State Codes and Statutes

Statutes > California > Hsc > 1288.45-1288.9

HEALTH AND SAFETY CODE
SECTION 1288.45-1288.9



1288.45.  For purposes of this article, the following definitions
shall apply:
   (a) "Advisory committee" or "HAI-AC" means the Healthcare
Associated Infection Advisory Committee established pursuant to
Section 1288.5.
   (b) "Health-care-associated infection," "health facility acquired
infection," or "HAI" means an infection defined by the National
Health and Safety Network of the federal Centers for Disease Control
and Prevention, unless the department adopts a definition consistent
with the recommendations of the advisory committee or its successor.
   (c) "Hospital" means a general acute care hospital as defined
pursuant to subdivision (a) of Section 1250.
   (d) "Infection prevention professional" means a registered nurse,
medical technologist, or other salaried employee or consultant who,
within two years of appointment, will meet the education and
experience requirements for certification established by the national
Certification Board for Infection Control and Epidemiology (CBIC),
but does not include a physician who is appointed or receives a
stipend as the infection prevention and control committee chairperson
or hospital epidemiologist.
   (e) "MRSA" means methicillin-resistant Staphylococcus aureus.
   (f) "National Healthcare Safety Network" or "NHSN" means a secure,
Internet-based system developed and managed by the federal Centers
for Disease Control and Prevention (CDC) to collect, analyze, and
report risk-adjusted HAI data related to the incidence of HAI and the
process measures implemented to prevent these infections.
   (g) "Program" means the health care infection surveillance,
prevention, and control program within the department.




1288.5.  (a) By July 1, 2007, the department shall appoint a
Healthcare Associated Infection Advisory Committee (HAI-AC) that
shall make recommendations related to methods of reporting cases of
hospital acquired infections occurring in general acute care
hospitals, and shall make recommendations on the use of national
guidelines and the public reporting of process measures for
preventing the spread of HAI that are reported to the department
pursuant to subdivision (b) of Section 1288.8.
   (b) The advisory committee shall include persons with expertise in
the surveillance, prevention, and control of hospital-acquired
infections, including department staff, local health department
officials, health care infection control professionals, hospital
administration professionals, health care providers, health care
consumers, physicians with expertise in infectious disease and
hospital epidemiology, and integrated health care systems experts or
representatives.
   (c) The advisory committee shall meet at least every quarter and
shall serve without compensation, but shall be reimbursed for
travel-related expenses that include transportation, lodging, and
meals at the state per diem reimbursement rate.
   (d) In addition to the responsibilities enumerated in subdivision
(a), the advisory committee shall do all of the following:
   (1) Review and evaluate federal and state legislation,
regulations, and accreditation standards and communicate to the
department how hospital infection prevention and control programs
will be impacted.
   (2) In accordance with subdivision (a) of Section 1288.6,
recommend a method by which the number of infection prevention
professionals would be assessed in each hospital.
   (3) Recommend an educational curriculum by which health facility
evaluator nurses and department consultants would be trained to
survey for hospital infection surveillance, prevention, and control
programs.
   (4) Recommend a method by which hospitals are audited to determine
the validity and reliability of data submitted to the NHSN and the
department.
   (5) Recommend a standardized method by which an HAI occurring
after hospital discharge would be identified.
   (6) Recommend a method by which risk-adjusted HAI data would be
reported to the public, the Legislature, and the Governor.
   (7) Recommend a standardized method by which department health
facility evaluator nurses and consultants would evaluate health care
workers for compliance with infection prevention procedures
including, but not limited to, hand hygiene and environmental
sanitation procedures.
   (8) Recommend a method by which all hospital infection prevention
professionals would be trained to use the NHSN HAI surveillance
reporting system.



