BILL ANALYSIS Ó
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|SENATE RULES COMMITTEE | SB 1311|
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CONSENT
Bill No: SB 1311
Author: Hill (D), et al.
Amended: 4/10/14
Vote: 21
SENATE HEALTH COMMITTEE : 8-0, 4/24/14
AYES: Hernandez, Morrell, Beall, DeSaulnier, Evans, Monning,
Nielsen, Wolk
NO VOTE RECORDED: De León
SENATE APPROPRIATIONS COMMITTEE : Senate Rule 28.8
SUBJECT : Public health: antimicrobial stewardship
SOURCE : Author
DIGEST : This bill requires general acute care hospitals, by
July 1, 2015, to adopt and implement an antimicrobial
stewardship policy, as specified; develop a physician-supervised
multidisciplinary antimicrobial stewardship committee,
subcommittee, or workgroup; appoint at least one physician or
pharmacist who has attended training specifically on
antimicrobial stewardship to the committee, subcommittee, or
workgroup, as specified; and report antimicrobial stewardship
program activities to appropriate hospital committees, as
specified.
ANALYSIS :
Existing law:
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1.Provides for the licensure and inspection of health
facilities, including general acute care hospitals, by the
Department of Public Health (DPH).
2.Requires general acute care hospitals to develop a process for
evaluating the judicious use of antibiotics, the result of
which is required to be monitored by appropriate
representatives and committees involved in quality improvement
activities.
This bill requires general acute care hospitals, by July 1,
2015, to:
1. Adopt and implement an antimicrobial stewardship policy in
accordance with guidelines established by the federal
government and professional organizations;
2. Develop a physician-supervised multidisciplinary
antimicrobial stewardship committee, subcommittee, or
workgroup;
3. Appoint to the committee, subcommittee, or workgroup, at
least one physician or pharmacist who has attended training
specifically on antimicrobial stewardship; including, but not
limited to, a continuing education training program offered
by the federal Centers for Disease Control and Prevention
(CDC), the Society for Healthcare Epidemiology of America
(SHEA), or similar recognized professional organizations, or
post graduate training with a concentration in antimicrobial
stewardship; and
4. Report antimicrobial stewardship program activities to each
appropriate hospital committee undertaking clinical quality
improvement activities.
Background
According to the CDC, antibiotic resistance is a quickly
growing, extremely dangerous problem. World health leaders have
described antibiotic-resistant bacteria as "nightmare bacteria"
that "pose a catastrophic threat" to people in every country in
the world. Most infections occur in the community, like skin
infections with Methicillin-resistant Staphylococcus aureus
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(MRSA) and sexually transmitted diseases. However, most deaths
related to antibiotic resistance occur from drug-resistant
infections picked up in health care settings, such as hospitals
and nursing homes. According to a February 2013 joint letter
from the Infectious Diseases Society of America and the SHEA to
the National Quality Forum, ample data exist from both inpatient
and outpatient settings demonstrating that antibiotics are often
prescribed sub-optimally or inappropriately. Antibiotics are
misused in a variety of ways. They are often administered when
they are not needed, continued when they are no longer
necessary, or prescribed at the wrong dose. Broad-spectrum
agents may be used unnecessarily against bacteria that are very
susceptible or the wrong antibiotic may be given to treat a
particular infection. Over the past 30 years, bacteria that are
extremely resistant to traditional treatments or resistant to
multiple drugs have spread widely among patients in health care
settings. In some cases these pathogens have been
pan-resistant, meaning that they are resistant to all available
antibiotics. The unique nature of antibiotics, in which the use
of the drugs in one patient can impact the effectiveness of the
drug in a different patient, make antibiotic overuse a serious
patient safety issue and public health threat. The World Health
Organization has characterized antibiotic resistance as "a
crisis that has been building up over decades, so that today
common and life-threatening infections are becoming difficult or
even impossible to treat." Resistant infections not only result
in increased morbidity and mortality, but increased economic
burdens. For example, studies have shown that
antibiotic-resistant infections are associated with longer
lengths of stay and increased mortality, both in the hospital
and in intensive care units.
California's program . In February 2010, the DPH Healthcare
Associated Infection (HAI) Program developed a statewide
antimicrobial stewardship program (ASP) initiative in order to
strengthen and promote optimization of antimicrobial utilization
in California health care facilities. According to DPH, the
purpose of an antimicrobial stewardship program in a health care
facility is to measure and promote the appropriate use of
antimicrobials by selecting the appropriate agent, dose,
duration and route of administration in order to improve patient
outcomes, while minimizing toxicity and the emergence of
antimicrobial resistance. Although guidelines exist for
developing ASPs, there is limited information on practical
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implementation of these guidelines, particularly in
resource-limited settings. According to DPH, its partners in
this statewide initiative include the Division of Healthcare
Quality and Promotion at CDC, Infectious Disease Association of
California, and SHEA.
Prior legislation
SB 158 (Florez, Chapter 294, Statutes of 2008), established an
infection surveillance, prevention, and control program within
DPH to provide oversight of hospital prevention and reporting of
general acute care hospital-associated infections, expanded the
responsibilities of DPH's HAI Advisory Committee, and requires
all hospitals to institute a patient safety plan for the purpose
of improving the health and safety of patients and reducing
preventable patient safety events.
SB 1058 (Alquist, Chapter 296, Statutes of 2008), established
the Medical Facility Infection Control and Prevention Act, which
requires hospitals to implement specified procedures for
screening, prevention, and reporting specified health care
associated infections also known as HAIs. Requires hospitals to
report positive MRSA and other HAI test results to DPH and
requires DPH to make specified information public on its
Internet Web site.
SB 739 (Speier, Chapter 526, Statutes of 2006), created a state
HAI advisory committee to make recommendations regarding
reporting cases of HAI in hospitals. Requires each general
acute care hospital, after January 1, 2008, to implement and
annually report to DPH its implementation of infection
surveillance and infection prevention process measures that have
been recommended by CDC Healthcare Infection Control Practices
Advisory Committee, as suitable for a mandatory public reporting
program. Requires DPH, in consultation with the HAI advisory
committee, to make this information public no later than six
months after receiving the data. Required 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.
SB 1487 (Speier of 2004), would have required specified
hospitals to have written infection control plans and report to
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Office of Statewide Health Planning and Development (OSHPD)
data, including the rate of HAIs and risk-adjusted infection
rate data according to the risk-adjustment methodology
determined by CDC. SB 1487 was vetoed by Governor
Schwarzenegger, whose veto message suggested that it was
unnecessary because of other national efforts, which could call
into question the quality and validity of the data without
proper auditing, and because it would impose significant costs
to hospitals and OSHPD.
FISCAL EFFECT : Appropriation: No Fiscal Com.: Yes
Local: Yes
SUPPORT : (Verified 5/6/14)
California Hospital Association
San Francisco Bay Area Physicians for Social Responsibility
ARGUMENTS IN SUPPORT : The California Hospital Association
(CHA) states that improving the use of antibiotics is an
important patient safety and public health issue as well as a
national priority. CHA states that ASPs can both optimize the
treatment of infections and reduce adverse events associated
with antibiotic use.
San Francisco Bay Area Physicians for Social Responsibility
states, one of the most important actions that can be taken to
slow the development of antibiotic resistance is to ensure that
antibiotics are used judiciously through the establishment of
ASP. ASPs represent a commitment to always use antibiotics only
when they are necessary; to choose the right antibiotics; and to
administer them in the right way.
JL:d 5/6/14 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
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