[Congressional Record Volume 153, Number 167 (Wednesday, October 31, 2007)]
[Senate]
[Pages S13629-S13632]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. DURBIN (for himself, Mr. Obama, and Mr. Schumer):
  S. 2278. A bill to improve the prevention, detection, and treatment 
of community and health care-associated infections (CHAI), with a focus 
on antibiotic-resistant bacteria; to the Committee on Health, 
Education, Labor, and Pensions.
  Mr. DURBIN. Mr. President, we have seen an increasing amount of 
attention on the growing problem of community and hospital-associated 
methicillin-resistant staphylococcus aureus, or MRSA, infections. The 
CDC estimates that in 2005 in the U.S., 94,000 people developed an 
invasive drug-resistant staph infection. Out of 94,000 infections, 
researchers found that more than half were acquired in the health care 
system--people who had recently had surgery or were on kidney dialysis, 
for example. Nearly 19,000 Americans die, often needlessly, from these 
infections every year. This is more than the number of people who died 
from HIV/AIDS, homicide, emphysema, or Parkinson's.
  The infections impact not only our civilian families but also our 
military families. CDC worked with the Army in 2003 to look at an 
outbreak of serious infections among soldiers. Between March and 
October 2003, they discovered that 145 American soldiers had been 
infected with another drug-resistant bacteria, Acinetobacter baumannii-
calcoaceticus complex, or ABC. This outbreak of drug-resistant wound 
infections among soldiers in Iraq appears to have come from the U.S. 
military hospitals where they were treated, not the battlefield.
  Hospitals are taking active steps to identify and control infections, 
but keep in mind that about half of the infections that end up being 
treated in a hospital were actually picked up in the community. Schools 
in Connecticut, Maryland, North Carolina, Ohio, Virginia, and Kentucky 
have had to close to help contain the spread of an infection. School 
officials in Mississippi, New Hampshire, and Virginia reported student 
deaths within the past month from bacteria, while officials in at least 
four other States reported cases of students being infected. Most 
recently, a 12-year-old in Brooklyn died from a community-aquired staph 
infection.

[[Page S13630]]

  In the State of Illinois, cases of the drug-resistant staph infection 
closed schools in Aurora and Joliet. Other cases were confirmed in the 
Indian Prairie School District in the Aurora Naperville area. Two 
suburban Catholic elementary schools outside of Chicago were closed for 
heavy-duty cleaning after school leaders discovered each of the student 
bodies had a case of a drug-resistant staph infection.
  States are taking important steps to control staph infection. The 
State of Illinois has taken aggressive steps to identify the infection 
before it grows out of control. Illinois is the first State to require 
testing of all high-risk hospital patients and isolation of those who 
carry the bacteria called MRSA. Twenty-two States have passed laws that 
will give their residents important information about hospital 
infections. Nineteen States have laws that require public reporting of 
infection rates.
  States are actively pursuing the options that the CDC recommends for 
communities and hospitals to help fight the spread of drug-resistant 
bugs. It is time for the Federal Government to follow suit.
  Today, I introduce the Community and Healthcare Associated Infections 
Reduction Act of 2007. This legislation builds on what hospitals are 
already doing and what infectious disease experts and Government 
agencies agree is critical to reducing the emergence of these 
infections.
  My colleagues, Senator Obama and Senator Schumer, and I introduced 
this bill because we believe we have a national responsibility to 
improve the prevention, detection, and treatment of community and 
health care-associated infections. To do so, we need to tackle the 
problem from all sides.
  We need better data to understand the problem at hand. The bill 
requires hospitals to report infection rates to the Federal Government, 
which we will then use to target high risk areas, identify hospitals 
that are doing a good job of controlling infections, and do a better 
job of communicating what we know to hospitals and health departments 
around the country. With better data, researchers will learn more about 
how to treat and, ideally, how to prevent these dangerous infections.
  But, reporting is not enough. We need comprehensive infection control 
programs. The bill commissions an updated, comprehensive look at best 
practices for hospitals on infection control to provide hospitals the 
tools they need to best address these infections.
  The bill also requires the Secretary to conduct a feasibility study 
on the creation of a Federal payment system to acknowledge and reward 
hospitals that are preventing these infections. Would this system work 
and is it what hospitals need? Hospital workers, doctors, and nurses do 
their very best to protect patients from infection. What more can be 
done to reward hospitals that are keeping infection rates low?
  In addition, the bill addresses the growing impact of these 
infections--inside and outside the hospital. A new public health 
campaign will increase awareness in the public and educate people about 
reducing and preventing infections, especially in schools, locker 
rooms, playgrounds--the areas where we know bacteria can thrive. 
Finally, the bill calls for greater coordination of and greater 
emphasis on research at the Federal level. There are promising 
approaches to the control of infectious disease--for example, some 
investigators are looking at the use of bacteria-resistant surfaces in 
hospitals and other settings.
  In a Nation as rich as ours, with the best health care professionals 
in the world, we don't expect people to come into a health care setting 
with a broken bone and then go home with a dangerous infection. Our 
health care system is safe and high quality, and I think we can only 
improve on that with a stronger emphasis on prevention, reporting and 
research. Our patients need it, our families deserve it, and everyone 
of us wants it.
  Mr. President, I ask unanimous consent that the text of the bill be 
printed in the Record.
  There being no objection, the text of the bill was ordered to be 
placed in the Record, as follows:

                                S. 2278

       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.

[[Page S13631]]

       (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

[[Page S13632]]

     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.
                                 ______