Preventable Risk: The Impact of Behaviors and Perceptions of Hospital Staff on Healthcare-Associated Infection Rates in U.S. Hospitals

Abstract

In the United States, healthcare-associated infections are a huge source of medical and economic burden. Annually, there are 1.7 million cases of healthcare-associated infection in U.S. hospitals, which cause an estimated 98,987 deaths. Direct medical cost is also massive, estimated to range from $28.4 to 45.0 billion each year. Much of this cost, however, is preventable. Evidence-based infection control guidelines meant to reduce the incidence of infection are well-established; despite this, healthcare-associated infections have been on the rise. One major reason for this has been behavioral noncompliance with infection control guidelines, on the part of hospital health professionals. Prior studies, however, have been limited in scope and size. Our study contributes to this burgeoning area of research with analysis of behaviors and perceptions of hospital staff in 82 U.S. hospitals, over 6 states. Using 2010 survey data and infection records for the same year, we examine which components of behavior and perception are relevant. We corroborate earlier reports that resource availability and amount of knowledge are not as important in changing infection rate as other behaviors; we find that issues pertaining to enforcement and lack of participation by others are more pressing. Overall, we find that larger macro factors of support are less influential in changing infection rate than more direct and tangible factors, which are immediately relatable to infection control. Specific interventions such as video tutorials and fixed bonuses for clinicians based on reductions in infection are also significantly associated with decrease in infection burden.