SB1261.DOC

SECTION 1. According to the Centers for Disease Control and Prevention, every year almost two million patients are infected while hospitalized and ninety-eight thousand of those patients die. This is more than the number of deaths caused by auto accidents and homicides combined. The costs are estimated to add $27,500,000,000 to hospital expenses each year. In 2005, of the infected patients, the Centers for Disease Control and Prevention estimated that 94,360 patients developed serious methicillin-resistant staphylococcus aureus (commonly known as MRSA) and nineteen thousand of them died, exceeding the number of annual acquired immune deficiency syndrome-related deaths in the United States.

Hospital-acquired infections include antibiotic resistant superbugs, such as MRSA and vancomycin-resistant enterococci (commonly known as VRE). As of 2007, about eighty-five per cent of all invasive MRSA infections were associated with health care delivery. Of those infections, approximately two-thirds occurred outside of the hospital and one-third occurred during hospitalization.

According to a local television news story of October 19, 2007, Hawaii's tropical paradise is also home to bacteria that cause infections. Methicillin-resistant staphylococcus aureus, the deadliest strain, may go to the heart or lungs after entering the body and may cause death, according to a University of Hawaii John A. Burns school of medicine infectious disease specialist. Although the bacteria that causes staphylococcus infection has been around for thousands of years, a 2007 medical study conducted by the Association for Professionals in Infection Control and Epidemiology found a disturbing trend in MRSA cases in Hawaii. Upon review of all the states, Hawaii ranked the worst in terms of the prevalence rate of patients with MRSA colonization and infection. In fact, Hawaii has twice the national average. Methicillin-resistant staphylococcus aureus is so serious, it has overtaken other well-known diseases, killing people as quickly as acquired immune deficiency syndrome in many respects and many other diseases as well.

Hospitals throughout the United States have demonstrated that using evidence-based prevention practices can dramatically reduce central line-related blood stream infection, surgical-site infection, ventilator-associated pneumonia, and catheter-related urinary tract infections. Evidence-based interventions, including utilizing practices such as screening new patients to identify those colonized with MRSA, isolating and decolonizing the patients identified, practicing strict hand hygiene, using contact precautions (gloves, gowns, and masks), and disinfecting the environment and equipment, can also contribute to the prevention of MRSA.

The purpose of this Act is to:

(1) Establish reporting requirements for hospitals, medical facilities, and certain medical professionals regarding hospital-acquired infections;

(2) Require the department of health to appoint an advisory committee to assist the department in the development of all aspects of the department's methodology for collecting, analyzing, and publicly disclosing information collected on hospital-acquired infections;

(3) Require the department of health to report annually to the legislature and the governor regarding hospital-acquired infections and to post the report on its website; and

(4) Require hospitals and medical facilities to implement hospital-acquired infection prevention programs that include strategies specified by this Act.

SECTION 2. Chapter 323, Hawaii Revised Statutes, is amended by adding a new part to be appropriately designated and to read as follows:

"Part . HOSPITAL-ACQUIRED

INFECTION DISCLOSURE AND HOSPITAL-ACQUIRED INFECTION PREVENTION

§323-A Definitions. As used in this part:

"Department" means the department of health.

"Hospital" shall include the same entities as referred to in section 321-11(10).

"Hospital-acquired infection" means a localized or systemic condition that:

(1) Results from adverse reaction to the presence of an infectious agent or its toxins; and

(2) Was not present or incubating at the time of admission of a patient to a hospital.

The term includes methicillin-resistant staphylococcus aureus, vancomycin-resistant enterococci, clostridium difficile, and acinetobacter baumannii infections.

§323-B Reporting requirements, hospital and departmental. (a) Beginning January 1, 2010, in a format and at intervals as required thereafter by the department, each hospital shall report to the department the information concerning:

(1) Incidents of hospital-acquired infection occurring at that hospital, including the pathogen causing the infection;

(2) Hand hygiene compliance rates, provided that the rate shall reflect compliance throughout the hospital as well as by hospital unit; and

(3) Other information as the department may determine to be relevant.

(b) The department may require hospitals to report information required under subsection (a) to the Centers for Disease Control and Prevention, the National Healthcare Safety Network, or its successor. If required, hospitals shall authorize the department to have access to hospital-specific data contained in the National Healthcare Safety Network database consistent with the requirements of this section.

(c) Beginning January 1, 2010, in a format and at intervals as required thereafter by the department, every physician, osteopathic physician, podiatrist, and dentist that has performed a clinical procedure in a hospital during the relevant time period shall report to the department information on the specific procedure performed and any diagnosis of hospital-acquired infection that the physician, osteopathic physician, podiatrist, or dentist diagnoses on a follow-up appointment or subsequent hospital visit.

