The Impact of State Mandated Healthcare-Associated Infection Reporting on Infection Prevention and Control Departments in Acute Care Hospitals: Results from a National Survey

Background: In addition to federally mandated reporting, most US states have adopted legislation requiring hospitals to submit healthcare-associated infection (HAI) data. Evidence that state HAI laws have increased patient safety and reduced HAI rates is inconsistent, however, and resources needed to comply are considerable. We evaluated the impact of state HAI laws on infection prevention and control departments (IPCD). Methods: Web-based survey of a national sample of hospital IPCD was conducted in Fall 2011; all non-VA hospitals enrolled in the National Healthcare Safety Network were eligible to participate. States with HAI laws effective prior to Fall 2011 were identified using systematic legal review. Variations in IPCD resources and characteristics in states with and without laws were compared using χ2or Wilcoxon-Mann-Whitney tests. Multinomial logistic regression was used to identify increases or decreases, vs no change, in resources and characteristics. Results: 1,038 IPCD provided complete data (30% response rate); 756 (73%) were located in states with laws. When asked how mandatory reporting affected their IPCD, more respondents in states with laws reported differences in resources (42% vs 33%, p \u3c 0.01), time for routine activities other than for mandatory reporting (79% vs 71%, p \u3c 0.01), influence in hospital decision making (55% vs 48%, p \u3c 0.05), and visibility of their department (75% vs 65%, p \u3c 0.001); they also spent more hours per week fulfilling mandatory reporting requirements (17 vs 13, p \u3c 0.0001). Based on regression analysis, respondents in states with laws were more likely to report increased resources (p = 0.02) and influence (p = 0.04) and decreased time for routine activities (p \u3c 0.01). Perception of visibility in the hospital was mixed with reports of both increased (p \u3c 0.001) and decreased (p = 0.01) visibility vs the same. Conclusion: Respondents in states with laws reported a significantly higher burden to their IPCD, beyond what was required by federally mandated HAI reporting alone. However, they also reported receiving increased resources to offset demands on time for routine activities and fulfilling reporting requirements. Further research is needed to investigate resources necessary to comply with state HAI laws, and to evaluate their unintended consequences

State law mandates for reporting of healthcare-associated Clostridium difficile infections in hospitals.

US state and territorial laws were reviewed to identify Clostridium difficile infection reporting mandates. Twenty states require reporting either under state law or by incorporating federal Centers for Medicare & Medicaid Services\u27 reporting requirements. Although state law mandates are more common, the incorporation of federal reporting requirements has been increasing

Implementation of antimicrobial stewardship policies in U.S. hospitals: findings from a national survey.

OBJECTIVE: To describe the use of antimicrobial stewardship policies and to investigate factors associated with implementation in a national sample of acute care hospitals. DESIGN: Cross-sectional survey. PARTICIPANTS: Infection Control Directors from acute care hospitals participating in the National Healthcare Safety Network (NHSN). METHODS: An online survey was conducted in the Fall of 2011. A subset of hospitals also provided access to their 2011 NHSN annual survey data. RESULTS: Responses were received from 1,015 hospitals (30% response rate). The majority of hospitals (64%) reported the presence of a policy; use of antibiograms and antimicrobial restriction policies were most frequently utilized (83% and 65%, respectively). Respondents from larger, urban, teaching hospitals and those that are part of a system that shares resources were more likely to report a policy in place (P CONCLUSION: This study provides a snapshot of the implementation of antimicrobial stewardship policies in place in U.S. hospitals and suggests that statewide efforts in California are achieving their intended effect. Further research is needed to identify factors that foster the adoption of these policies

Perceived barriers to infection prevention and control for nursing home certified nursing assistants: a qualitative study.

