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AN ACT
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relating to the reporting of health care-associated infections at |
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certain health care facilities and the creation of an advisory |
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panel. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Subtitle D, Title 2, Health and Safety Code, is |
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amended by adding Chapter 98 to read as follows: |
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CHAPTER 98. REPORTING OF HEALTH CARE-ASSOCIATED INFECTIONS |
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SUBCHAPTER A. GENERAL PROVISIONS |
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Sec. 98.001. DEFINITIONS. In this chapter: |
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(1) "Advisory panel" means the Advisory Panel on |
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Health Care-Associated Infections. |
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(2) "Ambulatory surgical center" means a facility |
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licensed under Chapter 243. |
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(3) "Commissioner" means the commissioner of state |
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health services. |
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(4) "Department" means the Department of State Health |
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Services. |
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(5) "Executive commissioner" means the executive |
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commissioner of the Health and Human Services Commission. |
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(6) "General hospital" means a general hospital |
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licensed under Chapter 241 or a hospital that provides surgical or |
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obstetrical services and that is maintained or operated by this |
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state. The term does not include a comprehensive medical |
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rehabilitation hospital. |
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(7) "Health care-associated infection" means a |
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localized or symptomatic condition resulting from an adverse |
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reaction to an infectious agent or its toxins to which a patient is |
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exposed in the course of the delivery of health care to the patient. |
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(8) "Health care facility" means a general hospital or |
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an ambulatory surgical center. |
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(9) "Infection rate" means the number of health |
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care-associated infections of a particular type at a health care |
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facility divided by a numerical measure over time of the population |
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at risk for contracting the infection, unless the term is modified |
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by rule of the executive commissioner to accomplish the purposes of |
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this chapter. |
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(10) "Pediatric and adolescent hospital" has the |
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meaning assigned by Section 241.003. |
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(11) "Reporting system" means the Texas Health |
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Care-Associated Infection Reporting System. |
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(12) "Special care setting" means a unit or service of |
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a general hospital that provides treatment to inpatients who |
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require extraordinary care on a concentrated and continuous basis. |
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The term includes an adult intensive care unit, a burn intensive |
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care unit, and a critical care unit. |
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Sec. 98.002. APPLICABILITY OF OTHER LAW. Chapter 2110, |
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Government Code, does not apply to the advisory panel created under |
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Subchapter B. |
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[Sections 98.003-98.050 reserved for expansion] |
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SUBCHAPTER B. ADVISORY PANEL |
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Sec. 98.051. ESTABLISHMENT. The commissioner shall |
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establish the Advisory Panel on Health Care-Associated Infections |
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within the infectious disease surveillance and epidemiology branch |
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of the department to guide the implementation, development, |
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maintenance, and evaluation of the reporting system. |
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Sec. 98.052. MEMBERSHIP; TERM. (a) The advisory panel is |
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composed of 16 members as follows: |
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(1) two infection control professionals who: |
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(A) are certified by the Certification Board of |
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Infection Control and Epidemiology; and |
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(B) are practicing in hospitals in this state, at |
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least one of which must be a rural hospital; |
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(2) two infection control professionals who: |
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(A) are certified by the Certification Board of |
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Infection Control and Epidemiology; and |
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(B) are nurses licensed to engage in professional |
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nursing under Chapter 301, Occupations Code; |
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(3) three board-certified or board-eligible |
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physicians who: |
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(A) are licensed to practice medicine in this |
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state under Chapter 155, Occupations Code, at least two of whom have |
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active medical staff privileges at a hospital in this state and at |
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least one of whom is a pediatric infectious disease physician with |
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expertise and experience in pediatric health care epidemiology; |
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(B) are active members of the Society for |
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Healthcare Epidemiology of America; and |
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(C) have demonstrated expertise in infection |
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control in health care facilities; |
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(4) two professionals in quality assessment and |
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performance improvement, one of whom is employed by a general |
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hospital and one of whom is employed by an ambulatory surgical |
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center; |
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(5) one officer of a general hospital; |
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(6) one officer of an ambulatory surgical center; |
