An Act To Strengthen the Laws on Methicillin-resistant Staphylococcus Aureus and To Improve Health Care
Maine Legislature, Session 125, LD 0267
Committee Amendment CA_A_H415 (House)

COMMITTEE AMENDMENT "11,, to H.P. 220, L.D. 267, Bill, "An Act To 
Strengthen the Laws on Methicillin-resistant Staphylococcus Aureus and To Improve 
Health Care" 
Amend the bill by striking out everything after the enacting clause and before the 
summary and inserting the following: 
'PART A 
Sec. A-I. 22 MRSA §§8762, 8763 and 8764 are enacted to read: 
§8762. Definitions 
As used in this chapter, unless the context otherwise indicates, the following terms 
have the following meanings. 
1. Colonized. "Colonized" means carrying MRS A but not infected with MRSA. 
2. Decolonization. "Deco Ionization" means the process of following a prescribed 
medical regime that includes nasal topical antibiotics and antibiotic soap bathing for up to 
days prior to a high-risk medical or surgical procedure or hospital admission. 
3. High-risk patient. "High-risk patient" means a patient who is very likely to be 
colonized or become infected with MRSA because of the patient's medical or social 
history or because of the medical problems or surgical procedure for which the patient is 
hospitalized. 
4. Infected with MRSA. "Infected with MRSA" means actively infected, with 
clinical symptoms and diagnostic tests to confirm the infection. 
5. MRSA. "MRSA" means methicillin-resistant Staphylococcus aureus. 
6. Nosocomial. "Nosocomial" means, of an infection, first appearing 48 hours or 
more after hospital admission or within 30 days after discharge. 
COMMITTEE AMENDMENT 
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COMMITTEE AMENDMENT" /1" to H.P. 220, L.D. 267 
7. Screening. "Screening" means taking a nasal culture unless otherwise medically 
indicated. 
§8763. MRSA screening and control measures 
A hospital or a nursing or intennediate care facility or unit licensed under chapter 405 
shall perform screening for MRSA and shall perfonn control measures in accordance 
with this section. 
1. Hospital screening. A hospital shall screen high-risk patients for MRSA upon 
admission, on transfer into intensive care units from other units within the hospital and up 
to 3 weeks prior to elective admission, allowing time for decolonization if prescribed. 
Factors indicating that a patient is a high-risk patient who must be screened include: 
A. Admission of the patient directly from a different hospital, nursing facility or 
rehabilitation hospital or facility or admission within a year of discharge from a 
hospital, nursing facility or rehabilitation hospital or facility; 
B. Admission of the patient from a correctional facility; 
C. Admission of the patient to an intensive care department of the hospital or transfer 
from within a hospital into an intensive care unit; 
D. That the patient receives renal dialysis treatment; 
E. That the patient has an open lesion that is moist, with redness and swelling, in 
which case screening is required, including screening of the nose and the lesion: 
F. That the patient has had in the past or is admitted to have surgical implantation of 
any medical device OT hardware; 
G. That the patient is from a geographic area with a local epidemic of MRS A; 
H. That the patient is admitted in order to have a medical or surgical procedure or is 
admitted into a hospital department within the hospital that has been identified with 
the occurrence of MRSA infection in the previous month; and 
I. That the patient has tested positive for MRSA in the past. 
2. Nursing or intermediate care facility screening. A nursing or intermediate care 
facility or unit shall screen all patients for MRS A upon admission. 
3. Controlling the spread of MRSA. A hospital or nursing or intermediate care 
facility, when admitting or providing care or treatment for a patient known to have tested 
positive for MRS A upon admission or in the preceding 12 months, shall: 
A. Place the patient in a private room or place the patient in a room only with 
another patient who has tested positive for MRSA, except that a patient who has 
tested positive for MRSA and who also has another infection must be placed in a 
pri vate room; and 
B. Use contact precautions as described by the Maine Center for Disease Control and 
Prevention, including but not limited to practicing hand hygiene before and after 
contact with the patient, using gloves and gowns and, if the identified MRSA 
infection is respiratory, using masks. 