1288.55.  (a) (1) Each health facility, as defined in paragraph (3)
of subdivision (a) of Section 1255.8, shall quarterly report all
cases of health-care-associated MRSA bloodstream infection,
health-care-associated clostridium difficile infection, and
health-care-associated Vancomycin-resistant enterococcal bloodstream
infection, and the number of inpatient days.
   (2) Each health facility shall report quarterly to the department
all central line associated bloodstream infections and the total
central line days.
   (3) Each health facility shall report quarterly to the department
all health-care-associated surgical site infections of deep or organ
space surgical sites, health-care-associated infections of orthopedic
surgical sites, cardiac surgical sites, and gastrointestinal
surgical sites designated as clean and clean-contaminated, and the
number of surgeries involving deep or organ space, and orthopedic,
cardiac, and gastrointestinal surgeries designated clean and
clean-contaminated.
   (b) The department's licensing and certification program shall do
all of the following:
   (1) Commencing January 1, 2011, post on the department's Web site
information regarding the incidence rate of health-care-acquired
central line associated bloodstream infections acquired at each
health facility in California, including information on the number of
inpatient days.
   (2) Commencing January 1, 2012, post on the department's Web site
information regarding the incidence rate of deep or organ space
surgical site infections, orthopedic, cardiac, and gastrointestinal
surgical procedures designated as clean and clean-contaminated,
acquired at each health facility in California, including information
on the number of inpatient days.
   (3) No later than January 1, 2011, post on the department's Web
site information regarding the incidence rate of
health-care-associated MRSA bloodstream infection,
health-care-associated clostridium difficile infection, and
health-care-associated Vancomycin-resistant enterococcal bloodstream
infection, at each health facility in California, including
information on the number of inpatient days.
   (c) Any information reported publicly as required under this
section shall meet all of the following requirements:
   (1) The department shall follow a risk adjustment process that is
consistent with the federal Centers for Disease Control and
Prevention's National Healthcare Safety Network (NHSN), or its
successor, risk adjustment, and use its definitions, unless the
department adopts, by regulation, a fair and equitable risk
adjustment process that is consistent with the recommendations of the
Healthcare Associated Infection Advisory Committee (HAI-AC),
established pursuant to Section 1288.5, or its successor.
   (2) For purposes of reporting, as required in subdivisions (a) and
(b), an infection shall be reported using the NHSN definitions
unless the department accepts the recommendation of the HAI-AC or its
successor.
   (3) If the federal Centers for Disease Control and Prevention do
not use a public reporting model for specific health-care-acquired
infections, then the department shall base its public reporting of
incidence rate on the number of inpatient days for infection
reporting, or the number of specified device days for relevant
device-related infections, and the number of specified surgeries
conducted for surgical site infection reporting, unless the
department adopts a public reporting model that is consistent with
recommendations of the HAI-AC or its successor.
   (d) Health facilities that report data pursuant to the system
shall report this data to the NHSN and the department, as
appropriate.



1288.6.  (a) (1) Each general acute care hospital, in collaboration
with infection prevention and control professionals, and with the
participation of senior health care facility leadership shall, as a
component of its strategic plan, at least once every three years,
prepare a written report that examines the hospital's existing
resources and evaluates the quality and effectiveness of the hospital'
s infection surveillance and prevention program.
   (2) The report shall evaluate and include information on all of
the following:
   (A) The risk and cost of the number of invasive patient procedures
performed at the hospital.
   (B) The number of intensive care beds.
   (C) The number of emergency department visits to the hospital.
   (D) The number of outpatient visits by departments.
   (E) The number of licensed beds.
   (F) Employee health and occupational health measures implemented
at the hospital.
   (G) Changing demographics of the community being served by the
hospital.
   (H) An estimate of the need and recommendations for additional
resources for infection prevention and control programs necessary to
address the findings of the plan.
   (3) The report shall be updated annually, and shall be revised at
regular intervals, if necessary, to accommodate technological
advances and new information and findings contained in the triennial
strategic plan with respect to improving disease surveillance and the
prevention of HAI.
   (b) Each general acute care hospital that uses central venous
catheters (CVCs) shall implement policies and procedures to prevent
occurrences of health care associated infection, as recommended by
the Centers for Disease Control and Prevention intravascular
bloodstream infection guidelines or other evidence-based national
guidelines, as recommended by the advisory committee. A general acute
care hospital that uses CVCs shall internally report CVC associated
blood stream infection rates in intensive care units, utilizing
device days to calculate the rate for each type of intensive care
unit, to the appropriate medical staff committee of the hospital on a
regular basis.


1288.7.  By July 1, 2007, the department shall require that each
general acute care hospital, in accordance with the Centers for
Disease Control guidelines, take all of the following actions:
   (a)  Annually offer onsite influenza vaccinations, if available,
to all hospital employees at no cost to the employee. Each general
acute care hospital shall require its employees to be vaccinated, or
if the employee elects not to be vaccinated, to declare in writing
that he or she has declined the vaccination.
   (b) Institute respiratory hygiene and cough etiquette protocols,
develop and implement procedures for the isolation of patients with
influenza, and adopt a seasonal influenza plan.
   (c) Revise an existing or develop a new disaster plan that
includes a pandemic influenza component. The plan shall also document
any actual or recommended collaboration with local, regional, and
state public health agencies or officials in the event of an
influenza pandemic.



