STATE LEGISLATION & INITIATIVES ON
HEALTHCARE-ASSOCIATED INFECTIONS

27 state laws require public reporting of hospital-acquired infection rates.
2 state laws allow confidential reporting of infection rates to state agencies (NE, NV).
3 states have voluntary public reporting of infection information (AR, AZ, WI).
5 states have study laws on public reporting (AK, GA, IN, NM, NC).
13 states and D.C. have no laws on public reporting of hospital infections, though some have bills pending on the matter.

Of the states that have laws requiring public reporting of hospital-acquired infections, 12 states also have laws requiring the screening and/or reporting of hospital-acquired MRSA rates (CA, CT, IL, MN, NJ, NV, PA, SC, TN, TX, VA, WA).  Three states, MA, ME and NY, have legislation pending on the matter as of this update.
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LAWS REQUIRING PUBLIC REPORTING OF INFECTION RATES

Alabama (2009)
Information on Infection Reporting Law

The Mike Denton Infection Reporting Act (SB89) became effective on August 1, 2009. Starting January 1, 2011, Healthcare facilities must begin collection of data on inpatient HAIs to report to the Alabama Department of Public Health (ADPH). It is mandatory that HAI data be reported from central line-associated bloodstream infections (CLABSI), surgical site infections (SSI), and catheter associated urinary tract infections (CAUTI). Healthcare facilities must join the ADPH National Healthcare Safety Network (NHSN) group and report all mandatory data. Healthcare facilities are required to report inpatient HAI data monthly. Reports and studies prepared and released by ADPH, and approved by the Advisory Council shall be public information. An advisory council of 18 people shall assist in developing internal and public reports.  

California (2008)
More Information

As of 2008, the following HAIs must be reported to the California Department of Public Health: Central Line-associated Bloodstream Infection (CLABSI), Staph Infections (MRSA), Vancomycin-resistant Enterococci (VRE) Bloodstream Infection (BSI), Clostridium difficile Infection (C. difficile, C. diff, CDI, CDAD), and Surgical Site Infection (SSI). As of January 2011, quarterly reporting is to start through NHSN.

The laws include screening of high-risk patients for Methicillin-resistant Staphylococcus aureus (MRSA), and follow-up screening for preventing the spread of both hospital-acquired and community-acquired MRSA. Additionally, those patients who are screened as positive for MRSA must be told of the results, and precautions must be taken to prevent the spread of MRSA in the hospital. Positive-tested patients must be given information on how to treat it and prevent the transmission of MRSA. The laws also call for improved oversight by the licensing agency, as well as training on prevention of infections for healthcare workers in hospitals. Additionally, the state calls for reporting of infection rates in long-term facilities.  

Colorado (2006)
2011 Annual Report
Annual Reports from 2008-2010

The law requires hospitals, ambulatory surgical centers and dialysis centers to report incidents of hospital-acquired infections to the CDC for analysis, which in turn will be used by Colorado’s department of health to publicize information on infection rates at individual sites.  The annual reports, found at the link above, include infection rates for cardiac and orthopedic surgical site infections, and central-line bloodstream infections.

Connecticut (2006)
Read the Law
Read the Reports

The law requires hospitals to report infections to the state’s health department. A committee, which includes consumer representatives, will advise the department on specifics regarding the types of outcome and process measures to be collected, as well as how these are to be collected and reported.  The department will then make hospital-specific infection information available to the public. 

Delaware (2007)
Read the 2009 Report

The law requires hospitals to report on infection rates through the state’s department of health.  Hospitals are to report infections to the CDC on a quarterly basis, and quarterly updates will be available to the public at each hospital and by the department of health.  However, it applies to hospitals and correctional facilities only. They should be reported to the Delaware Health and Social Services (DHSS) and the Center for Disease Control quarterly through NHSN. These reports must be made available to the public quarterly. The report above provides comparative hospital data on central-line associated bloodstream infections for intensive care units.

