The purpose of this bulletin is to inform hospitals that by January 1, 2023 hospitals must adopt a policy on the prevention and control of the transmission of pathogens of epidemiological concern in accordance with a new law enacted through HB 1739 (2022). This change is required because HB 1739 modernizes current RCW 70.41.430 from its’ narrow focus on methicillin-resistant staphylococcus aureus (MRSA) to general provisions addressing “pathogens of epidemiological concern.”We are ecstatic that Washington State’s law specific to outdated requirements for MRSA are removed and replaced with a requirement for hospitals to have a policy addressing pathogens of epidemiolocal concern. This change in law recognizes hospitals’ need to respond to pathogens posing the highest risk to their facilities that may differ at times across the state.
HB 1739 was a key piece of WSHA’s 2022 policy agenda and passed the legislature unanimously. WSHA received consistent feedback from members that the 2009 law dealing with MRSA requirements did not allow flexibility as science evolved and the law needed to be modernized. The new law was developed by a WSHA workgroup comprised of leaders from Washington’s Puget Sound Chapter of the Association of Professionals in Infection Control and Epidemiology (APIC), infectious disease doctors, nurses, and other health care professionals.
The new pathogen of epidemiological concern law applies to all hospitals licensed under chapter 70.41 RCW. The new law takes effect June 9, 2022.
Please see the Overview section for the “pathogen of epidemiological concern” definition and reporting requirements.
- Review this bulletin alongside HB 1739 to understand the law changes and share with appropriate staff members.
- Begin the process of developing the pathogens of epidemiological concern policy required by HB 1739 in preparation for the January 1, 2023 compliance deadline.
- Attend WSHA’s upcoming webinar on June 8, 2022 to learn more. The webinar will cover the law’s provisions and next steps for compliance. The webinar will feature subject experts who worked on the bill along with representatives from the Washington State Department of Health, followed by time for question and answer at the end of the webinar. Registration for the webinar is available here.
Current MRSA Law
From 2009, RCW 70.41.430 requires hospitals to adopt a policy regarding MRSA that contains the law’s specific testing, mitigation, patient notification, and reporting requirements. However, the current law is outdated and overcommits hospital resources to one pathogen without meaningfully increasing patient safety. Because of this, Governor Jay Inslee waived the MRSA law as part of the state’s COVID-19 pandemic response to provide hospitals more flexibility. With WSHA’s advocacy, those factors prompted the legislature to modernize RCW 70.41.430 through HB 1739.
New Pathogen Policy Requirements in HB 1739
Section 2 (1) in HB 1739 states that by January 1, 2023, hospitals will be required to adopt a policy regarding the prevention and control of the transmission of pathogens of epidemiological concern.
The policy must contain the following elements:
(a) A facility risk assessment to identify pathogens of epidemiological concern that considers elements such as the probability of occurrence as determined via surveillance, potential impact, and measures the hospital has implemented to mitigate the risk to patients, health care workers, and visitors; and
(b) Appropriate evidence-based procedures and intervention strategies to identify and help prevent patients from transmitting pathogens of epidemiological concern to other patients and health care workers.
This law change will allow hospitals to focus their infection prevention and control work on the pathogens that pose the greatest risk to their facilities, patients, employees, and visitors. However, the elements in (a) and (b) will differ by facility, which demonstrates the added flexibility of this law in comparison to the MRSA law’s rigidity.
Pathogen of Epidemiological Concern Definition
Current RCW 70.41.430 addresses methicillin-resistant staphylococcus aureus (MRSA) only and does not contemplate other pathogens. Section 2 (3) in HB 1739 expands the law beyond the singular focus on MRSA to a general focus on “pathogens of epidemiological concern,” which are defined as:
Infectious agents that have one or more of the following characteristics:
(a) A propensity for transmission within health care facilities based on published reports from the centers for disease control and prevention and the occurrence of temporal or geographic clusters of two or more patients;
(b) Antimicrobial resistance implications;
(c) Association with serious clinical disease or increased morbidity and mortality; or
(d) A newly discovered or reemerging pathogen.
Note: The “pathogens of epidemiological concern” definition still encompasses MRSA, but there will no longer be MRSA-specific requirements in RCW 70.41.430 once HB 1739 takes effect on June 9, 2022.
The 2009 law, RCW 70.41.430 requires hospitals to report MRSA diagnoses to the state through the Comprehensive Hospital Abstract Reporting System (CHARS). However, the data reported through CHARS reflects subjective diagnosis codes, not laboratory confirmed cases. This is different than the lab identified MRSA bacteremia reports that many hospitals currently report as required by the Centers for Medicare and Medicaid Services (CMS) through the U.S. Centers for Disease Control and Prevention’s (CDC) National Healthcare Safety Network (NHSN). This makes the data collected through CHARS inconsistent and less objective than the data gathered by CDC. Because of this, Section 2 (2) in HB 1739 replaces the CHARS reporting requirement with a new provision that aligns with current CMS and CDC reporting requirements. It specifies that hospitals that identify a patient through testing who has a pathogen of epidemiological concern are required to report the case to the CDC via NHSN as required by CMS. Below is a table compiled from WAC 246-440-100 that contains CMS’ current reporting requirements, which differ by hospital type and federal quality reporting program.
Please visit NHSN’s CMS Requirements page for additional information.
Hospitals should begin planning for compliance with HB 1739 in advance of the January 1, 2023 compliance deadline. The design process for the pathogen policy is likely to require the participation of hospital staff from multiple departments. To aid in the policy development process, WSHA will release a model policy for hospital use.
WSHA’s 2022 New Law Implementation Guide
Please visit WSHA’s new law implementation guide online. The Government Affairs team is hard at work preparing resources and information on the high priority bills that passed in 2022 to help members implement the new laws, as well as links to resources such as this bulletin. In addition, you will find the Government Affairs team’s schedule for release of upcoming resources on other laws and additional resources for implementation.