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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

Published online by Cambridge University Press:  10 May 2016

Philip Zachariah ,
Julie Reagan ,
E. Yoko Furuya ,
Andrew Dick ,
Hangsheng Liu ,
Carolyn T. A. Herzig ,
Monika Pogorzelska-Maziarz ,
Patricia W. Stone  and
Lisa Saiman
Philip Zachariah*
Affiliation:
Columbia University Medical Center, New York, New York
Julie Reagan
Affiliation:
Georgia Southern University, Jiann-Ping Hsu College of Public Health, Statesboro, Georgia
E. Yoko Furuya
Affiliation:
Columbia University Medical Center, New York, New York Department of Infection Prevention and Control, NewYork–Presbyterian Hospital, New York, New York
Andrew Dick
Affiliation:
RAND Corporation, Boston, Massachusetts
Hangsheng Liu
Affiliation:
RAND Corporation, Boston, Massachusetts
Carolyn T. A. Herzig
Affiliation:
Columbia University School of Nursing, Center for Health Policy, New York, New York
Monika Pogorzelska-Maziarz
Affiliation:
Thomas Jefferson University, Jefferson School of Nursing, Philadelphia, Pennsylvania
Patricia W. Stone
Affiliation:
Columbia University School of Nursing, Center for Health Policy, New York, New York
Lisa Saiman
Affiliation:
Columbia University Medical Center, New York, New York Department of Infection Prevention and Control, NewYork–Presbyterian Hospital, New York, New York
*
Division of Pediatric Infectious Diseases, Morgan Stanley Children’s Hospital of NewYork–Presbyterian, Columbia University College of Physicians and Surgeons, 622 West 168th Street, PH4-474, New York, NY 10032 (pz2177@columbia.edu).
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Extract

Objective

To determine the association between state legal mandates for data submission of central line–associated bloodstream infections (CLABSIs) in neonatal intensive care units (NICUs) with process and 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, ie, compliance with checklist/bundle components (process measures) in ICUs including NICUs. Corresponding 2011 NHSN NICU CLABSI rates (outcome measures) were used to calculate standardized infection ratios (SIRs). Association between mandates and process and outcome measures was assessed by multivariable logistic regression.

Results

Among 190 study NICUs, 107 (56.3%) were located in states with mandates, with mandates in place >3 years in 52 (49%). More NICUs in states with mandates reported ≥95% compliance to at least 1 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 (odds ratio, 2.8; 95% confidence interval, 1.4–6.1). NICUs in states with mandates reported lower mean CLABSI rates in the ≤750-g birth weight group (2.4 vs 5.7 CLABSIs/1,000 central line–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, which declined with the duration of mandate but not with lower CLABSI rates.

Infect Control Hosp Epidemiol 2014;35(9):1133-1139

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 35 , Issue 9 , 01 September 2014 , pp. 1133 - 1139
Copyright
© 2014 by The Society for Healthcare Epidemiology of America. All rights reserved.