(d) Based upon the information acquired under subsections (a) and (c), the department shall calculate the infection rates for the following categories of infection:

(1) Surgical site infections;

(2) Ventilator-associated pneumonia;

(3) Central line-associated blood stream infections;

(4) Catheter-related urinary tract infections;

(5) Methicillin-resistant staphylococcus aureus, vancomycin-resistant enterococci, clostridium difficile, and acinetobacter baumannii; and

(6) Other categories as may be determined by the advisory committee under section 323-C.

(e) The department shall submit an annual report, no later than January 5 of each year, to the governor and legislature containing information pertaining to the immediate preceding year on hospital-acquired infection, as follows:

(1) The infection rate calculated under subsection (d) for each hospital in the State, accounting for differences in patient populations among hospitals;

(2) The hand hygiene compliance rate; and

(3) A comparison of hospital-acquired infection rates among hospitals in the State.

The department shall make the report available on its website to the general public. The report shall be prepared on the advice, format, and recommendation of the advisory committee under section 323-C, provided that the report shall be written in plain language and shall include an executive summary, findings, conclusions, recommendations, and trends concerning the overall state of hospital-acquired infections in this State. Each hospital shall make the report available to the public upon the request of any patient or potential patient.

(f) No report under this section shall disclose confidential information, patient identification information, social security numbers, or any information prohibited from disclosure by law.

§323-C Advisory committee. (a) The department shall appoint an advisory committee, exempt from section 26-34, to assist the department in the development and periodic updating of all aspects of the department's methodology for collecting, analyzing, and disclosing the information required to be reported by hospitals under this part, including but not limited to, collection methods, formatting, and methods and means for release and dissemination of infection rates.

The advisory committee shall also assist the department in developing, implementing, and monitoring the hospital-acquired infection prevention program under section 323-D. In advising the department on section 323-D, the advisory committee shall apply guidelines prepared by The Society for Health Care Epidemiology of America, as published in the "Infection Control & Hospital Epidemiology", May 2003 issue.

(b) The advisory committee shall consist of representatives of public and private hospitals, infection control preventionists, direct care nursing staff, physicians, epidemiologists with expertise in hospital-acquired infections, academic researchers, consumer organizations, health insurers, health maintenance organizations, organized labor, and large purchasers of health insurance such as employers. The majority of the members shall represent interests other than hospitals.

(c) In developing the department's methodology under subsection (a), the advisory committee shall consider existing methodologies and systems for data collection, including the Centers for Disease Control and Prevention's national healthcare safety network.

§323-D Hospital-acquired infection prevention program. (a) No later than March 31, 2010, each hospital shall implement a hospital-acquired infection prevention program with priority given to the hospital's intensive care unit and surgical unit, or other unit where there is significant risk of hospital-acquired infections. Thereafter, other units of each hospital shall be incorporated into the program by no later than June 30, 2011.

(b) The hospital-acquired infection prevention program shall include the following strategies:

(1) Identification of methicillin-resistant staphylococcus aureus-colonized and -infected patients upon admission using active surveillance culture;

(2) Isolation of methicillin-resistant staphylococcus aureus-colonized and -infected patients in an appropriate manner;

(3) Contact precautions for patients found to test positive for methicillin-resistant staphylococcus aureus colonization and patients with methicillin-resistant staphylococcus aureus infections, as defined by the Centers for Disease Control and Prevention;

(4) A hand hygiene program and measures for strict adherence to hand hygiene, with oversight of personnel so that they are observed without their knowledge of the observation;

(5) Collection of patient cultures for methicillin-resistant staphylococcus aureus upon discharge or transfer from a unit that is implementing an infection prevention program and flagging colonized and infected patients who subsequently are readmitted to the hospital;

(6) A written infection prevention and control policy, formulated with input from frontline caregivers in the hospital; and

(7) A worker education requirement regarding modalities of transmission of hospital-acquired infection, use of protective equipment, disinfection policies and procedures, and other preventive measures.

§323-E Penalty. A violation of this part by a hospital shall be deemed grounds for suspension of a hospital's license or other disciplinary action by the department."

SECTION 3. Section 321-11, Hawaii Revised Statutes, is amended to read as follows:

"§321-11 Subjects of health rules, generally. The department pursuant to chapter 91 may adopt rules that it deems necessary for the public health and safety respecting:

(1) Nuisances, foul or noxious odors, gases, vapors, waters in which mosquitoes breed or may breed, sources of filth, and causes of sickness or disease, within the respective districts of the State, and on board any vessel;

(2) Adulteration and misbranding of food or drugs;

(3) Location, air space, ventilation, sanitation, drainage, sewage disposal, and other health conditions of buildings, courts, construction projects, excavations, pools, watercourses, areas, and alleys;

(4) Privy vaults and cesspools;

(5) Fish and fishing;

(6) Interments and dead bodies;

