Year: 2014
Type: conference-abstract
Abstract: Background. In the United States, central line-associated bloodstream infection (CLABSI) rates are used as a measure of healthcare quality. Many states mandate public reporting of CLABSI rates. Although it is assumed that publicizing CLABSI rates will improve patient safety, we do not know how healthcare workers perceive and respond to this policy. The objective of this study was to examine healthcare worker perceptions of public reporting of CLABSIs and to understand the consequences of this perception for their motivation to implement infection prevention practices. Methods. We conducted an innovative qualitative study combining 2250 hours of ethnographic observation of one hospital's infection prevention (IP) department coupled with 103 in-depth interviews with staff, purposively sampled to introduce variation by occupational role (doctors and nurses) and place in the organizational hierarchy (frontline clinicians, managers and hospital executives). Data were systematically analyzed in NVivo 10 using a modified grounded theory approach. Results. Frontline clinicians perceived that the National Healthcare Safety Network (NHSN) surveillance definitions for healthcare-associated CLABSI are poorly aligned with what they believe to be “truly” hospital acquired infections. That the data generated by the NHSN definitions had to be publicly reported provoked frontline clinician resistance. Three social consequences emerged as a result of mandatory public reporting of CLABSIs. First, the credibility of the hospital's IP staff was eroded by their strict adherence to NHSN definitions. Second, frontline clinicians perseverated on the inconsistencies between surveillance definitions and clinical diagnoses at the expense of confronting known gaps in practice. Third, staff perceived that other hospitals “gamed” their rates of CLABSI because of the subjectivities inherent in the NHSN definition. This decreased staff motivation to learn from other hospitals and to commit to improvement work locally. Conclusion. Public reporting of CLABSI rates may have the unintended social consequence of generating resistance amongst frontline staff that both distracts from and undermines the organizational goal of preventing infection. Disclosures. All authors: No reported disclosures.
Source: Open Forum Infectious Diseases
Authors: Julia E. Szymczak, Susan E. Coffin
Institution: Children's Hospital of Philadelphia
Language: English
Subfield: Infectious Diseases
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $4,053
OpenAlex ID: W2468518123