title: Impact of laws aimed at healthcare-associated infection reduction: a qualitative study.
abstract: BACKGROUND
  Healthcare-associated infections (HAIs) are preventable. Globally, laws aimed at reducing HAIs have been implemented. In the USA, these laws are at the federal and state levels. It is not known whether the state interventions are more effective than the federal incentives alone.
  
  
  OBJECTIVE
  The aims of this study were to explore the impact federal and state HAI laws have on state departments of health and hospital stakeholders in the USA and to explore similarities and differences in perceptions across states.
  
  
  METHODS
  A qualitative study was conducted. In 2012, we conducted semistructured interviews with key stakeholders from states with and without state-level laws to gain multiple perspectives. Interviews were transcribed and open coding was conducted. Data were analysed using content analysis and collected until theoretical saturation was achieved.
  
  
  RESULTS
  Ninety interviews were conducted with stakeholders from 12 states (6 states with laws and 6 states without laws). We found an increase in state-level collaboration. The publicly reported data helped hospitals benchmark and focus leaders on HAI prevention. There were concerns about the publicly reported data (eg, lack of validation and timeliness). Resource needs were also identified. No major differences were expressed by interviewees from states with and without laws.
  
  
  CONCLUSIONS
  While we could not tease out the impact of specific interventions, increased collaboration between departments of health and their partners is occurring. Harmonisation of HAI definitions and reporting between state and federal laws would minimise reporting burden. Continued monitoring of the progress of HAI prevention is needed.
authors.affiliation: School of Nursing, Center for Health Policy, Columbia University, New York, New York, USA.
authors.forename: Patricia W
authors.initials: PW
authors.lastname: Stone
authors.affiliation: Jefferson School of Nursing, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
authors.forename: Monika
authors.initials: M
authors.lastname: Pogorzelska-Maziarz
authors.affiliation: Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, Georgia, USA.
authors.forename: Julie
authors.initials: J
authors.lastname: Reagan
authors.affiliation: Center for Health Policy, Columbia University School of Nursing, New York, New York, USA.
authors.forename: Jacqueline A
authors.initials: JA
authors.lastname: Merrill
authors.affiliation: Center for Health Policy, The Keystone Center, Washington, District of Columbia, USA.
authors.forename: Brad
authors.initials: B
authors.lastname: Sperber
authors.affiliation: Center for Health Policy, Association of State and Territorial Health Officials (ASTHO), Arlington, Virginia, USA.
authors.forename: Catherine
authors.initials: C
authors.lastname: Cairns
authors.affiliation: Office for State, Tribal, Local, and Territorial Support, Centers for Disease Control and Prevention, Atlanta, Georgia, USA Public Health Law Program, Office for State, Tribal, Local, and Territorial Support, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
authors.forename: Matthew
authors.initials: M
authors.lastname: Penn
authors.affiliation: Public Health Law Program, Office for State, Tribal, Local, and Territorial Support, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
authors.forename: Tara
authors.initials: T
authors.lastname: Ramanathan
authors.affiliation: Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Mothershed
authors.affiliation: Office of Associate Director for Policy, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Skillen
mesh_terms: D019985:Benchmarking; D003299:Cooperative Behavior; D003428:Cross Infection / Q000517:prevention & control*; D006291:Health Policy; D006801:Humans; D017053:Infection Control / Q000331:legislation & jurisprudence / Q000458:organization & administration* / Q000592:standards; D007407:Interviews as Topic; D036301:Qualitative Research
keywords: Health policy; Healthcare quality improvement; Infection control; Nosocomial infections; Patient safety