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HEALTH & SAFETY CODE

CHAPTER 98. REPORTING OF HEALTH CARE-ASSOCIATED INFECTIONS

SUBCHAPTER A. GENERAL PROVISIONS


	§ 98.001.  DEFINITIONS.  In this chapter:                                   
		(1)  "Advisory panel" means the Advisory Panel on 
Health Care-Associated Infections.
		(2)  "Ambulatory surgical center" means a facility 
licensed under Chapter 243.
		(3)  "Commissioner" means the commissioner of state 
health services.        
		(4)  "Department" means the Department of State Health 
Services.            
		(5)  "Executive commissioner" means the executive 
commissioner of the Health and Human Services Commission.
		(6)  "General hospital" means a general hospital 
licensed under Chapter 241 or a hospital that provides surgical or 
obstetrical services and that is maintained or operated by this 
state.  The term does not include a comprehensive medical 
rehabilitation hospital.
		(7)  "Health care-associated infection" means a 
localized or symptomatic condition resulting from an adverse 
reaction to an infectious agent or its toxins to which a patient is 
exposed in the course of the delivery of health care to the patient.
		(8)  "Health care facility" means a general hospital or 
an ambulatory surgical center.
		(9)  "Infection rate" means the number of health 
care-associated infections of a particular type at a health care 
facility divided by a numerical measure over time of the population 
at risk for contracting the infection, unless the term is modified 
by rule of the executive commissioner to accomplish the purposes of 
this chapter.
		(10)  "Pediatric and adolescent hospital" has the 
meaning assigned by Section 241.003.
		(11)  "Reporting system" means the Texas Health 
Care-Associated Infection Reporting System.
		(12)  "Special care setting" means a unit or service of 
a general hospital that provides treatment to inpatients who 
require extraordinary care on a concentrated and continuous 
basis.  The term includes an adult intensive care unit, a burn 
intensive care unit, and a critical care unit.

Added by Acts 2007, 80th Leg., R.S., Ch. , § 1, eff. June 15, 
2007.


	§ 98.002.  APPLICABILITY OF OTHER LAW.  Chapter 2110, 
Government Code, does not apply to the advisory panel created under 
Subchapter B.

Added by Acts 2007, 80th Leg., R.S., Ch. , § 1, eff. June 15, 
2007.

SUBCHAPTER B. ADVISORY PANEL


	§ 98.051.  ESTABLISHMENT.  The commissioner shall 
establish the Advisory Panel on Health Care-Associated Infections 
within the infectious disease surveillance and epidemiology branch 
of the department to guide the implementation, development, 
maintenance, and evaluation of the reporting system.

Added by Acts 2007, 80th Leg., R.S., Ch. , § 1, eff. June 15, 
2007.


	§ 98.052.  MEMBERSHIP; TERM.  (a)  The advisory panel is 
composed of 16 members as follows:
		(1)  two infection control professionals who:                                 
			(A)  are certified by the Certification Board of 
Infection Control and Epidemiology; and
			(B)  are practicing in hospitals in this state, at 
least one of which must be a rural hospital;
		(2)  two infection control professionals who:                                 
			(A)  are certified by the Certification Board of 
Infection Control and Epidemiology; and
			(B)  are nurses licensed to engage in professional 
nursing under Chapter 301, Occupations Code;
		(3)  three board-certified or board-eligible 
physicians who:                
			(A)  are licensed to practice medicine in this 
state under Chapter 155, Occupations Code, at least two of whom have 
active medical staff privileges at a hospital in this state and at 
least one of whom is a pediatric infectious disease physician with 
expertise and experience in pediatric health care epidemiology;
			(B)  are active members of the Society for 
Healthcare Epidemiology of America; and
			(C)  have demonstrated expertise in infection 
control in health care facilities;
		(4)  two professionals in quality assessment and 
performance improvement, one of whom is employed by a general 
hospital and one of whom is employed by an ambulatory surgical 
center;
		(5)  one officer of a general hospital;                                       
		(6)  one officer of an ambulatory surgical center;                            
		(7)  three nonvoting members who are department 
employees representing the department in epidemiology and the 
licensing of hospitals or ambulatory surgical centers; and
		(8)  two members who represent the public as consumers.                       
	(b)  Members of the advisory panel serve two-year terms.                       

