BILL NUMBER: SB 1058	AMENDED
	BILL TEXT

	AMENDED IN ASSEMBLY  AUGUST 19, 2008
	AMENDED IN ASSEMBLY  AUGUST 12, 2008
	AMENDED IN ASSEMBLY  JULY 1, 2008
	AMENDED IN ASSEMBLY  JUNE 17, 2008
	AMENDED IN SENATE  MAY 23, 2008
	AMENDED IN SENATE  APRIL 15, 2008
	AMENDED IN SENATE  MARCH 26, 2008
	AMENDED IN SENATE  FEBRUARY 25, 2008

INTRODUCED BY   Senator Alquist

                        JANUARY 7, 2008

   An act to add Sections 1255.8 and  120141  
1288.55  to the Health and Safety Code, relating to health.


	LEGISLATIVE COUNSEL'S DIGEST


   SB 1058, as amended, Alquist. Health facilities: bacterial
infections.
   Existing law provides for the licensure and regulation of health
facilities by the State Department of Public Health. A violation of
these provisions is a crime.
   This bill would establish the Medical Facility Infection Control
and Prevention Act or  Niles   Nile's  Law,
which would require general acute care hospitals to implement
certain procedures for the screening, prevention, and reporting of
specified  health facility acquired  
health-care-associated  infections. This bill would require the
department to carry out certain duties in order to implement the
bill.  The bill would require each health facility covered by
the bill to pay a fee per inpatient day for each licensed facility,
as specified. These fees would be deposited into the State Department
of Public Health Licensing and Certification Program Fund,
established under existing law.  Because a violation of the
health facility provisions is a crime, the bill would impose a
state-mandated local program. 
   Existing law permits the State Department of Public Health to take
various actions to prevent and control the spread of infectious
diseases in this state. 
   This bill would require health facilities to report to the
department and the federal  centers   Centers
 for Disease Control and Prevention, specified infections. This
bill would require the department to develop and implement various
Internet-based reporting systems, as prescribed.
   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.
   Vote: majority. Appropriation: no. Fiscal committee: yes.
State-mandated local program: yes.


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

  SECTION 1.  The Legislature finds and declares all of the
following:
   (a) (1) The protection of patients in California health facilities
is of paramount importance to the citizens of this state.
   (2) During the past two decades health care facility
associated   health-care-associated  infections,
especially those that are resistant to commonly used antibiotics,
have increased dramatically.
   (3) The State Department of Public Health needs to develop a
better, more efficient system to monitor and report the incidence of
antibiotic-resistant and other organisms causing infection that are
acquired by patients in health facilities.
   (4) The department needs to establish and maintain a comprehensive
inspection and reporting system for health facilities that will
ensure that those facilities comply with state laws and regulations
designed to reduce the incidence of  facility associated
  health-care-associated  infections.
   (b) It is, therefore, the intent of the Legislature to enact
legislation that will do all of the following:
   (1) Ensure that California's standards for protecting patients
from exposure to pathogens in health facilities, including
Methicillin-resistant Staphylococcus aureus (MRSA), are adequate to
reduce the incidence of antibiotic-resistant organisms causing
infection acquired by patients in these facilities.
    (2) Ensure that the department develops and implements an
Internet-based public reporting system that provides updated
information regarding the incidence of infections, including
associated pathogens acquired in health facilities, as well as the
number of infection control personnel relative to the number of
licensed beds.
   (3) Ensure that health facilities implement improved procedures
intended to maintain sanitary standards in these facilities, 
avoid   reduce  transmission of pathogens that
cause infection, and provide adequate training to health care
professionals regarding the prevention and treatment of 
health-facility-associated   health-care-associated
 MRSA and other  health-facility-associated 
 health-care-associated  infections in these facilities.
  SEC. 2.  This act shall be known, and may be cited, as the Medical
Facility Infection Control and Prevention Act or Nile's Law.
  SEC. 3.  Section 1255.8 is added to the Health and Safety Code, to
read:
   1255.8.  (a) For purposes of this section, the following terms
have the following meanings:
   (1) "Colonized" means that a pathogen is present on the patient's
body, but is not causing any signs or symptoms of an infection.
   (2) "Committee" means the Healthcare Associated Infection Advisory
Committee established pursuant to Section 1288.5.
   (3) "Health facility" means a  licensed  facility
as defined in subdivision (a) of Section 1250. 
   (4) "Health facility acquired infection" means a health care
associated infection, as defined by the federal Centers for Disease
Control and Prevention 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 health facility and was not
documented as present or incubating in that patient at the time of
admission to the health facility, unless the infection was related to
a previous admission to the same health facility. Clinical evidence
may be derived from direct observation of the infection site, or
review of information in the patient chart or other clinical records.
 
