Healthcare Associated Infection

1
Healthcare Associated Infection MRSA Reporting

• Seeking Patient Safety through Data

2
Washington Current HAI Laws and Regulations

• In 2007, Washington enacted HB 1106, reporting of
  Healthcare Associated Infections (HAI) in health
  care facilities
• The Washington Department of Health (DOH) oversee
  and evaluate the HAI reporting program
• Hospitals are required to collect and report data
  concerning
• health-care associated infections, phased in as
  follows
• Beginning July 1, 2008 CLABSI in intensive care
  units
• Beginning January 1, 2009 VAP
• Beginning January 1, 2010 SSI in cardiac,
  hip/knee replacement hysterectomy procedures
• Hospitals are to submit HAI data to the CDC
  National Healthcare Surveillance Network on a
  regular basis
• Established an Advisory Committee on HAI to make
  recommendations to the DOH regarding its
  responsibilities
• relating to the reporting of health-care
  associated infections

3
Washington Current HAI Laws and Regulations

• Starting December 1, 2009, DOH will prepare and
  publish an annual report on the agency's website
  that compares the HAI
• rates at each individual hospital using the data
  reported in the previous year
• The report must not disclose information
• About individual patients
• Data sets determined by the DOH to be too small
  or unrepresentative of a hospital's
  ability to achieve an outcome
• The DOH may respond to data requests, at the
  requestor's expense, for analysis consistent with
  confidentiality of patient records and quality
  improvement

4
Washington Current HAI Laws and Regulations

• In 2007, DOH implemented a project program to
  monitor the incidence rate of MRSA
  infections through voluntary laboratory reporting
• In 2008, DOH required hospitals to report
  incidences of MRSA through the State
  Comprehensive Abstract Reporting System (CHARS)
• CHARS collects data on patients discharged from a
  hospital
• In addition, DOH developed public education
  materials about MRSA
• In collaboration with the Tacoma-Pierce County
  Health
• Department created Living with MRSA booklet to
  educate the public about MRSA, transmission of
  the infection and medical treatment, medical
  treatment, and prevention precautions

5
Washington HB 1123 An Act to Reduce the Spread
of MRSA

• In 2009, Legislature enacted a law requiring
  hospitals to reduce the spread of MRSA
• Sponsored by Washington State Representative Tom
  Campbell
• Governor Gregoire signed HB 1123 into law on
  April 28, 2009
• Amends RCW 43.70.056, by adding a new section to
  Chapter 70.41 RCW
• New law goes into effect July 26, 2009
• DOH is in the process of developing the timeline
  for regulations and rules for HB 1123
• Summary of HB 1123
• Requires hospitals to adopt a policy regarding
  MRSA (January 1, 2010)
• Requires hospitals to report incidences of MRSA
  infection to the DOH
• Requires the Advisory Committee on Health
  Care-Associated Infections to make annual
  recommendations on expanding MRSA testing
  requirements
• Requires certain medical professionals to note
  the presence of MRSA on a death certificate if it
  is a contributing factor to a patient's death

6
Washington HB 1123 Reduce the Spread of MRSA

• Hospital MRSA Policy
• By January 1, 2010, a hospital licensed under
  chapter 70.41 must adopt a MRSA policy with the
  following elements
• Required to test any patient for MRSA who is a
  member of a patient population identified as
  appropriate based on the hospital's MRSA risk
  assessment
• Required to test any patient in the adult or
  pediatric ICU (but not NICU) be tested for MRSA
  within 24 hours of admission unless the patient
  has already been tested during that hospital stay
  or has a previous history of MRSA
• Appropriate procedures for preventing a patient
  who tests positive for MRSA from transmitting
  MRSA to other patients, including isolation and
  cohorting
• Must notify patients if they are sharing a room
  with a MRSA positive patient
• Hospitals are required that every patient with a
  MRSA infection receive oral and written
  instructions regarding aftercare and precautions
  against spreading the infection
• Adds new section to 70.41 RCW and 70.58 RCW

7
Washington HB 1123 Reduce the Spread of MRSA

• MRSA Reporting
• Hospitals that have identified a hospitalized
  patient with a MRSA must report the infection to
  the Department of Health using CHARS
• Hospitals must report using U.S. Centers for
  Medicare and Medicaid Services codes, when
  available
• Adds new section to 70.41 RCW and 70.58 RCW

8
CHARS

• The Comprehensive Hospital Abstract Reporting
  System (CHARS) has hospital inpatient coded
  discharge information (derived from billing
  systems) available for 1987 to 2008. Hospital
  based observation coded data is available for
  2008. The database is used to collect public
  information such as the age, sex, zip code and
  billed charges of the patient, as well as the
  codes for their diagnosis and procedures among
  other items. 

9
CHARS

• The purpose of the CHARS system is to provide
  public health personnel, consumers, purchasers,
  payers, providers, and researchers useful
  information by which to make informed decisions
  on health care. The CHARS system provides those
  concerned with the development of public policy
  with information necessary to analyze many
  significant health care issues. Specifically, the
  department uses the CHARS data system to
• Identify and analyze health trends related to
  patients hospitalizations
• establish statewide diagnosis related groups
  (DRG) weights
• create hospital specific case mix indices and
• identify and quantify issues related to health
  care access, quality, and cost containment.