(7) Disinterments of dead human bodies, including the exposing, disturbing, or removing of these bodies from their place of burial, or the opening, removing, or disturbing after due interment of any receptacle, coffin, or container holding human remains or a dead human body or a part thereof and the issuance and terms of permits for the aforesaid disinterments of dead human bodies;

(8) Cemeteries and burying grounds;

(9) Laundries, and the laundering, sanitation, and sterilization of articles including linen and uniforms used by or in the following businesses and professions: barber shops, manicure shops, beauty parlors, electrology shops, restaurants, soda fountains, hotels, rooming and boarding houses, bakeries, butcher shops, public bathhouses, midwives, masseurs, and others in similar calling, public or private hospitals, and canneries and bottling works where foods or beverages are canned or bottled for public consumption or sale; provided that nothing in this chapter shall be construed as authorizing the prohibiting of laundering, sanitation, and sterilization by those conducting any of these businesses or professions where the laundering or sterilization is done in an efficient and sanitary manner;

(10) Hospitals, freestanding surgical outpatient facilities, skilled nursing facilities, intermediate care facilities, adult residential care homes, adult foster homes, assisted living facilities, special treatment facilities and programs, home health agencies, hospices, freestanding birthing facilities, adult day health centers, independent group residences, and therapeutic living programs, but excluding youth shelter facilities unless clinical treatment of mental, emotional, or physical disease or handicap is a part of the routine program or constitutes the main purpose of the facility, as defined in section 346-16 under "child [~~care~~] caring institution". For the purpose of this paragraph, "adult foster home" has the same meaning as provided in section 321-11.2;

(11) Hotels, rooming houses, lodging houses, apartment houses, tenements, and residences for persons with developmental disabilities including, but not limited to, those built under federal funding;

(12) Laboratories;

(13) Any place or building where noisome or noxious trades or manufacturers are carried on, or intended to be carried on;

(14) Milk;

(15) Poisons and hazardous substances, the latter term including but not limited to any substance or mixture of substances which:

(A) Is corrosive;

(B) Is an irritant;

(D) Is inflammable; or

(E) Generates pressure through decomposition, heat, or other means,

if the substance or mixture of substances may cause substantial personal injury or substantial illness during or as a proximate result of any customary or reasonably foreseeable handling or use, including reasonably foreseeable ingestion by children;

(16) Pig and duck ranches;

(17) Places of business, industry, employment, and commerce, and the processes, materials, tools, machinery, and methods of work done therein; and places of public gathering, recreation, or entertainment;

(18) Any restaurant, theater, market, stand, shop, store, factory, building, wagon, vehicle, or place where any food, drug, or cosmetic is manufactured, compounded, processed, extracted, prepared, stored, distributed, sold, offered for sale, or offered for human consumption or use;

(19) Foods, drugs, and cosmetics, and the manufacture, compounding, processing, extracting, preparing, storing, selling, and offering for sale, consumption, or use of any food, drug, or cosmetic;

(20) Devices as defined in section 328-1;

(21) Sources of ionizing radiation;

(22) Medical examination, vaccination, revaccination, and immunization of school children. No child shall be subjected to medical examination, vaccination, revaccination, or immunization, whose parent or guardian objects in writing thereto on grounds that the requirements are not in accordance with the religious tenets of an established church of which the parent or guardian is a member or adherent, but no objection shall be recognized when, in the opinion of the department, there is danger of an epidemic from any communicable disease;

(23) Disinsectization of aircraft entering or within the State as may be necessary to prevent the introduction, transmission, or spread of disease or the introduction or spread of any insect or other vector of significance to health;

(24) Fumigation, including the process by which substances emit or liberate gases, fumes, or vapors which may be used for the destruction or control of insects, vermin, rodents, or other pests, which, in the opinion of the department, may be lethal, poisonous, noxious, or dangerous to human life;

(25) Ambulances and ambulance equipment;

(26) Development, review, approval, or disapproval of management plans submitted pursuant to the Asbestos Hazard Emergency Response Act of 1986, Public Law 99‑519; [~~and~~]

(27) Development, review, approval, or disapproval of an accreditation program for specially trained persons pursuant to the Residential Lead-Based Paint Hazard Reduction Act of 1992, Public Law 102-550[.]; and

(28) Hospital-acquired infection prevention and reporting.

The department may require any certificates, permits, or licenses that it may deem necessary to adequately regulate the conditions or businesses referred to in this section."

SECTION 4. In codifying this Act, the revisor shall substitute the appropriate numbers for the letter designations used in this Act.

SECTION 5. Statutory material to be repealed is bracketed and stricken. New statutory material is underscored.

SECTION 6. This Act shall take effect upon its approval.

INTRODUCED BY:	_____________________________

THE SENATE	S.B. NO.	1261
TWENTY-FIFTH LEGISLATURE, 2009
STATE OF HAWAII