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Leapfrog Hospital Safety Score, Magnet Designation, and Healthcare-Associated Infections in United States Hospitals

Pakyz, Amy L. PharmD, MS, PhD; Wang, Hui PhD; Ozcan, Yasar A. PhD; Edmond, Michael B. MD, MPH, MPA; Vogus, Timothy J. PhD
Journal of Patient Safety: Post Author Corrections: April 27, 2017
doi: 10.1097/PTS.0000000000000378
Original Article: PDF Only


Healthcare-associated infections (HAIs) pose a challenge to patient safety. Although studies have explored individual level, few have focused on organizational factors such as a hospital's safety infrastructure (indicated by Leapfrog Hospital Safety Score) or workplace quality (Magnet recognition). The aim of the study was to determine whether Magnet and hospitals with better Leapfrog Hospital Safety Scores have fewer HAIs.


Ordered probit regression analyses tested associations between Safety Score, Magnet status, and standardized infection ratios, depicting whether a hospital had a Clostridium difficile infection (CDI) and methicillin-resistant Staphylococcus aureus (MRSA) bloodstream infection standardized infection ratio that was “better,” “no different,” or “worse” than a National Benchmark as per Centers for Disease Control and Prevention's National Healthcare Safety Network definitions.


Accounting for confounders, relative to “A” hospitals, “B” and “C” hospitals had significant and negative relationships with CDI (−0.16, P < 0.01, and −0.14, P < 0.05, respectively) but not MRSA bacteremia. Magnet hospitals had a significant and positive relationship with MRSA bloodstream infections (0.74, P < 0.001) but a significant negative relationship with CDI (−0.21, P < 0.01) compared with non-Magnet.


A hospitals performed better on CDI but not MRSA bloodstream infections. In contrast, Magnet designation was associated with fewer than expected MRSA infections but more than expected CDIs. These mixed results indicate that hospital global assessments of safety and workplace quality differentially and imperfectly predict its level of HAIs, suggesting the need for more precise organizational measures of safety and more nuanced approaches to infection prevention and reduction.

Correspondence: Amy L. Pakyz, PharmD, MS, PhD, Department of Pharmacotherapy and Outcomes Science, School of Pharmacy, Virginia Commonwealth University, 410 N 12th St, Box 980533, Richmond, VA, 23298 (e-mail:

Merck & Co, Inc investigator-initiated grant funding (to A.L.P.). The other authors disclose no conflict of interest.

This project was supported by grant number K08HS018578 (to A.L.P.) from the Agency for Healthcare Research and Quality.

Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved