Julie Reagan

Laws pertaining to healthcare-associated infections: a review of 3 legal requirements.

We reviewed US state and territorial healthcare-associated infection (HAI) laws, specifically addressing 3 legal requirements: data submission, reporting of data to the public, and inclusion of facility identifiers in public reports. The majority of US states and territories have HAI laws. The 3 studied legal provisions are all commonly included in state HAI laws in varying forms; however, only a minority of states and territories specifically mandate all 3 legal requirements. The laws of the remaining states vary considerably.

State-Mandated Reporting of Health Care–Associated Infections in the United States: Trends Over Time

Over the past decade, most US states and territories began mandating that acute care hospitals report health care–associated infections (HAIs) to their departments of health. Trends in state HAI law enactment and data submission requirements were determined through systematic legal review; state HAI coordinators were contacted to confirm collected data. As of January 31, 2013, 37 US states and territories (71%) had adopted laws requiring HAI data submission, most of which were enacted and became effective in 2006 and 2007. Most states with HAI laws required reporting of central line–associated bloodstream infections in adult intensive care units (92%), and about half required reporting of methicillin-resistant Staphylococcus aureus and Clostridium difficile infections (54% and 51%, respectively). Overall, data submission requirements were found to vary across states. Considering the facility and state resources needed to comply with HAI reporting mandates, future studies should focus on whether these laws have had the desired impact of reducing infection rates.

Variation in Surgical Site Infection Monitoring and Reporting by State

Objective Surgical site infections (SSIs) are common, costly, and often preventable. There are no national requirements for measuring or reporting hospital SSI rates and state‐level monitoring occurs with little coordination between states. We designed a study to describe the current status of SSI reporting in the United States. Methods We reviewed SSI monitoring and reporting legislation in all 50 states in September 2010. Data collected included whether SSI monitoring and reporting legislation exists, if public reporting is required, how the data are accessible, and for which procedures SSI data are reported. Results Twenty‐one (42%) states have legislation for SSI monitoring and reporting. All 21 of these states require public release of findings. Of the states with legislation, eight (38%) currently have SSI data available publicly. A range of two to seven procedures were reported for SSI measurement by individual states. Eighteen (86%) states use state agency websites to make their data publicly available. Conclusion There is wide variation in state monitoring and reporting of SSI rates. Standardized reporting may be needed so that consumers can make informed health choices based on quality metrics.

Variation in Public Reporting of Central Line-Associated Bloodstream Infections by State

Central line–associated bloodstream infections (CLABSIs) are common, costly, and largely preventable. Consumers who want high-quality care should have access to CLABSI rates to make health care decisions. The authors searched state health department Web sites for publicly available CLABSI data. Fourteen states, all with mandatory CLABSI monitoring laws, had publicly available data. The authors identified significant variation in the presentation of infection rates, methods of risk adjustment, locations and care settings reported, time span of data collection, and time lag to reporting. The wide variation in availability and content of information illustrates the need for standardized CLABSI monitoring and reporting mechanisms.

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.

OBJECTIVE 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. DESIGN Cross-sectional study. PARTICIPANTS National sample of level II/III and III NICUs participating in National Healthcare Safety Network (NHSN) surveillance. METHODS 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. RESULTS 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. CONCLUSIONS 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.

Impact of laws aimed at healthcare-associated infection reduction: a qualitative study

Background Healthcare-associated infections (HAIs) are preventable. Globally, laws aimed at reducing HAIs have been implemented. In the USA, these laws are at the federal and state levels. It is not known whether the state interventions are more effective than the federal incentives alone. Objective The aims of this study were to explore the impact federal and state HAI laws have on state departments of health and hospital stakeholders in the USA and to explore similarities and differences in perceptions across states. Methods A qualitative study was conducted. In 2012, we conducted semistructured interviews with key stakeholders from states with and without state-level laws to gain multiple perspectives. Interviews were transcribed and open coding was conducted. Data were analysed using content analysis and collected until theoretical saturation was achieved. Results Ninety interviews were conducted with stakeholders from 12 states (6 states with laws and 6 states without laws). We found an increase in state-level collaboration. The publicly reported data helped hospitals benchmark and focus leaders on HAI prevention. There were concerns about the publicly reported data (eg, lack of validation and timeliness). Resource needs were also identified. No major differences were expressed by interviewees from states with and without laws. Conclusions While we could not tease out the impact of specific interventions, increased collaboration between departments of health and their partners is occurring. Harmonisation of HAI definitions and reporting between state and federal laws would minimise reporting burden. Continued monitoring of the progress of HAI prevention is needed.

Perceived impact of state-mandated reporting on infection prevention and control departments

Background: Currently, most US states have adopted legislation requiring hospitals to submit health care‐associated infection (HAI) data. We evaluated the perceived impact of state HAI laws on infection prevention and control (IPC) departments. Methods: A web‐based survey of a national sample of all non‐veteran hospitals enrolled in the National Healthcare Safety Network was conducted in fall 2011. Variations in IPC department resources and characteristics in states with and without laws were compared by use of χ2, Mann‐Whitney (Wilcoxon), and Student t tests. Multinomial logistic regression was used to identify increases or decreases, versus no change, in perceived resources, time, influence, and visibility of the IPC department in states with and without HAI laws. Results: Overall, 1,036 IPC departments provided complete data (30% response rate); 755 (73%) were located in states with laws. Respondents in states with reporting laws were more likely to report less time for routine IPC activities (odds ratio, 1.61; 95% confidence interval, 1.12–2.31) and less visibility of the IPC department (odds ratio, 1.70; 95% confidence interval, 1.12–2.58) than respondents in states without laws, after controlling for geographic region, setting, and the presence of a hospital epidemiologist. Conclusions: Respondents in states with laws reported negative effects on their IPC department, beyond what was required by federal mandates. Further research should examine resources necessary to comply with state HAI laws and evaluate unintended consequences of state HAI laws.

An Analysis of the Massachusetts Healthcare Law

ABSTRACT Healthcare in the United States has been one topic of the debates and discussion in the country for many years. The challenge for affordable, accessible, and quality healthcare for most Americans has been on the agenda of federal and state legislatures. There is probably no other state that has drawn as much individual attention regarding this challenge as the state of Massachusetts. While researching the topic for this article, it was discovered that financial and political perspectives on the success or failure of the healthcare model in Massachusetts vary depending on the aspect of the system being discussed. In this article the authors give a brief history and description of the Massachusetts Healthcare Law, explanation of how the law is financed, identification of the targeted populations in Massachusetts for which the law provides coverage, demonstration of the actual benefit coverage provided by the law, and review of the impact of the law on healthcare providers such as physicians and hospitals. In addition, there are explanations about the impact of the law on health insurance companies, discussion of changes in healthcare premiums, explanation of costs to the state for the new program, reviews of the impact on the health of the insured, and finally, projections on the changes that healthcare facilities will need to make to maintain fiscal viability as a result of this program.