title: Mandated self-reporting of ventilator-associated pneumonia bundle and catheter-related bloodstream infection bundle compliance and infection rates.
abstract: OBJECTIVE
  As quality measures increasingly become tied to payment, evaluating the most effective ways to provide high-quality care becomes more important.
  
  
  OBJECTIVE
  To determine whether mandated reporting for ventilator and catheter bundle compliance is correlated with decreased infection rates, and to determine whether labor-intensive audits are correlated with compliance.
  
  
  METHODS
  Multiyear retrospective review of aggregated data from all patients admitted to 15 intensive care units in a Veterans Affairs hospital setting (the Veterans Integrated Service Network 16) from 2009 to 2011.
  
  
  METHODS
  Ventilator-associated pneumonia and catheter-related bloodstream infections.
  
  
  METHODS
  Mean rates of ventilator-associated pneumonia and catheter-related bloodstream infection were analyzed by year. Relationships between infection rates, self-reported compliance, and audits were analyzed by Pearson correlation.
  
  
  RESULTS
  During the study period, ventilator-associated pneumonia decreased from 2.50 to 1.60 infections per 1000 ventilator days (P = .07). The rate of pneumonia was not correlated with self-reported compliance overall (R = 0.19) or by individual year (2009, R = 0.30; 2010, R = 0.24; 2011, R = 0.46); there was a correlation in cardiac intensive care units (R = -0.70) but not other types of intensive care units (mixed, R = -0.18; medical, R = 0.42; surgical, R = 0.34). Catheter-related bloodstream infections decreased from 2.38 to 0.73 infections per 1000 catheter days (P = .04). The rate of catheter infection was not correlated with self-reported compliance overall (R = -0.18), by individual year (2009, R = -0.39; 2010, R = -0.42; 2011, R = 0.37), or by intensive care unit type (mixed, R = -0.19; cardiac, R = 0.55; medical, R = 0.17; surgical, R = -0.44).
  
  
  CONCLUSIONS
  Current mandated self-reported compliance and audit measures are poorly correlated with decreased ventilator-associated pneumonia or catheter-related bloodstream infection.
authors.affiliation: Department of Surgery, Baylor College of Medicine, Houston, Texas.
authors.forename: Ryan A
authors.initials: RA
authors.lastname: Helmick
authors.affiliation: Department of Surgery, Baylor College of Medicine, Houston, Texas.
authors.forename: Meredith L
authors.initials: ML
authors.lastname: Knofsky
authors.affiliation: Department of Surgery, Baylor College of Medicine, Houston, Texas2Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas.
authors.forename: Carla C
authors.initials: CC
authors.lastname: Braxton
authors.affiliation: Department of Surgery, Emory School of Medicine, Atlanta, Georgia.
authors.forename: Anuradha
authors.initials: A
authors.lastname: Subramanian
authors.affiliation: Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas.
authors.forename: Patricia
authors.initials: P
authors.lastname: Byers
authors.affiliation: Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas4Department of Medicine, Baylor College of Medicine, Houston, Texas.
authors.forename: Charlie K W
authors.initials: CK
authors.lastname: Lan
authors.affiliation: Department of Surgery, Baylor College of Medicine, Houston, Texas2Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas.
authors.forename: Samir S
authors.initials: SS
authors.lastname: Awad
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*; D006787:Hospitals, Veterans; D006801:Humans; D017053:Infection Control / Q000379:methods; D019221:Mandatory Reporting; D053717:Pneumonia, Ventilator-Associated / Q000453:epidemiology* / Q000517:prevention & control*; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology