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STATE LEGISLATION & INITIATIVES ON
Updated October 2011
27 state laws require public reporting of hospital-acquired infection rates.
Of the states that have laws requiring public reporting of hospital-acquired infections, 12 states also have laws requiring the screening and/or reporting of hospital-acquired MRSA rates (CA, CT, IL, MN, NJ, NV, PA, SC, TN, TX, VA, WA). Three states, MA, ME and NY, have legislation pending on the matter as of this update.
LAWS REQUIRING PUBLIC REPORTING OF INFECTION RATES
The Mike Denton Infection Reporting Act (SB89) became effective on August 1, 2009. Starting January 1, 2011, Healthcare facilities must begin collection of data on inpatient HAIs to report to the Alabama Department of Public Health (ADPH). It is mandatory that HAI data be reported from central line-associated bloodstream infections (CLABSI), surgical site infections (SSI), and catheter associated urinary tract infections (CAUTI). Healthcare facilities must join the ADPH National Healthcare Safety Network (NHSN) group and report all mandatory data. Healthcare facilities are required to report inpatient HAI data monthly. Reports and studies prepared and released by ADPH, and approved by the Advisory Council shall be public information. An advisory council of 18 people shall assist in developing internal and public reports.
As of 2008, the following HAIs must be reported to the California Department of Public Health: Central Line-associated Bloodstream Infection (CLABSI), Staph Infections (MRSA), Vancomycin-resistant Enterococci (VRE) Bloodstream Infection (BSI), Clostridium difficile Infection (C. difficile, C. diff, CDI, CDAD), and Surgical Site Infection (SSI). As of January 2011, quarterly reporting is to start through NHSN.
The laws include screening of high-risk patients for Methicillin-resistant Staphylococcus aureus (MRSA), and follow-up screening for preventing the spread of both hospital-acquired and community-acquired MRSA. Additionally, those patients who are screened as positive for MRSA must be told of the results, and precautions must be taken to prevent the spread of MRSA in the hospital. Positive-tested patients must be given information on how to treat it and prevent the transmission of MRSA. The laws also call for improved oversight by the licensing agency, as well as training on prevention of infections for healthcare workers in hospitals. Additionally, the state calls for reporting of infection rates in long-term facilities.
The law requires hospitals, ambulatory surgical centers and dialysis centers to report incidents of hospital-acquired infections to the CDC for analysis, which in turn will be used by Colorado’s department of health to publicize information on infection rates at individual sites. The annual reports, found at the link above, include infection rates for cardiac and orthopedic surgical site infections, and central-line bloodstream infections.
The law requires hospitals to report infections to the state’s health department. A committee, which includes consumer representatives, will advise the department on specifics regarding the types of outcome and process measures to be collected, as well as how these are to be collected and reported. The department will then make hospital-specific infection information available to the public.
The law requires hospitals to report on infection rates through the state’s department of health. Hospitals are to report infections to the CDC on a quarterly basis, and quarterly updates will be available to the public at each hospital and by the department of health. However, it applies to hospitals and correctional facilities only. They should be reported to the Delaware Health and Social Services (DHSS) and the Center for Disease Control quarterly through NHSN. These reports must be made available to the public quarterly. The report above provides comparative hospital data on central-line associated bloodstream infections for intensive care units.
Healthcare facilities in this state are required by law to report HAI data to NHSN. The following are required by law to be reported: Central Line-associated Blood Stream Infection (CLABSI), Clostridium difficile Infections (CDI), Catheter-associated Urinary Tract Infections (CAUTI), Methicillin-resistant Staphylococcus aureus Infections (MRSA), Surgical Site Infections (SSI), and Ventilator-associated Pneumonia (VAP).
Florida was the first state to publish a hospital-specific report on infections based on the passage of HB1629. However, the results are disappointing as the state has not adopted a standardized system for the collection of data, which leads to great variation in the data and makes comparisons difficult if not altogether invalid. The information provided in the comparative report is limited and weak, as there is little specificity in the type or number of infections at individual facilities. Nor is there any explanation of the state’s methodology in reaching conclusions such as “As Expected” or “Higher than Expected” infection rates for facilities.
Under Illinois law, Healthcare Facilities (hospitals, ambulatory services, and residential facilities) are required to report. They are supposed to report staph infections (MRSAs), c. difficile (CDIs), central line associated bloodstream infections (CLABSIs), ventilator associated pneumonia (VAPs), and surgical site infections (SSIs). The law requires such healthcare facilities to make quarterly reports to the Illinois Department of Public Health. They, in turn, will publish the reports on their website annually. Healthcare facilities report CLABSIs and SSIs to the NHSN. If they do not comply, hospital licenses may be revoked. The specific laws are as follows: The Hospital Report Card Act (2003), Amends Report Card Act (2004), Multi-Drug Resistant Organisms (2004), MRSA Screening and Reporting Act (2007), MRSA Prevention, Control, and Reporting Act (2009).
