BILL NUMBER: SB 158	ENROLLED
	BILL TEXT

	PASSED THE SENATE  AUGUST 31, 2008
	PASSED THE ASSEMBLY  AUGUST 25, 2008
	AMENDED IN ASSEMBLY  AUGUST 21, 2008
	AMENDED IN ASSEMBLY  AUGUST 15, 2008
	AMENDED IN ASSEMBLY  AUGUST 8, 2008
	AMENDED IN ASSEMBLY  JULY 14, 2008
	AMENDED IN ASSEMBLY  JULY 1, 2008
	AMENDED IN ASSEMBLY  JUNE 18, 2008
	AMENDED IN ASSEMBLY  JUNE 5, 2008
	AMENDED IN ASSEMBLY  MAY 13, 2008
	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 Sections 1288.5 and 1288.8 of, and to add Sections
1279.6, 1279.7, 1288.45 and 1288.95 to, the Health and Safety Code,
relating to health facilities.


	LEGISLATIVE COUNSEL'S DIGEST


   SB 158, Florez. Hospitals: patient safety and 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.
   This bill would require health facilities, as defined, to develop,
implement, and comply with a patient safety plan for the purpose of
improving the health and safety of patients and reducing preventable
patient safety events. The bill would require the patient safety plan
to establish a patient safety committee composed of health care
professionals, and to contain other prescribed elements.
   This bill would also require health facilities, as defined, to
implement a facility wide hand hygiene program and, beginning January
1, 2011, would prohibit the use of intravenous, epidural, or enteral
feeding connections that would fit into a connection port other than
the type it was intended for, unless an emergency or urgent
situation exists and the prohibition impairs the ability to provide
health care.
   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 Healthcare Associated Infection Advisory
Committee (HAI-AC), 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 establish a health care infection surveillance,
prevention, and control program within the department and require the
department, the HAI-AC, and general acute care hospitals, as
defined, to take specified actions to implement the program.
   This bill would also require, no later than January 1, 2010,
specified training for a physician designated as the hospital
epidemiologist or infection surveillance, prevention, and control
committee chairperson. Also, beginning in January 2010, the bill
would require prescribed training for other hospital staff, as
specified.
   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.


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

  SECTION 1.  (a) The Legislature finds and declares all of the
following:
   (1) During the past two decades, health-care-associated infections
(HAI), especially those that are resistant to commonly used
antibiotics, have increased dramatically 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 inadequate regulatory oversight of hospital
surveillance, prevention, and 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) 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 federal 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) Establishment of an infection surveillance, prevention, and
control program within the State Department of Public Health.
   (2) Dissemination of current evidence-based standards of hospital
infection surveillance, prevention, and control practices.
   (3) Improvement of regulatory oversight.
   (4) Reports of the incidence rate of designated HAI are made to
the department, and as applicable, to the National Healthcare Safety
Network (NHSN) of the federal Centers for Disease Control and
Prevention.
   (5) Development and implementation of an Internet-based public
reporting system on HAI.
   (6) Maintenance of a sanitary environment and patient hygiene to
avoid transmission of pathogens that cause HAI.
  SEC. 2.  Section 1279.6 is added to the Health and Safety Code, to
read:
   1279.6.  (a) A health facility, as defined in subdivision (a),
(b), (c), or (f) of Section 1250, shall develop, implement, and
comply with a patient safety plan for the purpose of improving the
health and safety of patients and reducing preventable patient safety
events. The patient safety plan shall be developed by the facility,
in consultation with the facility's various health care
professionals.
   (b) The patient safety plan required pursuant to subdivision (a)
shall, at a minimum, provide for the establishment of all of the
following:
   (1) A patient safety committee or equivalent committee in
composition and function. The committee shall be composed of the
facility's various health care professionals, including, but not
limited to, physicians, nurses, pharmacists, and administrators. The
committee shall do all of the following:
   (A) Review and approve the patient safety plan.
   (B) Receive and review reports of patient safety events as defined
in subdivision (c).
   (C) Monitor implementation of corrective actions for patient
safety events.
   (D) Make recommendations to eliminate future patient safety
events.
   (E) Review and revise the patient safety plan, at least once a
year, but more often if necessary, to evaluate and update the plan,
and to incorporate advancements in patient safety practices.
   (2) A reporting system for patient safety events that allows
anyone involved, including, but not limited to, health care
practitioners, facility employees, patients, and visitors, to make a
report of a patient safety event to the health facility.
   (3) A process for a team of facility staff to conduct analyses,
including, but not limited to, root cause analyses of patient safety
events. The team shall be composed of the facility's various
categories of health care professionals, with the appropriate
competencies to conduct the required analyses.
   (4) A reporting process that supports and encourages a culture of
safety and reporting patient safety events.
   (5) A process for providing ongoing patient safety training for
facility personnel and health care practitioners.
   (c) For the purposes of this section, patient safety events shall
be defined by the patient safety plan and shall include, but not be
limited to, all adverse events or potential adverse events as
described in Section 1279.1 that are determined to be preventable,
and health-care-associated infections (HAI), as defined in the
federal Centers for Disease Control and Prevention's National
Healthcare Safety Network, or its successor, unless the department
accepts the recommendation of the Healthcare Associated Infection
Advisory Committee, or its successor, that are determined to be
preventable.
  SEC. 3.  Section 1279.7 is added to the Health and Safety Code, to
read:
   1279.7.  (a) A health facility, as defined in subdivision (a),
(b), (c), or (f) of Section 1250, shall implement a facility-wide
hand hygiene program.
   (b) Beginning January 1, 2011, a health facility, as defined in
subdivision (a), (b), (c), or (f) of Section 1250, is prohibited from
using an intravenous connection, epidural connection, or enteral
feeding connection that would fit into a connection port other than
the type it was intended for, unless an emergency or urgent situation
exists and the prohibition impairs the ability to provide health
care.
  SEC. 4.  Section 1288.45 is added to the Health and Safety Code, to
begin Article 3.5 of Chapter 2 of Division 2, to read:
   1288.45.  For purposes of this article, the following definitions
shall apply:
   (a) "Advisory committee" or "HAI-AC" means the Healthcare
Associated Infection Advisory Committee established pursuant to
Section 1288.5.
   (b) "Health-care-associated infection," "health facility acquired
infection," or "HAI" means an infection defined by the National
Health and Safety Network of the federal Centers for Disease Control
and Prevention, unless the department adopts a definition consistent
with the recommendations of the advisory committee or its successor.
   (c) "Hospital" means a general acute care hospital as defined
pursuant to subdivision (a) of Section 1250.
   (d) "Infection prevention professional" means a registered nurse,
medical technologist, or other salaried employee or consultant who,
within two years of appointment, will meet the education and
experience requirements for certification established by the national
Certification Board for Infection Control and Epidemiology (CBIC),
but does not include a physician who is appointed or receives a
stipend as the infection prevention and control committee chairperson
or hospital epidemiologist.
   (e) "MRSA" means methicillin-resistant Staphylococcus aureus.
   (f) "National Healthcare Safety Network" or "NHSN" means a secure,
Internet-based system developed and managed by the federal Centers
for Disease Control and Prevention (CDC) to collect, analyze, and
report risk-adjusted HAI data related to the incidence of HAI and the
process measures implemented to prevent these infections.
   (g) "Program" means the health care infection surveillance,
