BILL NUMBER: SB 1058 AMENDED
BILL TEXT
AMENDED IN SENATE MAY 23, 2008
AMENDED IN SENATE APRIL 15, 2008
AMENDED IN SENATE MARCH 26, 2008
AMENDED IN SENATE FEBRUARY 25, 2008
INTRODUCED BY Senator Alquist
JANUARY 7, 2008
An act to add Sections 1255.8 and 120141 to the Health and Safety
Code, relating to health.
LEGISLATIVE COUNSEL'S DIGEST
SB 1058, as amended, Alquist. Health facilities: bacterial
infections.
Existing law provides for the licensure and regulation of health
facilities by the State Department of Public Health. A violation of
these provisions is a crime.
This bill would establish the Medical Facility Infection Control
and Prevention Act, which would require hospitals to implement
certain procedures for the screening, prevention, and reporting of
specified health facility acquired infections. The bill
would also require a laboratory that is licensed by the state to
perform specified microbiological testing relating to the
identification of bacterial species and the antibiotic resistance
patterns of those species to also report any information obtained by
that laboratory on the incidence of any facility acquired infections
within 5 working days after obtaining the information.
The bill would also require specified laboratories to report
positive MRSA test results to the General Acute Care Licensing
Program. This bill would require the department to carry out
certain duties in order to implement the bill. Because a violation of
the health facility provisions is a crime, the bill would impose a
state-mandated local program.
Existing law permits the State Department of Public Health to take
various actions to prevent and control the spread of infectious
diseases in this state.
This bill would require the department to take various
measures to prevent, control, and monitor the spread of infectious
diseases, including the sponsoring of local and regional training,
the provision of assistance to local health departments, and the
development and implementation of develop and
implement various Internet-based reporting systems, as
prescribed. The bill would allow the department, using existing
state and federal resources, to provide various training and support
programs to local health departments and health officers.
This bill would also authorize the department, subject to
appropriation, to sponsor pilot studies to identify methods of
reducing facility acquired infections, as prescribed.
The California Constitution requires the state to reimburse local
agencies and school districts for certain costs mandated by the
state. Statutory provisions establish procedures for making that
reimbursement.
This bill would provide that no reimbursement is required by this
act for a specified reason.
Vote: majority. Appropriation: no. Fiscal committee: yes.
State-mandated local program: yes.
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. The Legislature finds and declares all of the
following:
(a) (1) The protection of patients in California health facilities
is of paramount importance to the citizens of this state.
(2) During the past two decades health care facility associated
infections, especially those that are resistant to commonly used
antibiotics, have increased dramatically.
(3) The State Department of Public Health needs to develop a
better, more efficient system to monitor and report the incidence of
antibiotic-resistant and other infections that are acquired by
patients in health facilities.
(4) The department needs to establish and maintain a comprehensive
inspection and reporting system for health facilities that will
ensure that those facilities comply with state laws and regulations
designed to reduce the incidence of facility associated infections.
(b) It is, therefore, the intent of the Legislature to enact
legislation that will do all of the following:
(1) Ensure that California's standards for protecting patients
from exposure to pathogens in health facilities, including
Methicillin-resistant Staphylococcus aureus (MRSA), are adequate to
reduce the incidence of antibiotic-resistant infection acquired by
patients in these facilities.
(2) Require these departments to develop and implement an
Internet-based public reporting system that provides updated
information regarding the incidence of infections, including
associated pathogens acquired in health facilities, as well as the
number of infection control personnel relative to the number of
licensed beds.
(3) Ensure that health facilities implement improved procedures
intended to maintain sanitary standards in these facilities, avoid
transmission of pathogens that cause infection, and provide adequate
training to health care professionals regarding the prevention and
treatment of MRSA and other infections in these facilities.
SEC. 2. This act shall be known, and may be cited as, the Medical
Facility Infection Control and Prevention Act.
SEC. 3. Section 1255.8 is added to the Health and Safety Code, to
read:
1255.8. (a) For purposes of this section, the following terms
have the following meanings:
(1) "Colonized" means that a pathogen is present on the patient's
body, but is not causing any signs or symptoms of an infection.
(2) "Health facility" means a facility licensed as defined in
subdivision (a), (b), or (f) of Section 1250.
