October 19, 2004

Infection Control Advisory Panel Meets

 The Infection Control Advisory Panel held its first meeting on October 8. The panel was created to advise the Department of Health and Senior Services in developing regulations and standards to implement Senate Bill 1279 — the infection control legislation enacted earlier this year. Senate Bill 1279 provides for public reporting of risk-adjusted nosocomial infection rates in hospitals and ambulatory surgical centers.

At the meeting, DHSS staff presented a suggested timetable for finalizing regulations by July 1, 2005, the date specified in Senate Bill 1279. The timetable would require the panel to complete its recommendations by the end of 2004. In response, members concurred that the panel should focus on getting the regulations done correctly rather than on a fast timetable. Panel members and DHSS staff noted that inquiries from other states show that Missouri is being looked upon as a potential model for state action on this topic.

Much of the panel’s discussion focused on two topics. The first was whether participation in the Centers for Disease Control and Prevention’s next generation infection tracking system, the Health Care Safety Network, should be recommended as a means of complying with the state law. The network is slated to become available for all hospitals in 2005. The second topic was selecting the specific procedures that would be tracked by the infection reporting system.

The panel developed the following conclusions and recommendations, which will be used as the basis for DHSS staff to draft an initial set of regulations for review and refinement in subsequent meetings.

• The CDC infection control system should be adopted as a means of complying with the requirement of the state law.

• CDC risk adjustment standards should be used in analyzing data.

• CDC training modules should be mandated to ensure standardized data collection.

• Of the three categories of infection for which at least some reporting is required — class I surgical site infections, ventilator associated pneumonia and central line bloodstream infections:

- Data would be reported on class I surgical site infections for hip prostheses and coronary artery bypass grafts if the hospital performs more than 20 of the procedures in a year. Ambulatory surgical centers would report data on breast and hernia surgeries if the facility performs more than 20 of the procedures in a year. The panel acknowledged the possibility that one or two other types of surgeries may be added.

- Data would be reported on ventilator associated pneumonias occurring in ICUs that have more than 50 ventilator days in a year.

- Data would be reported on central line bloodstream infections occurring in ICUs which have 50 or more central line days in a year.

• If current law allows the infection reporting requirements for the three categories to be phased in, central line bloodstream infections should be implemented first, followed by class I surgical site infections, and then ventilator associated pneumonia.

• The panel recommended setting a standard for infection control practitioner staffing. The specific number of practitioners per number of occupied beds or designation of the appropriate organization to define the standard was left to future deliberations.

• If meeting the July 1, 2005, deadline for the promulgation of rules governing data collection and analysis is unworkable, the panel will consider developing rules that would go into effect on a later date. Senate Bill 1279 calls for the first reporting of infection data to be issued by December 31, 2006.

The committee plans to meet again in early December.

[top of page]