Rights, Abuse, and Neglect
Confidentiality and Protected Health Information
and Infection/Universal Precautions
New Employee and Provider Training Manual
Introduction to Consumer Rights
People seeking services in mental illness, developmental disabilities, substance abuse
or child and family services have the same rights that all other individuals have. They
also have special rights because the legal system has deemed these populations as
vulnerable and at special risk. Some of the more important human, civil and special
rights are:
Human Rights
Right to be treated with dignity
Right to privacy
Right to personal possessions
Right to freedom of movement
Right to freedom from fear
Right to make choices
Right to a clean, safe, and humane environment
Civil Rights
Right to freedom of speech and open communication
Right to freedom of religion
Right to vote
Right to an attorney
Right to due process
Special Rights
Right to least restrictive environment
Right to participate in individualized services
Right to informed consent
Right to confidentiality
When interacting with consumers, your behavior should always be professional and
consistent with consumer rights. You need to uphold a consumer’s rights and, if you
are aware of possible rights violations, you need to report it. To report alleged rights
violations submit an Incident Report within twenty-four business hours. If you are
unsure if a situation is a possible rights violation, feel free to call the Ombudsman for
further assistance.
Phyllis J. Wolf, MA, LPCS
Ombudsman
(512) 440-4086
Staff and Consumers may also choose to contact Voice, ATCIC’s avenue of due
process that does not involve an agency employee. Either may contact voice:
Calling: 445-7718 or by mail: P.O. Box 3601, Austin, TX 78764
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Communication of rights to consumers
Consumers seeking services have the right to be provided with a copy of the
appropriate Consumer Rights Handbook before agreeing to accept services.
Consumers must have their rights explained to them in terms they can understand
within 24 hours of being admitted for services. The consumer’s record should include
signed documentation that this has occurred. A consumer may also request that
someone else receive a copy of the rights handbook. If the consumer is under 18 years
of age or has a guardian, the parent or guardian must be provided the information on
consumer’s rights.
Due Process
ATCIC has four avenues of due process. Due process means following certain rules
and procedures before making a decision that affects someone’s rights. The right to
due process guarantees that a consumer’s rights cannot be restricted arbitrarily. Integral
Cares avenues of due process are:
1. The complaint procedure
Consumers have the right to have their complaints heard by an impartial person or
person not involved in the dispute issue. To file a complaint, consumers may call the
Ombudsman. Staff is obligated to assist consumers in exercising the right to use the
complaint process if requested.
2. The appeal procedure
Consumers may appeal decisions to reduce, deny, terminate their services, or decisions
that find them ineligible for services. For assistance with filing an appeal, consumers
may call the Ombudsman. Staff must provide consumers information on how to appeal
when they are open to services and when an adverse determination has occurred. An
appeal process flyer for consumers is attached to this training packet. Ombudsman:
440-4086
3. The Human Rights Committee
Decisions to restrict consumers’ rights must be approved by the Human Rights
Committee (HRC). Consumers, and/or their legal guardians, or family members are
encouraged to attend HRC meetings. The committee is held on an as needed basis but
not more than once a month. Information regarding the consumer, requested restriction
and plan for reinstating that restriction is required by the Ombudsman before scheduling
the committee to meet.
4. The Voice Committee
Center volunteers that have been specially training to address complaints and
investigate when necessary. Voice committee members receive pertinent Integral Care
training and are assisted by the Ombudsman. To contact Voice you may write or call:
P.O. Box 3601, Austin, TX 78764 or 445-7718
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There are also external mechanisms for due process that involves the appropriate
professional board. The Ombudsman can provide those numbers as needed.
Restriction of Rights
Generally, a consumer’s rights may not be restricted unless their treatment team has
recommended the restriction, and the agency’s Human Rights Committee has approved
the restriction. The only time that a person’s rights can be restricted without going
through this process is if there is imminent danger of harm to self or others that requires
immediate intervention. In an emergency situation, temporary restrictions may be
imposed but any long-term restrictions must still go through the requirements of due
process.
Restrictions of rights cannot be used as a type of punishment.
Unit or Program Rules
Any rules that are to be followed by all consumers in a particular unit or program should
be in writing and should be fully explained to the consumer at the time he or she is
admitted to the program. Consequences for violating program or unit rules should be
specified. Such rules are to be reviewed initially and then if changed by the
Ombudsman to ensure they are reasonable. Some examples of reasonable rules may
include:
 Restrictions on having certain kinds of possessions on the unit premises
(E.g., weapons, drugs, alcohol, etc)
 No non-emergency personal calls during unit activities; and
 Rules that require consumers in a residential program to participate in completing
certain household chores.
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Reduction of Abuse, Neglect and Exploitation
Training Goals: At the end of this training, you should be able to identify:
A. Actions that are considered to be abuse, neglect and exploitation
B. Indicators of possible abuse, neglect and exploitation
C. Procedures for reporting possible abuse, neglect and exploitation
Types of Consumer Abuse, Neglect and Exploitation
The legal basis for the Department of Family and Protective Services (DFPS)
investigations of abuse, neglect, and exploitation in facilities operated by the Texas
Department of State Health Services (DSHS), community centers, local authorities,
Home and Community-Based Waiver (HCSW) providers, and related contractors is
found in the following codes:
Texas Human Resources Code (HRC), Title 2, Chapter 48:
Texas Family Code Chapter 261;
Texas Administrative Code, Title 25, Part I, Chapter 404, E;;
Texas Administrative Code, Title 40, Part I;
Texas Penal Code, Chapters 19,21,22.02, 2204, 22.05, 22.07, 22.08 and 22.10
JA, RI .010101. RI 01.02.01, RI.01.03.01, RI01.03.05, RI01.04.01, RI01.06.05,
RI.01.07.01, RI01.07.03,
RI.02.01.01
In September 2003, the Adult Protective Services-Facility Investigations reviewed and
updated definitions used in the program. The changes were incorporated on January 1,
2004, based on the last legislative session. Following are those definitions.
Physical Abuse
 Any act or failure to act performed knowingly, recklessly, or intentionally,
including incitement to act, which caused or may have caused physical injury or
death to a person served;
 Any act of inappropriate or excessive force or corporal punishment, regardless of
whether the act results in an injury to a person served;
 Any use of chemical or bodily restraints not in compliance with federal and state
laws and regulations;
Verbal/ Emotional Abuse
 Any act or use of verbal or other communication, including gestures to curse,
vilify or degrade a person served or threaten a person served with physical or
emotional harm. The act or communication must result in observable tress or
harm to the person served, or be of such nature that a reasonable person would
consider it harmful or causing distress.
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Sexual Abuse
 Any sexual activity, including sexual exploitation and sexual assault as defined in
Section 22.011 of the Texas Penal Code, involving an employee, agent or
contractor and a person served. Sexual activity includes but is not limited to
kissing, hugging, stroking, or fondling with sexual intent; oral sex or sexual
intercourse; request or suggestion or encouragement by staff for performance of
sex with the employee or with another person served,
Exploitation
 The illegal or improper act or process of using a person or the resources of a
person served for monetary or personal benefit, profit or gain.
Neglect
 Caused or may have caused physical or emotional injury or death to a person
served.
 Placed a person served at risk of physical or emotional injury or death, and
 Includes an act or omission such as:
* the failure to establish or carry out an appropriate individual program
plan or treatment plan for a person served, if such failure results in a
specific incident or allegation involving a person served;
* the failure to provide adequate nutrition, clothing, or health care to a
served (in a community center, the failure to provide adequate
clothing, or health care only applies to in-patient or residential); or
* the failure to provide a safe environment for a person served, including
the failure to maintain adequate numbers of appropriately trained staff
if such failure results in a specific incident or allegation involving a
person served.
Deleted: ¶
¶
¶
¶
¶
¶
¶
¶
¶
Detecting Signs of Abuse and Neglect
The following are signals that abuse may have occurred:
A. Physical Abuse:
1. Physical trauma such as black eyes or whelps.
2. Bruises
a) Large or numerous bruises
b) Bruises to the inner thighs and arms
c) Clustered bruises as from repeated strikes
d) Marks with shapes, like fingerprints
e) Any unexplained marks or injuries on the body
3. Injuries that are not consistent with the explanation
4. Injuries to the back, chest, stomach, head
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5. Sudden changes in behavior that:
a) Continue over a period of time (example: The individual’s behavior
suddenly changes after moving in with a particular person)
b) Reoccur intermittently, which might suggest a pattern for abuse
occurring (example: The individual’s behavior suddenly changes after
each visit/ encounter with a particular person)
6. Wearing cloths to cover bruises, such as long sleeves in hot weather
7. Flinching in response to normal, non-aggressive gestures to an individual
8. Obvious fear, cowering, trembling, withdrawal
9. References or general statements by an individual, such as “someone hurt
me”, “someone won’t leave me alone”, “someone is bothering me”
10. Reference or general statements by an individual that they are sick, hurt or
need help.
11. Individual identifies with the person that may be abusing them, i.g., appears to
be overly friendly, trying extra hard to make peace or be friends.
B. Sexual Abuse
Age 0-8*
1.
2.
3.
4.
5.
6.
7.
8.
9.
Drawing picture or relating stories with strong, unusual or bizarre sexual themes
Overt sexual behaviors
Withdrawal from peer interactions
Poor peer relations
Aggressive behavior
Extreme fear of being alone with others
Poor self-concept
Reluctance or fearfulness about going home after school
Frequent absences from school that are justified by only one parent without
regard for the child’s school performance
10. Appearance or behavior more mature than peers
11. Manipulative behavior
Age 9 and older1
1.
2.
3.
4.
5.
6.
7.
8.
1
Overt sexual behavior
Withdrawal
Poor self-concept
Appearance/ behavior more mature than peers
Poor attendance and academic performance
Poor attention span
Refusal to dress for physical education
Unwillingness to participate in recreational activities
Adapted from Eyrich, M., in The Texas Legal System for Child Protection, by Pena, E. 1980
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9. Repeated attempts to run away from home by a child who is otherwise not a
behavior problem
10. Use of drugs
11. Prostitution
12. Frequent absences from school justified by one parent only, without apparent
regard for the child’s school performance
Other possible indicators
1. Sudden change in eating habits (medical problems should be ruled out)
2. Change in eating habits (nightmares, sleep walking, etc.).
3. Poor or unusual school behavior (not attending, grades dropping, coming early,
staying late, etc).
4. Unusual fear of adults, teenagers or older peers and relatives.
5. Expressing feelings of being “damaged goods”.
6. Talk of suicide, death or dying.
7. Venereal disease in young children.
8. Excessive scratching of genitalia.
9. Recurring urinary infections, vaginal infections.
10. Excessive body odor.
11. Evidence of physical trauma to the genital area.
12. Pregnancy (child refuses to reveal any information about the father of baby/ or
complete denial of the pregnancy by the child or family).
C. Neglect
1. Withholding meals.
2. Not being provided clothing appropriate to the weather conditions, not ensuring
proper dress, or individuals wearing the same clothes repeatedly.
3. Withholding or depriving sleep.
4. Withholding or delaying medical care or dental attention.
5. Not providing supervision as determined by level of need.
6. Denying supervision of under-aged children.
7. Leaving potentially toxic substances out where an individual can get them, such
as cleaning fluids, medication.
8. Allowing unsafe conditions in the living environment, such as fire hazards, icy
steps, broken glass, unsanitary conditions.
Reporting to the Department of Family & Protective Services (DFPS)
When to report
You must make a report of possible abuse, neglect or exploitation whenever;
1. You see or hear it occur.
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2. You hear of it from another person.
3. You have any other reason to suspect it.
Failure to report may result in disciplinary action, up to and including termination.
In accordance with the Texas Administrative Code any allegation of abuse or neglect
needs to be reported immediately or within one hour. This applies when the alleged
perpetrator is Center or Center contracted staff. In cases where the alleged perpetrator
is not a staff member, then reporting timelines fall under the Texas Family Code, which
is 48 hours to report any kind of abuse or neglect. The best practice is to always made
reports of allegations of abuse as soon as you can regardless of which code applies.
Department of Family and Protective Services (DFPS) can be reached by staff,
consumers or family by calling: 1-800-252-5400
You may also report abuse/ neglect via Internet
Children & adults: http://reportabuse.ws
User name: professional password: report1
The Ombudsman investigates allegations regarding Substance Abuse Programs and
rights violations. To report an allegation to the Ombudsman, submit an incident report
within 24 hours to Quality Management Department.. For any questions or concerns
regarding any possible abuse, neglect or rights violation, feel free to call the
Ombudsman for further assistance 440-4086.
Guidelines for handling sexual assault/abuse of consumers:
The following guidelines are will help staff ensure that consumers receive appropriate
treatment when they report sexual assault or sexual abuse. Remember that people with
disabilities are very vulnerable to sexual abuse and exploitation, resulting in a higher
rate of sexual abuse/assault. Staff support of the consumer through this trauma is
critical.
1.
2.
3.
4.
5.
6.
Affirm that you heard them.
Do not try to investigate.
Assess the safety of the consumer at the present time.
Help the consumer obtain medical care immediately if necessary.
Contact DFPS immediately or within one hour. DFPS may refer you to the police.
Explain to the consumer that he/she has the right to file charges against the
perpetrator, and in the case of rape for a rape exam to collect evidence (within 72
hours of the assault) if they want to make a statement to the police.
7. File an Incident Report, including DFPS or police case numbers, within 24 hours.
8. Offer crisis-counseling services.
9. Respect the consumer’s privacy and feelings.
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Helpful Numbers:




