Previous research has linked invasive devices and clinical practice to hospital-acquired infections (HAIs). There is now evidence suggesting that elements of nursing care are also linked to the prevalence of HAIs.
Few studies have rigorously examined the possible underlying mechanisms of the relationship between nurse staffing and HAIs. In the American Journal of Infection Control, my colleagues and I had a study published that assessed job-related burnout among registered nurses to determine its accountability for the relationship between nurse staffing and infections acquired during hospital stays.
Burnout Affects Infection Rate
Our findings show that job-related burnout among nurses appears to be a plausible explanation for some HAIs. Nurses had an average total of 17 years experience, caring for an average of about six patients. Almost 37% reported high levels of burnout. At the hospitals involved in the study, 16 of 1,000 patients acquired some type of infection, particularly urinary tract infections (UTIs), surgical site infections (SSIs), and gastrointestinal infections, as well as pneumonia.
For modeling and further analysis, we limited the types of infection to UTIs and SSIs. As patient loads escalated, the number of UTIs and SSIs increased significantly. In additional modeling, nurse burnout was highly associated with these infections, a finding that hasn’t been reported in previous research. A 10% increase in a hospital’s composition of high-burnout nurses was linked to an increase of nearly one UTI and two SSIs per 1,000 patients.
Perhaps the most important finding from our model was that reducing nurse burnout by 30% could prevent more than 4,000 UTIs and more than 2,200 SSIs each year and save up to $69 million annually in healthcare costs. Even a 20% reduction in nurse burnout could prevent about 2,600 UTIs and nearly 1,500 SSIs each year and save about $46 million annually.
Alleviating Burnout Cheaper than HAIs
The results from our study are significant, considering the enormous burden of HAIs and the fact that insurance providers nationwide are denying payment for costs associated with these infections. It has been speculated that the cognitive detachment associated with high levels of burnout may result in inadequate hand hygiene practices and lapses in other infection control procedures among nurses. More data are needed to better understand these relationships. In the meantime, healthcare facilities can take many simple, cost-effective steps to alleviate job-related burnout in nurses at a much lower cost than those associated with HAIs.
Readings & Resources (click to view)
Cimiotti JP, Aiken LH, Sloane DM, Wu ES. Nurse staffing, burnout, and health care-associated infection. Am J Infect Control. 2012;40:486-490. Available at: http://www.ajicjournal.org/article/S0196-6553(12)00709-2/fulltext.
Alonso-Echanove J, Edwards JR, Richards MJ, et al. Effect of nurse staffing and antimicrobial-impregnated central venous catheters on the risk for bloodstream infections in intensive care units. Infect Control Hosp Epidemiol. 2003;24:916-925.
Sannoh S, Clones B, Munoz J, et al. A multimodal approach to central venous catheter hub care can decrease catheter-related bloodstream infection. Am J Infect Control. 2010;38:424-49.
Stone PW, Pogorzelska M, Kunches L, Hirschhorn LR. Hospital staffing and health care-associated infections: a systematic review of the literature. Clin Infect Dis. 2008;47:937-944
Manojlovich M, Sidani S, Covell CL, Antonakos CL. Nurse dose: linking staffing variables to adverse patient outcomes. Nurs Res. 2011;60:214-220.
Cimiotti JP, Haas J, Saiman L, Larson EL. Impact of staffing on bloodstream infections in the neonatal intensive care unit. Arch Pediatr Adolesc Med. 2006;160:832-836.
Frith KH, Anderson EF, Caspers B, et al. Effects of nurse staffing on hospital-acquired conditions and length of stay in community hospitals. Qual Manag Health Care. 2010;19:147-155.
McHugh MD, Kutney-Lee A, Cimiotti JP, et al. Nurses’ widespread job dissatisfaction, burnout, and frustration with health benefits signal problems for patient care. Health Aff (Millwood). 2011;30:202-210.