Chapter 3 – Health Care Operations

Policy

• California Correctional Health Care Services (CCHCS) health care providers in California Department of Corrections and Rehabilitation (CDCR) institutions shall report public health diseases to the Local Health Officer (LHO) and to the CCHCS Public Health Branch (PHB).

• CCHCS health care providers at each institution shall comply with state regulations and requirements related to reporting diseases including timeliness and the mechanisms required for reports.  Reportable diseases shall be reported to the LHO for the county in which the patient is housed at the time of the diagnosis of the reportable disease.

• Outbreaks and diseases of public health significance shall be reported to the CCHCS PHB.  The following must be reported to the PHB:

  • Outbreaks of any reportable communicable disease;

  • Outbreaks or individual cases of diseases of public health significance (e.g., chickenpox or acute hepatitis cases) that require investigation because they pose a risk of infection to patients or staff or because they may be sentinel events heralding outbreaks;

  • Tuberculosis suspect and confirmed cases; and

  • Additional diseases or conditions by request of the PHB.

• Failure to report diseases as mandated by state regulations is a misdemeanor and is a citable offense under the Department of Consumer Affairs, Medical Board of California, Citation and Fine Program.

Purpose

• To ensure that CDCR patients receive appropriate access to services for diseases of public health significance.

Responsibility

• The Chief Executive Officer, or designee, is responsible for the implementation, monitoring, and the evaluation of this policy.

Procedure

• Reporting Diseases of Public Health Significance to the LHO

  • All Title 17 reportable diseases, except TB, HIV, and AIDS must be reported to the LHO using the CDPH, Confidential Morbidity Report, 110a.

  • TB suspect and confirmed cases shall be reported to the LHO using the Correctional Facility Tuberculosis Patient Plan (CFTP). This form includes all of the information required to be reported to the LHO per the Health and Safety Code. The CFTP shall be updated and re-submitted whenever a TB suspect is confirmed with TB disease; is notified of new, crucial laboratory results; initiates, changes, discontinues, or completes TB treatment; is hospitalized in the community; or is transferred between institutions, paroled, or discharged. HIV infection and AIDS cases shall be reported by traceable mail or person-to-person transfer within seven calendar days by completion of the HIV/AIDS Case Report form available from the LHO.

• Reporting Diseases of Public Health Significance to the CCHCS PHB

  • Outbreaks of any reportable disease shall be submitted to the PHB using the web-based Preliminary Outbreak Reporting System (PORS). Institutions new to PORS can submit an IT Solution Center ticket to gain workstation access to PORS. 

  • Individual cases or outbreaks of other diseases of public health significance that require investigation because they pose a risk of infection to patients or staff or because they may be sentinel events heralding outbreaks shall be reported to the PHB using PORS.

  • TB suspect and confirmed cases shall be reported by CFTP to the PHB whenever a TB suspect is identified; is confirmed with TB disease; is notified of new, crucial laboratory results; initiates, changes, discontinues, or completes TB treatment; is hospitalized in the community; or is transferred between institutions, paroled, or discharged.

  • Institutions shall report additional diseases or conditions by request of the PHB, and by the mechanism specified by the PHB.

Policy

• Patients who are medically restricted from the Coccidioidomycosis (Cocci) 2 area, who are not medical high risk and do not have a negative cocci skin test are permitted to waive the medical restriction from residence in the Cocci 2 area.  Patients meeting these criteria may waive their medical restriction at any time and may do so regardless of their current housing location.  Prior to waiving their medical restriction, patients must be fully informed of the morbidity and mortality risks of waiving the medical restriction.

  • Patients may rescind the waiver of the medical restriction at any time.  Within 60 business days of rescinding of the waiver, patients with waivers who reside in the Cocci 2 area shall be transferred out of the Cocci 2 area.

  • Invalid Waivers of Medical Restriction from the Cocci 2 area

    • Waivers for medical restrictions from the Cocci 2 area shall become invalid when a patient:

      • Has a negative cocci skin test.

      • Becomes medical high risk (e.g., when a patient turns 65 years of age).

      • Has changes in their medical condition resulting in a change to their Cocci status.

• Patients with an invalid waiver shall be transferred out of the Cocci 2 area within 60 business days.

• Patients with a history of cocci are not restricted from residing in the Cocci 2 area and thus do not need to sign waivers to reside in the Cocci 2 area.

