HCS HB 1477 & 1563 -- MISSOURI HOSPITAL INFECTION CONTROL ACT

SPONSOR:  Holand (Schaaf)

COMMITTEE ACTION:  Voted "do pass" by the Committee on Health
Care Policy by a vote of 13 to 0.

This substitute creates the Missouri Nosocomial Infection Control
Act of 2004.  The substitute:

(1)  Authorizes the Department of Health and Senior Services to
collect, analyze, and disclose nosocomial data obtained from
hospital patient medical records.  Currently, the department
obtains this information to conduct epidemiological studies;

(2)  Creates various definitions, including "nosocomial
infection," "nosocomial infection incidence rate," and "other
facility";

(3)  Requires the department to maintain the confidentiality of a
patient's medical records;

(4)  Requires the department to collect patient abstract data and
nosocomial incidence infection rates from hospitals, ambulatory
surgical centers, and other facilities as determined by
administrative rule.  The collection of nosocomial infection data
does not extend to a physician's office;

(5)  Requires the department to develop rules governing the
collection, risk adjustment, and reporting of nosocomial
infection incidence rates by July 1, 2005;

(6)  Requires the department to use data collection methodologies
established by the National Nosocomial Infection Surveillance
Program of the Centers for Disease Control and Prevention;

(7)  Requires the department to submit quarterly reports of
nosocomial infections to the public.  The department is also
required to post the reports on their web site beginning April 1,
2006.  The reports will also be distributed on an annual basis to
the Governor and the General Assembly;

(8)  Requires the quarterly reports to reveal risk-adjusted
nosocomial infection incidence rate data for methicillin-
resistant staphylococcus aureus, vancomycin-resistant
enterococcus infections, and other infections;

(9)   Requires the department to collect nosocomial infection
incidence rates if the Hospital Industry Data Institute fails to
do so by July 31, 2008;

(10)  Requires the nosocomial infection data collected or
published to be available to the department for the purpose of
licensing hospitals and ambulatory surgical centers;

(11)  Requires hospitals, ambulatory surgical centers, and other
facilities to have procedures for monitoring compliance with
infection control regulations;

(12)  Gives infection control officers the authority to require
hospitals to terminate a practice or procedure which does not
meet the standard of care for the prevention of nosocomial
infections;

(13)  Prohibits hospitals and ambulatory surgical centers from
taking retaliatory actions against infection control officers and
other employees who discuss any aspect of care with an agent of
the department concerning potential hospital infection issues or
complaints;

(14)  Requires each hospital and ambulatory surgical center to
have an active multi-disciplinary infection control committee
responsible for implementing and monitoring compliance with the
substitute or similar federal regulations;

(15)  Requires the department to develop rules to establish
standards for an infection control program by July 1, 2005, and
specifies the subject areas for the standards;

(16)  Requires that on-site surveys of hospitals by
non-governmental entities who evaluate the quality of health care
delivered be unannounced.  Announced survey results will not be
used to issue statements about the quality of the hospital
surveyed;

(17)  Gives the department access to all data and information
held by hospitals, ambulatory surgical centers, and other medical
facilities relating to their infection control practices.
Facilities that willfully impede access to the information will
be subject to a subpoena; and

(18)  Prohibits information disclosed by the public for the
purpose of compliance with the substitute from being used to
establish a standard of care in a private civil suit.

FISCAL NOTE:  Estimated Cost on General Revenue Fund of $430,739
in FY 2005, $536,824 in FY 2006, and $550,587 in FY 2007.  No
impact on Other State Funds in FY 2005, FY 2006, and FY 2007.

PROPONENTS:  Supporters say that current hospital infection
control practices are inadequate.  Recent figures reveal that
over 1,000 Missouri patients experienced staphylococcus
infections and 217 deaths occurred as a result of the infection.
A recent report from the Centers for Disease Control and
Prevention estimate that costs associated with treating
nosocomial infections amount to $5 billion annually.  The bill
will promote better antiseptic practices among hospital
personnel, provide access to data concerning the prevalence of
nosocomial infections, and give patients a choice among health
care providers based on their reporting of infection data to the
Department of Health and Senior Services.

Testifying for the bill were Representative Schaaf; Raymond T.
Wagner, Jr.; Raymond Wagner III; Kim Gardner; Audrey Ikemeier;
and Cynthia McMaster.

OPPONENTS:  Those who oppose the bill say that current law allows
the Attorney General to represent the Department of Health and
Senior Services in actions brought against persons or
governmental entities who violate the licensure law for
hospitals.  The bill needs to consider issues of data collection,
standardization, and analyzing comparative data pertaining to the
incidence of hospital-based infections.

Testifying against the bill was Missouri Hospital Association.

OTHERS:  Others testifying on the bill say that since the 1980s,
hospital-based infections have become more serious and deadly.  A
number of factors are correlated with the increased number of
hospital-based infections, including staff reductions, increased
use of antibiotics, and a lack of hand washing among hospital
personnel.

Others testifying on the bill were Missouri Trial Lawyers
Association; and Department of Health and Senior Services.

Joseph Deering, Legislative Analyst

Missouri House of Representatives
92nd General Assembly, 2nd Regular Session
Last Updated September 23, 2004 at 11:15 am