   (4) "Health-care-associated infection," "health-facility-acquired
infection," or "HAI" means a health-care-associated infection as
defined by the National Healthcare Safety Network of the federal
Centers for Disease Control and Prevention, unless the department
adopts a definition consistent with the recommendations of the
committee or its successor. 
   (5) "MRSA" means Methicillin-resistant Staphylococcus aureus.
   (b) (1) Each patient who is admitted to a health facility shall be
tested for MRSA in the following cases, within 24 hours of
admission:
   (A) The patient is scheduled for inpatient surgery and has a
documented medical condition making the patient susceptible to
infection, based either upon federal Centers for Disease Control and
Prevention findings or the recommendations of the committee or its
successor.
   (B) It has been documented that the patient has been previously
discharged from a general acute care hospital within 30 days prior to
the current hospital admission.
   (C) The patient will be admitted to an intensive care unit or burn
unit of the hospital.
   (D) The patient receives inpatient dialysis treatment.
   (E) The patient is being transferred from a skilled nursing
facility.
    (2) The department may interpret this subdivision to take into
account the recommendations of the federal Centers for Disease
Control and Prevention, or recommendations of the committee or its
successor. 
   (3) This subdivision shall not apply to a patient who has tested
positive for MRSA infection or colonization upon entering the
facility.  
   (3) If a patient tests positive for MRSA, the attending physician
shall inform the patient or the patient's representative immediately
or as soon as practically possible. 
   (4) A patient who tests positive for MRSA infection shall, prior
to discharge, receive oral and written instruction regarding
aftercare and precautions to prevent the spread of the infection to
others.
   (c) Commencing January 1, 2011, a patient tested in accordance
with subdivision (b) and who shows evidence of increased risk of
invasive MRSA shall again be tested for MRSA immediately prior to
discharge from the facility.  A   This
subdivision shall not apply to a patient who has tested positive for
MRSA infection or colonization upon entering the facility. 
    (d)     A  patient who is tested
pursuant to subdivision  (b)   (c)  and who
tests positive for MRSA infection shall  , prior to
discharge,  receive oral and written instructions regarding
aftercare and precautions to prevent the spread of the infection to
others. 
   (d) 
    (e)  The infection control policy required pursuant to
Section 70739 of Title 22 of the California Code of Regulations, at a
minimum, shall include all of the following:
   (1) Procedures to reduce health care associated infections.
   (2) Regular disinfection of all restrooms, countertops, furniture,
televisions, telephones, bedding, office equipment, and surfaces in
patient rooms, nursing stations, and storage units.
   (3) Regular removal of accumulations of bodily fluids and
intravenous substances, and cleaning and disinfection of all movable
medical equipment, including point-of-care testing devices such as
glucometers, and transportable medical devices.
   (4) Regular cleaning and disinfection of all surfaces in common
areas in the facility such as elevators, meeting rooms, and lounges.

