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We were very interested to read the article by Meddings et al which evaluated the association between patient safety culture and catheter-associated infections among hospitals in two infection-reducing collaboratives.1 The authors found that while infection rates declined, there was no association between 13 dimensions of patient safety culture, as measured by the Agency for Healthcare Research and Quality (AHRQ) Hospital Survey on Patient Safety Culture (HSOPS), and unadjusted infection rates (catheter-associated urinary tract infections (CAUTI) and central-line-associated bloodstream infection (CLABSI) rates per 1000 catheter days).
We comment on several of the article’s conclusions and pose some questions about the data collection and analysis methods used to examine the relationship between HSOPS and infection rates.
First, the study reported HSOPS response rates averaging 24% for the CLABSI collaborative and 43% for the CAUTI collaborative, which were described as ’a low response rate' and ’important finding' which they attribute to ’survey fatigue'. The article speculates that the low response rate is ’empirical evidence of the difficulty in using these survey tools in busy inpatient units'. However, the numbers reported in the article are actually more like participation rates—the number of units with HSOPS data out of the total number of units in the collaborative—not respondent-level response rates of how many individuals responded to the survey among those asked to take the survey. The AHRQ HSOPS Comparative Database shows that hospitals actually …
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