BILL ANALYSIS �
SB 1311
Page 1
SENATE THIRD READING
SB 1311 (Hill)
As Amended August 7, 2014
Majority vote
SENATE VOTE : 35-0
HEALTH 17-0 APPROPRIATIONS 17-0
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|Ayes:|Pan, Maienschein, |Ayes:|Gatto, Bigelow, |
| |Bonilla, Bonta, Chesbro, | |Bocanegra, Bradford, Ian |
| |Gomez, Gonzalez, | |Calderon, Campos, |
| |Roger Hern�ndez, | |Donnelly, Eggman, Gomez, |
| |Lowenthal, Mansoor, | |Holden, Jones, Linder, |
| |Nazarian, Nestande, | |Pan, Quirk, |
| |Patterson, Ridley-Thomas, | |Ridley-Thomas, Wagner, |
| |Rodriguez, Wagner, | |Lowenthal |
| |Wieckowski | | |
| | | | |
|-----+--------------------------+-----+--------------------------|
| | | | |
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SUMMARY : Requires all general acute-care hospitals to adopt and
implement an antimicrobial stewardship policy (ASP) that
includes a process to evaluate the judicious use of antibiotics.
Specifically, this bill requires general acute care hospitals,
by July 1, 2015, to:
1)Adopt and implement an ASP in accordance with guidelines
established by the federal government and professional
organizations, which includes a process to evaluate the
judicious use of antibiotics.
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
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Healthcare Epidemiology of America, or similar recognized
professional organizations.
4)Report antimicrobial stewardship program activities to each
appropriate hospital committee undertaking clinical quality
improvement activities.
FISCAL EFFECT : According to the Assembly Appropriations
Committee, one-time costs of approximately $50,000, likely in
2017, to aggregate data collected through enforcement and
prepare a report on compliance (Licensing and Certification
Fund) and minor and absorbable ongoing costs to the Department
of Public Health (DPH) to oversee compliance among licensed
hospitals (Licensing and Certification Fund).
COMMENTS : 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 ASP and
only 22% said they were influenced by current law to develop a
stewardship program.
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
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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 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.
Analysis Prepared by : Lara Flynn / HEALTH / (916) 319-2097
FN: 0004401