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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 ([email protected]).
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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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