   (e) 
    (f)  Each facility shall designate an infection control
officer who, in conjunction with the hospital infection control
committee, shall ensure implementation of the testing and reporting
provisions of this section and other hospital infection control
efforts. The reports shall be presented to the appropriate committee
within the facility for review. The name of the infection control
officer shall be made publicly available, upon request. 
   (f) (1) 
    (g)    The department shall establish a health
care acquired infection program pursuant to this section. 
   (2) Each health facility shall pay a fee per licensed bed for each
licensed facility to be used to cover the costs of the program
established pursuant to paragraph (1). This fee shall be in addition
to the annual licensing and certification program fees established by
the Licensing and Certification Program each fiscal year. The fees
paid by facilities for the cost of the program established pursuant
to this paragraph shall be deposited into the State Department of
Public Health Licensing and Certification Program Fund established by
Section 1266.9. 
  SEC. 4.  Section  120141   1288.55  is
added to the Health and Safety Code, to read: 
   120141.  (a) (1) Each health facility, as defined in paragraph (3)
of subdivision (a) of Section 1255.8, shall quarterly report to the
department all cases of health-care-acquired MRSA bacteremia,
health-facility-acquired Clostridium difficile, and
health-care-acquired Vancomycin-resistant Enterococci. The department
shall make the information provided pursuant to this paragraph
available on its Web site. 
    1288.55.   (a) (1) Each health facility, as defined
in paragraph (3) of subdivision (a) of Section 1255.8, shall
quarterly report all cases of health-care-associated MRSA blood
stream infection, health-care-associated clostridium difficile
infection, and health-care-associated Vancomycin-resistant
enterococcal blood stream infection, and the number of inpatient
days. 
   (2) Each health facility shall report quarterly to the department
all central line associated blood stream infections and the total
central line days.
   (3) Each health facility shall report quarterly to the department
 health-care-associated surgical site infections, and the
number of specified surgical procedures, pursuant to paragraph (2) of
subdivision (b).   all health-care-associated surgical
site infections of deep or organ space surgical sit   es,
health-care-associated infections of orthopedic surgical sites,
cardiac surgical sites, and gastrointestinal surgical sites
designated as clean and clean-contaminated, and the number of
surgeries involving deep or organ space, and orthopedic, cardiac, and
gastrointestinal surgeries designated clean and clean-contaminated.

   (b) The department's licensing and certification program shall do
 both   all  of the following:
   (1) Commencing January 1, 2011, post on the department's Web site
information regarding the incidence rate of health-care-acquired
central line associated blood stream infections acquired at each
health facility in California, including information on the number of
 licensed  inpatient days.  The information
shall be posted in a manner consistent with subdivisions (c), (d),
and (e). 
   (2) Commencing January 1, 2012, post on the department's Web site
information regarding the incidence rate of deep or organ space
surgical site infections, orthopedic, cardiac, and gastrointestinal
surgical procedures designated as clean and clean-contaminated,
acquired at each health facility in California, including information
on the number of inpatient days.  The information shall be
posted in a manner consistent with subdivisions (c), (d), and (e).
 
   (3) No later than January 1, 2011, post on the department's Web
site information regarding the incidence rate of
health-care-associated MRSA blood stream infection,
health-care-associated clostridium difficile infection, and
health-care-associated Vancomycin-resistant enterococcal blood stream
infection, at each health facility in California, including
information on the number of inpatient days. 
   (c)  The   Any information reported publicly
as required under this section shall meet all of the following
requirements: 
    (1)     The  department shall follow a
risk adjustment process that is consistent with the federal Centers
for Disease Control and Prevention's National Healthcare Safety
Network (NHSN), or its successor, risk adjustment, and use its
definitions, unless the department adopts, by regulation, a fair and
equitable risk adjustment process that is consistent with the
recommendations of the Healthcare Associated Infection Advisory
Committee (HAI-AC), established pursuant to Section 1288.5, or its
successor. 
   (d) 
    (2)  For purposes of reporting  ,   as
 required in subdivisions (a) and (b), an infection shall be
reported using the NHSN definitions unless the department accepts the
recommendation of the HAI-AC or its successor. 
   (e) 
    (3)  If the federal Centers for Disease Control and
Prevention do not use a public reporting model for specific
health-care-acquired infections, then the department shall base its
public reporting of incidence rate on the number of inpatient days
for infection reporting, or the number of specified device days for
relevant device-related infections, and the number of specified
surgeries conducted for surgical site infection reporting, unless the
department adopts a public reporting model that is consistent with
recommendations of the HAI-AC or its successor. 
   (f) 
    (d)  Health facilities that report data pursuant to the
system shall report this data to the NHSN and the department, as
appropriate.
  SEC. 5.  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.