S.B. No. 288

	AN ACT
	relating to the reporting of health care-associated infections 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.  REPORTING OF HEALTH CARE-ASSOCIATED INFECTIONS
	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 general hospital
	licensed under Chapter 241 or a hospital that provides surgical or
	obstetrical services and that is maintained or operated by this
	state. The term does not include a comprehensive medical
	rehabilitation hospital.
	(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 the delivery of health care to the patient.
	(8)  "Health care facility" means a general hospital or
	an ambulatory surgical center.
	(9)  "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.
	(10)  "Pediatric and adolescent hospital" has the
	meaning assigned by Section 241.003.
	(11)  "Reporting system" means the Texas Health
	Care-Associated Infection Reporting System.
	(12)  "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 to guide the implementation, development,
	maintenance, and evaluation of the reporting system.
	Sec. 98.052.  MEMBERSHIP; TERM.  (a)  The advisory panel is
	composed of 16 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 have
	active medical staff privileges at a hospital in this state and at
	least one of whom is a pediatric infectious disease physician with
	expertise and experience in pediatric health care epidemiology;
	(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)  two professionals in quality assessment and
	performance improvement, one of whom is employed by a general
	hospital and one of whom is employed by an ambulatory surgical
	center;
	(5)  one officer of a general hospital;
	(6)  one officer of an ambulatory surgical center;
	(7)  three nonvoting members who are department
	employees representing the department in epidemiology and the
	licensing of hospitals or ambulatory surgical centers; and
	(8)  two members who represent the public as consumers.
	(b)  Members of the advisory panel serve two-year terms.
	Sec. 98.053.  MEMBER ELIGIBILITY.  (a)  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.
	(b)  A person may not be a member of the advisory panel if the
	person is an officer, employee, or paid consultant of a Texas trade
	association in the field of 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.  The officers serve two-year terms.
	Sec. 98.055.  COMPENSATION; EXPENSES.  Members of the
	advisory panel serve without compensation but are entitled to
	reimbursement of the travel expenses incurred by the member while
	conducting the business of the advisory panel from department
	funds, in accordance with the General Appropriations Act.
	Sec. 98.056.  VACANCY.  A vacancy on the advisory panel shall
	be filled by the commissioner.
	[Sections 98.057-98.100 reserved for expansion]
	SUBCHAPTER C.  DUTIES OF DEPARTMENT AND ADVISORY PANEL; REPORTING
	SYSTEM
	Sec. 98.101.  RULEMAKING.  (a)  The executive commissioner
	may adopt rules for the department to implement this chapter.
	(b)  The executive commissioner may not adopt rules that
	conflict with or duplicate any federally mandated infection
	reporting program or requirement.
	Sec. 98.102.  DEPARTMENTAL RESPONSIBILITIES; REPORTING
	SYSTEM.  (a)  The department shall establish the Texas Health
	Care-Associated Infection Reporting System within the infectious
	disease surveillance and epidemiology branch of the department.
	The purpose of the reporting system is to provide for:
	(1)  the reporting of health care-associated
	infections by health care facilities to the department;
	(2)  the public reporting of information regarding the
	health care-associated infections by the department; and
	(3)  the education and training of health care facility
	staff by the department regarding this chapter.
	(b)  The reporting system shall provide a mechanism for this
	state to collect data, at state expense, through a secure
	electronic interface with health care facilities.
	(c)  The data reported by health care facilities to the
	department must contain sufficient patient identifying information
	to:
	(1)  avoid duplicate submission of records;
	(2)  allow the department to verify the accuracy and
	completeness of the data reported; and
	(3)  allow the department to risk adjust the
	facilities' infection rates.
	(d)  The department shall review the infection control and
	reporting activities of health care facilities to ensure the data
	provided by the facilities is valid and does not have unusual data
	patterns or trends that suggest implausible infection rates.
	Sec. 98.103.  REPORTABLE INFECTIONS.  (a)  A health care
	facility, other than a pediatric and adolescent hospital, shall
	report to the department the incidence of surgical site infections
	occurring in the following procedures:
	(1)  colon surgeries;
	(2)  hip arthroplasties;
	(3)  knee arthroplasties;
	(4)  abdominal hysterectomies;
	(5)  vaginal hysterectomies;
	(6)  coronary artery bypass grafts; and
	(7)  vascular procedures.
	(b)  A pediatric and adolescent hospital shall report the
	incidence of surgical site infections occurring in the following
	procedures to the department:
	(1)  cardiac procedures, excluding thoracic cardiac
	procedures;
	(2)  ventriculoperitoneal shunt procedures; and
	(3)  spinal surgery with instrumentation.
	(c)  A general hospital shall report the following to the
	department:
	(1)  the incidence of laboratory-confirmed central
	line-associated primary bloodstream infections occurring in any
	special care setting in the hospital; and
	(2)  the incidence of respiratory syncytial virus
	occurring in any pediatric inpatient unit in the hospital.
	(d)  The department shall ensure that the health
	care-associated infections a health care facility is required to
	report under this section have the meanings assigned by the federal
	Centers for Disease Control and Prevention.
