80R3768 YDB-D

By: Vo H.B. No. 1885

A BILL TO BE ENTITLED

AN ACT

relating to health care-associated infection rates at certain health care facilities and the creation of an advisory panel.

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

SECTION 1. Subtitle D, Title 2, Health and Safety Code, is amended by adding Chapter 98 to read as follows: CHAPTER 98. HEALTH CARE-ASSOCIATED INFECTION RATES SUBCHAPTER A. GENERAL PROVISIONS

Sec. 98.001. DEFINITIONS. In this chapter:

(1) "Advisory panel" means the Advisory Panel on Health Care-Associated Infections.

(2) "Ambulatory surgical center" means a facility licensed under Chapter 243.

(3) "Commissioner" means the commissioner of state health services.

(4) "Department" means the Department of State Health Services.

(5) "Executive commissioner" means the executive commissioner of the Health and Human Services Commission.

(6) "General hospital" means a public or private general hospital licensed under Chapter 241. The term does not include comprehensive medical rehabilitation facilities.

(7) "Health care-associated infection" means a localized or symptomatic condition resulting from an adverse reaction to an infectious agent or its toxins to which a patient is exposed in the course of health care delivery.

(8) "Health care facility" means:

(A) a general hospital;

(B) an ambulatory surgical center; or

(C) a state-owned or state-operated hospital that provides acute medical or surgical services subject to reporting requirements under this chapter.

(9) "Infection control professional" means a person who has the training required by this chapter and department rule and who is responsible for identifying information a health care facility is required to report to the department under this chapter.

(10) "Infection rate" means the number of health care-associated infections of a particular type at a health care facility divided by a numerical measure over time of the population at risk for contracting the infection, unless the term is modified by rule of the executive commissioner to accomplish the purposes of this chapter.

(11) "Outcome measure" means a measure of the outcome of medical care in terms of mortality, selected complications, medical errors, or the effectiveness of evidence-based infection prevention processes.

(12) "Pediatric and adolescent hospital" has the meaning assigned by Section 241.003.

(13) "Process measure" means a measure of a health care facility's compliance with recommended infection control practices.

Sec. 98.002. APPLICABILITY OF OTHER LAW. Chapter 2110, Government Code, does not apply to the advisory panel created under Subchapter B. [Sections 98.003-98.050 reserved for expansion] SUBCHAPTER B. ADVISORY PANEL

Sec. 98.051. ESTABLISHMENT. The commissioner shall establish the Advisory Panel on Health Care-Associated Infections within the regulatory licensing unit of the health care quality section of the department as a permanent advisory panel to guide the implementation, development, and evaluation of a health care-associated infection rate reporting system in this state.

Sec. 98.052. MEMBERSHIP; TERM. (a) The commissioner shall appoint the members of the advisory panel in accordance with Subsection (b).

(b) The advisory panel is composed of 14 members as follows:

(1) two infection control professionals who:

(A) are certified by the Certification Board of Infection Control and Epidemiology; and

(B) are practicing in hospitals in this state, at least one of which must be a rural hospital;

(2) two infection control professionals who:

(A) are certified by the Certification Board of Infection Control and Epidemiology; and

(B) are nurses licensed to engage in professional nursing under Chapter 301, Occupations Code;

(3) three board-certified or board-eligible physicians who:

(A) are licensed to practice medicine in this state under Chapter 155, Occupations Code, at least two of whom must have active medical staff privileges at a hospital in this state;

(B) are active members of the Society for Healthcare Epidemiology of America; and

(C) have demonstrated expertise in infection control in health care facilities;

(4) one chief executive officer of a general hospital;

(5) one chief executive officer of an ambulatory surgical center;

(6) three nonvoting members who are department employees representing the department in epidemiology and the licensing of hospitals or ambulatory surgical centers; and

(7) two public members who represent health care consumers.

(c) Members of the advisory panel serve two-year terms.

