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A BILL TO BE ENTITLED
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AN ACT
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relating to health care associated infection rates at certain |
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health care facilities and the creation of an advisory panel. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Subtitle D, Title 2, Health and Safety Code, is |
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amended by adding Chapter 98 to read as follows: |
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CHAPTER 98. HEALTH CARE ASSOCIATED INFECTION RATES |
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SUBCHAPTER A. GENERAL PROVISIONS |
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Sec. 98.001. DEFINITIONS. In this chapter: |
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(1) "Advisory panel" means the Advisory Panel on |
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Health Care Associated Infections. |
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(2) "Ambulatory surgical center" means a facility |
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licensed under Chapter 243. |
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(3) "Commissioner" means the commissioner of state |
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health services. |
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(4) "Department" means the Department of State Health |
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Services. |
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(5) "Executive commissioner" means the executive |
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commissioner of the Health and Human Services Commission. |
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(6) "General hospital" means a public or private |
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general hospital licensed under Chapter 241. The term includes a |
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pediatric and adolescent hospital. The term does not include |
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comprehensive medical rehabilitation facilities. |
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(7) "Health care associated infection" means a |
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localized or symptomatic condition resulting from an adverse |
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reaction to an infectious agent or its toxins to which a patient is |
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exposed in the course of health care delivery. |
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(8) "Health care facility" means: |
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(A) a general hospital; |
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(B) an ambulatory surgical center; or |
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(C) a state-owned or state-operated hospital |
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that provides acute medical or surgical services subject to |
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reporting requirements under this chapter. |
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(9) "Infection control professional" means a person: |
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(A) whose primary training is in nursing, medical |
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technology/clinical laboratory science, microbiology, public |
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health, or epidemiology; and |
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(B) who has acquired specialized training in |
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infection control. |
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(10) "Infection rate" means the number of health care |
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associated infections of a particular type at a health care |
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facility divided by a numerical measure over time of the population |
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at risk for contracting the infection, unless the term is modified |
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by rule of the executive commissioner to accomplish the purposes of |
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this chapter. |
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(11) "Pediatric and adolescent hospital" has the |
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meaning assigned by Section 241.003. |
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(12) "Reporting system" means the Texas Health Care |
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Associated Infection Reporting System established under Subchapter |
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C. |
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(13) "Special care setting" means a unit or service of |
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a general hospital that provides treatment to inpatients who |
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require extraordinary care on a concentrated and continuous basis. |
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The term includes an adult intensive care unit, a burn intensive |
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care unit, and a critical care unit. |
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Sec. 98.002. APPLICABILITY OF OTHER LAW. Chapter 2110, |
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Government Code, does not apply to the advisory panel created under |
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Subchapter B. |
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[Sections 98.003-98.050 reserved for expansion] |
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SUBCHAPTER B. ADVISORY PANEL |
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Sec. 98.051. ESTABLISHMENT. The commissioner shall |
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establish the Advisory Panel on Health Care Associated Infections |
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within the infectious disease surveillance and epidemiology branch |
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of the department as a permanent advisory panel to guide the |
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development, implementation, and evaluation of the reporting |
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system. |
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Sec. 98.052. MEMBERSHIP; TERM. (a) The commissioner shall |
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appoint the members of the advisory panel in accordance with |
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Subsection (b). |
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(b) The advisory panel is composed of 14 members as follows: |
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(1) two infection control professionals who: |
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(A) are certified by the Certification Board of |
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Infection Control and Epidemiology; and |
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(B) are practicing in hospitals in this state, at |
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least one of which must be a rural hospital; |
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(2) two infection control professionals who: |
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(A) are certified by the Certification Board of |
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Infection Control and Epidemiology; and |
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(B) are nurses licensed to engage in professional |
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nursing under Chapter 301, Occupations Code; |
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(3) three board-certified or board-eligible |
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physicians who: |
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(A) are licensed to practice medicine in this |
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state under Chapter 155, Occupations Code, at least two of whom must |
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have active medical staff privileges at a hospital in this state; |
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(B) are active members of the Society for |
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Healthcare Epidemiology of America; and |
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(C) have demonstrated expertise in infection |
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control in health care facilities; |
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(4) one chief executive officer of, or person with |
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similar decision-making authority at, a general hospital; |
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(5) one chief executive officer of, or person with |
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similar decision-making authority at, an ambulatory surgical |
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center; |
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(6) three nonvoting members who are department |
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employees representing the department in epidemiology and the |
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licensing of hospitals or ambulatory surgical centers; and |
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(7) two public members who represent health care |
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consumers. |
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(c) Members of the advisory panel serve two-year terms. |
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Sec. 98.053. MEMBER ELIGIBILITY. A person may not be a |
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member of the advisory panel if the person is required to register |
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as a lobbyist under Chapter 305, Government Code, because of the |
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person's activities for compensation on behalf of a profession |
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related to health care. |
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Sec. 98.054. OFFICERS. The members of the advisory panel |
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shall elect a presiding officer and an assistant presiding officer |
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from among the members. |
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Sec. 98.055. COMPENSATION; EXPENSES. (a) Except as |
