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BMJ Qual Saf. 2018 Jun;27(6):464-473. doi: 10.1136/bmjqs-2017-006610. Epub 2017 Sep 26.

Evaluation of the association between Nursing Home Survey on Patient Safety culture (NHSOPS) measures and catheter-associated urinary tract infections: results of a national collaborative.

Author information

1
Division of General Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA.
2
Institute for Social Research, Quantitative Methodology Program, University of Michigan, Ann Arbor, Michigan, USA.
3
Department of Psychiatry, University of Michigan Medical School, Ann Arbor, Michigan, USA.
4
VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA.
5
Division of Geriatric and Palliative Medicine,Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA.
6
Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, Michigan, USA.
7
Institute of Gerontology, University of Michigan Medical School, Ann Arbor, Michigan, USA.
8
Division of General Pediatrics, Department of Pediatrics and Communicable Diseases, University of Michigan Medical School, Ann Arbor, Michigan, USA.

Abstract

BACKGROUND:

Recent efforts to reduce patient infection rates emphasise the importance of safety culture. However, little evidence exists linking measures of safety culture and infection rates, in part because of the difficulty of collecting both safety culture and infection data from a large number of nursing homes.

OBJECTIVE:

To examine the association between nursing home safety culture, measured with the Nursing Home Survey on Patient Safety Culture (NHSOPS), and catheter-associated urinary tract infection rates (CAUTI) using data from a recent national collaborative for preventing healthcare-associated infections in nursing homes.

METHODS:

In this prospective cohort study of nursing homes, facility staff completed the NHSOPS at intervention start and 11 months later. National Healthcare Safety Network-defined CAUTI rates were collected monthly for 1 year. Negative binomial models examined CAUTI rates as a function of both initial and time-varying facility-aggregated NHSOPS components, adjusted for facility characteristics.

RESULTS:

Staff from 196 participating nursing homes completed the NHSOPS and reported CAUTI rates monthly. Nursing homes saw a 52% reduction in CAUTI rates over the intervention period. Seven of 13 NHSOPS measures saw improvements, with the largest improvements for 'Management Support for Resident Safety' (3.7 percentage point increase in facility-level per cent positive response, on average) and 'Communication Openness' (2.5 percentage points). However, these increases were statistically insignificant, and multivariate models did not find significant association between CAUTI rates and initial or over-time NHSOPS domains.

CONCLUSIONS:

This large national collaborative of nursing homes saw declining CAUTI rates as well as improvements in several NHSOPS domains. However, no association was found between initial or over-time NHSOPS scores and CAUTI rates.

KEYWORDS:

nursing homes; quality measurement; safety culture

PMID:
28951531
PMCID:
PMC5869141
[Available on 2019-06-01]
DOI:
10.1136/bmjqs-2017-006610

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