SB170.DOC

SECTION 1. The legislature finds that there has been an alarming increase in drug-resistant staph infections. Until now, there has been no state requirement for reporting staph infections. As a result, disease trackers have had difficulty calculating the severity of the problem.

Staph infections have been a problem in hospitals for decades, but since the 1990s various strains of drug-resistant staph have been turning up outside the medical setting, afflicting a broad spectrum of society, from jail inmates and injection drug users to athletes, mothers and schoolchildren.

According to the Mayo Clinic, methicillin-resistant staphylococcus aureus (MRSA) is an infection caused by a strain of staph that is resistant to the broad-spectrum antibiotics commonly used to treat it. Methicillin-resistant staphylococcus aureus can be fatal.

Most methicillin-resistant staphylococcus aureus infections occur in hospitals or other health care settings, such as nursing homes and dialysis centers. It is known as "health care-associated methicillin-resistant staphylococcus aureus." Older adults and people with weakened immune systems are at most risk of health care-associated methicillin-resistant staphylococcus aureus.

More recently, another type of methicillin-resistant staphylococcus aureus has occurred among otherwise healthy people in the wider community. This form, community-associated methicillin-resistant staphylococcus aureus, is responsible for serious skin and soft tissue infections and for a serious form of pneumonia, for which a majority of the infections are treated in emergency rooms across the United States.

A landmark study in the Journal of the American Medical Association in October 2007 found that nearly sixty per cent of life-threatening methicillin-resistant staphylococcus aureus cases occurred among people who were infected within a year of having been hospitalized for any reason, and that an additional twenty-five per cent acquired their infections while they were patients in a hospital. Epidemiologists typically view these early infections as community-acquired, because it can take more than two days for a hospital-acquired bug to incubate.

The purpose of this Act is to protect the public health by reducing the incidence and spread of staph infections by requiring all physicians, health care professionals, and laboratory directors to report every incidence of an individual infected with staphylococcus aureus bacteria to the department of health. In addition, this Act establishes a permanent staph advisory committee to research and collect data on staphylococcus aureus infection rates in Hawaii, and to establish guidelines for education and monitoring of persons infected with staphylococcus aureus bacteria.

SECTION 2. Chapter 325, Hawaii Revised Statutes, is amended by adding a new section to be appropriately designated and to read as follows:

"§325- Staph advisory committee; establishment. (a) There is established within the department of health the staph advisory committee to consist of seven members, of which, one shall be the director of health or the director's designee, and six shall be from the clinical medical community statewide. The director shall be the chairperson of the committee. The members shall serve without compensation, but shall be reimbursed for reasonable expenses, including travel expenses, incurred in the performance of their duties.

(b) The committee shall adopt rules in accordance with chapter 91 as it may consider necessary for the conduct of its business.

(1) Establish standards and guidelines for the reporting, screening, identification, diagnosis, control, intervention, and monitoring of persons infected with staphylococcus aureus bacteria;

(2) Research and collect data on staphylococcus aureus infection rates in Hawaii, its causes, and the relationship of the use or overuse of antimicrobials to staphylococcus aureus infections;

(3) Collect and analyze data reported to the department of health in relation to the duties and responsibilities of the department; and

(4) Submit annual reports to the department of health on the reported incidences of staph infections and any recommendations."

SECTION 3. Section 325-2, Hawaii Revised Statutes, is amended to read as follows:

"§325-2 Physicians, laboratory directors, and health care professionals to report. Every physician or health care professional having a client affected by or suspected of being affected by a disease, staphylococcus aureus bacteria, or a condition declared to be communicable or dangerous to the public health by the director of health shall report the incidence or suspected incidence of [~~such~~] the disease or condition to the department of health in writing or in the manner specified by the department of health. Every laboratory director having laboratory data regarding an individual affected by or suspected of being affected by a disease, staphylococcus aureus bacteria, or a condition declared to be communicable or dangerous to the public health shall report [~~such~~] the diseases or conditions to the department of health in writing or in a manner specified by the health department. Every physician, laboratory director, or health care professional who refuses or neglects to give [~~such~~] the notice, or make [~~such~~] a report, as required by this section, may be fined in an amount not to exceed $1,000 per violation, to be assessed by the director of health. The director of health is authorized to impose the penalty pursuant to this section."

SECTION 4. Statutory material to be repealed is bracketed and stricken. New statutory material is underscored.

SECTION 5. This Act shall take effect upon its approval.

INTRODUCED BY:	_____________________________

THE SENATE	S.B. NO.	170
TWENTY-FIFTH LEGISLATURE, 2009
STATE OF HAWAII