BILL NUMBER: SB 158 AMENDED
BILL TEXT
AMENDED IN ASSEMBLY MARCH 11, 2008
AMENDED IN ASSEMBLY JUNE 11, 2007
AMENDED IN SENATE MARCH 12, 2007
INTRODUCED BY Senator Florez
JANUARY 30, 2007
An act to amend Section 2890.2 of the Public Utilities
Code, relating to telecommunications. An act to repeal
and add Article 3.5 (commencing with Section 1288.5) of Chapter 2 of
Division 2 of the Health and Safety Code, relating to health
facilities.
LEGISLATIVE COUNSEL'S DIGEST
SB 158, as amended, Florez. Telecommunications: mobile
telephony services: handsets. Hospitals: infection
control.
Existing law provides for the licensure and regulation by the
State Department of Public Health of health facilities, including
general acute care hospitals, acute psychiatric hospitals, and
special hospitals, as defined. A violation of these provisions is a
crime.
Existing law requires health facilities to implement various
measures to protect against the spread of infection in health
facilities.
Existing law establishes the Hospital Infectious Disease Control
Program, which, among other things, requires 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 department is required, by July
1, 2007, to appoint a Health Care Associated Infection Advisory
Committee, composed of specified members, to make recommendations
related to methods of reporting cases of hospital acquired infections
occurring in general acute care hospitals, as provided.
Existing law also requires 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.
This bill would repeal the above-described provisions relating to
the Hospital Infectious Disease Control Program and require the
department to establish a health care infection surveillance,
prevention, and control program, as specified.
The bill would require the State Public Health Officer to appoint
an advisory committee that shall make recommendations on methods of
reporting designated HAI and evaluating process measures to prevent
HAI. The bill would require the department to adopt hospital staffing
regulations for hospital infection surveillance, prevention, and
control programs, among other requirements.
By changing the definition of an existing crime, this 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 no reimbursement is required by this
act for a specified reason.
Under existing law, the Federal Communications Commission licenses
and partially regulates providers of commercial mobile radio
service, including providers of cellular radiotelephone service
(cellular), broadband Personal Communications Services (PCS), and
digital Specialized Mobile Radio (SMR) services (collectively, mobile
telephony service providers). Under existing law, no state or local
government may regulate the entry of, or the rates charged by, any
commercial mobile radio service, but a state or local government is
generally not prohibited from regulating the other terms and
conditions of commercial mobile radio service. Existing law requires
a provider of mobile telephony services to provide subscribers with a
means by which a subscriber can obtain reasonably current and
available information on the subscriber's calling plan or plans and
service usage.
This bill would require that a provider of mobile telephony
services, upon request, remove or deactivate any device in a handset
that prevents the subscriber from using that handset to activate
service with a different mobile telephony services provider, upon the
customer completing the term of a service contract or, if the
handset is purchased separate and apart from a service contract, upon
completing the purchase of the handset.
Vote: majority. Appropriation: no. Fiscal committee: no
yes . State-mandated local program: no
yes .
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 associated infections (HAI), especially those
related to antibiotic-resistant organisms, are increasing in
California.
(2) There is currently no system within the State Department of
Public Health to determine the incidence or prevalence of HAI or to
determine if current infection prevention and control measures are
effective in reducing HAI.
(3) A significant percentage of HAI can be prevented with intense
programs for surveillance and the development, implementation, and
constant evaluation and monitoring of prevention strategies.
(4) There is currently no regulatory oversight of health care
association infection control programs by the department.
(5) The protection of patients in a general acute care hospital is
of paramount importance to the citizens of California.
(6) During the past two decades, HAI, especially those that are
resistant to commonly used antibiotics, have increased dramatically.
(7) Existing state law requires the department to establish and
maintain an inspection and reporting system to ensure that general
acute care hospitals are in compliance with state statutes and
regulations. Existing law also requires general acute care hospitals
receiving funding from the Centers for Medicare and Medicaid Services
to be in compliance with the federal regulations known as the
"conditions of participation."
(b) It is the intent of the Legislature to enact legislation to
ensure the occurrence of all of the following:
(1) The establishment of general acute care hospital infection
surveillance, prevention, and control programs that report designated
HAI.
(2) With assistance from the State Department of Public Health,
the development and dissemination of current standards of infection
prevention and control practices.
(3) Regulatory oversight.
(4) General acute care hospital reports of the incidence of
designated health care associated pathogens to the department.
(5) The development and implementation by the department of an
Internet-based public reporting system that summarizes the incidence
of health care associated pathogens.
