Hostname: page-component-78c5997874-j824f Total loading time: 0 Render date: 2024-11-14T04:31:50.277Z Has data issue: false hasContentIssue false
  • English
  • Français

Impact of Mandatory Public Reporting of Central Line–Associated Bloodstream Infections on Blood Culture and Antibiotic Utilization in Pediatric and Neonatal Intensive Care Units

Published online by Cambridge University Press:  27 April 2015

Kelly B. Flett ,
Al Ozonoff ,
Dionne A. Graham ,
Thomas J. Sandora  and
Gregory P. Priebe
Kelly B. Flett*
Affiliation:
Division of Infectious Diseases, Department of Medicine, Boston Children’s Hospital, Boston, Massachusetts Harvard Medical School, Boston, Massachusetts
Al Ozonoff
Affiliation:
Harvard Medical School, Boston, Massachusetts Center for Patient Safety and Quality Research, Boston Children’s Hospital, Boston, Massachusetts
Dionne A. Graham
Affiliation:
Harvard Medical School, Boston, Massachusetts Center for Patient Safety and Quality Research, Boston Children’s Hospital, Boston, Massachusetts
Thomas J. Sandora
Affiliation:
Division of Infectious Diseases, Department of Medicine, Boston Children’s Hospital, Boston, Massachusetts Harvard Medical School, Boston, Massachusetts Infection Prevention and Control, Boston Children’s Hospital, Boston, Massachusetts
Gregory P. Priebe
Affiliation:
Division of Infectious Diseases, Department of Medicine, Boston Children’s Hospital, Boston, Massachusetts Harvard Medical School, Boston, Massachusetts Division of Critical Care Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children’s Hospital, Boston, Massachusetts
*
Address correspondence to Kelly B. Flett, MD, MMSc, Division of Infectious Diseases, Boston Children’s Hospital, 300 Longwood Ave, Boston, MA 02115 (kelly.flett@childrens.harvard.edu).
Get access Rights & Permissions [Opens in a new window]

Abstract

BACKGROUND

As mandatory public reporting of healthcare-associated infections increases, there is concern that clinicians could attempt to decrease rates by avoiding the diagnosis of reportable infections.

OBJECTIVE

To determine whether blood culture and antibiotic utilization changed after mandatory public reporting of central line–associated bloodstream infection (CLABSI).

DESIGN

Interrupted time-series of blood culture and antibiotic rates before and after state-specific implementation of mandatory public reporting. We analyzed data from pediatric and neonatal intensive care units (ICUs) at 17 children’s hospitals that contributed to the Pediatric Health Information System administrative database. We used multivariable regression with generalized linear mixed-effects models to determine adjusted rate ratios (ARRs) after implementation of mandatory public reporting. We conducted subgroup analysis on patients with central venous catheters. To assess temporal trends, we separately analyzed data from 4 pediatric hospitals in states without mandatory public reporting.

RESULTS

There was no significant effect of mandatory public reporting on rates of blood culture (pediatric ICU ARR, 1.03 [95% CI, 0.82–1.28]; neonatal ICU ARR, 1.06 [0.85–1.33]) or antibiotic utilization (pediatric ICU ARR, 0.86 [0.72–1.04]; neonatal ICU ARR, 1.09 [0.87–1.35]). Results were similar in the subgroup of patients with central venous catheter codes. Hospitals with and without mandatory public reporting experienced small decreases in blood culture and antibiotic use across the study period.

CONCLUSIONS

Mandatory public reporting of central line–associated bloodstream infection did not impact blood culture and antibiotic utilization, suggesting that clinicians have not shifted their practice in an attempt to detect fewer infections.

Infect Control Hosp Epidemiol 2015;36(8):878–885

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 36 , Supplement 8 , August 2015 , pp. 878 - 885
Copyright
© 2015 by The Society for Healthcare Epidemiology of America. All rights reserved 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

T.J.S. and G.P.P. contributed equally to this article

a

Presented in part: IDWeek 2013; San Francisco, California; October 3, 2013; (Abstract 559).

