Assessment of NABH Implementation and Its Impact on Patient Safety Indicators in Tertiary Care Hospitals

Background: Hospital accreditation is intended to convert broad quality aspirations into observable structures, processes, and accountabilities. In India, the National Accreditation Board for Hospitals & Healthcare Providers (NABH) has become an important mechanism for organizing hospital quality systems, infection prevention, medication management, documentation, and patient-safety governance. Yet the strongest question for hospital leaders is not whether accreditation produces better paperwork. It is whether implementation is followed by measurable changes in clinical harm. The supplied study manuscript reports a retrospective comparison of three tertiary care teaching hospitals in Dehradun, Uttarakhand, before and after NABH accreditation, focusing on device-associated infections and medication errors. [1] [2] [3] [4] [5] [6] [7] [8] [9] [10] [11] [12] Objective: To assess the reported association between NABH implementation and selected patientsafety indicators, with particular attention to central line-associated bloodstream infection (CLABSI), catheter-associated urinary tract infection (CAUTI), ventilator-associated pneumonia (VAP), surgicalsite infection (SSI), medication errors, and safety-reporting behavior. Methods: The study used a retrospective, observational, mixed-methods design. According to the supplied manuscript, three academic tertiary care hospitals transitioning from unaccredited status to full NABH accreditation between January 2022 and December 2025 were studied. Twelve months of preaccreditation data were compared with twelve months of post-accreditation data. Quantitative data were obtained from hospital information systems and internal quality incident registries. HAI measures were expressed using device-day or procedure denominators, while medication errors were categorized using the NCC MERP framework. Poisson regression was specified for rate comparisons, and patientsafety culture was assessed using the Hospital Survey on Patient Safety Culture. [13] [14] [15] [16] [17] [18] [19] [20] [21] [22] [23] Results: The supplied study reports a 41% reduction in CLABSI and a 34% reduction in CAUTI after accreditation. The manuscript gives absolute CLABSI rates of 4.8 versus 2.8 per 1,000 central-line days and CAUTI rates of 6.2 versus 4.1 per 1,000 catheter days. Medication-error reporting increased by 28% during the first six months after accreditation, while severe adverse drug events declined by 22% in the second post-accreditation year. These findings are interpreted through the literature on accreditation, infection-prevention bundles, reporting culture, human factors, and digital surveillance. [24] [25] [26] [27] [28] [29] [30] [31] [32] [33] [34] [35] Conclusion: The evidence supports a cautious interpretation: accreditation can provide an organizational infrastructure within which safer clinical practice becomes more reliable, but the certificate itself is not the causal agent. The reported reductions in CLABSI and CAUTI are compatible with the expected effects of standardized insertion and maintenance practices, device-necessity review, surveillance, staff accountability, and environmental redesign. The rise in reported medication errors is more plausibly interpreted as a reporting-culture signal when accompanied by a later reduction in severe harm. Sustained improvement will require measurement discipline, non-punitive learning systems, adequate infection-control staffing, clinical leadership, and selective use of electronic and predictive surveillance.