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
1201411288.55 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 NilesNile's Law, which would require general acute care hospitals to implement certain procedures for the screening, prevention, and reporting of specified health facility acquiredhealth-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 centersCenters 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 associatedhealth-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 associatedhealth-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, avoidreduce transmission of pathogens that cause infection, and provide adequate training to health care professionals regarding the prevention and treatment of health-facility-associatedhealth-care-associated MRSA and other health-facility-associatedhealth-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 licensedfacility 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. AThis 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 1201411288.55 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 bothall 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 licensedinpatient 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) TheAny 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.