BILL ANALYSIS                                                                                                                                                                                                    



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          Date of Hearing:  August 19, 2015


                        ASSEMBLY COMMITTEE ON APPROPRIATIONS


                                 Jimmy Gomez, Chair


          SB 361  
          (Hill) - As Amended August 17, 2015


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          Urgency:  Yes State Mandated Local Program:  YesReimbursable:   
          No


          SUMMARY:


          This bill, an urgency measure, contains two requirements  
          intended to combat antimicrobial resistance.  Specifically, this  
          bill:








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          1)Requires skilled nursing facilities (SNFs) to, by January  
            2017, adopt and implement antimicrobial stewardship policies;  
            requires compliance with related federal guidelines, and  
            allows for state citations for non-compliance.


          2)Requires a veterinarian who receives a license after January  
            1, 2018 to complete an approved course on the judicious use of  
            antibiotics every four years as part of existing continuing  
            education (CE) requirements.


          FISCAL EFFECT:


          1)Minor and absorbable costs to the Licensing and Certification  
            division of the California Department of Public Health (CDPH)  
            to verify SNF compliance with the new antimicrobial  
            stewardship policy requirement during the course of routine  
            inspections or on a complaint basis (Licensing and  
            Certification Fund). 


          2)Minor and absorbable costs to the Veterinary Medical Board to  
            approve required courses and verify compliance with the new CE  
            requirement (Veterinary Medical Board Fund). 


          3)Potential unknown, likely minor information technology costs  
            to both departments for system modifications to capture the  
            new requirements (Licensing and Certification Fund /Veterinary  
            Medical Board Contingent Fund).  


          COMMENTS:










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          1)Purpose. The author indicates the overuse and misuse of  
            antibiotics in medicine is a significant factor driving the  
            development of antibiotic resistance, a growing public health  
            threat.  This bill intends to ensure best practices in the use  
            of human and animal antibiotic administration to encourage  
            judicious use.  


          2)Antimicrobial Stewardship.  Antibiotics are credited with  
            significantly reducing morbidity and mortality associated with  
            bacterial infections.  Unfortunately, widespread use of  
            antibiotics has led to antibiotic resistance, which, according  
            to the World Health Organization (WHO), is an increasingly  
            serious threat to global public health. The WHO indicates  
            evolution of drug-resistant strains is a natural phenomenon,  
            but the use and misuse of antibiotics accelerates their  
            emergence. Drug-resistant infections are often difficult to  
            treat and can be deadly. The Centers for Disease Control and  
            Prevention (CDC) indicates at least 2 million people become  
            infected with resistant bacteria nationwide, and at least  
            23,000 people die as a direct result of these infections, each  
            year.  Antibiotic stewardship programs are designed to promote  
            and measure the appropriate use of antibiotics in a facility,  
            and are recommended by WHO, CDC, and DPH.  DPH provides  
            technical assistance to hospitals and other facilities to  
            implement local antimicrobial stewardship programs as part of  
            their Healthcare Acquired Infections program, and collects  
            data on these programs that are submitted on a voluntary  
            basis.


          3)Current Related Legislation.  SB 27 (Hill) restrict the use of  
            medically important antimicrobial drugs in livestock, require  
            a veterinarian's prescription or feed directive for use,  
            eliminate the over-the-counter availability of these drugs,  
            require the California Department of Food and Agriculture  
            (CDFA) to develop a program to track antimicrobial drug use in  
            livestock and the emergence of antimicrobial-resistant  
            bacteria, and require CDFA to adopt judicious use and  








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            antimicrobial stewardship guidelines.  


          4)Prior Related Legislation.  SB 1311 (Hill), Chapter 843,  
            Statutes of 2014, requires all general acute-care hospitals to  
            adopt and implement an antimicrobial stewardship policy that  
            includes a process to evaluate the judicious use of  
            antibiotics.  


          Analysis Prepared by:Lisa Murawski / APPR. / (916)  
          319-2081