Aligned with critical research gaps identified as a priority for the National Occupational Research Agenda (NORA) Healthcare and Social Assistance (HCSA) sector over the next decade, this proposed study will address NORA strategic goals to: Promote safe and healthy workplaces and optimize safety culture in healthcare organizations; Reduce sharps injuries and their impacts among all healthcare personnel; and STOP transmission of infectious diseases in HCSA settings among workers, patients and visitors. This NIOSH Mentored Research Scientist Development Award supports the first step in a program of research that addresses three intertwined and important public health problems: 1) high rates of healthcare worker (HCW) blood-borne pathogen exposures; 2) high rates of patient healthcare associated infections (HAI); and 3) low levels of standard precaution adherence. The specific project aims are to: 1) describe the direction and magnitude of relationships among patient safety climate and self-reported and observed standard precaution adherence; 2) identify the relationship between standard precaution adherence and HCW blood-borne pathogen exposure and HAI; and 3) determine the direct and indirect relationships among patient safety climate, observed and reported standard precaution adherence, and HCW and HAI outcomes. To achieve these aims we will conduct a multi-site, cross-sectional study in a sample of 1600 hospital based nurses from 100 units in 50 U.S. hospitals and collect surveys on patient safety climate and standard precaution adherence, observational standard precaution adherence data, and existing unit level data on HCW blood-borne pathogen exposures and HAIs. Using novel tools developed and pilot tested by the PI we will recruit and train hospital based staff on observational surveillance methodology to foster the NORA Research to Practice (r2P) goals. We will pool data from these four sources and use advanced multilevel modeling, accounting clustering, and important hospital and nurse potential confounders to determine whether hospital units with better patient safety climate have better standard precaution adherence and also have better HCW and patient outcomes. Findings from this study may identify modifiable features of the safety climate that impede or facilitate the uptake of evidence-based recommendations for standard precaution behaviors, and are associated with better HCW and patient outcomes. Potential implications of this study include developing a model for surveillance methodology and training and generating actionable knowledge for institutional, governmental, and academic stakeholders of important and modifiable features of the patient safety climate to improve HCW and patent safety. To our knowledge, this study will be the first to examine these relationships, aligned with NORA strategic goals. To accomplish this study a carefully constructed career development plan will be implemented aligned with the NORA research priority to prepare highly trained scientists to address occupational safety and health critical issues. The long term goal of the plan is to prepare the candidate as a successful independent investigator with expertise in organizational factors that influence HCW behaviors and occupational health and patient safety outcomes. The immediate goals of the training plan are to provide the candidate with an opportunity to 1) engage in intensive and extensive training focused on occupational health and safety, survey methodology, advanced quantitative methods, and dissemination and translational science skills, and 2) conduct an independent research project examining the relationships among patient safety climate, standard precaution adherence and adverse HCW and patient outcomes. The Principal Investigator will be guided by a team of mentors and collaborators that include senior scientists and faculty with extensive experience in Occupational Health and Safety, Infection Prevention and Epidemiology, Survey methodology and Biostatistics, and support from two national professional organizations.

Public Health Relevance

Nearly one in 25 patients has a hospital infection at any given time and one in 25 nurses suffers a blood-borne exposure every year. Basic procedures, termed ?standard precautions,? may prevent these outcomes but are not often used by healthcare workers. This study will examine the organizational factors that are associated with higher levels of standard precaution adherence and lower levels of health care worker exposures and patient infections in hospitals.

Agency
National Institute of Health (NIH)
Institute
National Institute for Occupational Safety and Health (NIOSH)
Type
Research Scientist Development Award - Research & Training (K01)
Project #
1K01OH011186-01
Application #
9162403
Study Section
Safety and Occupational Health Study Section (SOH)
Program Officer
Lioce, Maria
Project Start
2016-09-01
Project End
2019-08-31
Budget Start
2016-09-01
Budget End
2017-08-31
Support Year
1
Fiscal Year
2016
Total Cost
$108,000
Indirect Cost
Name
Columbia University (N.Y.)
Department
Other Health Professions
Type
Schools of Nursing
DUNS #
621889815
City
New York
State
NY
Country
United States
Zip Code
10032
Hessels, Amanda J; Liu, Jianfang; Cohen, Bevin et al. (2018) Severity of Illness Measures for Pediatric Inpatients. J Healthc Qual 40:e77-e89
Hessels, Amanda J; Murray, Meghan T; Cohen, Bevin et al. (2018) Perception of Patient Safety Culture in Pediatric Long-Term Care Settings. J Healthc Qual 40:384-391
Hessels, Amanda J; Paliwal, Mani; Weaver, Susan H et al. (2018) Impact of Patient Safety Culture on Missed Nursing Care and Adverse Patient Events. J Nurs Care Qual :
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Hessels, Amanda J; Murray, Meghan; Cohen, Bevin et al. (2017) Patient Safety Culture Survey in Pediatric Complex Care Settings: A Factor Analysis. J Patient Saf :
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Estinville, Michael Fritz; Hessels, Amanda; Davis, James (2017) Journal Club: Developing a user-friendly report for electronically assisted surveillance of catheter-associated urinary tract infections. Am J Infect Control 45:822-823
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