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