HB4303ham001 95TH GENERAL ASSEMBLY

Health Care Availability and Access Committee

Filed: 3/4/2008

09500HB4303ham001 LRB095 16104 DRJ 47418 a

AMENDMENT TO HOUSE BILL 4303

AMENDMENT NO. ______. Amend House Bill 4303 by replacing everything after the enacting clause with the following:

"Section 1. Short title. This Act may be cited as the MRSA Screening, Prevention, and Reporting Act for State Residential Facilities.

Section 5. Definition. In this Act, "State residential facility" or "facility" means: any Department of Human Services operated residential facility, including any State mental health hospital, State developmental center, or State residential school for the deaf and visually impaired; any Department of Veterans' Affairs operated veterans home; any Department of Corrections operated correctional center, work camp or boot camp, or adult transition center; and any Department of Juvenile Justice operated juvenile center or boot camp.

Section 10. MRSA control program. In order to improve the prevention of infections due to methicillin-resistant Staphylococcus aureus ("MRSA"), every State residential facility shall establish an MRSA control program that includes the following features:

(1) Screening and surveillance.

(A) All residents, patients, students, or inmates of the facility undergoing intake medical screening and physical examinations shall be carefully evaluated for skin infections. This screening shall include culturing of skin abscesses, boils, "spider bites", or other suspicious skin conditions.

(B) Recently hospitalized residents, patients, students, or inmates of the facility shall be screened for infections immediately upon return to the facility and shall be instructed to report any new onset skin infection or fever.

(C) Residents, patients, students, or inmates of the facility with risk factors such as diabetes, immunocompromised conditions, open wounds, recent surgery, indwelling catheters, implantable devices, chronic skin conditions, or paraplegia with decubiti shall be evaluated for skin infections during routine medical evaluations.

(D) All residents, patients, students, or inmates of the facility with skin infections shall be referred to health services for evaluation.

(E) Facility health care providers shall consider MRSA infection in the differential diagnosis for all residents, patients, students, or inmates presenting with a skin or soft tissue infection or any other clinical presentation consistent with a staphylococcal infection.

(F) Appropriate bacterial cultures shall be obtained in all cases of suspected MRSA infection.

(G) No resident, patient, student, or inmate of the facility with a skin or soft tissue infection shall be transferred to another facility until fully evaluated and appropriately treated except when required for reasons of appropriate security or care. Residents, patients, students, or inmates with MRSA infections requiring transfer shall have draining wounds dressed the day of transfer to contain the draining. Escort personnel shall be notified of the resident, patient, student, or inmate's condition and educated on infection control measures. The clinical director of the sending facility or his or her designee shall notify the receiving institution's clinical director or health services administrator of pending transfers of individuals with MRSA.

(2) Reporting.

(A) All confirmed MRSA and other antibiotic-resistant infections shall be documented in the resident, patient, student, or inmate's medical record.

(B) All confirmed MRSA and other antibiotic-resistant infections shall be reported to the director of the department operating the facility and to the Department of Public Health. The report shall indicate whether the MRSA infection was present on intake or contracted at the facility, if known.

(3) Prevention.

(A) Education. Employees, residents, patients, students, and inmates of the facility shall be provided with information on the transmission, prevention, treatment, and containment of MRSA infections.

(B) Hand Hygiene program: Each facility shall develop and implement a hand hygiene program for employees, residents, patients, students, and inmates of the facility that includes adequate hand-washing equipment and supplies and regular training on effective hand hygiene techniques and education on the importance of hand hygiene. These trainings must be conducted at least once each year and may be conducted in conjunction with other trainings.

(C) Sanitation. Each facility shall develop and implement a sanitation program for cleaning and disinfecting the environment that includes the following:

(i) Use of an Environmental Protection Agency (EPA)-registered disinfectant according to the manufacturer's instructions.

(ii) Regularly cleaning or disinfecting washable surfaces in residents', patients', and students' rooms, in inmates' cells, and in shared areas such as showers, fitness areas, and food services areas.

(iii) Cleaning or disinfecting restraining devices after every use.

(iv) Treating all linen (towels, sheets, and similar items) as potentially infectious and following recommendations of the Centers for Disease Control and Prevention for laundering.

(D) Personal protective equipment. Employees of the facility shall be provided with personal protective equipment (gloves, eye protection, and gowns) for use when contact with blood, body fluids, or wound drainage is likely.

(E) Isolation of residents, patients, students, or inmates with MRSA. Each State residential facility shall develop guidelines for isolating MRSA-diagnosed residents, patients, students, or inmates from others when a clinician determines the individual to be a high risk for spreading the contagion. Residents, patients, students, or inmates diagnosed with MRSA shall be examined by a clinician to determine their risk of contagion to others. The determination about whether to isolate residents, patients, students, or inmates with MRSA infections shall include consideration of the degree to which wound drainage can be contained and the ability or willingness of a resident, patient, student, or inmate to comply with infection control instructions.

(4) Infection control. Upon the diagnosis of a single MRSA case at a State residential facility, that facility shall implement surveillance measures to detect additional MRSA cases through the following procedures:

(A) The individual diagnosed with MRSA shall be interviewed to identify potential sources of infections and close contacts. The interview should seek to determine the date of onset and activity immediately before and following onset, including recent hospitalizations, housing, work assignments, sharing of personal hygiene items, sexual contact, participation in close-contact sports, or exposure to other residents, patients, students, or inmates with draining wounds or skin infections.

(B) An individual shall not be required to make a copayment for the testing or treatment of an MRSA infection.

(C) Employees, residents, patients, students, or inmates of the facility identified as having contact with the infected individual should be examined for signs and symptoms of infection.

(D) State residential facility management shall inform all employees of the facility of the MRSA case. The notification must protect the identity of the infected individual. Management shall immediately conduct a training program on MRSA and hand hygiene, in addition to the training program required under subdivision (3)(B) of this Section, unless there has been a confirmed case of MRSA at the facility within the previous 6 months and a training was conducted at that time.

(E) State residential facility management shall inform all health care providers evaluating residents or inmates of the facility of the MRSA case so they may be on the alert for inmates with skin or soft tissue infections or other evidence of MRSA infections.

(F) No resident, patient, student, or inmate with a skin or soft tissue infection shall be transferred to another facility until fully evaluated and appropriately treated except when required for security reasons, medical care, or other special circumstances. Residents, patients, students, or inmates with MRSA infections requiring transfer shall have draining wounds dressed the day of transfer to contain the draining. Escort personnel shall be notified of the resident, patient, student, or inmate's condition and educated on infection control measures. The clinical director of the sending facility or his or her designee shall notify the receiving institution's clinical director or health services administrator of pending transfers of individuals with MRSA.

(5) Treatment. The Department of Public Health shall develop an MRSA treatment protocol for each department operating a State residential facility. Upon issuance of the protocol by the Department of Public Health, each department operating a State residential facility shall educate all clinical staff at the facility and healthcare vendors for the facility on that protocol.

Section 99. Effective date. This Act takes effect upon becoming law.".