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

Evaluation of the association between Hospital Survey on Patient Safety Culture (HSOPS) measures and catheter-associated infections: results of two national collaboratives.
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Meddings J, Reichert H, Greene MT, Safdar N, Krein SL, Olmsted RN, Watson SR, Edson B, Albert Lesher M, Saint S,


Meddings J, Reichert H, Greene MT, Safdar N, Krein SL, Olmsted RN, Watson SR, Edson B, Albert Lesher M, Saint S, (click to view)

Meddings J, Reichert H, Greene MT, Safdar N, Krein SL, Olmsted RN, Watson SR, Edson B, Albert Lesher M, Saint S,

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BMJ quality & safety 2016 05 2426(3) 226-235 doi 10.1136/bmjqs-2015-005012
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.

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