Analysis shows link between high psychological safety and adoption of infection prevention practices

Hospitals reporting high levels of psychological safety are more likely to have comprehensive infection prevention and control (IPC) programs, according to the results of a survey appearing in the American Journal of Infection Control (AJIC), the journal of the Association for Professionals in Infection Control and Epidemiology (APIC), published by Elsevier.

Psychological safety refers to the shared belief that team members will not be reprimanded, punished, or embarrassed for speaking up, sharing ideas, posing questions, raising concerns, or making mistakes.

Healthcare-associated infections (HAI) result in tens of thousands of deaths, costing the US healthcare system billions of dollars each year. Despite the presence of evidence-based guidelines focused on HAI prevention and the proliferation of large-scale HAI implementation initiatives, variation in the use of recommended infection prevention practices across US hospitals remains an issue.

Researchers at University of Michigan Medical School and the VA Ann Arbor Healthcare System conducted a survey of infection preventionists in a random sample of nearly 900 US acute care hospitals in 2017 to identify hospital and IPC program characteristics, organizational factors, and the use of practices to prevent common HAIs. Hospitals were also ranked based on seven psychological safety questions. Their analysis showed a positive link between high psychological safety and the adoption of infection prevention practices that require staff to speak up and challenge deep-rooted customs. Only 38 percent of responding hospitals were deemed to have a high level of psychological safety.

"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," stated the study authors. "Multiple studies have shown that organizational efforts to prevent HAIs require both technical and socioadaptive interventions. 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."

Although the use of some practices to prevent device-related HAIs has increased in recent years, several socioadaptive prevention practices are still not used as frequently as they could be, according to the study authors, particularly for prevention of catheter-associated urinary tract infections and ventilator-associated pneumonia.

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."

Karen Hoffmann, RN, MS, CIC, FSHEA, FAPIC, 2019 APIC President