SENATE BILL REPORT

ESHB 1123

This analysis was prepared by non-partisan legislative staff for the use of legislative members in their deliberations. This analysis is not a part of the legislation nor does it constitute a statement of legislative intent.

As Reported by Senate Committee On:

Health & Long-Term Care, March 26, 2009

Title: An act relating to reducing the spread of methicillin-resistant staphylococcus aureus.

Brief Description: Reducing the spread of multidrug resistant organisms.

Sponsors: House Committee on Health Care & Wellness (originally sponsored by Representatives Campbell, Morrell, Hunter, Pedersen, Chase, Ormsby, Simpson, Wood and Conway).

Brief History: Passed House: 3/09/09, 97-0.

Committee Activity: Health & Long-Term Care: 3/25/09, 3/26/09 [DPA].

SENATE COMMITTEE ON HEALTH & LONG-TERM CARE

Majority Report: Do pass as amended.

Signed by Senators Keiser, Chair; Franklin, Vice Chair; Pflug, Ranking Minority Member; Becker, Fairley, Marr, Murray and Parlette.

Staff: Edith Rice (786-7444)

Background: Methicillin-Resistant Staphylococcus Aureus. Staphylococcus aureus, or "staph," are bacteria that live on the skin and can cause infections ranging from pimples or boils to more serious infections of the internal organs. The majority of staph infections are minor and do not require treatment with antibiotics. More severe staph infections, however, are often treated with antibiotics. Methicillin-resistant staphylococcus aureus (MRSA) is a strain of staph that has become resistant to methicillin and other antibiotics.

MRSA is spread by touch or contact and can enter the body through cuts or surgical incisions. MRSA can lead to a range of health consequences from minor skin infections to more serious infections of organs and bones. Most MRSA infections are acquired in hospitals and other health care settings, but the number of MRSA infections acquired in the community has been increasing.

The Incidence of MRSA. In 2007 the Centers for Disease Control and Prevention (CDC) estimated that approximately 94,360 people nationwide developed a serious MRSA infection in 2005. Of these people, the CDC estimated that approximately 18,650 died during a hospital stay related to the infection.

In Washington, the Department of Health (DOH) and local health jurisdictions have issued a variety of reports relating to MRSA, which all indicate that the incidence of MRSA in Washington is increasing. For example, data collected by the DOH from hospitals and laboratories participating in Washington's Antibiotic Resistance Sentinel Network indicated that the percentage of staph infections identified as MRSA increased from 28 percent to 43 percent between 2002 and 2004. Data collected by several counties from hospitals, long-term care facilities, and outpatient clinics indicated that the rates of MRSA infections increased between 2003 and 2006.

More recently, in November of 2007, the Governor asked the DOH to monitor for invasive MRSA infections through voluntary lab reporting. Although the monitoring project confirmed that MRSA infections are occurring statewide, the DOH found that the utility of the data was limited. For example, the DOH found that it was impossible to use the data to calculate the total incidence of MRSA in the general population, to determine the severity of a given infection, or to determine whether a given patient was hospitalized.

In 2008 the DOH began to require hospitals to report incidences of MRSA through its Comprehensive Abstract Reporting System (CHARS). The CHARS collects data on patients discharged from a hospital. Information from the CHARS is used to help public health personnel, consumers, purchasers, payers, providers, and researchers make informed decisions regarding health care and health care policy.

Public Education About MRSA. The DOH has developed a variety of materials to educate the public about MRSA. For example, the DOH collaborated with the Tacoma-Pierce County Health Department, Group Health Cooperative, and Multi-Care Health Systems to create a "Living with MRSA" booklet. The booklet contains a variety of information on MRSA including how it is transmitted, how it is treated, and how a person with MRSA should care for himself or herself. The DOH has also developed a fact sheet regarding MRSA skin infections, which includes information on how to prevent the spread of the infection.

Hospital Polices on Infection Control. The DOH, by rule, requires hospitals to develop and implement an infection-control program, which must include written policies and procedures that are consistent with CDC guidelines. The policies must be specific to service areas when appropriate and must address a variety of issues.

Hospitals are required to collect and report data concerning healthcare associated infections, phased in as follows:

The DOH is required to convene an advisory to make recommendations to the DOH regarding its responsibilities relating to the reporting of healthcare associated infections.

Summary of Bill (Recommended Amendments): Every hospital in the state must adopt a policy on MRSA by January 1, 2010. The policy must contain the following elements:

A hospital that has identified a hospitalized patient with a MRSA diagnosis must report the infection to the DOH using the CHARS. When making the report, the hospital must use codes used by the U.S. Centers for Medicare and Medicaid Services, when available.

The Advisory Committee on Hospital-Acquired Infections must make an annual recommendation to the DOH as to whether current science supports expanding pre-surgical MRSA screenings prior to open chest cardiac, and total hip and total knee elective surgeries.

Death certificates must note the presence of MRSA if it is a cause or contributing factor in the patient's death.

EFFECT OF CHANGES MADE BY HEALTH & LONG-TERM CARE COMMITTEE (Recommended Amendments): Death certificates must note the presence of MRSA if it is a cause or contributing factor in the patient's death.

Appropriation: None.

Fiscal Note: Available.

Committee/Commission/Task Force Created: No.

Effective Date: Ninety days after adjournment of session in which bill is passed.

Staff Summary of Public Testimony (on Engrossed Substitute House Bill): PRO: This is more than just a reporting bill. This is a matter of safety. More people die of MRSA infections in this country than AIDS. It's a practical approach to dealing with this problem.

Persons Testifying: PRO: Representative Campbell, prime sponsor.