(6) General acute care hospital maintenance of a sanitary
environment and patient hygiene to avoid transmission of health care
associated pathogens.
SEC. 2. Article 3.5 (commencing with Section
1288.5) of Chapter 2 of Division 2 of the Health and
Safety Code is repealed.
SEC. 3. 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. Health Care Associated Infections
1288.5. For purposes of this article, the following definitions
shall apply:
(a) "Advisory committee" means the Health Care Associated
Infections Advisory Committee.
(b) "Antibiotic-resistant organism" means any organism that, upon
being tested, is found to be resistant to an antibiotic that was
previously determined to be effective against that organism. These
organisms include, but are not limited to, methicillin-resistant
staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE),
acinetobacter spp., and certain gram negative bacteria.
(c) "Health care associated infection" or "HAI" means a health
care associated infection, defined by the federal Centers for Disease
Control and Prevention (CDC) as, any localized or systemic condition
resulting from an adverse reaction to an infectious agent or its
toxin that both occurs in a patient in a hospital and was found not
to be present or incubating in that patient at the time of admission
to the hospital, unless the infection was related to a previous
admission to the same hospital.
(d) "Hospital" means a general acute care hospital as defined
pursuant to subdivision (a) of Section 1250.
(e) "MRSA" means methicillin-resistant staphylococcus aureus.
(f) "National Healthcare Safety Network" or "NHSN" means the
secure, Internet-based system developed by the CDC to collect data
related to HAI and the process measures implemented to prevent these
infections.
(g) "Professional staff" means a registered nurse, medical
technologist, or other salaried medical professional who meets the
education and experience requirements for certification as an
infection prevention and control professional established by the
national Certification Board for Infection Control and Epidemiology
(CBIC) or similar requirements within two years of employment as an
infection surveillance, prevention, and control professional within a
hospital or the department, but does not include a physician who is
appointed or receives a stipend as the infection prevention and
control committee chairperson or hospital epidemiologist.
(h) "Program" means the health care infection surveillance,
prevention, and control program within the department.
(i) "Risk adjustment" means a statistical procedure for comparing
patient outcomes that takes into account the differences in patient
populations, including risk factors, such as patients with central
line catheters, urinary catheters, or the number of patients
undergoing a specific type of surgical procedure, as a percentage of
the number of patients who undergo that surgical procedure. For
purposes of this article, risk adjustment shall duplicate the NHSN
surgical wound infection risk index or use the number of
central-catheter or urinary-catheter days as a risk-adjustment
factor.
(j) "Serious disability" means a physical or mental impairment
that substantially limits one or more major life activities of an
individual, or loss of bodily function, if the impairment lasts more
than seven days, results in the loss of a body part, or is still
present or is being treated at the time of discharge.
(k) "VRE" means vancomycin-resistant enterococci.
1288.6. The department shall establish a health care infection
surveillance, prevention, and control program pursuant to this
article.
1288.7. In order to decrease the incidence of HAI, the department
shall do all of the following as part of the program:
(a) Adopt the federal regulations and interpretive guidelines
regarding the methods by which hospitals shall be surveyed for
compliance with infection surveillance, prevention, and control.
(b) Provide annual surveillance, prevention, and control education
and training to department staff surveyors to effectively survey
hospitals and other licensed health care facilities for compliance
with infection surveillance and prevention strategies, and
regulations. As part of this training, the department shall provide
guidance on the interpretation of infection surveillance, prevention,
and control recommendations issued by the CDC and professional
organizations, including, but not limited to, the advisory committee,
the Society for Healthcare Epidemiology of America, and the
Association for Professionals in Infection Control and Epidemiology.
(c) Develop a statewide electronic reporting database to monitor
increases in specific invasive infections caused by
antibiotic-resistant organisms, including, but not limited to,
methicillin-resistant staphylococcus aureus and the incidence of
health care associated infections, including, but not limited to,
bloodstream infections, surgical site infections, and pneumonia
occurring in patients who require mechanical ventilation.
(d) Develop training and education programs for hospital infection
prevention professionals.
(e) Provide consultation and assistance to other state agencies in
the development and implementation of infection prevention
guidelines.
(f) Provide educational materials and Internet-based training
programs and current infection prevention information on a Web site
available to the public.
(g) Assist in the investigation and followup of clusters and
outbreaks of health care associated infections.
(h) Provide sufficient laboratory capacity to support health care
facilities and local health departments with pathogen identification,
molecular epidemiology, and antimicrobial susceptibility testing for
the investigation of outbreaks and surveillance of unusual
pathogens.
