Variation in Public Reporting of Central Line–Associated Bloodstream Infections by State

Aswani, Monica S.; Reagan, Julie; Jin, Linda X.; Pronovost, Peter J.; Goeschel, Christine A.

doi:10.1177/1062860611399116

Cited by 19 publications

(20 citation statements)

References 15 publications

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“…To account for possible non-independence of observations among NICUs from the same state, possibly due to factors such as statewide CLABSI reduction collaboratives 13, 14 or state law mandated CLABSI reporting, 15 we accounted for clustering by state, and Huber White robust standard errors were calculated. Possible heterogeneity in duration and BW-specific use of CL's across compliance categories, that could explain any observed association between overall CLABSI rates and the level of compliance in the primary model were also examined.…”

Section: Methodsmentioning

confidence: 99%

Compliance with prevention practices and their association with central line–associated bloodstream infections in neonatal intensive care units

Zachariah¹,

Furuya²,

Edwards³

et al. 2014

American Journal of Infection Control

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Background Bundles and checklists have been shown to decrease CLABSIs, but implementation of these practices and association with CLABSI rates have not been described nationally. We describe implementation and levels of compliance with prevention practices in a sample of US Neonatal ICUs and assess their association with CLABSI rates. Methods An online survey assessing infection prevention practices was sent to hospitals participating in National Healthcare Safety Network CLABSI surveillance in October 2011. Participating hospitals permitted access to their NICU CLABSI rates. Multivariable regressions were used to test the association between compliance with NICU specific CLABSI prevention practices and corresponding CLABSI rates. Results Overall, 190 Level II/III and Level III NICUs participated. The majority of NICUs had written policies (84%-93%) and monitored compliance with bundles and checklists (88% - 91%). Reporting ≥ 95% compliance for any of the practices ranged from 50%- 63%. Reporting ≥ 95% compliance with insertion checklist and assessment of daily line necessity were significantly associated with lower CLABSI rates (p<0.05). Conclusions Most NICUs in this national sample have instituted CLABSI prevention policies and monitor compliance, although reporting compliance ≥ 95% was suboptimal. Reporting ≥ 95% compliance with select CLABSI prevention practices was associated with lower CLABSI rates. Further studies should focus on identifying and improving compliance with effective CLABSI prevention practices in neonates.

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Section: Methodsmentioning

confidence: 99%

Compliance with prevention practices and their association with central line–associated bloodstream infections in neonatal intensive care units

Zachariah¹,

Furuya²,

Edwards³

et al. 2014

American Journal of Infection Control

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“…For example, CDC recently reported that CLABSI rates in US ICUs decreased 58% from 2001 to 2009. 1 These rates also are publicly reported in 14 states by mandate 22 and are used by CMS to qualify hospitals for their annual payment update. In addition, healthcareassociated-infections data are now available on the CMS Hospital Compare website (http://www.hospitalcompare.hhs .gov/), effectively reporting NHSN ICU CLABSI rates for all hospitals that receive reimbursements from Medicare.…”

Section: Discussionmentioning

confidence: 99%

Diagnosing and Reporting of Central Line–Associated Bloodstream Infections

Beekmann

Diekema

Huskins

et al. 2012

Infect. Control Hosp. Epidemiol.

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Our survey documents a strong preference for drawing 1 set of blood culture samples from a peripheral line and 1 from the central line when evaluating fever in an ICU patient, as recommended by IDSA guidelines and in contrast to current Centers for Disease Control and Prevention recommendations. Our data show substantial variability when infectious-diseases physicians were asked to determine whether bloodstream infections were primary bacteremias, and therefore subject to public reporting by National Healthcare Safety Network guidelines, or secondary bacteremias, which are not reportable.

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“…20 Our methodology cannot determine if these findings reflect more institutional attention to infection control practices in the setting of a state data submission mandate versus “gaming” the system. There is heterogeneity in the legal requirement for CLABSI data submission across states 7 that was not addressed, as we only considered the presence of mandatory data submission requirements and did not analyze other variations in provisions of HAI laws (e.g. public reporting, facility identifiers, use of risk adjustment).…”

Section: Discussionmentioning

confidence: 99%

“…The 2012 Centers for Disease Control and Prevention (CDC)/Association of State and Territorial Health Officials combined HAI prevention policy tool kit recommends public reporting of HAI data, 6 and many states have enacted statutes requiring mandatory CLABSI data submission. 7 The association of these mandates for HAI data submission with process and outcome measures for CLABSI prevention in pediatric settings has not been well described. We assessed whether the presence of state mandate for submission of neonatal intensive care units (NICU) CLABSI data was associated with CLABSI prevention policy compliance and/or CLABSI rates reported to CDC’s National Healthcare Safety Network [NHSN]) in a sample of NICUs in the U.S. We hypothesized that NICUs in states with legal mandates to submit CLABSI data would report greater compliance with CLABSI prevention practices and lower CLABSI rates than NICUs located in states without such mandates.…”

Section: Introductionmentioning

confidence: 99%

The Association of State Legal Mandates for Data Submission of Central Line–Associated Bloodstream Infections in Neonatal Intensive Care Units with Process and Outcome Measures

Zachariah

Reagan

Furuya

et al. 2014

Infect. Control Hosp. Epidemiol.

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Objective To determine the association between state legal mandates for data submission of central line-associated blood stream infections (CLABSIs) in neonatal intensive care units (NICUs) with process/outcome measures. Design Cross-sectional study. Participants National sample of level II/III and III NICUs participating in National Healthcare Safety Network (NHSN) surveillance. Methods State mandates for data submission of CLABSIs in NICUs in place by 2011 were compiled and verified with state healthcare-associated infection coordinators. A web-based survey of infection control departments in October 2011 assessed CLABSI prevention practices i.e. compliance with checklist and bundle components (process measures) in ICUs including NICUs. Corresponding 2011 NHSN NICU CLABSI rates (outcome measures) were used to calculate Standardized Infection Ratios (SIR). The association between mandates and process/outcome measures was assessed by multivariable logistic regression. Results Among 190 study NICUs, 107 (56.3%) NICUs were located in states with mandates, with mandates in place for 3 or more years for half. More NICUs in states with mandates reported ≥95% compliance to at least one CLABSI prevention practice (52.3% – 66.4%) than NICUs in states without mandates (28.9% – 48.2%). Mandates were predictors of ≥95% compliance with all practices (OR 2.8; 95% CI 1.4–6.1). NICUs in states with mandates reported lower mean CLABSI rates in the <750gm birth-weight group (2.4 vs. 5.7 CLABSIs/1000 CL-days) but not in others. Mandates were not associated with SIR <1. Conclusions State mandates for NICU CLABSI data submission were significantly associated with ≥95% compliance with CLABSI prevention practices but not with lower CLABSI rates.

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Variation in Public Reporting of Central Line–Associated Bloodstream Infections by State

Cited by 19 publications

References 15 publications

Compliance with prevention practices and their association with central line–associated bloodstream infections in neonatal intensive care units

Compliance with prevention practices and their association with central line–associated bloodstream infections in neonatal intensive care units

Diagnosing and Reporting of Central Line–Associated Bloodstream Infections

The Association of State Legal Mandates for Data Submission of Central Line–Associated Bloodstream Infections in Neonatal Intensive Care Units with Process and Outcome Measures

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