1227. A Comparison of Central Line-Associated Bloodstream Infections in States with Mandatory versus Voluntary Reporting through the National Healthcare Safety Network
Session: Oral Abstract Session: Impact of National Policy on HAI Reporting and Prevention
Friday, October 19, 2012: 2:00 PM
Room: SDCC 32 AB

Background: Prior to implementation of national incentives for reporting central line-associated bloodstream infections (CLABSI) in January 2011, 21 state legislatures passed laws mandating healthcare facilities to report CLABSIs through the National Healthcare Safety Network (NHSN). Neither the potential for underreporting immediately following implementation of mandatory reporting laws nor the impact of these laws over time has been examined. The objective of this study was to assess whether NHSN-CLABSI reporters in states with mandatory reporting laws had accelerated CLABSI reductions over time compared to voluntary reporters.

Methods: The CLABSI standardized infection ratio (SIR) compares the number of observed CLABSIs during a given time interval to the number expected based on location-specific published rates from NHSN (2006 2008). CLABSI data reported from 1/1/2009 through 12/31/2010 was analyzed. SIRs were stratified by state mandate category: states with new laws (implemented January of 2009, n=4), states with existing laws (implemented before January 2009, n=13), and states with only voluntary reporting (n=31). CLABSI SIR trends over time were assessed using weighted linear regression; the interaction between time (quarter) and mandate status was assessed to determine statistical differences in trends.

Results: During the study period there were 296 NHSN reporters from states with new mandatory reporting laws (as of 1/1/2009), 1012 from states with existing laws (pre-2009), and 690 from states with no mandate (i.e., voluntary reporters). Over time CLABSI SIRs decreased significantly in states with new laws (p=0.002), in states with existing laws (p=0.004), and in states with no mandate (p=0.003). There was no statistical difference in trends across the three mandatory reporting categories (Figure 1). Results were confirmed in a sensitivity analysis that included only continuous reporters.

Conclusion: CLABSI SIRs decreased over the two-year study period among NHSN reporters in states with and without mandatory reporting laws. Results do not suggest underreporting immediately following implementation and suggest that decreasing CLABSI trends in mandatory reporting states mirror trends among voluntary reporters.


Katherine Ellingson, PhD, Kelly McCormick, MSPh, John A. Jernigan, MD, MS, Jonathan Edwards, MStat and Scott Fridkin, MD, FSHEA, Centers for Disease Control and Prevention, Atlanta, GA


K. Ellingson, None

K. McCormick, None

J. A. Jernigan, None

J. Edwards, None

S. Fridkin, None

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