Hawaii Healthcare-Associated Infections Legislation Passes, Awaits Governor’s Signature

May 25, 2011

The Hawaii State Legislature has passed legislation requiring mandatory reporting of healthcare-associated infections (HAI). H.B. 889 (2011) aims to “ensure that Hawaii is consistent with the efforts of federal agencies to control health care-associated infections.” The legislation was passed on April 12, 2011 and was transmitted to the Governor on May 6, 2011. It is currently awaiting his signature. The veto deadline is July 12, 2011. If not signed beforehand, the Governor must send notification to the legislature of his intent to veto by June 27, 2011.

Support for HB 889

The Department of Health supported the bill. Also supporting the bill was the Healthcare Association of Hawaii (HAH), an organization advocating for acute care hospitals, long-term care facilities, home care agencies, and hospices.  The Association for Professionals in Infection Control and Epidemiology (APIC), Hawaii Chapter, also supported the bill. In a letter to the Hawaii State House of Representatives, Susan M. Slavis, the APIC-Hawaii Legislative Representative, stated the following:

Members of APIC-Hawai’i are infection preventionists who work in Hawai’i’s healthcare organizations and our primary focus is the elimination of healthcare associated infections (HAIs) in the patients cared for in our facilities. While infection prevention efforts have occurred in Hawai’i’s hospitals for over 35 years this effort was expanded in 2009 through a cooperative agreement between all 17 acute care facilities in the state, Hawai’i Medical Services Association (HtVISA) and Johns Hopkins University Quality and Safety Research Group. The HAl that was the focus of this cooperative agreement was central-line related bloodstream infection (CLAB SI) in patients in the intensive care unit. The methodology that was employed to reduce, and eventually eliminate, these infections was CUSP (Comprehensive Unit-base Safety Program) and the goal of On the CUSP-Stop BSI was elimination of bloodstream infections in patients in the intensive care units. This project has been extremely successful, with many ICUs in the participating hospitals achieving a zero CLABSI rate for greater than one year. And the reduction in CLABSIs statewide has been substantial. This same cooperative effort is now being used to address catheter-associated urinary tract infections (CAUTI) and is being led by the Quality Committee of the Healthcare Association.

In addition, several acute care hospitals in Hawai’i are already reporting data on various HAIs to the Center for Disease Control and Prevention’s (CDC) National Healthcare Safety Network (NHSN).

This bill represents the efforts of DOll, HAIl, Mountain-Pacific Quality Health, and HI{IC. It will assure that all of Hawai’i’s healthcare facilities will be in compliance with reporting requirements established by the Centers for Medicare and Medicaid (CMS). The proposed reporting system will also assure that HAT data reported for Hawai’i is done using approved CDCINHSN definitions for HATs, is consistent with national standards and is comparable with data from other states.

Components of the Legislation

Specific components of the legislation include the following:

Data Submission Requirements

If enacted, Healthcare facilities certified by the Centers for Medicare and Medicaid Services (CMS) are required to report under the law. Reporting is to be made to the Centers for Disease Control and Prevention’s (CDC) National Healthcare Safety Network (NHSN). Healthcare facilities subject to the law must authorize the CDC to allow the Hawaii Department of Health access to the reported data.

Rule Making Authority

The department may adopt rules pursuant to the law requiring the reporting of HAIs that are multidrug-resistant. The rules promulgated under the law must specify which healthcare facilities are required to report as well as the patient populations to be targeted.

Confidentiality

The law contains confidentiality protections for patient information. Patient information, including patient-level data shall remain confidential. The department may issue reports to the public regarding HAIs, however those reports must be aggregated to protect individual patient identities. The reports may identify individual healthcare facilities.

Privilege Protections

The law contains privilege protections. HAI information held by the department as a result of reporting is not subject to subpoena, discovery, or introduction into evidence in any civil or criminal proceeding.

Public Reporting

If enacted, the law would require the department to issue annual public reports containing information about the HAI data submitted during the previous calendar year. The first report is required by June 20, 2013. However, the first year of reporting shall be a pilot test in which any data submitted by the healthcare facilities shall not be disclosed to the public. The department is also required to submit a report to the legislature providing update information about the reported HAI information. That report is due prior to the 2012 regular legislative session.

References:

H.B. 889 (2011).

Testimony of Loretta J. Fuddy, Acting Director of Heath. To the House Committee on Finance, H.B. 889, H.D. 2, Relating to Health. March 1, 2011.

Slavish, Susan M. Letter to the Hawaii State House of Representatives, Committee on Finance. March 1, 2011.

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