Testimony on Senate Bill 1819 by Sen. Konni Burton
Senate Health and Human Services
March 27, 2017
The Texas Medical Association, representing more than 50,000 members, appreciates the opportunity to comment on Senate Bill 1819 by Sen. Konni Burton.
We appreciate the committee’s attention today on the issues related to improving quality care at long-term care (LTC) facilities in Texas. Some of our most vulnerable and medically fragile Texans reside in these facilities and our comments focus on protecting these patients from infectious diseases. While this bill addresses broader issues related to regulatory oversight and administrative penalties, we ask you to consider the following concerns related to infectious diseases and opportunities to incorporate them into this important legislation.
Residents of LTC facilities are at high risk for certain infectious diseases, in part because of their existing medical conditions, including advancing age, and in part because a residential facility is a setting in which infections are more likely to be transmitted – by patients, by visitors, and by employees. There are effective measures that can reduce the burden of certain infectious diseases in these facilities caused by close contact among residents.
Influenza is a disease that disproportionately affects the health of older residents of LTC facilities — often requiring hospitalization and sometimes leading to death. LTC facilities should have specific plans in place to respond to influenza. When plans are already established, responses to outbreaks can be quicker and more effective. According to the Centers for Disease Control and Prevention, the risk for complications and hospitalizations from influenza are higher among persons 65 years of age and older, young children, and persons of any age with certain underlying medical conditions. An average of more than 200,000 hospitalizations per year are related to influenza, with more than 60 percent occurring in persons older than 65 years. More people are hospitalized during years when certain strains of influenza are predominant. In nursing homes, attack rates may be as high as 60 percent, with fatality rates as high as 30 percent.
While we can remain diligent in our efforts to prevent influenza with good hand hygiene – washing with soap and water, using alcohol-based antiseptic hand gels – a new resident, health care worker, or visitor can easily introduce influenza into a facility. In addition, it only takes two or more ill residents to indicate a potential outbreak. While facilities are required to report outbreaks to public health authorities, they must have a relationship and plan with local or state public health agencies before any outbreak. Resources for surveillance, testing, and chemoprophylaxis medications for patients and healthcare staff should all be prioritized. LTC facilities should develop plans to include either on-site capability for rapid influenza testing or access to 24-hour, off-site turnaround with a contracted lab. Effective planning can mean a more coordinated and effective response to outbreaks.
Understanding who may be at highest risk during a potential influenza outbreak is critical in an effective response. In part, we could better understand this if we can measure vaccine coverage at each facility. Currently Texas LTC facilities are only required to offer influenza vaccine annually to residents and staff and the two recommended pneumococcal vaccines to all staff members as well as residents who are 65 years of age or older if younger than 65 years, have other conditions that put them at high risks. Each health care facility in Texas is also required to create and implement an employee vaccination policy. Facilities are already required to keep a record of receipt of or exemption from vaccination for employees and residents. However, state-level collection of this coverage information and making aggregate data available could increase public health awareness of how effective facilities are in terms of promoting and implementing vaccination and monitoring vaccine coverage. Patients and families will be better informed on facilities’ success in achieving best public health practices.
Other infectious agents that may be transmitted in LTC facilities are managed more effectively when the presence of certain agents is known. This is especially true with serious infections such as those caused by multidrug resistant organisms (MDROs). The Texas Department of State Health Services has been analyzing and helping manage MDRO outbreaks in long-term care facilities in Texas. Currently, however, residents can be transferred to and from acute-care facilities without any communication to the receiving facility about the MDRO colonization or infection status of the patient. Requiring transfer forms to include a patient’s known MDRO history is essential to communications with an accepting facility, whether it is another LTC or an acute-care facility. This can help identify opportunities to prevent the spread of an infection through a community and protect others from acquiring these difficult-to-treat infections. As antibiotics are among the most frequently prescribed medications in nursing homes, these settings can play a key role in state and national efforts to reduce the threat of antibiotic resistance. This issue seriously affects all citizens, regardless of their connection to LTC facilities.
We specifically recommend expanding language regarding the quality-based program to include references to incorporating such measures as rapid testing for influenza, utilization of transfer forms for patients with a history of MDRO and tracking aggregate vaccination rates for facility employees and residents.
We thank you for the opportunity to submit these comments. We believe these issues are important to consider at the same time you consider this legislation which would strengthen oversight and enforcement to ensure quality services that protect the health and safety of older Texans. We look forward to the opportunity to work with you on these important issues.