Purpose

• To formalize a process that permits certain patients with medical restrictions for the Cocci 2 area to waive the medical restrictions and permit these patients to reside in Cocci 2 institutions despite the medical restriction in the medical classification system.  This policy stipulates that those who test negative and those with high risk medical conditions may not waive their medical restriction and cannot reside in an institution in the Cocci 2 area.

Responsibility

• The Chief Executive Officer, or designee, is responsible for developing a local operating procedure to ensure the policy and procedure are followed.

Procedure Overview

• The procedure outlines a process for patients who are medically restricted from the Cocci 2 area, who are not medical high risk, and do not have a negative cocci skin test to waive the medical restriction from residence in a Cocci 2 area. Patients may rescind the waiver of the medical restriction at any time.

Procedure

• Waiving of the Medical Restriction from the Cocci 2 Area

  • Patients requesting a waiver of the medical restriction shall be scheduled for an evaluation by a health care provider.

  • At the encounter, patient education and information regarding the health care risks of waiving the medical restriction, including the risk of morbidity and mortality from cocci exposure, shall be discussed.

  • If the patient still wishes to waive the medical restriction at the conclusion of the encounter, the provider shall complete the following:

    • Progress Notes, documenting the chrono discussion,

    • CDC 7225, Refusal of Examination and/or Treatment.

    • CDCR 128-C ASP and PVSP, Coccidioidomycosis Waiver.

  • One copy of the waiver shall be forwarded to the Classification and Parole Representative for inclusion in the patient’s central file; a second copy shall be scanned into the health record; and a third copy shall be provided to the patient.

• Rescinding of the Waiver Of Medical Restriction from the Cocci 2 Area

  • The staff member shall make contact with the assigned counselor or the counselor’s supervisor within three business days informing them of the patient’s request.

  • The staff member shall document the patient’s request, date and time of the request, and the name of the counselor informed of the request on a CDC 128-B, General Chrono.

  • Patients must be transferred to an appropriate intermediate institution within 60 business days from the date the patient rescinds the waiver; therefore, case work, Unit or Institution Classification Committee appearances, and transfers must be accomplished within that timeframe.

Policy

• The California Correctional Health Care Services (CCHCS) program of detection, reporting, isolation, treatment, contact investigations, screening, and surveillance of tuberculosis (TB) cases and recent latent TB infections (LTBIs) shall comply with applicable state law, regulations, and national and state guidelines. Using evidence-based guidelines, CCHCS shall control TB transmission among patients by:

• Rapidly identifying, isolating, treating, and providing case management of patients with active TB disease.

• Identifying recently exposed patients (contact investigations) and detecting and treating recent LTBIs.

• Providing case management of recently infected but untreated patients for two years to detect active TB disease.

• Providing case management of patients with LTBI who are receiving treatment to prevent development of active TB disease.

• Ensuring CCHCS providers reference and consider the current CCHCS TB Care Guide and Centers for Disease Control and Prevention guidelines.

Purpose

• To minimize morbidity and mortality from TB among patients under the care of CCHCS.

Responsibility

• The Chief Executive Officer shall designate a provider who is knowledgeable in infectious diseases to be responsible for oversight of the institution’s TB control program. This provider, usually the Chief Medical Executive (CME), shall manage the medical services program for all patients who require TB evaluation and treatment.  Health care staff under the supervision of the CME and Chief Nursing Executive shall be trained to conduct contact investigations and provide case management of patients with active TB disease and LTBI.

Procedure Overview

• California Correctional Health Care Services (CCHCS) and the California Department of Corrections and Rehabilitation (CDCR) shall maintain guidelines for the assessment, screening, treatment, and containment of tuberculosis (TB) in the correctional setting.  These guidelines shall be consistent with community standards and the recommendations of the American Thoracic Society (ATS) and the Centers for Disease Control and Prevention (CDC).

• As required by Penal Code Sections 7570 through 7576, this procedure ensures that all patients receive the required annual TB surveillance, testing, education, and medically necessary treatment consistent with the CCHCS Tuberculosis Care Guide, community standards, and the recommendations of the ATS and CDC.

Responsibility

• Statewide

  • CDCR and CCHCS departmental leadership, at all levels of the organization, within the scope of their authority, shall ensure administrative, custodial, and clinical systems are in place and appropriate tools, training, technical assistance, and levels of resources are available to ensure the TB Surveillance Program is successfully maintained.

• Regional

  • Regional Health Care Executives are responsible for ensuring this procedure is operationalized at the subset of institutions within an assigned region.

