Nurse burnout, understaffing linked to hospital infections

More than a third of nurses reported being burnt out, linked to higher rates of healthcare-associated infections (HAI), according to a study published in the August American Journal of Infection Control.

Nurse burnout came from largely understaffing and can spell bad news not only for nurses but also for patient safety, researchers from the University of Pennsylvania's School of Nursing concluded.

Researchers looked at more than 7,000 registered nurses at 161 hospitals in the state to see how nurse staffing and burnout affected the two most common HAIs, catheter-associated urinary tract infections and surgical site infections, according to the study announcement. They found that more than a third said they had an emotional exhaustion score of 27 or greater on the Maslach Burnout Inventory-Human Services Survey, the equivalent of being "burned out."

When there are staffing problems and lack of teamwork and support, "stress builds up and builds up and builds up until the giver of care just detaches … all of a sudden they are doing work, but they are not even cognizant of what they are doing, they are so stressed," lead author Jeannie Cimiotti told The Philadelphia Inquirer about safety precautions like washing their hands.

Nurses had an average patient load of 5.7 patients. For every additional patient assigned to a nurse, there was about one extra catheter-associated urinary tract infection per 1,000 patients. And when hospitals have 10 percent more burnt-out nurses, there was an additional one catheter-associated infection and two additional surgical site infections per 1,000 patients.

"It is costing hospitals more money not to spend money on nursing," study author Linda H. Aiken, director of the university's Center for Health Outcomes and Policy Research, told the newspaper. If nurse burnout could be cut from the average 30 percent to 10 percent, Pennsylvania hospitals could prevent an estimated 4,160 infections with savings racking up to $41 million each year, the study said.

Staffing ratios have garnered particular attention in the state, when the health department found that two patient deaths at Carlisle Regional Medical Center were associated with low nurse staffing levels last year. Although the hospital insisted the quality of care is excellent, the Pennsylvania Department of Health found having too few nurses in the hospital did, in fact, play a part in one patient waiting for a hospital transfer and another patient waiting to undergo a scan.

On the other coast, California has gone as far as taking the controversial tactic of mandating nurse ratios since 1999. According to a 2011 Health Affairs study, state mandates could be working, as the number of registered nurse staff has increased, allaying some fears that hospitals would simply hire lower-skilled nurses to meet requirements.

For more information:
- see the research announcement
- read the article

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