HCS/SS/SCS/SB 1279 - This act creates the "Missouri Nosocomial Infection Control Act of 2004" to encourage health care facilities to take appropriate actions to decrease the risk of infection.

SECTION 192.020 - The Department shall include MRSA and VRE in its list of communicable diseases.

SECTION 192.067 - The Department shall have the authority to collect, analyze, and disclose nosocomial infection data from patient records.

SECTION 192.131(1)-(2) - This section provides definitions for "advisory panel", "antibiogram", and "antimicrobial". Every laboratory performing culture and sensitivity testing on humans in Missouri shall submit data on health care associated infections to the Department. The data to be reported shall be defined by the Department. By July 1, 2005, the data must include the number of patients or isolates by hospital, ambulatory surgical center, and other facility who are infected with MRSA and VRE.

SECTION 192.131(3)-(5) - All information collected pursuant to this section shall be confidential. However, this information shall be available to the appropriate facility or professional licensing authorities. The Advisory Panel shall develop a plan, using the collected data, to create a system that enhances the ability of health care providers to track preventable infections and monitors trends relating to antibiotic-resistant microbes. The Advisory Panel and the Department must conform to standards adopted by the Centers for Disease Control and Prevention.

SECTION 192.665 - This section adds new definitions for "nosocomial infection", "nosocomial infection incidence rate", and "other facility".

SECTION 192.667(1)-(11) - The Department must collect data on nosocomial infection incidence rates from hospitals, ambulatory surgical centers, and other appropriate facilities. By July 1, 2005, the Department must promulgate rules regarding the standards and procedures for the collection and reporting of nosocomial infection incidence rates and these rules shall be based upon the methodologies established by the Centers for Disease Control and Prevention National Nosocomial Infection Surveillance System and the recommendations of the Infection Control Advisory Panel.

The Infection Control Advisory Panel shall make a recommendation, based on certain factors, to the Department regarding the implementation of nosocomial infection data collection, analysis, and reporting. If the Department chooses the requirements of the Centers for Disease Control Prevention's National Nosocomial Infection Surveillance System instead of the requirements listed in this section, then hospitals and ambulatory surgical centers that opt to participate in the federal program must provide the necessary data as a condition for licensure. Any hospital or ambulatory surgical center which does not voluntarily participate in the federal program shall be required to abide by the requirements enumerated in subsections 2,3, and 6 through 12 of this section.

SECTION 192.667(11)-(14) - Physician's offices shall be exempt from the reporting and disclosure of infection incidence rates. In consultation with the Advisory Panel, the Department must disseminate reports to the public, based on data compiled over a twelve-month period and updated quarterly thereafter, that show for each hospital, ambulatory surgical center, and other facility a risk-adjusted nosocomial infection incidence rate for class I surgical site infections, ventilator-associated pneumonia, central line-related bloodstream infections, and other infections defined by rule by the Department. By December 31, 2006, these reports shall also be published on the Department's website and shall be annually distributed to the Governor and the General Assembly.

SECTION 192.667(15)-(17) - If the Hospital Industry Data Institute fails by July 31, 2008 and annually thereafter to publish a report of Missouri's compliance with the quality of care measures established by the Centers for Medicare and Medicaid Services, the Department shall have the authority to collect and publish this information. This information shall also be available to the Department for the licensing of hospitals and ambulatory surgical centers pursuant to Chapter 197, RSMo.

SECTION 197.150 - Hospitals, ambulatory surgical centers, and other facilities must have procedures for monitoring compliance with infection control regulations and standards. These procedures must be coordinated with administrative and personnel staff. The infection control program shall include the surveillance of personnel, with a portion of the surveillance done without the staff's knowledge. However, this unobserved surveillance requirement cannot be considered grounds for licensure enforcement actions until the Department establishes clear and verifiable criteria for determining compliance.

SECTION 197.152 - Infection control officers and other employees shall be protected from retaliation from any hospitals, ambulatory surgical centers, or other facilities. Any interference in the duties of an infection control officer shall be reported to the hospital and ambulatory surgical center supervisors. Infection control officers have the authority to order the termination of any practice that falls outside the standard of care in infection control. The hospital or ambulatory surgical center infection control committee must convene as soon as possible to review any termination action. Employees who report infection control concerns in good faith shall not be subject to retaliation or discrimination.

SECTION 197.154 - By July 1, 2005, the Department must promulgate rules establishing certain standards for the infection control programs, which shall based upon nationally recognized standards.

SECTION 197.156 - "Nosocomial infection outbreaks" are defined by the Centers for Disease Control and Prevention within a defined time period. The Department shall define the time period based upon the number of infected patients in a facility.

SECTION 197.158 - Beginning June 1, 2006, all hospitals and ambulatory surgical centers shall provide each patient an opportunity to submit complaints, comments, or suggestions relating to the quality of care received.

SECTION 197.160 - The Department shall have access to all information compiled by hospitals, ambulatory surgical centers, and other facilities related to infection control practices, rates, and treatments. The failure to provide access to this information shall be grounds for a full or partial licensure suspension or revocation. If a hospital, ambulatory surgical center, or other facility willfully impedes access to this information, then the Department has the authority to direct any state agency to suspend all or a portion of state payments until the Department receives the information.

SECTION 197.162 - For the licensing of hospitals and ambulatory surgical centers, the Department shall give special attention to infection control practices and shall direct these facilities to set quantifiable measures of performance for reducing nosocomial infections. The Department must annually prepare a report on infection control standards and compliance. The report shall be distributed to the General Assembly and the Governor.

SECTION 197.165 - The Department must appoint an "Infection Control Advisory Panel", which shall consist of thirteen members. Any reasonable expenses of the Panel shall be paid from private donations made specifically to the "Infection Control Advisory Panel Fund", which is created in the State Treasury.

SECTION 197.294 - No information disclosed by the Department to the public pursuant to this act shall be used to establish a standard of care in a civil action.

This act is identical to SCS/HS/HCS/HB 1477 & 1563 (2004).
LORIE TOWE