Washington D.C. District of Columbia (2010)

Healthcare facilities in this state are required by law to report HAI data to NHSN. The following are required by law to be reported: Central Line-associated Blood Stream Infection (CLABSI), Clostridium difficile Infections (CDI), Catheter-associated Urinary Tract Infections (CAUTI), Methicillin-resistant Staphylococcus aureus Infections (MRSA), Surgical Site Infections (SSI), and Ventilator-associated Pneumonia (VAP).

Florida (2004)
Florida Hospital Finder

Florida was the first state to publish a hospital-specific report on infections based on the passage of HB1629.   However, the results are disappointing as the state has not adopted a standardized system for the collection of data, which leads to great variation in the data and makes comparisons difficult if not altogether invalid.   The information provided in the comparative report is limited and weak, as there is little specificity in the type or number of infections at individual facilities.  Nor is there any explanation of the state’s methodology in reaching conclusions such as “As Expected” or “Higher than Expected” infection rates for facilities.        

Hawaii  
More Information

The HB2829, Hospital Infection Disclosure Act, passed the Health Committee and the Judiciary in early February 2010; the bill is now in Finance Committee. However, the state has implemented MRSA (staph infection) preventative measures.

Illinois (2009)
Comparative Data on Infection Rates
MRSA Report

Under Illinois law, Healthcare Facilities (hospitals, ambulatory services, and residential facilities) are required to report. They are supposed to report staph infections (MRSAs), c. difficile (CDIs), central line associated bloodstream infections (CLABSIs), ventilator associated pneumonia (VAPs), and surgical site infections (SSIs). The law requires such healthcare facilities to make quarterly reports to the Illinois Department of Public Health. They, in turn, will publish the reports on their website annually. Healthcare facilities report CLABSIs and SSIs to the NHSN. If they do not comply, hospital licenses may be revoked. The specific laws are as follows: The Hospital Report Card Act (2003), Amends Report Card Act (2004), Multi-Drug Resistant Organisms (2004), MRSA Screening and Reporting Act (2007), MRSA Prevention, Control, and Reporting Act (2009).  

Maine (2008/2009)
2011 Report
2009 Report

Chapter 594 of the Sessions Law directed Dirigo Health Agency’s Maine Quality Forum to submit an annual report to the legislature on various hospital performance indicators, including statewide efforts to prevent hospital-acquired infections, which were then to be made available to the public.  The first report, published in 2009 and found at the link above, includes rates of central-line associated bloodstream infections, as stipulated by a later law (Chapter 270) passed in 2009.  The 2009 also empowers the Quality Forum to determine whether other infection rates are to be collected, how they are to be collected and when.

Currently under consideration is LD1687, which defines high-risk groups/individuals for MRSA screening.
Continuing to expand lab capacity for genotyping Clostridium difficile and MRSA for outbreak investigations

Maryland (2006)
More Information

This law requires the healthcare commission to include hospital-acquired infection information in the current reporting system on the quality of care in hospitals, which includes comparative data on individual hospitals in the state.  Last year, some MD hospitals were fined for not reporting data like avoidable errors and infections… but no report has yet emerged from the 2006 law.

Massachusetts (2008)
Healthcare Associated Infection Public Report

Requires hospitals to report infection rates and prohibits payment for some hospital- acquired conditions by state agencies. The preliminary report published in April 2009 bodes well for the state’s reporting efforts, and presents initial findings on central-line associated bloodstream infections and surgical site infections for knee/hip surgeries.  The report may be accessed at the link above.

Minnesota (2007)
Initial Reports
Hospital Quality Report

Hospitals are required to report risk-adjusted infection rates for central-line associated bloodstream infections (CLABSI), surgical site infections (SSI), and ventilator-associated pneumonia (VAP).  Other types of infections may be added on by the Department of Health & Senior Services in conjunction with the MN Hospital Association.  The first report, which may be found at the Minnesota Hospital Association website and accessed at the link above, includes rates for surgical infections of hip replacements, bloodstream infections, coronary-artery bypass surgeries, and hysterectomies.  MN also passed a law requiring the reporting of hospital-acquired MRSA rates. 
 