1288.8.  (a) By January 1, 2008, the department shall take all of
the following actions to protect against HAI in general acute care
hospitals statewide:
   (1) Implement an HAI surveillance and prevention program designed
to assess the department's resource needs, educate health facility
evaluator nurses in HAI, and educate department staff on methods of
implementing recommendations for disease prevention.
   (2) Revise existing and adopt new administrative regulations, as
necessary, to incorporate current federal Centers for Disease Control
and Prevention (CDC) guidelines and standards for HAI prevention.
   (3) Require that general acute care hospitals develop a process
for evaluating the judicious use of antibiotics, the results of which
shall be monitored jointly by appropriate representatives and
committees involved in quality improvement activities.
   (b) On and after January 1, 2008, each general acute care hospital
shall implement and annually report to the department on its
implementation of infection surveillance and infection prevention
process measures that have been recommended by the federal Centers
for Disease Control and Prevention Healthcare Infection Control
Practices Advisory Committee, as suitable for a mandatory public
reporting program. Initially, these process measures shall include
the CDC guidelines for central line insertion practices, surgical
antimicrobial prophylaxis, and influenza vaccination of patients and
healthcare personnel. In consultation with the advisory committee,
the department shall make this information public no later than six
months after receiving the data.
   (c) The advisory committee shall make recommendations for phasing
in the implementation and public reporting of additional process
measures and outcome measures by January 1, 2008, and, in doing so,
shall consider the measures recommended by the CDC.
   (d)  Each general acute care hospital shall also submit data on
implemented process measures to the National Healthcare Safety
Network of the CDC, or to any other scientifically valid national HAI
reporting system based upon the recommendation of the federal
Centers for Disease Control and Prevention Healthcare Infection
Control Practices Advisory Committee or to another scientifically
valid reporting database, as determined by the department based on
the recommendations of the HAI-AC. Hospitals shall utilize the
federal Centers for Disease Control and Prevention definitions and
methodology for surveillance of HAI. Hospitals participating in the
California Hospital Assessment and Reporting Task Force (CHART) shall
publicly report those HAI measures as agreed to by all CHART
hospitals.
   (e) In addition to the requirements in subdivision (a), the
department shall establish an infection surveillance, prevention, and
control program to do all of the following:
   (1) Designate infection prevention professionals to serve as
consultants to the licensing and certification program.
   (2) Provide education and training to department health facility
evaluator nurses and consultants to effectively survey hospitals for
compliance with infection surveillance, prevention, and control
recommendations, as well as state and federal statutes and
regulations.
   (3) By January 1, 2011, in consultation with the HAI-AC, develop a
scientifically valid statewide electronic reporting system or
utilize an existing scientifically valid database system capable of
receiving electronically transmitted reports from hospitals related
to HAI.
   (4) Provide current infection prevention and control information
to the public on the Internet.
   (5) Beginning January 1, 2011, provide to the Governor, the
Legislature, and the Chairs of the Senate Committee on Health and
Assembly Committee on Health, and post on the department's Web site,
an annual report of publicly reported HAI infection information
received and reported pursuant to this article.



1288.9.  By January 1, 2009, the department shall do all of the
following:
   (a) Require each general acute care hospital to develop,
implement, and periodically evaluate compliance with policies and
procedures to prevent secondary surgical site infections (SSI). The
results of this evaluation shall be monitored by the infection
prevention committee and reported to the surgical committee of the
hospital.
   (b) Require each general acute care hospital to develop policies
and procedures to implement the current Centers for Disease Control
and Prevention guidelines and Institute for Healthcare Improvement
(IHI) process measures designed to prevent ventilator associated
pneumonia.
   (c) During surveys, evaluate the facility's compliance with
existing policies and procedures to prevent HAI, including any
externally or internally reported HAI process and outcome measures.



State Codes and Statutes

Statutes > California > Hsc > 1288.45-1288.9

HEALTH AND SAFETY CODE
SECTION 1288.45-1288.9



1288.45.  For purposes of this article, the following definitions
shall apply:
   (a) "Advisory committee" or "HAI-AC" means the Healthcare
Associated Infection Advisory Committee established pursuant to
Section 1288.5.
   (b) "Health-care-associated infection," "health facility acquired
infection," or "HAI" means an infection defined by the National
Health and Safety Network of the federal Centers for Disease Control
and Prevention, unless the department adopts a definition consistent
with the recommendations of the advisory committee or its successor.
   (c) "Hospital" means a general acute care hospital as defined
pursuant to subdivision (a) of Section 1250.
   (d) "Infection prevention professional" means a registered nurse,
medical technologist, or other salaried employee or consultant who,
within two years of appointment, will meet the education and
experience requirements for certification established by the national
Certification Board for Infection Control and Epidemiology (CBIC),
but does not include a physician who is appointed or receives a
stipend as the infection prevention and control committee chairperson
or hospital epidemiologist.
   (e) "MRSA" means methicillin-resistant Staphylococcus aureus.
   (f) "National Healthcare Safety Network" or "NHSN" means a secure,
Internet-based system developed and managed by the federal Centers
for Disease Control and Prevention (CDC) to collect, analyze, and
report risk-adjusted HAI data related to the incidence of HAI and the
process measures implemented to prevent these infections.
   (g) "Program" means the health care infection surveillance,
prevention, and control program within the department.




1288.5.  (a) By July 1, 2007, the department shall appoint a
Healthcare Associated Infection Advisory Committee (HAI-AC) that
shall make recommendations related to methods of reporting cases of
hospital acquired infections occurring in general acute care
hospitals, and shall make recommendations on the use of national
guidelines and the public reporting of process measures for
preventing the spread of HAI that are reported to the department
pursuant to subdivision (b) of Section 1288.8.
   (b) The advisory committee shall include persons with expertise in
the surveillance, prevention, and control of hospital-acquired
infections, including department staff, local health department
officials, health care infection control professionals, hospital
administration professionals, health care providers, health care
consumers, physicians with expertise in infectious disease and
hospital epidemiology, and integrated health care systems experts or
representatives.
   (c) The advisory committee shall meet at least every quarter and
shall serve without compensation, but shall be reimbursed for
travel-related expenses that include transportation, lodging, and
meals at the state per diem reimbursement rate.
   (d) In addition to the responsibilities enumerated in subdivision
(a), the advisory committee shall do all of the following:
   (1) Review and evaluate federal and state legislation,
regulations, and accreditation standards and communicate to the
department how hospital infection prevention and control programs
will be impacted.
   (2) In accordance with subdivision (a) of Section 1288.6,
recommend a method by which the number of infection prevention
professionals would be assessed in each hospital.
   (3) Recommend an educational curriculum by which health facility
evaluator nurses and department consultants would be trained to
survey for hospital infection surveillance, prevention, and control
programs.
   (4) Recommend a method by which hospitals are audited to determine
the validity and reliability of data submitted to the NHSN and the
department.
   (5) Recommend a standardized method by which an HAI occurring
after hospital discharge would be identified.
   (6) Recommend a method by which risk-adjusted HAI data would be
reported to the public, the Legislature, and the Governor.
   (7) Recommend a standardized method by which department health
facility evaluator nurses and consultants would evaluate health care
workers for compliance with infection prevention procedures
including, but not limited to, hand hygiene and environmental
sanitation procedures.
   (8) Recommend a method by which all hospital infection prevention
professionals would be trained to use the NHSN HAI surveillance
reporting system.



1288.55.  (a) (1) Each health facility, as defined in paragraph (3)
of subdivision (a) of Section 1255.8, shall quarterly report all
cases of health-care-associated MRSA bloodstream infection,
health-care-associated clostridium difficile infection, and
health-care-associated Vancomycin-resistant enterococcal bloodstream
infection, and the number of inpatient days.
   (2) Each health facility shall report quarterly to the department
all central line associated bloodstream infections and the total
central line days.
   (3) Each health facility shall report quarterly to the department
all health-care-associated surgical site infections of deep or organ
space surgical sites, health-care-associated infections of orthopedic
surgical sites, cardiac surgical sites, and gastrointestinal
surgical sites designated as clean and clean-contaminated, and the
number of surgeries involving deep or organ space, and orthopedic,
cardiac, and gastrointestinal surgeries designated clean and
clean-contaminated.
   (b) The department's licensing and certification program shall do
all of the following:
   (1) Commencing January 1, 2011, post on the department's Web site
information regarding the incidence rate of health-care-acquired
central line associated bloodstream infections acquired at each
health facility in California, including information on the number of
inpatient days.
   (2) Commencing January 1, 2012, post on the department's Web site
information regarding the incidence rate of deep or organ space
surgical site infections, orthopedic, cardiac, and gastrointestinal
surgical procedures designated as clean and clean-contaminated,
acquired at each health facility in California, including information
on the number of inpatient days.
   (3) No later than January 1, 2011, post on the department's Web
site information regarding the incidence rate of
health-care-associated MRSA bloodstream infection,
health-care-associated clostridium difficile infection, and
health-care-associated Vancomycin-resistant enterococcal bloodstream
infection, at each health facility in California, including
information on the number of inpatient days.
   (c) Any information reported publicly as required under this
section shall meet all of the following requirements:
   (1) The department shall follow a risk adjustment process that is
consistent with the federal Centers for Disease Control and
Prevention's National Healthcare Safety Network (NHSN), or its
successor, risk adjustment, and use its definitions, unless the
department adopts, by regulation, a fair and equitable risk
adjustment process that is consistent with the recommendations of the
Healthcare Associated Infection Advisory Committee (HAI-AC),
established pursuant to Section 1288.5, or its successor.
   (2) For purposes of reporting, as required in subdivisions (a) and
(b), an infection shall be reported using the NHSN definitions
unless the department accepts the recommendation of the HAI-AC or its
successor.
   (3) If the federal Centers for Disease Control and Prevention do
not use a public reporting model for specific health-care-acquired
infections, then the department shall base its public reporting of
incidence rate on the number of inpatient days for infection
reporting, or the number of specified device days for relevant
device-related infections, and the number of specified surgeries
conducted for surgical site infection reporting, unless the
department adopts a public reporting model that is consistent with
recommendations of the HAI-AC or its successor.
   (d) Health facilities that report data pursuant to the system
shall report this data to the NHSN and the department, as
appropriate.



