BILL ANALYSIS                                                                                                                                                                                                    Ó



                                                                  SB 1311
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          Date of Hearing:  June 10, 2014

                            ASSEMBLY COMMITTEE ON HEALTH
                                 Richard Pan, Chair
                      SB 1311 (Hill) - As Amended:  June 4, 2014

           SENATE VOTE  :  35-0
           
          SUBJECT  :  Hospitals: antimicrobial stewardship.

           SUMMARY  :  Requires all general acute-care hospitals to adopt and  
          implement an antimicrobial stewardship policy (ASP).   
          Specifically,  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 is knowledgeable on the  
            subject  of antimicrobial stewardship through prior training,  
            professional experience, or attendance at continuing education  
            programs; 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.

          4)Report antimicrobial stewardship program activities to each  
            appropriate hospital committee undertaking clinical quality  
            improvement activities.

           EXISTING LAW  :  

          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  








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            representatives and committees involved in quality improvement  
            activities. 

           FISCAL EFFECT  :  According to the Senate Appropriations  
          Committee, pursuant to Senate Rule 28.8, negligible state costs.  


           COMMENTS  :

           1)PURPOSE OF THIS BILL  .  According to the author, this bill  
            ensures that California continues to be at the forefront of  
            the fight against antibiotic resistance and 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.  The author further states, to promote judicious  
            use, the CDC recommends the establishment of ASPs, which  
            represent a "commitment to always use antibiotics only when  
            they are necessary to treat and in some cases prevent,  
            disease; to choose the right antibiotics; and, to administer  
            them in the right way in every case. The author states that  
            effective stewardship ensures that every patient gets the  
            maximum benefit from the antibiotics, avoids unnecessary harm  
            from allergic reaction and side effects, and helps preserve  
            the life-saving potential of these drugs for the future."   
            Finally, the author notes that the Infectious Diseases Society  
            of America says that although California has "the first  
            legislative mandate of its kind, it does not specify that  
            hospitals must intervene to improve antimicrobial use, that  
            is, to have an antimicrobial stewardship program," and due to  
            this ambiguity, only 50% of hospitals have established an  
            antimicrobial stewardship program and only 22% said they were  
            influenced by current law to develop a stewardship program.  

           2)BACKGROUND  .  Antibiotics and similar drugs, together called  
            antimicrobial agents, have been used for the last 70 years to  
            treat patients who have infectious diseases.  Since the 1940s,  
            these drugs have greatly reduced illness and death from  
            infectious diseases.  Antibiotic use has been beneficial and,  
            when prescribed and taken correctly, their value in patient  
            care is enormous.  However, these drugs have been used so  
            widely and for so long that the infectious organisms the  
            antibiotics are designed to kill have adapted to them, making  
            the drugs less effective.  People infected with  
            antimicrobial-resistant organisms are more likely to have  
            longer, more expensive hospital stays, and may be more likely  








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            to die as a result of the infection.  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." 

            Antimicrobial stewardship refers to a set of interventions  
            that improve the appropriate use of antimicrobial agents,  
            including optimal drug selection, dosing, duration of therapy,  
            and route of administration.  The primary objective is to  
            achieve the best clinical outcomes for patients while  
            minimizing toxicity and other adverse events associated with  
            antimicrobial use, thereby limiting selective pressure on  
            bacterial populations that drives the emergence of  
            antimicrobial resistant strains.  Antimicrobial stewardship  
            policy implementation has also been shown to reduce costs due  
            to improper antimicrobial use.  

            The DPH Hospital Acquired Infection Program supports an  
            antimicrobial stewardship initiative to provide consultation  
            and education to assist California hospitals and other  
            healthcare facilities to implement these important local  
            programs necessary for strengthening the optimization of  
            antimicrobial utilization.  Current DPH activities include  
            developing evidence-based recommendations on how to implement  
            or strengthen ASPs given available resources and facility  
            attributes, developing recommendations on internal and  
            external outcome antimicrobial metrics with a group of experts  
            across California, and defining activities that comprise ASPs  
            in California hospitals.

           3)SUPPORT  .  In support of this bill, California Hospital  
            Association writes that a growing body of evidence  
            demonstrates that hospital-based programs dedicated to  
            improving antibiotic use can both optimize the treatment of  
            infections and reduce adverse events associated with  
            antibiotic use. 

           4)PREVIOUS LEGISLATION  .  

             a)   SB 158 (Florez), Chapter 294, Statutes of 2008,  
               establishes an infection surveillance, prevention, and  
               control program within DPH to provide oversight of hospital  
               prevention and reporting of general acute care  
               hospital-associated infections (HAI), expands the  








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               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.

             b)   SB 1058 (Alquist), Chapter 296, Statutes of 2008,  
               establishes the Medical Facility Infection Control and  
               Prevention Act, which requires hospitals to implement  
               specified procedures for screening, prevention, and  
               reporting specified HAIs.  Requires hospitals to report  
               positive Methicillin-resistant Staphylococcus aureus and  
               other HAI test results to DPH and requires DPH to make  
               specified information public on its website.

             c)   SB 739 (Speier), Chapter 526, Statutes of 2006, creates  
               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,  
               initially, these process measures to include the CDC  
               guidelines for central line insertion practices, surgical  
               antimicrobial prophylaxis, and influenza vaccination of  
               patients and healthcare personnel.  Requires DPH, in  
               consultation with the HAI advisory committee, to make this  
               information public no later than six months after receiving  
               the data.  Requires 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.

             d)   SB 1487 (Speier) of 2004 would have required specified  
               hospitals to have written infection control plans and  
               report to 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 then Governor Schwarzenegger, whose veto message  
               said, in part, that it was unnecessary because of other  
               national efforts, which could call into question the  
               quality and validity of the data without proper auditing,  








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               and because it would impose significant costs to hospitals  
               and OSHPD.

           REGISTERED SUPPORT / OPPOSITION  :

           Support  
          California Hospital Association
          Physicians for Social Responsibility
          Stanford Hospital and Clinics
           
            Opposition  
          None on file.

           Analysis Prepared by  :    Lara Flynn / HEALTH / (916) 319-2097