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. . Copyright
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