HEALTH AND SAFETY CODE
TITLE 2. HEALTH
SUBTITLE D. PREVENTION, CONTROL, AND REPORTS OF DISEASES
CHAPTER 98. REPORTING OF HEALTH CARE-ASSOCIATED INFECTIONS AND
PREVENTABLE ADVERSE EVENTS
Chapter 98, consisting of Secs. 98.001 to 98.151, was added by
Acts 2007, 80th Leg., R.S., Ch.
359, Sec. 1.
For another Chapter 98, consisting of Secs. 98.001 to 98.009,
added by Acts 2007, 80th Leg., R.S., Ch.
671, Sec. 3, see Sec. 98.001 et seq., post.
SUBCHAPTER A. GENERAL PROVISIONS
Sec. 98.001. DEFINITIONS. In this chapter:
(1) "Advisory panel" means the Advisory Panel on Health
Care-Associated Infections and Preventable Adverse Events.
(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 and Preventable Adverse Events 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.
359, Sec. 1, eff. June 15, 2007.
Amended by:
Acts 2009, 81st Leg., R.S., Ch.
724, Sec. 2(b), eff. September 1, 2009.
Sec. 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.
359, Sec. 1, eff. June 15, 2007.
SUBCHAPTER B. ADVISORY PANEL
Sec. 98.051. ESTABLISHMENT. The commissioner shall establish
the Advisory Panel on Health Care-Associated Infections and
Preventable Adverse Events within the department to guide the
implementation, development, maintenance, and evaluation of the
reporting system. The commissioner may establish one or more
subcommittees to assist the advisory panel in addressing health
care-associated infections and preventable adverse events
relating to hospital care provided to children or other special
patient populations.
Added by Acts 2007, 80th Leg., R.S., Ch.
359, Sec. 1, eff. June 15, 2007.
Amended by:
Acts 2009, 81st Leg., R.S., Ch.
724, Sec. 2(c), eff. September 1, 2009.
Sec. 98.052. MEMBERSHIP; TERM. (a) The advisory panel is
composed of 18 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 quality assessment and
performance improvement or infection control in health care
facilities;
(4) four additional professionals in quality assessment and
performance improvement;
(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.
359, Sec. 1, eff. June 15, 2007.
Amended by:
Acts 2009, 81st Leg., R.S., Ch.
724, Sec. 2(d), eff. September 1, 2009.
Sec. 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.
359, Sec. 1, eff. June 15, 2007.
Sec. 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.
359, Sec. 1, eff. June 15, 2007.
Sec. 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.
359, Sec. 1, eff. June 15, 2007.
Sec. 98.056. VACANCY. A vacancy on the advisory panel shall be
filled by the commissioner.
Added by Acts 2007, 80th Leg., R.S., Ch.
359, Sec. 1, eff. June 15, 2007.
SUBCHAPTER C. DUTIES OF DEPARTMENT AND ADVISORY PANEL; REPORTING
SYSTEM
Sec. 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.
359, Sec. 1, eff. June 15, 2007.
Sec. 98.102. DEPARTMENTAL RESPONSIBILITIES; REPORTING SYSTEM.
(a) The department shall establish the Texas Health
Care-Associated Infection and Preventable Adverse Events
Reporting System within 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 reporting of health care-associated preventable adverse
events by health care facilities to the department;
(3) the public reporting of information regarding the health
care-associated infections by the department;
(4) the public reporting of information regarding health
care-associated preventable adverse events by the department; and
(5) 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) for data reported under Section 98.103 or 98.104, 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.
359, Sec. 1, eff. June 15, 2007.
Amended by:
Acts 2009, 81st Leg., R.S., Ch.
724, Sec. 2(e), eff. September 1, 2009.
Sec. 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, including the causative pathogen if the infection is
laboratory-confirmed, 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, including the causative
pathogen if the infection is laboratory-confirmed, 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, including the
causative pathogen, 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.
(e) Effective September 1, 2009, this section does not apply to
the reporting of methicillin-resistant Staphylococcus aureus
infections by a health care facility located in an area served by
a health authority participating in the pilot program established
under Section 81.0445. This subsection expires September 1, 2011.
Added by Acts 2007, 80th Leg., R.S., Ch.
359, Sec. 1, eff. June 15, 2007.
Amended by:
Acts 2009, 81st Leg., R.S., Ch.
369, Sec. 2, eff. June 19, 2009.
Acts 2009, 81st Leg., R.S., Ch.
724, Sec. 1, eff. September 1, 2009.
Sec. 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.
359, Sec. 1, eff. June 15, 2007.
Sec. 98.1045. REPORTING OF PREVENTABLE ADVERSE EVENTS. (a)
Each health care facility shall report to the department the
occurrence of any of the following preventable adverse events
involving the facility's patient:
(1) a health care-associated adverse condition or event for
which the Medicare program will not provide additional payment to
the facility under a policy adopted by the federal Centers for
Medicare and Medicaid Services; and
(2) subject to Subsection (b), an event included in the list of
adverse events identified by the National Quality Forum that is
not included under Subdivision (1).
(b) The executive commissioner may exclude an adverse event
described by Subsection (a)(2) from the reporting requirement of
Subsection (a) if the executive commissioner, in consultation
with the advisory panel, determines that the adverse event is not
an appropriate indicator of a preventable adverse event.
Added by Acts 2009, 81st Leg., R.S., Ch.
724, Sec. 2(f), eff. September 1, 2009.
Sec. 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.
359, Sec. 1, eff. June 15, 2007.
Sec. 98.106. DEPARTMENTAL SUMMARY. (a) The department shall
compile and make available to the public a summary, by health
care facility, of:
(1) the infections reported by facilities under Sections 98.103
and 98.104; and
(2) the preventable adverse events reported by facilities under
Section 98.1045.
(b) Information included in the departmental summary with
respect to infections reported by facilities under Sections
98.103 and 98.104 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 and preventable adverse events to the department.
Added by Acts 2007, 80th Leg., R.S., Ch.
359, Sec. 1, eff. June 15, 2007.
Amended by:
Acts 2009, 81st Leg., R.S., Ch.
724, Sec. 2(g), eff. September 1, 2009.
Sec. 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.
359, Sec. 1, eff. June 15, 2007.
Sec. 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, 98.104, and 98.1045. Facilities
may not be required to report more frequently than quarterly.
Added by Acts 2007, 80th Leg., R.S., Ch.
359, Sec. 1, eff. June 15, 2007.
Amended by:
Acts 2009, 81st Leg., R.S., Ch.
724, Sec. 2(h), eff. September 1, 2009.
Sec. 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.
(b-1) A state employee or officer may not be examined in a
civil, criminal, or special proceeding, or any other proceeding,
regarding the existence or contents of information or materials
obtained, compiled, or reported by the department under this
chapter.
(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 patient, employee, contractor,
volunteer, consultant, health care professional, student, or
trainee in connection with a specific incident.
Added by Acts 2007, 80th Leg., R.S., Ch.
359, Sec. 1, eff. June 15, 2007.
Amended by:
Acts 2009, 81st Leg., R.S., Ch.
724, Sec. 2(i), eff. September 1, 2009.
Sec. 98.110. DISCLOSURE AMONG CERTAIN AGENCIES. Notwithstanding
any other law, the department may disclose information reported
by health care facilities under Section 98.103, 98.104, or
98.1045 to other programs within the department, to the Health
and Human Services Commission, and to other health and human
services agencies, as defined by Section 531.001, Government
Code, for public health research or analysis purposes only,
provided that the research or analysis relates to health
care-associated infections or preventable adverse events. The
privilege and confidentiality provisions contained in this
chapter apply to such disclosures.
Added by Acts 2007, 80th Leg., R.S., Ch.
359, Sec. 1, eff. June 15, 2007.
Amended by:
Acts 2009, 81st Leg., R.S., Ch.
724, Sec. 2(j), eff. September 1, 2009.
Sec. 98.111. CIVIL ACTION. Published infection rates or
preventable adverse events 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.
359, Sec. 1, eff. June 15, 2007.
Amended by:
Acts 2009, 81st Leg., R.S., Ch.
724, Sec. 2(j), eff. September 1, 2009.
SUBCHAPTER D. ENFORCEMENT
Sec. 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.
359, Sec. 1, eff. June 15, 2007.