References

1. Magill, SS, Edwards, JR, Bamberg, W, et al. Multistate point-prevalence survey of health care-associated infections. N Engl J Med 2014;370:1198–1208.CrossRefGoogle ScholarPubMed
2. Fung, CH, Lim, Y-W, Mattke, S, Damberg, C, Shekelle, PG. Systematic review: the evidence that publishing patient care performance data improves quality of care. Ann Intern Med 2008;148:111–123.CrossRefGoogle ScholarPubMed
3. Muller, MP, Detsky, AS. Public reporting of hospital hand hygiene compliance—helpful or harmful? JAMA 2010;304:1116–1117.CrossRefGoogle ScholarPubMed
4. Klevens, RM, Edwards, JR, Richards, CL, et al. Estimating health care-associated infections and deaths in U.S. hospitals, 2002. Public Health Rep 2007;122:160–166.CrossRefGoogle ScholarPubMed
5. Pines, JM, Isserman, JA, Hinfey, PB. The measurement of time to first antibiotic dose for pneumonia in the emergency department: a white paper and position statement prepared for the American Academy of Emergency Medicine. J Emerg Med 2009;37:335–340.CrossRefGoogle Scholar
6. Joynt, KE, Blumenthal, DM, Orav, EJ, Resnic, FS, Jha, AK. Association of public reporting for percutaneous coronary intervention with utilization and outcomes among Medicare beneficiaries with acute myocardial infarction. JAMA 2012;308:1460–1468.CrossRefGoogle ScholarPubMed
7. Backman, LA, Melchreit, R, Rodriguez, R. Validation of the surveillance and reporting of central line-associated bloodstream infection data to a state health department. Am J Infect Control 2010;38:832–838.CrossRefGoogle ScholarPubMed
8. Uchida, M, Stone, PW, Conway, LJ, Pogorzelska, M, Larson, EL, Raveis, VH. Exploring infection prevention: policy implications from a qualitative study. Policy Polit Nurs Pract 2011;12:82–89.CrossRefGoogle ScholarPubMed
9. Polk, RE, Hohmann, SF, Medvedev, S, Ibrahim, O. Benchmarking risk-adjusted adult antibacterial drug use in 70 US academic medical center hospitals. Clin Infect Dis 2011;53:1100–1110.CrossRefGoogle ScholarPubMed
10. Gerber, JS, Newland, JG, Coffin, SE, et al. Variability in antibiotic use at children’s hospitals. Pediatrics 2010;126:1067–1073.CrossRefGoogle ScholarPubMed
11. Claridge, JA, Pang, P, Leukhardt, WH, Golob, JF, Carter, JW, Fadlalla, AM. Critical analysis of empiric antibiotic utilization: establishing benchmarks. Surg Infect (Larchmt) 2010;11:125–131.CrossRefGoogle ScholarPubMed
12. Wylie, MC, Graham, DA, Potter-Bynoe, G, et al. Risk factors for central line–associated bloodstream infection in pediatric intensive care units. Infect Control Hosp Epidemiol 2010;31:1049–1056.CrossRefGoogle ScholarPubMed
13. Odetola, FO, Moler, FW, Dechert, RE, VanDerElzen, K, Chenoweth, C. Nosocomial catheter-related bloodstream infections in a pediatric intensive care unit: risk and rates associated with various intravascular technologies. Pediatr Crit Care Med 2003;4:432–436.CrossRefGoogle Scholar
14. Elward, AM, Fraser, VJ. Risk factors for nosocomial primary bloodstream infection in pediatric intensive care unit patients: a 2-year prospective cohort study. Infect Control Hosp Epidemiol 2006;27:553–560.CrossRefGoogle ScholarPubMed
15. Yogaraj, JS, Elward, AM, Fraser, VJ. Rate, risk factors, and outcomes of nosocomial primary bloodstream infection in pediatric intensive care unit patients. Pediatrics 2002;110:481–485.CrossRefGoogle ScholarPubMed
16. Feudtner, C, Hays, RM, Haynes, G, Geyer, JR, Neff, JM, Koepsell, TD. Deaths attributed to pediatric complex chronic conditions: national trends and implications for supportive care services. Pediatrics 2001;107:E99.CrossRefGoogle ScholarPubMed
17. Roque, P, Oliver, B, Anderson, L, et al. Inpatient utilization of blood cultures drawn in an urban ED. Am J Emerg Med 2012;30:110–114.CrossRefGoogle Scholar