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(7) three nonvoting members who are department |
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employees representing the department in epidemiology and the |
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licensing of hospitals or ambulatory surgical centers; and |
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(8) two members who represent the public as consumers. |
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(b) Members of the advisory panel serve two-year terms. |
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Sec. 98.053. MEMBER ELIGIBILITY. (a) A person may not be a |
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member of the advisory panel if the person is required to register |
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as a lobbyist under Chapter 305, Government Code, because of the |
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person's activities for compensation on behalf of a profession |
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related to health care. |
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(b) A person may not be a member of the advisory panel if the |
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person is an officer, employee, or paid consultant of a Texas trade |
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association in the field of health care. |
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Sec. 98.054. OFFICERS. The members of the advisory panel |
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shall elect a presiding officer and an assistant presiding officer |
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from among the members. The officers serve two-year terms. |
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Sec. 98.055. COMPENSATION; EXPENSES. Members of the |
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advisory panel serve without compensation but are entitled to |
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reimbursement of the travel expenses incurred by the member while |
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conducting the business of the advisory panel from department |
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funds, in accordance with the General Appropriations Act. |
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Sec. 98.056. VACANCY. A vacancy on the advisory panel shall |
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be filled by the commissioner. |
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[Sections 98.057-98.100 reserved for expansion] |
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SUBCHAPTER C. DUTIES OF DEPARTMENT AND ADVISORY PANEL; REPORTING |
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SYSTEM |
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Sec. 98.101. RULEMAKING. (a) The executive commissioner |
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may adopt rules for the department to implement this chapter. |
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(b) The executive commissioner may not adopt rules that |
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conflict with or duplicate any federally mandated infection |
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reporting program or requirement. |
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Sec. 98.102. DEPARTMENTAL RESPONSIBILITIES; REPORTING |
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SYSTEM. (a) The department shall establish the Texas Health |
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Care-Associated Infection Reporting System within the infectious |
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disease surveillance and epidemiology branch of the department. |
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The purpose of the reporting system is to provide for: |
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(1) the reporting of health care-associated |
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infections by health care facilities to the department; |
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(2) the public reporting of information regarding the |
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health care-associated infections by the department; and |
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(3) the education and training of health care facility |
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staff by the department regarding this chapter. |
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(b) The reporting system shall provide a mechanism for this |
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state to collect data, at state expense, through a secure |
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electronic interface with health care facilities. |
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(c) The data reported by health care facilities to the |
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department must contain sufficient patient identifying information |
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to: |
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(1) avoid duplicate submission of records; |
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(2) allow the department to verify the accuracy and |
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completeness of the data reported; and |
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(3) allow the department to risk adjust the |
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facilities' infection rates. |
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(d) The department shall review the infection control and |
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reporting activities of health care facilities to ensure the data |
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provided by the facilities is valid and does not have unusual data |
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patterns or trends that suggest implausible infection rates. |
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Sec. 98.103. REPORTABLE INFECTIONS. (a) A health care |
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facility, other than a pediatric and adolescent hospital, shall |
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report to the department the incidence of surgical site infections |
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occurring in the following procedures: |
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(1) colon surgeries; |
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(2) hip arthroplasties; |
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(3) knee arthroplasties; |
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(4) abdominal hysterectomies; |
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(5) vaginal hysterectomies; |
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(6) coronary artery bypass grafts; and |
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(7) vascular procedures. |
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(b) A pediatric and adolescent hospital shall report the |
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incidence of surgical site infections occurring in the following |
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procedures to the department: |
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(1) cardiac procedures, excluding thoracic cardiac |
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procedures; |
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(2) ventriculoperitoneal shunt procedures; and |
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(3) spinal surgery with instrumentation. |
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(c) A general hospital shall report the following to the |
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department: |
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(1) the incidence of laboratory-confirmed central |
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line-associated primary bloodstream infections occurring in any |
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special care setting in the hospital; and |
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(2) the incidence of respiratory syncytial virus |
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occurring in any pediatric inpatient unit in the hospital. |
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(d) The department shall ensure that the health |
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care-associated infections a health care facility is required to |
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report under this section have the meanings assigned by the federal |
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Centers for Disease Control and Prevention. |
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Sec. 98.104. ALTERNATIVE FOR REPORTABLE SURGICAL SITE |
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INFECTIONS. A health care facility that does not perform at least |
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an average of 50 procedures per month of the procedures listed in |
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Section 98.103(a) or (b), as modified under Section 98.105, is not |
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required to comply with the reporting requirements of Section |
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98.103 but instead shall report to the department the surgical site |
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infections relating to the three surgical procedures most |
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frequently performed at the facility, based on the list of surgical |
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procedures promulgated by the federal Centers for Disease Control |
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and Prevention's National Healthcare Safety Network or its |
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successor. |
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Sec. 98.105. REPORTING SYSTEM MODIFICATIONS. Based on the |
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recommendations of the advisory panel, the executive commissioner |
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by rule may modify in accordance with this chapter the list of |
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procedures that are reportable under Section 98.103 or 98.104. The |
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modifications must be based on changes in reporting guidelines and |
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in definitions established by the federal Centers for Disease |
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Control and Prevention. |
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Sec. 98.106. DEPARTMENTAL SUMMARY. (a) The department |
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shall compile and make available to the public a summary, by health |
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care facility, of the infections reported by facilities under |
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Sections 98.103 and 98.104. |
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(b) The departmental summary must be risk adjusted and |
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include a comparison of the risk-adjusted infection rates for each |
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health care facility in this state that is required to submit a |
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report under Sections 98.103 and 98.104. |
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(c) In consultation with the advisory panel, the department |
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shall publish the departmental summary in a format that is easy to |
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read. |
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(d) The department shall publish the departmental summary |
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at least annually and may publish the summary more frequently as the |
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department considers appropriate. |
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(e) The executive commissioner by rule shall allow a health |
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care facility to submit concise written comments regarding |
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information contained in the departmental summary that relates to |
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the facility. The department shall attach the facility's comments |
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to the public report and the comments must be in the same format as |
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the summary. |
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(f) The disclosure of written comments to the department by |
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a health care facility as provided by Subsection (e) does not |
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constitute a waiver of a privilege or protection under Section |
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98.109. |
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(g) The department shall make the departmental summary |
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available on an Internet website administered by the department and |
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may make the summary available through other formats accessible to |
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the public. The website must contain a statement informing the |
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public of the option to report suspected health care-associated |
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infections to the department. |
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Sec. 98.107. EDUCATION AND TRAINING REGARDING REPORTING |
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SYSTEM. The department shall provide education and training for |
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health care facility staff regarding this chapter. The training |
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must be reasonable in scope and focus primarily on: |
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(1) the implementation and management of a facility |
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reporting mechanism; |
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(2) characteristics of the reporting system, |
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including public reporting by the department and facility reporting |
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to the department; |
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(3) confidentiality; and |
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(4) legal protections. |
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Sec. 98.108. FREQUENCY OF REPORTING. In consultation with |
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the advisory panel, the executive commissioner by rule shall |
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establish the frequency of reporting by health care facilities |
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required under Sections 98.103 and 98.104. Facilities may not be |
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required to report more frequently than quarterly. |
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Sec. 98.109. CONFIDENTIALITY; PRIVILEGE. (a) Except as |
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provided by Sections 98.106 and 98.110, all information and |
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materials obtained or compiled or reported by the department under |
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this chapter or compiled or reported by a health care facility under |
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this chapter, and all related information and materials, are |
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confidential and: |
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(1) are not subject to disclosure under Chapter 552, |
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Government Code, or discovery, subpoena, or other means of legal |
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compulsion for release to any person; and |
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(2) may not be admitted as evidence or otherwise |
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disclosed in any civil, criminal, or administrative proceeding. |
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(b) The confidentiality protections under Subsection (a) |
