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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

  • Philip Zachariah (a1), Julie Reagan (a2), E. Yoko Furuya (a1) (a3), Andrew Dick (a4), Hangsheng Liu (a4), Carolyn T. A. Herzig (a5), Monika Pogorzelska-Maziarz (a6), Patricia W. Stone (a5) and Lisa Saiman (a1) (a3)...



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.


Cross-sectional study.

Participants. National sample of level II/III and III NICUs participating in National Healthcare Safety Network (NHSN) surveillance.


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.


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.


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.

Infect Control Hosp Epidemiol 2014;35(9):1133-1139


Corresponding author

Division of Pediatric Infectious Diseases, Morgan Stanley Children’s Hospital of NewYork–Presbyterian, Columbia University College of Physicians and Surgeons, 622 West 168th Street, PH4-474, New York, NY 10032 (


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1. Pronovost, P, Needham, D, Berenholtz, S, et al. An intervention to decrease catheter-related bloodstream infections in the ICU. N Engl J Med 2006;355(26):27252732.
2. Using a comprehensive unit-based safety program to prevent healthcare-associated infections. Agency for Healthcare Research and Quality website. Accessed December 22, 2013.
3. Wise, ME, Scott RD 2nd, Baggs, JM, et al. National estimates of central line–associated bloodstream infections in critical care patients. Infect Control Hosp Epidemiol 2013;34(6):547554.
4. Schulman, J, Stricof, R, Stevens, TP, et al. New York State Regional Perinatal Care Centers—statewide NICU central-line-associated bloodstream infection rates decline after bundles and checklists. Pediatrics 2011;127(3):436444.
5. Centers for Disease Control and Prevention (CDC). Vital signs: central line–associated bloodstream infections—United States, 2001, 2008, and 2009. MMWR Morb Mortal Wkly Rep 2011;60(8):243248.
6. CDC and ASTHO release policy toolkit for healthcare-associated infection prevention. CDC website. Accessed December 22, 2013.
7. Aswani, MS, Reagan, J, Jin, L, Pronovost, PJ, Goeschel, C. Variation in public reporting of central line–associated bloodstream infections by state. Am J Med Qual 2011;26(5):387395.
8. Stone, PW, Pogorzelska-Maziarz, M, Herzig, CTA, et al. State of infection prevention in U.S. hospitals enrolled in NHSN. Am J Infect Control (forthcoming).
9. National Healthcare Safety Network (NHSN). CDC website. Accessed December 22, 2013.
10. Stone, PW, Dick, A, Pogorzelska, M, Horan, TC, Furuya, EY, Larson, EL. Staffing and structure of infection prevention and control programs. Am J Infect Control 2009;37:351357.
11. Furuya, EY, Dick, A, Perencevich, EN, Pogorzelska, M, Goldmann, D, Stone, PW. Central line bundle implementation in US intensive care units and impact on bloodstream infections. PLoS ONE 2011;6(1):e15452.
12. NHSN—key terms. CDC website Accessed August 25, 2013.
13. NHSN report, data summary for 2011, device-associated module. CDC website. Accessed August 22, 2013.
14. Eliminating, CLABSI, a national patient safety imperative: neonatal CLABSI prevention. Agency for Healthcare Research and Quality website. Accessed August 22, 2013.
15. Kaplan, HC, Lannon, C, Walsh, MC, Donovan, EF; Ohio Perinatal Quality Collaborative. Ohio statewide quality-improvement collaborative to reduce late-onset sepsis in preterm infants. Pediatrics 2011;127(3):427435.
16. Wirtschafter, DD, Powers, RJ, Pettit, JS, et al. Nosocomial infection reduction in VLBW infants with a statewide quality-improvement model. Pediatrics 2011;127(3):419426.
17. Vostok, J, Lapsley, W, McElroy, N, Onofrey, S, McHale, E, Johnson, N, DeMaria, A. Assessment of the burden of mandatory reporting of health care-associated infection using the National Healthcare Safety Network in Massachusetts. Am J Infect Control 2013;41(5):466468.
18. Stone, PW, Pogorzelska, M, Graham, D, Jia, H, Uchida, M, Larson, EL. California hospitals response to state and federal policies related to health care–associated infections. Policy Polit Nurs Pract 2011;12(2):7381.
19. Pakyz, AL, Edmond, MB. Influence of state laws mandating reporting of healthcare-associated infections: the case of central line-associated bloodstream infections. Infect Control Hosp Epidemiol 2013;34(8):780784.
20. Thompson, ND, Yeh, LL, Magill, SS, Ostroff, SM, Fridkin, SK. Investigating systematic misclassification of central line–associated bloodstream infection (CLABSI) to secondary bloodstream infection during health care–associated infection reporting. Am J Med Qual 2013;28(1):5659.


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