HR 4214 IHCommentsClose CommentsPermalink

To improve the prevention, detection, and treatment of community and healthcare-associated infections (CHAI), with a focus on antibiotic-resistant bacteria.CommentsClose CommentsPermalink

November 15, 2007

Mr. CUMMINGS (for himself, Mr. SARBANES, Mr. TOWNS, and Mr. WYNN) introduced the following bill; which was referred to the Committee on Energy and CommerceCommentsClose CommentsPermalink

To improve the prevention, detection, and treatment of community and healthcare-associated infections (CHAI), with a focus on antibiotic-resistant bacteria.CommentsClose CommentsPermalink

Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled,CommentsClose CommentsPermalink

SECTION 1. SHORT TITLE.

This Act may be cited as the `Community and Healthcare-Associated Infections Reduction Act of 2007'.CommentsClose CommentsPermalink

SEC. 2. FINDINGS.

Congress makes the following findings:CommentsClose CommentsPermalink





(1) Effective antibiotics have transformed the practice of medicine and saved millions of lives, but the emergence and spread of antibiotic-resistant bacterial pathogens poses a significant threat to patient and public health.CommentsClose CommentsPermalink





(2) Although many antibiotic-resistant infections occur most frequently among individuals in hospitals and other healthcare facilities, they also affect otherwise healthy individuals in the community.CommentsClose CommentsPermalink





(3) According to the Centers for Disease Control and Prevention (referred to in this Act as the `CDC'), healthcare-associated infections (referred to in this Act as `HAI') are one of the top 10 leading causes of death in the United States.CommentsClose CommentsPermalink





(4) In American hospitals alone, HAI account for an estimated 1,700,000 infections and 99,000 associated deaths each year. In 70 percent of these deaths, the bacteria are resistant to at least one commonly used antibiotic.CommentsClose CommentsPermalink





(5) Dr. John Jernigan, Chief of Interventions and Evaluations at the CDC, estimates that HAI in hospitals result in up to $27,500,000,000 in additional healthcare costs annually. The growing problem of antibiotic resistance, which affects the most common and least expensive antibiotics first, also shifts utilization toward more expensive antibiotics.CommentsClose CommentsPermalink





(6) Methicillin-resistant Staphylococcus aureus (referred to in this Act as `MRSA'), one of the most dangerous forms of antibiotic-resistant staph infections, highlights the magnitude of the problem. A recent study by the CDC estimates that nearly 95,000 people became infected with invasive MRSA in 2005 in the United States, resulting in 19,000 deaths, more than the number who died from HIV/AIDS, Parkinson's disease, emphysema, or homicide. A vast majority (85 percent) of these infections were associated with healthcare treatment.CommentsClose CommentsPermalink





(7) MRSA also affects individuals outside the healthcare setting and in the community. Recent weeks have seen an increase by health and education officials in reported staph infection outbreaks, including antibiotic-resistant strains. These infections have occurred in New York, Kentucky, Virginia, Maryland, Illinois, Ohio, North Carolina, Florida, and the District of Columbia.CommentsClose CommentsPermalink





(8) The problem of antibiotic-resistant infections is not limited to MRSA. High levels of resistance in enterococci, Klebsiella pneumonia, Pseudomonas aeruginosa, and E. coli have also been reported.CommentsClose CommentsPermalink





(9) Antibiotic-resistant infections have been discovered in troops coming back from Iraq and Afghanistan. A CDC study showed that between March and October 2003, 145 United States service members at military treatment facilities were infected or colonized with a multidrug-resistant gram-negative bacterium called Acinetobacter baumannii. The most likely source of this outbreak was bacteria within deployed field hospitals.CommentsClose CommentsPermalink





(10) Despite this significant public health threat, information on community and healthcare-associated infections (referred to in this Act as `CHAI') is incomplete and unreliable. Policymakers, healthcare providers, and individual consumers have little information about hospital infection rates, making it difficult to diagnose the scope of the problem and evaluate current infection prevention efforts, and assess potential remedies.CommentsClose CommentsPermalink

SEC. 3. DEFINITIONS.

