THE SENATE	S.B. NO.	184
TWENTY-SIXTH LEGISLATURE, 2011
STATE OF HAWAII

A BILL FOR AN ACT

relating to health.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:

     SECTION 1.  Hospital-acquired infections are costly to both the health care system and individual patients.  Antibiotic resistant superbugs such as methicillin-resistant staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE) are frequently spread through hospital-based infection and can cause serious illness and death.  A 2007 medical study conducted by the Association for Professionals in Infection Control and Epidemiology found MRSA colonization and infection were more prevalent in Hawaii than anywhere else in the nation, occurring at twice the national average rate.

     Hospitals throughout the United States have demonstrated that certain prevention practices can dramatically reduce hospital-acquired infections including central line-related blood stream infection, surgical-site infection, ventilator-associated pneumonia, and catheter-related urinary tract infections.  Practices such as screening new patients to identify, isolate, and decolonize infected persons; practicing strict hand hygiene; using contact precautions such as gloves, gowns, and masks; and disinfecting environment and equipment have proven to be effective.

     The purpose of this Act is to:

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

     (2)  Establish an advisory committee within the department of health to assist in the development of a methodology for collecting, analyzing, and publicly reporting 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 the department's website; and

     (4)  Require hospitals and medical facilities to implement hospital-acquired infection prevention programs as 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 PREVENTION

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

     "Department" means the department of health.

     "Hospital" means the entities listed in section 321-11(10).

     "Hospital-acquired infection" means invasion by and multiplication of a pathogenic microorganism including methicillin-resistant staphylococcus aureus, vancomycin-resistant enterococci, clostridium difficile, and acinetobacter baumannii in a bodily part or tissue which may produce disease or tissue injury; provided that the relevant pathogen was neither present nor incubating in the infected patient at the time of admission to a hospital.

§323-B  Reporting requirements; health care providers.  (a)  Beginning January 1, 2012, each hospital in the State shall report to the department, in a manner and at intervals determined by the department by rule adopted pursuant to chapter 91, information concerning:

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

     (2)  Hand hygiene compliance rates reported in the aggregate and by individual hospital unit; and

     (3)  Other information that the department determines to be relevant.

     (b)  The department may require hospitals to report information required under subsection (a) to the National Healthcare Safety Network of the Centers for Disease Control and Prevention and to authorize the department access to hospital-specific data contained in the National Healthcare Safety Network database.

     (c)  Beginning January 1, 2012, each physician, osteopathic physician, nurse practitioner, podiatrist, and dentist who has performed any clinical procedure in a hospital shall report to the department, in a manner and at intervals determined by the department by rule adopted pursuant to chapter 91:

     (1)  The specific procedure performed; and

     (2)  Whether or not the physician, osteopathic physician, nurse practitioner, podiatrist, or dentist diagnosed the patient with a hospital-acquired infection at the time of the procedure or at a later time.

§323-C  Department's annual report.  (a)  No later than January 5 of each year, the department shall submit to the governor and to the legislature an annual report containing information pertaining to hospital-acquired infection for the previous calendar year.  A report submitted pursuant to this section shall include the following information for each hospital in the State:

     (1)  The number and rate of the following categories of infections:

          (A)  Surgical site infections;

         (B)  Ventilator-associated pneumonia;

         (C)  Central line-associated blood stream infections;

         (D)  Catheter-related urinary tract infections;

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

         (F)  Other categories as determined by the advisory committee pursuant to section 323-D;

     (2)  The hand hygiene compliance rate; and

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

     (b)  The department shall publish reports prepared pursuant to this section on a publicly-accessible portion of the department's official website and through any other means that the advisory committee, acting pursuant to section 323-D, directs in order to ensure access by the general public.  All reports prepared pursuant to this section 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.

     (c)  No report prepared pursuant to this section shall contain any information that is protected from disclosure by state or federal law.

§323-D  Advisory committee.  (a) The department shall appoint an advisory committee, which shall be exempt from the requirements of section 26-34, to assist the department in the administration of this part.  The advisory committee shall include 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; provided that the majority of members shall represent interests other than hospitals.

     (b)  The advisory committee shall assist the department in developing and periodically updating the department's methodology and policies for collecting, analyzing, and reporting the information contained in the department's annual report published pursuant to section 323-C.  In developing methodologies and systems for data collection under this subsection, the advisory committee shall consider existing industry-standard practices, including those employed by the National Health Care Safety Network of the Centers for Disease Control.

     (c)  The advisory committee shall assist the department in developing, implementing, and monitoring the hospital-acquired infection prevention program as provided by section 323-E.

§323-E  Hospital-acquired infection prevention program.  (a) Each hospital in this State shall implement a hospital-acquired infection prevention program.  A program adopted pursuant to this section shall be implemented by March 31, 2012, in priority units, including intensive care units, surgical units, and other units where there is significant risk of hospital-acquired infections.  Other units of each hospital shall be incorporated into the program by no later than June 30, 2013. 

     (b)  Each hospital-acquired infection prevention program shall consider input from hospital personnel with direct service-delivery experience, shall apply guidelines published by the Society for Health Care Epidemiology of America in the May 2003 edition of Infection Control & Hospital Epidemiology, and shall include the following strategies:

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

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

     (3)  Use of contact precautions for methicillin-resistant staphylococcus aureus-colonized and -infected patients;

     (4)  Implementation of a hand hygiene program with measures for monitoring strict adherence, including unannounced oversight of personnel;

     (5)  Collection and analysis of patient cultures for methicillin-resistant staphylococcus aureus upon discharge from a hospital or transfer from a unit for the purpose of identifying colonized and infected patients upon readmission to the hospital or unit;

     (6)  Publication and dissemination of a written infection prevention and control policy; and

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

§323-F  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 of health 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] exposure, disturbance, or removal of [these] bodies from their place of burial[, or]; the opening, [removing, or disturbing] removal, or disturbance 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 specification of 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, home care agencies, hospices, freestanding birthing facilities, adult day health centers, independent group residences, and therapeutic living programs[, but excluding]; provided that this paragraph shall not apply to 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 [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 those built under federal funding;

    (12)  Laboratories;

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

    (14)  Milk;

    (15)  Poisons and hazardous substances[, the latter term] including any substance or mixture of substances that:

         (A)  Is corrosive;

         (B)  Is an irritant;

         (C)  Is a strong sensitizer;

         (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)  [[Device]] Devices as defined in section 328-1;

    (21)  Sources of ionizing radiation;

    (22)  Medical examination, vaccination, revaccination, and immunization of school children[.  No]; provided that 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]; provided further that 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 that 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 of health 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 the new sections added by section 2 of this Act, the revisor of statutes shall substitute appropriate section numbers for the letters used in designating the new sections 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:

_____________________________

Report Title:

Hospital-Acquired Infection; Department of Health

Description:

Requires hospitals to implement measures to prevent the spread of certain hospital-acquired infections; creates reporting requirements for hospitals and other health care providers; creates information-gathering, public disclosure, and oversight requirements for the department of health.

The summary description of legislation appearing on this page is for informational purposes only and is not legislation or evidence of legislative intent.