| Summary: | Healthcare associated infections (HAI) continue to be a significant patient safety problem. Researchers have found that nurses; perception of organizational climate is associated with patient outcomes. However, given the increased prevalence of HAI, an examination of multiple organizational factors within the healthcare organization particularly amongst infection prevention and control staff is warranted. The purpose of this study was to gain a knowledge base on the issue of HAI in acute care hospitals and the role organizational climate plays in improving clinician;s performance and ultimately decreasing HAI rates. Guided by the integrative model of organizational climate and safety conceptual framework the specific aims were to: 1) systematically review published evidence examining relationships between organizational climate, adherence to infection prevention and control processes and HAI rates in hospital settings; 2) assess the psychometric properties of an organizational climate measure, the Leading a Culture of Quality (LCQ) scale, in a national sample of Infection Preventionists (IPs); and 3) identify setting characteristics that predict a more positive perception of organizational climate by the IP and measured by the LCQ revised, using a national sample. Ten studies, mostly cross sectional design, were included in the systematic review. There was evidence that positive perceptions of organizational climate as perceived by nurses and/or an intervention aimed at improving organizational climate are associated with decreased HAI rates and adherence to evidence based guidelines. The exploratory factor analysis on the LCQ identified a four factor solution explaining 59.65% of the total variance. The Cronbach's alpha of the new subscales ranged from .74 to .90 and .93 for the final composite LCQ, the LCQ revised. The subscales are: Psychological Safety, Organizational Leadership and Work Environment, HAI Prevention/Communication and Vision/Perspective of Organization. In a sample of 1,013 IPs, relationships were found between the structural characteristics examined and organizational climate. IPs who worked in hospitals that share or pool infection prevention resources with a larger facility perceived the climate more positively among 2 subscales (Psychological Safety β = 0.113, p-value = 0.006; HAI Prevention/Communication β = 0.129, p-value = 0.005) and the overall climate (β = 0.085, p-value = 0.027). IPs in hospitals with an Infection Control Director position in the Infection Control department perceived the organizational climate more positively among 3 subscales (Psychological Safety β = 0.120, p-value = 0.005; Organizational Leadership β = 0.198, p-value = 0.000; HAI Prevention/Communication β = 0.159 , p-value = 0.001) and the overall climate (β = 0.152, p-value = 0.000). IPs working in hospitals located in a rural area as compared to urban perceived organizational climate more negatively on all 4 subscales (Psychological Safety β = -0.123, p-value = 0.001; Organizational Leadership and Work Environment β = -0.099, p-value = 0.029; HAI Prevention/Communication β = -0.168, p-value = 0.002; Vision/Perspective of Organization β = -0.179, p-value = 0.000) and the overall climate (β = -0.124, p-value = 0.001). Also, IPs working in hospitals located in a suburban area as compared to urban perceived organizational climate more negatively among HAI Prevention/Communication (β = -0.111, p-value = 0.039). These findings suggest the need for additional support and organizational resources for the infection prevention and control department. As the issue of patient safety continues to progress, particularly around HAI, concerns of how to improve organizational systems to enable implementation and adherence to safety processes should be a priority on the research agenda. This is the first study to evaluate associations between structural characteristics of the hospital setting and organizational climate via the IP perspective using a large national sample. Future research should focus on other structural variables such as IP staffing. Also, further analyses on organizational climate and outcomes such as clinician adherence to evidence based practices and HAI rates should be conducted.
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