California State Legislation Infection Prevention and Reporting

1. California State LegislationInfection Prevention and Reporting • SB 158 • SB 1058 • SB 739 Quality Management Council November 14, 2008 Jennifer Giusti Shelly Morris

2. SB 158 and SB 1058Background • Both bills signed into law September 25, 2008 • SB 1058 in memory of Nile Moss of Gavilan Hills, CA, who died from a MRSA infection after a visit to the hospital where he was getting an MRI. His mother Carole Moss worked tirelessly to call attention to the problem of hospital infections and to work for passage of SB 1058. • SB 158 – Off-shoot of 1058 • Very prescriptive • AFLs not released yet • Awaiting interpretations of some language • Future legislation with revised language not expected for at least 1 year

3. Nile's Story

4. SB 158 and SB 1058 • January 2009 • Patient Safety Plan • Patient Safety Committee - Interdisciplinary • Receive and review reports of Patient Safety Events • Monitor implementation of corrective action • Review and revise Pt Safety Plan at least annually • Patient Safety Event Reporting • System that allows anyone (including patients & visitors) to report an event • Reporting process that encourages ‘Culture of Safety’ • Patient Safety Event Analysis • Current interpretation = ALL events, including all HAI would require RCA • May need to make an assessment and plan to prioritize events • Responsibility for RCA in your hospital – Need for additional trained staff

5. SB 158 and SB 1058 • January 2009 • Facility-wide hand hygiene program • EVS Staff Training – upon hire, changes, and annually • Infection Control Policy • Regular disinfection of environment, med equipment, common areas • Intent – Insure clear assignment and accountability for the various areas

6. SB 158 and SB 1058 • January 2009 • MRSA Testing within 24 hours of admission • Exception: patients with known MRSA • Scheduled for inpatient surgery and has documented ‘medical condition making the patient susceptible to infection’ • May become void or be left to hospital discretion if CDC is unable to provide list • Documented that pt was DC’d from acute care hospital within 30 days of admit • Admitted to ICU or Burn Unit

7. SB 158 and SB 1058 • January 2009 • MRSA Testing within 24 hours of admission • Receives inpatient dialysis • Transferred from a SNF • Notification: MRSA+ Patients • By attending physician • Immediately, or as soon as practically possible • Education for MRSA+ Patients • Oral and written instructions prior to discharge

8. SB 158 and SB 1058 • January 2009 • HAI Reporting: Quarterly • All HA-MRSA BSI, HA-C diff, HA-VRE BSI infections, and the number of inpatient days • Includes both primary and secondary BSIs • CLABSI and CL days reported to CDPH • ICU CLABSI via NHSN, others batched on CDPH form • ICU Monthly reporting: Internal deadline – 5 wks post end of month • SSI: All HAI of deep organ space sites, ortho, cardiac, and GI sites • Prioritize: CABG, total knee, total hip, colon

9. SB 158 and SB 1058 • 2010 • Staff and Physician Training • Hospital epidemiologist, IC Committee Chair • SHEA/IDSA interested in developing CME • All staff, contract physicians and LIPs • Training in hospital-specific infection prevention and control policies: upon hire, changes, and annually • Includes temporary staff • Additional education requirements in NPSG 7

10. SB 158 and SB 1058 • 2011 • IV, Epidural, and Enteral Feeding connections • Prohibited from using connections that would fit into a connection port other than intended • MRSA Testing • Patients with ‘increased risk’ to be tested again immediately prior to discharge • MRSA+ Notification and Education

11. SB 158 and SB 1058 • Other key elements: • Infection Prevention Professional Definition: • Salaried employee or consultant who, within two years of appointment, will meet the education and experience requirements for certification by the CBIC. • Does not include physician who is appointed or receives a stipend as the IC Committee Chair or Epidemiologist • CDPH and HAI-AC Responsibilities • Reporting of data to public and governor • Method to assess needed # of ICPs in each hospital • Method to audit hospitals for validity of data submitted • Standardized method to identify HAI post discharge • Method for risk-adjusted HAI data for public reporting • HAI training for health facility evaluators

12. SB 7392007 • January 2007 • Formation of HAI Advisory Committee (HAI-AC) • Strategic Plan to include IC Report, updated annually • CLABSI Prevention and internal reporting • July 2007 • Annual onsite flu vaccines for employees • Seasonal Flu Plan (cough etiquette, isolation, etc) • Pandemic Influenza Plan

13. SB 7392008 • January 2008 • Judicious use of antibiotics • Join NHSN • Utilize CDC (NHSN) Definitions and surveillance methodology for HAIs • July 2008 • Join CDPH Group on NHSN website, confer rights to view data • Central Line Insertion Practice (CLIP) • Mandatory Reporting into NHSN Database • Daily LIP assessment - Necessity of Central Line • Surgical Antimicrobial Prophy - CDPH harvest of SCIP measures 1, 2, 3 (no action needed by hospitals)

14. SB 7392008 • September 1, 2008 • Prioritized list of healthcare personnel • September 30, 2008 • Flu Vaccination/Declination rates (2007/2008 season – Employees) ‘requested’ by CDPH • Flu Vaccination Outreach plan for all Healthcare Personnel • Incorporate specific verbiage on declination forms • October 30, 2008 • 2008/2009 Flu Pre-Season Survey to CDPH

15. SB 7392009 • January 2009 • VAP Prevention • SSI Prevention • April 2009 • Flu Post-Season Survey to CDPH • Healthcare Personnel Safety Component Facility Survey to CDPH

16. Concluding Thoughts… • Key Challenges: • MRSA Testing • Data collection and reporting • Education (staff, physicians, patients) • Analysis (RCAs, etc) • Resources needed beyond current infection prevention model • System Level Action • Sutter Infection Control Council – share solutions • Risk Management – policy templates coming! • Summary Grid and Action Plans • HAI-AC Representation: Shelly Morris • Potential Sutter Health System Collaboration • Policy/Procedure templates, Education tools • Influence on legislation interpretations and revisions

17. Questions ???