Health Care Availability and Access Committee
Filed: 3/4/2008
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1 | AMENDMENT TO HOUSE BILL 4303
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2 | AMENDMENT NO. ______. Amend House Bill 4303 by replacing | ||||||
3 | everything after the enacting clause with the following:
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4 | "Section 1. Short title. This Act may be cited as the MRSA | ||||||
5 | Screening, Prevention, and Reporting Act for State Residential | ||||||
6 | Facilities. | ||||||
7 | Section 5. Definition. In this Act, "State residential | ||||||
8 | facility" or "facility" means: any Department of Human Services | ||||||
9 | operated residential facility, including any State mental | ||||||
10 | health hospital, State developmental center, or State | ||||||
11 | residential school for the deaf and visually impaired; any | ||||||
12 | Department of Veterans' Affairs operated veterans home; any | ||||||
13 | Department of Corrections operated correctional center, work | ||||||
14 | camp or boot camp, or adult transition center; and any | ||||||
15 | Department of Juvenile Justice operated juvenile center or boot | ||||||
16 | camp.
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1 | Section 10. MRSA control program. In order to improve the | ||||||
2 | prevention of infections due to methicillin-resistant | ||||||
3 | Staphylococcus aureus ("MRSA"), every State residential | ||||||
4 | facility shall establish an MRSA control program that includes | ||||||
5 | the following features: | ||||||
6 | (1) Screening and surveillance. | ||||||
7 | (A) All residents, patients, students, or inmates | ||||||
8 | of the facility undergoing intake medical screening | ||||||
9 | and physical examinations shall be carefully evaluated | ||||||
10 | for skin infections. This screening shall include | ||||||
11 | culturing of skin abscesses, boils, "spider bites", or | ||||||
12 | other suspicious skin conditions. | ||||||
13 | (B) Recently hospitalized residents, patients, | ||||||
14 | students, or inmates of the facility shall be screened | ||||||
15 | for infections immediately upon return to the facility | ||||||
16 | and shall be instructed to report any new onset skin | ||||||
17 | infection or fever.
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18 | (C) Residents, patients, students, or inmates of | ||||||
19 | the facility with risk factors such as diabetes, | ||||||
20 | immunocompromised conditions, open wounds, recent | ||||||
21 | surgery, indwelling catheters, implantable devices, | ||||||
22 | chronic skin conditions, or paraplegia with decubiti | ||||||
23 | shall be evaluated for skin infections during routine | ||||||
24 | medical evaluations. | ||||||
25 | (D) All residents, patients, students, or inmates |
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1 | of the facility with skin infections shall be referred | ||||||
2 | to health services for evaluation. | ||||||
3 | (E) Facility health care providers shall consider | ||||||
4 | MRSA infection in the differential diagnosis for all | ||||||
5 | residents, patients, students, or inmates presenting | ||||||
6 | with a skin or soft tissue infection or any other | ||||||
7 | clinical presentation consistent with a staphylococcal | ||||||
8 | infection. | ||||||
9 | (F) Appropriate bacterial cultures shall be | ||||||
10 | obtained in all cases of suspected MRSA infection. | ||||||
11 | (G) No resident, patient, student, or inmate of the | ||||||
12 | facility with a skin or soft tissue infection shall be | ||||||
13 | transferred to another facility until fully evaluated | ||||||
14 | and appropriately treated except when required for | ||||||
15 | reasons of appropriate security or care. Residents, | ||||||
16 | patients, students, or inmates with MRSA infections | ||||||
17 | requiring transfer shall have draining wounds dressed | ||||||
18 | the day of transfer to contain the draining. Escort | ||||||
19 | personnel shall be notified of the resident, patient, | ||||||
20 | student, or inmate's condition and educated on | ||||||
21 | infection control measures. The clinical director of | ||||||
22 | the sending facility or his or her designee shall | ||||||
23 | notify the receiving institution's clinical director | ||||||
24 | or health services administrator of pending transfers | ||||||
25 | of individuals with MRSA. | ||||||
26 | (2) Reporting. |
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1 | (A) All confirmed MRSA and other | ||||||
2 | antibiotic-resistant infections shall be documented in | ||||||
3 | the resident, patient, student, or inmate's medical | ||||||
4 | record. | ||||||
5 | (B) All confirmed MRSA and other | ||||||
6 | antibiotic-resistant infections shall be reported to | ||||||
7 | the director of the department operating the facility | ||||||
8 | and to the Department of Public Health. The report | ||||||
9 | shall indicate whether the MRSA infection was present | ||||||
10 | on intake or contracted at the facility, if known. | ||||||
11 | (3) Prevention. | ||||||
12 | (A) Education. Employees, residents, patients, | ||||||
13 | students, and inmates of the facility shall be provided | ||||||
14 | with information on the transmission, prevention, | ||||||
15 | treatment, and containment of MRSA infections. | ||||||
16 | (B) Hand Hygiene program: Each facility shall | ||||||
17 | develop and implement a hand hygiene program for | ||||||
18 | employees, residents, patients, students, and inmates | ||||||
19 | of the facility that includes adequate hand-washing | ||||||
20 | equipment and supplies and regular training on | ||||||
21 | effective hand hygiene techniques and education on the | ||||||
22 | importance of hand hygiene. These trainings must be | ||||||
23 | conducted at least once each year and may be conducted | ||||||
24 | in conjunction with other trainings. | ||||||
25 | (C) Sanitation. Each facility shall develop and | ||||||
26 | implement a sanitation program for cleaning and |
