Evaluating the impact of mandatory public reporting on participation and performance in a program to reduce central line–associated bloodstream infections: Evidence from a national patient safety collaborative

Marsteller, Jill A.; Hsu, Yea Jen; Weeks, Kristina

doi:10.1016/j.ajic.2014.06.001

Cited by 41 publications

(61 citation statements)

References 22 publications

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“…2 Although CLABSIs are important and should be prevented, other BSIs constitute 37% of all BSIs, affecting clinical care of PHO patients and resulting in significant healthcare charges and unplanned extended hospital admissions, However, these cases are not visible in the public spotlight. 9 Expanding from a CLABSI-centered approach to a comprehensive all-BSI approach is the first step toward addressing this important category of infections.…”

Section: Discussionmentioning

confidence: 99%

A Prospective, Holistic, Multicenter Approach to Tracking and Understanding Bloodstream Infections in Pediatric Hematology-Oncology Patients

Gaur

Bundy

Werner

et al. 2017

Infect. Control Hosp. Epidemiol.

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objective. To assess the burden of bloodstream infections (BSIs) among pediatric hematology-oncology (PHO) inpatients, to propose a comprehensive, all-BSI tracking approach, and to discuss how such an approach helps better inform within-center and across-center differences in CLABSI rate.design. Prospective cohort study.setting. US multicenter, quality-improvement, BSI prevention network.participants. PHO centers across the United States who agreed to follow a standardized central-line-maintenance care bundle and track all BSI events and central-line days every month.methods. Infections were categorized as CLABSI (stratified by mucosal barrier injury-related, laboratory-confirmed BSI [MBI-LCBI] versus non-MBI-LCBI) and secondary BSI, using National Healthcare Safety Network (NHSN) definitions. Single positive blood cultures (SPBCs) with NHSN defined common commensals were also tracked.results. Between 2013 and 2015, 34 PHO centers reported 1,110 BSIs. Among them, 708 (63.8%) were CLABSIs, 170 (15.3%) were secondary BSIs, and 232 (20.9%) were SPBCs. Most SPBCs (75%) occurred in patients with profound neutropenia; 22% of SPBCs were viridans group streptococci. Among the CLABSIs, 51% were MBI-LCBI. Excluding SPBCs, CLABSI rates were higher (88% vs 77%) and secondary BSI rates were lower (12% vs 23%) after the NHSN updated the definition of secondary BSI (P < .001). Preliminary analyses showed across-center differences in CLABSI versus secondary BSI and between SPBC and CLABSI versus non-CLABSI rates.conclusions. Tracking all BSIs, not just CLABSIs in PHO patients, is a patient-centered, clinically relevant approach that could help better assess across-center and within-center differences in infection rates, including CLABSI. This approach enables informed decision making by healthcare providers, payors, and the public. 2017;38:690-696 Bloodstream infections (BSIs) cause morbidity and mortality and are especially concerning in pediatric hematology-oncology (PHO) patients. 1 Most oncology patients and some hematology patients have a long-term central line that facilitates their treatment, and these devices can be a source of centralline-associated BSI (CLABSI). Other sources of BSI in immunosuppressed PHO patients include disrupted skin or mucosal surfaces, such as the upper or lower gastrointestinal tract, and deep-seated infections. Frequently, an obvious source of BSI cannot be found. CLABSIs in inpatients are considered healthcare-associated infections that are preventable and must be reported 2 to payors and local, state, and federal agencies, with implications for reimbursement. 3,4 As a result, BSI surveillance in PHO inpatients has disproportionately focused on CLABSIs; the Centers for Disease Control and Prevention's National Healthcare Safety Network (NHSN) surveillance definition of CLABSI is widely used for this purpose. 5 A BSI from an alternate source of infection (other than the central line), defined by the NHSN as "secondary BSI," has not received similar scrutiny. Additionally, the NHSN definitio...

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Section: Discussionmentioning

confidence: 99%

A Prospective, Holistic, Multicenter Approach to Tracking and Understanding Bloodstream Infections in Pediatric Hematology-Oncology Patients

Gaur

Bundy

Werner

et al. 2017

Infect. Control Hosp. Epidemiol.

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“…This is of potentially crucial importance given the increasing number of states in the USA requiring public reporting of CLABSI rates, and the finding that ICUs in states with mandatory public reporting trended toward a greater reduction in CLABSI rates after implementation of a multifaceted program [75].…”

Section: Recent Considerationsmentioning

confidence: 99%

Eliminating Infections in the ICU: CLABSI

Latif

Halim

Pronovost

2015

Curr Infect Dis Rep

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Central line-associated bloodstream infections (CLABSI) are one of the leading causes of death in the USA and around the world. As a preventable healthcare-associated infection, they are associated with significant morbidity and excess costs to the healthcare system. Effective and long-term CLABSI prevention requires a multifaceted approach, involving evidence-based best practices coupled with effective implementation strategies. Currently recommended practices are supported by evidence and are simple, such as appropriate hand hygiene, use of full barrier precautions, avoidance of femoral lines, skin antisepsis, and removal of unnecessary lines. The most successful and sustained improvements in CLABSI rates further utilize an adaptive component to align provider behaviors with consistent and reliable use of evidence-based practices. Great success has been achieved in reducing CLABSI rates in the USA and elsewhere over the past decade, but more is needed. This article aims to review the initiatives undertaken to reduce CLABSI and summarizes the sentinel and recent literature regarding CLABSI and its prevention.

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“…1 The majority of states in this country now have laws or regulations requiring public reporting of HAIs. 2 For almost a decade, the care necessitated to treat many of these infections has not been reimbursed by the Centers for Medicare & Medicaid Services. A different approach has been adopted by private insurers with pay-forperformance or value-based purchasing programs.…”

Section: Surgical Site Infection Prevention In 2018 and Beyondmentioning

confidence: 99%

“…The majority of states in this country now have laws or regulations requiring public reporting of HAIs . For almost a decade, the care necessitated to treat many of these infections has not been reimbursed by the Centers for Medicare & Medicaid Services.…”

mentioning

confidence: 99%

Surgical Site Infection Prevention in 2018 and Beyond

Barnes¹

2018

AORN Journal

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Evaluating the impact of mandatory public reporting on participation and performance in a program to reduce central line–associated bloodstream infections: Evidence from a national patient safety collaborative

Cited by 41 publications

References 22 publications

A Prospective, Holistic, Multicenter Approach to Tracking and Understanding Bloodstream Infections in Pediatric Hematology-Oncology Patients

A Prospective, Holistic, Multicenter Approach to Tracking and Understanding Bloodstream Infections in Pediatric Hematology-Oncology Patients

Eliminating Infections in the ICU: CLABSI

Surgical Site Infection Prevention in 2018 and Beyond

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