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Summary update of state activity relating to hospital acquired infection reporting

The following is a summary of state activity and legislation regarding the disclosure by hospitals of their hospital infection rates. To date:

  • 21 states have laws requiring public reporting of infection rates (CO, CT, DE, FL, IL, MD, MN, MO, NJ, NY, NH, OH, OK, OR, PA, SC, TN,TX, VA, VT, WA);
  • 2 states have laws requiring public reporting of infection information but not specifically rates (CA, RI);
  • 1 state has voluntary law requiring public reporting of infection information (AK)
  • All other states except WY, AZ, MT, ND have considered hospital infection reporting laws, but have not yet passed legislation

Alaska
In 2006, the Alaska Legislature adopted a resolution to create a task force to develop recommendations for hospitals to disclose their infection rates, to be presented in the form of legislation in 2007.

Arkansas
Introduced into law in 2007, hospitals to voluntarily submit infection rates to the Division of Health of the Department of Health and Human Services. Hospitals will collect data for health care associated infection rates for the following: coronary artery bypass surgical site infections; total hip or knee arthroplasty surgical site infections; knee arthroscopy surgical site infections; hernia repair surgical site infections; and central line-associated bloodstream infection in an intensive care unit. The Department will publish an annual report to their Web site with aggregate statewide numbers without identifying hospitals by January 1, 2010.

California
Introduced into law in 2006, and effective January 1, 2008, hospitals will report health care associated infections to the State. Its public reporting will relate to the rate at which prevention practices are used. The reporting requirements however do not include hospital infection rates, which would reveal whether hospital policies are actually reducing infections.

In October 2007, a bill which would have disclosed hospital infection and death rates to the public was vetoed by California’s Governor Arnold Schwarzenegger (R). While Schwarzenegger’s own healthcare bill contains some data collection provisions, it did not require the state to release any information to the public. The California Hospital Association had opposed the disclosures.

Colorado
Introduced into law in 2006: By July 31, 2007, hospitals, ambulatory surgical centers and dialysis centers commenced reporting incidents of hospital-acquired infections to the CDC to be analyzed and risk adjusted. The Colorado Department of Public Health and Environment will use that information to issue facility-specific infection rates to the public. The first report will include infection rates for cardiac and orthopedic surgical site infections and central line-related blood stream infections. The first annual comparative report will be issued in January 2008.

In 2008, hospital-acquired infection measures will be included in the Hospital Report card released by the Colorado Hospital Association in 2007.

Connecticut
Introduced into law in 2006, hospitals are to report infection rates to the Connecticut Department of Health who will make hospital-specific infection information available to the public. The first report is to be issued by October 2008.

Delaware
Introduced into law in 2007, hospitals to report to the Department quarterly on hospital-acquired infection rates for Surgical site infections; Ventilator-associated pneumonia; Central line-related bloodstream infections; and Urinary tract infections. These quarterly reports will be made available to the public at each hospital and through the Department. The first quarterly report is due January 1, 2008. The Department will publish the annual report summarizing the hospital quarterly reports on its Web site by January 1, 2010, to be updated on a quarterly basis after this. The annual report shall compare hospital-acquired infection rate collected for each individual hospital in the State and include trends concerning the overall state of hospital-acquired infections in the State, including a comparison to prior years.

Florida
Introduced into law in 2004, hospitals report hospital-acquired infection rates to the State via their Web site www.floridahealthfinder.gov.

Georgia
2006 legislation: The Georgia Senate created the Health Care Standards Commission for Prevention of Hospital Acquired Infections. Members include legislators, representatives of the hospital and medical community, and one researcher, but no public members. The commission will study safety standards, best practices, infection rates and causes.

Illinois
First introduced into law in 2003, and revised 2005. Infection rates relating to surgical site infections and ventilator-associated pneumonia, and central vascular bloodstream infection rates in designated critical care units to be reported to the state Department of Public Health. Commencing 2007, reporting is to occur quarterly, with the annual report due on December 31 of each year.

In September 2007, Northwest Community Hospital became the first in the Chicago area to post care quality information and patient satisfaction ratings online (Northwest Community Hospital Quality Report site) including data about hospital-acquired infections.

