Article Text

Download PDFPDF

Evaluation of the association between Hospital Survey on Patient Safety Culture (HSOPS) measures and catheter-associated infections: results of two national collaboratives
  1. Jennifer Meddings1,2,3,
  2. Heidi Reichert1,
  3. M Todd Greene1,3,
  4. Nasia Safdar4,5,
  5. Sarah L Krein1,3,
  6. Russell N Olmsted6,
  7. Sam R Watson7,
  8. Barbara Edson8,
  9. Mariana Albert Lesher8,
  10. Sanjay Saint1,2,3
  1. 1Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
  2. 2Department of Medicine, Ann Arbor Veterans Affairs Medical Center, Ann Arbor, Michigan, USA
  3. 3VA Center for Clinical Management Research, Ann Arbor Veterans Affairs Medical Center, Ann Arbor, Michigan, USA
  4. 4Department of Internal Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
  5. 5Department of Medicine, William S. Middleton Memorial Veterans Affairs Hospital, Madison, Wisconsin, USA
  6. 6Infection Prevention and Control, Trinity Health, Livonia, Michigan, USA
  7. 7Michigan Health & Hospital Association, Keystone Center for Patient Safety & Quality, Okemos, Michigan, USA
  8. 8Health Research and Educational Trust (HRET), Chicago, Illinois, USA
  1. Correspondence to Dr Jennifer Meddings, Department of Internal Medicine, University of Michigan Medical School, 2800 Plymouth Road, Building 16, Room 430 W, Ann Arbor, MI, 48019-2800, USA; meddings{at}


Background The Agency for Healthcare Research and Quality (AHRQ) has funded national collaboratives using the Comprehensive Unit-based Safety Program to reduce rates of two catheter-associated infections—central-line-associated bloodstream infection (CLABSI) and catheter-associated urinary tract infection (CAUTI), using evidence-based intervention bundles to improve technical aspects of care and socioadaptive approaches to foster a culture of safety.

Objective Examine the association between hospital units' results for the Hospital Survey on Patient Safety Culture (HSOPS) and catheter-associated infection rates.

Methods We analysed data from two prospective cohort studies from acute-care intensive care units (ICUs) and non-ICUs participating in the AHRQ CLABSI and CAUTI collaboratives. National Healthcare Safety Network catheter-associated infections per 1000 catheter-days were collected at baseline and quarterly postimplementation. The HSOPS was collected at baseline and again 1 year later. Infection rates were modelled using multilevel negative binomial models as a function of HSOPS components over time, adjusted for hospital-level characteristics.

Results 1821 units from 1079 hospitals (CLABSI) and 1576 units from 949 hospitals (CAUTI) were included. Among responding units, infection rates declined over the project periods (by 47% for CLABSI, by 23% for CAUTI, unadjusted). No significant associations were found between CLABSI or CAUTI rates and HSOPS measures at baseline or over time.

Conclusions We found no association between results of the HSOPS and catheter-associated infection rates when measured at baseline and postintervention in two successful large national collaboratives focused on prevention of CLABSI and CAUTI. These results suggest that it may be possible to improve CLABSI and CAUTI rates without making significant changes in safety culture, particularly as measured by instruments like HSOPS.

  • Patient safety
  • Safety culture
  • Infection control
  • Nosocomial infections

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:

Statistics from


  • Funding National Institute of Health-National Institute on Aging (Probiotics for improving outcomes of C. difficile), Agency for Healthcare Research and Quality (HHSA290201000025I/HHSA29032001T) and (K08 HS19767) and (VA MERIT grant (Probiotics for reducing carriage by S. aureus)).

  • Competing interests JM has reported receiving honoraria for lectures and teaching related to prevention and value-based purchasing policies involving catheter-associated urinary tract infection and hospital-acquired pressure ulcers. SS has received numerous honoraria and speaking fees from academic medical centres, hospitals, specialty societies, state-based hospital associations, group purchasing organisations and non-profit foundations (eg, Michigan Health and Hospital Association, Institute for Healthcare Improvement) for lectures about healthcare-associated infection prevention. He is on the medical advisory board of Doximity and Jvion. RO served as an external faculty for HRET’s On the CUSP: stop CAUTI project, serves on a Speaker's Bureau sponsored by Ethicon, and is a member of Premier Safety Institute.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Permission to share data can only be requested to and given only by the Agency for Healthcare Research and Quality (AHRQ).

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.