Targeted implementation of the Comprehensive Unit-Based Safety Program through an assessment of safety culture to minimize central line-associated bloodstream infections
| Autor: | Jason P Richter, Ann Scheck McAlearney |
|---|---|
| Rok vydání: | 2018 |
| Předmět: |
Catheterization
Central Venous Safety Management medicine.medical_specialty Quality management Leadership and Management Strategy and Management Staffing Unit (housing) Odds 03 medical and health sciences Patient safety 0302 clinical medicine stomatognathic system medicine Humans 030212 general & internal medicine Safety culture Infection Control business.industry 030503 health policy & services Health Policy Health services research Quality Improvement Hospitals United States Catheter-Related Infections Emergency medicine Cusp (anatomy) Health Services Research Patient Safety 0305 other medical science business |
| Zdroj: | Health Care Management Review. 43:42-49 |
| ISSN: | 1550-5030 0361-6274 |
| DOI: | 10.1097/hmr.0000000000000119 |
| Popis: | Background Approximately 250,000 central line-associated bloodstream infections (CLABSIs) occur annually in the United States, with 30,000 related deaths. CLABSIs are largely preventable, and the Comprehensive Unit-Based Safety Program (CUSP) is a proven sustainable model that can be used to reduce CLABSIs. CUSP is a resource intensive program that, although widely used, has not been universally adopted. Purpose The purpose of this study is to identify the significant factors of safety culture prior to CUSP implementation associated with a reduction or elimination of CLABSIs. By identifying these factors, hospitals can target CUSP to those units expected to have the greatest odds of reducing CLABSIs. Methodology/approach Using logistic and negative binomial regressions, we analyzed 649 hospital units that completed the national On the CUSP: Stop BSI study between May 2009 and June 2012. Hospital units provided CLABSI rates and staff survey responses on perceptions of factors of safety culture prior to CUSP implementation and CLABSI rates for six quarters thereafter. Findings We found that hospital units reduced infection rates in the six quarters following CUSP implementation from 1.95 to 1.04 CLABSIs per 1,000 central line days. Most of the improvement occurred within the first two quarters following implementation. Hospitals with a stronger preimplementation safety culture had lower CLABSI rates at conclusion of the study. We found communication openness, staffing, organizational learning, and teamwork to be significantly associated with zero or reduced CLABSI rates. Practice implications CUSP appears to have a greater impact on CLABSI rates when implemented by units with a strong existing safety culture. Targeted implementation allows hospitals to optimize success, maximize scarce resources, and alleviate some of the CUSP program's cost concerns if CUSP cannot be implemented in all units. To enhance the impact of CUSP, hospitals should improve safety culture prior to implementation in units that poorly exhibit it. |
| Databáze: | OpenAIRE |
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