IMPACT OF PATIENT SAFETY CLIMATE ON INFECTION PREVENTION PRACTICES AND HEALTHCARE WORKER AND PATIENT OUTCOMES

PROJECT SUMMARYAligned with critical research gaps identified as a priority for the National Occupational Research Agenda(NORA) Healthcare and Social Assistance (HCSA) sector over the next decade, this proposed study willaddress NORA strategic goals to: Promote safe and healthy workplaces and optimize safety culture inhealthcare organizations; Reduce sharps injuries and their impacts among all healthcare personnel; and STOPtransmission of infectious diseases in HCSA settings among workers, patients and visitors. This NIOSHMentored Research Scientist Development Award supports the first step in a program of research thataddresses three intertwined and important public health problems: 1) high rates of healthcare worker (HCW)blood-borne pathogen exposures; 2) high rates of patient healthcare associated infections (HAI); and 3) lowlevels of standard precaution adherence.The specific project aims are to: 1) describe the direction and magnitude of relationships among patient safetyclimate and self-reported and observed standard precaution adherence; 2) identify the relationship betweenstandard precaution adherence and HCW blood-borne pathogen exposure and HAI; and 3) determine thedirect and indirect relationships among patient safety climate, observed and reported standard precautionadherence, and HCW and HAI outcomes. To achieve these aims we will conduct a multi-site, cross-sectionalstudy in a sample of 1600 hospital based nurses from 100 units in 50 U.S. hospitals and collect surveys onpatient safety climate and standard precaution adherence, observational standard precaution adherence data,and existing unit level data on HCW blood-borne pathogen exposures and HAIs. Using novel tools developedand pilot tested by the PI we will recruit and train hospital based staff on observational surveillancemethodology to foster the NORA Research to Practice (r2P) goals. We will pool data from these four sourcesand use advanced multilevel modeling, accounting clustering, and important hospital and nurse potentialconfounders to determine whether hospital units with better patient safety climate have better standardprecaution adherence and also have better HCW and patient outcomes.Findings from this study may identify modifiable features of the safety climate that impede or facilitate theuptake of evidence-based recommendations for standard precaution behaviors, and are associated with betterHCW and patient outcomes. Potential implications of this study include developing a model for surveillancemethodology and training and generating actionable knowledge for institutional, governmental, and academicstakeholders of important and modifiable features of the patient safety climate to improve HCW and patentsafety. To our knowledge, this study will be the first to examine these relationships, aligned with NORAstrategic goals.To accomplish this study a carefully constructed career development plan will be implemented aligned with theNORA research priority to prepare highly trained scientists to address occupational safety and health criticalissues. The long term goal of the plan is to prepare the candidate as a successful independent investigatorwith expertise in organizational factors that influence HCW behaviors and occupational health and patientsafety outcomes. The immediate goals of the training plan are to provide the candidate with an opportunityto 1) engage in intensive and extensive training focused on occupational health and safety, surveymethodology, advanced quantitative methods, and dissemination and translational science skills, and 2)conduct an independent research project examining the relationships among patient safety climate,standard precaution adherence and adverse HCW and patient outcomes. The Principal Investigator will beguided by a team of mentors and collaborators that include senior scientists and faculty with extensiveexperience in Occupational Health and Safety, Infection Prevention and Epidemiology, Survey methodologyand Biostatistics, and support from two national professional organizations.