Missouri (2004)
Healthcare Association Infection Reporting
2009 HAI Report

The law requires hospitals to report risk-adjusted rates for surgical-site infections, ventilator-associated pneumonia and central-line bloodstream infections, and to report their rates on an annual basis.  The first report was issued in 2006 and updates have been provided regularly.  The link above provides the December 2009 report on hospital-acquired infections, with an internal link to the state’s Department of Health which offers additional information. 
  

New Hampshire (2006)
State Hospital Infection Website

Facilities in this state are required by law to report HAI data to the National Healthcare Safety Network (NHSN). This is stated in House Bill 1741(2007) which became effective in July 2007. Licensed hospitals are required to report such data. Reports are to be made about central line associated bloodstream infections (CLABSIs), surgical site infections (SSIs) , and ventilator associated pneumonia (VAPs) . Reports are to be made to U.S.A. Department of Health and Human Services (DHHS) and to NHSN. Every six months a report is to be made to the Legislative Oversight Committee on Health and Human Services and then annual reports are made. Penalties for noncompliance include up to $1,000 for each day of noncompliance.  

New Jersey (2007)
More Information

The law requires that hospitals provide quarterly reports on infections to the state’s Department of Health, which includes disclosure of surgical site infections, urinary tract infections related to catheters, pneumonia related to ventilators, and bloodstream infections related to catheters. The law also gives the state’s health department authority to expand the list of reportable infections.  Rates are to be publicized on a state website, still in development.  No reports are available of this update. 

 New Mexico (2009)
2009 HAI Report

New Mexico has passed two laws thus far relating to the prevention of HAIs. The Hospital Acquired Infection act (2009) finalized the HAI Advisory Committee and provided for select hospital to report HAI data, selection of HAI indicators, and identification of reporting systems. HJM067 was passed by the New Mexico Legislature in 2007 requesting the New Mexico Department of Health to assess the feasibility of HAI surveillance in New Mexico. " Participating hospitals shall report to the department the incidence of selected indicators using the national healthcare safety network surveillance system according to a schedule recommended by the advisory committee based on reporting frequencies identified by the national healthcare safety network. Reported data shall be verifiable and actionable. " Disclaimer: only participating hospitals selected by the advisory committee are mandated to report. 

New York (2005)
Initial and Full Reports

This model law was adopted by the National Conference of Insurance Legislators (NCOIL) as an exemplar of hospital infection reporting laws. Healthcare facilities in this state are required by law to report HAI data to the National Healthcare Safety Network (NHSN).

In July, 2005, the Legislature passed and the Governor signed Public Health Law 2819 requiring hospitals to report select hospital-acquired infections (HAIs) to the New York State Department of Health. The legislation provided an initial "pilot phase" year (2007) to develop the reporting system; train hospitals on its use; standardize definitions, methods of surveillance and reporting; audit and validate the hospitals' infection data and modify the system to ensure that the hospital-identified infection rates would be fair, accurate and reliable. On June 30, 2008, the Department issued the pilot year report for 2007. On June 30, 2009 a second report was released providing HAI rates identified by hospital.

The third annual report entitled "Hospital-Acquired Infections - New York State 2009" provides hospital-acquired infection rates by individual hospital, region, and NYS totals for 2009; and compares these rates to the most recent available national data (2006-2008). The infections selected for reporting in 2009 include colon surgical site infections, hip replacement surgical site infections, coronary artery bypass graft surgical site infections, central line-associated bloodstream infections in intensive care units (adult, pediatric and neonatal intensive care units) and umbilical catheter-associated infections in neonates. The report also contains information on infection control resources in NYS hospitals and describes HAI prevention projects supported by the Department.

Ohio (2006)
Hospital Care Compare

The law established a state advisory council that is to consult with consumers, nurses, and infection control professionals on developing hospital quality measures, including “measures that examine [hospital] infections.”  It requires various price and performance data to be collected from hospitals beginning in 2007, which is to be reported to the public within 90 days of getting the information from the hospitals. The director of health must adopt rules that will include measures that examine infections? as well as other measures of quality of care.  

