title: On the CUSP: Stop BSI: evaluating the relationship between central line-associated bloodstream infection rate and patient safety climate profile.
abstract: BACKGROUND
  Central line-associated bloodstream infection (CLABSI) remains one of the most common and deadly hospital acquired infections in the United States. Creating a culture of safety is an important part of healthcare-associated infection improvement efforts; however, few studies have robustly examined the role of safety climate in patient safety outcomes. We applied a pattern-based approach to measuring safety climate to investigate the relationship between intensive care unit (ICU) patient safety climate profiles and CLABSI rates.
  
  
  METHODS
  Secondary analyses of data collected from 237 adult ICUs participating in the On the CUSP: Stop BSI project. Unit-level baseline scores on the Hospital Survey on Patient Safety, a survey designed to assess patient safety climate, and CLABSI rates, were investigated. Three climate profile characteristics were examined: profile elevation, variability, and shape.
  
  
  RESULTS
  Zero-inflated Poisson analyses suggested an association between the relative incidence of CLABSI and safety climate profile shape. K-means cluster analysis revealed 5 climate profile shapes. ICUs with conflicting climates and nonpunitive climates had a significantly higher CLABSI risk compared with ICUs with generative leadership climates.
  
  
  CONCLUSIONS
  Relative CLABSI risk was related to safety climate profile shape. None of the climate profile shapes was related to the odds of reporting zero CLABSI. Our findings support using pattern-based methods for examining safety climate rather than examining the relationships between each narrow dimension of safety climate and broader safety outcomes like CLABSI.
authors.affiliation: Armstrong Institute for Patient Safety and Quality and Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD; Johns Hopkins Carey School of Business, Baltimore, MD. Electronic address: sjweaver@jhu.edu.
authors.forename: Sallie J
authors.initials: SJ
authors.lastname: Weaver
authors.affiliation: Armstrong Institute for Patient Safety and Quality and Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: Kristina
authors.initials: K
authors.lastname: Weeks
authors.affiliation: Armstrong Institute for Patient Safety and Quality and Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD; Armstrong Institute for Patient Safety and Quality, and Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: Julius Cuong
authors.initials: JC
authors.lastname: Pham
authors.affiliation: Armstrong Institute for Patient Safety and Quality and Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Pronovost
mesh_terms: D000328:Adult; D016470:Bacteremia / Q000453:epidemiology / Q000517:prevention & control*; D055499:Catheter-Related Infections / Q000453:epidemiology* / Q000517:prevention & control*; D002405:Catheterization, Central Venous / Q000009:adverse effects; D003428:Cross Infection / Q000453:epidemiology / Q000517:prevention & control; D003625:Data Collection; D006801:Humans; D017053:Infection Control / Q000379:methods*; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D061214:Patient Safety; D016012:Poisson Distribution; D058996:Quality Improvement; D057566:Self Report; D014481:United States
keywords: Central line–associated bloodstream infection; Organizational culture; Patient safety