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provided by Subsection (b), a member of the advisory panel is not |
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entitled to compensation for service on the advisory panel and is |
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not entitled to reimbursement for travel expenses. |
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(b) A member who is a representative of a state agency shall |
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be reimbursed for travel expenses incurred while conducting the |
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business of the advisory panel from the funds of the agency the |
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person represents in accordance with the General Appropriations |
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Act. |
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Sec. 98.056. VACANCY. A vacancy on the advisory panel shall |
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be filled by the commissioner. |
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Sec. 98.057. MEETINGS; DEPARTMENT ASSISTANCE. (a) The |
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advisory panel shall meet at the call of the presiding officer or |
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the commissioner. |
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(b) The department shall provide the advisory panel the |
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assistance it needs to perform its duties. |
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Sec. 98.058. DUTIES. (a) The advisory panel shall advise |
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the department regarding the development, implementation, and |
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evaluation of the reporting system. |
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(b) The advisory panel, using existing resources, may |
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consult with other persons who have technical or clinical expertise |
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in infectious diseases or infection control. |
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Sec. 98.059. REPORT TO LEGISLATURE. Not later than |
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November 1 of each even-numbered year, the commissioner shall file |
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a report with the presiding officer of each house of the legislature |
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on the advisory panel's recommendations for legislation regarding |
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the collection and reporting of infection rates. |
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[Sections 98.060-98.100 reserved for expansion] |
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SUBCHAPTER C. REPORTING INFECTION RATE |
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Sec. 98.101. COLLECTION OF HEALTH CARE ASSOCIATED INFECTION |
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DATA. (a) A health care facility at least quarterly shall submit |
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to the infectious disease surveillance and epidemiology branch of |
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the department a report of the health care associated infections at |
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the facility for the period covered by the report. The information |
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for the report must be identified by an infection control |
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professional using accepted methods of clinical surveillance in |
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accordance with rules of the executive commissioner. |
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(b) The report required by Subsection (a) must include |
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patient-identified information sufficient for the department to |
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calculate risk-adjusted infection rates for the following: |
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(1) central line-associated, laboratory-confirmed |
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primary bloodstream infections in special care settings; |
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(2) surgical site infections identified, including |
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infections identified through post-discharged surveillance, for |
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the following surgical procedures performed in general hospitals |
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and ambulatory surgical centers: |
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(A) colon surgery; |
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(B) hip and knee arthroplasty; |
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(C) abdominal and vaginal hysterectomy; |
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(D) coronary artery bypass graft; and |
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(E) other vascular procedures specified by |
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department rule; |
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(3) health care associated respiratory syncytial |
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viruses in pediatric inpatient units of general hospitals; |
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(4) surgical site infections identified, including |
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those identified through post-discharged surveillance, for the |
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following surgical procedures performed in pediatric and |
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adolescent hospitals: |
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(A) cardiac procedures, excluding thoracic; |
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(B) ventriculoperitoneal shunt procedures; and |
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(C) spinal surgery with instrumentation; and |
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(5) any other surgical site infections, including |
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those identified through post-discharged surveillance, that the |
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department by rule requires a health care facility to report. |
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(c) An ambulatory surgical center or a general hospital, |
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including a pediatric and adolescent hospital, that performs fewer |
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than 50 of the surgical procedures listed in Subsections (b)(2) and |
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(4) shall report surgical site infection data, including |
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post-discharge surveillance data, for the three procedures most |
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frequently performed at the center or hospital that are on the |
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federal Centers for Disease Control and Prevention's National |
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Health Safety Network list of surgical procedures. |
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(d) The executive commissioner and department by rule shall |
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phase in for inclusion in the report required under Subsection (a) |
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additional surgical site infections listed on the federal Centers |
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for Disease Control and Prevention's National Health Safety Network |
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list of surgical procedures. The executive commissioner and |
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department may exclude a procedure or include an unlisted procedure |
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as the department determines appropriate to protect the public |
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health and safety or to follow federal reporting requirements. |
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(e) In adopting rules under this section, the executive |
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commissioner shall ensure that the health care associated |
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infections that a health care facility is required to report under |
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this section have the meanings assigned by the federal Centers for |
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Disease Control and Prevention. |
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(f) A health care facility may not use hospital discharge |
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diagnosis codes to determine the information that must be reported |
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under this section. |
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Sec. 98.102. REPORTING SYSTEM. The department, using |
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existing resources, shall: |
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(1) develop the Texas Health Care Associated Infection |
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Reporting System, a flexible and expandable system to collect data |
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through electronic communications with health care facilities; and |
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(2) review infection control and reporting activities |
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of health care facilities to ensure the data provided is valid and |
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does not have unusual data patterns or trends that suggest |
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implausible rates. |
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Sec. 98.103. INFORMATION AVAILABLE TO PUBLIC. The |
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department, on its Internet website and in a written report, shall |
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at least annually disclose to the public for each health care |
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facility required to submit a report under Section 98.101 the |
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risk-adjusted infection rate for: |
