BILL REQ. #:  S-0891.2 

Read first time 01/23/09.   Referred to Committee on Health & Long-Term Care.

     AN ACT Relating to the screening for and reporting of methicillin-resistant staphylococcus aureus in Washington hospitals; amending RCW 43.70.056; adding a new section to chapter 70.58 RCW; and creating a new section.

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

NEW SECTION.  Sec. 1   The legislature finds that increasing rates of methicillin-resistant staphylococcus aureus are a threat to the public health. The legislature further finds that methicillin-resistant staphylococcus aureus poses a particular threat to patients in hospital intensive care units and undergoing certain surgeries. Measurement of rates of methicillin-resistant staphylococcus aureus in patients in intensive care units can serve as a useful indicator of the effectiveness of hospital infection control practices. The public health may be improved by a uniform strategy of risk assessment and screening for methicillin-resistant staphylococcus aureus for all patients in hospital intensive care units.

Sec. 2   RCW 43.70.056 and 2007 c 261 s 2 are each amended to read as follows:
     (1) The definitions in this subsection apply throughout this section unless the context clearly requires otherwise.
     (a) "Admission" means within seventy-two hours for all patients expected to stay longer than seventy-two hours in an intensive care unit.
     (b) "Discharge" means patients who are discharged from the intensive care unit after staying more than seventy-two hours.
     (c) "Health care-associated infection" means a localized or systemic condition that results from adverse reaction to the presence of an infectious agent or its toxins and that was not present or incubating at the time of admission to the hospital.
     (((b))) (d) "Hospital" means a health care facility licensed under chapter 70.41 RCW.
     (e) "Intensive care unit" means adult and pediatric, but not neonatal, intensive care units.
     (f) "Screen" means using a nasal swab tested by standard culture or advanced technologies to detect the presence or absence of methicillin-resistant staphylococcus aureus.
     (2)(a) A hospital shall collect data related to health care-associated infections as required under this subsection (2) on the following:
     (i) Beginning July 1, 2008, central line-associated bloodstream infection in the intensive care unit;
     (ii) Beginning January 1, 2009, ventilator-associated pneumonia; and
     (iii) Beginning January 1, 2010, surgical site infection for the following procedures:
     (A) Deep sternal wound for cardiac surgery, including coronary artery bypass graft;
     (B) Total hip and knee replacement surgery; and
     (C) Hysterectomy, abdominal and vaginal.
     (b) Until required otherwise under (c) of this subsection, a hospital must routinely collect and submit the data required to be collected under (a) of this subsection to the national healthcare safety network of the United States centers for disease control and prevention in accordance with national healthcare safety network definitions, methods, requirements, and procedures.
     (c)(i) With respect to any of the health care-associated infection measures for which reporting is required under (a) of this subsection, the department must, by rule, require hospitals to collect and submit the data to the centers for medicare and medicaid services according to the definitions, methods, requirements, and procedures of the hospital compare program, or its successor, instead of to the national healthcare safety network, if the department determines that:
     (A) The measure is available for reporting under the hospital compare program, or its successor, under substantially the same definition; and
     (B) Reporting under this subsection (2)(c) will provide substantially the same information to the public.
     (ii) If the department determines that reporting of a measure must be conducted under this subsection (2)(c), the department must adopt rules to implement such reporting. The department's rules must require reporting to the centers for medicare and medicaid services as soon as practicable, but not more than one hundred twenty days, after the centers for medicare and medicaid services allow hospitals to report the respective measure to the hospital compare program, or its successor. However, if the centers for medicare and medicaid services allow infection rates to be reported using the centers for disease control and prevention's national healthcare safety network, the department's rules must require reporting that reduces the burden of data reporting and minimizes changes that hospitals must make to accommodate requirements for reporting.
     (d) Data collection and submission required under this subsection (2) must be overseen by a qualified individual with the appropriate level of skill and knowledge to oversee data collection and submission.
     (e)(i) A hospital must release to the department, or grant the department access to, its hospital-specific information contained in the reports submitted under this subsection (2), as requested by the department.
     (ii) The hospital reports obtained by the department under this subsection (2), and any of the information contained in them, are not subject to discovery by subpoena or admissible as evidence in a civil proceeding, and are not subject to public disclosure as provided in RCW 42.56.360.
     (3) A hospital methicillin-resistant staphylococcus aureus risk assessment and surveillance program is established as follows:
     (a) Hospitals shall conduct methicillin-resistant staphylococcus aureus risk assessment and surveillance as recommended in the compendium of strategies to prevent health care-associated infections in intensive care units and report to the department as follows:
     (i) For three months beginning April 1st of each year, screen all patients for methicillin-resistant staphylococcus aureus on admission and discharge from each intensive care unit. However, if a hospital operates more than two intensive care units it must complete its screening for at least two intensive care units during the three months beginning April 1st, and the hospital may elect to screen intensive care unit patients in the additional units during three months beginning July 1st of each year. Hospitals are not required to screen patients known to have a medical history of methicillin-resistant staphylococcus aureus, but must include those patients as positive in the admission rate for purposes of the report required by (a)(ii) of this subsection.
     (ii) At the conclusion of the screening period in (a)(i) of this subsection hospitals shall report to the department: (A) The number of patients screened on admission to an intensive care unit, (B) the methicillin-resistant staphylococcus aureus rate among patients screened on admission to the intensive care unit, (C) the number of patients screened on discharge from the intensive care unit, and (D) the methicillin-resistant staphylococcus aureus rate among patients screened on discharge from the intensive care unit.
     (iii)(a) The difference in rates between admission and discharge must be identified in the report as the hospital transmission rate.
     (b) The combined methicillin-resistant staphylococcus aureus rate among patients who have a previous medical history of methicillin-resistant staphylococcus aureus and who test positive on admission to an intensive care unit shall be identified in the report as the community acquired rate.
     (c) If the results of the methicillin-resistant staphylococcus aureus intensive care unit surveillance described under (a) of this subsection show a hospital transmission rate of two cases or five percent of intensive care unit admissions, whichever is greater, the hospital shall continue screening intensive care unit patients on admission and on discharge and report to the department quarterly information on the numbers of patients screened on admission to the intensive care unit, the methicillin-resistant staphylococcus aureus rate among patients screened on admission to the intensive care unit, the number of patients screened on discharge from the intensive care unit, and the methicillin-resistant staphylococcus aureus rate among patients screened on discharge from the intensive care unit until the hospital transmission rate is less than two cases or five percent of intensive care unit admissions, whichever is greater for two consecutive quarters.
     (d) Hospitals not required to conduct ongoing intensive care unit patient screening and reporting under (a) of this subsection may voluntarily screen intensive care unit patients for methicillin-resistant staphylococcus aureus on an ongoing basis and submit data to the department.
     (e) Hospitals shall ensure that any inpatient under the care of a physician or other practitioner at the hospital who receives a positive screening result for methicillin-resistant staphylococcus aureus is informed of the result. Hospitals shall provide any patient who is notified of a positive methicillin-resistant staphylococcus aureus screening result with (i) education and counseling regarding the recommended treatment for his or her condition, including possible nontreatment and (ii) information about how the patient can prevent the spread of methicillin-resistant staphylococcus aureus and safely interact with family members and members of the public.
     (4) The department shall:
     (a) Provide oversight of the health care-associated infection reporting program established in this section;
     (b) By January 1, 2011, submit a report to the appropriate committees of the legislature based on the recommendations of the advisory committee established in subsection (((5))) (6) of this section for additional reporting requirements related to health care-associated infections, considering the methodologies and practices of the United States centers for disease control and prevention, the centers for medicare and medicaid services, the joint commission, the national quality forum, the institute for healthcare improvement, and other relevant organizations;
     (c) Delete, by rule, the reporting of categories that the department determines are no longer necessary to protect public health and safety;
     (d) By December 1, 2009, and by each December 1st thereafter, prepare and publish a report on the department's web site that compares the health care-associated infection rates at individual hospitals in the state using the data reported in the previous calendar year pursuant to subsection (2) of this section. The department may update the reports quarterly. In developing a methodology for the report and determining its contents, the department shall consider the recommendations of the advisory committee established in subsection (((5))) (6) of this section. The report is subject to the following:
     (i) The report must disclose data in a format that does not release health information about any individual patient; and
     (ii) The report must not include data if the department determines that a data set is too small or possesses other characteristics that make it otherwise unrepresentative of a hospital's particular ability to achieve a specific outcome; and
     (e) Evaluate, on a regular basis, the quality and accuracy of health care-associated infection reporting required under subsection (2) of this section and the data collection, analysis, and reporting methodologies.
     (((4))) (5) The department may respond to requests for data and other information from the data required to be reported under subsections (2) and (3) of this section, at the requestor's expense, for special studies and analysis consistent with requirements for confidentiality of patient records.
     (((5))) (6)(a) The department shall establish an advisory committee which may include members representing infection control professionals and epidemiologists, licensed health care providers, nursing staff, organizations that represent health care providers and facilities, health maintenance organizations, health care payers and consumers, and the department. The advisory committee shall make recommendations to assist the department in carrying out its responsibilities under this section, including making recommendations on allowing a hospital to review and verify data to be released in the report and on excluding from the report selected data from certified critical access hospitals.
     (b) In developing its recommendations, the advisory committee shall consider methodologies and practices related to health care-associated infections of the United States centers for disease control and prevention, the centers for medicare and medicaid services, the joint commission, the national quality forum, the institute for healthcare improvement, and other relevant organizations.
     (((6))) (7) The department shall adopt rules as necessary to carry out its responsibilities under this section.

NEW SECTION.  Sec. 3   A new section is added to chapter 70.58 RCW to read as follows:
     In completing a certificate of death in compliance with this chapter, a physician, physician assistant, or advanced registered nurse practitioner must note the presence of methicillin-resistant staphylococcus aureus, if it is a cause or contributing factor in the patient's death.