(3) "Health facility acquired infection" means a
localized or systemic condition resulting from an adverse reaction to
the presence of an infectious agent not present or incubating at the
time of admission to the health facility. health care
associated infection, as defined by the federal Centers for Disease
Control and Prevention as any localized or systemic condition
resulting from an adverse reaction to an infectious agent or its
toxin that both occurs in a patient in a hospital and was found not
to be present or incubating in that patient at the time of admission
to the hospital, unless the infection was related to a previous
admission to the same hospital, or as defined by the department in
regulation.
(4) "MRSA" means Methicillin-resistant Staphylococcus aureus.
(b) (1) Each health facility shall develop, implement, and
periodically evaluate procedures for identifying patients who are
colonized by, or infected with, MRSA.
(2) Each health facility shall, in accordance with subdivision
(d), implement a procedure to screen each patient who is scheduled to
undergo an inpatient or outpatient surgery, or who is admitted to an
intensive care unit, burn unit, or other unit at high risk for the
presence of MRSA. Test results shall be provided to each
If a patient tests positive for MRSA, the attending
physician shall inform the patient or each
patient's surrogate immediately, or as soon as practically possible.
For individuals testing positive for colonization, but not for
infection, with MRSA, information shall be provided by the health
care provider at discharge describing MRSA, its care, and how to
avoid spreading MRSA to others. Additional information on wound care
and ways to prevent the spread of MRSA shall be provided, upon
discharge, to patients who test positive for an infection caused by
MRSA.
(c) Each patient who is admitted to a general acute care hospital
shall be screened for MRSA in the following cases:
(1) The patient presents with an open, nondraining wound,
cellulitis, dermatological lesions, or a pressure ulcer on the skin.
(2)
(1) The patient has been previously discharged from a
general acute care hospital within 30 days prior to the current
hospital admission.
(3)
(2) The patient will be admitted to an intensive care
unit of the hospital.
(4)
(3) The patient receives inpatient or outpatient
dialysis treatment.
(5)
(4) The patient is being transferred from a
rehabilitation or skilled nursing facility.
(6) The patient is homeless or is being admitted directly from a
homeless shelter.
(7) The patient is being admitted directly from prison.
(8) The patient is a hospital roommate of another patient who has
tested positive for MRSA.
(9) The patient has a prior history of MRSA infection.
(10) The patient is an intravenous drug user.
(5) The patient has other risk factors as determined by the
department, taking into account the recommendations of the federal
Centers for Disease Control and Prevention.
(d) A patient screened in accordance with subdivision (c) shall
again be tested for MRSA immediately prior to his or her discharge
from the facility. A patient who tests positive for MRSA pursuant to
this paragraph subdivision shall not be
discharged from the facility until a licensed medical
professional the attending physician determines
that the patient's infection can be controlled and
does not pose a threat to the health and safety of others.
(e) Each health facility shall take all reasonable measures to
maintain a clean and sanitary environment, that, at a minimum, shall
include all of the following:
(1) Regular disinfection of all restrooms, countertops, furniture,
televisions, telephones, bedding, office equipment, and surfaces in
patient rooms, nursing stations, and storage units.
(2) Regular removal of accumulations of bodily fluids and
intravenous substances, and cleaning and disinfection of all movable
medical equipment, including point-of-care testing devices such as
glucometers, and transportable medical devices such as cardiac
monitors, gurneys, feeding pumps, storage containers, and medication
dispensing devices.
(3) Regular cleaning and disinfection of all surfaces in common
areas in the facility such as elevators, meeting rooms, and lounges.
(f) (1) Each health facility shall maintain one infection control
staff person for every 100 licensed beds at the facility who shall be
responsible for the implementation of infection control programs.
(2) An infection control staff person required to be employed by a
health facility pursuant to paragraph (1) shall be a properly
licensed registered nurse or other qualified infection control
professional.
(g) Each health facility shall regularly report to the department
all cases of a health facility acquired infection, including
identification of the pathogen causing each infection. The department
shall make those statistics pertaining to health facility acquired
infection rates at specified health facilities available on its
Internet Web site. This information shall be public and shall include
the rate of infections caused by MRSA and other pathogens.
