BILL ANALYSIS �
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