	Sec. 98.104.  ALTERNATIVE FOR REPORTABLE SURGICAL SITE
	INFECTIONS.  A health care facility that does not perform at least
	an average of 50 procedures per month of the procedures listed in
	Section 98.103(a) or (b), as modified under Section 98.105, is not
	required to comply with the reporting requirements of Section
	98.103 but instead shall report to the department the surgical site
	infections relating to the three surgical procedures most
	frequently performed at the facility, based on the list of surgical
	procedures promulgated by the federal Centers for Disease Control
	and Prevention's National Healthcare Safety Network or its
	successor.
	Sec. 98.105.  REPORTING SYSTEM MODIFICATIONS.  Based on the
	recommendations of the advisory panel, the executive commissioner
	by rule may modify in accordance with this chapter the list of
	procedures that are reportable under Section 98.103 or 98.104.  The
	modifications must be based on changes in reporting guidelines and
	in definitions established by the federal Centers for Disease
	Control and Prevention.
	Sec. 98.106.  DEPARTMENTAL SUMMARY.  (a)  The department
	shall compile and make available to the public a summary, by health
	care facility, of the infections reported by facilities under
	Sections 98.103 and 98.104.
	(b)  The departmental summary must be risk adjusted and
	include a comparison of the risk-adjusted infection rates for each
	health care facility in this state that is required to submit a
	report under Sections 98.103 and 98.104.
	(c)  In consultation with the advisory panel, the department
	shall publish the departmental summary in a format that is easy to
	read.
	(d)  The department shall publish the departmental summary
	at least annually and may publish the summary more frequently as the
	department considers appropriate.
	(e)  The executive commissioner by rule shall allow a health
	care facility to submit concise written comments regarding
	information contained in the departmental summary that relates to
	the facility.  The department shall attach the facility's comments
	to the public report and the comments must be in the same format as
	the summary.
	(f)  The disclosure of written comments to the department by
	a health care facility as provided by Subsection (e) does not
	constitute a waiver of a privilege or protection under Section
	98.109.
	(g)  The department shall make the departmental summary
	available on an Internet website administered by the department and
	may make the summary available through other formats accessible to
	the public.  The website must contain a statement informing the
	public of the option to report suspected health care-associated
	infections to the department.
	Sec. 98.107.  EDUCATION AND TRAINING REGARDING REPORTING
	SYSTEM.  The department shall provide education and training for
	health care facility staff regarding this chapter.  The training
	must be reasonable in scope and focus primarily on:
	(1)  the implementation and management of a facility
	reporting mechanism;
	(2)  characteristics of the reporting system,
	including public reporting by the department and facility reporting
	to the department;
	(3)  confidentiality; and
	(4)  legal protections.
	Sec. 98.108.  FREQUENCY OF REPORTING.  In consultation with
	the advisory panel, the executive commissioner by rule shall
	establish the frequency of reporting by health care facilities
	required under Sections 98.103 and 98.104.  Facilities may not be
	required to report more frequently than quarterly.
	Sec. 98.109.  CONFIDENTIALITY; PRIVILEGE.  (a)  Except as
	provided by Sections 98.106 and 98.110, all information and
	materials obtained or compiled or reported by the department under
	this chapter or compiled or reported 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; and
	(2)  may not be admitted as evidence or otherwise
	disclosed in any civil, criminal, or administrative proceeding.
	(b)  The confidentiality protections under Subsection (a)
	apply without regard to whether the information or materials are
	obtained from or compiled or reported 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)  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.
	(e)  A 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.
	Sec. 98.110.  DISCLOSURE WITHIN DEPARTMENT.
	Notwithstanding any other law, the department may disclose
	information reported by health care facilities under Section 98.103
	or 98.104 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. 98.111.  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.
	[Sections 98.112-98.150 reserved for expansion]
	SUBCHAPTER D.  ENFORCEMENT
	Sec. 98.151.  VIOLATIONS. (a)  Except as provided by
	Subsection (b), a general hospital that violates this chapter or a
	rule adopted under this chapter is subject to the enforcement
	provisions of Subchapter C, Chapter 241, and rules adopted and
	enforced under that subchapter as if the hospital violated Chapter
	241 or a rule adopted under that chapter.
	(b)  Subsection (a) does not apply to a comprehensive medical
	rehabilitation hospital as defined in Section 241.003.
	(c)  An ambulatory surgical center that violates this
	chapter or a rule adopted under this chapter is subject to the
	enforcement provisions of Chapter 243 and rules adopted and
	enforced under that chapter as if the center violated Chapter 243 or
	a rule adopted under that chapter.
	SECTION 2.  Not later than June 1, 2008, the Department of
	State Health Services shall establish the Texas Health
	Care-Associated Infection Reporting System as required under
	Chapter 98, Health and Safety Code, as added by this Act.
	SECTION 3.  (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)  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.
	______________________________	______________________________
	President of the Senate	Speaker of the House
	I hereby certify that S.B. No. 288 passed the Senate on
	April 4, 2007, by the following vote: Yeas 30, Nays 0; and that
	the Senate concurred in House amendment on May 15, 2007, by the
	following vote: Yeas 31, Nays 0.
	______________________________
	Secretary of the Senate
	I hereby certify that S.B. No. 288 passed the House, with
	amendment, on May 3, 2007, by the following vote: Yeas 141,
	Nays 0, one present not voting.
	______________________________
	Chief Clerk of the House
	Approved:
	______________________________
	Date
	______________________________
	Governor