Standard precautions, including hand hygiene and sharps safety, keep patients and staff safe, but adherence is suboptimal. An earlier systematic review shows an association between standard precaution compliance and overall safety climate. This study aimed to determine if adherence to standard precautions and safety climate were associated with healthcare associated infection (HAI) rates. Adherence rates were low (64%) and associated with HAI and healthcare worker needlesticks.

Health care-associated infections continue to be one of the most common health care-related complications. This systematic review including 67 studies identified several cost-effective interventions addressing health care-associated infections, including screening high-risk individuals, universal decolonization in intensive care units, hand hygiene, environmental cleaning, and surveillance. The authors found limited evidence evaluating the cost-effectiveness of other strategies such as education and training or use of personal protective equipment.

Hand hygiene is known to be a critical part of effective infection prevention and control. This study examined the level of hand hygiene implementation using the WHO Hand Hygiene Self-Assessment Framework global survey and its drivers. There were 3,206 organizations from 90 different countries that responded. Over half of the participants indicated they had intermediate hand hygiene implementation, particularly those with higher county income levels and facility funding. Implementation of alcohol-based hand rub stations was an important system change associated with improved scores.

The large burden placed on hospitals and healthcare providers during the COVID-19 pandemic has raised concerns about nosocomial transmission of the virus. This narrative review summarizes existing reports on nosocomial outbreaks of COVID-19 and the strategies health systems have implemented to control healthcare-associated outbreaks. The authors found little evidence describing the role of healthcare workers in reducing or amplifying infection transmission in healthcare settings.  

This thematic analysis explored variations in the impact of hand hygiene interventions to prevent healthcare-associated infections. The analysis identified several directions for future research, including exploring ways to avoid the Hawthorne effect, embed the interventions into wider patient safety initiatives, and develop systematic approaches to implementation.

Presenteeism among healthcare workers can lead to burnout and healthcare-associated infections, but prior research has found that significant numbers of healthcare workers continue to work despite having influenza-like illness. This study surveyed 249 healthcare workers and 284 non-healthcare workers from 49 countries about their behaviors when experiencing influenza-like illness between October 2018 and January 2019. Overall, 59% of workers would continue to work when experiencing influenza-like illness, and the majority of healthcare workers (89.2-99.2%) and non-healthcare workers (80-96.5%) would continue to work with mild symptoms, such as a mild cough, fatigue or sinus cold.  Fewer non-healthcare workers (16.2%) than healthcare workers (26.9%) would continue working with fever alone.

Prior research has shown that nurse staffing is an important consideration with regard to patient safety. Lower nurse-to-patient ratios are associated with increased mortality and have prompted policies mandating particular nurse staffing ratios, especially in the intensive care unit. To address the criticism that previous studies have compared different institutions with higher nurse staffing to those with lower staffing levels and that there may be other reasons for observed differences in patient outcomes, this study evaluated the relationship between inpatient mortality and exposure to shifts with decreased registered nurse staffing, lower nursing support staffing, and increased patient turnover at three sites within a single academic medical center. Consistent with prior studies, researchers found an association between low nurse and nursing support staffing and increased patient mortality; there was no association between patient turnover and mortality. An accompanying editorial advocates for additional prospective research on interventions put in place to address nurse staffing.

Researchers tested and validated a survey to measure safety culture in pediatric long-term care settings. The survey instrument was found to meet standards for reliability and concurrent validity, through association with overall safety ratings. They propose measuring and tracking safety culture using this survey in pediatric long-term-care facilities.

This matched case-control study examined costs and payments to hospitals related to hospital-acquired central line infections and catheter-associated urinary tract infections. Investigators found that hospitals could either experience financial penalty or gain depending on the particular payment structure for the patient. They suggest aligning payment structures more closely with safety goals.

Clostridium difficile diarrhea is a common and highly morbid health care–associated infection. This study demonstrated that when a hospitalized patient receives antibiotics, the next patient who occupies the same hospital bed is at risk for C. difficile infection. This finding highlights the importance of both antibiotic stewardship programs and environmental approaches to infection control.

This systematic review of interventions to prevent health care–associated infections identified organizational factors such as positive safety culture, hospital-wide infection control efforts, guidelines, training, auditing, feedback, and optimal staffing and ergonomics. The results suggest that reducing hospital-acquired infections requires a systems approach.

The seemingly simple act of hand hygiene has proved to be a formidable obstacle in patient safety, as hand hygiene rates remain unacceptably low at many hospitals. In this survey of hospitals participating in the World Health Organization's hand hygiene program, greater overall infection control staffing appeared to be associated with a higher level of engagement in the project.

Recent research has focused on identifying patient safety issues in the ambulatory setting. In this study, advanced practice nursing students recognized more than 800 patient safety issues during only 497 outpatient encounters.

Advanced practice nursing students reported witnessing a wide variety of errors in their training experiences, primarily related to communication between providers.

Infection control specialists had a more positive view of safety culture than did hospital quality directors, in this survey conducted at California hospitals.

Nursing students identified several categories of near misses relating to infection control practices in this study, using data from a Web-based voluntary reporting system.

This review examined programs that engage patients as partners in hand hygiene improvement. The authors report that successful programs include at least one of the following tactics: educational tools, motivational tools, or role modeling.

This study found that organizations that prioritized teamwork—specifically by using morning huddles among nurses—reported higher rates of hand hygiene. Although system factors may play a role in suboptimal hand hygiene, some observers have argued for greater emphasis on individual responsibility in this area.

Reporting on a consensus conference, this article outlines a research agenda to determine the influence of financial incentives on patient safety improvement efforts.

Engaging patients in safety efforts is required as one of the National Patient Safety Goals, and is a key component of providing patient-centered care. This review examines ways in which patients have been integrated into clinical decision-making, discusses examples of patient involvement in reducing medication errors and encouraging hand hygiene, and proposes a framework for including patients in safety efforts. Although patient engagement has significantly improved safety efforts in some circumstances, surveys have shown that patients may be reluctant to engage in safety programs if they feel they are being asked to challenge their health care providers.