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apply without regard to whether the information or materials are |
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obtained from or compiled or reported by a health care facility or |
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an entity that has an ownership or management interest in a |
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facility. |
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(c) The transfer of information or materials under this |
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chapter is not a waiver of a privilege or protection granted under |
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law. |
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(d) The provisions of this section regarding the |
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confidentiality of information or materials compiled or reported by |
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a health care facility in compliance with or as authorized under |
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this chapter do not restrict access, to the extent authorized by |
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law, by the patient or the patient's legally authorized |
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representative to records of the patient's medical diagnosis or |
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treatment or to other primary health records. |
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(e) A department summary or disclosure may not contain |
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information identifying a facility patient, employee, contractor, |
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volunteer, consultant, health care professional, student, or |
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trainee in connection with a specific infection incident. |
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Sec. 98.110. DISCLOSURE WITHIN DEPARTMENT. |
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Notwithstanding any other law, the department may disclose |
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information reported by health care facilities under Section 98.103 |
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or 98.104 to other programs within the department for public health |
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research or analysis purposes only, provided that the research or |
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analysis relates to health care-associated infections. The |
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privilege and confidentiality provisions contained in this chapter |
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apply to such disclosures. |
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Sec. 98.111. CIVIL ACTION. Published infection rates may |
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not be used in a civil action to establish a standard of care |
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applicable to a health care facility. |
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[Sections 98.112-98.150 reserved for expansion] |
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SUBCHAPTER D. ENFORCEMENT |
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Sec. 98.151. VIOLATIONS. (a) Except as provided by |
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Subsection (b), a general hospital that violates this chapter or a |
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rule adopted under this chapter is subject to the enforcement |
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provisions of Subchapter C, Chapter 241, and rules adopted and |
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enforced under that subchapter as if the hospital violated Chapter |
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241 or a rule adopted under that chapter. |
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(b) Subsection (a) does not apply to a comprehensive medical |
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rehabilitation hospital as defined in Section 241.003. |
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(c) An ambulatory surgical center that violates this |
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chapter or a rule adopted under this chapter is subject to the |
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enforcement provisions of Chapter 243 and rules adopted and |
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enforced under that chapter as if the center violated Chapter 243 or |
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a rule adopted under that chapter. |
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SECTION 2. Not later than June 1, 2008, the Department of |
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State Health Services shall establish the Texas Health |
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Care-Associated Infection Reporting System as required under |
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Chapter 98, Health and Safety Code, as added by this Act. |
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SECTION 3. (a) As soon as practicable after the effective |
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date of this Act, the executive commissioner of the Health and Human |
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Services Commission shall adopt the rules and procedures necessary |
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to implement Chapter 98, Health and Safety Code, as added by this |
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Act. |
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(b) As soon as practicable after the effective date of this |
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Act, the commissioner of state health services shall appoint |
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members to the Advisory Panel on Health Care-Associated Infections |
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as required by Chapter 98, Health and Safety Code, as added by this |
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Act. |
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SECTION 4. This Act takes effect immediately if it receives |
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a vote of two-thirds of all the members elected to each house, as |
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provided by Section 39, Article III, Texas Constitution. If this |
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Act does not receive the vote necessary for immediate effect, this |
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Act takes effect September 1, 2007. |
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______________________________ |
______________________________ |
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President of the Senate |
Speaker of the House |
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I hereby certify that S.B. No. 288 passed the Senate on |
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April 4, 2007, by the following vote: Yeas 30, Nays 0; and that |
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the Senate concurred in House amendment on May 15, 2007, by the |
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following vote: Yeas 31, Nays 0. |
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______________________________ |
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Secretary of the Senate |
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I hereby certify that S.B. No. 288 passed the House, with |
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amendment, on May 3, 2007, by the following vote: Yeas 141, |
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Nays 0, one present not voting. |
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______________________________ |
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Chief Clerk of the House |
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Approved: |
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______________________________ |
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Date |
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______________________________ |
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Governor |