Added by Acts 2007, 80th Leg., R.S., Ch. , § 1, eff. June 15, 
2007.


	§ 98.053.  MEMBER ELIGIBILITY.  (a)  A person may not be a 
member of the advisory panel if the person is required to register 
as a lobbyist under Chapter 305, Government Code, because of the 
person's activities for compensation on behalf of a profession 
related to health care.
	(b)  A person may not be a member of the advisory panel if the 
person is an officer, employee, or paid consultant of a Texas trade 
association in the field of health care.

Added by Acts 2007, 80th Leg., R.S., Ch. , § 1, eff. June 15, 
2007.


	§ 98.054.  OFFICERS.  The members of the advisory panel 
shall elect a presiding officer and an assistant presiding officer 
from among the members.  The officers serve two-year terms.

Added by Acts 2007, 80th Leg., R.S., Ch. , § 1, eff. June 15, 
2007.


	§ 98.055.  COMPENSATION; EXPENSES.  Members of the 
advisory panel serve without compensation but are entitled to 
reimbursement of the travel expenses incurred by the member while 
conducting the business of the advisory panel from department 
funds, in accordance with the General Appropriations Act.

Added by Acts 2007, 80th Leg., R.S., Ch. , § 1, eff. June 15, 
2007.


	§ 98.056.  VACANCY.  A vacancy on the advisory panel 
shall be filled by the commissioner.

Added by Acts 2007, 80th Leg., R.S., Ch. , § 1, eff. June 15, 
2007.

SUBCHAPTER C. DUTIES OF DEPARTMENT AND ADVISORY PANEL; REPORTING 
SYSTEM


	§ 98.101.  RULEMAKING.  (a)  The executive commissioner 
may adopt rules for the department to implement this chapter.
	(b)  The executive commissioner may not adopt rules that 
conflict with or duplicate any federally mandated infection 
reporting program or requirement.

Added by Acts 2007, 80th Leg., R.S., Ch. , § 1, eff. June 15, 
2007.


	§ 98.102.  DEPARTMENTAL RESPONSIBILITIES; REPORTING 
SYSTEM.  (a)  The department shall establish the Texas Health 
Care-Associated Infection Reporting System within the infectious 
disease surveillance and epidemiology branch of the 
department.  The purpose of the reporting system is to provide for:
		(1)  the reporting of health care-associated 
infections by health care facilities to the department;
		(2)  the public reporting of information regarding the 
health care-associated infections by the department; and
		(3)  the education and training of health care facility 
staff by the department regarding this chapter.
	(b)  The reporting system shall provide a mechanism for this 
state to collect data, at state expense, through a secure 
electronic interface with health care facilities.
	(c)  The data reported by health care facilities to the 
department must contain sufficient patient identifying information 
to:
		(1)  avoid duplicate submission of records;                                   
		(2)  allow the department to verify the accuracy and 
completeness of the data reported; and
		(3)  allow the department to risk adjust the 
facilities' infection rates.   
	(d)  The department shall review the infection control and 
reporting activities of health care facilities to ensure the data 
provided by the facilities is valid and does not have unusual data 
patterns or trends that suggest implausible infection rates.

Added by Acts 2007, 80th Leg., R.S., Ch. , § 1, eff. June 15, 
2007.


