By: Nelson S.B. No. 288

(In the Senate - Filed January 24, 2007; January 30, 2007, read first time and referred to Committee on Health and Human Services; March 26, 2007, reported adversely, with favorable Committee Substitute by the following vote: Yeas 8, Nays 0; March 26, 2007, sent to printer.)

COMMITTEE SUBSTITUTE FOR S.B. No. 288 By: Nelson

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 includes a pediatric and adolescent hospital. 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:

(A) whose primary training is in nursing, medical technology/clinical laboratory science, microbiology, public health, or epidemiology; and

(B) who has acquired specialized training in infection control.

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

(12) "Reporting system" means the Texas Health Care Associated Infection Reporting System established under Subchapter C.

(13) "Special care setting" means a unit or service of a general hospital that provides treatment to inpatients who require extraordinary care on a concentrated and continuous basis. The term includes an adult intensive care unit, a burn intensive care unit, and a critical care unit.

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 infectious disease surveillance and epidemiology branch of the department as a permanent advisory panel to guide the development, implementation, and evaluation of the reporting system.

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, or person with similar decision-making authority at, a general hospital;

(5) one chief executive officer of, or person with similar decision-making authority at, 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.

Sec. 98.058. DUTIES. (a) The advisory panel shall advise the department regarding the development, implementation, and evaluation of the reporting system.

(b) The advisory panel, using existing resources, may consult with other persons who have technical or clinical expertise in infectious diseases or infection control.

Sec. 98.059. 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.

[Sections 98.060-98.100 reserved for expansion]

SUBCHAPTER C. REPORTING INFECTION RATE

Sec. 98.101. COLLECTION OF HEALTH CARE ASSOCIATED INFECTION DATA. (a) A health care facility at least quarterly shall submit to the infectious disease surveillance and epidemiology branch of the department a report of the health care associated infections at the facility for the period covered by the report. The information for the report must be identified by an infection control professional using accepted methods of clinical surveillance in accordance with rules of the executive commissioner.

(b) The report required by Subsection (a) must include patient-identified information sufficient for the department to calculate risk-adjusted infection rates for the following:

(1) central line-associated, laboratory-confirmed primary bloodstream infections in special care settings;

(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 thoracic;

(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 or a general hospital, including a 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 Health Safety Network 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 Health Safety Network 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) In adopting rules under this section, the executive commissioner shall ensure that the health care associated infections that a health care facility is required to report under this section have the meanings assigned by the federal Centers for Disease Control and Prevention.

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

Sec. 98.102. REPORTING SYSTEM. The department, using existing resources, shall:

(1) develop the Texas Health Care Associated Infection Reporting System, a flexible and expandable system 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. 98.103. INFORMATION AVAILABLE TO PUBLIC. The department, on its Internet website and in a written report, shall at least annually disclose to the public for each health care facility required to submit a report under Section 98.101 the risk-adjusted infection rate for:

(1) central line-associated, laboratory-confirmed primary bloodstream infections in special care settings;

(2) surgical site infections; and

(3) health care associated respiratory syncytial virus in pediatric inpatient units of general hospitals.

Sec. 98.104. TRAINING FOR INFECTION CONTROL PROFESSIONALS. The department shall provide training for infection control professionals regarding the reporting system.

Sec. 98.105. 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. 98.106. CONFIDENTIALITY; PRIVILEGE. (a) Except as otherwise provided by this chapter, all information and materials obtained or compiled by the department under this chapter or compiled by a health care facility under this chapter, and all related information and materials, are confidential and:

(1) are not subject to disclosure under Chapter 552, Government Code, or discovery, subpoena, or other means of legal compulsion for release to any person;

(2) may not be admitted as evidence or otherwise disclosed in any civil, criminal, or administrative proceeding; and

(3) may not otherwise be released or made public except as provided by this chapter.

(b) The confidentiality protections under Subsection (a) apply without regard to whether the information or materials are obtained from or compiled by a health care facility or an entity that has an ownership or management interest in a facility.

(c) The transfer of information or materials under this chapter is not a waiver of a privilege or protection granted under law.

(d) Information reported by a health care facility under this chapter and analyses, plans, records, and reports obtained, prepared, or compiled by the facility under this chapter and all related information and materials are subject to an absolute privilege and may not be used in any form against the facility or the facility's agents, employees, partners, assignees, or independent contractors in any civil, criminal, or administrative proceeding, regardless of the means by which a person came into possession of the information, analysis, plan, record, report, or related information or material. A court shall enforce this privilege for all matters covered by this subsection.

(e) The provisions of this section regarding the confidentiality of information or materials compiled or reported by a health care facility in compliance with or as authorized under this chapter do not restrict access, to the extent authorized by law, by the patient or the patient's legally authorized representative to records of the patient's medical diagnosis or treatment or to other primary health records.

(f) A health care facility report or department summary or disclosure may not contain information identifying a facility patient, employee, contractor, volunteer, consultant, health care professional, student, or trainee in connection with a specific infection incident.

(g) 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. 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. 98.107. DISCLOSURE WITHIN DEPARTMENT. Notwithstanding any other law, the department may disclose information reported by health care facilities under this chapter to other programs within the department for public health research or analysis purposes only, provided that the research or analysis relates to health care associated infections. The privilege and confidentiality provisions contained in this chapter apply to such disclosures.

Sec. 98.108. 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:

(1) 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; and

(2) disclose to the public the information required by Section 98.103, Health and Safety Code, as added by this Act, not later than June 1, 2008.

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.

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