Is self-perceived personal behavior related to infection prevention safety culture?

Background: A growing body of evidence reveals the importance of evaluating and improving safety culture in efforts to eliminate healthcare-associated infections (HAI).  However, little is known about the extent to which perceptions of personal behavior are associated with safety culture, infection prevention practices and knowledge.  Under the Theory of Planned Behavior, greater social pressure to adhere to recommended infection practices should lead to changes in personal behavioral intentions and actual behavior. Objective: The primary aim was to assess whether higher scores on perceived personal behavior and knowledge were associated with HAI prevention practices and safety culture.  A secondary aim was to assess the extent to which these dimensions are influenced by healthcare worker experience and roles.
Methods: A cross-sectional survey was conducted of 316 staff across disciplines at five unrelated hospitals participating in an AHRQ-sponsored broad scale infection prevention initiative.  Questions were grouped into domains of demographics (5 items), perception of personal behavior (5 items), perception of personal knowledge (6 items), HAI prevention practices (5 items) and hospital safety culture (6 items). Linear regression evaluated the relationship between domains and perceived behavioral variables adjusting for demographic factors.

Results: Nurses were the largest category of respondents (38%); residents and interns the second largest group (18.8%), followed by physicians (7.9%) and respiratory therapists (7.6%).  The average years in healthcare was 17.0 (SD=12.0, median= 15, range 0 to 44).  Internal consistency was high for three domains (HAI prevention practices alpha = 0.70; hospital safety culture alpha = 0.85; and personal knowledge alpha = 0.62).  The mean response to “percent of time I always clean my hands before and after every patient” was 93.4 (SD=11.24, median=98, range 20-100). The mean estimate of “percent of time I am always able to follow standard operating procedures” was 93.7 (SD=8.25, median=95, range 50-100).  In the regression model, aggregate perception of personal behavior was positively associated with HAI prevention practice (p=0.02), hospital safety culture (0.003) and years in health care.  Comfort with stopping the line insertion was associated with hospital safety culture (p<0.001), personal knowledge (p=0.006) and years in healthcare (0.004) but not HAI prevention practices (p=0.62).

Conclusions: It is important to measure organizational safety culture to understand subjective norms as well as infection prevention practices when implementing broad-scale initiatives because each contributes independently to perceptions of personal behavior.  Efforts to improve safety culture together with continued training, monitoring and improvement in infection prevention practices, are likely to reap the benefit of changes in intended and actual behavior.