Oklahoma (2006)
Comparative Hospital Report
2008 HAI Report

This law gives the Oklahoma Hospital Advisory Council, which is appointed by the state Commissioner of Health, the authority to develop hospital quality indicators, including some hospital infections.  The facility-specific comparative data may be found at the link above, on the Oklahoma Hospitals Accountable for Quality website.  The comparative data on hospital infections is poor, and includes information solely on whether antibiotics were properly administered prior to diverse procedures at each hospital.  OK citizens are encouraged to call their state representatives to insist upon more comprehensive, clear data on hospital infection rates.

Oregon
More Information
2010 HAI Report

Facilities in this state are required by law to report HAI data to NHSN. Hospitals (long-term care facilities, ambulatory surgical centers, freestanding birthing centers and outpatient renal dialysis facilities included in law under different reporting requirements) are required to report. The advisory committee is made up of 16 members including 7 healthcare providers and 9 representatives from consumer, academic, government, and business groups. Surgical site infections (SSIs) from Coronary artery bypass graft surgery with both chest and graft incisions, Coronary artery bypass graft surgery with chest incision only, Knee prosthesis procedures are to be reported. Central line associated bloodstream infections (CLABSIs) in intensive care units and urinary tract infections in long-term care facilities are to be reported, too. Healthcare facilities are to report to the Oregon Health Policy and Research. Reports are to be made annually. Penalties for noncompliance include up to $500 per facility for each day it does not report. 

Pennsylvania (2005/amended in 2007) 
2009 HAI Report

(Act 52 of 2007; Amends SB 293 2005) Healthcare facilities in this state are required by law to report HAI data to the National Healthcare Safety network (NHSN). Hospitals, ambulatory surgical centers, birthing centers, and nursing homes are required to report. The advisory committee consults with technical advisors who are regionally or nationally acknowledged as experts in infection/disease prevention and control to develop risk adjustment methods. Staph infections (MRSAs), multi drug resistant organisms (MDROs), surgical site infections (SSIs), catheter associated urinary tract infections (CAUTIs), ventilator associated pneumonia (VAPs), and central line associated bloodstream infections (CLABSIs) are to be reported. Quarterly reports are to be made to the U.S. Department of Health, The Pennsylvania Healthcare Cost Containment Center, the Pennsylvania Patient Safety Authority, and NHSN. Penalties for noncompliance include up to $1,000 per facility for each day it does not report.  

Rhode Island (2008)
Performance Measuring of Hospitals
2009 HAI Report

Two bills (S2382 and HB7962), passed and signed into law, require the Department of Health to issue public reports comparing infection rates among RI hospitals. An advisory committee will help to develop the infection reporting system and will serve as a permanent subcommittee to an already existing steering committee on health care quality. The majority of the advisory committee members must come from the infection control community, but representatives of consumers, labor and employers who purchase health care are also included. Through regulations based on the advisory committee‘s recommendations, the department will establish which types of infections rates are to be reported. The law allows for reporting on the four major types of hospital-acquired infections -- surgical site infections, ventilator associated pneumonia, central line blood stream infections, and urinary tract infections -- and allows for the advisory committee to recommend additional reporting. Surgical infection reporting must include post-discharge surveillance. The state may also report measures that indicate hospitals‘ compliance with infection prevention practices. 

South Carolina (2006)
2008 and 2009 Reports
2010 HAI Report

Facilities in this state are required by law to report HAI data to the National Healthcare Safety Network. NHSN. Article 20 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. A committee, which includes consumer representation, will advise the Department on the methodology for collecting, analyzing and disclosing the information. The department has the authority to add measures in the future. The first annual report was issued in August 2008.  

Tennessee (2006)
First Report

The law is limited as it calls only for the reporting of central-line bloodstream infections in intensive-care units.  The first report, issued in December 2009, includes ICU infections in the pediatric, surgical, medical, major teaching medical surgical, non-major teaching medical-surgical, neurosurgical, coronary, and cardiothoracic-surgical units.  The report is clear, comprehensive, and easy to understand for patients – and should act as a model for state expansion of reporting requirements.  TN citizens are urged to call their state representatives to encourage expansion of the list of reportable infections, including surgical site infections, coronary artery bypass grafts, MRSA and C. diff.    