10
Washington HB 1123 Reduce the Spread of MRSA

• Advisory Committee on HAI Recommendations
• Beginning January 1, 2011, the Advisory Committee
  on HAI must make an annual
• recommendation to the DOH as to whether current
  science supports expanding
• pre-surgical screening for MRSA prior to the
  following surgical procedures
• open chest cardiac
• total hip
• total knee elective
• In developing its recommendations, the advisory
  committee shall consider methodologies and
  practices related to HAIs based on CDC, CMS,
  Joint Commission National Quality Forum,
  Institute for Healthcare improvement, and other
  relevant organizations
• DOH will adopt rules as necessary to carry out
  Advisory Committees added responsibilities
• Amends RCW 73.70.056 Chapter 261 Section 2

11
Washington HB 1123 Reduce the Spread of MRSA

• Cause of Death
• A physician, physician assistant, or advanced
  registered nurse practitioner must note the
  presence of MRSA on a patient's death certificate
  if it was a contributing factor in the patient's
  death
• Adds new section to Chapter 70.58 RCW

12
HB 1021 Hospital Readiness Bill

• In 2009, Legislature enacted a law changing the
  hospital inspection notification
• Sponsored by Washington State Representative Tom
  Campbell
• Governor Gregoire signed HB 1021 into law on
  April 28, 2008
• New law goes into effect July 26, 2009
• DOH is in the process of developing the timeline
  for regulations and rules for HB 1021
• Summary of HB 1021
• Requires DOH to perform unannounced hospital
  inspections
• Prohibits DOH from issuing its final report
  regarding a hospital infection unless certain
  requirements are met
• Adds Det Norske Veritas as an authorized entity
  to conduct hospital surveys
• Changes provisions relating to the phase-in of
  the certificate of need exemption for swing beds
  in critical access hospitals
• Amends RCW 70.41.120, 70.41.122, 70.38.105 RCW

13
HB 1021 Hospital Readiness Bill

• Hospital Inspections
• DOH will no longer notify a hospital before an
  inspection
• DOH must now conduct all hospital inspections on
  an
• unannounced basis
• Hospital inspections to be conducted on average
  at least every 18 months
• The DOH is prohibited from issuing its final
  unannounced inspection report until
• The hospital is given at least two weeks to
  provide any information or documentation
  requested by the DOH during the inspection that
  was not available at the time of the request
• At least one person from the DOH conducting the
  inspection meets personally with the chief
  administrator or executive officer of the
  hospital following the inspection, or the
  chief administrator or executive officer declines
  such a meeting.
• Amends RCW 70.41.120 and 2005 chapter 447 section
  1

14
HB 1021 Hospital Readiness Bill

• DOH Hospital Survey and Audits
• Adds Det Norske Veritas (DNV) as an authorized
  entity of the DOH to conduct hospital surveys
• DNV, based in Norway, healthcare accreditation
  program is known as the National Integrated
  Accreditation for Healthcare Organizations
  (NIAHO)
• CMS approves DNV to accredit hospitals
• In September 2008, CMS approved DNV as a national
  accreditation organization for hospitals seeking
  to participate in the Medicare or Medicaid
  programs
• Other Washington DOH authorized entities, on
  hospitals accredited by those bodies
• Joint Commission
• American Osteopathic Association
• Amends RCW 70.41.122 and 2005 c 447 section 2

15
State MRSA Testing Laws/Regulations (As of June
2009)
Washington and Nevada enacted MRSA laws in 2009
Law encourages hospitals to establish a MRSA
infection control program, including testing ICU
and at-risk patients for MRSA
16
Five States Mandate Active MRSA Surveillance
Testing
report published 1/15/08)
17
Healthcare Associated Infections (HAIs) National
Problem

• According to CDC, the overall annual direct
  medical costs of HAIs in US hospitals ranges from
  35.7 Billion to 45 Billion
• SSI cost per patient case is 25,546
• Total Hospital Cost annually is 3.45 10.07
  Billion
• CLABSI cost per patient case is 36,441
• Total Hospital cost annually is 0.67 - 2.68
  billion
• VAP cost per patient case is 36,441
• Total Hospital cost annually is 1.03 - 1.50
  Billion
• CA-UTI cost per patient case is 1,006
• Total hospital cost annually is 0.39 0.45
  Billion
• CDI cost per patient case is 9,124
• Total hospital cost annually is 1.14 1.62
  Billion
• Healthcare costs for MRSA is much higher
• Estimated annual cost of MRSA infections to U.S.
  hospitals to be 3.2 to 4.2 Billion
• Patient hospitalized with a MRSA infection
  25,000 - 35,000 per case Patients
• Patients infected with MRSA stay in the hospital
  an average of 10-12 days longer
• Source CDC Direct Medical Costs of HAIs, HHS
  Action Plan to Reduce HAIs, US Outcomes Research
  Group of Pfizer Inc presented at ISPOR (Abstract
  9489)

18
Current State HAI Laws (As of June 2009)
19
SHEA/IDSA Practice Recommendations Prevent
Transmission of MRSA in Acute Care Hospitals
Source Infect Control Hosp Epidemiol 2008
29S62-S80
20
SHEA/IDSA Practice RecommendationsTo decrease
the incidence rate of MRSA, if basic
non-preventive measures are not successful
Source Infect Control Hosp Epidemiol 2008
29S62-S80