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Impact of Mandatory Public Reporting of Central Line–Associated Bloodstream Infections on Blood Culture and Antibiotic Utilization in Pediatric and Neonatal Intensive Care Units

Published online by Cambridge University Press:  27 April 2015

Kelly B. Flett ,
Al Ozonoff ,
Dionne A. Graham ,
Thomas J. Sandora  and
Gregory P. Priebe
Kelly B. Flett*
Affiliation:
Division of Infectious Diseases, Department of Medicine, Boston Children’s Hospital, Boston, Massachusetts Harvard Medical School, Boston, Massachusetts
Al Ozonoff
Affiliation:
Harvard Medical School, Boston, Massachusetts Center for Patient Safety and Quality Research, Boston Children’s Hospital, Boston, Massachusetts
Dionne A. Graham
Affiliation:
Harvard Medical School, Boston, Massachusetts Center for Patient Safety and Quality Research, Boston Children’s Hospital, Boston, Massachusetts
Thomas J. Sandora
Affiliation:
Division of Infectious Diseases, Department of Medicine, Boston Children’s Hospital, Boston, Massachusetts Harvard Medical School, Boston, Massachusetts Infection Prevention and Control, Boston Children’s Hospital, Boston, Massachusetts
Gregory P. Priebe
Affiliation:
Division of Infectious Diseases, Department of Medicine, Boston Children’s Hospital, Boston, Massachusetts Harvard Medical School, Boston, Massachusetts Division of Critical Care Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children’s Hospital, Boston, Massachusetts
*
Address correspondence to Kelly B. Flett, MD, MMSc, Division of Infectious Diseases, Boston Children’s Hospital, 300 Longwood Ave, Boston, MA 02115 ([email protected]).
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Abstract

BACKGROUND

As mandatory public reporting of healthcare-associated infections increases, there is concern that clinicians could attempt to decrease rates by avoiding the diagnosis of reportable infections.

OBJECTIVE

To determine whether blood culture and antibiotic utilization changed after mandatory public reporting of central line–associated bloodstream infection (CLABSI).

DESIGN

Interrupted time-series of blood culture and antibiotic rates before and after state-specific implementation of mandatory public reporting. We analyzed data from pediatric and neonatal intensive care units (ICUs) at 17 children’s hospitals that contributed to the Pediatric Health Information System administrative database. We used multivariable regression with generalized linear mixed-effects models to determine adjusted rate ratios (ARRs) after implementation of mandatory public reporting. We conducted subgroup analysis on patients with central venous catheters. To assess temporal trends, we separately analyzed data from 4 pediatric hospitals in states without mandatory public reporting.

RESULTS

There was no significant effect of mandatory public reporting on rates of blood culture (pediatric ICU ARR, 1.03 [95% CI, 0.82–1.28]; neonatal ICU ARR, 1.06 [0.85–1.33]) or antibiotic utilization (pediatric ICU ARR, 0.86 [0.72–1.04]; neonatal ICU ARR, 1.09 [0.87–1.35]). Results were similar in the subgroup of patients with central venous catheter codes. Hospitals with and without mandatory public reporting experienced small decreases in blood culture and antibiotic use across the study period.

CONCLUSIONS

Mandatory public reporting of central line–associated bloodstream infection did not impact blood culture and antibiotic utilization, suggesting that clinicians have not shifted their practice in an attempt to detect fewer infections.

Infect Control Hosp Epidemiol 2015;36(8):878–885

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 36 , Supplement 8 , August 2015 , pp. 878 - 885
Copyright
© 2015 by The Society for Healthcare Epidemiology of America. All rights reserved 

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Footnotes

T.J.S. and G.P.P. contributed equally to this article

a

Presented in part: IDWeek 2013; San Francisco, California; October 3, 2013; (Abstract 559).

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