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1 | disinfecting the environment that includes the | ||||||
2 | following: | ||||||
3 | (i) Use of an Environmental Protection Agency | ||||||
4 | (EPA)-registered disinfectant according to the | ||||||
5 | manufacturer's instructions. | ||||||
6 | (ii)
Regularly cleaning or disinfecting | ||||||
7 | washable surfaces in residents', patients', and | ||||||
8 | students' rooms, in inmates' cells, and in shared | ||||||
9 | areas such as showers, fitness areas, and food | ||||||
10 | services areas. | ||||||
11 | (iii)
Cleaning or disinfecting restraining | ||||||
12 | devices after every use. | ||||||
13 | (iv)
Treating all linen (towels, sheets, and | ||||||
14 | similar items) as potentially infectious and | ||||||
15 | following recommendations of the Centers for | ||||||
16 | Disease Control and Prevention for laundering. | ||||||
17 | (D) Personal protective equipment. Employees of | ||||||
18 | the facility shall be provided with personal | ||||||
19 | protective equipment (gloves, eye protection, and | ||||||
20 | gowns) for use when contact with blood, body fluids, or | ||||||
21 | wound drainage is likely. | ||||||
22 | (E) Isolation of residents, patients, students, or | ||||||
23 | inmates with MRSA. Each State residential facility | ||||||
24 | shall develop guidelines for isolating MRSA-diagnosed | ||||||
25 | residents, patients, students, or inmates from others | ||||||
26 | when a clinician determines the individual to be a high |
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1 | risk for spreading the contagion. Residents, patients, | ||||||
2 | students, or inmates diagnosed with MRSA shall be | ||||||
3 | examined by a clinician to determine their risk of | ||||||
4 | contagion to others. The determination about whether | ||||||
5 | to isolate residents, patients, students, or inmates | ||||||
6 | with MRSA infections shall include consideration of | ||||||
7 | the degree to which wound drainage can be contained and | ||||||
8 | the ability or willingness of a resident, patient, | ||||||
9 | student, or inmate to comply with infection control | ||||||
10 | instructions. | ||||||
11 | (4) Infection control.
Upon the diagnosis of a single | ||||||
12 | MRSA case at a State residential facility, that facility | ||||||
13 | shall implement surveillance measures to detect additional | ||||||
14 | MRSA cases through the following procedures: | ||||||
15 | (A) The individual diagnosed with MRSA shall be | ||||||
16 | interviewed to identify potential sources of | ||||||
17 | infections and close contacts. The interview should | ||||||
18 | seek to determine the date of onset and activity | ||||||
19 | immediately before and following onset, including | ||||||
20 | recent hospitalizations, housing, work assignments, | ||||||
21 | sharing of personal hygiene items, sexual contact, | ||||||
22 | participation in close-contact sports, or exposure to | ||||||
23 | other residents, patients, students, or inmates with | ||||||
24 | draining wounds or skin infections. | ||||||
25 | (B) An individual shall not be required to make a | ||||||
26 | copayment for the testing or treatment of an MRSA |
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1 | infection. | ||||||
2 | (C) Employees, residents, patients, students, or | ||||||
3 | inmates of the facility identified as having contact | ||||||
4 | with the infected individual should be examined for | ||||||
5 | signs and symptoms of infection. | ||||||
6 | (D) State residential facility management shall | ||||||
7 | inform all employees of the facility of the MRSA case. | ||||||
8 | The notification must protect the identity of the | ||||||
9 | infected individual. Management shall immediately | ||||||
10 | conduct a training program on MRSA and hand hygiene, in | ||||||
11 | addition to the training program required under | ||||||
12 | subdivision (3)(B) of this Section, unless there has | ||||||
13 | been a confirmed case of MRSA at the facility within | ||||||
14 | the previous 6 months and a training was conducted at | ||||||
15 | that time. | ||||||
16 | (E) State residential facility management shall | ||||||
17 | inform all health care providers evaluating residents | ||||||
18 | or inmates of the facility of the MRSA case so they may | ||||||
19 | be on the alert for inmates with skin or soft tissue | ||||||
20 | infections or other evidence of MRSA infections. | ||||||
21 | (F) No resident, patient, student, or inmate with a | ||||||
22 | skin or soft tissue infection shall be transferred to | ||||||
23 | another facility until fully evaluated and | ||||||
24 | appropriately treated except when required for | ||||||
25 | security reasons, medical care, or other special | ||||||
26 | circumstances. Residents, patients, students, or |
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1 | inmates with MRSA infections requiring transfer shall | ||||||
2 | have draining wounds dressed the day of transfer to | ||||||
3 | contain the draining. Escort personnel shall be | ||||||
4 | notified of the resident, patient, student, or | ||||||
5 | inmate's condition and educated on infection control | ||||||
6 | measures. The clinical director of the sending | ||||||
7 | facility or his or her designee shall notify the | ||||||
8 | receiving institution's clinical director or health | ||||||
9 | services administrator of pending transfers of | ||||||
10 | individuals with MRSA. | ||||||
11 | (5) Treatment.
The Department of Public Health shall | ||||||
12 | develop an MRSA treatment protocol for each department | ||||||
13 | operating a State residential facility. Upon issuance of | ||||||
14 | the protocol by the Department of Public Health, each | ||||||
15 | department operating a State residential facility shall | ||||||
16 | educate all clinical staff at the facility and healthcare | ||||||
17 | vendors for the facility on that protocol.
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18 | Section 99. Effective date. This Act takes effect upon | ||||||
19 | becoming law.".
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