Exploring the Impact of Negative Perceptions of Safety Climate on Standard Precaution Adherence Among Health Care Workers

Personal protection masks, gloves, and safety glasses

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While the influence of positive perceptions of safety climate on health care worker behaviors has been extensively documented, the potential impact of negative perceptions still needs to be explored, particularly regarding standard precaution (SP) adherence. A recent study in the American Journal of Infection Control bridges that gap, utilizing data from a multisite, cross-sectional survey of 452 nurses across 43 medical-surgical units. It identifies significant associations between negative perceptions of patient safety climate and adherence to SP among hospital-based nurses.

The study, “Associations between Negative Patient Safety Climate and Infection Prevention Practices,” was written by Cara Thurman Johnson, MPH, RN, research project manager for the University of North Carolina at Chapel Hill, North Carolina, and Amanda Hessels, PhD, MPH, RN, CIC, FAPIC, FDAAN, an assistant professor of nursing for the Columbia University School of Nursing, New York City, New York.

Central to a robust patient safety culture of reliable care is the adherence to SPs, which are critical in disrupting the transmission chain between patients and providers. SP practices such as hand hygiene, using personal protective equipment (PPE), and properly handling sharps are fundamental to safeguarding all parties involved. Despite their importance, there is a notable gap in research exploring the relationship between patient safety culture, SP adherence, health care worker exposure to bloodborne pathogens, and the incidence of preventable health care-associated infections (HAIs).

“We previously published research demonstrating how positive perceptions of patient safety climate can be predictors of SP adherence, HAIs, and occupational health outcomes,” the authors wrote. “While organizational leaders may seek and support those positive deviants as they can be influential, toxic negativity may exist at the unit level and be a powerful undercurrent that can potentially erode any progress towards patient safety aims. This research aims to identify if associations among negative perceptions of patient safety climate and observed and reported standard precaution adherence of hospital-based nurses exist and describe those relationships.”

Previous publications have detailed the study methods, demographics, and descriptive results. This cross-sectional study was conducted across 13 hospitals in 6 US states and focused on medical-surgical units. Data were collected through surveys of direct care nurses assessing patient safety climate and self-reported SP adherence, complemented by direct observations of SP adherence by health care workers.

Nurses evaluated 44 items across 12 dimensions of patient safety climate (eg, management support, nonpunitive environment) and 22 items related to the SP environment and self-reported SP adherence, using 5-point Likert scales (1 = low, 5 = high). Nurse liaisons observed SP opportunities, with 100-200 observations per unit at each hospital. The data were aggregated and analyzed at the unit level. The study received Institutional Review Board approval, with data collection spanning from January 2017 to October 2018.

The relationships between dimensions of patient safety climate and both reported and observed SP adherence were analyzed using Pearson correlation coefficients, with statistical significance set at P less than or equal to .05. Negative perceptions of patient safety climate dimensions, defined as ratings of 1 or 2, were analyzed as composite frequency scores at the unit level using STATA/MP13.1.

Data from 43 units in 13 hospitals across 6 states were analyzed. A total of 2,139 health care worker-patient encounters and 5,285 SP behavior instances were observed and aggregated per unit. The average response rate for the patient safety climate survey was 38.7% (n = 452).

Negative perceptions of patient safety and reported SP adherence in Feedback and Communication about Error were significantly correlated (r = .31, P = .04).

Significant correlations were identified between negative perceptions of patient safety climate. They observed SP adherence for Supervisor Expectations and Actions (r = -.35, p = .02) and Management Support for Patient Safety (r = -.35, p = .03), indicating lower overall SP adherence in units with negative ratings in these dimensions.

Specific associations with lower hand hygiene adherence were noted for negative perceptions of Supervisor Expectations and Actions (r = -.33, P = .03), Management Support for Patient Safety (r = -.32, p = .04), and Staffing (r = -.31, p = .05).

Lower levels of sharps adherence were associated with negative perceptions of Frequency of Events Reported (r = -.37, p = .03), and lower levels of safe handling of contaminated linens were linked to negative perceptions of Management Support for Patient Safety (r = -.43, p = .02).

This study aimed to determine whether hospital units with more frequently reported negative perceptions of patient safety climate also exhibited lower levels of SP adherence, both reported and observed. The findings suggest that negative perceptions of patient safety climate, particularly regarding management support, are significant factors influencing SP adherence. The authors write that this underscores the necessity for health care administrators to comprehensively understand and address the perceptions of all team members to foster successful interventions.

The authors note that their study is the first to report that negative nurse perceptions of patient safety climate are linked to poor adherence to SP practices among health care teams. The authors write that hospital leaders should be equally attentive to nurses who express negative views of the work environment as they are to those with positive perceptions. Targeted interventions to improve perceptions of management support for safety, supervisor expectations, and staffing may enhance adherence to critical practices like hand hygiene, sharps safety, and proper handling of contaminated linens.