Impact of laws aimed at healthcare-associated infection reduction: a qualitative study

Abstract

Background Healthcare-associated infections (HAIs) are preventable. Globally, laws aimed at reducing HAIs have been implemented. In the USA, these laws are at the federal and state levels. It is not known whether the state interventions are more effective than the federal incentives alone. Objective The aims of this study were to explore the impact federal and state HAI laws have on state departments of health and hospital stakeholders in the USA and to explore similarities and differences in perceptions across states. Methods A qualitative study was conducted. In 2012, we conducted semistructured interviews with key stakeholders from states with and without state-level laws to gain multiple perspectives. Interviews were transcribed and open coding was conducted. Data were analysed using content analysis and collected until theoretical saturation was achieved. Results Ninety interviews were conducted with stakeholders from 12 states (6 states with laws and 6 states without laws). We found an increase in state-level collaboration. The publicly reported data helped hospitals benchmark and focus leaders on HAI prevention. There were concerns about the publicly reported data (eg, lack of validation and timeliness). Resource needs were also identified. No major differences were expressed by interviewees from states with and without laws. Conclusions While we could not tease out the impact of specific interventions, increased collaboration between departments of health and their partners is occurring. Harmonisation of HAI definitions and reporting between state and federal laws would minimise reporting burden. Continued monitoring of the progress of HAI prevention is needed.

Variable Case Detection and Many Unreported Cases of Surgical-Site Infection Following Colon Surgery and Abdominal Hysterectomy in a Statewide Validation

“…Without such validation, hospitals that perform more robust surveillance may be unfairly penalized by hospital performance measures linked to these data. At the same time, state and federal laws mandating reporting of healthcare-associated infections have led to increasing collaboration between hospitals and departments of health, 23 along with greater attention from hospital leadership focused on preventing targeted HAIs 24 . Therefore, it is critical that we focus on the benefits of public reporting while understanding and addressing some of the limitations of the publicly reported data.…”

A systematic review and meta-synthesis of policy intervention characteristics that influence the implementation of government-directed policy in the hospital setting: implications for infection prevention and control

“…In most studies, however, consideration of policy implementation was not reported at the point of policy development but was actively performed separate to the directing government body. In some cases, this was undertaken by a coordinating centre or other health system entity or by hospital clinicians themselves as part of the policy implementation and evaluation process (Canaway et al, 2017;Hauschildt et al, 2017;Iorio, 2015;Ketko et al, 2015;Kozhimannil et al, 2013;Nisly et al, 2013;Rejtar et al, 2017;Richards et al, 2008;Shiloach et al, 2010;Smith et al, 2009;Stone et al, 2015;Yelland et al, 2017).…”

“…Planning and resourcing Planning for implementation and resourcing of implementation activity was included in policy intervention Canaway et al, 2017;Deasy et al, 2016;Dharampal et al, 2016;Fassl et al, 2012;Hauschildt et al, 2017;Heitmann et al, 2017;Iorio, 2015;Jorgensen et al, 2010;Ketko et al, 2015;Kodal et al, 2012;Kozhimannil et al, 2013;Lambert et al, 2015;Lanese, 2016;Martínez et al, 2009;McClain et al, 2017;Morrow et al, 2012;Nisly et al, 2013;Rejtar et al, 2017;Richards et al, 2008;Russ et al, 2015;Shiloach et al, 2010;Smith et al, 2009;Stone et al, 2015;…”

“…Since the identification of significant problems with patient safety and preventable medical error in the late 20th century (Jha et al, 2010;Kohn et al, 2000), governmentdirected policies have become important tools in efforts to systematically improve healthcare quality (Kachalia et al, 2016). Over the last two decades, policy makers have introduced numerous strategies aiming to persuade hospitals to address practice issues that contribute to safety and quality issues (Braithwaite et al, 2017), including the transmission of healthcare-associated infections (Stone et al, 2015). However, translating these government-directed strategies into real-life practice change and sustaining these changes is challenging, especially in complex healthcare settings (Hupe and Hill, 2016).…”

Update on infection control practices in cancer hospitals

“…Although it took decades before the medical community accepted this discovery, infection control practices have changed the practice of medicine, have improved patients' outcomes, and have become the law of the land . For immunocompromised patients, infection control strategies are a fundamental part of modern oncologic care and comprise a multilevel approach, including the patient, the health care environment, the community, and health care workers (Fig.…”