Sec. 98.053. MEMBER ELIGIBILITY. A person may not be a member of the advisory panel if the person is required to register as a lobbyist under Chapter 305, Government Code, because of the person's activities for compensation on behalf of a profession related to health care.

Sec. 98.054. OFFICERS. The members of the advisory panel shall elect a presiding officer and an assistant presiding officer from among the members.

Sec. 98.055. COMPENSATION; EXPENSES. (a) Except as provided by Subsection (b), a member of the advisory panel is not entitled to compensation for service on the advisory panel and is not entitled to reimbursement for travel expenses.

(b) A member who is a representative of a state agency shall be reimbursed for travel expenses incurred while conducting the business of the advisory panel from the funds of the agency the person represents in accordance with the General Appropriations Act.

Sec. 98.056. VACANCY. A vacancy on the advisory panel shall be filled by the commissioner.

Sec. 98.057. MEETINGS; DEPARTMENT ASSISTANCE. (a) The advisory panel shall meet at the call of the presiding officer or the commissioner.

(b) The department shall provide the advisory panel the assistance it needs to perform its duties. [Sections 98.058-98.100 reserved for expansion] SUBCHAPTER C. DUTIES OF ADVISORY PANEL

Sec. 98.101. GENERAL DUTIES. (a) The advisory panel shall guide the implementation, development, and evaluation of a health care-associated infection rate reporting system in this state. The advisory panel shall determine the methods for collecting and reporting evidence-based data on:

(1) infection rates;

(2) process measures; and

(3) outcome measures.

(b) In developing the methods under Subsection (a), the advisory panel shall consider:

(1) adjusting the reported infection rates to account for the differences in patient populations and for factors outside the control of the health care facility;

(2) standardizing data collection methodology and reporting;

(3) reviewing data collection and reporting systems of other entities related to infection rates, such as the National Nosocomial Infections Surveillance System of the federal Centers for Disease Control and Prevention;

(4) reviewing data collection and reporting systems of other entities related to process measures, such as the Joint Commission on Accreditation of Healthcare Organizations or the Centers for Medicare and Medicaid Services;

(5) maximizing the efficient use of the resources required for health care facilities to conduct required surveillance and reporting;

(6) recognizing the potential unintended consequences of releasing to the public data that was collected using a poorly designed or executed reporting system that may diminish the overall quality of this state's health care or mislead or fail to protect health care consumers who use the data; and

(7) providing additional benefits to health care consumers.

Sec. 98.102. REPORT TO LEGISLATURE. Not later than November 1 of each even-numbered year, the commissioner shall file a report with the presiding officer of each house of the legislature on the advisory panel's recommendations for legislation regarding the collection and reporting of infection rates, process measures, or outcome measures. [Sections 98.103-98.150 reserved for expansion] SUBCHAPTER D. REPORTING INFECTION RATE

Sec. 98.151. COLLECTION OF HEALTH CARE-ASSOCIATED INFECTION DATA. (a) A health care facility shall submit each quarter to the department a health care-associated infection rate report for the previous quarter. The information for the report must be identified by an infection control professional using accepted methods of clinical surveillance in accordance with department rules.

(b) The report required by Subsection (a) must include the infection rates for:

(1) central line-associated, laboratory-confirmed primary bloodstream infections in special care settings, such as intensive care units, of general hospitals;

(2) surgical site infections identified, including infections identified through post-discharged surveillance, for the following surgical procedures performed in general hospitals and ambulatory surgical centers:

(A) colon surgery;

(B) hip and knee arthroplasty;

(C) abdominal and vaginal hysterectomy;

(D) coronary artery bypass graft; and

(E) other vascular procedures specified by department rule;

(3) health care-associated respiratory syncytial viruses in pediatric inpatient units of general hospitals;

(4) surgical site infections identified, including those identified through post-discharged surveillance, for the following surgical procedures performed in pediatric and adolescent hospitals:

(A) cardiac procedures, excluding thoracid;

(B) ventriculoperitoneal shunt procedures; and

(C) spinal surgery with instrumentation; and

(5) any other surgical site infections, including those identified through post-discharged surveillance, that the department by rule requires a health care facility to report.