Texas (2007)

Facilities in this state are required by law to report HAI data to NHSN. Ambulatory surgical centers, general hospitals, pediatric hospitals, and surgical centers are required to report central line associated bloodstream infections (CLABSIs) in ICUs to NHSN. The Department of State Health Services will publish health care acquired infection rates at hospitals and ambulatory surgical centers, for seven types of surgical procedures and central line associated blood stream infections in ICUs. The law establishes special reporting requirements for pediatric and adolescent hospitals and major pediatric units in general hospitals. Hospitals that do not perform a sufficient number of the specific procedures for which SSI rates are to be reported, will report on the three most frequent operations performed.

Virginia (2005)
HAI Report

Facilities in this state are required by law to report HAI data to NHSN. The bill was passed in 2005 and went into effect in 2008. Hospitals must make the information available to the Virginia Department of Health (VDH), and VDH in turn must provide the information to the public upon request. The Code further directed the Board of Health to develop regulations that specify the infections to be reported and the patient populations to be included. The applicable regulations specify that acute care hospitals shall collect and report data on central line-associated bloodstream infections (CLABSI) in adult intensive care units. Infection rate data are aggregated to ensure that no individual patient may be identified. The results of reporting must be released to the public by the department upon request. 

Vermont (2006)
2010 HAI Report
2009 HAI Report  

The first state reports on hospital infections did not include comparative data on hospital infection rates.  More recent annual reports include user-friendly comparative data on individual hospitals. Facilities in this state are required by law to report HAI data to NHSN. In 2006 the law on public reporting was amended to include the publication of HAI data. Dialysis facilities in this state are cooperative in preventing HAIs. The HAIs meant to be reported are VAPs, CLABSIs, and SSIs for abdominal hysterectomies.

Washington (2007)
HAI Report

Washington released its first report on hospital-acquired infections in December 2009. Acute-care hospitals used the National Healthcare Safety Network (NHSN) by the Centers for Disease Control and Prevention (CDC) to collect and analyze information on hospital-acquired infections.  The report includes information on central line-associated bloodstream infection in intensive care units; ventilator-associated pneumonias (VAP) and surgical site infections (SSI) for the following procedures: deep sternal wound for cardiac surgery, including coronary artery bypass graft; total hip and knee replacement surgery; abdominal and vaginal hysterectomy.

West Virginia (2008)

The law requires hospitals to report hospital-acquired infections to the West Virginia Health care Authority using the CDC National Healthcare Safety Network. The law does not specify any infections, however. An Infection Control Advisory Panel will work with the Authority in developing the details of the reporting system and advising on the manner in which the information should be made available to the public. The law includes enforcement assessing fines for failure to report and allows the Bureau of Public Health for hospital oversight and disease surveillance activities. In West Virginia, data on central line-associated blood stream infections (CLABSI) in medical intensive care units, surgical intensive units and medical-surgical intensive care units are reported through the National Healthcare Safety Network (NHSN) effective July 1, 2009 and West Virginia HCA released baseline CLABSI data on January 27, 2011. Effective January 1, 2011, Centers for Medicaid and Medicare Services (CMS) also mandated reporting of CLABSI data through NHSN. Data collection has also been implemented for influenza immunization of healthcare workers in all hospitals in West Virginia during 2009. By December 31, 2011, a second priority prevention target shall be identified for mandatory reporting.

VOLUNTARY OR NON-PUBLIC HOSPITAL INFECTION REPORTING

Arizona (2006)  
More Information- Facilities may voluntarily submit quarterly reports to the Division of Health of the State Department of Health and Human Services. The health department should submit a summary of the reports to the Arizona state legislature which in turn will make the reports available on the website. Quarterly reporting by facilities (including hospitals, surgery centers, recuperation centers, and outpatient surgery centers) to the Health Department may begin January 31, 2009 or any time thereafter. Facilities report surgical site infections from: 1) Coronary artery bypass 2) total hip or knee arthroplasty 3) knee arthroscopy 4) hernia repair; Central line-associated bloodstream infection in ICU. Annual reports are not facility specific.

