Faculty Collaboration Database

Mandated self-reporting of ventilator-associated pneumonia bundle and catheter-related bloodstream infection bundle compliance and infection rates. JAMA Surg 2014 Oct;149(10):1003-7

Date

08/28/2014

Pubmed ID

25162479

DOI

10.1001/jamasurg.2014.1627

Scopus ID

2-s2.0-84908297507 (requires institutional sign-in at Scopus site)   9 Citations

Abstract

IMPORTANCE: As quality measures increasingly become tied to payment, evaluating the most effective ways to provide high-quality care becomes more important.

OBJECTIVES: To determine whether mandated reporting for ventilator and catheter bundle compliance is correlated with decreased infection rates, and to determine whether labor-intensive audits are correlated with compliance.

DESIGN, SETTING, AND PARTICIPANTS: Multiyear retrospective review of aggregated data from all patients admitted to 15 intensive care units in a Veterans Affairs hospital setting (the Veterans Integrated Service Network 16) from 2009 to 2011.

EXPOSURES: Ventilator-associated pneumonia and catheter-related bloodstream infections.

MAIN OUTCOMES AND MEASURES: Mean rates of ventilator-associated pneumonia and catheter-related bloodstream infection were analyzed by year. Relationships between infection rates, self-reported compliance, and audits were analyzed by Pearson correlation.

RESULTS: During the study period, ventilator-associated pneumonia decreased from 2.50 to 1.60 infections per 1000 ventilator days (P = .07). The rate of pneumonia was not correlated with self-reported compliance overall (R = 0.19) or by individual year (2009, R = 0.30; 2010, R = 0.24; 2011, R = 0.46); there was a correlation in cardiac intensive care units (R = -0.70) but not other types of intensive care units (mixed, R = -0.18; medical, R = 0.42; surgical, R = 0.34). Catheter-related bloodstream infections decreased from 2.38 to 0.73 infections per 1000 catheter days (P = .04). The rate of catheter infection was not correlated with self-reported compliance overall (R = -0.18), by individual year (2009, R = -0.39; 2010, R = -0.42; 2011, R = 0.37), or by intensive care unit type (mixed, R = -0.19; cardiac, R = 0.55; medical, R = 0.17; surgical, R = -0.44).

CONCLUSIONS AND RELEVANCE: Current mandated self-reported compliance and audit measures are poorly correlated with decreased ventilator-associated pneumonia or catheter-related bloodstream infection.

Author List

Helmick RA, Knofsky ML, Braxton CC, Subramanian A, Byers P, Lan CK, Awad SS

Author

Ryan Helmick MD Associate Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Bacteremia
Catheter-Related Infections
Cross Infection
Hospitals, Veterans
Humans
Infection Control
Mandatory Reporting
Pneumonia, Ventilator-Associated
Retrospective Studies
United States