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(1) central line-associated, laboratory-confirmed |
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primary bloodstream infections in special care settings; |
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(2) surgical site infections; and |
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(3) health care associated respiratory syncytial |
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virus in pediatric inpatient units of general hospitals. |
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Sec. 98.104. TRAINING FOR INFECTION CONTROL PROFESSIONALS. |
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The department shall provide training for infection control |
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professionals regarding the reporting system. |
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Sec. 98.105. PROTECTION FOR REPORTING. (a) A health care |
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facility may not retaliate against an infection control |
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professional employed by or under contract with a health care |
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facility for identifying information that must be submitted to the |
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department under this chapter. |
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(b) This section does not prohibit a health care facility |
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from terminating an employee for a reason other than retaliation. |
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Sec. 98.106. CONFIDENTIALITY; PRIVILEGE. (a) Except as |
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otherwise provided by this chapter, all information and materials |
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obtained or compiled by the department under this chapter or |
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compiled by a health care facility under this chapter, and all |
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related information and materials, are confidential and: |
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(1) are not subject to disclosure under Chapter 552, |
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Government Code, or discovery, subpoena, or other means of legal |
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compulsion for release to any person; |
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(2) may not be admitted as evidence or otherwise |
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disclosed in any civil, criminal, or administrative proceeding; and |
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(3) may not otherwise be released or made public |
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except as provided by this chapter. |
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(b) The confidentiality protections under Subsection (a) |
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apply without regard to whether the information or materials are |
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obtained from or compiled by a health care facility or an entity |
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that has an ownership or management interest in a facility. |
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(c) The transfer of information or materials under this |
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chapter is not a waiver of a privilege or protection granted under |
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law. |
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(d) Information reported by a health care facility under |
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this chapter and analyses, plans, records, and reports obtained, |
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prepared, or compiled by the facility under this chapter and all |
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related information and materials are subject to an absolute |
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privilege and may not be used in any form against the facility or |
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the facility's agents, employees, partners, assignees, or |
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independent contractors in any civil, criminal, or administrative |
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proceeding, regardless of the means by which a person came into |
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possession of the information, analysis, plan, record, report, or |
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related information or material. A court shall enforce this |
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privilege for all matters covered by this subsection. |
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(e) The provisions of this section regarding the |
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confidentiality of information or materials compiled or reported by |
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a health care facility in compliance with or as authorized under |
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this chapter do not restrict access, to the extent authorized by |
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law, by the patient or the patient's legally authorized |
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representative to records of the patient's medical diagnosis or |
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treatment or to other primary health records. |
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(f) A health care facility report or department summary or |
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disclosure may not contain information identifying a facility |
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patient, employee, contractor, volunteer, consultant, health care |
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professional, student, or trainee in connection with a specific |
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infection incident. |
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(g) Except as provided by this chapter, the reports, |
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records, and information obtained under this chapter are for the |
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confidential use of the department and the persons or entities that |
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the department determines are necessary to carry out the intent of |
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this chapter. Medical or epidemiological information may be |
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released: |
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(1) for statistical purposes in a manner that prevents |
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identification of individuals or health care practitioners; or |
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(2) with the consent of each person identified in the |
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information. |
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Sec. 98.107. DISCLOSURE WITHIN DEPARTMENT. |
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Notwithstanding any other law, the department may disclose |
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information reported by health care facilities under this chapter |
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to other programs within the department for public health research |
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or analysis purposes only, provided that the research or analysis |
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relates to health care associated infections. The privilege and |
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confidentiality provisions contained in this chapter apply to such |
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disclosures. |
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Sec. 98.108. CIVIL ACTION. Published infection rates may |
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not be used in a civil action to establish a standard of care |
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applicable to a health care facility. |
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SECTION 2. (a) As soon as practicable after the effective |
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date of this Act, the executive commissioner of the Health and Human |
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Services Commission shall adopt the rules and procedures necessary |
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to implement Chapter 98, Health and Safety Code, as added by this |
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Act. |
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(b) The Department of State Health Services shall: |
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(1) require submission of the initial reports required |
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under Chapter 98, Health and Safety Code, as added by this Act, not |
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later than January 1, 2008, based on data from the previous quarter; |
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and |
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(2) disclose to the public the information required by |
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Section 98.103, Health and Safety Code, as added by this Act, not |
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later than June 1, 2008. |
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SECTION 3. As soon as practicable after the effective date |
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of this Act, the commissioner of state health services shall |
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appoint members to the Advisory Panel on Health Care Associated |
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Infections as required by Chapter 98, Health and Safety Code, as |
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added by this Act. |
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SECTION 4. This Act takes effect immediately if it receives |
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a vote of two-thirds of all the members elected to each house, as |
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provided by Section 39, Article III, Texas Constitution. If this |
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Act does not receive the vote necessary for immediate effect, this |
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Act takes effect September 1, 2007. |