Prevent Disease Outbreaks in Long-Term Care Facilities

TMA Testimony on House Bill 3711 

House Bill 3711 by Rep. J.D. Sheffield, DO
 House Public Health Committee 

April 25, 2017

The Texas Medical Association, representing 50,000 physician and medical student members, supports Representative Sheffield’s HB 3711. Our physicians also thank Dr. Sheffield for addressing this important health and safety issue for our patients. 

We believe the bill will strengthen the existing infection programs at long-term care (LTC) facilities and improve Texans’ quality of care. Requiring facilities to make flu testing available in the facility is a critical step in identifying or preventing an outbreak. Including multidrug resistant organisms (MDROs) as part of facility infection control programs is also necessary to help reduce the spread of these serious infections. 

Residents of LTC facilities are at high risk for certain infectious diseases, in part because of their existing medical conditions and advancing age. Additionally, infections are more likely to be transmitted — by patients, by visitors, and by employees — in such a facility. However, there are preventive measures that are effective and evidence-based which can reduce certain infectious diseases and the associated costs in these facilities. 

Influenza is a disease that disproportionately affects the health of older residents of LTC facilities — often requiring hospitalization and sometimes leading to death. According to the Centers for Disease Control and Prevention, the risk for complications and hospitalizations from influenza is 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 be 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. It only takes two or more ill residents to indicate a potential outbreak. Preventing the spread of the disease requires a comprehensive approach, including vaccination, infection control, and testing. In order to respond effectively, LTC facilities must develop plans to include either on-site capability for rapid influenza testing or access to 24-hour, off-site test turnaround with a contracted lab. Planning can lead to a more coordinated and effective response to outbreaks. 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. 

HB 3711 would also require planning to address MDROs, which are a serious concern to health care facilities and communities. These are often difficult to treat infections and can easily spread throughout facilities. The Texas Department of State Health Services analyzes and helps manage MDRO outbreaks in long-term care facilities in Texas. 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. Incorporating MDRO into infection-control plans can help us better reduce the spread of these organisms. These plans should include better communication on any known MDRO colonization or infection status of the patient, especially related to transferring patients. Consulting with experts, accessing laboratories, and training personnel should also be standard procedures. 

Antimicrobial stewardship
Antimicrobial resistance is a significant threat in our communities and considered one of the world’s most pressing public health problems. Misuse and overuse of antibiotics has allowed organisms to adapt to the medications, making the drugs useless. In response, antimicrobial stewardship refers to a coordinated effort to reduce the spread of infections, and to use antimicrobials appropriately. We believe establishing regional advisory committees in collaboration with the Department of State Health Services, local public health, and other stakeholders will help strengthen coordination by gathering the necessary experts to provide guidance to facilities working to prevent or respond to antimicrobial resistance. 

We thank you for the opportunity to provide comments. We believe this legislation is important to protect the health and safety of our most vulnerable patients. We look forward to the opportunity to continue to work on these important issues. 

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Last Updated On

May 03, 2017