(c) An ambulatory surgical center, general hospital, or pediatric and adolescent hospital that performs fewer than 50 of the surgical procedures listed in Subsections (b)(2) and (4) shall report surgical site infection data, including post-discharge surveillance data, for the three procedures most frequently performed at the center or hospital that are on the federal Centers for Disease Control and Prevention's National Nosocomial Infections Surveillance System list of surgical procedures.

(d) The executive commissioner and department by rule shall phase in for inclusion in the report required under Subsection (a) additional surgical site infections listed on the federal Centers for Disease Control and Prevention's National Nosocomial Infections Surveillance System list of surgical procedures. The executive commissioner and department may exclude a procedure or include an unlisted procedure as the department determines appropriate to protect the public health and safety or to follow federal reporting requirements.

(e) A health care facility may not use hospital discharge diagnosis codes to determine the information that must be reported under this section.

Sec. 98.152. REPORTING SYSTEM. The department, using existing resources, shall:

(1) develop a health-care-associated infection rate reporting system in this state that is flexible and expandable to collect data through electronic communications with health care facilities; and

(2) review infection control and reporting activities of health care facilities to ensure the data provided is valid and does not have unusual data patterns or trends that suggest implausible rates.

Sec. 98.153. INFORMATION AVAILABLE TO PUBLIC. The department, on its Internet website and in a written report, shall disclose to the public the infection rate for central line-associated, laboratory-confirmed primary bloodstream infections in special care settings, such as intensive care units, of general hospitals. The report must identify each health care facility included in the report.

Sec. 98.154. TRAINING FOR INFECTION CONTROL PROFESSIONALS. The executive commissioner by rule shall establish the training requirements and qualifications for infection control professionals based on recommendations of the Healthcare Infection Control Practices Advisory Committee of the federal Centers for Disease Control and Prevention.

Sec. 98.155. PROTECTION FOR REPORTING. (a) A health care facility may not retaliate against an infection control professional employed by or under contract with a health care facility for identifying information that must be submitted to the department under this chapter.

(b) This section does not prohibit a health care facility from terminating an employee for a reason other than retaliation.

Sec. 98.156. CONFIDENTIALITY. (a) Reports, records, and information obtained under this chapter, including information identifying an individual patient, are confidential and are not subject to disclosure under Chapter 552, Government Code, are not subject to subpoena, and may not otherwise be released or made public except as provided by this chapter. Except as provided by this chapter, the reports, records, and information obtained under this chapter are for the confidential use of the department and the persons or entities that the department determines are necessary to carry out the intent of this chapter.

(b) Medical or epidemiological information may be released:

(1) for statistical purposes in a manner that prevents identification of individuals or health care practitioners; or

(2) with the consent of each person identified in the information.

Sec. 98.157. CIVIL ACTION. Published infection rates may not be used in a civil action to establish a standard of care applicable to a health care facility.

SECTION 2. (a) As soon as practicable after the effective date of this Act, the executive commissioner of the Health and Human Services Commission shall adopt the rules and procedures necessary to implement Chapter 98, Health and Safety Code, as added by this Act.

(b) The Department of State Health Services shall require submission of the initial reports required under Chapter 98, Health and Safety Code, as added by this Act, not later than January 1, 2008, based on data from the previous quarter.

SECTION 3. As soon as practicable after the effective date of this Act, the commissioner of state health services shall appoint members to the Advisory Panel on Health Care-Associated Infections as required by Chapter 98, Health and Safety Code, as added by this Act.

SECTION 4. This Act takes effect immediately if it receives a vote of two-thirds of all the members elected to each house, as provided by Section 39, Article III, Texas Constitution. If this Act does not receive the vote necessary for immediate effect, this Act takes effect September 1, 2007.