For the most part, hospital administrators don’t give infection preventionists the help they need. That’s just one of the findings in a survey published today in the American Journal of Infection Control, the journal of the Association for Professionals in Infection Control and Epidemiology (APIC).In 2017, investigators with University of Michigan Medical School and the VA Ann Arbor Healthcare System surveyed infection preventionists at about 900 hospitals (59% of which responded) about the link between good management of hospital-acquired infections (HAIs) and “psychological safety,” the feeling among employees that they can speak out about problems without fear of being reprimanded, punished, or embarrassed for sharing ideas, posing questions, raising concerns, or making mistakes.
And although nearly 80% of the hospitals were making a concerted effort to reduce HAIs, only 53% of infection preventionists said that they received strong support for infection control programs from hospital leadership.
“Over 41% of hospitals reported they had a hospital epidemiologist, and 62% had a lead infection preventionist certified in infection control,” the study states. “Less than half (47%) of hospitals had a program engaging patients and families in infection prevention.”
Hospitals that scored 4 or 5 (5-point Likert scale) on 7 psychological safety questions were classified as high psychological safety, the survey states. “Using sample weights, we conducted multivariable regression to determine associations between psychological safety and the use of select HAI prevention practices.”
High psychological safety, reported by about 38% of the respondents, meant increased odds of regularly using urinary catheter reminders or stop-orders and/or nurse-initiated urinary catheter discontinuation for catheter-associated urinary tract infection prevention, and regularly using sedation for ventilator-associated pneumonia prevention.
The average bed size of the responding hospitals was 193 beds, and over 26% of them were affiliated with a medical school.
Investigators said that they found it “concerning” that a large majority of responding hospitals did display phycological safety, but they weren’t surprised. “Much of the literature on psychological safety provides little insight into how psychological safety unfolds and builds, or lessens, or even is destroyed,” the study states. “What is known is that an environment that supports psychological safety does not emerge naturally.”
There may be a simple remedy if hospital leaders are unsure if their institutions can be considered psychologically safe. They should ask.
“Psychological safety does not organically emerge; it must be fostered, supported, and routinely addressed so organizations can realize the positive impacts on performance and patient safety,” the study states. “HAI prevention practices are an ideal platform to attempt culture change, for it has been proposed that HAI prevention is a social problem that can be addressed through a professional movement with grassroots efforts.”
The study authors said in a press release that it is not surprising that high levels of psychological safety are associated with frequent use of socioadaptive safety interventions-those requiring personnel to speak up, ask for help, or provide feedback. “Multiple studies have shown that organizational efforts to prevent HAIs require both technical and socioadaptive interventions,” the study states. “Ensuring that infection prevention programs are well supported may enhance safety climates and provide a platform for organizations to build a culture of psychological safety to improve patient safety.”
APIC President Karen Hoffmann said in a statement that “with the increasing threat of antibiotic resistance, prevention of infection is more important than ever before. In order to effectively prevent HAIs and protect patients, healthcare facilities must cultivate environments that are psychologically safe and fully supported by leadership, so that comprehensive IPC programs can be fully implemented.”
The authors acknowledge some limitations in their research, including the fact that the data are self-reported and may only reflect the views of infection preventionists, and not all hospital employees. Also, participating hospitals (about 10% of hospitals in the US) may be different than non-participating hospitals.
“Despite these important limitations, we provide a snapshot of psychological safety among US hospitals, and how this organizational characteristic is related to the use of HAI prevention practices,” the study states.