In this Act:CommentsClose CommentsPermalink





(1) ADMINISTRATOR- The term `Administrator' means the Administrator of the Centers for Medicare & Medicaid Services.CommentsClose CommentsPermalink





(2) AHRQ- The term `AHRQ' means the Agency for Healthcare Research and Quality.CommentsClose CommentsPermalink





(3) CHAI- The term `CHAI' means community and healthcare-associated infections.CommentsClose CommentsPermalink





(4) DIRECTOR- The term `Director' means the Director of the Centers for Disease Control and Prevention, unless otherwise specifically designated.CommentsClose CommentsPermalink





(5) HAI- The term `HAI' means healthcare-associated infections, which are infections that patients acquire during the course of receiving treatment for other conditions within a healthcare setting.CommentsClose CommentsPermalink





(6) HOSPITAL- The term `hospital' means a subsection (d) hospital (as defined in section 1886(d)(1)(B) of the Social Security Act (42 U.S.C. 1395ww(d)(1)(B))).CommentsClose CommentsPermalink





(7) INTERAGENCY WORKING GROUP- The term `interagency working group' means the interagency working group on community and healthcare-associated infections established under section 9.CommentsClose CommentsPermalink





(8) MRSA- The term `MRSA' means Methicillin-resistant Staphylococcus aureus.CommentsClose CommentsPermalink





(9) SECRETARY- The term `Secretary' means the Secretary of Health and Human Services.CommentsClose CommentsPermalink

SEC. 4. COMMUNITY AND HEALTHCARE-ASSOCIATED INFECTION CONTROL PROGRAM.

(a) Establishment of Best Practices Guidelines for Infection Control-CommentsClose CommentsPermalink





(1) IN GENERAL- Not later than 90 days after the date of enactment of this Act, AHRQ in collaboration with CDC shall develop best-practices guidelines for internal infection control plans to prevent, detect, control, and treat CHAI at hospitals.CommentsClose CommentsPermalink





(2) REQUIREMENTS- In carrying out paragraph (1), AHRQ shall--CommentsClose CommentsPermalink





(A) establish a set of best practices with supporting justification of their appropriateness and effectiveness based on nationally-recognized or evidence-based standards, which practices may include--CommentsClose CommentsPermalink





(i) the establishment of an infection control oversight committee; andCommentsClose CommentsPermalink





(ii) the establishment of measures for the prevention, detection, control, and treatment of CHAI, such as--CommentsClose CommentsPermalink





(I) staff training and education on CHAI prevention and control, including the monitoring and strict enforcement of hand hygiene procedures;CommentsClose CommentsPermalink





(II) a system to identify, designate, and manage patients known to be colonized or infected with CHAI, including diagnostic surveillance processes and policies, procedures and protocols for staff who may have had potential exposure to a patient or resident known to be colonized or infected with a CHAI, and an outreach process for notifying a receiving healthcare facility of any patient known to be colonized or infected with CHAI prior to transfer of such patient within or between facilities;CommentsClose CommentsPermalink





(III) the development and implementation of an infection control intervention protocol that may include active detection and isolation procedures, the alternation of the physical plan of a hospital, the appropriate use of anti-microbial agents, and other infection control precautions for general surveillance of infected or colonized patients;CommentsClose CommentsPermalink





(B) work in collaboration with other agencies and organizations whose area of expertise is the identification, treatment, and prevention of infectious disease;CommentsClose CommentsPermalink





(C) publish proposed guidelines for internal infection control plans;CommentsClose CommentsPermalink





(D) provide for a comment period of not less than 90 days; andCommentsClose CommentsPermalink





(E) establish final guidelines, taking into consideration any comment received under subparagraph (D).CommentsClose CommentsPermalink





(b) Consultation of Best Practices Guidelines- The Administrator shall consult best practices guidelines in evaluating hospitals infection control plans as a condition of participation in the Medicare program.CommentsClose CommentsPermalink





(c) Authorization of Appropriations- For the purpose of carrying out this section, there is authorized to be appropriated such sums as may be necessary for each of fiscal years 2008 through 2012.CommentsClose CommentsPermalink

SEC. 5. COLLECTION, REPORTING, AND COMPILATION OF COMMUNITY AND HEALTHCARE-ASSOCIATED INFECTION DATA.

