Columbia Nursing Study Finds Link Between Health Care Associated Infections and Nurse Understaffing

A unit-level nurse staffing study conducted by Columbia University School of Nursing found an association between nurse understaffing and health care associated infections (HAIs) in patients, demonstrating that understaffing increases the risk of HAIs, which adds billions to health care costs annually. HAIs included in the analysis were urinary tract infections, bloodstream infections, and cases of pneumonia. The study, published recently in the Journal of Nursing Administration and titled “Nurse Staffing and Healthcare Associated Infection, Unit-level Analysis,” was conducted using cross-sectional data from a large urban hospital system.

Nurse-Staffing Levels Impact Likelihood of HAIs

According to the study, which examined data from more than 100,000 patients, 15 percent of patient-days had one shift understaffed with registered nurses (defined as registered nurse [RN] staffing below 80 percent of the unit median for a shift) and 6.2% had both day and night shifts RN understaffed. Patients on units with both shifts understaffed with RNs were 15 percent more likely to develop HAIs on or after the third day of exposure to these periods of understaffing than were patients in units with both day and night shifts adequately staffed. The study also found units were understaffed with nursing supporting staff, defined as licensed practical nurses and nurse assistants, and this also increased patients’ risk of HAIs.

“As they often serve as coordinators within multidisciplinary health care teams, nurses play a critical role in preventing HAIs, which is a top priority for improving quality of care and reducing hospital costs,” said lead author Jingjing Shang, PhD, associate professor at Columbia Nursing. “Being at the forefront of infection control and prevention is a unique responsibility and opportunity for nurses, and our study shows that hospital administrators should ensure adequate nurse staffing to provide the safest patient care. This could be achieved through better nurse recruitment and retention practices, together with methods of managing burnout and fatigue.”

Excessive Workloads May Compromise Patient Care & Nurses’ Wellbeing

According to the study’s authors, when a unit was understaffed, nurses in the unit experienced excessive workloads. Such working conditions may compromise infection prevention practices and surveillance activities intended to recognize the signs and symptoms of infection. In addition, continuous understaffing may negatively impact nurses’ wellbeing and patient care.

HAIs: Serious But Preventable Problems

HAIs are serious but often preventable problems associated with high morbidity and mortality. Given the danger and prevalence of the condition, with approximately four percent of patients having one or more HAIs during their hospital stays, the U.S. government has taken steps to curbing the incidence of HAIs. For example, the Department of Health and Human Services has made eliminating HAIs a core feature of the department’s national health care improvement action plan. The Centers for Medicare & Medicaid Services also included HAIs in evaluating the performance of hospitals participating in its value-based purchasing programs.

In addition to Shang, the study’s other Columbia Nursing authors were: Jianfang Liu, PhD; Elaine Larson, PhD; and Patricia W. Stone, PhD. Funding for the study was provided by Health Information Technology to Reduce Healthcare-Associated Infections (HIT-HAIs) R01NR010822 by the National Institute of Nursing Research.

Read the full study in the Journal of Nursing Administration.