Impact of Patient Safety Climate on Infection Prevention Practices and Healthcare Worker and Patient Outcomes

Details

• Personal Author:
  Gershon RRM ; Hessels A ; Larson E
• Description:
  Nearly one in 25 patients has a hospital infection at any given time and one in 25 nurses suffers and blood-borne exposure every year. Basic procedures, termed "standard precautions" may prevent these outcomes, but are not often used by healthcare workers; organizational factors such as perceptions of safety might contribute to adherence. Standard precautions are a fundamental set of actions healthcare workers should take as a primary infection prevention strategy, designed to limit risk of blood-borne infections, other occupational infections, as well as patient healthcare associated infections (HAIs), such as methicillin-resistant Staphylococcus aureus (MRSA). Precautions include hand hygiene, use of personal protective equipment, safe use and disposal of sharps, decontamination of environment and equipment, and linen and waste management. The specific aims were to: 1) describe the direction and magnitude of relationships among patient safety climate and self-reported and observed standard precaution adherence, 2) identify the relationship between standard precaution adherence and blood-borne and other potentially infectious pathogen exposures and HAIs and 3) determine the direct and indirect relationships among patient safety climate, standard precaution adherence, and healthcare worker exposures and HAIs. This multi-site, cross-sectional study includes survey data on patient safety climate and standard precaution adherence, observational standard precaution adherence data, and existing unit level data on healthcare worker exposures and HAI. The approach included using novel tools and methodology to train hospital based staff on observational surveillance methodology, fostering the NORA Research to Practice (r2P) goals. A total of 5,285 standard precaution observations and 452 surveys were collected across 43 units in 13 hospitals from 6 states. Data was pooled from these four sources and the analytic approach accounted for other important hospital and nurse factors, to determine whether hospital units with better patient safety climate have better standard precaution adherence and also have better healthcare worker and patient outcomes. Observed adherence to all categories of standard precautions by all provider categories was 64.4%, and there were significant differences by role of nurse, physician, and ancillary healthcare workers. We identified modifiable features of the safety climate that impede or facilitate the uptake of evidence-based recommendations for standard precaution behaviors, and are associated with better healthcare worker and patient outcomes. A combination of a positive patient safety climate, better standard precaution adherence, and key hospital characteristics, predict HAI and occupational health outcomes, explaining sizeable variance in MRSA (41%), CAUTI (23%), mucotaneous exposures (43%) and needlestick and sharps injuries (38%). Potentially modifiable organizational factors of nurse staffing and Magnet hospital status are important explanatory variables. Potential implications of this study include developing a model for surveillance methodology and training and generating actionable knowledge for institutional, governmental and academic stakeholders of important and modifiable features of the PSC to improve healthcare worker and patent safety. These breakthroughs also provide future orientation for policy makers to support research that further clarifies and disentangles the factors that meaningfully contribute to high-reliability organizations and positive patient and HCW outcomes. [Description provided by NIOSH]
• Subjects:
  Blood Blood-Borne Pathogens Communicable Diseases Health Personnel Hematologic Diseases Occupational Health Safety
• Keywords:
  Bloodborne Pathogens Health Care Workers Infection Prevention Infectious Diseases Methicillin Resistant Staphylococcus Aureus MRSA Nosocomial Infections Nurses Nursing Safety Climate Safety Practices Work Organization

  More +
• Series:
  Grant Final Reports
• Publisher:
  National Institute for Occupational Safety and Health
• Document Type:
  Text
• Funding:
  Grant
• Genre:
  Final Grant Report
• Place as Subject:
  New York ; OSHA Region 2
• CIO:
  National Institute for Occupational Safety and Health (NIOSH)
• Division:
  OEP - Office of Extramural Programs
• Topic:
  Workplace Safety & Health
• Location:
  North America
• Pages in Document:
  1-30
• NIOSHTIC Number:
  nn:20061903
• NTIS Accession Number:
  PB2022-100391
• Citation:
  Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, K01-OH-011186, 2020 Nov; :1-30
• Contact Point Address:
  Amanda Hessels, PhD, MPH, RN, CIC, CPHQ, FAPIC, Assistant Professor of Nursing, Columbia University, School of Nursing, 560 W. 168th Street, Room 630, New York, NY 10032
• Email:
  ah3269@cumc.columbia.edu
• Federal Fiscal Year:
  2021
• NORA Priority Area:
  Healthcare and Social Assistance
• Performing Organization:
  Columbia University Health Sciences - New York
• Peer Reviewed:
  False
• Start Date:
  20160901
• Source Full Name:
  National Institute for Occupational Safety and Health
• End Date:
  20190831
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:815992b4a9253f677a6f5c408126de4cc44dc71aa05504b52422a8a28e230dacb7fab1b46f740170cd0f7775e58f03d8fd41e11fbc7866b9a09df36a2a3f4894
• Download URL:
  https://stacks.cdc.gov/view/cdc/219042/cdc_219042_DS1.pdf
• File Type:
  [PDF - 705.77 KB ]