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

Sallie J Weaver; Kristina Weeks; Julius Cuong Pham; Peter J Pronovost

doi:10.1016/j.ajic.2014.05.020

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.

Authors

Sallie J Weaver¹, Kristina Weeks², Julius Cuong Pham³, Peter J Pronovost⁴

Affiliations

¹ Armstrong Institute for Patient Safety and Quality and Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD; Johns Hopkins Carey School of Business, Baltimore, MD. Electronic address: sjweaver@jhu.edu.
² Armstrong Institute for Patient Safety and Quality and Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
³ Armstrong Institute for Patient Safety and Quality and Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD; Armstrong Institute for Patient Safety and Quality, and Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
⁴ Armstrong Institute for Patient Safety and Quality and Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD.

Abstract

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

Abstract

Publication types

MeSH terms

Grants and funding