Staffing and the risk of infection: A quantitative perspective

Patricia Stone 


Importance: Previous studies of the association between healthcare associated infections (HAIs) and nurse staffing are inconsistent and limited by methodological errors.

Objective: To examine whether HAIs and nurse staffing 2 days prior to infection onset are associated by using unit-level staffing data, adopting precise measure of HAIs from Centers for Disease Control and Prevention (CDC)’s National Healthcare Safety Network (NHSN), and risk adjusting for individual risks.

Design: Cross-sectional analysis of data from 2007 through 2012 linking nurse payroll data using multiple electronic medical data sources.

Setting: A large urban hospital system with three campuses.

Participants: 100,264 adult patients from ICUs, medical, medical/surgical, and step-down units.

Main Outcome Measure: A composite HAI measure (urinary tract infection, bloodstream infection, pneumonia) associated with standardized unit-level nurse staffing.

Results: On approximately 15% of patient-days there was 1 shift understaffed and 6.2% patient-days in which both day and night shifts were understaffed. 4.34% patients developed HAIs during the hospitalization. After adjusting for patient characteristics, unit type and unit turnover, patients on units with both shifts understaffed were significantly more likely to develop HAIs 2 days later (RN: hazard ratio: 1.15, 95% confidence interval, 1.02, 1.30; nursing supporting staff: hazard ratio, 1.11, 95% confidence interval, 1.01, 1.21).

Conclusions: These data suggest that low nurse staffing has a negative effect on patient outcomes such as HAIs.

About the College

The ACIPC is the peak body for Infection Prevention and Control professionals in the Australasian region. Our stated vision is the prevention and control of infection in our communities. We commenced in January 2012 bringing together the various State and Territory infection control associations formerly in AICA (The Australian Infection Control Association) to support and encourage collaboration across Australasia.

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