SB 739. Where the Rubber Meets the Road. Jan ’08 version (2) presented: (insert your chapter, current date here) Sue Chen RN, MPH, CIC HAI Program Coordinator California Dept of Public Health [email protected] Objectives. SB 739 in context History of mandatory reporting
Where the Rubber Meets the Road
Jan ’08 version (2) presented:
(insert your chapter, current date here)
Sue Chen RN, MPH, CIC
HAI Program Coordinator
California Dept of Public Health
Number of nosocomial pathogens, according to infection site, identified in the hospital-wide component of the NNISprogram from January 1990 to March 1996
HAIs- The Big Four
* From Klevens et al..Public Health Rep. 2007;122:160-6 +12% of U.S.
$25,072 for VAP – $23,242 per CLA BSI
$10,443 per SSI – $758 per CAUTI
Anderson et al. Underresourced Hospital Infection Control and Prevention Programs: Penny Wise, Pound Foolish. Infect Control Hosp Epidemiol 2007; 28:767-773
What Hospitals Don’t Get
Two economists are walking down the street. One sees a dollar lying on the sidewalk, and says, “Look, there is a dollar lying on the ground!” “Obviously not,” says the other. “If there were, someone would have picked it up!”
from Hollenbeak, APIC 2007
Effective October 1, 2008, hospitals will no longer receive higher payments for the additional costs of treatment associated with following HAIs*
* Unless condition is present upon admission
*Gill C, Gill G. Nightengale in Scutari: Her Legacy Reexamined. CID 2005:40.
Trend over time in bloodstream infections associated w/ catheters in pediatric ICU
Nov 1998: use of maximal barrier precautions
July 1999: use of antibiotic-impregnated catheters
March 2000: annual hand washing campaigns
April 2003: move to new unit with private rooms
May 2003: introduction of skin disinfection with chlorhexidine
U Arkansas Children’s Hospital Bhutta et. al., BMJ 2007;334:362-5
Focus on obtaining data on HAIs so consumer can make an informed choice; also
pressures hospitals to improve
“Rep. Tim Murphy (PA) is sponsoring the "Healthy Hospitals Act of 2007" (HR1174). The bill will make you safer during a hospital stay by requiring public disclosure of hospital-acquired infection rates. If hospitals must tell you about their infections, they will work harder to reduce them.”
“Please ask your representative to co-sponsor this bill!”
Source: CHCF sponsored survey of Californians, 2004
But Hospitals Do…
* For those w/ attention deficit or CRS
On or after Jan 1, 2008:
Specific directions will be forthcoming from CDPH with details and start dates for mandated reporting.
NHSN participation was never designed or intended to be the sole responsibility of Infection Control.
Am J Infect Control 2007;35:290-310
Percentage of Hospitals in AHA Survey Enrolled* in NHSN
Status as of June 18, 2007
National Healthcare Safety Network (NHSN)for State Reporting
Heavily* Plagiarized by CDPH from
CSTE 2007 Annual Conference presentation
R. Monina Klevens, DDS, MPH
Division for Healthcare Quality Promotion
National Center for Infectious Diseases
* Heavily is not an infestation
“The information contained in this surveillance system that would permit identification of any individual or institution is collected with a guarantee that it will be held in strict confidence, will be used only for the purposes stated, and will not be disclosed or released without the consent of the individual, or the institution in accordance with Sections 304, 306, and 308(d) of the Public Health Service Act (42 USC 242b, 242k, and 242m(d)).”
1Leape LL. Reporting of adverse events. NEJM 2002;347:1633-8.
2Burke JP. Infection control—a problem for patient safety. NEJM 2003; 348:651-6.
Accept Rules of Behavior
NHSN sends email w/ instructions for digital certificate
You read and follow directions – carefully; complete modules
NHSN sends further instructions
You read and follow directions – carefully; sign away first born
Etc. Etc. Etc.
(From Facility Administrator
I certify that I completed
the required training to participate
National Healthcare Safety Network
Name of participant
Name of facility
Dates of training:
* Undefined measures
Disclaimer: While willing, CDC lacks personnel and monetary resources to develop these capacities at this time.
Infectious Diseases Experts Applaud Bill Against "Bad Bugs"
With extensively drug-resistant tuberculosis, life-threatening drug-resistant respiratory and skin infections, and other “bad bugs” routinely making headlines, infectious diseases physicians are applauding Rep. Jim Matheson (D-UT) and Rep. Michael Ferguson (R-NJ) for introducing H.R. 3697, Strategies To Address Antimicrobial Resistance (STAAR) Act
*Community-Associated and Healthcare-Associated Infections
*Introduced Dec 11, 2007; D-NY
*Introduction Dec 11, 2007; R-FL
*Introduced Dec 19, 2007; D-NJ, IL, MA
Health facilities and residential care facilities for the elderly must implement procedures for screening, prevention, and reporting of specified infections
* Introduced Jan 8, 2008 by E Alquist, D-Santa Clara
**CDC definition of “previously healthy”:
Persons “who have not been recently (within the past year) hospitalized or had a medical procedure (such as dialysis, surgery, catheters)…”