Work Environment Makes a Difference When Tackling HAIs

Healthcare-associated infections (HAIs) are less likely to occur in favorable critical care work environments, according to a study of more than 3,200 nurses in the November issue of American Journal of Critical Care (AJCC).

HAIs are infections acquired while patients are receiving medical treatment for other conditions. These infections lead to the loss of tens of thousands of lives and cost the U.S. healthcare system billions of dollars each year. In addition, HAIs can have devastating emotional, financial and medical consequences. Among the most common HAIs are central line-associated bloodstream infections (CLABSIs), ventilator-associated pneumonia (VAP) and urinary tract infections (UTIs).

Titled The Critical Care Work Environment and Nurse-Reported Health Care-Associated Infections, the study found nurses working in favorable critical care environments were about 40 percent less likely to report that UTIs, VAP and CLABSIs occurred frequently (more than once a month) compared to nurses working in poor critical care work environments.

These findings substantiate efforts to focus on the quality of the work environment as a way to minimize the frequency of HAIs. The study also concludes that critical care nurses, as the largest group of clinicians providing direct care in intensive care units, are well positioned to influence the prevalence and prevention of HAIs in critically ill patients.

For the study, nurse researchers and professors from the Center for Health Outcomes and Policy Research (CHOPR) at University of Pennsylvania School of Nursing, Philadelphia, analyzed nurse survey and hospital data on the association between the critical care work environment and nurse-reported patient outcomes in four states during 2005 to 2008.

The sample included adult, nonfederal, acute care hospitals in New Jersey, Pennsylvania, California and Florida that responded to the American Hospital Association Annual Survey in 2007 and also had at least five critical care nurse respondents from the University of Pennsylvania Multi-State Nursing Care and Patient Safety Study. The final sample totaled 3,217 nurses from 320 hospitals, making it one of the largest samples of critical care nurses to date.

The studys lead author, Deena Kelly, RN, PhD, is a postdoctoral research fellow in the Department of Critical Care Medicine at the University of Pittsburgh School of Medicine. CHOPR co-authors include Ann Kutney-Lee, RN, PhD; Eileen T. Lake, RN, PhD; and Linda H. Aiken, RN, PhD.

Critically ill patients are particularly susceptible to healthcare-associated infections, and the nurse work environment may be a key organizational strategy for preventing them, Kelly says. Each hospitals critical care nursing staff, led by administrators and nurse managers, should examine how best to improve their work environment to mitigate the effects of HAIs in already vulnerable patients.

The results suggest that administrators and nurses focus their efforts on addressing weaknesses in their critical care work environments by using scores from of the 31-item Practice Environment Scale of the Nursing Work Index (PES-NWI) as a guide.

Implementing a primary care staffing model, ensuring appropriate support staff and resources are available and providing support for nurse managers are examples of interventions that might lower risk for development of HAIs, result in greater staff satisfaction and translate into improvements in multiple patient outcomes.

The survey findings are consistent with clinical reasoning that HAIs are sensitive to variation in nurses work environments because critical care nurses maintain patients central and urinary catheters, perform oral hygiene and encourage early mobility.

The study provides the latest data to support the link between work environments and patient outcomes, an underlying tenet of the American Association of Critical-Care Nurses healthy work environment initiative and its 2005 report, AACN Standards for Establishing and Sustaining Healthy Work Environments.

The research was supported in part by grants from the National Institute of Nursing Research and the National Heart, Lung, and Blood Institute.

Source: American Association of Critical-Care Nurses: