Safety Dance

Reviewed by Lauren M. DiBiase, MS, University of North Carolina Hospitals

Psychological safety is defined as the degree to which people view the environment as conducive to interpersonally risky behaviors like speaking up if they witness an error or asking for help if they have concerns about an order. Greene et al. report out results from a cross-sectional survey intended to examine relationships between psychological safety and the use of specific infection prevention practices related to patient safety.  The survey was sent to infection preventionists in a random sample of 900 U.S. acute care hospitals and included questions about infection control program characteristics, organizational factors and use of specific evidence-based prevention practices. Multivariate logistic regression was conducted to determine associations between psychological safety and regular use of specific catheter-associated UTI (CAUTI), ventilator associated pneumonia, and general infection prevention practices.

Approximately a third of participating hospitals rated all seven psychological safety questions as “regular use” or “agree/strongly agree” and were categorized as having “high psychological safety.”  High psychological safety was associated with increased odds of regularly using urinary catheter reminders or stop-orders and/or nurse-initiated urinary catheter discontinuation (odds ratio, 2.37; 95% CI, 1.39-4.04) for CAUTI prevention, and regularly using sedation vacation (odds ratio, 1.93; 95% CI, 1.02-3.68) for VAP prevention.  Authors conclude that it’s not surprising that high levels of psychological safety are associated with frequent use of safety interventions such as nurse-initiated urinary catheter discontinuation or ventilator sedation vacation as these practices require communication between different disciplines and the willingness to speak up and challenge entrenched customs and practices.  Although nearly 80% of hospitals were involved in collaborative efforts to reduce healthcare associated infections (HAI), only 53% of hospitals reported receiving strong to very strong support for infection control programs from hospital leadership. Communication and teamwork interventions are a start to balancing role-based status and HAI prevention practices are an ideal platform to attempt culture change.  Ensuring infection prevention programs are well supported may provide a platform for organizations to build a culture of psychological safety that will ultimately improve overall patient safety.


Greene MT, Gilmartin HM, Saint S. Psychological safety and infection prevention practices: Results from a national survey. Am J Infect Control. 2020 Jan;48(1):2-6. doi: 10.1016/j.ajic.2019.09.027. Epub 2019 Nov 7. 10.1016/j.ajic.2019.09.027

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