Reduce nurses’ burden, reduce in-hospital infections

By Sarah Guy, MedWire Reporter

The rate of "burnout" felt by nurses could be directly related to the rate of hospital-acquired infections (HAIs) via staffing rates, indicate US study results.

The researchers found a significant positive association between the number of patients assigned to nurses and the rate of urinary tract and surgical site infection, but after accounting for nurse burnout - measured with the Maslach Burnout Inventory-Human Services Survey (MBI-HSS) - this staffing effect was no longer significant.

"We hypothesize 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 registered nurses," suggest Jeannie Cimiotti (The State University of New Jersey, Newark) and co-researchers.

And while job-related burnout has been associated with inferior medical care and patient satisfaction, its potential link to nurse staffing and patient HAIs remains unknown, they add, in the American Journal of Infection Control.

An average of 48 nurses from 161 acute care hospitals in Pennsylvania responded to the researchers' survey which sought demographic information as well as a response to the MBI-HSS. The team combined these results with national data on hospital infections, and data on US hospital characteristics.

Nurses cared for an average of 5.7 patients, and more than a third reported high levels of job-related burnout, with a score of at least 27 on the MBI-HSS. The two most common HAIs were catheter-associated urinary tract infection, at 8.6 per 1000 patients, and surgical site infections, at 4.2 per 1000 patients.

The researchers found that for every additional patient assigned to a nurse, the rate of urinary tract infection at the institution increased by 0.86, equating to almost one patient per 1000. In the current study population, that would equate to 1351 additional infections, remark Cimiotti et al.

Surgical site infection rates showed a similar, significant association with staffing levels, however; none of these associations retained statistical significance when the researchers adjusted the data for nurse burnout.

Indeed, high levels of nurse burnout were also highly associated with rates of HAIs, indicating that a 10% increase in a hospitals' composition of nurses with burnout equates to almost one additional urinary tract infection and almost two additional surgical site infections per hospital.

"Health care facilities can improve nurse staffing and other elements of the care environment and alleviate job-related burnout in nurses at a much lower cost than those associated with health care associated infections," Cimiotti and colleagues conclude.

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