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References

1. Pronovost, P, Needham, D, Berenholtz, S, et al. An intervention to decrease catheter-related bloodstream infections in the ICU. N Engl J Med 2006;355(26):2725–2732.CrossRefGoogle ScholarPubMed
2. Using a comprehensive unit-based safety program to prevent healthcare-associated infections. Agency for Healthcare Research and Quality website. http://www.ahrq.gov/professionals/quality-patient-safety/cusp/index.html. Accessed December 22, 2013.Google Scholar
3. Wise, ME, Scott RD 2nd, Baggs, JM, et al. National estimates of central line–associated bloodstream infections in critical care patients. Infect Control Hosp Epidemiol 2013;34(6):547–554.CrossRefGoogle ScholarPubMed
4. Schulman, J, Stricof, R, Stevens, TP, et al. New York State Regional Perinatal Care Centers—statewide NICU central-line-associated bloodstream infection rates decline after bundles and checklists. Pediatrics 2011;127(3):436–444.CrossRefGoogle Scholar
5. Centers for Disease Control and Prevention (CDC). Vital signs: central line–associated bloodstream infections—United States, 2001, 2008, and 2009. MMWR Morb Mortal Wkly Rep 2011;60(8):243–248.Google Scholar
6. CDC and ASTHO release policy toolkit for healthcare-associated infection prevention. CDC website. http://www.cdc.gov/HAI/prevent/astho-policy-toolkit.html. Accessed December 22, 2013.Google Scholar
7. Aswani, MS, Reagan, J, Jin, L, Pronovost, PJ, Goeschel, C. Variation in public reporting of central line–associated bloodstream infections by state. Am J Med Qual 2011;26(5):387–395.CrossRefGoogle ScholarPubMed
8. Stone, PW, Pogorzelska-Maziarz, M, Herzig, CTA, et al. State of infection prevention in U.S. hospitals enrolled in NHSN. Am J Infect Control (forthcoming).Google Scholar
9. National Healthcare Safety Network (NHSN). CDC website. http://www.cdc.gov/nhsn/acute-care-hospital/clabsi/. Accessed December 22, 2013.Google Scholar
10. Stone, PW, Dick, A, Pogorzelska, M, Horan, TC, Furuya, EY, Larson, EL. Staffing and structure of infection prevention and control programs. Am J Infect Control 2009;37:351–357.CrossRefGoogle ScholarPubMed
11. Furuya, EY, Dick, A, Perencevich, EN, Pogorzelska, M, Goldmann, D, Stone, PW. Central line bundle implementation in US intensive care units and impact on bloodstream infections. PLoS ONE 2011;6(1):e15452.CrossRefGoogle ScholarPubMed
12. NHSN—key terms. CDC website http://www.cdc.gov/nhsn/PDFs/pscManual/16PSCkeyterms_current.pdf. Accessed August 25, 2013.Google Scholar
13. NHSN report, data summary for 2011, device-associated module. CDC website. http://www.cdc.gov/nhsn/pdfs/datastat/nhsn-report-2011-data-summary.pdf. Accessed August 22, 2013.Google Scholar
14. Eliminating, CLABSI, a national patient safety imperative: neonatal CLABSI prevention. Agency for Healthcare Research and Quality website. http://www.ahrq.gov/professionals/quality-patient-safety/cusp/using-cusp-prevention/clabsi-neonatal/index.html. Accessed August 22, 2013.Google Scholar
15. Kaplan, HC, Lannon, C, Walsh, MC, Donovan, EF; Ohio Perinatal Quality Collaborative. Ohio statewide quality-improvement collaborative to reduce late-onset sepsis in preterm infants. Pediatrics 2011;127(3):427–435.CrossRefGoogle ScholarPubMed
16. Wirtschafter, DD, Powers, RJ, Pettit, JS, et al. Nosocomial infection reduction in VLBW infants with a statewide quality-improvement model. Pediatrics 2011;127(3):419–426.CrossRefGoogle ScholarPubMed
17. Vostok, J, Lapsley, W, McElroy, N, Onofrey, S, McHale, E, Johnson, N, DeMaria, A. Assessment of the burden of mandatory reporting of health care-associated infection using the National Healthcare Safety Network in Massachusetts. Am J Infect Control 2013;41(5):466–468.CrossRefGoogle ScholarPubMed
18. Stone, PW, Pogorzelska, M, Graham, D, Jia, H, Uchida, M, Larson, EL. California hospitals response to state and federal policies related to health care–associated infections. Policy Polit Nurs Pract 2011;12(2):73–81.CrossRefGoogle ScholarPubMed
19. Pakyz, AL, Edmond, MB. Influence of state laws mandating reporting of healthcare-associated infections: the case of central line-associated bloodstream infections. Infect Control Hosp Epidemiol 2013;34(8):780–784.CrossRefGoogle ScholarPubMed
20. Thompson, ND, Yeh, LL, Magill, SS, Ostroff, SM, Fridkin, SK. Investigating systematic misclassification of central line–associated bloodstream infection (CLABSI) to secondary bloodstream infection during health care–associated infection reporting. Am J Med Qual 2013;28(1):56–59.CrossRefGoogle ScholarPubMed