HB2829.DOC

SECTION 1. The legislature finds that, according to the Consumer's Union, more Americans die each year from hospital-acquired infections than from automobile accidents and homicides combined. Furthermore, according to the Centers for Disease Control and Prevention, an estimated two million patients per year, or one of every twenty patients, contract an infection through a health procedure and about ninety thousand people die each year in the United States from infections contracted in the hospital, incurring a cost of some $4,500,000,000.

Statistics indicate that approximately five to ten per cent of all hospital patients develop infections, adding to hospital mortalities, length of stay, and costs. The risks for contracting an infection while hospitalized have steadily increased during recent decades. However, existing law and rules in Hawaii do not require hospitals to report infection rates. Thus, there is no means of comparison between hospitals and the public has no way of knowing if a particular hospital is doing a good job of minimizing infection risks. At least fourteen other states have enacted laws requiring public reporting of infection rates by hospitals.

The legislature also finds that the most expedient means of reducing hospital infection rates is to make information on infection rates public. For hospitals, there is no greater incentive to reduce infection rates than the need to respond to informed consumers demanding the quality of care they deserve.

The purpose of this Act is to require hospitals to report infection rates and to establish procedures for collecting information and disclosing it to the public.

SECTION 2. Chapter 321, Hawaii Revised Statutes, is amended by adding a new section to be appropriately designated and to read as follows:

"§321- Hospitals; infection rates reporting; quarterly and annual reports; advisory committee; methodology; rules; patient privacy; definitions. (a) Each hospital in the State shall collect and maintain records on hospital-acquired infection rates for specific clinical procedures determined by the department, including the causative pathogen if the infection is laboratory-confirmed, for the following categories:

(1) Surgical site infections;

(2) Ventilator-associated pneumonia;

(3) Central line-associated bloodstream infections;

(4) Catheter-associated urinary tract infections; and

(5) Other categories as determined by the department.

Each physician who performs a clinical procedure to be reported in accordance with this section shall report to the hospital at which the clinical procedure was performed a hospital-acquired infection that the physician diagnoses at a follow-up appointment with the patient. This information shall be included in the hospital reports required pursuant to subsection (b).

(b) Each hospital in the State shall submit quarterly reports on its hospital-acquired infection rates to the Centers for Disease Control and Prevention's National Healthcare Safety Network in accordance with its requirements and procedures. Reports shall be submitted by January 31, April 30, July 31, and October 31 of each year for the previous quarter. Data in the quarterly reports shall cover a period ending no earlier than one month prior to submission of the report. The first quarterly report shall be due no later than October 31, 2010. 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) The department shall annually submit to the legislature, by September 1 of each year, a report summarizing the hospital quarterly reports and shall publish the annual report on its website. The first annual report shall be submitted and published no later than November 1, 2011, and following that report, the department shall update the public information on a quarterly basis. All reports issued by the department shall:

(1) Be risk-adjusted, or use some other method to account for the differences in patient populations among hospitals;

(2) Compare hospital-acquired infection rates, collected under subsection (a), for each individual hospital in the State; provided that the department shall consult with the advisory committee to make this comparison as easy to comprehend as possible;

(3) Include an executive summary, written in plain language that shall include, but not be limited to, a discussion of findings, conclusions, and trends concerning the overall state of hospital-acquired infections in the State, including a comparison to prior years and, as appropriate, policy recommendations;

(4) Be publicized as widely as practical to interested parties, including, but not limited to, hospitals, providers, media organizations, health insurers, health maintenance organizations, purchasers of health insurance, organized labor, consumer or patient advocacy groups, and individual consumers; and

(5) Be made available to any person upon request.

(d) If a hospital is a division or subsidiary of another entity that owns or operates other hospitals or related organizations, the quarterly report shall be for the specific division or subsidiary and not for the other entity.

(e) The director of health shall establish and appoint an advisory committee that shall include representation from public and private hospitals, infection control professionals, direct care nursing staff, physicians, epidemiologists with hospital-acquired infection expertise, academic researchers, health insurers, health maintenance organizations, consumer organizations, organized labor, and purchasers of health insurance such as employers. The majority of the members of the advisory committee shall represent interests other than hospitals.

(f) The advisory committee shall assist the department in the development of all aspects of the department's methodology for collecting, analyzing, and disclosing the information collected pursuant to this section, including collection methods, formatting, and method and means for release and dissemination. In addition, the department and the advisory committee shall evaluate on a regular basis the quality and accuracy of hospital information reported pursuant to this section and the data collection, analysis, and dissemination methodologies. The department, after consultation with the advisory committee, may require hospitals to collect data on hospital-acquired infection rates in categories additional to those set forth in subsection (a).

(g) In developing the methodology for collecting and analyzing the infection rate data, the department and the advisory committee shall use the existing methodologies and system for data collection at the Centers for Disease Control and Prevention's National Healthcare Safety Network, or its successor. The data collection and analysis methodology shall be disclosed to the public.

(h) The department shall adopt rules under chapter 91 to effectuate the purposes of this section, including enforcing compliance with this section.

(i) No hospital report or department disclosure made available to the public shall contain information identifying a patient, employee, or licensed health care professional in connection with a specific infection incident.

(j) Nothing in this section shall be construed to authorize disclosure of confidential patient information or violation of a patient's right of confidentiality in any way. Patient social security numbers and any other information that could be used to identify an individual patient shall not be released notwithstanding any other provision of law.

(k) The department shall be responsible for ensuring compliance with the provisions of this section as a condition of licensure under section 321-14.5.

(l) Any hospital that violates the provisions of this section may be subject to:

(1) Termination of licensure or other sanctions relating to licensure by the department of health; and

(2) An administrative fine of up to $1,000 per day per violation.

(m) As used in this section:

"Department" means the department of health.

"Hospital" means a general or special hospital, nonprofit or for-profit, licensed by the department.

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

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

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

SECTION 3. Section 321-14.5, Hawaii Revised Statutes, is amended to read as follows:

"[[]§321-14.5[]] Hospitals; licensing. (a) All hospitals shall be licensed by the department to ensure the health, safety, and welfare of the individuals placed therein.

(b) The director shall adopt rules in accordance with chapter 91 that shall provide for the licensing of hospitals.

(c) The rules may provide that accreditation by the joint commission on accreditation of healthcare organizations demonstrates a hospital's compliance with all licensing inspections required by rules for the year in which the joint commission on accreditation of healthcare organizations accreditation is issued. The rules may exempt a hospital from a licensing inspection for the year in which a joint commission on accreditation of healthcare organizations accreditation is issued under the following conditions:

(1) The hospital provides a certified copy of the hospital's official joint commission on accreditation of healthcare organizations accreditation report to the department;

(2) The hospital holds full accreditation by the joint commission on accreditation of healthcare organizations; and

(3) The hospital holds a current and valid license.

(d) The rules shall provide that the department may conduct inspections and investigations of exempt hospitals to investigate complaints, follow up on adverse accreditation findings, or conduct periodic validation surveys.

(e) Information contained in reports of survey and official accreditation letters made by the joint commission on accreditation of healthcare organizations used in determining compliance with licensing requirements shall be public information.

(f) All other records maintained by the department shall be governed by chapter 92F.

(g) The rules shall provide for administrative fines, termination of licensure, and other sanctions for failure to comply with reporting of hospital-acquired infections pursuant to section 321- ."

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

SECTION 5. This Act shall take effect on July 1, 2010.

INTRODUCED BY:	_____________________________

HOUSE OF REPRESENTATIVES	H.B. NO.	2829
TWENTY-FIFTH LEGISLATURE, 2010
STATE OF HAWAII