• Institutional

  • The Chief Executive Officer (CEO) has overall responsibility for the ongoing oversight of the TB Surveillance Program at the institution and patient panel level.  The CEO delegates decision-making authority to the Chief Medical Executive (CME) and the Chief Nurse Executive (CNE) for daily operations of the TB Surveillance Program and ensures adequate resources are deployed to support the system including, but not limited to, the following:

    • Access to and utilization of equipment, supplies, health information systems, Patient Registries and other patient care tools, and evidence-based guidelines.

    • New Care Team members including other health care staff with a role in TB surveillance are adequately prepared to assume team roles and responsibilities in the TB Surveillance Program.

    • Competence of existing Care Team members including other health care staff with a role in TB surveillance.

    • Procedures, roles, and responsibilities are updated as new tools and technology become available.

    • Institutional leadership, in consultation with the CCHCS Public Health Branch (PHB), develops a Local Operating Procedure (LOP) to address the application of the TB Surveillance Program within their institution.

    • Ongoing review by the Public Health Nurse (PHN) of all patients housed at the institution to confirm that each patient is participating in the TB Surveillance Program.

  • The CME is responsible for the overall medical management of patients and ensures resources are available to meet the needs of the population.

  • The CNE is responsible for the oversight of daily operations, and management of the TB Surveillance Program, processes, and resources including personnel.  The CNE shall ensure that the institution’s PHN participates in all aspects of the TB Surveillance Program as described in the procedure below. 

  • The institutional PHN, in conjunction with the responsible local Health Officer, or designee, shall act as the liaison between the institution and the CCHCS PHB for coordination of operational strategies, questions, and concerns.

  • The CNE and CME, or their designees, shall meet to review the Care Teams’ performance including the overall quality of TB Surveillance Program services provided and shall utilize dashboards, patient registries, patient summaries, and other patient care and decision support tools to address or elevate issues as necessary.

Procedure

• Reception Centers

  • Upon arrival to a CDCR Reception Center (RC), patients shall be screened and tested for TB unless there is documentation of a negative Interferon-Gamma Release Assay (IGRA) test or negative Tuberculin Skin Test (TST) in the prior 30 calendar days, or documentation of latent tuberculosis.

    • All patients shall be screened for TB symptoms upon arrival at the RC before being housed as part of the RC initial health screening process using the Initial Health Screening PowerForm and the TB Screening/Evaluation Report PowerForm in the Electronic Health Record System (EHRS).  The CDCR 7277, Initial Health Screening (All Institutions), and CDCR 7331, Tuberculin Screening/Evaluation Report, paper forms shall be used during EHRS downtime periods to document symptom screening and health record review.

      • Licensed health care staff (PHN, Registered Nurse [RN], Licensed Vocational Nurse [LVN], Psychiatric Technician [PT], or the Medical Assistant [MA]) shall:

        • Question the patient about signs and symptoms of disease and previous TB history.

        • Listen actively.

        • Prompt the patient for additional information, if necessary.

        • Allow time for questions.

        • Refer to an RN or health care clinician if the patient has any signs or symptoms consistent with active TB disease.

    • Symptomatic Patients

      • Patients with signs or symptoms of TB, regardless of any past IGRA test or TST result, shall wear a procedure mask and shall be transported to the Triage and Treatment Area (TTA) for further evaluation of active TB disease. The workup shall include a medical evaluation and, if clinically indicated, a chest ray (CXR) and sputum smears and cultures for Acid-Fast Bacilli (AFB). The results of the TB symptom screening shall be recorded on the Initial Health Screening PowerForm in EHRS. Refer to the CCHCS Care Guide: Tuberculosis for details.

    • Asymptomatic Patients

      • Patients with a prior negative IGRA test, negative TST, or unknown or inadequate documentation of latent TB infection (LTBI) status shall have an IGRA test drawn at the RC, except in the following situations:

        • History of an IGRA test interpreted as positive; or

        • TST with millimeter (mm) reading interpreted as positive at any time in the past; or

        • TST < 5 mm in the prior 30 calendar days, with a high-risk condition; or

        • TST < 10 mm in prior 30 calendar days, without a high-risk condition; or

        • Negative IGRA test in the prior 30 calendar days.

      • Refer to the CCHCS Care Guide: Tuberculosis for definition of high-risk conditions.

    • Human Immunodeficiency Virus (HIV) Infected

      • Asymptomatic patients known to be HIV infected shall also receive a CXR within 72 hours of arrival unless their records contain documentation of a normal or stable CXR within the preceding 30 calendar days.

