title: 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.
abstract: 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.
  
  
  METHODS
  Cross-sectional study.
  
  
  METHODS
  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.
authors.affiliation: Columbia University Medical Center, New York, New York.
authors.forename: Philip
authors.initials: P
authors.lastname: Zachariah
authors.forename: Julie
authors.initials: J
authors.lastname: Reagan
authors.forename: E Yoko
authors.initials: EY
authors.lastname: Furuya
authors.forename: Andrew
authors.initials: A
authors.lastname: Dick
authors.forename: Hangsheng
authors.initials: H
authors.lastname: Liu
authors.forename: Carolyn T A
authors.initials: CT
authors.lastname: Herzig
authors.forename: Monika
authors.initials: M
authors.lastname: Pogorzelska-Maziarz
authors.forename: Patricia W
authors.initials: PW
authors.lastname: Stone
authors.forename: Lisa
authors.initials: L
authors.lastname: Saiman
mesh_terms: D016470:Bacteremia / Q000453:epidemiology / Q000517:prevention & control*; D055499:Catheter-Related Infections / Q000453:epidemiology / Q000517:prevention & control*; D003428:Cross Infection / Q000453:epidemiology / Q000517:prevention & control*; D003430:Cross-Sectional Studies; D018563:Disease Notification / Q000331:legislation & jurisprudence*; D033161:Government Regulation; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D019538:Health Care Surveys; D006801:Humans; D007231:Infant, Newborn; D017053:Infection Control / Q000592:standards / Q000706:statistics & numerical data*; D007363:Intensive Care Units, Neonatal / Q000331:legislation & jurisprudence* / Q000706:statistics & numerical data; D016015:Logistic Models; D015999:Multivariate Analysis; D010043:Outcome and Process Assessment, Health Care; D017410:Practice Guidelines as Topic; D013219:State Government; D014481:United States / Q000453:epidemiology
references.citation: N Engl J Med. 2006 Dec 28;355(26):2725-32
references.pmid: 17192537
references.citation: Infect Control Hosp Epidemiol. 2013 Jun;34(6):547-54
references.pmid: 23651883
references.citation: Infect Control Hosp Epidemiol. 2013 Aug;34(8):780-4
references.pmid: 23838217
references.citation: Policy Polit Nurs Pract. 2011 May;12(2):73-81
references.pmid: 22042613
references.citation: Pediatrics. 2011 Mar;127(3):427-35
references.pmid: 21339274
references.citation: Am J Med Qual. 2013 Jan-Feb;28(1):56-9
references.pmid: 22679125
references.citation: Pediatrics. 2011 Mar;127(3):436-44
references.pmid: 21339265
references.citation: Pediatrics. 2011 Mar;127(3):419-26
references.pmid: 21339273
references.citation: PLoS One. 2011 Jan 18;6(1):e15452
references.pmid: 21267440
references.citation: Am J Med Qual. 2011 Sep-Oct;26(5):387-95
references.pmid: 21825038
references.citation: Am J Infect Control. 2014 Feb;42(2):94-9
references.pmid: 24485365
references.citation: Am J Infect Control. 2009 Jun;37(5):351-357
references.pmid: 19201510
references.citation: Am J Infect Control. 2013 May;41(5):466-8
references.pmid: 23102983
references.citation: MMWR Morb Mortal Wkly Rep. 2011 Mar 4;60(8):243-8
references.pmid: 21368740