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)
For more information on the infection reporting law, go to: http://www.bcbsal.org/providers/tieredHospital/HAIProgramPresentation.pdf

The Mike Denton Infection Reporting Act (SB89) became effective on August 1, 2009 and requires that hospitals report rates of surgical site infections (SSI), ventilator-associated pneumonia (VAP), and central line-associated bloodstream infections (CLABSI). 

An advisory council, consisting of 18 members, will develop the standards necessary to prepare the report, which must be ready by August 1, 2010.  Data collection shall commence thereafter, provided funding is made available for the project – and the first report is due one year after the commencement of collection of data.  Thus, the first report is not likely to be out until 2011 or later.   

California (2008)
For more information, go to:
http://www.cdph.ca.gov/search/results.aspx?k=hospital%20infection%20reporting

CA has passed a set of comprehensive laws intended to improve hospital care, patient safety, and infection monitoring and reporting.  Beginning January 2011, annual reports will provide facility-specific hospital infection rates for for: MRSA; Vancomycin-resistant enterococcal (VRE) bloodstream infections, and the number of inpatient days; central line-associated bloodstream infections, and the total number of days patients have central lines; surgical-site infections; and C. difficile. 

The laws include screening of high-risk patients for 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)
For annual reports from 2008-2010, go to: www.cdphe.state.co.us/hf/PatientSafety/HFAI/index.html

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 three annual reports, found at the link above, include infection rates for cardiac and orthopedic surgical site infections, and central-line bloodstream infections.

Connecticut (2006)
To read the law, go to: 
http://www.cga.ct.gov/2006/ACT/PA/2006PA-00142-R00SB-00160-PA.htm
For the reports, go to: http://www.ct.gov/dph/cwp/view.asp?a=3136&q=417318

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.  Quality reports and publications are available at the site above.

Delaware (2007)
For the first report, go to:  http://www.dhss.delaware.gov/dhss/dph/epi/files/clabsi2009_apr_jun.pdf

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.  The first report, found at the site above, provides comparative hospital data on central-line associated bloodstream infections for intensive care units.

Florida (2004)
For the reports, go to: www.FloridaHealthFinder.com.  Click “Compare Hospitals…” then click “Compare Infections…”  You may choose to compare infections by type, geographical location or facility.

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.        

Illinois (2003/amended in 2005)
For comparative data on infection rates, go to: http://www.healthcarereportcard.illinois.gov/contents/view/health_care_associated_infections

Though the 2003 law had more expansive reporting requirements than the amended version, the law still requires reporting of central-line infections, surgical site infections and ventilator-associated pneumonia in the critical-care units of hospitals.  The law stipulates that an annual report is due on December 31 of each year, and the first was to be issued in 2007, but no such report has ever materialized. 

Instead, the state’s Department of Health provides limited data on infection rates for individual hospitals at the link provided above.  The data, which are not user-friendly or extensive, can only be accessed by entering a geographical location or facility name, upon which quality information is provided, including the limited information on hospital infection rates.   Still, IL took a step forward by enacting a law that screens and reports hospital-acquired MRSA rates.

Maine (2008/2009)
For the 2009 report, go to:
http://www.dirigohealth.maine.gov/Documents/HAI%20Report%20to%20HHS1.30.09%20FINAL.pdf

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.

Maryland (2006)
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)
For the preliminary report on infections, go to:
http://www.mass.gov/Eeohhs2/docs/dph/quality/healthcare/hai_prelim_report.pdf

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)
For initial reports, go to: http://www.mnhospitals.org/index/Infection1

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)
For more information, go to: http://168.166.46.233/DataAndStatisticalReports/2009NosocomialReport.pdf

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)
For more information, go to the state’s hospital infection website: http://www.dhhs.nh.gov/DHHS/CDCS/hai.htm

This law requires hospitals to report the rate of central-line related bloodstream infections, ventilator-associated pneumonia and surgical-site infections.  The first report, expected in June 2010 and available at the same website above, will provide facility-specific infection rates for central-line associated bloodstream infections in adult ICUs, and for surgical-site infections of knee replacements, colon surgeries, and coronary-artery bypass grafts.  Ventilator-associated pneumonia is omitted in the first report.  The state’s Department of Health has the authority to add other hospital infection types in the future.  