      • Any HIV infected patient with a CXR abnormality that cannot be documented as stable for 60 or more calendar days by previous records with the exception of an isolated calcified granuloma or apical pleural thickening, shall be isolated and evaluated by a clinician even if asymptomatic.

  • Workup for Positive Tests

    • A patient with a positive IGRA test or TST shall have a workup as follows:

    • A CXR shall be completed to assess for radiographic evidence of active TB disease within 72 hours for patients with the following:

      • New positive IGRA test result.

      • TST 5-9 mm result, with high-risk condition.

      • TST ≥ 10 mm, with or without high-risk condition.

    • Refer to the CCHCS Care Guide: Tuberculosis for definition of high-risk conditions.

    • After active TB disease is ruled out by a CXR and a physical assessment by a health care provider, treatment for LTBI should be considered.

  • Evaluation for CXR Findings Consistent with Active TB Disease

    • If the patient has an abnormal CXR consistent with TB, or if the CXR is normal but the patient has symptoms consistent with TB, the patient should wear a procedure mask and be sent to the TTA to be evaluated for active TB disease.

    • Treatment for LTBI should be delayed until active TB disease has been ruled out.

    • Sputum specimens for AFB smear and culture shall be obtained even when the radiographic abnormalities appear stable (excluding isolated calcified granulomas and apical pleural thickening).

    • Treatment LTBI shall not be initiated until three culture results are documented as negative for active TB disease.

  • Documented Prior Positive IGRA Test or Prior Positive TST

    • Patients with written documentation of a positive IGRA or TST with a written record of an mm read and a positive interpretation of ≥5 mm with risk factors or ≥10 mm without risk factors, and no documentation of a complete course of treatment for LTBI, and no prior CXR or the prior CXR was taken more than six months before entry or re-entry into CDCR, shall within 72 hours of arrival at an RC, have a CXR and further workup as clinically indicated to rule out active TB disease.

    • If there is no documentation of treatment or if previous treatment was incomplete or inadequate, patients shall be encouraged to accept treatment for LTBI.

  • Documented Prior Active TB Disease

    • Patients with a history of prior active TB disease shall be evaluated by a health care provider and shall have a baseline CXR.

• Interfacility Transfers

  • The following types of patients shall be screened for TB symptoms pursuant to Section (c)(1)(A)1.a above to evaluate for TB disease as part of the transfer screening process:

    • Patients who are transferred between CDCR institutions, returned from out-to-court, returned from a higher level of care, or who are laid over (enroute or short stay) patients with no known recent exposure to a patient with active TB disease.

    • All Category “S” patients (patients who transfer into a CDCR institution from county or city jails for reasons such as riots or a natural disaster).

    • Patients transferring to or from Department of State Hospitals facilities.

• Annual and other Periodic Screening

  • Patients housed in a CDCR facility shall receive an annual TB evaluation based on the TB status of the patient.  In addition, a patient may receive periodic screenings based on the status of LTBI treatment.

  • The following processes shall be used for conducting annual TB evaluations. Each institution shall develop an LOP to operationalize the tasks below if necessitated by institutional or operational needs (e.g., physical plant, staffing or other factors such as oversight of Fire Camps or Modified Community Correctional Facilities).

    • The PHN or RN shall review the Quality Management (QM) TB registry at least monthly and determine which patients are due or overdue for their annual TB evaluation.

    • The Nursing Supervisor shall coordinate with the Care Team(s) to ensure that all patients who are due or overdue for an annual or periodic TB evaluation are scheduled for the appropriate screening (refer to Appendix 1).

      • An LVN, PT, or MA may screen patients who have no history of a LTBI or who have completed a full course of treatment for LTBI.  The evaluation consists of a thorough TB symptom screen for active TB disease pursuant to Section (c)(1)(A)1.a above.

      • An RN or PHN shall evaluate patients with LTBI who have not been treated, patients currently on treatment for LTBI, patients currently on treatment for active TB disease, and patients who have completed treatment for active TB disease.

        • TB symptom screening and education tailored to the patient’s TB status shall be provided.

          • All patients shall be educated about LTBI and active TB disease.

          • Patients with untreated LTBI shall be encouraged to initiate and complete treatment for LTBI and encouraged to seek medical attention if they develop symptoms of active TB disease.

          • Patients on treatment for LTBI shall be:

            • Encouraged to complete the full course of treatment,

            • Advised about possible side effects of treatment, and

            • Encouraged to seek medical attention if they develop symptoms of active TB disease or possible side effects.

