BILL NUMBER: SB 1058	ENROLLED
	BILL TEXT

	PASSED THE SENATE  AUGUST 29, 2008
	PASSED THE ASSEMBLY  AUGUST 20, 2008
	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 1288.55 to the Health and Safety
Code, relating to health.


	LEGISLATIVE COUNSEL'S DIGEST


   SB 1058, 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 Nile's Law, which would require general acute
care hospitals to implement certain procedures for the screening,
prevention, and reporting of specified health-care-associated
infections. This bill would require the department to carry out
certain duties in order to implement the bill. Because a violation of
the health facility provisions is a crime, the bill would impose a
state-mandated local program.
   This bill would require health facilities to report to the
department and the federal 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.


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-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 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, reduce
transmission of pathogens that cause infection, and provide adequate
training to health care professionals regarding the prevention and
treatment of health-care-associated MRSA and other
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 facility as defined in subdivision
(a) of Section 1250.
   (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) 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. 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 (c) and who
tests positive for MRSA infection shall receive oral and written
instructions regarding aftercare and precautions to prevent the
spread of the infection to others.
   (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.
   (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.
   (g) The department shall establish a health care acquired
infection program pursuant to this section.
  SEC. 4.  Section 1288.55 is added to the Health and Safety Code, to
read:
   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 bloodstream infection,
health-care-associated clostridium difficile infection, and
health-care-associated Vancomycin-resistant enterococcal bloodstream
infection, and the number of inpatient days.
   (2) Each health facility shall report quarterly to the department
all central line associated bloodstream infections and the total
central line days.
   (3) Each health facility shall report quarterly to the department
all health-care-associated surgical site infections of deep or organ
space surgical sites, 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
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 bloodstream infections acquired at each
health facility in California, including information on the number of
inpatient days.
   (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.
   (3) No later than January 1, 2011, post on the department's Web
site information regarding the incidence rate of
health-care-associated MRSA bloodstream infection,
health-care-associated clostridium difficile infection, and
health-care-associated Vancomycin-resistant enterococcal bloodstream
infection, at each health facility in California, including
information on the number of inpatient days.
   (c) 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.
   (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.
   (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.
   (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.