1288.6.  (a) (1) Each general acute care hospital, in collaboration
with infection prevention and control professionals, and with the
participation of senior health care facility leadership shall, as a
component of its strategic plan, at least once every three years,
prepare a written report that examines the hospital's existing
resources and evaluates the quality and effectiveness of the hospital'
s infection surveillance and prevention program.
   (2) The report shall evaluate and include information on all of
the following:
   (A) The risk and cost of the number of invasive patient procedures
performed at the hospital.
   (B) The number of intensive care beds.
   (C) The number of emergency department visits to the hospital.
   (D) The number of outpatient visits by departments.
   (E) The number of licensed beds.
   (F) Employee health and occupational health measures implemented
at the hospital.
   (G) Changing demographics of the community being served by the
hospital.
   (H) An estimate of the need and recommendations for additional
resources for infection prevention and control programs necessary to
address the findings of the plan.
   (3) The report shall be updated annually, and shall be revised at
regular intervals, if necessary, to accommodate technological
advances and new information and findings contained in the triennial
strategic plan with respect to improving disease surveillance and the
prevention of HAI.
   (b) Each general acute care hospital that uses central venous
catheters (CVCs) shall implement policies and procedures to prevent
occurrences of health care associated infection, as recommended by
the Centers for Disease Control and Prevention intravascular
bloodstream infection guidelines or other evidence-based national
guidelines, as recommended by the advisory committee. A general acute
care hospital that uses CVCs shall internally report CVC associated
blood stream infection rates in intensive care units, utilizing
device days to calculate the rate for each type of intensive care
unit, to the appropriate medical staff committee of the hospital on a
regular basis.


1288.7.  By July 1, 2007, the department shall require that each
general acute care hospital, in accordance with the Centers for
Disease Control guidelines, take all of the following actions:
   (a)  Annually offer onsite influenza vaccinations, if available,
to all hospital employees at no cost to the employee. Each general
acute care hospital shall require its employees to be vaccinated, or
if the employee elects not to be vaccinated, to declare in writing
that he or she has declined the vaccination.
   (b) Institute respiratory hygiene and cough etiquette protocols,
develop and implement procedures for the isolation of patients with
influenza, and adopt a seasonal influenza plan.
   (c) Revise an existing or develop a new disaster plan that
includes a pandemic influenza component. The plan shall also document
any actual or recommended collaboration with local, regional, and
state public health agencies or officials in the event of an
influenza pandemic.



1288.8.  (a) By January 1, 2008, the department shall take all of
the following actions to protect against HAI in general acute care
hospitals statewide:
   (1) Implement an HAI surveillance and prevention program designed
to assess the department's resource needs, educate health facility
evaluator nurses in HAI, and educate department staff on methods of
implementing recommendations for disease prevention.
   (2) Revise existing and adopt new administrative regulations, as
necessary, to incorporate current federal Centers for Disease Control
and Prevention (CDC) guidelines and standards for HAI prevention.
   (3) Require that general acute care hospitals develop a process
for evaluating the judicious use of antibiotics, the results of which
shall be monitored jointly by appropriate representatives and
committees involved in quality improvement activities.
   (b) On and after January 1, 2008, each general acute care hospital
shall implement and annually report to the department on its
implementation of infection surveillance and infection prevention
process measures that have been recommended by the federal Centers
for Disease Control and Prevention Healthcare Infection Control
Practices Advisory Committee, as suitable for a mandatory public
reporting program. Initially, these process measures shall include
the CDC guidelines for central line insertion practices, surgical
antimicrobial prophylaxis, and influenza vaccination of patients and
healthcare personnel. In consultation with the advisory committee,
the department shall make this information public no later than six
months after receiving the data.
   (c) The advisory committee shall make recommendations for phasing
in the implementation and public reporting of additional process
measures and outcome measures by January 1, 2008, and, in doing so,
shall consider the measures recommended by the CDC.
   (d)  Each general acute care hospital shall also submit data on
implemented process measures to the National Healthcare Safety
Network of the CDC, or to any other scientifically valid national HAI
reporting system based upon the recommendation of the federal
Centers for Disease Control and Prevention Healthcare Infection
Control Practices Advisory Committee or to another scientifically
valid reporting database, as determined by the department based on
the recommendations of the HAI-AC. Hospitals shall utilize the
federal Centers for Disease Control and Prevention definitions and
methodology for surveillance of HAI. Hospitals participating in the
California Hospital Assessment and Reporting Task Force (CHART) shall
publicly report those HAI measures as agreed to by all CHART
hospitals.
   (e) In addition to the requirements in subdivision (a), the
department shall establish an infection surveillance, prevention, and
control program to do all of the following:
   (1) Designate infection prevention professionals to serve as
consultants to the licensing and certification program.
   (2) Provide education and training to department health facility
evaluator nurses and consultants to effectively survey hospitals for
compliance with infection surveillance, prevention, and control
recommendations, as well as state and federal statutes and
regulations.
   (3) By January 1, 2011, in consultation with the HAI-AC, develop a
scientifically valid statewide electronic reporting system or
utilize an existing scientifically valid database system capable of
receiving electronically transmitted reports from hospitals related
to HAI.
   (4) Provide current infection prevention and control information
to the public on the Internet.
   (5) Beginning January 1, 2011, provide to the Governor, the
Legislature, and the Chairs of the Senate Committee on Health and
Assembly Committee on Health, and post on the department's Web site,
an annual report of publicly reported HAI infection information
received and reported pursuant to this article.