New Jersey (2007)
For more information, go to: http://www.state.nj.us/health/hais/index.shtml

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 York (2005)
For the initial and full reports, go to:
http://www.health.state.ny.us/statistics/facilities/hospital/hospital_acquired_infections/

This model law was adopted by the National Conference of Insurance Legislators (NCOIL) as an exemplar of hospital infection reporting laws.  The law was developed by the state’s hospital associations and consumer organizations, including the Committee to Reduce Infection Deaths (RID).  

An initial report, released in June 2008 and accessed at the link above, provided aggregate statewide data and hospital-level data without naming the hospital. 

The first full report, released in June 2009, also found at the link above, includes facility specific data on central-line and surgical-site infection rates in intensive-care units.  The report is user-friendly, comprehensive and outstanding in most regards.  However, it omits MRSA and C. diff rates, which are not required by law nor included by the state’s advisory committee.  RID urges patients to contact their local state lawmakers to insist on the inclusion of MRSA rates, which is currently under consideration by state legislators.

Ohio (2006)
For 2008 information on comparing hospital quality data, go to: http://www.odh.ohio.gov/healthstats/hlthserv/hospitaldata/datahosp.aspx

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 2008 comparative information on hospital quality, which is found at the link above, seems comprehensive enough.  But solid data on hospital infection rates is limited.  The site is a bit unwieldy to use, and would benefit from some explanation of methodology and more guidance on how to compare hospital data for patients.    

Oklahoma (2006)
For comparative information on OK hospitals, go to: http://www.okhospitalquality.org/reports_step1.aspx

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
For more information, go to: http://www.oregon.gov/OHPPR/Healthcare_Acquired_infections.shtml

The law gives the Office of Health Policy and Research (OHPR) authority to implement hospital infection reporting, but does not specify which infections are to be reported.  OHPR works with the state’s Department of Health to develop its metrics and collect facility-specific data on hospital infections. 

The first report was expected in January, but is being released the end of April 2010.  The link above provides information on fact-checking currently in process before final publication of the report, which will be available at the OHPR site.  The report will include central-line associated bloodstream infections, surgical site infections for knee replacements and coronary-artery bypass grafts for in-patient care only.  Invasive MRSA rates are tracked by the state’s Public Health department at ambulatory and acute-care facilities, and may be found on their website.

Pennsylvania (2004/amended in 2007) 
For the reports, go to:  http://www.phc4.org  and http://www.phc4.org/reports/hai/06/

PA has published some of the most comprehensive reports on hospital infections since 2006, including central-line infections, surgical-site infections, ventilator-associated pneumonia and catheter-associated urinary-tract infections – and the state finds it has some of the lowest hospital infection rates in the country.   The reports at the site above include a preliminary analysis of C. diff and MRSA (PA has a screening, surveillance, and reporting law for MRSA), making PA one of the first states to extend infection surveillance to this deadly germ raging through U.S. hospitals.  

Rhode Island (2008)
For the first report, go to: http://www.health.ri.gov/publications/qualityreports/hospitals/CentralLineAssociatedBloodstreamInfections.pdf

The law requires the state’s Department of Health to compare infection rates among the state’s hospitals.  An advisory committee is to develop the reporting system and determine which infection 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 bloodstream infections, and urinary tract infections), but 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. 

The first report, which can be accessed at the link above, was released in late 2009 and updated in February 2010.  The report focuses on central line-associated bloodstream infections and pressure ulcers or sores.  This first effort is precise, clear, easy to read and interpret, and very thorough – an excellent model for expansion of infection reporting in the future.

South Carolina (2006)
For the 2009 and 2008 reports, go to: http://www.scdhec.gov/health/disease/hai/reports.htm

The state’s law is quite rigorous, calling for reporting of surgical site infections, ventilator associated pneumonia, central-line related bloodstream infections and other categories as recommended by the advisory committee of the state’s Department of Health & Environmental Control.  A preliminary study of hospital-acquired MRSA rates is also included for the 2009 report.  Hospitals must submit reports to the state at least every six months on their infection rates. 

The 2008 and 2009 reports, found at the link above, are facility-specific, but they are not very user friendly.  Researchers use statistical estimates of expected infections to calculate a baseline for each infection type and for each facility (i.e. – that means they don’t work from a “zero tolerance” starting point; they assume there will be some infections).  While this approach is used by many states, the data is presented in statistical terms, which makes it very difficult to interpret for most patients.  The final result is that the reports show little or no difference at all between any of the hospitals.  The report should be written in lay language, with simple, clear means for comparing hospitals.  Instead of enlightening, these reports obscure information.     

