Abstract
Preventing central line-associated bloodstream infections (CLABSIs), a common and costly quality problem, is a national priority. Researchers have identified an evidence-based bundle of practices that reduce CLABSI yet hospital compliance with this bundle remains low. The purpose of this study is to assess whether differences in work environment -workload, quality of relationships, and prioritization of quality-are associated with variation in maximal CLABSI bundle compliance i.e., compliance 95-100% of the time in intensive-care units (ICUs). We conducted a cross-sectional study of U.S. hospital ICUs. Work environment and bundle compliance data were obtained from the 2011 Prevention of Nosocomial Infections & Cost Effectiveness Refined Survey completed by infection prevention directors, and ICU and hospital characteristics data from the National Healthcare Safety Network. Factor and multi-level regression analyses were conducted. Reasonable workload and prioritization of quality were found to be positively associated with maximal CLABSI bundle compliance. High-quality relationships had no significant effect after accounting for reasonable workload and prioritization of quality. Results suggest aspects of the staff work environment are associated with maximal CLABSI bundle compliance in ICUs. Hospitals could foster improvement in ensuring maximal CLABSI bundle compliance-a precursor to reducing CLABSI rates-by establishing reasonable workloads and prioritizing quality.
Published Version
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