prevention, and control program within the department.
  SEC. 5.  Section 1288.5 of the Health and Safety Code is amended to
read:
   1288.5.  (a) By July 1, 2007, the department shall appoint a
Healthcare Associated Infection Advisory Committee (HAI-AC) 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.
   (b) 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.
   (c) The advisory committee shall meet at least every quarter and
shall serve without compensation, but shall be reimbursed for
travel-related expenses that include transportation, lodging, and
meals at the state per diem reimbursement rate.
   (d) In addition to the responsibilities enumerated in subdivision
(a), the advisory committee shall do all of the following:
   (1) Review and evaluate federal and state legislation,
regulations, and accreditation standards and communicate to the
department how hospital infection prevention and control programs
will be impacted.
   (2) In accordance with subdivision (a) of Section 1288.6,
recommend a method by which the number of infection prevention
professionals would be assessed in each hospital.
   (3) Recommend an educational curriculum by which health facility
evaluator nurses and department consultants would be trained to
survey for hospital infection surveillance, prevention, and control
programs.
   (4) Recommend a method by which hospitals are audited to determine
the validity and reliability of data submitted to the NHSN and the
department.
   (5) Recommend a standardized method by which an HAI occurring
after hospital discharge would be identified.
   (6) Recommend a method by which risk-adjusted HAI data would be
reported to the public, the Legislature, and the Governor.
   (7) Recommend a standardized method by which department health
facility evaluator nurses and consultants would evaluate health care
workers for compliance with infection prevention procedures
including, but not limited to, hand hygiene and environmental
sanitation procedures.
   (8) Recommend a method by which all hospital infection prevention
professionals would be trained to use the NHSN HAI surveillance
reporting system.
  SEC. 6.  Section 1288.8 of the Health and Safety Code is amended to
read:
   1288.8.  (a) By January 1, 2008, the department shall take all of
the following actions to protect against 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) Revise existing and adopt new administrative regulations, as
necessary, to incorporate current federal Centers for Disease Control
and Prevention (CDC) guidelines and standards for HAI prevention.
   (3) 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 federal Centers
for Disease Control and Prevention 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,
the department shall make this information public no later than six
months after receiving the data.
   (c) The 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 federal
Centers for Disease Control and Prevention Healthcare Infection
Control Practices Advisory Committee or to another scientifically
valid reporting database, as determined by the department based on
the recommendations of the HAI-AC. Hospitals shall utilize the
federal 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.
   (e) In addition to the requirements in subdivision (a), the
department shall establish an infection surveillance, prevention, and
control program to do all of the following:
   (1) Designate infection prevention professionals to serve as
consultants to the licensing and certification program.
   (2) Provide education and training to department health facility
evaluator nurses and consultants to effectively survey hospitals for
compliance with infection surveillance, prevention, and control
recommendations, as well as state and federal statutes and
regulations.
   (3) By January 1, 2011, in consultation with the HAI-AC, develop a
scientifically valid statewide electronic reporting system or
utilize an existing scientifically valid database system capable of
receiving electronically transmitted reports from hospitals related
to HAI.
   (4) Provide current infection prevention and control information
to the public on the Internet.
   (5) Beginning January 1, 2011, provide to the Governor, the
Legislature, and the Chairs of the Senate Committee on Health and
Assembly Committee on Health, and post on the department's Web site,
an annual report of publicly reported HAI infection information
received and reported pursuant to this article.
  SEC. 7.  Section 1288.95 is added to the Health and Safety Code, to
read:
   1288.95.  (a) No later than January 1, 2010, a physician
designated as a hospital epidemiologist or infection surveillance,
prevention, and control committee chairperson shall participate in a
continuing medical education (CME) training program offered by the
federal Centers for Disease Control and Prevention (CDC) and the
Society for Healthcare Epidemiologists of America, or other
recognized professional organization. The CME program shall be
specific to infection surveillance, prevention, and control.
Documentation of attendance shall be placed in the physician's
credentialing file.
   (b) Beginning January 2010, all staff and contract physicians and
all other licensed independent contractors, including, but not
limited to, nurse practitioners and physician assistants, shall be
trained in methods to prevent transmission of HAI, including, but not
limited to, MRSA and Clostridium difficile infection.
   (c) By January 2010, all permanent and temporary hospital
employees and contractual staff, including students, shall be trained
in hospital-specific infection prevention and control policies,
including, but not limited to, hand hygiene, facility-specific
isolation procedures, patient hygiene, and environmental sanitation
procedures. The training shall be given annually and when new
policies have been adopted by the infection surveillance, prevention,
and control committee.
   (d) Environmental services staff shall be trained by the hospital
and shall be observed for compliance with hospital sanitation
measures. The training shall be given at the start of employment,
when new prevention measures have been adopted, and annually
thereafter. Cultures of the environment may be randomly obtained by
the hospital to determine compliance with hospital sanitation
procedures.
  SEC. 8.  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.