Are ICU Nurses Working Conditions Linked to an Increase in HAIs?

I wanted to share with you a report from researchers at Columbia University School of Nursing that indicates that hospitals which provide their ICU nurses with better working conditions see a correlation to their healthcare-acquired infection (HAI) rate. We know that according to the Centers for Disease Control and Prevention (CDC), HAIs are the No. 6 cause of death in the United States and that nurses are a frontline defense against lapses in patient safety in ICUs if they are provided with the right environment in which to do their jobs.

The Columbia reports review of outcomes data for more than 15,000 patients in 51 U.S. hospital ICUs showed that those with high nurse staffing levels (average of 17 registered nurse hours per patient day) had a lower incidence of infections. Higher levels of overtime hours were associated with increased rates of infection and skin ulcers. On average nurses worked overtime 5.6 percent of the time. Nurses are the hospitals safety officers, remarks co-author Patricia W. Stone, PhD, MPH, RN, assistant professor of nursing at Columbia University Medical Center. However, nursing units that are understaffed and that have overworked nurses are shown to have poor patient outcomes. Improvements in nurse working conditions are necessary for the safety of our nations sickest patients. With the looming nursing shortage, hospitals direly need to address working conditions in order to help retain current staff now and recruit people into nursing in the future.

Researchers evaluated several measures of working conditions to assess their effect on hospital-associated infections. They analyzed the organizational climate as measured by nurse surveys, and reviewed objective measures of staffing, overtime and wages with payroll data. They also looked at hospital profitability and magnet accreditation. Findings revealed that ICUs with higher staffing had lower incidence of central line-associated bloodstream infections (CLSBI), a common cause of mortality in intensive care settings. Other conditions such as ventilator-associated pneumonia and skin ulcers, were also reduced in units with high staffing levels. Patients were also less likely to die within 30 days in these higher-staffed units. Increased overtime hours in ICUs were associated with increased rates of catheter-associated urinary tract infection, as well as increased rates of skin ulcers on patients.

Our careful analysis found that decisions related to staffing, overtime, and overall work environment directly affected patient safety outcomes, says Andrew W. Dick, PhD, a senior health economist at the RAND Corp. and a co-author of this study. Involvement from hospital administrators, staffing professionals, legislators and consumers is needed in order to address problems in the ICU work environment.

Our hope is that with concentrated efforts, we can prevent hospital infections and improve patient safety in ICUs.

One possible solution presented in the study suggests increasing the availability of highly-qualified float nurses through cross training. This would allow hospitals to more appropriately staff their ICUs and further develop the skills of nursing staff based on other units. I say, how about hiring more nursing-educated infection control practitioners? And dont forget to give them the essential tools, resources and budgets they need.

Until next month, bust those bugs!

Kelly M. Pyrek 
Group Editor, Medical Division

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