1288.9.  By January 1, 2009, the department shall do all of the
following:
   (a) Require each general acute care hospital to develop,
implement, and periodically evaluate compliance with policies and
procedures to prevent secondary surgical site infections (SSI). The
results of this evaluation shall be monitored by the infection
prevention committee and reported to the surgical committee of the
hospital.
   (b) Require each general acute care hospital to develop policies
and procedures to implement the current Centers for Disease Control
and Prevention guidelines and Institute for Healthcare Improvement
(IHI) process measures designed to prevent ventilator associated
pneumonia.
   (c) During surveys, evaluate the facility's compliance with
existing policies and procedures to prevent HAI, including any
externally or internally reported HAI process and outcome measures.




State Codes and Statutes

State Codes and Statutes

Statutes > California > Hsc > 1288.45-1288.9

HEALTH AND SAFETY CODE
SECTION 1288.45-1288.9



1288.45.  For purposes of this article, the following definitions
shall apply:
   (a) "Advisory committee" or "HAI-AC" means the Healthcare
Associated Infection Advisory Committee established pursuant to
Section 1288.5.
   (b) "Health-care-associated infection," "health facility acquired
infection," or "HAI" means an infection defined by the National
Health and Safety Network of the federal Centers for Disease Control
and Prevention, unless the department adopts a definition consistent
with the recommendations of the advisory committee or its successor.
   (c) "Hospital" means a general acute care hospital as defined
pursuant to subdivision (a) of Section 1250.
   (d) "Infection prevention professional" means a registered nurse,
medical technologist, or other salaried employee or consultant who,
within two years of appointment, will meet the education and
experience requirements for certification established by the national
Certification Board for Infection Control and Epidemiology (CBIC),
but does not include a physician who is appointed or receives a
stipend as the infection prevention and control committee chairperson
or hospital epidemiologist.
   (e) "MRSA" means methicillin-resistant Staphylococcus aureus.
   (f) "National Healthcare Safety Network" or "NHSN" means a secure,
Internet-based system developed and managed by the federal Centers
for Disease Control and Prevention (CDC) to collect, analyze, and
report risk-adjusted HAI data related to the incidence of HAI and the
process measures implemented to prevent these infections.
   (g) "Program" means the health care infection surveillance,
prevention, and control program within the department.




1288.5.  (a) By July 1, 2007, the department shall appoint a
Healthcare Associated Infection Advisory Committee (HAI-AC) that
shall make recommendations related to methods of reporting cases of
hospital acquired infections occurring in general acute care
hospitals, and shall make recommendations on the use of national
guidelines and the public reporting of process measures for
preventing the spread of HAI that are reported to the department
pursuant to subdivision (b) of Section 1288.8.
   (b) The advisory committee shall include persons with expertise in
the surveillance, prevention, and control of hospital-acquired
infections, including department staff, local health department
officials, health care infection control professionals, hospital
administration professionals, health care providers, health care
consumers, physicians with expertise in infectious disease and
hospital epidemiology, and integrated health care systems experts or
representatives.
   (c) The advisory committee shall meet at least every quarter and
shall serve without compensation, but shall be reimbursed for
travel-related expenses that include transportation, lodging, and
meals at the state per diem reimbursement rate.
   (d) In addition to the responsibilities enumerated in subdivision
(a), the advisory committee shall do all of the following:
   (1) Review and evaluate federal and state legislation,
regulations, and accreditation standards and communicate to the
department how hospital infection prevention and control programs
will be impacted.
   (2) In accordance with subdivision (a) of Section 1288.6,
recommend a method by which the number of infection prevention
professionals would be assessed in each hospital.
   (3) Recommend an educational curriculum by which health facility
evaluator nurses and department consultants would be trained to
survey for hospital infection surveillance, prevention, and control
programs.
   (4) Recommend a method by which hospitals are audited to determine
the validity and reliability of data submitted to the NHSN and the
department.
   (5) Recommend a standardized method by which an HAI occurring
after hospital discharge would be identified.
   (6) Recommend a method by which risk-adjusted HAI data would be
reported to the public, the Legislature, and the Governor.
   (7) Recommend a standardized method by which department health
facility evaluator nurses and consultants would evaluate health care
workers for compliance with infection prevention procedures
including, but not limited to, hand hygiene and environmental
sanitation procedures.
   (8) Recommend a method by which all hospital infection prevention
professionals would be trained to use the NHSN HAI surveillance
reporting system.



