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Evaluation of the association between Nursing Home Survey on Patient Safety culture (NHSOPS) measures and catheter-associated urinary tract infections: results of a national collaborative
  1. Shawna N Smith1,2,3,
  2. M Todd Greene1,4,
  3. Lona Mody4,5,
  4. Jane Banaszak-Holl6,7,
  5. Laura D Petersen1,
  6. Jennifer Meddings1,4,8
  1. 1 Division of General Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
  2. 2 Institute for Social Research, Quantitative Methodology Program, University of Michigan, Ann Arbor, Michigan, USA
  3. 3 Department of Psychiatry, University of Michigan Medical School, Ann Arbor, Michigan, USA
  4. 4 VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
  5. 5 Division of Geriatric and Palliative Medicine,Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
  6. 6 Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
  7. 7 Institute of Gerontology, University of Michigan Medical School, Ann Arbor, Michigan, USA
  8. 8 Division of General Pediatrics, Department of Pediatrics and Communicable Diseases, University of Michigan Medical School, Ann Arbor, Michigan, USA
  1. Correspondence to Dr Shawna N Smith, General Medicine, University of Michigan, 2800 Plymouth Rd, Ann Arbor, Michigan 48109-2800, USA; shawnana{at}


Background Recent efforts to reduce patient infection rates emphasise the importance of safety culture. However, little evidence exists linking measures of safety culture and infection rates, in part because of the difficulty of collecting both safety culture and infection data from a large number of nursing homes.

Objective To examine the association between nursing home safety culture, measured with the Nursing Home Survey on Patient Safety Culture (NHSOPS), and catheter-associated urinary tract infection rates (CAUTI) using data from a recent national collaborative for preventing healthcare-associated infections in nursing homes.

Methods In this prospective cohort study of nursing homes, facility staff completed the NHSOPS at intervention start and 11 months later. National Healthcare Safety Network-defined CAUTI rates were collected monthly for 1 year. Negative binomial models examined CAUTI rates as a function of both initial and time-varying facility-aggregated NHSOPS components, adjusted for facility characteristics.

Results Staff from 196 participating nursing homes completed the NHSOPS and reported CAUTI rates monthly. Nursing homes saw a 52% reduction in CAUTI rates over the intervention period. Seven of 13 NHSOPS measures saw improvements, with the largest improvements for ‘Management Support for Resident Safety’ (3.7 percentage point increase in facility-level per cent positive response, on average) and ‘Communication Openness’ (2.5 percentage points). However, these increases were statistically insignificant, and multivariate models did not find significant association between CAUTI rates and initial or over-time NHSOPS domains.

Conclusions This large national collaborative of nursing homes saw declining CAUTI rates as well as improvements in several NHSOPS domains. However, no association was found between initial or over-time NHSOPS scores and CAUTI rates.

  • nursing homes
  • quality measurement
  • safety culture

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  • Contributors Each author has contributed significantly to the manuscript and meets the requirements of authorship as specified by the International Committee of Medical Journal Editors.

  • Funding This work was supported by a contract from the Agency for Healthcare Research and Quality (AHRQ), US Department of Health and Human Services, Contract Number: HHSA 2902010000251.

  • Disclaimer The findings and conclusions in this report are those of the authors and do not necessarily represent those of the sponsor.

  • Competing interests None declared.

  • Patient consent This project was reviewed by the University of Michigan Institutional Review Board and determined to be non-regulated research, so no consent form was required.

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