Chapter 594 of the Sessions Law directed Dirigo Health Agency’s Maine Quality Forum to submit an annual report to the legislature on various hospital performance indicators, including statewide efforts to prevent hospital-acquired infections, which were then to be made available to the public. The first report, published in 2009 and found at the link above, includes rates of central-line associated bloodstream infections, as stipulated by a later law (Chapter 270) passed in 2009. The 2009 also empowers the Quality Forum to determine whether other infection rates are to be collected, how they are to be collected and when.
Currently under consideration is LD1687, which defines high-risk groups/individuals for MRSA screening.
Requires hospitals to report infection rates and prohibits payment for some hospital- acquired conditions by state agencies. The preliminary report published in April 2009 bodes well for the state’s reporting efforts, and presents initial findings on central-line associated bloodstream infections and surgical site infections for knee/hip surgeries. The report may be accessed at the link above.
Hospitals are required to report risk-adjusted infection rates for central-line associated bloodstream infections (CLABSI), surgical site infections (SSI), and ventilator-associated pneumonia (VAP). Other types of infections may be added on by the Department of Health & Senior Services in conjunction with the MN Hospital Association. The first report, which may be found at the Minnesota Hospital Association website and accessed at the link above, includes rates for surgical infections of hip replacements, bloodstream infections, coronary-artery bypass surgeries, and hysterectomies. MN also passed a law requiring the reporting of hospital-acquired MRSA rates.
The law requires hospitals to report risk-adjusted rates for surgical-site infections, ventilator-associated pneumonia and central-line bloodstream infections, and to report their rates on an annual basis. The first report was issued in 2006 and updates have been provided regularly. The link above provides the December 2009 report on hospital-acquired infections, with an internal link to the state’s Department of Health which offers additional information.
New Hampshire (2006)
Facilities in this state are required by law to report HAI data to the National Healthcare Safety Network (NHSN). This is stated in House Bill 1741(2007) which became effective in July 2007. Licensed hospitals are required to report such data. Reports are to be made about central line associated bloodstream infections (CLABSIs), surgical site infections (SSIs) , and ventilator associated pneumonia (VAPs) . Reports are to be made to U.S.A. Department of Health and Human Services (DHHS) and to NHSN. Every six months a report is to be made to the Legislative Oversight Committee on Health and Human Services and then annual reports are made. Penalties for noncompliance include up to $1,000 for each day of noncompliance.
New Jersey (2007)
The law requires that hospitals provide quarterly reports on infections to the state’s Department of Health, which includes disclosure of surgical site infections, urinary tract infections related to catheters, pneumonia related to ventilators, and bloodstream infections related to catheters. The law also gives the state’s health department authority to expand the list of reportable infections. Rates are to be publicized on a state website, still in development. No reports are available of this update.
New Mexico (2009)
New Mexico has passed two laws thus far relating to the prevention of HAIs. The Hospital Acquired Infection act (2009) finalized the HAI Advisory Committee and provided for select hospital to report HAI data, selection of HAI indicators, and identification of reporting systems. HJM067 was passed by the New Mexico Legislature in 2007 requesting the New Mexico Department of Health to assess the feasibility of HAI surveillance in New Mexico. " Participating hospitals shall report to the department the incidence of selected indicators using the national healthcare safety network surveillance system according to a schedule recommended by the advisory committee based on reporting frequencies identified by the national healthcare safety network. Reported data shall be verifiable and actionable. " Disclaimer: only participating hospitals selected by the advisory committee are mandated to report.
New York (2005)
This model law was adopted by the National Conference of Insurance Legislators (NCOIL) as an exemplar of hospital infection reporting laws. Healthcare facilities in this state are required by law to report HAI data to the National Healthcare Safety Network (NHSN).
The law established a state advisory council that is to consult with consumers, nurses, and infection control professionals on developing hospital quality measures, including “measures that examine [hospital] infections.” It requires various price and performance data to be collected from hospitals beginning in 2007, which is to be reported to the public within 90 days of getting the information from the hospitals. The director of health must adopt rules that will include measures that examine infections? as well as other measures of quality of care.
This law gives the Oklahoma Hospital Advisory Council, which is appointed by the state Commissioner of Health, the authority to develop hospital quality indicators, including some hospital infections. The facility-specific comparative data may be found at the link above, on the Oklahoma Hospitals Accountable for Quality website. The comparative data on hospital infections is poor, and includes information solely on whether antibiotics were properly administered prior to diverse procedures at each hospital. OK citizens are encouraged to call their state representatives to insist upon more comprehensive, clear data on hospital infection rates.