Arkansas (2007)
It is required that healthcare facilities collect data on HAIs for surgical site infections and central line-associated bloodstream infections. However, reports of such HAI data are made voluntarily. If submitted, the reports are quarterly and must be submitted to the Arkansas Department of Health (ADH). Currently, only 45% of healthcare facilities voluntarily submit such reports. The state health department is collaborating on a Comprehensive Unit-based Safety Program (CUSP) to prevent central line associated bloodstream infection (CLABSI)/ catheter associated urinary tract infection (CAUTI).

Nebraska (2005) 
Though it is mandatory to gather information on the numbers of hospital infection, the information is held only by state agencies and is not shared with the public. 

Nevada (2005) 
Though it is mandatory to gather information on the numbers of hospital infection, the information is held only by state agencies and is not shared with the public. The following changes are looking to be made: " Enrollment and training requirements; confidentiality of data, including what can be publicly reported; collection and reporting of data; and data accuracy and retention."

Wisconsin
Currently, 61% of healthcare facilities in this state reporting data on at least one HAI to CDC's NHSN but not to the public. – Voluntary reporting of surgical site infections by hospitals can be found at www.wicheckpoint.org.  

STATES WITH STUDIES ON HAI REPORTING

Alaska (2006)  
Currently only 38 % of healthcare facilities report. However, they have acted in compliance with the U.S. HHS Action Plan, and the Alaska Department of Health and Social Services has created its own action plan. Two bills were introduced by the Alaska Department of Health and Social services (AKDHSS) that would have mandated HAI reporting; however, both were rejected by the state legislature. More information

Georgia (2006)  
52% of healthcare facilities voluntarily make such reports. The state health department is working on a CUSP (Comprehensive Unit-based Safety Program) initiative, and it is one of 10 state health departments working as a part of Emerging Infections Program (EIP) network which “works to build and strengthen public health capacity by enhancing the ability of CDC and its public health partners to prepare for, prevent, and respond to infectious diseases, including outbreaks, bioterrorism, and other public health emergencies, through cross-cutting and specialized programs, technical expertise, and public health leadership.” (CDC)

Indiana (2005 and 2007)  
The 2007 law requires the state department of health to collect, analyze and disseminate findings on patient safety.  The law makes it voluntary for certain persons to submit information to the agency, and makes the reports and certain other information confidential and privileged.   The 2005 act establishes the medical informatics commission, which is to conduct a study on health care information and which is to develop health care quality indicators on various patient safety issues, including healthcare-associated infection rates. Recently, however, The Indiana Department of Health is working on initiatives to prevent HAIs and have them reported. Such hypothetical measures are to be finalized by 2012.  

North Carolina (2007)  
This law establishes an advisory commission for the purpose of preparing state agencies, hospitals, and the public for the reporting and public disclosure of hospital-acquired infection incidence rates, but is not yet required.

STATES WITH PENDING HAI LEGISLATION OR NO LAW ON REPORTING

Georgia – bill died in session in 2008; no new bill introduced on the matter.
Hawaii – HB2829, Hospital Infection Disclosure Act, passed the Health Committee and the Judiciary in early February 2010; the bill is now in Finance Committee.
Idaho – bill died in session in 2008; no new bill introduced on the matter.
Iowa – law on correctional facility infection incidence only; no public reporting of HAI.
Kansas – bill died in session in 2008; no new bill introduced on the matter.
Kentucky – bill died in session in 2008; no new bill introduced on the matter.
Louisiana – has no bill on the matter.
Michigan – bills died in session in 2008; no new bills introduced on the matter. 
Mississippi – SB2360 died in Senate Public Health & Welfare Committee in 2010.
Montana – has no bill on the matter.
North Dakota – has no bill on the matter.
South Dakota – bill died in session in 2008; no new bill introduced on the matter.
Wyoming – has no bill on the matter.