(i) Employ professional staff, consisting of four nurse
consultants and one nurse consultant supervisor, to provide
information related to community and health care associated pathogens
to survey staff within the department, infection control personnel,
physicians and surgeons, other state agencies responsible for the
health and welfare of patients.
1288.8. (a) There is established the Health Care Associated
Infections Advisory Committee, to be appointed by the State Public
Health Officer. The advisory committee shall do all of the following:
(1) Recommend methods by which hospitals would be required to
report designated health care associated infections, including those
associated with antibiotic-resistant organisms, to the National
Healthcare Safety Network, the department, and the public.
(2) Recommend evidence-based process measures that would be
required to be implemented and monitored to prevent the acquisition
and transmission of health care associated pathogens.
(3) Recommend methods by which health care workers, including
nursing staff, physicians, ancillary staff, technicians, and
contractors would be required to be monitored for compliance with
hand hygiene, isolation precautions, as well as environmental and
patient hygiene practices.
(4) Review the annual reports submitted by hospitals pursuant to
Section 1288.12 and make corrective action recommendations to the
department.
(5) Review and evaluate, on an ongoing basis, federal and state
legislation and regulations and communicate to the department how
infection prevention and control programs will be impacted by them.
(6) Annually review infection surveillance, prevention, and
control deficiencies issued during any hospital survey by the
department and the Joint Commission on the Accreditation of
Hospitals.
(7) Annually provide to the Governor, Legislature, and the Chairs
of the Senate Health Committee and the Assembly Health Committee, and
post on the department's Web site, a summary of infection rates and
process measures implemented to prevent the acquisition and
transmission of health care associated pathogens.
(b) The advisory committee shall be composed of not more than 20
individuals and shall include all of the following:
(1) A representative from the Office of Statewide Health Planning
and Development.
(2) A representative from Medi-Cal.
(3) A representative from the State Department of Public Health,
Licensing and Certification Program.
(4) A representative from the State Department of Public Health,
Division of Communicable Disease Control, Infectious Disease Branch.
(5) Six infection prevention and control professionals.
(6) Three hospital epidemiologists representing licensed acute
care hospitals.
(7) Two health care consumers at large.
(8) Two hospital administrators.
(9) The remaining committee members shall represent any of the
following: the insurance industry, a hospital association, a medical
association, Medicare, and other associations deemed necessary by the
State Public Health Officer.
(c) Each committee member shall have one vote. The advisory
committee shall meet at least quarterly alternating the meeting
places between northern and southern California. The advisory
committee shall serve without remuneration, but shall be reimbursed
for travel-related expenses to include transportation, hotel, and
meals at the state per diem reimbursement rate.
1288.9. The department shall adopt regulations that require the
following staffing for hospital infection surveillance, prevention,
and control programs:
(a) Hospitals licensed for not more than 50 beds shall have a
minimum of 0.5 full-time equivalent (FTE) of professional staff.
(b) Hospitals licensed for 51-100 beds shall have a minimum of one
FTE of professional staff.
(c) Hospitals licensed for 101-200 beds shall have a minimum of
2.5 FTE of professional staff.
(d) Hospitals licensed for 200-300 beds shall have a minimum of
3.5 FTE of professional staff.
(e) Hospitals licensed for 301-400 beds shall have a minimum of
4.5 FTE of professional staff.
(f) Hospitals licensed for 401-500 beds shall have a minimum of
5.5 FTE of professional staff.
(g) Hospitals licensed for more than 500 beds shall have a minimum
of 6.5 FTE of professional staff.
1288.10. (a) Each hospital shall submit data for the following
HAI to the NHSN and to the program:
(1) Surgical site infections.
(2) Bloodstream infections not related to central vascular access
catheters.
(3) Vascular access catheter-related culture positive blood stream
infections.
(4) Pneumonia occurring in patients requiring mechanical
ventilation.
(b) Each hospital shall report to the department's licensing and
certification district office with jurisdiction over the hospital any
HAI or series of infections that cause death or serious disability
to a patient, hospital personnel, or visitor. A licensing and
certification district office that receives this report shall, within
24 hours of receipt, consult with program staff to determine the
extent and seriousness of the infection and whether program staff
expertise is necessary to the investigation.
(c) Each hospital shall, on a quarterly basis, submit the rate of
antibiotic-resistant organisms, including, but not limited to, MRSA,
Clostridium difficile, and vancomycin-resistant enterococci to the
department. The data submitted shall designate if the infection with
the organism was present within 72 hours after admission or
subsequently.
