Effective Date of Rule: Thirty-one days after filing.

     Purpose: The amendment eliminates a numbering/typographical error that has existed in the rule. Specifically, there have been two subsections (1)(d). The amendment renumbers the second subsection (1)(d) and correctly identifies it as subsection (1)(e). Amending the rule will eliminate confusion regarding which subsection of WAC 388-78A-2480 is being referenced.

     Citation of Existing Rules Affected by this Order: Amending WAC 388-78A-2480.

     Statutory Authority for Adoption: RCW 18.20.090.

      Adopted under notice filed as WSR 06-19-086 on September 19, 2006.

     Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 0, Amended 0, Repealed 0; or Recently Enacted State Statutes: New 0, Amended 0, Repealed 0.

     Number of Sections Adopted at Request of a Nongovernmental Entity: New 0, Amended 0, Repealed 0.

     Number of Sections Adopted on the Agency's Own Initiative: New 0, Amended 0, Repealed 0.

     Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 0, Amended 1, Repealed 0.

     Number of Sections Adopted Using Negotiated Rule Making: New 0, Amended 0, Repealed 0;      Pilot Rule Making: New 0, Amended 0, Repealed 0; or Other Alternative Rule Making: New 0, Amended 1, Repealed 0.

     Date Adopted: November 27, 2006.

Andy Fernando, Manager

Rules and Policies Assistance Unit

     (a) Except when a staff person provided the boarding home with documentation of a previous positive Mantoux skin test, a staff person hired before September 1, 2004 must have had:

     (i) A tuberculin skin test by the Mantoux method within six months preceding the date of employment in the boarding home; and

     (ii) A second tuberculin skin test within one to three weeks after a negative Mantoux test if the staff person was thirty-five years of age or older at the time of hiring.

     (b) A staff person hired on or after September 1, 2004 must have a baseline two-step skin test initiated within three days of being hired unless the staff person meets the requirements in (c) or (d) of this subsection. The skin tests must be:

     (i) Given no less than one and no more than three weeks apart;

     (ii) By intradermal (Mantoux) administration of purified protein derivative (PPD);

     (iii) Read between forty-eight and seventy-two hours following administration, by trained personnel; and

     (iv) Recorded in millimeters of induration.

     (c) A staff person needs to have only a one-step skin test within three days of being hired if:

     (i) There is documented history of a negative result from previous two-step testing; or

     (ii) There was a documented negative result from one-step skin testing in the previous twelve months.

     (d) A staff person does not need to be skin tested for tuberculosis if he/she has:

     (i) Documented history of a previous positive skin test consisting of ten or more millimeters of induration; or

     (ii) Documented evidence of adequate therapy for active disease; or

     (iii) Documented evidence of adequate preventive therapy for infection.

     (((d))) (e) If a skin test results in a positive reaction, the boarding home must:

     (i) Ensure that the staff person has a chest X ray within seven days;

     (ii) Report positive chest X rays to the appropriate public health authority; and

     (iii) Follow precautions ordered by a physician or public health authority.

     (2) The boarding home must:

     (a) Keep in the boarding home for the duration of the staff person's employment, and at least two years following termination of employment, records of:

     (i) Tuberculin test results;

     (ii) Reports of X-ray findings; and

     (iii) Physician or public health official orders.

     (b) Provide staff persons with a copy of the records specified in (a) of this subsection:

     (i) During the time the staff person is employed in the boarding home, limited to one copy per report; and

     (ii) When requested by the staff person.

     (3) The boarding home must ensure that caregivers caring for a resident with suspected tuberculosis comply with the WISHA standard for respiratory protection.

[Statutory Authority: RCW 18.20.090. 06-01-047, § 388-78A-2480, filed 12/15/05, effective 1/15/06. Statutory Authority: RCW 18.20.090 (2004 c 142 § 19) and chapter 18.20 RCW. 04-16-065, § 388-78A-2480, filed 7/30/04, effective 9/1/04.]

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