Original article
On the CUSP: Stop BSI: Evaluating the relationship between central line–associated bloodstream infection rate and patient safety climate profile

https://doi.org/10.1016/j.ajic.2014.05.020Get rights and content

Background

Central line–associated bloodstream infection (CLABSI) remains one of the most common and deadly hospital acquired infections in the United States. Creating a culture of safety is an important part of healthcare–associated infection improvement efforts; however, few studies have robustly examined the role of safety climate in patient safety outcomes. We applied a pattern-based approach to measuring safety climate to investigate the relationship between intensive care unit (ICU) patient safety climate profiles and CLABSI rates.

Methods

Secondary analyses of data collected from 237 adult ICUs participating in the On the CUSP: Stop BSI project. Unit-level baseline scores on the Hospital Survey on Patient Safety, a survey designed to assess patient safety climate, and CLABSI rates, were investigated. Three climate profile characteristics were examined: profile elevation, variability, and shape.

Results

Zero-inflated Poisson analyses suggested an association between the relative incidence of CLABSI and safety climate profile shape. K-means cluster analysis revealed 5 climate profile shapes. ICUs with conflicting climates and nonpunitive climates had a significantly higher CLABSI risk compared with ICUs with generative leadership climates.

Conclusions

Relative CLABSI risk was related to safety climate profile shape. None of the climate profile shapes was related to the odds of reporting zero CLABSI. Our findings support using pattern-based methods for examining safety climate rather than examining the relationships between each narrow dimension of safety climate and broader safety outcomes like CLABSI.

Section snippets

Methods

Secondary analyses were conducted using a subset of data collected as part of the On the CUSP: Stop BSI project, a national improvement collaborative funded by the Agency for Healthcare Research and Quality (AHRQ). The Stop BSI program used a multiple time series design to evaluate the effectiveness a multifaceted intervention that included the Comprehensive Unit-Based Safety Program (CUSP),3, 20, 21 a model for translating research into practice that includes using a checklist of best

Relationships between the 3 safety climate profile characteristics and CLABSI

Overall, the mean CLABSI rate was 1.78 infections per 1000 central line-days (SD, 2.09) across all ICUs during the baseline period. Boxplots examining infection rates by unit type suggested meaningful variation among unit types, and lowess plots examining unadjusted relationships between unit size and rate also implicated size as a potential confounder of the safety climate–infection relationship.

We used an initial series of ZIP regression models to examine the unadjusted relationship between

Discussion

Understanding the role that organizational factors, such as patient safety climate, play in shaping clinician behavior and patient outcomes is critical for improving the quality and safety of care provided to some of the most at-risk patients. Our findings indicate that patient safety climate, when operationalized in terms of climate profile characteristics, is significantly related to the CLABSI rate in ICUs after controlling for other unit factors, such as size and type. Although simple

Acknowledgment

We thankfully recognize the contributions of other members of the multi-disciplinary team that lead the National Stop BSI project: Sean Berenholtz, Christine Goeschel, David Thompson, Lisa Lubomski, Marianna Lesher, Justin St. Andre, Stephen Hines, and Sam Watson, as well as many others brought this work to fruition. We are also grateful to the ICU teams participating in the Stop BSI project for their time and dedication to this work. Finally, we are appreciative of the constructive comments

References (38)

  • C.P. Landrigan et al.

    Temporal trends in rates of patient harm resulting from medical care

    N Engl J Med

    (2010)
  • L.L. Leape et al.

    What practices will most improve safety? Evidence-based medicine meets patient safety

    JAMA

    (2002)
  • L.L. Leape et al.

    Five years after to Err Is Human: what have we learned?

    JAMA

    (2005)
  • D.T. Huang et al.

    Intensive care unit safety culture and outcomes: a US multicenter study

    Int J Qual Health Care

    (2010)
  • S.M. Shortell et al.

    The performance of intensive care units: does good management make a difference?

    Med Care

    (1994)
  • R.E. Mardon et al.

    Exploring relationships between hospital patient safety culture and adverse events

    J Patient Saf

    (2010)
  • A.K. Rosen et al.

    Hospital safety climate and safety outcomes: is there a relationship in the VA?

    Med Care Res Rev

    (2010)
  • S.J. Singer et al.

    Safety climate research: taking stock and looking forward

    BMJ Qual Saf

    (2013)
  • J.Z. Carr et al.

    Climate perceptions matter: a meta-analytic path analysis relating molar climate, cognitive and affective states, and individual-level work outcomes

    J Appl Psychol

    (2003)
  • Cited by (46)

    • Safety climate profiles in remote workers: Association with key predictors and outcomes at the team level

      2022, Safety Science
      Citation Excerpt :

      The comprehensive profile in both studies was characterized by medium-to-high scores across the overall safety climate dimensions; this profile represents a fair or good team-level safety climate perception and was the most common profile in the present study. The generative leadership profile of Weaver et al. (2014) and the outstanding profile in the present study were similar in that they represented generally high scores across the overall safety climate dimensions. Teams with this profile have a well-rounded and wholesome safety climate that can be benchmarked for safety climate promotion efforts.

    • Evidence Review for the American College of Surgeons Quality Verification Part I: Building Quality and Safety Resources and Infrastructure

      2020, Journal of the American College of Surgeons
      Citation Excerpt :

      There is a strong correlation between safety culture and workforce safety performance demonstrated through studies within healthcare and the industrial sector.6,45 The relationship between safety culture and patient outcomes is less well-defined—some patient outcomes show an association with positive safety culture (infection rates, Patient Safety Indicators) and others fail to show an association (mortality, readmission).37-39 There are important limitations to this review.

    • Safety culture in intensive care internationally and in Australia: A narrative review of the literature

      2019, Australian Critical Care
      Citation Excerpt :

      In benchmarking the HSOPSC, there tended to be a wider variety of studies incorporated.29,32 HSOPSC results can be submitted to a large database of studies for benchmarking purposes.59 Etchegaray and Thomas61 suggest choice of survey tool between the reliable and validated SAQ, and HSOPSC depends on several factors.

    View all citing articles on Scopus

    The original Stop BSI work was supported in part by funding from the Agency for Healthcare Research and Quality (AHRQ), (Contract HHSA290200600022; Task Order 7). The secondary analyses and work reported here was supported by the Johns Hopkins Institute for Clinical and Translational Research (ICTR), which is funded in part by Grant 1KL2TR001077-01 from the National Center for Advancing Translational Sciences (NCATS), a component of the National Institutes of Health (NIH), and NIH Roadmap for Medical Research. The contents are solely the responsibility of the authors and do not necessarily reflect the official views of AHRQ, ICTR, NCATS, or NIH.

    Publication of this article was supported by the Agency for Healthcare Research and Quality (AHRQ).

    Conflicts of interest: None to report

    View full text