An Act Regarding the Prevention and Reporti~g of Methicillin-resistant Staphylococcus Aureus
Maine Legislature, Session 124, LD 1038
Committee: Health and Human Services
Sponsors: GOODE, BRANNIGAN, BERRY, PETERSON, RICHARDSON, ROSEN, SANBORN, STUCKEY, PERRY

Legislative Document 
No. 1038 
H.P.713 
House of Representatives,March 17, 2009 
An Act Regarding the Prevention and Reporti~g of Methicillin-
resistant Staphylococcus Aureus 
Reference to the Committee on Health and Human Services suggested and 'ordered printed. 
Presented by Representative GOODE of Bangor. 
Cosponsored by Senator BRANNIGAN of Cumberland and 
711,t~ 111 .ll!iLC~l-W{ 
MILLICENT M. MacFARLAND 
Clerk 
Representatives: BERRY of Bowdoinham, MARTIN ofOr0110, PETERSON of Rumford, 
RICHARDSON of Warren, ROSEN of BuClcsport, SANBORN of Gorham, STUCKEY of 
Portland, Senator: PERRY of Penobscot. 
Printed lIn rccyck'd p.:lpcr 
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Be it enacted by the People of the State of Maine as follows: 
Sec. 1. 22 MRSA c. 1684-A is enacted to read: 
CHAPTER 1684-A 
PREVENTION OF l\mSA INFECTION 
§8761. Prevention of virulent infection 
There is established under this chapter a system for preventing MRSA infectio~~ in 
order to improve the health of citizens of the State and the quality of health care. 
§8762. Definitions 
As used in this chapter, unless the context otherwise indicates, the following terms 
have the following meanings. 
1. Centel'. "Center" means the Maine Center for Disease Control and Prevention. 
2. Cohorted.·· "Cohorted" means the placement of 2 patients with positive MRS A 
cultures in a room together. 
3. 
Decolonization. "Deco Ionization" means eliminating.MRSAcolonization from 
the naris or nose and from the body. 
4. 
Exposure to MRSA. 
"Exposure to MRSA" means close personal contact 
between a person who is infected or coionized with MRSA and a person who is not 
infected or colonized with MRSA. ' 
5. Hospital. "Hospital" means a hospital licensed under chapter 405 or a state 
institution as defined in Title 34-B, section 1001, subsection 8. 
6. Isolation. "Isolation" means the placement of a patient who is infected with 
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MRSA in a separate private room. 
7. l\mSA. "MRSA" means methicillin-resistant Staphylococcus aureus, a highly 
virulent drug-resistant strain of the Staphylococcus bact~rium. 
8. MRSA colonization. "MRS A colonization" means that the patient has tested 
positive, through a culture of a body part or fluid, for the presence of the MRSA 
infection, does not exhibit symptoms of MRSA infection, but is able to spread MRS A 
infection from one body part to another or from the patient's body to the body of another 
person. 
9. MRSA infection. "MRSA infection" means an active disease caused by MRSA 
with symptoms of infection such as fever, swelling, redness, drainage from a wound, 
cough and malaise. 
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10. Nursing facility. "Nursing facility" means a nursing facility licensed under 
chapter 405. 
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11. Patient. "Patient" means a person receiving care or treatment on an inpatient 
basis in a hospital. 
§8763. Screening of patients; recording results 
A hospital that admits a patient for care or treatment shall administer a MRsA 
screening test to the patient upon admission. Follow-up screening cultures must be done 
weekly or on transfer to another department and on discharge of the patient in order to 
identify all colonized and· infected patients so that they are cared for in isolation or 
cohorted to minimize spread of MRSA to other patients. The screening test must test for 
MRSA through 11 nasal culture and through a culture of all open wounds or sores and 
other body parts, as medically indicated. The results of the MRSA screening test must be 
recorded in the patient's record. If paper records are used in the hospital,.a red form must 
be used for positive MRSA-cultured patients and a green form for negative-cultured 
patients. If electronic records are used in the hospital, the positive cultures must be coded 
in the hospital computer system in a manner that is easily recognizable to hospital staff in 
all departments. 
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§8764. Reporting to and by the center 
The center shall establish a system for accepting. information on patient MRSA 
. colonization and MRSA infection filed under the requirements of this chapter and for 
dissemination of information to the public. 
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1. Reporting requirements. All hospitals shall report to the center information 
regarding all persons for whom it has provided services, health care or treatment whom 
the hospitals know to have been colonized or infected with MRSA. . The report must 
indicate whether the patient was colonized or infected with MRSA prior to arrival at the 
hospital or during hospitalization. The repoli must include the site on the body that tested 
positive for MRSA, whether the patient tested positive at the time of admission to the 
hospital or after admission, and deaths because of or related to MRSA .. 
2. Dissemination of information. The center shall disseminate information to the 
public about MRSA infection and deaths resulting from or related to MRSA infection. 
Information released to the public must distinguish between positive MRSA cultures on 
admission and positive cultures during hospitalization and must identifY the hospital that 
repOlied the information. The center shall organize MRSA-related information submitted 
by hospitals Ullder this section and shall post the information on the center's publicly 
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accessible website. 
§8765. Protective measures 
All hospitals shall implement protective measures to minimize exposure to MRSA. 
The protective measures must apply to the care· and treatment of all patients. 
1. Isolation; cohorting; decolonization. The procedures and protective measures 
under this section must include procedures to prevent exposure to MRSA .infection. 
A. A patient who tests positive for MRSAcolonization or MRSA infection must be 
placed in isolation or. i'f a separate room is not available, mav be cohmied with 
another patient known to have a positive culture for MRSA. 
B. A patient who is admitted with a fever of unknown origin must be placed in a 
separate room until the cause of infection is known. 
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C. The hospital shall consider decolonization of all patients who test positive for 
MRSA. 
If the hospital determines decolonization is in order, the hospital shall 
institute decolonization with nasal mupirocin 3 times a day for 5 days and 5 daily 
' baths with antiseptic detergent unless medically contraindicated or precluded by time 
constraints. 
2. Environmental precautions. The procedures and protective measures under this 
section must include procedures to protect the patient, the staff and the health of the 
environment in the hospital., The hospital shall monitor staff and patient care to 
encourage compliance with the procedures and protective measures. The procedures 
must include, as appropriate to the situation: 
A. ,Hand washing before entering and after exiting the room of a patient who has 
been exposed to or colonized or infected with MRSA 'and before and after patient 
care, the use of gloves and gowns and other protective gear as appropriate, frequent 
cleaning and disinfecting ,of all medical equiplnent used on the patient and daily 
cleaning of all parts of the patient room touched by the patient and staff, including 
over bed tables, bed rails, remote controls and telephones; 
B. The wearing of a mask if the patient infected with MRS A or the health care 
worker has respiratory symptoms, the wearing of gloves by any staff known to be ill" 
not encouraging an ill health care worker to work and not offering direct-care 
assignments to ill health care workers; 
C.' If protective gear becomes soiled with body fluids during care of a-patient 
infected 'with MRSA, staff must wash their hands and change their protective gear 
before performing any new procedure such as changing a catheter, inserting 
intravenous lines or changing dressings: 
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D. When leaving the room of a patient infected with MRS A and between care of 2 
patients cohorted in the same room, staff must wash their hands and. remove and 
replace their protective gear and dispose of their used protective gear properly; 
E. If a patient infected with MRS A is cohmied with another patient, the precautions 
listed in paragraphs A to C must be taken as appropriate to patient care;' 
F. Encouraging patients infected with MRS A to wash their hands frequently; 
G. Retaining in the room of a patient who is colonized or infected with MRS A for 
the duration of the patient's stay, and not using on other patients, all. individual blood 
pressure cuffs, medical instruments, thermometers, stethoscopes, tourniquets, 
intravenous pumps and other medical devices used on the patient; and 
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H. Upon the departure of a patient infected with MRSA from the patient's room, the 
room must be disinfected with appropriate cleansers using a method of cleaning that 
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includes soaking surfaces with disinfectant for a period oftime and wiping ch~an with 
clean cloths. 
§8766. Notification to staff and patients 
A hospital shall· provide to staff and patients infonnation about MRSA, MRSA 
transmission,MRSAcolonization, exposure to MRSA and control of MRSA infection 
including situations of close contact. Standard infonnation about symptoms of MRSA 
infection must be given. 
For the purposes of this section, "close contact" includes 
circumstances in which the patient is cared for by a hospital caregiver who is infected 
with MRSA or shares a room with another patient who is infected with MRSA. 
1. Staff. The hospital shall provide information under this section to all staff of the 
hospital as pali of the training for new employees and continuing health care training on 
infectious disease and the prevention of disease. 
2. ·Patients. The hospital shall provideinfonnation under this section to all patients 
whose close contact with MRSA or MRSA colonization or MRSA infection the hospital 
. learns of while the patient is receiving health care or treatment from the hospital. 
3. Former patients. The hospital shall provide information under this section to all 
recently discharged patients whose close contact with MRSA, exposure to MRSA or 
MRSA infection the hospital learns of after the patient has been discharged. 
§8767. Transfer and discharge 
A hospital or nursing facility may not refuse to admit, readmit or provide treatment or 
care for a person who has been colonized or infected with MRSA on the baSIS of the 
person's MRSA status. When a patient who is known to have been colonized or infected 
with MRS A is discharged to another hospital or to a nursing facility, a red form 
indicating exposure to MRSA or MRS A infection, similar to the form filed in the patient's 
record in the hospital under section 8763, must be transferred with the patient. 
§8768. Rulemaking 
The department shall adopt rules to implement this chapter that reflect the most 
recent best practices in health care in accordance with nationally recognized standards for. 
reducing antibiotic-resistant infections. Rules adopted pursuant to this section are major 
substantive rules as defined in Title 5, chapter 375, subchapter 2 A. 
SUMMARY 
This bill establishes a system for preventing methicillin-resistant Staphylococcus 
aureus, or MRS A, infections in order to improve the health of Maine citizens and the 
quality of health care. It establishes a system for testing hospital patients for MRSA upon 
admission and periodically during admission. It requires hospitals to establish procedures 
and protective measures to minimize exposure to MRS A infection, including procedures 
with regard to wearing a mask, the use of gloves and gowns, hand washing, washing and 
disinfecting portions of the patient's room and assignment of staff known to be ill. It 
requires reporting of positive MRSA test results, whether the patient was infected .or 
colonized prior to admission to the hospital and MRSA deaths. 
It requires the 
Department of Health and Human Services, Maine Center for Disease Control and 
Prevention to disseminate information on MRSA exposure and infection and information 
reported by hospitals .. It requires hospitals to provide information regarding MRSA to 
staff, patients and former patients. The bill prohibits hospitals and nursing facilities from 
refusing to admit, readmit or provide treatment or care fora person who has been infected 
with MRSA on the basis of that person's MRSA status. It directs the Department of 
Health and Human Services to adopt rules to implement the law. 
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