18. Sturmann, KM, Bopp, J, Molinari, D, Akhtar, S, Murphy, J. Blood cultures in adult patients released from an urban emergency department: a 15-month experience. Acad Emerg Med 1996;3:768–775.CrossRefGoogle ScholarPubMed
19. Laupland, KB, Church, DL, Gregson, DB. Blood cultures in ambulatory outpatients. BMC Infect Dis 2005;5:35.CrossRefGoogle ScholarPubMed
20. Darby, JM, Linden, P, Pasculle, W, Saul, M. Utilization and diagnostic yield of blood cultures in a surgical intensive care unit. Crit Care Med 1997;25:989–994.CrossRefGoogle Scholar
21. Hillier, R, Everett, B. Evaluating culture practices used to identify infection in patients with brain injury. Crit Care Nurs Q 2012;35:228–233.CrossRefGoogle ScholarPubMed
22. Kiragu, AW, Zier, J, Cornfield, DN. Utility of blood cultures in postoperative pediatric intensive care unit patients. Pediatr Crit Care Med 2009;10:364–368.CrossRefGoogle ScholarPubMed
23. Gross, PA, Van Antwerpen, CL, Hess, WA, Reilly, KA. Use and abuse of blood cultures: program to limit use. Am J Infect Control 1988;16:114–117.CrossRefGoogle ScholarPubMed
24. Madsen, KM, Schønheyder, HC, Kristensen, B, Sørensen, HT. Secular trends in incidence and mortality of bacteraemia in a Danish county 1981-1994. APMIS 1999;107:346–352.CrossRefGoogle Scholar
25. Hadziyannis, AS, Stephanou, I, Dimarogona, K, et al. Blood culture results during the period 1995-2002 in a Greek tertiary care hospital. Clin Microbiol Infect 2004;10:667–670.CrossRefGoogle Scholar
26. McCaig, LF, McDonald, LC, Cohen, AL, Kuehnert, MJ. Increasing blood culture use at US hospital emergency department visits, 2001 to 2004. Ann Emerg Med 2007;50:42–48.e2.CrossRefGoogle ScholarPubMed
27. Grohskopf, LA, Huskins, WC, Sinkowitz-Cochran, RL, et al. Use of antimicrobial agents in United States neonatal and pediatric intensive care patients. Pediatr Infect Dis J 2005;24:766–773.CrossRefGoogle ScholarPubMed
28. Zingg, W, Pfister, R, Posfay-Barbe, KM, Huttner, B, Touveneau, S, Pittet, D. Secular trends in antibiotic use among neonates: 2001-2008. Pediatr Infect Dis J 2011;30:365–370.CrossRefGoogle ScholarPubMed
29. Pakyz, AL, Gurgle, HE, Ibrahim, OM, Oinonen, MJ, Polk, RE. Trends in antibacterial use in hospitalized pediatric patients in United States academic health centers. Infect Control Hosp Epidemiol 2009;30:600–603.CrossRefGoogle ScholarPubMed
30. Meddings, JA, Reichert, H, Rogers, MAM, Saint, S, Stephansky, J, McMahon, LF. Effect of nonpayment for hospital-acquired, catheter-associated urinary tract infection: a statewide analysis. Ann Intern Med 2012;157:305–312.CrossRefGoogle ScholarPubMed
31. Morgan, DJ, Meddings, J, Saint, S, et al. Does nonpayment for hospital-acquired catheter-associated urinary tract infections lead to overtesting and increased antimicrobial prescribing? Clin Infect Dis 2012;55:923–929.CrossRefGoogle ScholarPubMed
32. Lee, GM, Kleinman, K, Soumerai, SB, et al. Effect of nonpayment for preventable infections in U.S. hospitals. N Engl J Med 2012;367:1428–1437.CrossRefGoogle ScholarPubMed
33. Cox, E, Flaspohler, T, Jennings, A, et al. Attempts to change culture in a line-obsessed pediatric world: the Riley Heart Center line initiative. Am J Infect Control 2011;39:690–692.CrossRefGoogle Scholar
34. Blanchard, AC, Fortin, E, Rocher, I, et al. Central line–associated bloodstream infection in neonatal intensive care units. Infect Control Hosp Epidemiol 2013;34:1167–1173.CrossRefGoogle ScholarPubMed
35. Wirtschafter, DD, Padilla, G, Suh, O, Wan, K, Trupp, D, Fayard, EES. Antibiotic use for presumed neonatally acquired infections far exceeds that for central line-associated blood stream infections: an exploratory critique. J Perinatol 2011;31:514–518.CrossRefGoogle ScholarPubMed
Supplementary material: File

Flett supplementary material

Table S4

Download Flett supplementary material(File)
File 101.5 KB