Multi-state evaluations of HAI laws: Understanding impact on prevention program implementation

Healthcare-associated infections (HAIs) are a serious patient safety concern. Growing demand for information by the public and consumer groups has led to an increase in federal efforts aimed at decreasing HAIs and the enactment of state HAI prevention laws. Although these state laws have common provisions, wide variation in their implementation may limit the generalizability of evaluations conducted within a single state. In this qualitative data study, consistent with socio-legal theory, we explored how HAI laws influence public health departments and other policy-makers in their efforts to implement HAI prevention programs. In total, over 90 in-depth, semi-structured interviews were conducted from varying stakeholders in states with and without mandatory reporting laws, seeking to assess the implementation of state HAI laws and the effects of particular legal provisions on state health department functions. The study found several themes that emerged in the form of success factors, best practices, recommendations, and “wish lists,” including the importance of sufficient alignment of policies and programs with other state and federal efforts, appropriate priorities and structures of the state program, balance between specificity and flexibility in crafting statutes, the need for accountability among key stakeholders, validation of data, training and education of providers and the public, and collaboration, communication, and leadership during the creation and implementation of the policy. The multi-state evaluations of these initiatives are useful to understand the barriers and facilitators of implementation, as well as the intended and unintended consequences of these policies, that will help to shape future state policy efforts.