SB 739: What it Means to You and Your Acute Care Facility

1
SB 739 What it Means to You and Your Acute Care
Facility
Hospital Infectious Disease Prevention Control
Programs
2
History

• Senator Speier introduced SB 1487 in 2004. It
  passed the legislative body but was vetoed by
  Governor Schwarzenegger as redundant costly.
• In 2005, SB 739 was introduced but stalled in
  legislature and was carried over to the 2006
  session.
• In 2006, significant revisions were made as a
  result of the DHS taskforce whitepaper entitled
  Recommendations for Reducing Morbidity and
  Mortality Related to Healthcare-Associated
  Infections in California (12-05).
• SB739 passed the legislature 8-30-06 and Governor
  Schwarzenegger signed it.

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SB 739

• An act to add Article 3.5 (commencing with
  section 1288.5) to Chapter 2 of Division 2 of the
  Health and Safety Code, relating to health
  facilities.
• Effective 1-1-07
• Copies available at http//www.leginfo.ca.gov/bili
  nfo.html

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Burden or Benefit?Lets Make it Benefit Our
Patients and Programs

• Utilize this regulation to create partnerships
  between senior leadership and members of the
  Infection Prevention and Control Program.
• Shines the spotlight on prioritizing infection
  prevention as important.
• Gets acute care facilities in California on the
  same page regarding identification of process and
  outcome measures.

5
Additional Benefits

• Better awareness of key measures within
  facilities.
• Ability to benchmark with other California
  hospitals.
• Begin to meet public expectation of infection
  reporting.
• Potential for improved resources/staffing for the
  infection prevention and control program.

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Summary of Requirements

• DHS must
• Create a multi-disciplinary advisory panel to
  monitor and oversee the operations and products
  of the California Healthcare-Associated
  Infections Reporting System by 7-1-07. Will
  include ICPs.
• Require general acute care facilities to prevent
  the spread of influenza by 7-1-07 .
• Mandate reporting of process measures by acute
  care facilities beginning 1-1-08. Make process
  measure data reported to the department public
  within 6 months.
• Revise regulations (T22) to incorporate current
  guidelines and standards to prevent HAI.
• Require hospitals to have a process for judicious
  use of antibiotics.

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Summary of Requirements

• DHS must
• Develop a plan to assess its own program and
  educate department staff on implementing
  recommendations by 1-1-08 .
• Explore electronic reporting by 1-1-08 .
• Recommend other process and outcome measures to
  be reported by acute care facilities by 1-1-08.
• Require facilities to develop policies
  procedures to prevent SSIs and VAPs by 1-1-09 .
• Evaluate compliance with these policies
  procedures during facility surveys.

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Summary of Requirements

• Hospitals must
• Create a written report every 3 years, as a
  component of the strategic plan, that addresses
  the resources and effectiveness of the infection
  control program. This is to be a joint effort
  between ICPs and hospital senior leadership.
• Submit process measure data to NHSN or other
  scientifically valid national HAI reporting
  systems.
• Utilize CDC definitions for defining HAIs.
• Hospitals participating in CHART shall publicly
  report those HAI measures as agreed to by all
  CHART hospitals.

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Summary of Requirements

• Hospitals must
• Implement policies and procedures to reduce the
  risk of CLA-BSI as outlined by the CDC. Report
  CLA-BSI rates for ICUs. No date defined.
• Reduce Risk of Influenza/Pandemic by 7-1-07.
• Offer influenza vaccine to all hospital employees
  at no charge and require a declination for those
  choosing not to be vaccinated.
• Institute respiratory hygiene/cough etiquette
  procedures.
• Isolation plan for influenza patient. CDC
  recommends droplet.
• Adopt a seasonal influenza plan.
• Include pandemic planning in the disaster plan.

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Summary of Requirements

• Hospitals must
• Report success with selected process measures to
  DHS by 1-1-08
• Insertion of CVC practices
• Antibiotic prophylaxis in surgical patients
• Influenza vaccination rates of patients and
  employees
• By 1-1-08 have a process for evaluating the
  judicious use of antibiotics which shall be
  monitored by committees involved in QI.
• By 1-1-09 have policies and procedures in place
  to reduce SSI's. Reports of compliance to the IC
  and Surgical Committees.
• By 1-1-09 develop policies and procedures to
  prevent VIPs.

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Suggestions for Complianceby Acute Care
Facilities
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Report on Resources Program Effectiveness
1288.6 (a) (1-3)

• Per JCAHO, annual plans and assessments are
  already required.
• Wording in SB739 confusing re every 3 year
  strategic plan with annual updates.
• Suggest that data elements outlined in SB739 be
  added to your plan (section 1288.6 a1-3). See
  next slide.

