Evaluation of the association between Hospital Survey on Patient Safety Culture (HSOPS) measures and catheter-associated infections: results of two national collaboratives

Abstract

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.

Keywords: Infection control; Nosocomial infections; Patient safety; Safety culture.

Figure 1

(A) Central-line-associated bloodstream infection (CLABSI) coefficient plots, Hospital Survey on Patient Safety Culture (HSOPS) models. (B) Catheter-associated urinary tract infection (CAUTI) coefficient plots, HSOPS models. Incidence rate ratios (IRRs) and their 99% confidence intervals (CIs) are given for the HSOPS domains. CIs that cross the vertical line at the value of 1 indicate non-significant findings. Models also adjusted for hospital characteristics including bed size, teaching and critical access hospital status and rurality. For detailed model results, see online supplementary appendix. ICU, intensive care unit.