Should public reporting be made for performance indicators on healthcare-associated infections?

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

Patient safety is a complex systems issue. In this study, we used a scoping review of peer-reviewed literature and a case study of provincial and territorial legislation in Canada to explore the influence of mandatory reporting legislation on patient safety outcomes in hospital settings. We drew from a conceptual model that examines the components of mandatory reporting legislation that must be in place as a part of a systems governance approach to patient safety and used this model to frame our results. Our results suggest that mandatory reporting legislation across Canada is generally designed to gather information about - rather than respond to and prevent - patient safety incidents. Overall, we found limited evidence of impact of mandatory reporting legislation on patient safety outcomes. Although legislation is one lever among many to improve patient safety outcomes, there are nonetheless several considerations for patient safety legislation to assist in broader system improvement efforts in Canada and elsewhere. Legislative frameworks may be enhanced by strengthening learning systems, accountability mechanisms and patient safety culture.

Overcoming the obstacles of implementing infection prevention and control guidelines

Reasons for a successful or unsuccessful implementation of infection prevention and control (IPC) guidelines are often multiple and interconnected. This article reviews key elements from the national to the individual level that contribute to the success of the implementation of IPC measures and gives perspectives for improvement. Governance approaches, modes of communication and formats of guidelines are discussed with a view to improve collaboration and transparency among actors. The culture of IPC influences practices and varies according to countries, specialties and healthcare providers. We describe important contextual aspects, such as relationships between actors and resources and behavioural features including professional background or experience. Behaviour change techniques providing goal-setting, feedback and action planning have proved effective in mobilizing participants and may be key to trigger social movements of implementation. The leadership of international societies in coordinating actions at international, national and institutional levels using multidisciplinary approaches and fostering collaboration among clinical microbiology, infectious diseases and IPC will be essential for success.

Evaluating the impact of mandatory public reporting on participation and performance in a program to reduce central line-associated bloodstream infections: evidence from a national patient safety collaborative

BACKGROUND

It is not clear whether mandatory reporting influences the efforts and performance of hospitals to prevent hospital-acquired infections. This study examines whether mandatory reporting impacted participation and performance in reducing central line-associated bloodstream infections (CLABSIs) in a national patient safety collaborative.

METHODS

We analyzed 1,046 adult intensive care units (ICUs) participating in the national On the CUSP: Stop BSI program. We used a difference-in-difference approach to compare changes in CLABSI rates in states with no public reporting mandate, recent mandates, and longer-standing mandates. Chi-square tests were used to examine the differences in the participation rate.

RESULTS

States enacting a law requiring mandatory public reporting of CLABSI rates around the time of the national program had the highest hospital participation rates (approximately 50%). Compared with units in states with no reporting requirement, units in the states with voluntary reporting systems or with longer periods of mandatory reporting experience had higher CLABSI rates at baseline and greater reductions in CLABSI in the first 6 months. State groups with mandatory public reporting of CLABSI showed a trend toward greater reduction in CLABSI after 1 year of program implementation.

CONCLUSION

Mandatory reporting requirements may spark hospitals to turn to proven infection prevention interventions to improve CLABSI rates. Reporting requirements do not teach sites how to reduce rates. ICUs need both motivation and facilitation to reach consumer expectations for infection prevention.