Safe Place
Victim Services Crisis Unit
Domestic Violence Hotline
Additional Referrals
267-7233(SAFE)
974-5037 (adults) 834-3890(children)
1-800-374-4673
211
Please read ATCIC policies and procedures on the intranet by clicking on the intranet
icon on your desktop, Select “P” from the top bar then scroll to policies and procedures.
Click on policies and procedures. Scroll to the following:
OP10.01 Rights of Persons Served
OP10.03 Prohibition of Consumer Abuse and Neglect
OP10.04 Voice Committee
OP10.05 Confidentiality of Protected Health Information
OP 10.06 Release Hearings for TDPRS finding
OP 10.07 Prohibition of Consumer Rights Violations
OP 10.08 Resolution of Consumer Complaints
The remainder of this training packet contains the appeal procedure, resolution of
concern document to be posted at each service site, documentation to post on how to
access DFPS and the Consumers Rights Policy and Procedures that can be found on
the Center’s intranet.
Please remember the Ombudsman is a resource to you. Call Phyllis Wolf at 4404086 with any questions/ concerns or training requests.
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RESOLUCIÓN DE DUDAS
Si usted tiene una sugerencia para Austin Travis County Integral Care Centro de
servicios, si usted está preocupado por sí mismo u otra persona, si usted cree
que se le han quitado los derechos,
Por favor, comuníquese con cualquiera de los siguientes contactos:
Contacto:Phyllis Wolf, Funcionario de Derechos del Consumidor, Oficina de Derechos
del Consumidor del Centro de Austin y del Condado de Travis 440-4086
Contacto: Comité “La voz”/VOICE Committee
512-445-7718 P.O. Box 3601, Austin, Texas 78764-9981
Contacto: Oficina de Protección de Servicios y Derechos del Consumidor, DSHS 1800-252-8154
P.O. Box 12688, Austin, Texas 78711-2668
Contacto: Texas Disability Rights 512-454-4816 ó 1-800-223-4206
7800 Shoal Creek Blvd., Austin, Texas 78757
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RESOLUTION OF CONCERNS
If you have a suggestion about Austin Travis County Integral Care services, or
concern about yourself or someone else, or feel that your rights have been taken
away,
Please contact any of the following:
Contact: Phyllis Wolf, Ombudsman Austin Travis County Integral Care
Ombudsman 440-4086
Contact: The VOICE Committee 512-445-7718
P.O. Box 3601, Austin, Texas 78764-9981
Contact: The Office of Consumer Services & Rights Protection, DSHS 1-800252-8154
P.O. Box 12688, Austin, Texas 78711-2668
Contact: Texas Disability Rights 512-454-4816 or 1-800-223-4206
7800 Shoal Creek Blvd., Austin, Texas 78757
Austin Travis County Integral Care staff is required to report abuse, neglect or
exploitation whenvever it is seen heard or suspected. Staff must report alleged
abuse immediately or within 1 hour to:
Department of Family & Protective Services
1-800-252-5400
Or by using DFPS’s secure website:
https://reportabuse.ws
Login: professional
Password: report1
Failure to report will lead to corrective up to and including termination
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AUSTIN TRAVIS COUNTY Integral Care
APPEALS PROCEDURE: A CONSUMERS GUIDE
Your Right to Appeal
You have the right to appeal the following decisions:




A decision that you are not eligible for services
A decision to reduce your services and supports
A decision to deny a service or support that you want
A decision to terminate your services and supports
If one of these decisions is made about your services, and you do not agree with the
decision, you have the right to appeal it.
How to Appeal

Call 440-4086 and say you want to make an appeal. The Ombudsman,
Phyllis Wolf, will assist you. Or, you may tell a staff member that you want
to appeal, and the staff member will assist you with the appeal process.
The Appeal Process




Your appeal will be reviewed by the Program Director of your services, or
a person appointed by the Program Director. The Medical Director
reviews appeals from psychiatric services. You may provide additional
information or meet in person with the reviewer.
You will receive a decision on your appeal within twenty (20) days. If your
appeal involves crisis service, the appeal will be completed within five (5)
days.
If you are not satisfied with the decision on your appeal, you may make a
second appeal.
Second level appeals must be started within fourteen calendar (14) days.
An Appeals Committee whose members are not from your service area
will review these appeals. A psychiatrist not employed by ATCIC reviews
second level appeals for psychiatric services. You will receive a decision
on your appeal in not less than twenty (20) days or within five (5) days for
crisis services.
In Addition……………………
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
If you have any questions or problems or need assistance with your
appeal, please call the Ombudsman:
Phyllis Wolf at 440-4086.

Revised July, 2011
You may also report any problem or complaints with the appeal process
to: DSHS Consumer Services and Rights Protection Office
1-800-252-8154
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Confidentiality of Clinical Records and Other Consumer Identifying Information
PURPOSE
The purpose of this procedure is to protect the rights of consumers with regard to the
disclosure of identifying information by providing instructions for use by Center
employees and others who may be associated with the Center in the provision of mental
health mental retardation services.
CONTENTS
Introduction and Overview
Subpoenas and Depositions
Release of Information Without Consent
Consumers Who Are Minors
Deceased Consumers
Texas Disability Rights
Arrest and Search Warrants
Telephone Inquiries for Consumer Identification Information
Disclosures Among Components of DSHS Service System
Warning Reasonably Identifiable Potential Victims (Tarasoff)
Consumer Access to Record Information
Automated Consumer Identifying Information
PROCEDURE
I. Introduction and Overview
Legal Considerations
1. Both state and federal laws govern the disclosure of information concerning
consumers. Unauthorized disclosure of consumer identifying information can carry both
civil and criminal penalties. Extensive regulations govern the disclosure of alcohol and
drug abuse clinical records. Requirements for the disclosure of consumer identifying
information for consumers receiving chemical dependency services apply to all
consumers who have a chemical dependency diagnosis, prognosis, or are receiving
chemical dependency services even if they are also receiving mental health and/or
mental retardation services.
2. The legal duty to protect consumer information applies to all staff, volunteers,
consultants, researchers, auditors, evaluators, students, contract providers, and others
having authorized access to such information. Third party contractors shall be advised
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of this duty through appropriate contract provisions. This duty continues to apply after
termination of employment, audit, research or contract.
3. The diagnostic (mental health, mental retardation, alcohol, or drug abuse) and legal
status of the consumer (competence, incompetence, minor, adult, and guardianship)
must always be taken into consideration in any situation involving disclosure of
consumer identifying information.
4. Consumer identifying information means the name, address, social security number,
or any information by which the identity of a consumer can be determined either directly
or by reference to other publicly available information. The term includes, but is not
limited to, a consumer's clinical record, graphs, or charts; statements made by the
consumer, either orally or in writing, while receiving services; photographs, videotapes,
computer stored information, computer reports, etc.; and any acknowledgment that a
person is or has been a consumer of Integral Care.
5. A consumer is a person who, voluntarily or involuntarily is seeking, receiving, or who
has received mental health, mental retardation, alcohol or drug services from the
Integral Care.
6. If the consumer is a competent adult, then the consumer is the only person who has
the power to authorize and consent to disclosure of information. Competent person
means one who has the ability to comprehend the effect and consequences of giving an
authorization for disclosure of consumer-identifying information and who has not been
adjudged incompetent by a court, or for whom an order of restoration has been
executed and recorded subsequent to the consumer’s has been adjudicated
incompetent.
7. Adult means a person who is at least 18 years of age, or who is under 18 years of
age but is or has been legally married or whose disabilities of minority have been legally
removed.
General Rules
1. Inquiries as to whether a person is a consumer should neither be affirmed nor
denied. Respond to these inquiries by explaining that information cannot be released
without proper authorization.
2. Except for certain specific legal exceptions, consumer information may not be
disclosed without the consumer's specific consent to disclose the information requested
pursuant to the Center's Consent to Disclosure of Information form. Other consent
documents should be reviewed for legal sufficiency by one of the Integral Care’s Clinical
Record Administrators.
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a. Some exceptions allow for disclosure without consent. However, legally
adequate consent provides better protection and should always be sought first.
This is because the exception relied upon could fail if legally challenged.
b. Information shall not be released based upon an incomplete, blanket,
materially false, revoked or expired consent form.
c. Consumers shall not sign blank, incomplete or partially completed consent
forms.
d. Questions regarding the validity of the consent form should be referred to one
of the Integral Care’s Clinical Record Administrators who will seek legal counsel
if necessary.
e. Verbal consent for release of consumer identifying information is never
adequate.
f. If the consumer is an incompetent adult, then the guardian of the consumer is
the only person who may authorize and consent to disclose information.
g. If the consumer is a minor then see Section IV. For guidelines
3. The records of consumers of drug and alcohol abuse services are federally protected.
Rules governing disclosure of this information are extensive. For example,
a. Records may not be released, even if consent is obtained, in response to a
subpoena related to criminal proceedings involving the consumer. A court order
is required.
b. Special rules govern the release of such information for minor consumers.
c. There are special requirements governing the documentation of the release of
such information.
4. Failure to abide by these Center procedures may result in a consumer rights
violation, and may result in disciplinary action up to and including termination.
5. Suspected violations of consumer rights shall be reported to the Consumer Rights
Coordinator. See Consumer Rights Operating Procedure 10.03.
6. Documentation of consumer information disclosures should be made according to
Clinical Record Operating Procedure 12.02. Disclosure of information concerning
alcohol/drug abuse consumers requires specific written documentation.
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7. All consumers receiving alcohol and drug abuse services must have reviewed with
them the Notice to Individuals Regarding Confidentiality of Alcohol and Drug Abuse
Records available at all programs serving these consumers. However, this notice does
not constitute consent or authorization to release records.
8. Communications among Integral Care staff having a legitimate need for consumer
information does not constitute unauthorized disclosure. However, communications
about consumers should be limited to only those staff that needs the information to
carry out appropriate job duties.
9. Any records received from another governmental or private source that becomes part
of the clinical record may be released under the guidelines established in this
procedure.
Procedure
1. No consumer identifying information should be released without legally adequate and
sufficient consent of the appropriate person who is competent to do so. This may
require legal review of pertinent legal documents, such as court orders, decrees, and
verifications of court appointments.
2. Any questions that arise concerning the status of a consumer and the law governing
disclosure in a given situation should be addressed to one of the Integral Care's Clinical
Record Administrators prior to the disclosure of consumer identifying information.
3. Disclosure of consumer identifying information for consumers who receive drug or
alcohol abuse services should be done only with appropriate consultation from one of
the Integral Care’s Clinical Record Administrators.
4. Questions regarding disclosure of consumer identifying information for consumers
who are dually diagnosed may be reviewed with one of the Integral Care's Clinical
Record Administrators prior to disclosure. Dually diagnosed refers to consumers who
are diagnosed with mental illness and mental retardation, or those diagnosed with either
mental illness or mental retardation and substance abuse.
5. Integral Care's designated legal counsel will be consulted as necessary regarding
disclosure of consumer identifying information.
II. Subpoenas and Deposition
Purpose
The purpose of this procedure is to protect the rights of consumers with regard to the
disclosure of identifying information in response to notice of subpoenas and depositions
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by providing instructions for use by Integral Care employees and others who may be
associated with the provision of services.
General Rule
Consumer consent or consent provided by the person legally authorized to give consent
is required before providing testimony in court or making records available.
Procedure
1. Release of records or consumer identifying information in response to a subpoena
alone is insufficient protection against a claim of unauthorized disclosure of confidential
records. Upon receipt of a subpoena requesting testimony, subpoena duces tecum
requesting records, or notice of deposition, the following should be done:
2. Notice to take Deposition: Receipt of notice to take deposition should be immediately
referred to one of the Integral Care's Clinical Record Administrators then follow the
applicable guidelines below.
3. Subpoena/Subpoena Duces Tecum
a. Do not accept a subpoena in anyone else's behalf.
b. Note on the subpoena the time and date of receipt and the name of the person
receiving the subpoena.
c. Immediately notify the Program Manager and fax or deliver a copy of the
subpoena to Clinical Records at Integral Care Administration.
d. File the original subpoena in the clinical record.
e. Review the record for current valid consent, which would permit disclosure of
the information through testimony or release of records to the person issuing the
subpoena.
f. If possible, attempt to obtain consumers written consent or consent of the
person legally authorized to consent for the consumer.
g. Review the record and note any indication of an attorney ad litem, guardian or
attorney representing the person whose records are sought.
h. If there is no current valid consent, and no legal exception applies, then
attempt to obtain the appropriate consent.
i. Contact one of the Integral Care's Clinical Records Administrators.
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j. Be prepared to discuss the diagnosis, legal status, consents and previous
subpoenas, court orders, and designation of guardian or attorney ad litem as, in
some limited circumstances, consent alone may not be sufficient.
k. Whenever there is doubt as to the proper procedure to be followed in such
matters, the subpoenaed party should immediately contact one of the Integral
Care's Clinical Records Administrators who will consult with or refer staff to the
Integral Care's legal counsel as necessary.
III. Release of Information Without Consent
Purpose
To describe those narrow instances in which consumer identifying information may be
released without consent in certain emergency situations and special cases.
Procedure
1. There are exceptions to this procedure which result in it generally not being
applicable in the following situations:
a. to consumers who receive mental retardation or alcohol and drug abuse
services;
b. where there are court proceedings pending; and
c. to consumer information related to HIV diagnosis or services.
2. Questions regarding the exceptions above or other situations should be referred to
one of the Integral Care's Clinical Record Administrators who will consult with or refer
staff to the Integral Care's legal counsel as necessary.
General Rules
Generally, only under the following circumstances, consumer-identifying information
may be disclosed without the consent of the consumer or the person authorized to
consent for the consumer:
1. To government agencies when authorized by law, for example, to the Department of
Family and Protective Services (DFPS) in cases of suspected abuse or neglect of
persons served.
2. To medical or law enforcement personnel when the Integral Care determines that
there is a probability of imminent physical injury by or to the consumer; however, do not
Revised July, 2011
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identify a consumer as a consumer or disclose information not essential to the purpose
for which the report is being made.
3. To qualified personnel for audit or research purposes when such research is being
conducted in accordance with applicable rules; however, auditors and examiners must
provide identification.
4. To persons involved in the collection of Integral Care fees for mental, behavioral, or
emotional health services to consumers. (Example: Integral Care billing personnel
disclosing information to consumer's insurance company in order to collect payment.)
Note, however, it is recommended that consent always be obtained upon registration or
admission.
5. To other professionals, under the direction of the treating professional, who are
participating in the diagnosis, evaluation and treatment of the consumer.
a. Professional means a person:
i) authorized to practice medicine in any state or nation;
ii) licensed or certified by this state to diagnose, evaluate, or treat any
mental or emotional condition or disorder; or
iii) the patient reasonably believes is authorized, licensed, or certified as
described above.
b. "Under the direction" is not defined but refers to communications between
professionals engaged by the Integral Care who direct other professionals who
are participating in the diagnosis, evaluation and treatment of the consumer.
c. Communications by professionals to other professionals outside the Integral
Care must be by authorized consent of the consumer or fall within an allowable
exception to applicable laws protecting the confidentiality of consumer records.
6. To persons legally authorized to conduct investigations of complaints of abuse or
denial of rights of Integral Care consumers. Verification that a person is legally
authorized to investigate must be reviewed with the Integral Care's Ombudsman.
7. To the attorney ad litem specifically appointed by a court of law to represent a
consumer in a legal process.
8. To other components of DSHS (i.e. state facilities, state hospitals, and other
community centers) having the need for information in connection with their duties
related to consumer care. Such disclosures are subject to related requirements set
forth in Section IX.
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9. To the Texas Department of Criminal Justice regarding convicted felons for the
purpose of providing continuity of care. Felony offenders whose information can be
disclosed without consent are offenders with mental impairments; elderly offenders; and
physically disabled, terminally ill, or significantly ill offenders.
IV. Consumers Who Are Minors
Purpose
The purpose of this procedure is to protect the rights of consumers who are minors with
regard to the disclosure of identifying information by providing guidelines for use by
Integral Care employees and others who may be associated with the Integral Care in
the provision of mental health mental retardation services.
A minor is someone under 18 years of age and who is not and never has been legally
married; and whose disabilities of minority have not been legally removed.
General Rules
Questions regarding disclosure of information related to minors receiving drug/alcohol
abuse services should be referred to one of the Integral Care's Clinical Record
Administrators.
Please note that the authority to consent to treatment, the authority to consent to
authorize release of clinical records, and the right to access clinical records may pose
different legal considerations and such rights and authority may not all be legally vested
in the same person.
1. Minor receiving mental retardation services: Only a parent, guardian of the
person, managing conservator or possessory conservator of the minor consumer may
authorize and consent to disclosure of consumer-identifying information to any third
party other than an attorney representing the consumer.
2. Minor receiving mental health services
a. If the consumer is a minor under 16 years of age receiving mental health
services, then the consumer does not have the capacity to consent to disclosure
of consumer-identifying information. A parent, guardian of the person, managing
conservator, or a possessory conservator of the minor consumer may authorize
and consent to disclosure of consumer-identifying information to a third party
other than an attorney representing the consumer.
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b. If the consumer is a competent minor at least 16 years of age but under 18
years of age receiving voluntary mental health services, then the consumer can
unilaterally authorize and consent to the disclosure of consumer identifying
information. The parent, managing conservator, or possessory conservator of
such a minor voluntary consumer also may unilaterally authorize and consent to
the disclosure of consumer identifying information.
c. If the consumer is a minor at least 16 years of age but under 18 years of age
receiving court-ordered mental health services, then only the parent, guardian of
the person, managing conservator, or possessory conservator may authorize and
consent to disclosure of consumer-identifying information to a third party other
than an attorney ad litem representing the consumer.
d. Generally, if the minor is represented by an attorney or an attorney ad litem,
then records may be disclosed to that attorney without consent from those
otherwise authorized to consent. Documentation of representation by legal
counsel or court appointment should be reviewed.
3. Minor receiving alcohol or drug abuse treatment:
a. If the minor is competent, consent must be evidenced by signature of the
minor.
b. If the minor is incompetent, the guardian must provide consent.
Procedure
Upon learning of a legal separation or divorce, consider doing the following:
1. Request that the party requesting treatment or information furnish a signed copy of
the court order establishing parental rights, powers, and duties. Explain that this is
required in order for the Integral Care to meet its duty to protect the confidentiality of the
consumer.
2. Any question regarding interpretation of the court order should be referred to one of
the Integral Care's Clinical Record Administrators.
3. Review of these legal documents may direct that a parent's access to certain records
be restricted. If so the same should be noted on the minor's records.
4. Review of these legal documents may direct that a parent's authority to consent to
certain types of treatment be limited which should also be noted on the minor's records.
5. Generally, a possessory conservator has the right of access to medical (psychiatric)
records, dental, and educational records of a minor to the same extent as the managing
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conservator. However, the court order or divorce decree must be reviewed as its
terms could dictate otherwise. Before releasing records to the possessory
conservator, all references in the records to the place of residence of the managing
conservator must be deleted.
6. Questions should be referred to one of the Integral Care's Clinical Records
Administrators.
V. Deceased Consumers
The purpose of this procedure is to protect the rights of deceased consumers with
regard to the disclosure of consumer identifying information.
General Rules
Consumer consent to disclose confidential information expires upon the consumer's
death.
Procedure
1. Deceased consumers who received Mental Health services - Consent may be given
by the personal representative, usually the executor or administrator of the consumer's
estate. This shall be verified by review of court documents.
2. Deceased consumers who received IDD Services-If no personal representative has
been appointed, consent may be given by the consumer's spouse, or if no spouse, by
an adult related within the first degree of consanguinity.
3. Deceased consumers who received Substance Abuse Services
a. Consent may be given by the executor or administrator of the consumer's
estate. Appropriate probate documents designating the executor or the
administrator should be reviewed prior to disclosure.
b. If no executor or administrator has been appointed, consent may be given by
the consumer's spouse, or if no spouse, then by any responsible member of the
consumer's family.
4. Questions should be referred to one of the Integral Care's Clinical Record
Administrators. The Integral Care's legal counsel will be consulted as necessary.
VI. Advocacy, Inc.
Purpose
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The purpose of this procedure is to provide instructions for response to requests for
consumer information received from Advocacy, Incorporated.
General Rules
Texas Disability Rights shall have access to records of:
1. Any individual who is a consumer if such individual, or the legal guardian,
conservator, or other legal representative of such individual, has authorized Texas
Disability Rights to have access.
2. Any individual (including an individual who has died or whose whereabouts are
unknown):
a. who by reason of the mental or physical condition of such individual is unable
to authorize Texas Disability Rights. to have such access;
b. who does not have a legal guardian, conservator, or other legal representative,
or for whom the legal guardian is the State; and
c. with respect to whom a complaint has been received by Texas Disability
Rights or with respect to whom as a result of monitoring or other activities (either
of which result from a complaint or other evidence) there is probable cause to
believe that such individual has been subject to abuse or neglect.
3. Any individual with a mental illness, who has a legal guardian, conservator, or other
legal representative, with respect to whom a complaint has been received by Texas
Disability Rights or with respect to whom there is probable cause to believe the health
or safety of the individual is in serious and immediate jeopardy, whenever:
a. such representative has been contacted by Texas Disability Rights upon
receipt of the name and address of such representative;
b. Texas Disability Rights has offered assistance to such representative to
resolve the situation; and
c. such representative has failed or refused to act on behalf of the individual.
Procedure
1. Should someone from Texas Disability Rights appear on Integral Care premises
requesting information do as follows:
a. As with any third party requesting information, proper identification of the
person requesting the information should be reviewed.
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b. If records are requested, refer to rules above regarding access to records.
c. Questions regarding requests for information from Texas Disability Rights
should be referred to one of the Integral Care's Clinical Record Administrators.
d. The appropriate Director or designee shall be advised of any Texas Disability
Rights request for information.
VII. Arrest and Search Warrants
Purpose
The purpose of this procedure is to provide guidelines on how to respond to law
enforcement personnel who present with an arrest warrant, search warrant or request to
search.
Procedure
1. If the law enforcement personnel are actively chasing a suspect("hot pursuit"), then
staff should cooperate as instructed by the police.
2. If the officer asks if the person is on the premises at the time the arrest warrant is
presented, staffs are to respond as follows:
a. If staff already knows that the person listed on the arrest warrant is not on the
premises, staff can simply tell the officer this.
b. If staff already knows that the person listed on the arrest warrant is on the
premises, staffs are to respond that they can neither confirm nor deny that the
person is or has ever been there due to confidentiality rules that apply to ATCIC
and their program. Staff is to have the officer wait in an appropriate waiting area
while they locate and talk to the person in question.
3. If the warrant is for a consumer on the premises make every effort to encourage the
consumer to peaceably meet with the person presenting the warrant.
4. If the consumer refuses or leaves the premises, staff is to again inform the officer that
they can neither confirm nor deny that the person is or has ever been there due to
confidentiality rules that apply to the Integral Care and their program.
5. The officer may then request your consent to search the premises.
6. Do not consent to a search of Integral Care premises, and explain that, as a matter of
Integral Care policy a search warrant is required. If the officer disagrees with you,
repeat the explanation but do not resist or impede any uncooperative response.
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7. These events should be reported to the appropriate Director or designee at the
earliest opportunity.
VIII. Telephone Inquiries for Consumer Identification Information
Purpose
The purpose of the procedure is to provide guidelines on how to respond to inquiries for
consumer identifying information made by telephone.
Procedure
1. Basic guidelines:
a. Confirm the identity of the caller utilizing the following steps.
i) Screen the call to ascertain the name of the caller; relationship to
consumer.
ii) Name and identifying information being requested.
iii) Reason for request for information,
iv) Do not acknowledge that an individual is a "consumer."
b. Tell the caller you will return their call, which will allow the opportunity to
evaluate whether or not to release the information sought.
2. Review Section III. of this procedure regarding release of information without consent
to determine whether release of information would be appropriate.
3. Review the clinical record to determine if a current consent form is filed in the record
for the party who is requesting information.
4. If it is determined that information can be released by telephone, provide only specific
information requested or needed and/or indicated on the existing and unexpired consent
form.
5. Any disclosures by telephone are to be documented in the clinical record and include:
a. The program and agency to which information is disclosed.
b. Name of staff person making the disclosure.
c. Date and time of the disclosure.
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d. Information disclosed and/or nature of the emergency precipitating the
disclosure.
6. When it has been determined that information can be released by telephone, this
shall be done through a return phone call, except in the case of a bona fide medical
emergency.
7. If it is determined that information cannot be disclosed, explain that the information
requested is confidential and that written specific consent is required.
8. Questions should be referred to one of the Integral Care's Clinical Records
Administrators.
9. This procedure is not to be interpreted or applied in any manner that restricts or
violates the consumer's rights to communicate with anyone.
IX. Disclosures Among Components of Department of State and Health Service
System
Purpose
To describe those instances in which consumer identifying information may be released
among components of the Department of State and Health Services (DSHS) service
system.
Definitions
1. Components of DSHS service system are as follows:
a. DSHS facilities
b. State hospitals
c. State supported living centers
d. State community centers
e. community centers
f. Designated providers - Individual, entity, or organization that contracts with
DSHS or Integral Care to provide community based services.
2. A qualified service organization is defined as follows: An individual, partnership,
corporation, governmental agency, or any other legal entity which:
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a. provides services for alcohol and drug abuse programs, such as;
i)data processing,
ii)bill collecting,
iii)dosage preparation,
iv)laboratory analysis,
v)legal, medical, accounting or other professional services, or
vi)services to prevent/treat child abuse/neglect, including training on
nutrition and child care and individual and group therapy, and
b. has entered into a written agreement with a program under which that entity:
i) acknowledges that in receiving, storing, processing, or otherwise dealing
with any consumer records from these programs, it is fully bound by
regulations governing confidentiality, and
ii) if necessary, will resist in judicial proceedings any efforts to obtain
access to consumer records except as permitted by applicable
regulations.
Procedure
1. Other than Drug/Alcohol Abuse Services: Integral Care consumer-identifying
information may be released between components of the DSHS service system (i.e.
between community centers) provided that the following conditions are met:
a. The consumer and/or legal guardian have been informed that the records may
be exchanged at the time or prior to release;
b. The consumer and/or legal guardian is informed of the purpose of the release,
i.e., to facilitate continuing care for the consumer; and
c. The advisement to the consumer and/or legal guardian is documented in the
consumer's record, dated and signed by the consumer and/or legal guardian and
staff.
2. Drug/Alcohol Abuse Services: Disclosure by the Integral Care to other community
centers requires the consumer's consent.
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a. Consent is required for disclosure by DSHS to community centers or other
designated providers as defined above.
b. Consent is not required for disclosure by DSHS to ATCIC if the community
center or designated provider is also a qualified service organization as defined
above.
X. Warning Reasonably Identifiable Potential Victims (Tarasoff)
Purpose
To provide guidelines to mental health providers in the event a consumer threatens a
third party.