Maryland
Introduced into law in 2006, hospital-acquired infection information to be reported to Maryland Health Care Commission. This information will be included in their existing hospital quality reporting system and be presented in a manner that will allow comparisons among hospitals.

Massachussetts
MA has no legislation requiring hospital-based infection reporting.

Beth Israel Deaconess Medical Center in MA has made available online, information on their performance in hospital-wide infection measures.

Minnesota
Introduced into law in 2007, Minnesota Hospital Association to include hospital-acquired infection rates in their existing Web based public reporting system for hospital specific quality and cost performance by January 1, 2009. To include facility to compare hospital specific data to State wide data. Minnesota to follow National Quality Forum guidelines.

Missouri
Introduced into law in 2004, hospitals report risk-adjusted rates for surgical site infections, ventilator-associated pneumonia and central line-related bloodstream infections. In 2006 the State released a report on bloodstream infections (Central line blood stream infections in intensive care units). Reports on surgical site infections for total hip replacements, CABG and abdominal hysterectomies were released in 2007. Ventilator-associated pneumonia (VAP) – pneumonia related to the use of artificial breathing machines will be added. This data will be updated every 3 months. The reported infection data are available, by facility, on the DHSS Web site (www.dhss.mo.gov/HAI).

New Jersey
Introducted into law in 2007, the law requires hospitals to publicly report infection rates quarterly with the state, including infection control procedures and information about the types of infection at the hospitals. The information then would be posted on a state Web site.

New York
Introduced into law in 2005, each hospital must collect hospital infection data and reports it to the Department of Health. Hospitals are required to maintain a program capable of identifying and tracking hospital-acquired infections for public reporting purpose with a two year implementation period. The first year’s data collection is considered a ‘pilot’ with no hospital-specific information revealed. However, the data can be released as an aggregate statewide data or hospital level information without the hospital name, which would enable the state to look at the variations among hospitals or in various regions of the state. The initial report will include surgical site infections, central line related blood stream infections, and ventilator associated pneumonia in critical care units.

In October 2007, North Shore-LIJ Health System published data for hospital-acquired infection rates at its 12 acute care hospitals serving New York City and Long Island (northshorelij.com/quality). North Shore is publishing three years of data on these infections: Ventilator-associated pneumonia; bloodstream infections caused by a catheter; methicillin-resistant staphylococcus aureus, or “staph” infection that patients may already have when they arrive; surgical site infections; and clostridium difficile, a bacteria that causes stomach discomfort.
In September, New York City Health and Hospitals Corporation began voluntarily making public infection and death rates at its 11 hospitals.

New Hampshire
Introduced into law in 2006, and effective July 2007, hospitals must report to the Department of Health and Human Services, their infection rates as well as measures they use to prevent infections. The first report’s outcome measures will include the rate of central line related blood stream infections; ventilator associated pneumonia and surgical site infections; the rate at which the hospital uses certain processes to prevent these types of infections will also be included. The first report is due June 2008.

Nebraska
Confidential hospital infection reporting to state agencies – not disclosed to the public. Hospitals report hospital infections as an aggregate number to the health department. Introduced into law in 2005.

Nevada
Confidential hospital infection reporting to state agencies – not disclosed to the public. Introduced into law in 2005.

North Carolina
Legislation introduced in April 2007 did not require public disclosure about hospital infections. HB 1738 establishes an advisory commission to develop recommendations for public reporting of hospital infection rates, but provides no guarantee that hospitals will be required to disclose such information.

Ohio
Introduced into law in 2006, and effective early 2007, hospitals report hospital-acquired infection rates to the Director of Health, along with other hospital performance and price data, including hospital-acquired infection measures, which is reported to the public on a website within 90 days of receiving the information from the hospitals.

In March 2007, Ohio Department of Health published its report on the rate of clostridium difficile in state hospitals and nursing homes for 2006.

Oklahoma
Introduced into law in 2006, the Oklahoma Hospital Advisory Council has the authority to recommend and approve new quality indicators. These measures are to be included in facility specific reports.

