VA Ann Arbor Healthcare System, Ann Arbor, MI; Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI; VA/UM Patient Safety Enhancement Program, Ann Arbor, MI.
Denver-Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, VA Eastern Colorado Health Care System, Aurora, CO; Department of Health Systems, Management, and Policy, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO.
Am J Infect Control. 2020 Jan;48(1):2-6. doi: 10.1016/j.ajic.2019.09.027. Epub 2019 Nov 7.
Psychological safety is a critical factor in team learning that positively impacts patient safety. We sought to examine the influence of psychological safety on using recommended health care-associated infection (HAI) prevention practices within US hospitals.
We mailed surveys to infection preventionists in a random sample of nearly 900 US acute care hospitals in 2017. Our survey asked about hospital and infection control program characteristics, organizational factors, and the use of practices to prevent common HAIs. Hospitals that scored 4 or 5 (5-point Likert scale) on 7 psychological safety questions were classified as high psychological safety. Using sample weights, we conducted multivariable regression to determine associations between psychological safety and the use of select HAI prevention practices.
Survey response rate was 59%. High psychological safety was reported in approximately 38% of responding hospitals, and was associated with increased odds of regularly using urinary catheter reminders or stop-orders and/or nurse-initiated urinary catheter discontinuation (odds ratio, 2.37; P = .002) for catheter-associated urinary tract infection prevention, and regularly using sedation vacation (odds ratio, 1.93; P = .04) for ventilator-associated pneumonia prevention.
We provide a snapshot of psychological safety in US hospitals and how this characteristic influences the use of select HAI prevention practices. A culture of psychological safety should be considered an integral part of HAI prevention efforts.
心理安全感是团队学习的一个关键因素，它对患者安全有积极影响。我们试图研究心理安全感对美国医院采用推荐的卫生保健相关感染（HAI）预防措施的影响。
我们于 2017 年向近 900 家美国急性护理医院的随机样本中的感染预防人员邮寄了调查。我们的调查询问了医院和感染控制计划的特征、组织因素以及预防常见 HAI 的实践。在 7 个心理安全感问题上得分为 4 或 5（5 分李克特量表）的医院被归类为心理安全感高。使用样本权重，我们进行了多变量回归分析，以确定心理安全感与采用某些 HAI 预防措施之间的关联。
调查的回复率为 59%。约 38%的应答医院报告了较高的心理安全感，与定期使用导尿管提醒或停止医嘱和/或护士主动停止导尿管的可能性增加相关（比值比，2.37；P=0.002），以预防导管相关尿路感染，以及定期使用镇静暂停（比值比，1.93；P=0.04），以预防呼吸机相关性肺炎。
我们提供了美国医院心理安全感的快照，以及这种特征如何影响某些 HAI 预防措施的使用。心理安全感文化应被视为 HAI 预防工作的一个组成部分。