Procedure
If a consumer of Integral Care services communicates to someone with whom he/she
has a mental health provider relationship and the threat is specific and directed at a
specific and readily identifiable victim (s) then do the following:
1. Review prior treatment records to assess the threat of violence within the context of
the consumer's psychiatric history.
2. If a determination of dangerousness is made, then consider involuntary inpatient
commitment.
3. If commitment is not appropriate, first consider notifying law enforcement personnel.
Potential victims should be then notified.
4. If, in light of the circumstances, it appears reasonable to first notify law enforcement
personnel, then do so immediately and document the notification in the consumer's
records.
5. If notification of law enforcement personnel will not result in timely notification of the
potential victim, then notify the potential victim directly and immediately, by telephone if
possible. Follow this by notification to the law enforcement personnel.
6. These disclosures impose a risk of liability for disclosure of confidential information. If
the mental health provider does not think the consumer really poses a threat to
someone, then there is no responsibility to warn and confidentiality should be
maintained.
7. These procedures are based upon an evaluation of the law and questions regarding
disclosures under the circumstances described above should be reviewed with the
Integral Care's legal counsel.
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8. Notify the appropriate Director or designee of disclosures made according to this
procedure.
XI. Consumer Access to Record Information
Purpose
Provide guidelines on how to respond to a consumer's request to access their own
clinical record information.
General Rule
1. Consumers have the right to have access to information contained in their own
record. The right extends to the parent or conservator of a minor (unless the minor has
admitted himself/herself for substance abuse services) and to the legal guardian of a
person declared to be legally incompetent.
2. When parent possessing/managing conservators are requesting access to record
information, request that the party furnish a signed copy of the court orders establishing
parental rights, powers, and duties. Explain that this is required in order for the Integral
Care to meet its duty to protect the confidentiality of the consumer.
3. Any questions regarding consumer access to record information or the interpretation
of a court order should be referred to one of the Integral Care's Clinical Record
Administrators. The Integral Care's legal counsel will be consulted as necessary.
Procedure
1. When a person requests access to or a copy of his/her record, the requested
information is to be made available to the consumer within a reasonable period of time.
A progress note is to be documented in the clinical record regarding the request: Date,
why the information was requested (if known), information released, and by whom it
was released.
2. If the request is made regarding the primary record, the IPC/SAI will be available to
answer any questions when the individual/representative reviews the record. If the
request is made regarding a secondary record, the case coordinator at the secondary
unit will be available to answer any questions when the individual/representative
reviews the record.
3. Part (s) of the record may be withheld but only if it is determined by a professional, as
defined in the Texas Administrative Code Chapter 403, that access would be harmful to
the consumer's physical, mental, or emotional health.
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a. For purposes of this procedure, the determination must be made by a Integral
Care physician (or the psychologist supervising the habilitation for a consumer
receiving Mental Retardation Services), but only after consultation with the
Integral Care's Medical Director.
b. Before denying any consumer access, the Integral Care professional must
contact one of the Integral Care's Clinical Record Administrators who will seek
legal counsel as necessary.
XI. Automated Consumer Identifying Information
Purpose
The purpose of this procedure is to provide guidelines for ensuring the confidentiality of
automated consumer identifying information.
General Rules
1. Computer stored consumer identifying information is to be protected as confidential in
the same manner as paper stored consumer-identifying information.
2. MIS staff will ensure that staff is assigned appropriate levels of access to computer
stored consumer identifying information in accordance with directions and requests from
program divisions. Logon passwords are changed regularly for current staff users and
deleted for staff users who leave Integral Care employment.
3. Staff who has access to automated consumer identifying information is to follow the
procedures listed below and is to access only information that is appropriate and
necessary to carry out their job duties.
Procedure
1. Personal computers (PC's)
a. PC screens are to be placed in areas that do not receive public traffic in order
to protect the confidentiality of consumer identifying information that may be
visible on the screen.
b. When a staff person leaves a PC workstation in a nonsecure area (any area to
which another person can have access), the staff person is to either logout of the
system, or locks the keyboard (if away momentarily).
2. Lap top computers
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a. Lap top computers are not to be left unattended in public areas while in use or
not in use.
b. While in use, the lap top computer screen is to be positioned in a way to
protect the confidentiality of consumer identifying information that may be visible
on the screen.
c. Lap top computers are to be secured by the responsible individual when not in
use.
3. Computer printers
a. Printers are to be placed in areas that do not receive public traffic in order to
protect the confidentiality of information that is being printed.
b. Printed documents that contain consumer-identifying information are to be
retrieved from a printer immediately and are to be destroyed by shredding after
their use.
4. Consumer identifying e-mail
a. As a general rule, consumer-identifying information should not be
communicated by e-mail. As an alternative, use case numbers and consumer
initials or communicate general information and ask the receivers of the e-mail to
call a designated person for detailed consumer identifying information.
b. If it is absolutely necessary for an e-mail to contain consumer identifying
information, send the e-mail to a designated person or group of persons.
Receivers are to be limited to those staff whose job duties require access. Do not
use the "everyone" option for sending consumer-identifying e-mail.
c. Receivers are not to forward consumer identifying e-mail without the sender's
permission.
d. Consumer identifying e-mail is to be deleted immediately after use.
e. Consumer identifying e-mail is not to be transferred to personal computers or
the Internet.
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Infection Control Plan
PURPOSE
To establish procedures in accordance with the Center for Disease Control, TXMHMR,
the Texas Department of Health and the Austin-Travis County Health Department. To
identify, resolve, and prevent the spread of infection among consumers and employees
of the Austin Travis County Mental Integral Care.
Staff is required to utilize the following infection control measures when dealing with all
consumers regardless of known or unknown diagnoses (universal precautions). NOTE:
Whenever "staff" or "employee" is used, it is meant to include interns, volunteers,
students, providers, etc.
RESPONSIBILITIES
All Staff: Practice required infection control techniques and following universal
precautions. Receive Infection Control training through New Employee Orientation and
annual refresher training. Report all infections or infection related incidents by
completing an Incident Report form and submitting it to the Quality Management
Department
Medical Director: Consults with Integral Care physicians and nurses in the
management of infections or potential infections.
Unit Managers/Team Leaders: Implement infection control procedures appropriate to
unit in service area. Insures communicable diseases are reported to the Infection
Control Nurse.
Quality Management Department: Reviews all incident reports. Maintains a central file
of all incident reports, compiles a quarterly Incident Report Summary for the Risk
Management Committee's review.
Universal Precautions/Personal Protective Equipment
Universal precautions shall be observed to prevent contact with blood or other
potentially infectious body fluids. In cases in which differentiation between body fluid
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types is difficult or impossible, all body fluids shall be considered potentially infectious
materials.
Personal Protective Equipment: Disposable latex gloves in appropriate sizes will be
readily available to all employees at all program sites. Hypoallergenic gloves, glove
liners, powderless gloves or other similar alternatives will be provided to those
employees who are allergic to normal gloves. NOTE: Hand creams, which are
petroleum based, may cause latex gloves to tear. Employees using latex gloves, as
personal protective equipment should be advised not to use such hand creams on the
job.
Staff must wear gloves under the following circumstances:
1. When providing direct care involving contact with all body fluids such as blood, fecal
matter, urine, saliva, tears, semen, vaginal fluids;
2. While handling objects that might be soiled with blood, saliva or other body fluids
(e.g., diapers, menstrual pads, clothes or equipment);
3. When handling all laundry;
4. When the employee has open oozing lesions on his/her hands or lower arms;
5. When cleaning toilets;
6. When removing waste or receptacle liners;
7. When working with irritating solutions;
8. When cleaning an area contaminated with blood, body fluids or fecal material;
9. When food is being handled directly (the gloves which should be worn in food
handling should be plastic rather than latex);
10. While feeding or assisting in the feeding of consumers if direct contact with saliva or
mucous is likely;
11. While giving any intimate personal care in which direct contact with body fluids is
likely, e.g., feces, urine, saliva, menstrual blood;
12. While applying topical medications to consumers;
13. When performing needle sticks of any kind, i.e., giving injections, performing
venipuncture, and in acupuncture when removing needles.
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14. Washing ones hands is required after glove removal.
15. CPR resuscitation masks and mouthpieces will be readily available in all programs.
CPR instructors and CPR certified staff would be trained in their use.
16. The resuscitation masks and mouthpieces used in CPR classes will be
decontaminated with the accepted 1:9 bleach/water solution, applied for ten minutes
and allowed to air dry.
17. Resuscitation masks used in emergency situations will be disposed of in red bags.
18. Gowns, gloves and masks will be made available to employees in direct care areas
in case of large blood spills or where there is spraying or spattering of blood. The
gowns and masks will be impervious in nature.
19. All personal protective equipment should be removed immediately if penetrated by
blood or other potentially infectious materials. When removed, it is considered to be
contaminated waste and must be placed in a red bag for disposal.
Disposable gloves may never be reused. Gloves must be changed after use with each
consumer. It is never appropriate to wear the same gloves when working with more than
one person.
Hygiene
Hand washing facilities will be available to all employees whenever possible. These
facilities will have hot water, liquid soap, paper towels or hot air dryers. If hand-washing
facilities are not available, approved antiseptic towelettes, sprays, or gels shall be
provided which can be used in any occasion. When such agents are used, hands shall
be washed with soap and hot running water as soon as feasible. NOTE: commercial
baby wipes and towelettes are not germicidal and therefore are not sufficient.)
It is absolutely essential for staff and consumers to wash their hands immediately in
the following circumstances:
1. After removal of disposable gloves;
2. After contact with blood or other body fluids;
3. After handling objects that might be soiled with blood, saliva or other body fluids
(e.g., diapers, menstrual pads, clothes or equipment);
4. After going to the bathroom or helping another person with toileting;
5. Before drinking, eating or smoking;
6. Before preparing, serving or handling food;
7. Before and after feeding or assisting in the feeding of consumers;
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8. Before and after giving any intimate personal care.
9. Proper hand washing procedures will be part of staff training.
10. Hand washing procedures will address options for occasions when soap and water
are not readily available e.g., camp, classrooms, recreation trips, vans, etc.
11. Special soap will be provided for staff with dermatitis and other skin conditions.
12. Eating, drinking, applying cosmetics or inserting contact lenses is prohibited in work
areas where there is a reasonable likelihood of exposure to potentially infectious
materials.
13. Food, medication and drink shall not be kept in refrigerators, in cabinets or on
counter tops where blood or other potentially infectious materials are present.
14. Body fluid specimens that need refrigeration must be kept in a separate refrigerator
or cooler from the ones in which food is kept. The specimen must be labeled, put in
a plastic bag, and then placed in the refrigerator, which is labeled with a biohazard
sign.
15. Gloves must be worn at all times when handling any body fluid specimens.
Housekeeping/Garbage Disposal
Staff must frequently disinfect all program areas, e.g., classrooms, especially in
preschools. A written schedule shall be established and implemented which identifies
appropriate methods of cleaning and decontamination. Types of surfaces, soils, tasks
and procedures being performed should be considered.
Dishes will be washed in a dishwasher, which maintains 140 degrees. If this is not
possible, paper plates, cups and plastic utensils will be used.
Environmental surfaces that have been contaminated with blood, body fluids or fecal
material shall be cleaned immediately with an approved germicidal solution or a onepart bleach to nine parts water solution in a labeled spray bottle. NOTE: The bleach
solution is only good for twenty-four hours and should be prepared fresh at the
beginning of each day, unless stored in an opaque spray bottle where it remains good
up to 7 days.
Staff must wear disposable gloves when cleaning contaminated materials. NOTE: HBV,
the Hepatitis B virus, can survive for up to 14 days in dried blood on environmental
surfaces.
Any items containing visible blood or potentially infectious materials must be disposed
of in containers clearly marked with biohazard signs or red bags. Staff must wear
disposable gloves when picking up and disposing of refuse. All wastebaskets and other
receptacles used for blood and other potentially infectious materials will have a cover
that will not spill when turned over. Red bags that fit the trash can shall be readily
available for disposal of contaminated substance.
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Nurses/physician's offices and all bathrooms should have trashcans with liners, soap,
and paper towels. All containers, pails, cans, etc., intended for reuse shall be inspected
and decontaminated with a germicidal solution on a regularly scheduled basis. Such
containers shall be cleaned and decontaminated immediately, or as soon as feasible,
upon visible contamination.
Staff must wear commercial rubber gloves when handling heavy refuse. After use the
gloves must be washed and decontaminated with a 1:9 bleach solution before reuse.
Broken glassware shall not be picked up directly with the hands and shall be cleaned up
using brushes, brooms, etc. If anyone has bled on the broken glass, it must be
considered to be a contaminated sharp and must be placed in a sharps container (See
Disposal of Sharps). The tools which are used in clean up must be properly
decontaminated or discarded after use.
Regulated waste shall be placed in containers that are closeable, leak proof, labeled
and color-coded in accordance with this plan. Before being removed such containers
shall be closed. If the container itself is contaminated, it shall be placed in a second
container with the same characteristics as the first. Housekeepers and other staff who
deal with housekeeping issues must be given training.
All red bags, sharps containers and waste materials labeled with biohazard signs
indicating contaminated materials must be disposed of by the hazardous waste
management company under contract with the Center.
Contaminated Laundry
Laundry contaminated with blood or other potentially infectious materials (e.g., feces,
urine, semen or vaginal secretions) shall be handled as little as possible and with a
minimum of agitation. Staff should wear gloves and utilize Universal Precautions
whenever handling laundry and should be sure not to brush laundry up against their
own clothing.
Contaminated laundry shall be put into red laundry bags or bags which are clearly
labeled with biohazard signs at the location where it was used. Whenever laundry may
be wet and might soak through or leak, the laundry should be placed and transported in
bags or containers that are soak proof or leak proof.
Contaminated laundry may be washed in program laundry facilities; however, it must be
washed separately from other laundry. Staff must ensure that contaminated laundry is
washed in hot water. Employees who come in contact with contaminated laundry shall
be required to wear personal protective equipment. In all cases linens and towels
should be washed in hot water, separate from any other laundry. Where laundry is
shipped off-site for cleaning or handling, contaminated laundry must be placed in bags
or containers that are labeled or color-coded in accordance with this policy.
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38
Disposal of Sharps
All persons, including relief nurses, who may be working with contaminated sharps or
needles shall read the Center's plan and procedures and shall be accountable for the
following guidelines.
1. All contaminated needles and sharps are not to be bent, broken, cut or recapped. All
used needles should be considered to be regulated medical waste regardless of the
presence of infectious agents.
2. All programs will have access to an approved sharps container for disposal of
needles, contaminated broken glass, etc. Immediately after use, sharps, e.g.,
needles must be placed in containers that can be closed, are puncture resistant, are
leak proof on sides and bottom and are designed to prevent people from reaching
into them. These containers must be specifically designed for the purpose of "sharps
containment." Sharps containers must be clearly marked with water-resistant
biohazard symbols and color-coded. See Section 9 regarding Labels and Signs.
3. These containers must be readily accessible to personnel using the sharps and
located as close as feasible to the immediate area where the sharps are used.
4. Broken glass and anything that might produce a puncture wound which would
expose employees to blood or other potentially infectious materials must be
considered to be "sharps." If anyone has been cut on this type of sharp and bled on
it. The contaminated sharp must be disposed of in a sharps container.
Personal Items - Consumers
1. Each consumer will have individual grooming items.
2. Used linens and towels will be washed before use by another individual.
3. Disposable thermometers will be used if possible.
4. All non-disposable thermometers will be covered with disposable sheaths, which
should then be cleaned appropriately.
Labels and Signs
Labels shall be florescent orange and orange-red in color with lettering or symbols in a
contrasting color. Labels should include the term "BIOHAZARD" and shall be affixed in
adhesive, wire, string or other method designed to prevent the loss or unintentional
removal of the label. Red bags or red containers may be substituted for labels.
Regulated waste containers shall have warning labels affixed.
Revised July, 2011
39
Refrigerators and freezers containing blood or other potentially infectious materials and
other containers used to store, transport or ship blood or other potentially infectious
materials must comply with this section of the plan. These shall be permanently marked
and identified as containing biohazardous waste.
Post-Exposure Procedures
As is true in any exposure to bloodborne pathogens or other potentially infectious
materials, the employee is to wash the exposed area immediately with soap and water.
An employee exposed to bloodborne pathogens which could be considered a potential
exposure to HIV (needle stick, direct inoculation, large blood spill or mucous membrane
exposure) should be seen by a physician within ONE HOUR so that the physician can
determine if the employee should be offered prophylactic treatment with medication
"Zidovudine" (AZT). If this is a potential Hepatitis exposure, the employees needs to be
seen by a physician within TWENTY-FOUR HOURS.
An Incident Report should be filled out by the exposed employee within TWENTYFOUR HOURS and processed according to Center procedures regarding incident
reporting. The employee will be responsible for filling out a release of information form
so that follow-up can be recorded and entered into the Employee Health Record. This
release form is specific only to information related to the work exposure incident.
Reportable Diseases
All employees and providers are responsible for reporting significant infections to their
Unit Manager and or appropriate supervisor
Health Maintenance
Each individual admitted to a residential program is to be evaluated for health and
medical issues. Current problems and a history of problems are to be documented in
the initial assessment.
Individuals in long-term residential programs (length of stay over 3 months) are to be
current on immunizations and vaccinations.
Where programs provide meals, individuals will be served a balanced and nutritious
diet.
Individuals in residential programs will be provided with a healthy living environment and
adequate physical activity for the maintenance of health.
Residential individuals will receive counseling and education as necessary to inform and
assist them in maintaining health.
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40
Direct care staff shall monitor each individual's health on an ongoing basis to detect any
problems or potential problems.
Individuals with health problems are to be seen by the physician/nurse or referred to the
appropriate treatment facility as soon as possible and scheduled for treatment as soon
as indicated.
The Unit Manager will develop specific procedures based on special needs of
individuals served.
Record Keeping Procedures for Employee Exposures to Bloodborne Pathogens
Any exposure to a bloodborne pathogen experienced by a consumer or an employee
must be documented on an Incident Report. NOTE: CPR will be considered to be an
exposure incident if a resuscitation mask and mouthpiece were not used. An Incident
Report will be written to document this exposure.
Implementation/Compliance Review
Unit Managers/Service Coordinators/Team Leaders or appropriate staff will be
responsible for implementation of the Infection Control Employees who refuse/fail to
comply may be subject to personnel action.
Exposure Control Plans must be specific to each program. For each program a Plan
Compliance Officer will be assigned full responsibility for ensuring program specific
implementation and follow-up on changes that may be made to the Center-wide plan.
The compliance officer should be the Unit Manager, Service Coordinator, Team Leader,
or his/her designee. Each program will also have a site-specific compliance officer to
follow-up on the Site-Specific Exposure Control Plan on a more frequent basis than the
Infection Control Nurse.
Known Exposures
The Infection Control Nurse will be notified immediately of any known exposures, which
will then notify the Medical Director. The Infection Control Nurse will consult with the
Medical Director to determine the appropriate medical follow-up and action to take.
If the exposure is suspected to be occupational exposure, the Infection Control Nurse
will notify the appropriate staff as indicated for follow-up and testing of other employees
who may have been exposed.
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41
If a consumer is suspected of having active Tuberculosis and his/her situation dictates
that he/she is seen in one of the Center's facilities, he/she will be asked to wear a
NIOSH approved particulate respirator while in the facility.
If the individual in inpatient or outpatient treatment refuses to comply with Infection
Control Protocols, every effort will be made to minimize exposure to employees and
consumers.
Positive Test Results
The employee will be directed by the Infection Control Nurse to go to the Austin-Travis
County Health Department or his/her private physician for a chest x-ray and follow-up
treatment. An appointment should be made within 3 working days.
As long as the employee is asymptomatic, he/she may continue to work until the
employee can obtain chest x-ray results. The x-ray results will be submitted to the
Infection Control Nurse as soon as available. If the employee is symptomatic of active
disease, i.e., coughing up blood, has had a dramatic weight loss, night sweats, he/she
may not return to work until he/she presents a physician's statement verifying his/her
ability to safely perform work duties without compromising the health and safety of self
or others according to ATCIC Human Resources Operating Procedures.
If an employee is diagnosed with active disease, he/she may NOT return to work until
he/she presents physician's statement verifying the employee’s ability to perform work
duties without compromising the health and safety of self or others according to ATCIC
Human Resources Operating Procedures.
Management of Immuno-Compromised Employees
Employees with impaired immune systems resulting from chronic or debilitating disease,
i.e., lupus erythematosis, rheumatoid arthritis, diabetes mellitus, HIV, are at increased
risk of acquiring or experiencing serious complications of infectious disease. Of
particular concern is risk of severe infection following exposure to persons with
infectious diseases that are easily transmitted if appropriate precautions are not taken.
Any employee who provides unsolicited information to a supervisor that he/she has an
impaired immune system, or any employee whom the Unit Manager has reason to
know, by operation of this procedure, that an employee has an impaired immune
system, will be counseled about the potential risk associated with providing health care
to persons with any transmissible infection and will continue to follow existing
recommendations for infection control to minimize risk of exposure to other infectious
agents.
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42
Alternative assignments, employee transfers, or other adjustments to job duties may be
indicated after full administrative evaluation of the total circumstances. Employees with
impaired immune systems or chronic and debilitating disease are expected to be able to
perform work duties without compromising the health and safety of self or others
according to ATCIC Human Resources Operating Procedures. They must follow
standard infection control procedures and demonstrate a willingness to do so.
Any medical documentation or information provided by an immuno-compromised
employee to Center medical or supervisory personnel must be considered confidential
and private information and is forbidden by law to be disclosed without the employee's
knowledge and consent. In addition, this information is not to be filed in the employee's
personnel file, which is maintained in the Human Resources Department.
Employee Infections
Employees with contagious/infectious diseases will be relieved of direct care and
cooking responsibilities during contagious periods. The Unit Manager may request an
employee to provide a medical release from a physician to resume direct care
responsibilities.
Health Maintenance
Each individual admitted to a residential program is to be evaluated for health and
medical issues. Current problems and a history of problems are to be documented in
the initial assessment.
Individuals in long-term residential programs (length of stay over 3 months) are to be
current on immunizations and vaccinations.
Where programs provide meals, individuals will be served a balanced and nutritious
diet.
Individuals in residential programs will be provided with a healthy living environment and
adequate physical activity for the maintenance of health.
Residential individuals will receive counseling and education as necessary to inform and
assist them in maintaining health.
Direct care staff shall monitor each individual's health on an ongoing basis to detect any
problems or potential problems.
Individuals with health problems are to be seen by the physician/nurse or referred to the
appropriate treatment facility as soon as possible and scheduled for treatment as soon
as indicated.
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43
The Unit Manager will develop specific procedures based on special needs of
individuals served.
Hepatitis
“Hepatitis” is a general term that describes any kind of inflammation of the liver, a vital
organ that has many functions. Viruses, bacteria, drugs, toxins, or excess alcohol intake
can cause the inflammation. A virus is a small microorganism that is made up of nucleic
acid (either RNA or DNA) and enclosed in an envelope of protein. It can multiply only
within the cells of an animal host (or in plants with some types of viruses).