          • Patients on treatment for active TB disease shall be:

            • Encouraged to complete the course of treatment,

            • Advised about possible side effects of treatment, and

            • Encouraged to seek medical attention if they develop side effects.

          • Education provided shall be documented in the health record.

        • If during the patient education session the patient agrees to begin treatment for LTBI, the RN shall notify the PHN of the patient’s decision on the same day the decision is made.  A routine referral to the Primary Care Provider (PCP) for evaluation and treatment of LTBI shall be made by the RN.  The PHN shall monitor the patient’s care to ensure the referral and evaluation by the Care Team PCP occurs within fourteen calendar days.

      • Patients who exhibit signs or symptoms of active TB disease during the screening and evaluation process shall wear a procedure mask and be referred to the TTA to be evaluated by a provider for active TB disease.

      • The results of the TB screening shall be documented on the Initial Health Screening PowerForm and in the health record.

• Monitoring and Sustainability

  • Institution leadership shall designate a standing committee that reports to the local QM Committee for oversight of the TB Surveillance Program activities.

  • The CEO and institution leadership team shall maintain an ongoing monitoring program to periodically assess the quality of the TB Surveillance Program and adherence to this procedure including, but not limited to:

    • Ensuring that each Care Team discusses surveillance program activities in the Population Management Working Sessions at least monthly.

    • Verifying accuracy and efficacy of patient case management and appointment strategies.

    • Monitoring compliance rates with required screening intervals based on patient TB risk levels.

    • Ensuring documentation of TB Surveillance activities and necessary follow-up.

    • Monitoring quality and documentation of patient education.

    • Ensuring inclusion of other team members or disciplines to manage patient care and compliance.

    • Reviewing information flow relative to required screening, referrals, and follow-up visits.

    • Monitoring adverse events linked to TB Surveillance Program processes described in this procedure.

    • Identifying and addressing barriers.

• Training and Decision Support

  • The CEO and institution leadership team shall maintain an orientation and training program to ensure that all staff serving as members of a Care Team or supporting Care Team functions, including other health care staff with a role in TB surveillance, fully understand their roles and responsibilities prior to assuming their duties.  Requirements of the training program shall include, but are not limited to:

  • Adhering to expectations in this procedure.

  • Monitoring national health care industry advances pertinent to the TB Surveillance Program.

  • Following new information systems or technology that may increase the efficiency or effectiveness of the TB Surveillance Program.

  • Monitoring updates in clinical practice, including new or revised CCHCS guidelines, standing orders, nursing protocols, industry best practices, and findings in clinical literature.

  • Identifying and addressing additional training needs.

  • Specifying clinical training including, but is not limited to:

    • Training RNs, LVNs, PTs, and MAs to be competent in:

      • Performing a TB symptom screen of patients and documenting in the health record.

      • Locating IGRA blood test results in EHRS.  Patients with a positive IGRA blood test shall have LTBI listed on the Problem List in EHRS.  Upon completion of LTBI treatment, “Resolved” shall be documented next to LTBI on the Problem List in EHRS.

      • Administering and measuring TSTs for patients in accordance with the CCHCS Care Guide: Tuberculosis and documenting the results in the health record.

      • Administering medication to patients on treatment for active TB disease or LTBI.

    • Training RNs and PHNs to also be competent in:

      • Ensuring that patients are screened yearly in accordance with the CCHCS Care Guide: Tuberculosis.

      • Reviewing the health record and accurately documenting previous TB testing and TB diagnoses.

      • Educating patients regarding the importance of:

        • Treatment for LTBI.

        • Treatment for active TB disease.

• Patient Refusals of TB Screening and Testing
  Refer to the CCHCS Care Guide: Tuberculosis for managing refusals.

Policy

• Health care staff shall communicate to custody staff the appropriate form of precautions to be used when dealing with a single patient or a small cluster of patients who have contracted certain communicable diseases.  Staff shall use either the Correctional Standard Precautions or the transmission-based precautions.

• When a patient has an infectious disease that is easily transmitted person-to-person but transmission-based precautions are not required e.g., Staphylococcus aureus infections, health care staff shall communicate the need for Correctional Standard Precautions to custody staff.

• When a patient needs transmission-based precautions (in addition to Correctional Standard Precautions), health care staff shall communicate the need for transmission-based precautions to custody staff.

Purpose

• To ensure both custody and health care staff are appropriately protected from communicable diseases by communicating the type of precautions required when patients have certain communicable diseases.

