Original article On the CUSP: Stop BSI: Evaluating the relationship between central lineeassociated bloodstream infection rate and patient safety climate profile Sallie J. Weaver PhD a, b, *, Kristina Weeks MHS a , Julius Cuong Pham MD, PhD a, c , Peter J. Pronovost MD, PhD a, d a Armstrong Institute for Patient Safety and Quality and Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD b Johns Hopkins Carey School of Business, Baltimore, MD c Armstrong Institute for Patient Safety and Quality, and Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD d Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD Key Words: Patient safety Organizational culture Central lineeassociated bloodstream infection Background: Central lineeassociated bloodstream infection (CLABSI) remains one of the most common and deadly hospital acquired infections in the United States. Creating a culture of safety is an important part of healthcareeassociated infection improvement efforts; however, few studies have robustly examined the role of safety climate in patient safety outcomes. We applied a pattern-based approach to measuring safety climate to investigate the relationship between intensive care unit (ICU) patient safety climate profiles and CLABSI rates. Methods: Secondary analyses of data collected from 237 adult ICUs participating in the On the CUSP: Stop BSI project. Unit-level baseline scores on the Hospital Survey on Patient Safety, a survey designed to assess patient safety climate, and CLABSI rates, were investigated. Three climate profile characteristics were examined: profile elevation, variability, and shape. Results: Zero-inflated Poisson analyses suggested an association between the relative incidence of CLABSI and safety climate profile shape. K-means cluster analysis revealed 5 climate profile shapes. ICUs with conflicting climates and nonpunitive climates had a significantly higher CLABSI risk compared with ICUs with generative leadership climates. Conclusions: Relative CLABSI risk was related to safety climate profile shape. None of the climate profile shapes was related to the odds of reporting zero CLABSI. Our findings support using pattern-based methods for examining safety climate rather than examining the relationships between each narrow dimension of safety climate and broader safety outcomes like CLABSI. Copyright Ó 2014 by the Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved. Central lineeassociated bloodstream infection (CLABSI) remains one of the most common and deadly hospital acquired infections in the United States. The most recently available estimates from the Centers for Disease Control and Prevention (CDC) indicate that approximately 41,000 patients experienced a CLABSI in 2011, and that approximately 1 in 4 affected patients died as a result. 1 In addition, CLABSIs represent a significant cost burden, with an estimated $17,000 (range $7288-$29,156) in added care expenses associated with each such infections. 1,2 Widespread patient safety efforts to reduce CLABSI focus on both the technical aspects of care (eg, clinical care procedures) and adaptive aspects of care (eg, behavioral norms among unit clinicians and staff regarding patient safety, teamwork, and communication, as reflected in the unit’s * Address correspondence to Sallie J. Weaver, PhD, Assistant Professor, Armstrong Institute for Patient Safety and Quality and Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, 750 E. Pratt St, 15th Fl, Rm 1544, Baltimore, MD 21202. E-mail address: sjweaver@jhu.edu (S.J. Weaver). The original Stop BSI work was supported in part by funding from the Agency for Healthcare Research and Quality (AHRQ), (Contract HHSA290200600022; Task Order 7). The secondary analyses and work reported here was supported by the Johns Hopkins Institute for Clinical and Translational Research (ICTR), which is funded in part by Grant 1KL2TR001077-01 from the National Center for Advancing Translational Sciences (NCATS), a component of the National Institutes of Health (NIH), and NIH Roadmap for Medical Research. The contents are solely the responsibility of the au- thors and do not necessarily reflect the official views of AHRQ, ICTR, NCATS, or NIH. Publication of this article was supported by the Agency for Healthcare Research and Quality (AHRQ). Conflicts of interest: None to report Contents lists available at ScienceDirect American Journal of Infection Control journal homepage: www.ajicjournal.org American Journal of Infection Control 0196-6553/$36.00 - Copyright Ó 2014 by the Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.ajic.2014.05.020 American Journal of Infection Control 42 (2014) S203-S208