Testing can be preformed to determine if you are infected with viral hepatitis. THE only
way to be sure if you are infected with viral hepatitis is to get tested.
Hepatitis A
Hepatitis A is contacted by eating food or drinking water that has been contaminated
with human excrement. CDC estimates that 150,000 people in the United States are
infected each year by hepatitis A. Acute hepatitis A usually resolves itself within 6
months and does not develop into a chronic disease. The CDC lists household or
sexual contact, day care attendance or employment, and recent international travel as
the major known risk factors for transmission of hepatitis A. Infected food handlers and
those who have used contaminated needles are also at risk for transmission. In
addition to getting hepatitis A from infected people, you can get hepatitis A by:
 Swallowing contaminated water or ice
 Eating raw shellfish, harvested from sewage-contaminated water
 Eating fruits, vegetables, or other food that may have become contaminated
during handling
 Oral/anal contact (rimming)
 Oral contact with partner’s penis or sex toy after anal sex
 Oral contact with fecal matter on hands or fingers that have been in or around
the anus, or handled a condom or sex tool used for anal sex
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44
A person can spread HAV about one week before symptoms appear and during the first
week of symptoms. Persons with no symptoms can still spread the virus. This often
happens with young children who unknowingly spread HAV to older children and adults.
Unlike hepatitis B and hepatitis C, hepatitis A causes no long-term liver damage and
usually does not cause death. There is no chronic carrier state with hepatitis A. Having
the disease produces lifelong immunity from future HAV infections.
Persons with hepatitis A can spread the virus to others who live in the save household
or with whom they have sexual contact. Causal contact as in the usual office,
factory or school setting, does not spread the virus.
Signs and Symptoms
 HAV can cause acute, flu-like illness with yellowing of the skin (jaundice)
 Nausea and vomiting
 Fatigue, loss of appetite, abdominal pain, or diarrhea
Symptoms can last 3 to 6 weeks, but can persist up to 6 months. Most people recover
with no long-term health problems. Symptoms are more severe in adults then children
who often have no symptoms.
Who is at risk?
 Persons who share a house hold or have sex contact with someone who has
hepatitis A
 Travelers to countries where hepatitis A is common and where clean water and
proper disposal are not available
 Men who have sex with men
 Persons who use street drugs
 Children and employees in child care centers (especially centers that have
children in drapers) where a child or an employee has hepatitis A
 Residents or staff of institutions for developmentally disabled persons when a
resident or an employee has hepatitis A
 Workers who handles HAV-infected animals or work with HAV in a research
laboratory setting (This does not include laboratories doing routine testing.)
 Persons with clotting factor disorders who receive factor concentrates
 However, appropriately one third or more of Hepatitis A, B, and C cases
result from unknown sources. This means that you do not necessary have
to be one the “high risk” groups to become infected with the viruses.
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45
How Can You Prevent Hepatitis A?
 Wash hands after using the bathroom
 Wash hands between providing services to consumers
 Wash hands before, during and after preparing/serving foods
Can HAV Be Killed?
Boiling at 85 degrees C (184 degrees F) for 1 minute kills the virus. However, the
disease can still be spread by cooked foods if they are contaminated after cooking.
Adequate chlorination of water, as recommended in the United States, kills HAV.
Hepatitis B
Hepatitis B is sexuality transmitted liver disease caused by the hepatitis B virus. Most
people can fight off the hepatitis B virus, but hepatitis B becomes chronic in about 10%
of cases. Chronic Hepatitis B is a life-long liver disease caused by infection with the
Hepatitis B virus, HBV for short. If you have other types of hepatitis, such as hepatitis A
or hepatitis C, you can still get hepatitis B.
It is estimated that about 200,000 new infections of hepatitis B occur in the U.S. each
year. Not all persons infected with the hepatitis B virus look or feel sick; they can have
the virus and not have symptoms or know they are sick.
Life-long infection increases your chances of getting cirrhosis (si-RO-sis, that is,
scarring) of the liver of liver cancer. Each year 5,000 people die as a result of liver
disease caused by HBV.
If you have viral hepatitis and drink alcohol, the possibility that you will suffer serious
liver damage greatly increases. People who have viral hepatitis should not drink
alcohol.
Symptoms








