Linking Nurse Staffing to Nosocomial Infections: A Potential Patient Safety Threat

Purpose: The goal of this paper is to inform the reader of the patient safety threat of nosocomial infections and its relationship to the nursing shortage. These elements are discussed in terms of the following: the decreasing nurse-to-patient ratios and the short-term remedy of float and agency nurses providing care. These elements are discussed in terms of their effect on the increasing rates of nosocomial infections and poor patient outcome. Materials and Methods: A review and collective analysis was conducted on published data pertaining to nosocomial infections and the nursing shortage. Results: The results from the collective analysis of evidence-based research concerning nosocomial infections and the nursing shortage indicate that the lack of adequate nursing staff contributes to the increased rate of infection. Conclusions: The nursing shortage decreases the nurse-to-patient ratio, increasing workload for nurses and decreasing time for infection control precautions. Float and agency nurses temporarily solve the gaps in staffing, but also create the problem of unfamiliarity with specific hospital and unit infection prevention practices. The consequences of the nursing shortage result in an increased nosocomial infection rate and poor patient outcome. Introduction and Overview According to the Centers for Disease Control and Prevention (CDC), healthcare-associated infections, or nosocomial infections, “are infections that patients acquire during the course of receiving treatment for other conditions within a healthcare setting” (1). In recent years, nosocomial infections have reached epidemic proportions and are one of the main concerns in the health care arena (2). A continuously increasing prevalence, 10 % of patients on general hospital units will acquire a nosocomial infection during their hospital stay. The risk for infection escalates to 1520% for those patients on intensive care units (3). Presently, two million patients each year acquire a nosocomial infection, approximately 90,000 succumbing to death. The risk for these infections poses a potential patient safety threat (4). Nosocomial infections not only affect patient health and safety, but also the health care system as a whole. It is estimated that nosocomial infections increase the cost of health care between $4.5 and $5.7 billion in patient care. In addition to monetary resources, nosocomial infections increase the number of days a patient spends in the hospital, requiring additional medical care and hours spent providing patient care. These costly infections divert funding and precious staff and nursing time from possible implementation of patient safety and infection control measures to protect patients (4). One of the most pertinent factors leading to nosocomial infections is noncompliance with infection control measures by health care providers (5). Heath care providers’ failure to abide by standard handwashing procedures leads to 10% of all nosocomial infections (3). When the nurse-to-patient ratio declines, the amount of care and time allotted to each patient also decreases. The Institute of Medicine reports that the estimated 98,000 preventable deaths were partly attributed to insufficient staffing of nurses (6). THE GEORGETOWN UNDERGRADUATE JOURNAL OF HEALTH SCIENCES 5 (2), 2008. According to Stone, Clarke, Cimiotti, and Correa-deAraujof, “In 60% of U.S. hospitals, vacancy rates for RNs have increased since 1999” (7). Fourteen percent of U.S. hospitals suffer from a severe nursing shortage with more than one-fifth of the registered nurse positions vacant. The American Hospital Association reports that of the 168,000 open positions in U.S. hospitals, 75% (126,000) are nursing positions. Already an immense health care concern, the scarcity of nurses is predicted by experts to increase in severity. Since 2004, the lack of and demand for nurses has grown by approximately 22%. By 2020, the nursing shortage is calculated to reach 800,000 vacant positions across the United States (7). There are many topics within the potential patient safety threat of nosocomial infections and its relationship to the nursing shortage. Two important components of this threat to patient safety that will be analyzed in this paper include: staffing levels (nurseto-patient ratios) and staff unfamiliar with the unit (float nurses and agency nurses). We will also discuss implications for nursing care within these topics, possible interventions and suggestions for future research. Analysis of the Link Between Staffing and Nosocomial Infections