Responsibility

• The Chief Executive Officer and Warden at each institution are responsible for enforcement and application of this policy and procedure.

Procedure

• Health care staff at California Department of Corrections and Rehabilitation (CDCR) institutions shall regularly consult with the California Correctional Health Care Services (CCHCS) Public Health Branch (PHB) about the prevention and control of infectious diseases in CDCR institutions.  PHB shall follow national guidelines when consulted about the use of precautions to prevent the transmission of infectious diseases.

• PHB recommends categories of precaution for specific diseases and conditions based on Federal Bureau of Prisons (BOP) guidelines.  The categories are standard, contact, droplet, and airborne.

• The California Department of Public Health recommends that when BOP does not have a precaution guideline for a specific disease or condition, PHB follows the Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings.  These are evidence-based guidelines developed by an expert panel.

• The BOP advises that all correctional institutions shall follow Correctional Standard Precautions when interacting with all incarcerated persons whether or not they have been diagnosed with a specific condition, and when interacting with patients with known bloodborne pathogen infections (e.g., hepatitis B or human immunodeficiency virus infections).

Procedure

• Medical Classification Chrono

  • Health care staff shall use the Medical Classification Chrono (MCC) to communicate the need for transmission-based precautions to custody staff.

    • To communicate transmission-based precautions, the health care clinician (i.e., Physician, Psychiatrist, Dentist, or Advanced Practice Provider) caring for the patient shall revise the patient’s MCC in the following manner:

      • Check the “Temp. Medical Isolation” box.

        • When the health care clinician checks the “Temp. Medical Isolation” box, the form will default select the “Temp. Medical Hold”, thereby placing the patient on a temporary medical hold.

        • If the health care clinician decides a patient who needs transmission-based precautions can move to another institution, they shall:

          • Deselect the “Temp. Medical Hold” box (which is the default).

          • Select the “Req. Medical Transport” box.

          • Indicate the specific type of transmission-based precautions in the non-confidential comments section.

      • In the non-confidential comments section, the health care clinician shall indicate the category of transmission-based precautions required for the patient.

        • Few patients are expected to require all three transmission-based precautions at any one time.

          • Refer to Appendix 1, Precautions for Frequently Encountered Infectious Diseases in CDCR Adult Institutions, for a list of precautions necessary for the common diseases which occur among patients (based on national evidence-based guidelines).

          • The information on the table is provided for informational purposes only and is not meant to be prescriptive.

          • The Chief Medical Executive or the health care clinician may deviate slightly from this table to require a change in the level of precautions based on clinical criteria or specific recommendations from either PHB or the local health department.

      • Indicate any change in the level of care based on the type of precaution.

        • The health care clinician shall select “OHU” or “CTC” for most patients with transmission-based precautions.

        • For patients who need special housing arrangements in general population (e.g., confined to cell, or to a special isolation area for patients with influenza), the health care clinician shall note the specific housing arrangement in the non-confidential comment section.

    • When the transmission-based precautions are no longer required, the health care clinician shall revise the MCC by deselecting “Temp. Medical Isolation” box and remove the type of precautions from the non-confidential comments section.

• Notification

  • The Chief Executive Officer and the Warden at each institution shall disseminate the following information to clinical and custody staff:

    • Use of Standard Precautions and Transmission-Based Precautions in the Correctional Setting for the General Population (Appendix 2)

    • Contact Precautions Checklist (Appendix 3)

    • Droplet Precautions Checklist (Appendix 4)

    • Airborne Precautions Checklist (Appendix 5)

  • Custody staff shall place signage regarding the patient’s specific transmission-based precautions in the following manner:

    • At the cell door, bunk, or area of the housing unit where the patient is isolated for patients who are housed in general population.

    • In the transportation vehicle for those patients who are transported.

  • Signage is not needed for Correctional Standard Precautions.

• Transportation Codes

  • All precautions link to the transportation coding system used by custody staff. Transportation codes correspond with patients’ precaution requirements in the following manner:

    • Code 90 – Patient has not yet been medically assessed in the reception centers or is on a temporary medical hold as indicated on the MCC. This code indicates that staff shall follow transmission-based precautions.

    • Code 91 – Patient is on temporary medical isolation. This code indicates that staff shall follow transmission-based precautions.

    • Code 92 – No transmission-based precautions. This code indicates that staff shall follow Correctional Standard Precautions.

  • Designated administrative staff (not clinical staff) at each institution shall maintain the transportation codes.