Facilities in this state are required by law to report HAI data to NHSN. Hospitals (long-term care facilities, ambulatory surgical centers, freestanding birthing centers and outpatient renal dialysis facilities included in law under different reporting requirements) are required to report. The advisory committee is made up of 16 members including 7 healthcare providers and 9 representatives from consumer, academic, government, and business groups. Surgical site infections (SSIs) from Coronary artery bypass graft surgery with both chest and graft incisions, Coronary artery bypass graft surgery with chest incision only, Knee prosthesis procedures are to be reported. Central line associated bloodstream infections (CLABSIs) in intensive care units and urinary tract infections in long-term care facilities are to be reported, too. Healthcare facilities are to report to the Oregon Health Policy and Research. Reports are to be made annually. Penalties for noncompliance include up to $500 per facility for each day it does not report.
Pennsylvania (2005/amended in 2007)
(Act 52 of 2007; Amends SB 293 2005) Healthcare facilities in this state are required by law to report HAI data to the National Healthcare Safety network (NHSN). Hospitals, ambulatory surgical centers, birthing centers, and nursing homes are required to report. The advisory committee consults with technical advisors who are regionally or nationally acknowledged as experts in infection/disease prevention and control to develop risk adjustment methods. Staph infections (MRSAs), multi drug resistant organisms (MDROs), surgical site infections (SSIs), catheter associated urinary tract infections (CAUTIs), ventilator associated pneumonia (VAPs), and central line associated bloodstream infections (CLABSIs) are to be reported. Quarterly reports are to be made to the U.S. Department of Health, The Pennsylvania Healthcare Cost Containment Center, the Pennsylvania Patient Safety Authority, and NHSN. Penalties for noncompliance include up to $1,000 per facility for each day it does not report.
Two bills (S2382 and HB7962), passed and signed into law, require the Department of Health to issue public reports comparing infection rates among RI hospitals. An advisory committee will help to develop the infection reporting system and will serve as a permanent subcommittee to an already existing steering committee on health care quality. The majority of the advisory committee members must come from the infection control community, but representatives of consumers, labor and employers who purchase health care are also included. Through regulations based on the advisory committee‘s recommendations, the department will establish which types of infections rates are to be reported. The law allows for reporting on the four major types of hospital-acquired infections -- surgical site infections, ventilator associated pneumonia, central line blood stream infections, and urinary tract infections -- and allows for the advisory committee to recommend additional reporting. Surgical infection reporting must include post-discharge surveillance. The state may also report measures that indicate hospitals‘ compliance with infection prevention practices.
Facilities in this state are required by law to report HAI data to the National Healthcare Safety Network. NHSN. Article 20 Requires hospitals in the state to report the rate at which their patients develop surgical site infections, ventilator assisted pneumonia, and central line bloodstream infections to the Department of Health and Environmental Control by February 2008. A committee, which includes consumer representation, will advise the Department on the methodology for collecting, analyzing and disclosing the information. The department has the authority to add measures in the future. The first annual report was issued in August 2008.
The law is limited as it calls only for the reporting of central-line bloodstream infections in intensive-care units. The first report, issued in December 2009, includes ICU infections in the pediatric, surgical, medical, major teaching medical surgical, non-major teaching medical-surgical, neurosurgical, coronary, and cardiothoracic-surgical units. The report is clear, comprehensive, and easy to understand for patients – and should act as a model for state expansion of reporting requirements. TN citizens are urged to call their state representatives to encourage expansion of the list of reportable infections, including surgical site infections, coronary artery bypass grafts, MRSA and C. diff.
Facilities in this state are required by law to report HAI data to NHSN. The bill was passed in 2005 and went into effect in 2008. Hospitals must make the information available to the Virginia Department of Health (VDH), and VDH in turn must provide the information to the public upon request. The Code further directed the Board of Health to develop regulations that specify the infections to be reported and the patient populations to be included. The applicable regulations specify that acute care hospitals shall collect and report data on central line-associated bloodstream infections (CLABSI) in adult intensive care units. Infection rate data are aggregated to ensure that no individual patient may be identified. The results of reporting must be released to the public by the department upon request.
West Virginia (2008)
VOLUNTARY OR NON-PUBLIC HOSPITAL INFECTION REPORTING
STATES WITH STUDIES ON HAI REPORTING
Indiana (2005 and 2007)
North Carolina (2007)
STATES WITH PENDING HAI LEGISLATION OR NO LAW ON REPORTING
Georgia – bill died in session in 2008; no new bill introduced on the matter.