1288.55.  (a) (1) Each health facility, as defined in paragraph (3)
of subdivision (a) of Section 1255.8, shall quarterly report all
cases of health-care-associated MRSA bloodstream infection,
health-care-associated clostridium difficile infection, and
health-care-associated Vancomycin-resistant enterococcal bloodstream
infection, and the number of inpatient days.
   (2) Each health facility shall report quarterly to the department
all central line associated bloodstream infections and the total
central line days.
   (3) Each health facility shall report quarterly to the department
all health-care-associated surgical site infections of deep or organ
space surgical sites, health-care-associated infections of orthopedic
surgical sites, cardiac surgical sites, and gastrointestinal
surgical sites designated as clean and clean-contaminated, and the
number of surgeries involving deep or organ space, and orthopedic,
cardiac, and gastrointestinal surgeries designated clean and
clean-contaminated.
   (b) The department's licensing and certification program shall do
all of the following:
   (1) Commencing January 1, 2011, post on the department's Web site
information regarding the incidence rate of health-care-acquired
central line associated bloodstream infections acquired at each
health facility in California, including information on the number of
inpatient days.
   (2) Commencing January 1, 2012, post on the department's Web site
information regarding the incidence rate of deep or organ space
surgical site infections, orthopedic, cardiac, and gastrointestinal
surgical procedures designated as clean and clean-contaminated,
acquired at each health facility in California, including information
on the number of inpatient days.
   (3) No later than January 1, 2011, post on the department's Web
site information regarding the incidence rate of
health-care-associated MRSA bloodstream infection,
health-care-associated clostridium difficile infection, and
health-care-associated Vancomycin-resistant enterococcal bloodstream
infection, at each health facility in California, including
information on the number of inpatient days.
   (c) Any information reported publicly as required under this
section shall meet all of the following requirements:
   (1) The department shall follow a risk adjustment process that is
consistent with the federal Centers for Disease Control and
Prevention's National Healthcare Safety Network (NHSN), or its
successor, risk adjustment, and use its definitions, unless the
department adopts, by regulation, a fair and equitable risk
adjustment process that is consistent with the recommendations of the
Healthcare Associated Infection Advisory Committee (HAI-AC),
established pursuant to Section 1288.5, or its successor.
   (2) For purposes of reporting, as required in subdivisions (a) and
(b), an infection shall be reported using the NHSN definitions
unless the department accepts the recommendation of the HAI-AC or its
successor.
   (3) If the federal Centers for Disease Control and Prevention do
not use a public reporting model for specific health-care-acquired
infections, then the department shall base its public reporting of
incidence rate on the number of inpatient days for infection
reporting, or the number of specified device days for relevant
device-related infections, and the number of specified surgeries
conducted for surgical site infection reporting, unless the
department adopts a public reporting model that is consistent with
recommendations of the HAI-AC or its successor.
   (d) Health facilities that report data pursuant to the system
shall report this data to the NHSN and the department, as
appropriate.



1288.6.  (a) (1) Each general acute care hospital, in collaboration
with infection prevention and control professionals, and with the
participation of senior health care facility leadership shall, as a
component of its strategic plan, at least once every three years,
prepare a written report that examines the hospital's existing
resources and evaluates the quality and effectiveness of the hospital'
s infection surveillance and prevention program.
   (2) The report shall evaluate and include information on all of
the following:
   (A) The risk and cost of the number of invasive patient procedures
performed at the hospital.
   (B) The number of intensive care beds.
   (C) The number of emergency department visits to the hospital.
   (D) The number of outpatient visits by departments.
   (E) The number of licensed beds.
   (F) Employee health and occupational health measures implemented
at the hospital.
   (G) Changing demographics of the community being served by the
hospital.
   (H) An estimate of the need and recommendations for additional
resources for infection prevention and control programs necessary to
address the findings of the plan.
   (3) The report shall be updated annually, and shall be revised at
regular intervals, if necessary, to accommodate technological
advances and new information and findings contained in the triennial
strategic plan with respect to improving disease surveillance and the
prevention of HAI.
   (b) Each general acute care hospital that uses central venous
catheters (CVCs) shall implement policies and procedures to prevent
occurrences of health care associated infection, as recommended by
the Centers for Disease Control and Prevention intravascular
bloodstream infection guidelines or other evidence-based national
guidelines, as recommended by the advisory committee. A general acute
care hospital that uses CVCs shall internally report CVC associated
blood stream infection rates in intensive care units, utilizing
device days to calculate the rate for each type of intensive care
unit, to the appropriate medical staff committee of the hospital on a
regular basis.


