Hospital Safety Climate and Organizational Characteristics Predict HAIs and Occupational Health Outcomes According to Study


Findings provide the first published evidence of the relationship between standard precaution adherence and the safety of health care workers and patients.

Health care workers  (Adobe Stock, unknown)

Health care workers

(Adobe Stock, unknown)

According to a recent study, safety adherence, and patient safety climates affect the rates of health care-acquired infections (HAIs) or health care worker (HCW) sharps and splash exposures. The study was published in the American Journal of Infection Control and describes how investigators created a novel study to determine these relationships and how they are affected by each other.

Amanda J. Hessels, PhD, MPH, RN, assistant professor, Columbia University School of Nursing and Nurse Scientist at Hackensack Meridian Health and the lead author of the published study, discussed the study with Infection Control Today (ICT®) in this exclusive interview.

ICT: Please summarize the key findings and why they are important.

Amanda J. Hessels, PhD, MPH, RN: Key and high-level findings from this study that advance the state of the science in patient and occupational health safety follow:

First, patient safety climate correlates with higher levels of self-reported and observed standard precaution behaviors.

Second, observed adherence to standard precautions is low across all professions and disciplines, and key role distinctions are noted; this is novel as no studies have collected these types of observational standard precaution data and have relied on self-report adherence only.

Third, we identify and document specific standard precaution actions associated with HAI and occupational pathogen exposures.

Finally, by employing innovative methods, strategies, and approaches to collect and analyze multiple complex data sources, we identified direct and indirect relationships among patient safety climate, observed and reported standard precaution adherence, and HCW and HAI outcomes. For example, among key findings, sizeable variance in patient outcomes of MRSA and catheter-associated urinary tract infections (CAUTI) and HCW outcomes of mucotaneous and needlestick injuries—ranging from 23-43% —was identified using a set of key predictors, such as observed standard precaution adherence and patient safety climate, and organizational factors, some modifiable such as nurse staffing levels and hospital Magnet status.

This is important because in combination: a) these results indicate that a stronger patient safety climate, better standard precaution adherence, and key organizational characteristics predict key HAI and occupational health outcomes, and b) actions to improve hospital unit safety climate, standard precaution adherence, nurse staffing, and hospital professional practice environment can improve patient and occupational safety outcomes.

ICT: What is the practical application for this study's key findings for infection preventionists?

AJH: Of the above-suggested action categories, IPs are exceptionally qualified to positively impact provider adherence to standard precaution behaviors. IPs can translate these findings at the point of care by a) employing cross-cutting surveillance methodology that captures risks at the intersection of patient and occupational health and safety and b) delivering targeted interventions. By employing data collection methods and measures, IPs can identify where and how patients and providers intersect, assess risks to both groups and formulate, propose, and implement risk mitigation strategies within their organizations.These leaders can identify and implement prevention strategies based on local surveillance data, using instruments such as the Standard Precaution Observational Tool and other organizational information that is specific to their setting, whether it be a hospital, long-term care, critical access hospital, or other- standard precautions apply to all providers in all places for all patient’s safety.

I would also share with IPs that the process of collecting these data and training others within the organization was illuminating and allowed observers to “slow-down” and be present in the patient–provider interaction space. Trained observers reported back to me that they gained an enhanced awareness of what was actually happening in that space, a situational cognition, of the complexity of the coordination of HCW behaviors to care for patients, communicate with others, such as providers and families, and follow many complex standards of care (not only infection prevention but medication management, pressure ulcer prevention, and so forth). Thus, a practical application of this surveillance methodology may be enhanced situational awareness for members within an IP’s organization.

By employing data collection methods and measures, IPs can identify where and how patients and providers intersect, assess risks to both groups and formulate, propose, and implement risk mitigation strategies within their organizations.

ICT: What results surprised you, if any?

AJH: First, the process of conducting a novel, multi-site study that includes surveys, direct observations, and outcomes data can be completed with a network of support, including IPs and occupational health professionals, skilled researchers, frontline nurses, healthcare administrators, and professional organizational support, such as Association for Professionals in Infection Control and Epidemiology and Association for Occupational Health Professionals. This is the largest known project of its kind and includes 5,285 standard precaution observations and 452 surveys across 43 hospital units; this network of contributors advances science beyond their organizational walls.

Second, I was surprised that we identified these relationships because our sample was less than our intended aim. (Despite posthoc analyses that indicate we were sufficiently powered.) I was also surprised by the magnitude of variance explained in our statistical models and how pronounced the effect on needlestick, and other exposures were, particularly as these events are often underreported.

It was alarming when we examined our data descriptively and saw such high exposure rates. We are moving in the wrong direction, especially if these data were also underreported! In fact, findings from this study amplify the recently published Moving the Sharps Safety in Healthcare Agenda Forward in the United States: 2020 Consensus Statement and Call to Action, which declares that the risk of occupational exposure is greater today than at the time of the initial report and calls to redouble our efforts.

Moreover, our data pre-dates the COVID-19 pandemic, when evidence-based strategies to prevent HAIs and reduce occupational exposures existed and were well adopted in practice. And we are all aware of the accruing evidence that since the onset of the pandemic, rates of HAIs have increased, and likely unnecessary exposures have as well, with reasons nicely summarized in ICT 4/12/23. [Reducing CLABSI and CAUTI: What Is an Infection Preventionist’s Role?].

Finally, in this study, the most extensive study of standard precaution adherence, observed adherence was higher than I anticipated at 64.4%- though it remains suboptimal, particularly hand hygiene. This is deeply concerning, given the unintended consequences of this omission to patients and those that provide patient care.

ICT: What, if any, future research will there be related to this one?

AJH: Terrific and timely question!I am leading a large research project (funded by AHRQ 1R18HS026418) entitled “Simulation to Improve Infection Prevention and Patient Safety: The SIPPS Trial.” In this study, we are testing a simulation intervention designed to improve provider performance of standard precautions and prevent HAIs and occupational blood-borne pathogen exposures. We have already learned several key factors that facilitate or impede this type of intervention and will be eager to share them with ICT readership once finalized and available!


Amanda J. Hessels, PhD, MPH, RN, CIC, CPHQ, FAPIC, FAAN

New York, New York, USA

Hackensack Meridian Health, Ann May Center, Neptune, NJ

Jingwen Guo, MS

Columbia University Data Science Institute

New York, New York, USA

Cara T. Johnson, RN, MPH

Columbia University School of Nursing

New York, New York, USA

Elaine Larson, RN, PhD, FAAN, CIC

Columbia University School of Nursing

New York, New York, USA

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