesia.
8. Lithotripsy
equipment used for direct patient care shall comply with the following:
a. Lithotripsy
equipment shall be fully approved by the Federal Food and Drug Administration
(FDA) for clinical use;
b. The licensee
shall establish and follow a written preventive maintenance program to ensure
that equipment shall be operative, properly calibrated, properly shielded, and
safe for the patient, operator, and environment;
c. All Personnel
engaged in the operation of diagnostic equipment shall have adequate training
and be currently licensed, certified or registered in accordance with
applicable Kentucky statutes and administrative regulations; and
d. There shall be a
written training plan for the adequate training of personnel in the safe and
proper usage of the equipment; and
e. There shall be
sufficiently trained on-duty personnel with adequate equipment to provide
emergency resuscitation in the event of a patient emergency.
(d) Other treatment
services, including IV therapy services, shall be performed only on the order
of a physician.
1. IV therapy shall
only be performed by a registered nurse and shall be limited to nursing
services which are required for the initial start-up of an IV therapy program.
2. If nursing
services are required which exceed the initial start-up of IV therapy, they
shall be provided by an appropriately licensed agency to provide care under a
physician’s plan of care.
3. All services
provided shall be under the supervision of a licensed physician.
4. Policies. The
licensee shall develop patient care policies with the advice of a group of
professional personnel that includes one (1) or more physician(s) and one (1)
or more registered nurse(s). At least one (1) member shall not be a member of
the service's staff. The policies shall include:
a. A description of
the services provided;
b. A requirement to
inform patients of other in-home services which can be provided only by other
appropriately licensed agencies;
c. A requirement for
a written common plan for treatment and coordination of treatment with other
licensed health care providers servicing the patient, and immediate verbal
communication between providers of revisions in the common plan shall be
documented in the plan of treatment;
d. Guidelines for
the medical management of health problems which include the conditions
requiring medical consultation or patient referral, and the maintenance of
health records;
e. Procedures for
review and evaluation of the services provided at least annually; and
f. Guidelines for
patient and environment assessment.
5. Personnel. The
service shall have a staff that includes at least one (1) registered nurse. The
service shall employ such other staff or ancillary personnel that are necessary
and essential to the service's operation. The registered nurse shall:
a. Participate in
the development, execution and period review of the written policies governing
the services provided;
b. Participate with
the physician in periodic review of patient health records;
c. Provide services
in accordance with established policies, protocols, the Nurse Practice Act (KRS
Chapter 314), and with administrative regulations promulgated thereunder;
(i) Arrange for or
refer patients to needed services that cannot be provided by the service; and
(ii) Assure that
adequate patient health records are maintained and transferred when patients
are referred.
6. In-service
training programs shall include instruction in:
a. Use of equipment;
b. Side effects and
precautions of drugs and biologicals; and
c. Infection control
measures.
7. The service shall
carry out, or arrange for an annual evaluation of its total program, shall
consider the findings of the evaluation, and take corrective action, if
necessary. The evaluation shall include:
a. The utilization
of the service including at least the number of patients served and the volume
of services;
b. A representative
sample of both active and closed records; and
c. The service's
health care policies.
Section 6. Waste
Processing. (1) Sharp wastes, such as broken glass, scalpel blades, and
hypodermic needles, shall be segregated from other wastes and aggregated in
rigid disposable containers immediately after use. Needles and syringes shall
not be cut, dismantled, or destroyed after use, but shall be placed intact into
a rigid container. The rigid containers of sharp wastes shall either be
incinerated or disposed of in a sanitary landfill approved pursuant to 401 KAR
47:080.
(2) The mobile
health service shall establish a written policy for the handling and disposal
of all pathological and microbiologic laboratory waste. Any incinerator used
for the disposal of waste shall be in compliance with 401 KAR 59:020 or 401 KAR
61:010.
(a) Pathological and
microbiologic laboratory waste shall be placed in double impervious plastic
bags and each bag shall be two (2) mils in thickness. A bag, when full, shall
not exceed twenty-five (25) pounds. All bags shall be securely closed and a
tag, which reads "INFECTIOUS WASTE" and identifies the mobile health
service from which the waste is being removed, shall be attached to the bag in
a conspicuous manner. These wastes shall be sterilized before disposal or be
disposed of by incineration if they are combustible.
(b) All unpreserved
tissue specimens shall be incinerated off site.
(3) The following
liquids shall be disposed of by incineration or by sanitary sewer:
(a) Blood;
(b) Vaginal or
cervical secretions or exudates;
(c) Semen;
(d) Cerebrospinal,
synovial, pleurol, pericardial, peritoneal or amniotic fluids;
(e) Saliva in dental
procedures;
(f) Fluids visibly
contaminated with blood; and
(g) Mixed fluids
where any of the above may be involved. (23 Ky.R. 2645; Am. 2999; eff.
1-15-1997; TAm eff. 3-11-2011; TAm eff. 12-10-2012.)
