Review of Best Practices for CLABSI Prevention and the Impact of Recent Legislation on CLABSI Reporting

Abstract

Central line-associated bloodstream infections (CLABSI) are a very common source of healthcare-associated infection (HAI). Incidence of CLABSI has been significantly reduced through the efforts of nurses, healthcare providers, and infection preventionists. Extrinsic factors such as recently enacted legislation and mandatory reporting have not been closely examined in relation to changes in rates of HAI. The following review will examine evidence-based practices related to CLABSI and how they are reported, as well as how the Affordable Care Act, mandatory reporting, and pay-for-performance programs have affected these best practices related to CLABSI prevention. There is a disconnect in the methods and guidelines for reporting CLABSI between these programs, specifically among local monitoring agencies and the various federal oversight organizations. Future research will focus on addressing the gap in what defines a CLABSI and whether or not these programs to incentivize hospital to reduce CLABSI rates are effective.

A systematic review and meta-synthesis of policy intervention characteristics that influence the implementation of government-directed policy in the hospital setting: implications for infection prevention and control

“…As more developed countries move to using financial penalties and pay-for-performance strategies, particularly in the infection prevention space (Mendelson et al, 2017), the evaluation and monitoring of policy-directed policy outcomes will also become increasingly important in ensuring policy mechanisms have the intended impact on reallife outcomes, an issue that has already been identified as a significant concern when it comes to policy directions and unforeseen consequences (Pogorzelska-Maziarz et al, 2019;Stone et al, 2015;Woodward and Umberger, 2016).…”

Mandatory reporting legislation in Canada: improving systems for patient safety?

“…Most of the eligible studies were conducted in the United States (Stone et al ., 2007, 2011, 2015; Linkin et al ., 2013; Pakyz and Edmond, 2013; Marsteller et al ., 2014; Woodward and Umberger, 2016), while one study was conducted in Canada (Daneman et al ., 2012), one in France (Lucet et al ., 2013) and another looked at England, France, Germany and the United States (Haustein et al ., 2011). They examined the impact of legislation on health care-associated infections.…”

“…They examined the impact of legislation on health care-associated infections. Three focussed on central line-associated bloodstream infections (CLABSI) in hospital intensive care units (Pakyz and Edmond, 2013; Marsteller et al ., 2014; Woodward and Umberger, 2016). Additional details on each article can be found in the Supplementary materials.…”

“…Two articles reported a statistically significant association between mandatory reporting and a reduction in patient safety incident rates (Stone et al ., 2011; Daneman et al ., 2012). The remaining studies found limited impact (Woodward and Umberger, 2016); inconclusive evidence of impact (Stone et al ., 2007, 2015; Haustein et al ., 2011; Lucet et al ., 2013) or no statistically significant impact (Linkin et al ., 2013; Pakyz and Edmond, 2013; Marsteller et al ., 2014). One article compared rates between mandatory reporting jurisdictions and voluntary reporting jurisdictions and found no difference in impact on outcomes (Stone et al ., 2015).…”

Frequency of Catheter Related Blood Stream Infections in a Cardiac Surgery Intensive Care Unit

“…This surveillance definition, used for non-research purposes, may overestimate number of infections attributable to the CVC. 8,9 CRBSI is diagnosed by taking paired samples, CVC tip culture and blood drawn percutaneously from the peripheral vein. A definitive diagnosis of CRBSI requires that the same organism grow from at percutaneous blood culture and from a culture of the catheter tip.…”