[Congressional Bills 110th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4214 Introduced in House (IH)]







110th CONGRESS
  1st Session
                                H. R. 4214

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


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                           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 Commerce

_______________________________________________________________________

                                 A BILL


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

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

SECTION 1. SHORT TITLE.

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

SEC. 2. FINDINGS.

    Congress makes the following findings:
            (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.
            (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.
            (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.
            (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.
            (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.
            (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.
            (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.
            (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.
            (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.
            (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.

SEC. 3. DEFINITIONS.

    In this Act:
            (1) Administrator.--The term ``Administrator'' means the 
        Administrator of the Centers for Medicare & Medicaid Services.
            (2) AHRQ.--The term ``AHRQ'' means the Agency for 
        Healthcare Research and Quality.
            (3) CHAI.--The term ``CHAI'' means community and 
        healthcare-associated infections.
            (4) Director.--The term ``Director'' means the Director of 
        the Centers for Disease Control and Prevention, unless 
        otherwise specifically designated.
            (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.
            (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))).
            (7) Interagency working group.--The term ``interagency 
        working group'' means the interagency working group on 
        community and healthcare-associated infections established 
        under section 9.
            (8) MRSA.--The term ``MRSA'' means Methicillin-resistant 
        Staphylococcus aureus.
            (9) Secretary.--The term ``Secretary'' means the Secretary 
        of Health and Human Services.

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

    (a) Establishment of Best Practices Guidelines for Infection 
Control.--
            (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.
            (2) Requirements.--In carrying out paragraph (1), AHRQ 
        shall--
                    (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--
                            (i) the establishment of an infection 
                        control oversight committee; and
                            (ii) the establishment of measures for the 
                        prevention, detection, control, and treatment 
                        of CHAI, such as--
                                    (I) staff training and education on 
                                CHAI prevention and control, including 
                                the monitoring and strict enforcement 
                                of hand hygiene procedures;
                                    (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;
                                    (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;
                    (B) work in collaboration with other agencies and 
                organizations whose area of expertise is the 
                identification, treatment, and prevention of infectious 
                disease;
                    (C) publish proposed guidelines for internal 
                infection control plans;
                    (D) provide for a comment period of not less than 
                90 days; and
                    (E) establish final guidelines, taking into 
                consideration any comment received under subparagraph 
                (D).
    (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.
    (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.

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:
            (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.
            (2) Hospitals shall submit data that allows the CDC to 
        distinguish between--
                    (A) infections that are present in patients upon 
                their admission to the hospital;
                    (B) infections that occur during a patient's 
                hospital stay; and
                    (C) infections caused by multiple drug resistant 
                organisms and nondrug resistant organisms.
            (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.
    (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.
    (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.
    (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--
            (1) make data available to interested researchers;
            (2) make data available to interested State Health 
        Departments;
            (3) produce useful and accessible reports for the public to 
        allow for comparisons of HAI rates across hospitals; and
            (4) use data to assist hospitals in evaluating and 
        formulating best practices strategies to reduce infection 
        rates.
    (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--
            (1) subject to admission as evidence or other disclosure in 
        any Federal, State, or local civil or administrative 
        proceeding; and
            (2) subject to use in a State or local disciplinary 
        proceeding against a hospital or provider.
    (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.

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.
    (b) Program.--The report under subsection (a) shall consider such 
factors as--
            (1) patient demographics, such as--
                    (A) the median income of patients;
                    (B) percentage of minority patients; and
                    (C) disease condition;
            (2) hospital characteristics, such as--
                    (A) median income;
                    (B) population density of the hospital zip code 
                locale;
                    (C) university affiliation; and
                    (D) hospital size as indicated by the number of 
                beds; and
            (3) other factors as determined to be appropriate by the 
        Centers for Medicare & Medicaid Services.
    (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.

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

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.--
            (1) Expansion and intensification of activities.--
                    (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.
                    (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.
            (2) Planning grants and contracts for innovative research 
        in chai.--
                    (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.
                    (B) Research.--In awarding planning grants or 
                contracts under paragraph (1), the Director may give 
                priority to--
                            (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;
                            (ii) research on the most effective copper-
                        based applications to stem infections in 
                        military and civilian healthcare facilities; 
                        and
                            (iii) research on new rapid diagnostic 
                        techniques for antibiotic-resistant bacteria.
    (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--
            (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;
            (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;
            (3) recommend strategies to publicize current incentives 
        available to encourage anti-infective, especially 
        antibacterial, drug research and development;
            (4) recommend additional regulatory and legislative 
        solutions to stimulate appropriate anti-infective, especially 
        antibacterial, drug research and development;
            (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; and
            (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.
    (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.
    (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.

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.
    (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--
            (1) the Centers for Medicare & Medicaid Services;
            (2) the Centers for Disease Control and Prevention;
            (3) the Health Resources and Services Administration;
            (4) the Agency for Healthcare Research and Quality;
            (5) the Food and Drug Administration;
            (6) the National Institutes of Health;
            (7) the Department of Agriculture;
            (8) the Department of Defense;
            (9) the Department of Veterans Affairs;
            (10) the Environmental Protection Agency; and
            (11) such other Federal agencies as determined appropriate.
    (c) Duties.--The interagency working group shall--
            (1) work in collaboration with the Interagency Task Force 
        on Anti-microbial Resistance;
            (2) facilitate communication and partnership on infection 
        prevention and quality health-related projects and policies;
            (3) serve as a centralized mechanism to coordinate a 
        national effort--
                    (A) to discuss and evaluate evidence and knowledge 
                on infection prevention;
                    (B) to determine the range of effective, feasible, 
                and comprehensive actions to improve healthcare quality 
                related to CHAI; and
                    (C) to examine and better address the growing 
                impact of CHAI in communities throughout the United 
                States;
            (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;
            (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;
            (6) develop an appropriate research agenda for Federal 
        agencies;
            (7) develop recommendations regarding evidence-based best 
        practices, model programs, effective guidelines, and other 
        strategies for promoting CHAI prevention and control;
            (8) monitor Federal progress in meeting specific CHAI 
        prevention and control promotion goals; and
            (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.
    (d) Meetings.--
            (1) In general.--The interagency working group shall meet 
        at least 6 times each year.
            (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.
    (e) Authorization of Appropriations.--There is authorized to be 
appropriated such sums as may be necessary to carry out this section.

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--
            (1) the prevalence of CHAI; and
            (2) the quality and availability of data about CHAI.

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.
                                 <all>