Major article
Nurse staffing, burnout, and health care–associated infection

https://doi.org/10.1016/j.ajic.2012.02.029Get rights and content

Background

Each year, nearly 7 million hospitalized patients acquire infections while being treated for other conditions. Nurse staffing has been implicated in the spread of infection within hospitals, yet little evidence is available to explain this association.

Methods

We linked nurse survey data to the Pennsylvania Health Care Cost Containment Council report on hospital infections and the American Hospital Association Annual Survey. We examined urinary tract and surgical site infection, the most prevalent infections reported and those likely to be acquired on any unit within a hospital. Linear regression was used to estimate the effect of nurse and hospital characteristics on health care–associated infections.

Results

There was a significant association between patient-to-nurse ratio and urinary tract infection (0.86; P = .02) and surgical site infection (0.93; P = .04). In a multivariate model controlling for patient severity and nurse and hospital characteristics, only nurse burnout remained significantly associated with urinary tract infection (0.82; P = .03) and surgical site infection (1.56; P < .01) infection. Hospitals in which burnout was reduced by 30% had a total of 6,239 fewer infections, for an annual cost saving of up to $68 million.

Conclusions

We provide a plausible explanation for the association between nurse staffing and health care–associated infections. Reducing burnout in registered nurses is a promising strategy to help control infections in acute care facilities.

Section snippets

Methods

In this study, we analyzed secondary data from a 2006 survey of 7,076 registered nurses working in 161 hospitals in Pennsylvania. We merged 3 data sources: the nurse survey data, the 2006 Pennsylvania Health Care Cost Containment Council (PHC4) report on hospital infections, and the American Hospital Association (AHA) Annual Survey on hospital characteristics. The PHC4 data on health care–associated infections are not identified by administrative patient discharge data codes, but rather

Data analysis

Descriptive information is provided for the hospitals and nurses in our sample. We used ordinary least squares regression models to estimate the effect of nurse staffing on infection rates, before and after controlling for nurse and hospital characteristics. We estimated 3 linear regression models for both types of hospital infections to assess the individual effect of nurse staffing on infection rate, and the extent to which nurse burnout could explain that effect. In our first model, we

Results

Characteristics of the study hospitals and nurses used as controls are summarized in Table 1. Our sample included 161 acute care Pennsylvania hospitals that provided infection data to the PHC4 and nurses who were surveyed and employed in those same hospitals. The average number of beds per hospital was 227, almost half of the hospitals were identified as teaching hospitals, and 40% were high-technology hospitals. On average, nurses cared for 5.7 patients, the average number of patients per

Discussion

In this study, we examined the effect of nurse staffing and burnout on health care–associated urinary tract and surgical site infections. Our findings confirm an association between nurse staffing and health care–associated infection rates, with fewer infections seen in hospitals in which nurses care for fewer patients. The higher rate of infections in hospitals in which nurses care for more patients seems to be related, at least in part, to the high nurse burnout associated with heavier

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    Research for this article was conducted at the Center for Health Outcomes and Policy Research, University of Pennsylvania School of Nursing, Philadelphia, PA.

    Supported by the National Institute of Nursing Research, National Institutes of Health (grant R01-NR004513).

    The authors have no conflicts of interest to disclose.

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