May have flu like symptoms
Yellowing of the skin (jaundice)
Fatigue
Nausea/vomiting
Abdominal pain
Loss of appetite
Diarrhea
Dark urine, light-colored stools
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How It Is Spread






Unprotected sex with an infected partner
Sharing needles or drug injection equipment with an infected person
Sharing a razor or toothbrush with an infected person
Occupational exposure to infected blood
Being born to an infected mother
There is no evidence of increased rates of viral hepatitis due to sexual contact
between women, but women should speak with their health care provider if
they believe their health may be at risk.
You cannot get HBV from sneezing or coughing, kissing or hugging, sharing eating
utensils or drinking glasses, breast feeding, food or water, or casual contact (such as on
office setting.)
Precautions: How Can You Protect Yourself?
 Get vaccinated!
Hepatitis B vaccine is safe, effective, and your best protection.
 Practice “safer” sex.
If your having sex, but not with one steady partner, use latex condoms
correctly every time you have sex and get vaccinated against hepatitis B.
Men who have sex with men should be vaccinated against hepatitis A and
hepatitis B.
 Don’t share anything that might have blood on it.
Hepatitis C
Four million people in the U.S. have been infected with the hepatitis C virus. The major
of these people will develop chronic hepatitis C.
Hepatitis C is one type of virus that can damage the liver. About one third of people with
new hepatitis C infection develop symptoms, which may include fatigue, mild fever, flulike illness, nausea and vomiting, stomachache, loss of appetite or jaundice. Up to 70%
of people who have just been infected with hepatitis C may have no symptoms. They
may not even know they are infected. Many people first find out they are infected with
this virus when they are tested at the time they donate blood or when they begin to have
symptoms of liver damage. This is often years later.
Between 75% and 85% of persons with hepatitis C infection develop chronic hepatitis C,
which persists over a long period of time. Fatigue is the most common complaint of
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people with chronic disease. Other symptoms may include mild upper right abdominal
pain, poor appetite, and muscle and joint pain.
Why is hepatitis C a major health problem?
Hepatitis C is the most common chronic bloodborne infection in the United States. An
estimated four million Americans have been infected with HCV. Of these, 2.7 million are
chronically infected. About 70% of persons with chronic hepatitis C infection develop
liver disease, which can progress to cirrhosis (scarring), liver failure, and/or cancer of
the liver. Severe liver disease from hepatitis C infection accounts for almost one-half of
liver transplants in the United States.
The Centers for Disease Control and Prevention (CDC) estimates that 8,000 to 10,000
people in the United States die each year from chronic hepatitis C. The costs
associated with hepatitis C are considerable. It is estimated that well over $600 million
are spent nationally each year on medical care and lost wages related to hepatitis C.
A recent study, published by Wong and colleagues in the American Journal of Public
Health (2000; 90:1562-1569), estimated the future hepatitis C morbidity, mortality, and
costs in the United States for the years 2010 through 2019. They based these estimates
on data from the third National Health and Nutrition Examination Survey, published
literature on the morbidity and mortality from chronic liver disease and hepatocellular
carcinoma, and cost estimates for patients with hepatitis C treated at a university
hospital. Their conservative model projected 165,900 deaths from chronic liver disease
attributable to HCV, 27,200 deaths from hepatocellular carcinoma, and 10.7 billion
dollars in direct medical costs for this disease for the 10-year period.
For the same time period, they projected 54.2 billion dollars cost to society from
premature deaths of persons less than 65 and 21.3 billion dollars in cost incurred as the
result of disabilities related to cirrhosis and liver cancer.
Why do most persons with hepatitis C become chronically infected?
The hepatitis C virus mutates rapidly. The changes in the protein envelope that
surrounds the virus particle may help it evade the body’s immune system.
Is there a vaccine or other drug to help prevent hepatitis C infection?
No vaccines or immune globulin products to prevent hepatitis C are currently available.
Developing a vaccine will be difficult because the hepatitis C virus includes several
strains, and the virus may undergo many mutations. Vaccines for hepatitis A and B do
not provide protection against hepatitis C. However, persons with hepatitis C should get
these vaccines to protect the liver from being infected with hepatitis A and B. Persons
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with chronic hepatitis C may suddenly develop life-threatening illness if also infected
with another hepatitis virus.
How does a person get infected with hepatitis C?
A person infected with either acute or chronic hepatitis C may infect other people,
especially if no safety measures are taken. The virus is found in the blood and is spread
by direct contact with blood and blood products.
People can be infected with the virus when they use needles, toothbrushes, and nail
files that contain blood from an infected person. People who have acupuncture, body
piercing, or tattooing done are at risk if the equipment used is not sterile and was used
on persons infected with hepatitis C. These procedures should be done using proper
infection control practices that include washing hands, using disposable gloves,
disinfecting work surfaces, and using sterilize or disinfected instruments and materials.
The highest risk of getting infected with hepatitis C comes from injecting illegal drugs.
The risk is very low, however, when a person gets a blood transfusion. Nowadays all
donor blood is carefully tested in the laboratory for hepatitis C.
A small proportion of people with hepatitis C infection report no known history of
exposure to blood or to drug use. They might have been exposed when a cut or wound
came in contact with blood from an infected person.
Hepatitis C may also be spread through sexual contact, although this is not a very
efficient method of transmission. People with many sex partners are at increased risk of
contracting hepatitis C. A person with multiple sex partners, regardless of infection
status, should use latex condoms to help prevent the spread of this virus as well as
other infections that can be transmitted through sexual contact.
People with hepatitis C infection who have one long-term sex partner do not need to
change their practices. The partner’s risk is low, but not absent. To lower this small
risk, they can use barrier precautions such as latex condoms and ask their doctor about
having their partner tested.
For every 100 infants born to HCV-infected mothers, about 5 become infected at the
time of birth. There is no treatment that can prevent this from happening. Most infants
who are infected at birth have no symptoms and do well during childhood. More studies
are needed to see if these children will have problems later.
Current information indicates that babies do not become infected with hepatitis C from
their mothers’ breast milk. However, mothers who have cracked or bleeding nipples
should use formula feeding until their nipples are healed.
Who are the major high-risk groups for hepatitis C?
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1. People who have been notified that they have received blood or blood products from
a donor who tested positive for hepatitis C.
2. People who received a blood transfusion or solid organ transplant (such as a kidney,
liver, or heart) before July 1992.
3. People with blood clotting problems who received treatment with a blood product
made before 1987.
4. People who have ever injected street drugs, even once many years ago.
5. People who were ever on long-term kidney dialysis.
6. Persons with accidental injuries due to contaminated needles or other sharp objects,
which have been exposed to blood from a hepatitis C positive person.
7. Children born to HCV-infected women.
8. Persons who have been injected with a syringe that has been used on others. This
is primarily a problem in developing countries.
Are health care workers at increased risk for getting hepatitis C?
Health care workers who have had accidental needle sticks from sharps used on an
infected source may develop hepatitis C. After needle stick or sharps exposure to HCVpositive blood, about 2 health care workers out of 100 will get infected with HCV.
Recent surveys of health care workers, however, have shown them to have
approximately the same prevalence of hepatitis C infection as the general population.
Any healthcare worker who is exposed to blood should receive the hepatitis B vaccine.
After an accidental needle stick with infectious blood, less than one healthcare worker
out of 100 (0.3%) will get infected with HIV, and 30 out of 100 will get Hepatitis B.
What should be done if a health care worker is exposed to HCV positive blood
such as a needle stick?
At this time, anti-viral agents (such as interferon) or immune globulin are not
recommended for post-exposure prevention of hepatitis C. The following steps should
be taken after these types of exposures:
1. For the source, baseline testing for anti-HCV should be done.
2. For the person exposed to an HCV-positive source, baseline and follow-up testing
should include:




