BILL NUMBER: SB 739	CHAPTERED
	BILL TEXT

	CHAPTER  526
	FILED WITH SECRETARY OF STATE  SEPTEMBER 28, 2006
	APPROVED BY GOVERNOR  SEPTEMBER 28, 2006
	PASSED THE SENATE  AUGUST 31, 2006
	PASSED THE ASSEMBLY  AUGUST 30, 2006
	AMENDED IN ASSEMBLY  AUGUST 8, 2006
	AMENDED IN ASSEMBLY  AUGUST 7, 2006
	AMENDED IN ASSEMBLY  JUNE 15, 2006
	AMENDED IN ASSEMBLY  AUGUST 30, 2005
	AMENDED IN ASSEMBLY  JULY 13, 2005
	AMENDED IN SENATE  JUNE 1, 2005
	AMENDED IN SENATE  APRIL 28, 2005
	AMENDED IN SENATE  APRIL 20, 2005
	AMENDED IN SENATE  APRIL 7, 2005

INTRODUCED BY   Senator Speier

                        FEBRUARY 22, 2005

   An act to add Article 3.5 (commencing with Section 1288.5) to
Chapter 2 of Division 2 of the Health and Safety Code, relating to
health facilities.



	LEGISLATIVE COUNSEL'S DIGEST


   SB 739, Speier  Hospitals: infection control.
   Existing law provides for the licensure and regulation by the
State Department of Health Services of health facilities, including
general acute care hospitals, as defined. A violation of these
provisions by a health facility is a crime. Existing law requires
health facilities to implement various measures to protect against
the spread of infection in health facilities.
   This bill would establish the Hospital Infectious Disease Control
Program, which would require the department and general acute care
hospitals to implement various measures relating to disease
surveillance and the prevention of health care associated infection
(HAI). In that regard, the bill would require the department, by July
1, 2007, to appoint a Healthcare Associated Infection (HAI) Advisory
Committee, composed of specified members, that would be required to
make recommendations related to methods of reporting cases of
hospital acquired infections occurring in general acute care
hospitals, as provided.
   The bill would require each general acute care hospital, in
collaboration with infection prevention and control professionals,
and with the participation of senior health care facility leadership,
as a component of its strategic plan, at least once every 3 years,
to prepare a written report that examines the hospital's existing
resources and evaluates the quality and effectiveness of the hospital'
s infection surveillance and prevention program, including specified
information. The bill would require each general acute care hospital
that uses central venous catheters (CVCs) to implement policies and
procedures to prevent occurrences of HAI, as recommended by specified
guidelines and other evidence.
   The bill would require the department, by July 1, 2007, to require
that each general acute care hospital, in accordance with specified
guidelines, implement specified measures designed to prevent the
spread of influenza in those hospitals, and would require the
department, by January 1, 2008, to take specified actions to protect
against HAI in general acute care hospitals statewide, as provided.
   The bill would require each general acute care hospital, on and
after January 1, 2008, to implement and annually report to the
department on its implementation of infection surveillance and
infection prevention process measures that have been recommended by
the Centers for Disease Control and Prevention (CDC) Healthcare
Infection Control Practices Advisory Committee. It would require the
department to make this information public within a specified period.
The bill would require the department, by January 1, 2009, to
require each general acute care hospital to develop, implement, and
periodically evaluate policies and procedures to prevent secondary
surgical site infections, and to implement the current CDC guidelines
and other prescribed process measures designed to prevent ventilator
associated pneumonia, as specified. It would require the department,
during surveys, to evaluate the facility's compliance with existing
policies and procedures to prevent HAI, as specified.
   By increasing the duties of local health officials with respect to
service on the advisory committee, and imposing various new duties
on acute care hospitals with respect to disease surveillance and
prevention, a violation of which would be a crime, the bill would
impose a state-mandated local program.
  The California Constitution requires the state to reimburse local
agencies and school districts for certain costs mandated by the
state. Statutory provisions establish procedures for making that
reimbursement.
   This bill would provide that with regard to certain mandates no
reimbursement is required by this act for a specified reason.
   With regard to any other mandates, this bill would provide that,
if the Commission on State Mandates determines that the bill contains
costs so mandated by the state, reimbursement for those costs shall
be made pursuant to the statutory provisions noted above.


THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:


  SECTION 1.  (a) The Legislature finds and declares all of the
following:
   (1) Health care facilities across the nation have seen a steady
increase in the risk of healthcare associated infection (HAI) during
recent decades.
   (2) According to published estimates, approximately 5 to 10
percent of hospitalized patients develop one or more HAI every year.

   (3) Infections associated with catheters, blood stream infections
associated with central venous lines, pneumonia associated with the
use of ventilators, and surgical site infections account for more
than 80 percent of all HAI.
   (4) Approximately 25 percent of HAI cases occur among patients in
intensive care units, and two-thirds of those cases are linked to
antimicrobial resistance.
   (5) Conservative estimates indicate that approximately 240,000
patients admitted to California hospitals each year develop HAI,
which results in an estimated cost of $3.1 billion to the state.
   (6) A significant percentage of HAI cases can be eliminated with
intensive programs for surveillance and prevention of HAI.
   (b) It is the intent of the Legislature, in enacting this measure,
to improve existing disease surveillance and infection prevention
measures in all California general acute care hospitals, thereby
preventing prolonged and unnecessary hospitalizations and decreasing
mortality rates resulting from HAI.
  SEC. 2.  Article 3.5 (commencing with Section 1288.5) is added to
Chapter 2 of Division 2 of the Health and Safety Code, to read:

      Article 3.5.  Hospital Infectious Disease Control Program

   1288.5.  By July 1, 2007, the department shall appoint a
Healthcare Associated Infection (HAI) Advisory Committee that shall
make recommendations related to methods of reporting cases of
hospital acquired infections occurring in general acute care
hospitals, and shall make recommendations on the use of national
guidelines and the public reporting of process measures for
preventing the spread of HAI that are reported to the department
pursuant to subdivision (b) of Section 1288.8. The advisory committee
shall include persons with expertise in the surveillance,
prevention, and control of hospital-acquired infections, including
department staff, local health department officials, health care
infection control professionals, hospital administration
professionals, health care providers, health care consumers,
physicians with expertise in infectious disease and hospital
epidemiology, and integrated health care systems experts or
representatives.
   1288.6.  (a) (1) Each general acute care hospital, in
collaboration with infection prevention and control professionals,
and with the participation of senior health care facility leadership
shall, as a component of its strategic plan, at least once every
three years, prepare a written report that examines the hospital's
existing resources and evaluates the quality and effectiveness of the
hospital's infection surveillance and prevention program.
   (2) The report shall evaluate and include information on all of
the following:
   (A) The risk and cost of the number of invasive patient procedures
performed at the hospital.
   (B) The number of intensive care beds.
   (C) The number of emergency department visits to the hospital.
   (D) The number of outpatient visits by departments.
   (E) The number of licensed beds.
   (F) Employee health and occupational health measures implemented
at the hospital.
   (G) Changing demographics of the community being served by the
hospital.
   (H) An estimate of the need and recommendations for additional
resources for infection prevention and control programs necessary to
address the findings of the plan.
   (3) The report shall be updated annually, and shall be revised at
regular intervals, if necessary, to accommodate technological
advances and new information and findings contained in the triennial
strategic plan with respect to improving disease surveillance and the
prevention of HAI.
   (b) Each general acute care hospital that uses central venous
catheters (CVCs) shall implement policies and procedures to prevent
occurrences of health care associated infection, as recommended by
the Centers for Disease Control and Prevention intravascular
bloodstream infection guidelines or other evidence-based national
guidelines, as recommended by the advisory committee. A general acute
care hospital that uses CVCs shall internally report CVC associated
blood stream infection rates in intensive care units, utilizing
device days to calculate the rate for each type of intensive care
unit, to the appropriate medical staff committee of the hospital on a
regular basis.
   1288.7.  By July 1, 2007, the department shall require that each
general acute care hospital, in accordance with the Centers for
Disease Control guidelines, take all of the following actions:
   (a)  Annually offer onsite influenza vaccinations, if available,
to all hospital employees at no cost to the employee. Each general
acute care hospital shall require its employees to be vaccinated, or
if the employee elects not to be vaccinated, to declare in writing
that he or she has declined the vaccination.
   (b) Institute respiratory hygiene and cough etiquette protocols,
develop and implement procedures for the isolation of patients with
influenza, and adopt a seasonal influenza plan.
   (c) Revise an existing or develop a new disaster plan that
includes a pandemic influenza component. The plan shall also document
any actual or recommended collaboration with local, regional, and
state public health agencies or officials in the event of an
influenza pandemic.
   1288.8.  (a) By January 1, 2008, the department shall take all of
the following actions to protect against health care associated
infection (HAI) in general acute care hospitals statewide:
   (1) Implement an HAI surveillance and prevention program designed
to assess the department's resource needs, educate health facility
evaluator nurses in HAI, and educate department staff on methods of
implementing recommendations for disease prevention.
   (2) Investigate the development of electronic reporting databases
and report its findings to the HAI advisory committee established
pursuant to Section 1288.5.
   (3) Revise existing and adopt new administrative regulations, as
necessary, to incorporate current Centers for Disease Control and
Prevention guidelines and standards for HAI prevention.
   (4) Require that general acute care hospitals develop a process
for evaluating the judicious use of antibiotics, the results of which
shall be monitored jointly by appropriate representatives and
committees involved in quality improvement activities.
   (b) On and after January 1, 2008, each general acute care hospital
shall implement and annually report to the department on its
implementation of infection surveillance and infection prevention
process measures that have been recommended by the Centers for
Disease Control and Prevention (CDC) Healthcare Infection Control
Practices Advisory Committee, as suitable for a mandatory public
reporting program. Initially, these process measures shall include
the CDC guidelines for central line insertion practices, surgical
antimicrobial prophylaxis, and influenza vaccination of patients and
healthcare personnel. In consultation with the advisory committee
established pursuant to Section 1288.5, the department shall make
this information public no later than six months after receiving the
data.
   (c) The Healthcare Associated Infection Advisory Committee shall
make recommendations for phasing in the implementation and public
reporting of additional process measures and outcome measures by
January 1, 2008, and, in doing so, shall consider the measures
recommended by the CDC.
   (d)  Each general acute care hospital shall also submit data on
implemented process measures to the National Healthcare Safety
Network of the CDC, or to any other scientifically valid national HAI
reporting system based upon the recommendation of the Centers for
Disease Control (CDC) Healthcare Infection Control Practices Advisory
Committee.  Hospitals shall utilize the Centers for Disease Control
and Prevention definitions and methodology for surveillance of HAI.
Hospitals participating in the California Hospital Assessment and
Reporting Task Force (CHART) shall publicly report those HAI measures
as agreed to by all CHART hospitals.
   1288.9.  By January 1, 2009, the department shall do all of the
following:
   (a) Require each general acute care hospital to develop,
implement, and periodically evaluate compliance with policies and
procedures to prevent secondary surgical site infections (SSI). The
results of this evaluation shall be monitored by the infection
prevention committee and reported to the surgical committee of the
hospital.
   (b) Require each general acute care hospital to develop policies
and procedures to implement the current Centers for Disease Control
and Prevention guidelines and Institute for Healthcare Improvement
(IHI) process measures designed to prevent ventilator associated
pneumonia.
   (c) During surveys, evaluate the facility's compliance with
existing policies and procedures to prevent HAI, including any
externally or internally reported HAI process and outcome measures.
  SEC. 3.  No reimbursement is required by this act pursuant to
Section 6 of Article XIII B of the California Constitution for
certain costs that may be incurred by a local agency or school
district because, in that regard, this act creates a new crime or
infraction, eliminates a crime or infraction, or changes the penalty
for a crime or infraction, within the meaning of Section 17556 of the
Government Code, or changes the definition of a crime within the
meaning of Section 6 of Article XIII B of the California
Constitution.
   However, if the Commission on State Mandates determines that this
act contains other costs mandated by the state, reimbursement to
local agencies and school districts for those costs shall be made
pursuant to Part 7 (commencing with Section 17500) of Division 4 of
Title 2 of the Government Code.