1288.7.  By July 1, 2007, the department shall require that each
general acute care hospital, in accordance with the Centers for
Disease Control guidelines, take all of the following actions:
   (a)  Annually offer onsite influenza vaccinations, if available,
to all hospital employees at no cost to the employee. Each general
acute care hospital shall require its employees to be vaccinated, or
if the employee elects not to be vaccinated, to declare in writing
that he or she has declined the vaccination.
   (b) Institute respiratory hygiene and cough etiquette protocols,
develop and implement procedures for the isolation of patients with
influenza, and adopt a seasonal influenza plan.
   (c) Revise an existing or develop a new disaster plan that
includes a pandemic influenza component. The plan shall also document
any actual or recommended collaboration with local, regional, and
state public health agencies or officials in the event of an
influenza pandemic.



1288.8.  (a) By January 1, 2008, the department shall take all of
the following actions to protect against HAI in general acute care
hospitals statewide:
   (1) Implement an HAI surveillance and prevention program designed
to assess the department's resource needs, educate health facility
evaluator nurses in HAI, and educate department staff on methods of
implementing recommendations for disease prevention.
   (2) Revise existing and adopt new administrative regulations, as
necessary, to incorporate current federal Centers for Disease Control
and Prevention (CDC) guidelines and standards for HAI prevention.
   (3) Require that general acute care hospitals develop a process
for evaluating the judicious use of antibiotics, the results of which
shall be monitored jointly by appropriate representatives and
committees involved in quality improvement activities.
   (b) On and after January 1, 2008, each general acute care hospital
shall implement and annually report to the department on its
implementation of infection surveillance and infection prevention
process measures that have been recommended by the federal Centers
for Disease Control and Prevention Healthcare Infection Control
Practices Advisory Committee, as suitable for a mandatory public
reporting program. Initially, these process measures shall include
the CDC guidelines for central line insertion practices, surgical
antimicrobial prophylaxis, and influenza vaccination of patients and
healthcare personnel. In consultation with the advisory committee,
the department shall make this information public no later than six
months after receiving the data.
   (c) The advisory committee shall make recommendations for phasing
in the implementation and public reporting of additional process
measures and outcome measures by January 1, 2008, and, in doing so,
shall consider the measures recommended by the CDC.
   (d)  Each general acute care hospital shall also submit data on
implemented process measures to the National Healthcare Safety
Network of the CDC, or to any other scientifically valid national HAI
reporting system based upon the recommendation of the federal
Centers for Disease Control and Prevention Healthcare Infection
Control Practices Advisory Committee or to another scientifically
valid reporting database, as determined by the department based on
the recommendations of the HAI-AC. Hospitals shall utilize the
federal Centers for Disease Control and Prevention definitions and
methodology for surveillance of HAI. Hospitals participating in the
California Hospital Assessment and Reporting Task Force (CHART) shall
publicly report those HAI measures as agreed to by all CHART
hospitals.
   (e) In addition to the requirements in subdivision (a), the
department shall establish an infection surveillance, prevention, and
control program to do all of the following:
   (1) Designate infection prevention professionals to serve as
consultants to the licensing and certification program.
   (2) Provide education and training to department health facility
evaluator nurses and consultants to effectively survey hospitals for
compliance with infection surveillance, prevention, and control
recommendations, as well as state and federal statutes and
regulations.
   (3) By January 1, 2011, in consultation with the HAI-AC, develop a
scientifically valid statewide electronic reporting system or
utilize an existing scientifically valid database system capable of
receiving electronically transmitted reports from hospitals related
to HAI.
   (4) Provide current infection prevention and control information
to the public on the Internet.
   (5) Beginning January 1, 2011, provide to the Governor, the
Legislature, and the Chairs of the Senate Committee on Health and
Assembly Committee on Health, and post on the department's Web site,
an annual report of publicly reported HAI infection information
received and reported pursuant to this article.



1288.9.  By January 1, 2009, the department shall do all of the
following:
   (a) Require each general acute care hospital to develop,
implement, and periodically evaluate compliance with policies and
procedures to prevent secondary surgical site infections (SSI). The
results of this evaluation shall be monitored by the infection
prevention committee and reported to the surgical committee of the
hospital.
   (b) Require each general acute care hospital to develop policies
and procedures to implement the current Centers for Disease Control
and Prevention guidelines and Institute for Healthcare Improvement
(IHI) process measures designed to prevent ventilator associated
pneumonia.
   (c) During surveys, evaluate the facility's compliance with
existing policies and procedures to prevent HAI, including any
externally or internally reported HAI process and outcome measures.