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Report on Resources Program Effectiveness

• Elements
• Risk and cost and number of invasive cases
  performed at your facility (invasive cases is not
  defined so you should define what you are
  counting).
• Number of ICU beds, ER visits annually,
  outpatient visits annually, and licensed beds
• Employee health measures implemented at your
  facility

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• Elements
• Demographics of the community you serve
• Estimate of needs and recommendations for
  additional resources for the Infection Prevention
  and Control Program to address issues identified
  in your plan.
• Update as necessary to address changes.

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Central Venous Catheters1288.6 (b)

• Implement PP to reduces CLA-BSI (central
  line-associated bloodstream infections).
• Refer to CDC guidelines http//www.cdc.gov/ncidod/
  dhqp/guidelines.html

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CLA-BSI Rates

• Identify a way to collect line days from your ICU
  settings. Any patient with any number of central
  lines gets counted once.
• Familiarize self with CDC definition of
  laboratory confirmed BSI.
• Review positive blood cultures for ICU patients.
• Eliminate those without central lines.
• List CLA-BSIs not present on admission.
• Determine a rate (CLA-BSI/line days).
• Report findings to Medical Staff Committees
  (i.e. Infection Control , Critical Care).

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Influenza 1288.7 (a-c)

• Onsite influenza vaccinations to ALL hospital
  employees at no cost.
• If employee does not want vaccination, a
  declination must be signed.
• Immunization Coalition http//www.immunize.org/cat
  g.d/p4068.htm or
• SHEAs Position Paper on HCW vaccination includes
  sample form available at http//www.shea-online.or
  g/publications/shea_position_papers.cfm

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Influenza

• Develop respiratory and cough etiquette
  protocols, isolation procedures (droplet
  recommended) seasonal influenza plans
• See CDC signs, protocols, and programs at
  http//www.cdc.gov/flu/
• Revise Emergency Plans to include a pandemic
  component (JCAHO already requires a surge if
  infectious disease patients)

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Process Measures

• These will be reportable to DHS starting 1-1-08
  DHS will make this data PUBLIC within 6 months
  (methods yet to be determined)
• Compliance with CVC insertion procedures
• Timing of surgical antibiotic prophylaxis
• Influenza vaccination rates of patients and
  employees (NHSN Healthcare worker vaccination
  module)

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HAI Definitions

• Expectation is that all facilities will utilize
  CDC definitions last updated 2004 and available
  at http//www.cdc.gov/ncidod/hip/nhsn/members/memb
  ers.htm
• Use of NHSN when available or other national
  reporting system (yet to be defined by the HAI
  Advisory Committee)

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Prevention of Surgical Site Infections

• Develop PP to prevent SSI's and periodically
  evaluate compliance with same ( antibiotic
  prophyl., skin prep, etc).
• Report compliance rates to Infection Control
  Committee and Surgery Committee.
• Sites IHI http//www.ihi.org/IHI/Topics/PatientSaf
  ety/SurgicalSiteInfections/Resources/NationalSurg
  icalInfectionPrevention.htm

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More SSI Sites

• AHRQ http//www.qualitymeasures.ahrq.gov/summary/s
  ummary.aspx?ss1doc_id256
• SCIP ( formerly known as SIP ) http//www.medqic.o
  rg/dcs/ContentServer?cid1122904930422pagenameMe
  dqic2FContent2FParentShellTemplateparentNameTo
  piccMQParents

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Ventilator Associated Pneumonias

• Develop PP to prevent VIPs.
• Sites
• AHQR http//www.qualitymeasures.ahrq.gov/summary/s
  ummary.aspx?doc_id8021
• CDC http//www.cdc.gov/ncidod/dhqp/dprc_ventilate.
  html
• IHI http//www.ihi.org/IHI/Topics/CriticalCare/Int
  ensiveCare/Changes/ImplementtheVentilatorBundle.ht
  m

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Analysis of Data Documentation

• Be sure Infection Control minutes reflect the
  presentation and discussion of PP developed or
  revised, measures of compliance, data submitted,
  and annual review of the Infection Prevention and
  Control Plan and Annual Assessment.
• Your minutes, if comprehensive, will often
  satisfy surveyors as proof of your actions.

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Updates Next Steps

• Educate your senior leadership.
• Stay involved with your APIC Chapter for updates.
• Share resources, tools, forms and tips.
• Check the CACC website at www.cacc.net for
  updates.

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Summary

• Many of these requirements are not entirely
  defined. The HAI Advisory Committee, yet to be
  appointed, may provide clarification down the
  road.
• Use this time to assess what you are doing and
  what needs to be done to comply with these new
  regulations.
• Change has a considerable psychological impact on
  the human mind. To the fearful it is threatening
  because it means that things may get worse. To
  the hopeful it is encouraging because things may
  get better. To the confident it is inspiring
  because the challenge exists to make things
  better.
• King Whitney Jr.

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• Copies of SB739 available at http//www.leginfo.c
  a.gov/bilinfo.html