Tennessee (2006)
For the first report, go to: http://health.state.tn.us/Downloads/TN_HAI_Report_2008_Jan_Dec_final.pdf

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)
This law on hospital reporting requires hospitals and ambulatory surgical centers to reports surgical-site infections and central-line bloodstream infections in intensive-care units.  It also requires reporting for pediatric and adolescent hospitals/units.  The first reporting system was to be ready by June 2008, but the state failed to fund the initiative so nothing materialized.  When the legislature reconvened in 2009, it appropriated funds for the development and implementation of a reporting system.  The first HAI report is expected some time in 2011. 

In 2009, the legislature also passed HB3233, a law that requires the reporting of MRSA.  The upcoming 2011 report is expected to include the MRSA data.  

Virginia (2005)
For the first report, go to:
http://www.vdh.virginia.gov/Epidemiology/Surveillance/HAI/VDH_CLABSI_Report_Q3_2009_Updated_12-4-09.pdf

Though the bill was passed in 2005, the law went into effect in July 2008.  It requires acute-care hospitals to report nosocomial infection rates through the CDC National Health Safety Network, but does not stipulate which infections are to be reported. 

The first report, issued in December 2009 and found at the link above, is limited to central line-associated bloodstream infections in adult intensive-care units only.  The effort is puny, with little information on methodology and no guidance on how to interpret the number of infections found at individual hospitals.    

Vermont (2006)
For annual reports from 2005 through 2008, see: www.vthospitalreportcards.info
 
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.  The reports present infection rates for ventilator-associated pneumonia, central-line associated bloodstream infections, and surgical site infections for abdominal hysterectomies.  All reports may be accessed at the link above. 

Washington (2007)
To read the first report, go to:
http://www.doh.wa.gov/ehsphl/hai/hai_default.htm
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.
The web report does a good job of describing the infections and it clearly spells out the methodology used for collecting the data.  But the site is not very user-friendly and it makes comparing infection rates among hospitals difficult.  The state needs to include some guidance on how to interpret the numbers, especially because there is no standard, like a state average or an expected estimate, against which to compare the individual hospital rates.  If one assumes that “zero” is the number to aim for – which RID advocates – then clearly consumers should look for the lowest infection rates of any hospital.

West Virginia (2008)
The first report on hospital infections is expected in January 2011.  Hospitals may be fined for failure to disclose infection rates.  Though the law doesn’t specify the infections to be reported, an advisory committee working in conjunction with the West Virginia Healthcare Authority, is to develop a reporting system and decide how information is to be reported to the public. 

As a result of the stimulus package of 2009, WV received funding to develop a prevention campaign for hospital infections.  Among their key objectives, WV is improving reporting and investigation of hospital infections and setting prevention targets for hospital infections.   

VOLUNTARY OR NON-PUBLIC HOSPITAL INFECTION REPORTING

Arizona (2006)  Non-legislative initiative by the state calls for voluntary reporting of hospital infections to the state health department.

Arkansas (2007)  The law requires health facilities to collect data on healthcare-associated infections for knee/hip/hernia surgical-site infections; coronary artery bypass surgical site infections; and central-line bloodstream infections in intensive care units.  Facilities may voluntarily submit quarterly reports to the state’s Department of Health and Human Services, which is summarized for the legislature and presented to the public.  A report was expected in January 2010, however it is not available as of this update.

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. 

Wisconsin – Voluntary reporting of surgical site infections by hospitals can be found at www.wicheckpoint.org. 

STATES WITH STUDIES ON HAI REPORTING

Alaska (2006)  While there is no law requiring hospitals to report their infection rates, a task force has been put together to make recommendations on how hospitals should disclose their infection rates.  Additionally, Alaska’s Public Health division is adopting the U.S. HHS plan to prevent hospital infections, including hospital quality metrics and prevention targets.

Georgia (2006)  A state commission is studying hospital safety standards and best practices, as well as the cause and incidence of infections.  No report has been disclosed yet.  

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. 

New Mexico (2007)  A state task force is initiating a pilot program for reporting hospital-acquired infections. The results of the pilot program, which is launched in six hospitals, will be used to determine the best methods for reporting infections.

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

District of Columbia – has no bill on the matter.
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.