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

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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 >95% 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 > 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 >95% 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 < 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 >95% 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.


Academy Health Annual Research Meeting (ARM)


San Diego, CA

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