COMMITTEE AMENDMENT 
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COMMITTEE AMENDMENT "A "to H.P. 220, L.D. 267 
§8764. Pnblic reporting of nosocomial infections 
Beginning January 
1, 2012, 
a 
hospital 
shall report nosocomial MRSA, 
methicillin-sensitive 
Staphylococcus 
aureus, 
Clostridium 
difficile 
and 
vancomycin-resistant Enterococcus infections of its patients to the Maine Center for 
Disease Control and Prevention, referred to in this section as "the center," as provided in 
this section. 
1. Reporting. A hospital shall report all nosocomial MRSA, methicillin-sensitive 
Staphylococcus aureus, Clostridium difficile and vancomycin-resistant Enterococcus 
infections to the center using the surveillance system designed and operated by the United 
States Department of Health and Human Services, Centers for Disease Control and 
Prevention National Healthcare Safety Network on a yearly basis. 
2. Information from the center. The center shall collect the information reported 
under this section; organize the information by hospital, organism, diagnosis and medical 
or surgical procedure; protect the confidentiality of patients and health care practitioners; 
and make the information available without charge to the public, easily accessible and 
available in a format that is easily understood by the general public. 
3. Information from hospitals. A hospital shall make the information reported 
under this section available to the public upon request and shall provide additional 
information regarding the reported nosocomial infections as long as information 
designated by law or rule as confidential is appropriately protected from disclosure. 
PARTB 
Sec. B-1. 22 MRSA §§1711-G and 1711-H are enacted to read: 
§1711-G. Patient's right to personal advocacy in a hospital 
A patient admitted to a hospital licensed under chapter 405 has the right to a patient 
advocate, as chosen by the patient and at the discretion of the patient, to stay at the side of 
the patient at all times within the hospital including during procedures, examinations, 
consultations and any interactions that may affect the patient's medical or surgical 
outcome, except as provided in this section, and to assist the patient in health care 
decisions and to monitor and help with the patient's care. The hospital may limit the right 
to personal advocacy in sterile areas and if the presence of an advocate poses a risk to the 
patient. A patient may designate more than one person to act as the patient's advocate. If 
the presence of a patient advocate is denied, a member of the hospital staff shall state in 
writing the reason for the denial and provide a copy to the patient and the patient's 
advocate. 
§1711-H. Patient's right to personal advocacy in a nonhospital setting 
A patient in a nonhospital health care setting governed by this chapter has the right to 
a patient advocate, as chosen by the patient and at the discretion of the patient, to stay at 
the side of the patient at all times including during procedures, examinations, 
consultations and any interactions that may affect the patient's medical or surgical 
outcome, except as provided in this section, and to assist in health care decisions made 
with the patient. The nonhospital health care setting may limit the right to personal 
COMMITTEE AMENDMENT 
II 
COMMITTEE AMENDMENT "A" to H.P. 220, L.D. 267 
advocacy in sterile areas and if the presence of an advocate poses a risk to the patient. A 
patient may designate more than one person to act as the patient's advocate. If the 
presence of a patient advocate is denied, a member of the staffat the nonhospital health 
care setting shall state in writing the reason for the denial and provide a copy to the 
patient and the patient's advocate.' 
SUMMARY 
This amendment is the minority report of the committee. The amendment adds 
mandatory screening for methicillin-resistant Staphylococcus aureuson transfer into an 
intensive care unit in a hospital and screening up to 3 weeks prior to elective admission. 
It requires screening of certain lesions. It requires screening of patients admitted for 
surgical implantation of any medical device or hardware and of patients who have had 
those procedures in the past. It qualifies the authority of a patient advocate, making it 
dependent on the discretion of the patient. It makes other changes in the proposed law on 
patient advocates. 
FISCAL NOTE REQUIRED 
(See Attachedj 
COMMITTEE AMENDMENT 
• 
Approved: OS/21/11 :tPac. 
LD267 
LR 430(02) 
An Act To Strengthen the Laws on Methicillin-resistant Staphylococcus Aureus and To Improve 
Health Care 
Fiscal Detail and Notes 
Fiscal Note for Bill as Amended by Committee Amendment "ff' 
Committee: Health and Human Services 
Fiscal Note Required: Yes 
Fiscal Note 
Minor cost increase - General Fund 
Minor cost increase - Other Special Revenue Funds 
The additional costs to the Department of Health and Human Services can be absorbed utilizing existing budgeted 
resources. 
LR0430(02) - Fiscal Note - Page 1 of I