	§ 98.103.  REPORTABLE INFECTIONS.  (a)  A health care 
facility, other than a pediatric and adolescent hospital, shall 
report to the department the incidence of surgical site infections 
occurring in the following procedures:
		(1)  colon surgeries;                                                         
		(2)  hip arthroplasties;                                                      
		(3)  knee arthroplasties;                                                     
		(4)  abdominal hysterectomies;                                                
		(5)  vaginal hysterectomies;                                                  
		(6)  coronary artery bypass grafts; and                                       
		(7)  vascular procedures.                                                     
	(b)  A pediatric and adolescent hospital shall report the 
incidence of surgical site infections occurring in the following 
procedures to the department:
		(1)  cardiac procedures, excluding thoracic cardiac 
procedures;             
		(2)  ventriculoperitoneal shunt procedures; and                               
		(3)  spinal surgery with instrumentation.                                     
	(c)  A general hospital shall report the following to the 
department:        
		(1)  the incidence of laboratory-confirmed central 
line-associated primary bloodstream infections occurring in any 
special care setting in the hospital; and
		(2)  the incidence of respiratory syncytial virus 
occurring in any pediatric inpatient unit in the hospital.
	(d)  The department shall ensure that the health 
care-associated infections a health care facility is required to 
report under this section have the meanings assigned by the federal 
Centers for Disease Control and Prevention.

Added by Acts 2007, 80th Leg., R.S., Ch. , § 1, eff. June 15, 
2007.


	§ 98.104.  ALTERNATIVE FOR REPORTABLE SURGICAL SITE 
INFECTIONS.  A health care facility that does not perform at least 
an average of 50 procedures per month of the procedures listed in 
Section 98.103(a) or (b), as modified under Section 98.105, is not 
required to comply with the reporting requirements of Section 
98.103 but instead shall report to the department the surgical site 
infections relating to the three surgical procedures most 
frequently performed at the facility, based on the list of surgical 
procedures promulgated by the federal Centers for Disease Control 
and Prevention's National Healthcare Safety Network or its 
successor.

Added by Acts 2007, 80th Leg., R.S., Ch. , § 1, eff. June 15, 
2007.


	§ 98.105.  REPORTING SYSTEM MODIFICATIONS.  Based on the 
recommendations of the advisory panel, the executive commissioner 
by rule may modify in accordance with this chapter the list of 
procedures that are reportable under Section 98.103 or 98.104.  The 
modifications must be based on changes in reporting guidelines and 
in definitions established by the federal Centers for Disease 
Control and Prevention.

Added by Acts 2007, 80th Leg., R.S., Ch. , § 1, eff. June 15, 
2007.


	§ 98.106.  DEPARTMENTAL SUMMARY.  (a)  The department 
shall compile and make available to the public a summary, by health 
care facility, of the infections reported by facilities under 
Sections 98.103 and 98.104.
	(b)  The departmental summary must be risk adjusted and 
include a comparison of the risk-adjusted infection rates for each 
health care facility in this state that is required to submit a 
report under Sections 98.103 and 98.104.
	(c)  In consultation with the advisory panel, the department 
shall publish the departmental summary in a format that is easy to 
read.
	(d)  The department shall publish the departmental summary 
at least annually and may publish the summary more frequently as the 
department considers appropriate.
	(e)  The executive commissioner by rule shall allow a health 
care facility to submit concise written comments regarding 
information contained in the departmental summary that relates to 
the facility.  The department shall attach the facility's comments 
to the public report and the comments must be in the same format as 
the summary.
	(f)  The disclosure of written comments to the department by 
a health care facility as provided by Subsection (e) does not 
constitute a waiver of a privilege or protection under Section 
98.109.
	(g)  The department shall make the departmental summary 
available on an Internet website administered by the department and 
may make the summary available through other formats accessible to 
the public.  The website must contain a statement informing the 
public of the option to report suspected health care-associated 
infections to the department.

Added by Acts 2007, 80th Leg., R.S., Ch. , § 1, eff. June 15, 
2007.