1288.12. Each hospital shall annually submit to the department a
written report on the effectiveness of the program. The report shall
include a year-to-year comparison of all of the following:
(a) The number of infection control professionals on staff.
(b) The number of hospital discharges.
(c) The number of births, including births by caesarean section.
(d) The number of emergency department visits.
(e) The number of intensive care unit discharges, including, when
applicable, the number of neonatal intensive care unit discharges.
(f) The number of licensed beds, including the number of special
care unit beds.
(g) The number of inpatient and, when applicable, the number of
outpatient surgical procedures performed.
(h) The total number of beds, including special care unit beds,
that will be added in the coming year.
(i) The total number of full-time equivalent professional staff.
(j) The annual summary of the incidence of HAI and designated
antibiotic-resistant organisms, and the process measures implemented
to reduce these infections.
1288.13. (a) Each hospital shall develop, implement, monitor, and
periodically evaluate procedures for identifying patients who are
colonized or infected with specified health care associated
pathogens.
(b) As a part of the procedures described in subdivision (a), each
hospital shall take a culture for MRSA from every patient who is
admitted to the hospital under any of the following conditions:
(1) The patient has open, nondraining or draining wounds,
cellulitis, dermatological lesions, and pressure ulcers.
(2) The patient is readmitted to the hospital with an infection
within 30 days after discharge.
(3) The patient is admitted to an intensive care unit.
(4) The patient is discharged from an intensive care unit more
than 48 hours after admission to the unit.
(5) The patient is receiving dialysis.
(6) The patient resides in a rehabilitation or skilled nursing
facility or homeless shelter, is homeless, or is transferred from
another hospital.
(7) The patient's roommate tests culture-positive for MRSA.
(8) The patient has a history of MRSA.
(9) The patient is an injection drug user.
(10) The patient is admitted from a correctional facility.
1288.14. (a) Each hospital shall develop, implement, monitor, and
periodically evaluate compliance with policies and procedures to
prevent HAI. The results of these evaluations shall be monitored by
the hospital's infection prevention and control committee and
reported to an executive committee of the medical staff and the board
of directors.
(b) No later than July 1, 2009, and every four years thereafter,
physicians designated as the hospital epidemiologist or hospital
infection control committee chairpersons shall participate in a
training program that is specific to infection surveillance,
prevention, and control. Documentation of attendance shall be placed
in the physicians' credentialing file.
(c) The hospital's infection surveillance, prevention, and control
committee shall meet not less than four times each year and shall
quarterly report the incidence of HAI and compliance with process
measures to the executive committee of the medical staff and the
governing body of the hospital.
(d) To prevent transmission of health care associated infections,
all permanent, temporary, and contractual hospital employees who have
contact with a patient shall be trained in infection prevention and
control measures. The training shall be given to new employees prior
to having any patient contact, annually, and when new prevention
measures have been adopted.
(e) Nonambulatory patients and patients who require assistance
with bathing shall be completely bathed at least daily.
(f) Patient occupied rooms, including all equipment and frequently
touched surfaces, shall be cleaned and disinfected daily, and when
soiled with blood or other body fluids and at the time of patient
transfer or discharge. Equipment and surfaces in nurses' stations,
utility, and medication rooms, and public areas shall be cleaned and
disinfected daily.
SEC. 4. No reimbursement is required by this act
pursuant to Section 6 of Article XIII B of the California
Constitution because the only costs that may be incurred by a local
agency or school district will be incurred because 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.
SECTION 1. Section 2890.2 of the Public
Utilities Code is amended to read:
2890.2. (a) A provider of mobile telephony services, as defined
in Section 224.4, shall provide subscribers with a means by which a
subscriber can obtain reasonably current and available information,
as determined by the provider, on the subscriber's calling plan or
plans and service usage, including roaming usage and charges.
(b) On or before January 1, 2007, a provider of mobile telephony
services shall provide subscribers with a means by which a subscriber
can obtain reasonably current and available information, as
determined by the provider, on the subscriber's text messaging and
Internet usage and charges.
(c) Each provider of mobile telephony services shall inform
subscribers at the time service is established of the availability of
the information described in subdivisions (a) and (b) and how it may
be obtained.
(d) A provider of mobile telephony services shall, upon request,
remove or deactivate any device in a handset that prevents the
subscriber from using that handset to activate service with a
different mobile telephony services provider, upon the customer
completing the term of a service contract or, if the handset is
purchased separate and apart from a service contract, upon completing
the purchase of the handset.