Healthcare-associated infections, while preventable, result in increased morbidity and mortality in nursing home (NH) residents. Frontline personnel, such as certified nursing assistants (CNAs), are crucial to successful implementation of infection prevention and control (IPC) practices. The purpose of this study was to explore barriers to implementing and maintaining IPC practices for NH CNAs as well as to describe strategies used to overcome these barriers. We conducted a multi-site qualitative study of NH personnel important to infection control. Audio-recorded interviews were transcribed verbatim and transcripts were analyzed using conventional content analysis. Five key themes emerged as perceived barriers to effective IPC for CNAs: 1) language/culture; 2) knowledge/training; 3) per-diem/part-time staff; 4) workload; and 5) accountability. Strategies used to overcome these barriers included: translating in-services, hands on training, on-the-spot training for per-diem/part-time staff, increased staffing ratios, and inclusion/empowerment of CNAs. Understanding IPC barriers and strategies to overcome these barriers may better enable NHs to achieve infection reduction goals

State Mandated Reporting of Healthcare-Associated Infections in the United States: Trends Over Time

Over the past decade, most US states and territories began mandating that acute care hospitals report health care–associated infections (HAIs) to their departments of health. Trends in state HAI law enactment and data submission requirements were determined through systematic legal review; state HAI coordinators were contacted to confirm collected data. As of January 31, 2013, 37 US states and territories (71%) had adopted laws requiring HAI data submission, most of which were enacted and became effective in 2006 and 2007. Most states with HAI laws required reporting of central line–associated bloodstream infections in adult intensive care units (92%), and about half required reporting of methicillin-resistant Staphylococcus aureus and Clostridium difficile infections (54% and 51%, respectively). Overall, data submission requirements were found to vary across states. Considering the facility and state resources needed to comply with HAI reporting mandates, future studies should focus on whether these laws have had the desired impact of reducing infection rates

Legislative Mandates for Central Line-Associated Blood Stream Infection Reporting and Process and Outcome Measures in Neonatal Intensive Care Units

Research Objective: To determine the association between legislative mandates for reporting central line-associated blood stream infections (CLABSIs) and adherence with CLABSI prevention practices (process measures) and CLABSI rates (outcome measures) in Neonatal Intensive Care Units (NICUs) in the United States. Study Design: Cross-sectional study design. Population Studied: The study population was a national sample of level 2/3 and level 3 NICUs from hospitals participating in CDC’s National Healthcare Safety Network (NHSN) surveillance. In October 2011, study sites completed a webbased survey to assess NICU-specific CLABSI prevention practices (checklists and insertion/maintenance bundles), and provided the study team with access to birth weight (BW) stratified 2011 NICU CLABSI rates reported to NHSN. Standardized Infection Ratios (SIRs) were calculated for study NICUs using national CLABSI rates from NHSN. State-specific reporting requirements for NICU CLABSIs were determined by systematic review of state statutes, laws, and administrative regulations and verified with state healthcare-associated infection (HAI) coordinators. Multivariable logistic regression analysis was used to determine the association of reporting requirements with \u3e95% reported compliance with all five CLABSI prevention practices surveyed (process measure) and CLABSI SIR (outcome measure). Principal Findings: Over half the study NICUs (n=107/190, 56.3%) were in states with NICU CLABSI reporting requirements. The number of NICU beds per site, NICU level (2/3 vs. 3), type of ownership, and medical school affiliation were similar among NICUs in states with and without reporting requirements. More NICUs in states with reporting requirements reported \u3e 95% compliance to at least one CLABSI prevention practice (52.3% - 66.4% per practice) compared to NICUs in states without requirements (28.9% - 48.2% per practice). A reporting requirement was an independent predictor of \u3e95% compliance with all surveyed CLABSI preventive practices in multivariable logistic regression analysis (adjusted OR 2.8; 95% CI 1.4-6.1). NICUs in states with reporting requirements had lower overall CLABSI rates than those without reporting requirements (1.2/1000 CL-days vs. 1.6/1000 CL-days, respectively), but this was significant only in the \u3c 750 grams BW group (p=0.05). NICUs in states with reporting requirements had a lower mean SIR than those without reporting requirements (1.6 vs. 2.7), but reporting requirements did not predict SIR. Conclusions: NICUs in states with NICU-specific CLABSI reporting requirements were significantly more likely to report \u3e95% compliance with CLABSI prevention practices. NICUs in states with reporting requirements also reported lower overall CLABSI rates and had lower SIR, but these differences were not statistically significant. Implications for Policy, Delivery, or Practice: To our knowledge, this is the first study of the impact of reporting requirements on process and outcome measures in a pediatric population and has implications for the design and implementation of legislative reporting mandates for other HAIs