(h) In accordance with Section 2505 of Title 17 of the California
Code of Regulations, each laboratory licensed by the state to perform
microbiological testing, including, but not limited to, routine
culture and antibiotic resistance testing, or biochemical,
biological, genetic or other assays to determine bacterial species
identification and the antibiotic resistance patterns of those
species shall also report any information obtained by that laboratory
pertaining to the discovery or the incidence of any health facility
acquired infections, including MRSA, within five working days after
obtaining the information.
(h) Laboratories located within facilities specified in paragraph
(2) of subdivision (a) of Section 1255.8 that process a positive test
for MRSA shall notify the General Acute Care Licensing Program.
SEC. 4. Section 120141 is added to the Health and Safety Code, to
read:
120141. The department shall take all of the following measures
to prevent, control, and monitor the spread of infectious diseases:
(a) Sponsor local and regional training on basic data analysis to
better prepare local health departments to control and track disease
outbreaks.
(b) Provide local health departments and local health officers
with an inventory of basic electronic disease investigation data
analysis software.
(c) Develop statewide exercises that emphasize the complete cycle
involving communicable disease investigation, including surveillance,
response investigation, disease control and recovery, and that
assist local health officers to enhance, improve, and evaluate the
responses of local health departments to disease outbreaks.
120141. The department's General Acute Care
Hospitals Licensing Program shall do all of the following:
(d)
(a) Beginning January 1, 2010, develop and implement
through a phased implementation schedule, an Internet-based public
reporting system that provides updated, easily understood consumer
information regarding the relative incidence of central line
associated blood stream infections, including associated pathogens,
acquired at each health facility in California, including information
on the number of licensed beds, the number of infection control
personnel employed at the facility, and a working toll-free telephone
number for customers to call for more information on the facility's
infection control and prevention initiatives.
(e)
(b) Beginning January 1, 2011, develop and implement
through a phased implementation schedule, an Internet-based public
reporting system that provides updated, easily understood consumer
information regarding the relative incidence of surgical site
infections, including associated pathogens, acquired at each health
facility in California, including information on the number of
licensed beds, the number of infection control personnel employed at
the facility, and a working toll-free telephone number for customers
to call for more information on the facility's infection control and
prevention initiatives.
(f) Beginning January 1, 2012
(c) Once standard definitions for
ventilator acquired pneumonia and catheter acquired urinary tract
infection have been developed , develop and implement through a
phased implementation schedule, an Internet-based public reporting
system that provides updated, easily understood consumer information
regarding incidence of ventilator acquired pneumonia and catheter
acquired urinary tract infections acquired at each health facility in
California, including information on the number of licensed beds,
the number of infection control personnel employed at the facility,
and a working toll-free telephone number for customers to call for
more information on the facility's infection control and prevention
initiatives.
(g)
(d) The public reports required in subdivisions
(d), (e), and (f) (a), (b), and (c)
shall follow the National Healthcare Safety Network (NHSN) risk
adjustment and, when possible, utilize NHSN definitions.
(h)
(e) The State Department of Public Health may, upon
appropriation, in the Budget Act or other statute sponsor pilot
studies to identify methods to reduce health facility acquired
infections. These studies should include the establishment of
explicit ratios of infection control personnel to licensed beds in a
health facility, enhanced Medi-Cal reimbursement strategies, and
other methods.
(f) The department may, at its discretion, by using existing state
or federal resources, sponsor local and regional training to do any
of the following:
(1) Teach basic data analysis to better prepare local health
departments to control and track disease outbreaks.
(2) Provide local health departments and local health officers
with an inventory of basic electronic disease investigation data
analysis software.
(3) Develop statewide exercises that emphasize the complete cycle
involving communicable disease investigation, including surveillance,
response investigation, disease control and recovery, and that
assist local health officers to enhance, improve, and evaluate the
response of local health departments to disease outbreaks.
SEC. 5. No reimbursement is required by this act pursuant to
Section 6 of Article XIII B of the California Constitution because
the only costs that may be incurred by a local agency or school
district will be incurred because this act creates a new crime or
infraction, eliminates a crime or infraction, or changes the penalty
for a crime or infraction, within the meaning of Section 17556 of the
Government Code, or changes the definition of a crime within the
meaning of Section 6 of Article XIII B of the California
Constitution.