Baseline testing for anti-HCV and liver enzymes (ALT activity).
Follow-up testing at 4 to 6 months for anti-HCV and ALT activity.
If earlier diagnosis of HCV infection is desired, testing for HCR RNA may be
performed at 4-6 weeks.
Confirmation of all anti-HCV positive results should be done with supplemental
anti-HCV testing such as the RIBA test.
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Have persons caught the hepatitis C virus from having medical or dental
procedures in the U.S.?
Medical and dental procedures done in most settings in the U.S. do not pose a risk for
the spread of HCV given that the standard infection control practices are adhered to.
There have, however, been some reports that HCV has been spread between patients
in hemodialysis units where supplies or equipment may have been shared between
patients. Several studies of the transmission of HCV in countries outside the U.S. have
found evidence of HCV transmission from medical or dental procedures in which
needles or other medical equipment were reused without adequate disinfection or
sterilization.
What should people do if they have hepatitis C or think they are at risk?
Don’t panic! Many people continue to carry the virus for 20 – 40 years before serious
symptoms appear, though most will never develop serious problems (though drinking
alcohol can greatly increase the likelihood of developing serious problems).
Persons with hepatitis C can protect their livers from further harm by:
1. Getting a medical evaluation for chronic liver disease and possible treatment.
(Persons are encouraged to discuss their disease with their primary healthcare
provider. Gastroenterologists and hepatologists are health care providers who
specialize in the treatment of liver diseases and other digestive organ diseases.)
2. Not drinking alcohol.
3. Consulting their physician or pharmacist before starting any new medicines,
including over-the-counter and herbal medicines.
4. Getting vaccinated against hepatitis A and hepatitis B.
Persons with hepatitis C can reduce the risk of infecting others by:
1. Not donating blood, body organs, other tissue, or semen.
2. Not sharing toothbrushes, dental appliances, razors, manicure scissors, other
personal care articles that might have blood on them.
3. Covering cuts and sores on the skin to keep from spreading infectious blood or
secretions.
Persons who are injection drug users:
1. Should stop using and injecting drugs. If at all possible, they should enter and
complete substance abuse treatment, including relapse-prevention programs
2. If they continue to use drugs, they can lessen their risk of getting hepatitis C or
spreading it to others by:
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







Using a new sterile syringe each time they prepare and inject drugs.
Not reusing or sharing any equipment used to prepare or inject drugs such as
syringes, needles, cottons, or water. Otherwise, used equipment should be
sterilized or disinfected first (see below).
Using sterile water to prepare drugs. Clean tap water can be sterilized by boiling
it for one minute.
Using a new or disinfected container (“cooker”) and a new filter (“cotton”) to
prepare drugs.
Cleaning the injection site with a new alcohol swab before Injection.
Sterilizing/disinfecting equipment
Sterilize needles, cookers, and other injection equipment between EACH use.
Boiling for 20 minutes will sterilize equipment and kill HIV and many other
disease-producing pathogens.
Clean all injection equipment with bleach. Although this process is less effective
than using new equipment each time, or sterilizing between uses, it is much
easier, less time-consuming, and may offer a more realistic approach, especially
when other options are not available.
Instructions for bleaching (note however that it is not known whether this will kill
hepatitis C virus; therefore using new equipment each time, and NOT sharing any
injecting equipment is always safest):
1. Fill syringe with water, shake well, and then empty. Do not empty syringe back into
the remaining water. Do these three times to flush out all residues.
2. Fill syringe with full strength chlorine bleach (normal liquid household bleach), shake
well, and then empty. Do not empty syringe into the remaining bleach supply. Do
these three times to allow bleach to cover all surfaces.
3. Fill syringe with water, shake well, and then empty. Do not use water previously
used to flush the first time; use fresh. Do not empty syringe back into the remaining
water. Do these three times to flush out all remaining bleach.
What other information should persons with hepatitis C know?
General Information
1. HCV is not spread by sneezing, kissing, hugging, coughing, food or water, sharing
eating utensils or drinking glasses, or casual contact such as shaking hands.
2. Having HCV is not a reason to be excluded from work, school, play, childcare, or
other group setting. Persons with hepatitis C can handle food as part of their work
without infecting others. Infected health care workers also can continue to work in a
health care setting. As recommended for all health care workers, those who are
HCV-positive should follow strict aseptic technique and standard precautions,
including appropriate use of hand washing, protective barriers, and care in the use
and disposal of needles and other sharp instruments.
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3. As noted by Hepatitis Foundation International (HFI), “fatigue is a common problem.
Finding a happy balance between relaxation and activities is helpful. Frequently,
short naps between activities or outings prevent overwhelming fatigue at the end of
the day. Don’t plan too many activities for one day, instead space them out over a
week. Separate the activities requiring a lot of energy with less strenuous ones.
Allow yourself time to regroup while still keeping busy. If your workday is exhausting,
try arranging flexible hours or a work-from-home option. Telecommuting, the
computer-modem connection, creates new opportunities everyday.”
4. HFI further goes on to say, “In addition to the physical symptoms, hepatitis can
cause emotional stress. It is important to have people you can count on for support
and encouragement. Talk to friends and loved ones about difficulties you experience
and what you need from them. People are not mind readers, and open discussions
can help minimize problems and misunderstandings. Support from loved ones and
friends makes coping easier. Try not to set unreasonable standards for yourself or
anyone else.”
Who should be tested for HCV infection?
The Centers for Disease Control and Prevention have developed the following set of
recommendations for screening and testing for HCV: Persons who should be tested
routinely forHCV infection based on their increased risk for infection:






Recipients of clotting factor concentrates before 1987
Injecting drug users (including past users)
Persons with persistently abnormal liver enzymes (alanine aminotransferase
levels
Chronic hemodialysis patients recipients of blood and solid-organ transplants
before July 1992
Persons notified that they received blood from a donor who later tested positive
for HCV
Persons who should be tested routinely for HCV based on a recognized
exposure:



Children born to HCV-infected women
Health care, emergency medical, and public safety workers after needle stick,
sharp, or mucosal exposures to HCV-positive blood
Persons for whom routine testing for hepatitis C infection is of uncertain need:




Persons who have received transplanted tissue (e.g. corneal, musculoskeletal,
skin, ova, sperm)
Intranasal cocaine and other non-injecting illegal drug users
Persons with a history of tattooing or body piercing
Persons with a history of multiple sex partners or sexually transmitted diseases
Revised July, 2011
53

Long-term steady sex partners of hepatitis C-positive persons
Persons for whom routine testing is not necessary:



Health-care, emergency medical, and public safety workers unless a needle stick
or sharps exposure has occurred from a positive source
Pregnant women unless they have risk factors for HCV infection
Household (nonsexual) contacts of HCV-positive persons unless an exposure to
a contaminated source has occurred such as razors or sharps from an HCVpositive household member
Revised July, 2011
54