On the CUSP: Stop BSI: evaluating the relationship between central line-associated bloodstream infection rate and patient safety climate profile

Am J Infect Control. 2014 Oct;42(10 Suppl):S203-8. doi: 10.1016/j.ajic.2014.05.020.


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.

Keywords: Central line–associated bloodstream infection; Organizational culture; Patient safety.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Bacteremia / epidemiology
  • Bacteremia / prevention & control*
  • Catheter-Related Infections / epidemiology*
  • Catheter-Related Infections / prevention & control*
  • Catheterization, Central Venous / adverse effects
  • Cross Infection / epidemiology
  • Cross Infection / prevention & control
  • Data Collection
  • Humans
  • Infection Control / methods*
  • Intensive Care Units / statistics & numerical data*
  • Patient Safety
  • Poisson Distribution
  • Quality Improvement
  • Self Report
  • United States