(a) In General- Not later than 120 days after the date of enactment of this Act, hospitals shall report information about CHAI to the CDC National Healthcare Safety Network (NHSN), which shall be used by the CDC to develop a national database of infection rates in hospitals. With respect to reporting such information, the following shall apply:CommentsClose CommentsPermalink





(1) Hospitals shall meet data reporting standards as required by the NHSN, including timeframes, case-finding techniques, submission formats, infection definitions and other relevant terms, methodology for surveillance of infections, risk-adjustment techniques, or other specifications necessary to render the incoming data valid, consistent, compatible, and manageable.CommentsClose CommentsPermalink





(2) Hospitals shall submit data that allows the CDC to distinguish between--CommentsClose CommentsPermalink





(A) infections that are present in patients upon their admission to the hospital;CommentsClose CommentsPermalink





(B) infections that occur during a patient's hospital stay; andCommentsClose CommentsPermalink





(C) infections caused by multiple drug resistant organisms and nondrug resistant organisms.CommentsClose CommentsPermalink





(3) The CDC shall have the authority to make such orders, findings, rules, and regulations as necessary to ensure that hospitals accurately and timely track and report data.CommentsClose CommentsPermalink





(b) Consultation- The CDC shall review and revise NHSN standards as appropriate, working in consultation with the Centers for Medicare & Medicaid Services, AHRQ, and national organizations engaged in healthcare quality measurement and reporting.CommentsClose CommentsPermalink





(c) Data Harmonization- The Director shall work in collaboration with the Administrator to support the harmonization of data for purposes of developing a national database of infections rates in hospitals and other purposes determined to be appropriate.CommentsClose CommentsPermalink





(d) Dissemination of Data- Not later than 1 year after the date of enactment of this Act, subject to the confidentiality of patient records, the CDC shall--CommentsClose CommentsPermalink





(1) make data available to interested researchers;CommentsClose CommentsPermalink





(2) make data available to interested State Health Departments;CommentsClose CommentsPermalink





(3) produce useful and accessible reports for the public to allow for comparisons of HAI rates across hospitals; andCommentsClose CommentsPermalink





(4) use data to assist hospitals in evaluating and formulating best practices strategies to reduce infection rates.CommentsClose CommentsPermalink





(e) Privacy of Data- Notwithstanding any other provision of Federal, State, or local law, the infection data collected pursuant to this Act shall be privileged and shall not be--CommentsClose CommentsPermalink





(1) subject to admission as evidence or other disclosure in any Federal, State, or local civil or administrative proceeding; andCommentsClose CommentsPermalink





(2) subject to use in a State or local disciplinary proceeding against a hospital or provider.CommentsClose CommentsPermalink





(f) Authorization of Appropriations- For the purpose of carrying out this section, there is authorized to be appropriated such sums as may be necessary for each of fiscal years 2008 through 2012.CommentsClose CommentsPermalink

SEC. 6. QUALITY IMPROVEMENT PAYMENT PROGRAM.

(a) Pay for Performance Initiatives Report- Not later than 90 days after the date of enactment of this Act, the Administrator shall submit to Congress a report studying the feasibility of reducing HAI rates through a Quality Improvement Payment Program.CommentsClose CommentsPermalink





(b) Program- The report under subsection (a) shall consider such factors as--CommentsClose CommentsPermalink





(1) patient demographics, such as--CommentsClose CommentsPermalink





(A) the median income of patients;CommentsClose CommentsPermalink





(B) percentage of minority patients; andCommentsClose CommentsPermalink





(C) disease condition;CommentsClose CommentsPermalink





(2) hospital characteristics, such as--CommentsClose CommentsPermalink





(A) median income;CommentsClose CommentsPermalink





(B) population density of the hospital zip code locale;CommentsClose CommentsPermalink





(C) university affiliation; andCommentsClose CommentsPermalink





(D) hospital size as indicated by the number of beds; andCommentsClose CommentsPermalink





(3) other factors as determined to be appropriate by the Centers for Medicare & Medicaid Services.CommentsClose CommentsPermalink





(c) Authorization of Appropriations- For the purpose of carrying out this section, there is authorized to be appropriated such sums as may be necessary for each of fiscal years 2008 through 2012.CommentsClose CommentsPermalink

SEC. 7. PUBLIC AWARENESS CAMPAIGN.

(a) In General- The Director shall award grants to States for the purpose of enabling the States to carry out public awareness campaigns to provide public education and increase awareness with respect to the issue of reducing, preventing, detecting, and controlling CHAI.CommentsClose CommentsPermalink





(b) Requirements- To be eligible for a grant under subsection (a), a State shall provide assurances to the Secretary that the State campaign to be conducted under the grant shall--CommentsClose CommentsPermalink





(1) provide information on the prevention and control of CHAI, including appropriate antibiotic use, causes and symptoms, and management, treatment and reduction methods, in healthcare settings and non-healthcare settings;CommentsClose CommentsPermalink





(2) provide information to healthcare providers and the public, including schools, non-profit organizations, and private-sector entities; andCommentsClose CommentsPermalink





(3) work with members of the community to promote awareness and education, including hospitals, school health centers, schools, local governments, doctors' offices, prisons, jails, and other public- and private-sector entities.CommentsClose CommentsPermalink





(c) Authorization of Appropriations- For the purpose of carrying out this section, there is authorized to be appropriated such sums as may be necessary for each of fiscal years 2008 through 2012.CommentsClose CommentsPermalink

SEC. 8. EXPANSION AND COORDINATION OF ACTIVITIES OF THE NATIONAL INSTITUTES OF HEALTH REGARDING COMMUNITY AND HEALTHCARE-ASSOCIATED INFECTIONS.

(a) Community and Healthcare-Associated Infections Initiative Through the National Institutes of Health-CommentsClose CommentsPermalink





(1) EXPANSION AND INTENSIFICATION OF ACTIVITIES-CommentsClose CommentsPermalink





(A) IN GENERAL- The Director of National Institutes of Health (referred to in this section as the `Director'), in coordination with the directors of the other national research institutes (as appropriate), may expand and intensify programs of the National Institutes of Health with respect to research and related activities concerning CHAI.CommentsClose CommentsPermalink





(B) COORDINATION- The directors referred to in paragraph (1) may jointly coordinate the programs referred to in such paragraph and consult with additional Federal officials, voluntary health associations, medical professional societies, and private entities, as appropriate.CommentsClose CommentsPermalink





(2) PLANNING GRANTS AND CONTRACTS FOR INNOVATIVE RESEARCH IN CHAI-CommentsClose CommentsPermalink





(A) IN GENERAL- In carrying out subsection (a)(1) the Director may award planning grants or contracts for the establishment of new research programs, or the enhancement of existing research programs, that focus on CHAI.CommentsClose CommentsPermalink





(B) RESEARCH- In awarding planning grants or contracts under paragraph (1), the Director may give priority to--CommentsClose CommentsPermalink





(i) collaborative partnerships, which may include academic institutions, private sector entities, or nonprofit organizations with a focus on infectious disease science, medicine, public health, veterinary medicine, or other discipline impacting or influenced by emerging infectious diseases;CommentsClose CommentsPermalink





(ii) research on the most effective copper-based applications to stem infections in military and civilian healthcare facilities; andCommentsClose CommentsPermalink





(iii) research on new rapid diagnostic techniques for antibiotic-resistant bacteria.CommentsClose CommentsPermalink





(b) Report- Not later than 6 months after the date of enactment of this Act, the Secretary, in collaboration with the Director, the Commissioner of Food and Drugs, and the Director of the National Institutes of Health, shall prepare and submit to the appropriate committees of the Congress a report that describes the obstacles to anti-infective, especially antibacterial, drug research and development. Such report shall--CommentsClose CommentsPermalink





(1) identify, in concurrence with infectious disease clinicians and appropriate professional associations, the infectious pathogens that are (or are likely to become) a significant threat to public health because of drug resistance or other factors;CommentsClose CommentsPermalink





(2) identify those incentives that may already exist through Federal programs, such as Orphan Product designation, including an explanation of how such programs would apply to infectious diseases and in particular resistant bacterial infections;CommentsClose CommentsPermalink





(3) recommend strategies to publicize current incentives available to encourage anti-infective, especially antibacterial, drug research and development;CommentsClose CommentsPermalink





(4) recommend additional regulatory and legislative solutions to stimulate appropriate anti-infective, especially antibacterial, drug research and development;CommentsClose CommentsPermalink





(5) update the progress made in response to the `Public Health Action Plan to Combat Antimicrobial Resistance' to include a narrative summary of activities in addition to tables provided in existing progress reports, highlighting where gaps remain as well as obstacles to future progress; andCommentsClose CommentsPermalink





(6) recommend strategies to strengthen the Federal response to antimicrobial resistance, as outlined in the Action Plan, in particular additional actions needed to address remaining gaps or obstacles to progress in implementing the Plan, as well as Federal funding needs.CommentsClose CommentsPermalink





(c) Public Information- The coordinating committee shall make readily available to the public information concerning the research, education, and other activities relating to CHAI, that are conducted or supported by the National Institutes of Health.CommentsClose CommentsPermalink





(d) Authorization of Appropriations- There is authorized to be appropriated such sums as may be necessary for each of fiscal years 2008 through 2012 to carry out this section.CommentsClose CommentsPermalink

SEC. 9. INTERAGENCY WORKING GROUP ON COMMUNITY AND HEALTHCARE-ASSOCIATED INFECTIONS.

(a) Establishment- The Secretary, in coordination with the Administrator, shall establish an interagency working group on CHAI to consider issues relating to the reduction and prevention of these infections.CommentsClose CommentsPermalink





(b) Membership- The interagency working group shall be composed of a representative from each Federal agency (appointed by the head of each such agency) that has jurisdiction over, or is affected by, CHAI including--CommentsClose CommentsPermalink





(1) the Centers for Medicare & Medicaid Services;CommentsClose CommentsPermalink





(2) the Centers for Disease Control and Prevention;CommentsClose CommentsPermalink





(3) the Health Resources and Services Administration;CommentsClose CommentsPermalink





(4) the Agency for Healthcare Research and Quality;CommentsClose CommentsPermalink





(5) the Food and Drug Administration;CommentsClose CommentsPermalink





(6) the National Institutes of Health;CommentsClose CommentsPermalink





(7) the Department of Agriculture;CommentsClose CommentsPermalink





(8) the Department of Defense;CommentsClose CommentsPermalink





(9) the Department of Veterans Affairs;CommentsClose CommentsPermalink





(10) the Environmental Protection Agency; andCommentsClose CommentsPermalink





(11) such other Federal agencies as determined appropriate.CommentsClose CommentsPermalink





(c) Duties- The interagency working group shall--CommentsClose CommentsPermalink





(1) work in collaboration with the Interagency Task Force on Anti-microbial Resistance;CommentsClose CommentsPermalink





(2) facilitate communication and partnership on infection prevention and quality health-related projects and policies;CommentsClose CommentsPermalink





(3) serve as a centralized mechanism to coordinate a national effort--CommentsClose CommentsPermalink





(A) to discuss and evaluate evidence and knowledge on infection prevention;CommentsClose CommentsPermalink





(B) to determine the range of effective, feasible, and comprehensive actions to improve healthcare quality related to CHAI; andCommentsClose CommentsPermalink





(C) to examine and better address the growing impact of CHAI in communities throughout the United States;CommentsClose CommentsPermalink





(4) coordinate plans to communicate research results relating to CHAI prevention and control to enable reporting and outreach activities to produce more useful and timely information;CommentsClose CommentsPermalink





(5) consider and determine the feasibility of establishing an active surveillance program involving other entities (such as athletic teams or correctional facilities) for the purpose of identifying those individuals in the community that are colonized and at risk of susceptibility to and transmission of bacteria;CommentsClose CommentsPermalink





(6) develop an appropriate research agenda for Federal agencies;CommentsClose CommentsPermalink





(7) develop recommendations regarding evidence-based best practices, model programs, effective guidelines, and other strategies for promoting CHAI prevention and control;CommentsClose CommentsPermalink





(8) monitor Federal progress in meeting specific CHAI prevention and control promotion goals; andCommentsClose CommentsPermalink





(9) not later than 2 years after the date of enactment of this Act, submit to Congress a report that describes the appropriateness and effectiveness of best practices guidelines developed by the Centers for Disease Control and Prevention for infection control plans.CommentsClose CommentsPermalink





(d) Meetings-CommentsClose CommentsPermalink





(1) IN GENERAL- The interagency working group shall meet at least 6 times each year.CommentsClose CommentsPermalink





(2) ANNUAL CONFERENCE- The Secretary shall sponsor an annual conference on CHAI prevention, detection, and control to enhance coordination and share best practices in CHAI data collection, analysis, and reporting.CommentsClose CommentsPermalink





(e) Authorization of Appropriations- There is authorized to be appropriated such sums as may be necessary to carry out this section.CommentsClose CommentsPermalink

SEC. 10. GOVERNMENT ACCOUNTABILITY OFFICE REPORT ON COMMUNITY AND HEALTHCARE-ASSOCIATED INFECTIONS.

Not later than 2 years after the date of enactment of the Act, the Government Accountability Office shall submit to Congress a report on the impact of this Act on--CommentsClose CommentsPermalink





(1) the prevalence of CHAI; andCommentsClose CommentsPermalink





(2) the quality and availability of data about CHAI.CommentsClose CommentsPermalink

SEC. 11. PREEMPTION.

Nothing in this Act shall be construed to preempt existing State laws, except to the extent that such State laws would result in the establishment of duplicative or conflicting surveillance or reporting requirements.CommentsClose CommentsPermalink