Impact of the California Hospital-Acquired Infection Prevention Initiative on Patient Safety Practices

Background: From 2008-2010, the Blue Shield of California Foundation provided grants to 49 hospitals to participate in the California Hospital-Acquired Infection Prevention Initiative (CHAIPI) to improve patient safety. This learning collaborative adopted the Institute for Health Improvement Breakthrough Series that focused on HAI prevention processes, education, and applied quality improvements. The HAI prevention curriculum included best practice discussions and guides, as well as monthly performance measurement. Emphasis was placed on peer learning via monthly online seminars and biannual face-to-face meetings.

Objective: The objective of the research was to evaluate the impact of CHAIPI on hospital adoption and implementation of evidence-based patient safety practices and reduction of HAI rates.

Methods: Two statewide computer-assisted telephone surveys of California’s general acute care hospitals (non-specialty hospitals with 20 or more beds and an ALOS of <30 days were eligible) were conducted in the fall of 2008 and summer of 2010 (response rates: 78% and 74%, respectively).  Difference-in-difference methods were used to compare changes in process and HAI rate outcomes for two cohorts: 1) 43 participating CHAIPI hospitals, and 2) 128 non-CHAIPI general acute care hospitals that responded to both waves of the statewide survey. In addition, an online survey of CHAIPI participants was conducted to evaluate their experience in the collaborative (response rate: 88%).

Results: Hospital participating in CHAIPI made greater improvements between 2008 and 2010 in adoption (p=0.04) and implementation (p=0.02) of written evidence-based practices for preventing HAI and in assessing their compliance (p=0.08) with these practices compared to non-CHAIPI hospitals. In particular, CHAIPI hospitals were more likely to have implemented evidence-based practices to prevent Clostridium Difficile (p=0.01) and practices for appropriate hand hygiene (p=0.049). However, there were no statistically significant differences in changes in HAI rates between CHAIPI and non-CHAIPI hospitals over this same time period. The online survey results found that 86% of the CHAIPI participating hospitals reported a “positive” or “very positive” experience with the learning collaborative, and 95% report that CHAIPI participation benefited their hospital overall.

Conclusions: Participation in an active patient safety learning collaborative resulted in significant improvements in hospital adoption and implementation of patient safety practices compared to hospitals that did not participate in the collaborative. However, it may take additional time for evidence-based practices to translate into lower HAI rates.  The results suggest that all hospitals be offered the opportunity to participate in an active learning collaborative to improve patient safety.