Oregon
Introduced into law in 2007, Oregon Health Care Acquired Infection Reporting Program established within the Office for Oregon Health Policy and Research the The program shall provide useful and credible infection measures, specific to each health care facility, to consumers. Under this law, health care facilities are required to report to the office,
health care acquired infection measures, including health care acquired infection rates.

Pennsylvania
Introduced into law in 2004,hospitals report hospital-acquired infection rates to the Pennsylvania Health Care Cost Containment Council (PHC4). PHC4 published three reports, based on 2004 data and the first nine months of 2005. The PHC4 issued two reports in 2005.

In July 2007, legislation was introduced requiring hospitals and nursing homes to report patient infections to state authorities. The bill will require hospitals to test their highest-risk patients and patients admitted from nursing homes for infections that are resistant to antibiotics as part of his “Prescription for Pennsylvania” plan. The bill, which will provide higher reimbursements to hospitals that meet benchmarks in preventing infections, will require most hospitals to install software to assist in tracking infections. Hospitals will be required to report infections to CDC, which then would provide the information to state agencies in Pennsylvania. The law will be phased in over several years

Rhode Island
Introduced into law in 2006, Rhode Island does not specifically mandate public reporting but requires an existing hospital quality steering committee to consider adding measures associated with hospital-acquired infections, in consultation with experts, to the state’s hospital quality of care reports. These reports are issued in January of each year.

South Carolina
Introduced into law in 2006, requires hospitals in the state to report the rate at which their patients develop surgical site infections, ventilator assisted pneumonia, and central line bloodstream infections to the Department of Health and Environmental Control by February 2008. The first annual report will be issued by February 2009. In December 2007, it was reported that the release of hospital preventable infections information to the public could be delayed because of concerns about its validity.

Tennessee
Introduced into law in 2006, the Department of Health will publish on their website infection rates for central line associated blood stream infections in intensive care units. The reports will be updated every six months with the most recent four quarters of data. The department will report only aggregate statewide CABG surgical infection rates. Data will be reported through the CDC National Healthcare Safety Network (NHSN).

Texas
Introduced into law in 2007, requires the reporting of health care-associated infections at certain health care facilities to the Department of State Health Services. Not later than June 1, 2008, the Department of State Health Services shall establish the Texas Health Care-Associated Infection Reporting System. The department shall compile and make available to the public a risk-adjusted summary, by health care facility, of the infections reported by facilities.

The measure requires hospitals to report on rates of several specific infections, including bloodstream infections and surgical site infections from colon, hip and knee surgeries.

Virginia
Introduced into law in 2005, and effective July 2008, acute care hospitals to report nosocomial infection rates through the CDC National Health Safety Network. Information will be available to the public upon request.

Vermont
Introduced into law in 2006, First State report issued in the Summer of 2006 include rates at which hospitals use procedures that prevent surgical site infections. Hospitals are also required to complete the LeapFrog survey on hand washing and numerous other patient safety and quality-of-care measures will be included about each VT hospital.

In August 2007, the State of Vermont Dept of Banking, Insurance, Securities & Health Care Administration released its Central Line Associated Bloodstream Infection Rates report

Washington
Introduced into law in 2007, hospitals in the state will disclose the rate at which patients acquire certain infections during treatment. Hospitals will be required to collect data on central-line associated bloodstream infections in intensive care units (from July 1, 2008), then ventilator-associated pneumonia (from January 1, 2009), and then surgical site infections for certain procedures (beginning January 1,2010). Commencing December 1, 2009, the Department of Health will publish an annual report on its web site that compares the health care associated infection rates at individual hospitals in the state using the date reported in the previous calendar year.

In September 2007, hospital-specific errors in Washington state were no longer to be made available to the public, after the state sided with the hospital association in interpreting a 2006 law on quality improvement. However, in October, Washington State Hospital Association reversed its opposition to reporting hospital-specific errors after a fierce public outcry. The state Legislature reconvenes in January and at least one lawmaker has already vowed to introduce a bill that will allow public disclosure of adverse events at individual hospitals once again

Sources:
– Legislative Session Hospital-acquired infection public reporting bills, ConsumersUnion.org
– Hospital Based Reporting Requirements, StateHealthFacts.org
– AboutHealthTransparency.org

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