• Ryan A Helmick, Meredith L Knofsky, Carla C Braxton, Anuradha Subramanian, Patricia Byers, Charlie K W Lan, and Samir S Awad.
• Department of Surgery, Baylor College of Medicine, Houston, Texas.
• JAMA Surg. 2014 Oct 1;149(10):1003-7.

ImportanceAs quality measures increasingly become tied to payment, evaluating the most effective ways to provide high-quality care becomes more important.ObjectivesTo 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 ParticipantsMultiyear 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.ExposuresVentilator-associated pneumonia and catheter-related bloodstream infections.Main Outcomes And MeasuresMean 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.ResultsDuring 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 RelevanceCurrent mandated self-reported compliance and audit measures are poorly correlated with decreased ventilator-associated pneumonia or catheter-related bloodstream infection.

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