	§ 98.107.  EDUCATION AND TRAINING REGARDING REPORTING 
SYSTEM.  The department shall provide education and training for 
health care facility staff regarding this chapter.  The training 
must be reasonable in scope and focus primarily on:
		(1)  the implementation and management of a facility 
reporting mechanism;   
		(2)  characteristics of the reporting system, 
including public reporting by the department and facility reporting 
to the department;
		(3)  confidentiality; and                                                     
		(4)  legal protections.                                                       

Added by Acts 2007, 80th Leg., R.S., Ch. , § 1, eff. June 15, 
2007.


	§ 98.108.  FREQUENCY OF REPORTING.  In consultation with 
the advisory panel, the executive commissioner by rule shall 
establish the frequency of reporting by health care facilities 
required under Sections 98.103 and 98.104.  Facilities may not be 
required to report more frequently than quarterly.

Added by Acts 2007, 80th Leg., R.S., Ch. , § 1, eff. June 15, 
2007.


	§ 98.109.  CONFIDENTIALITY; PRIVILEGE.  (a)  Except as 
provided by Sections 98.106 and 98.110, all information and 
materials obtained or compiled or reported by the department under 
this chapter or compiled or reported by a health care facility under 
this chapter, and all related information and materials, are 
confidential and:
		(1)  are not subject to disclosure under Chapter 552, 
Government Code, or discovery, subpoena, or other means of legal 
compulsion for release to any person; and
		(2)  may not be admitted as evidence or otherwise 
disclosed in any civil, criminal, or administrative proceeding.
	(b)  The confidentiality protections under Subsection (a) 
apply without regard to whether the information or materials are 
obtained from or compiled or reported by a health care facility or 
an entity that has an ownership or management interest in a 
facility.
	(c)  The transfer of information or materials under this 
chapter is not a waiver of a privilege or protection granted under 
law.
	(d)  The provisions of this section regarding the 
confidentiality of information or materials compiled or reported by 
a health care facility in compliance with or as authorized under 
this chapter do not restrict access, to the extent authorized by 
law, by the patient or the patient's legally authorized 
representative to records of the patient's medical diagnosis or 
treatment or to other primary health records.
	(e)  A department summary or disclosure may not contain 
information identifying a facility patient, employee, contractor, 
volunteer, consultant, health care professional, student, or 
trainee in connection with a specific infection incident.

Added by Acts 2007, 80th Leg., R.S., Ch. , § 1, eff. June 15, 
2007.


	§ 98.110.  DISCLOSURE WITHIN 
DEPARTMENT.  Notwithstanding any other law, the department may 
disclose information reported by health care facilities under 
Section 98.103 or 98.104 to other programs within the department 
for public health research or analysis purposes only, provided that 
the research or analysis relates to health care-associated 
infections.  The privilege and confidentiality provisions 
contained in this chapter apply to such disclosures.

Added by Acts 2007, 80th Leg., R.S., Ch. , § 1, eff. June 15, 
2007.


	§ 98.111.  CIVIL ACTION.  Published infection rates may 
not be used in a civil action to establish a standard of care 
applicable to a health care facility.

Added by Acts 2007, 80th Leg., R.S., Ch. , § 1, eff. June 15, 
2007.

SUBCHAPTER D. ENFORCEMENT


	§ 98.151.  VIOLATIONS.  (a)  Except as provided by 
Subsection (b), a general hospital that violates this chapter or a 
rule adopted under this chapter is subject to the enforcement 
provisions of Subchapter C, Chapter 241, and rules adopted and 
enforced under that subchapter as if the hospital violated Chapter 
241 or a rule adopted under that chapter.
	(b)  Subsection (a) does not apply to a comprehensive medical 
rehabilitation hospital as defined in Section 241.003.
	(c)  An ambulatory surgical center that violates this 
chapter or a rule adopted under this chapter is subject to the 
enforcement provisions of Chapter 243 and rules adopted and 
enforced under that chapter as if the center violated Chapter 243 or 
a rule adopted under that chapter.

Added by Acts 2007, 80th Leg., R.S., Ch. , § 1, eff. June 15, 
2007.