Nurse burnout linked to higher health-care associated infections

How to just say 'no' to a patient
How to just say 'no' to a patient

HealthDay News -- Pennsylvania hospitals reporting lower nurse staffing levels and higher levels of nursing burnout experienced higher rates of health-care associated infections, researchers found.

Risk for urinary tract infections rose 0.86 per 1,000 patients (P=0.02) and 0.93 per 1,000 patients for surgical site infections (P=0.04) for each patient added to a nurse's workload, Jeannie P. Cimiotti, DNSc, RN, of Rutgers University College of Nursing, and colleagues reported in the American Journal of Infection Control.

Furthermore, each 10% increase in the proportion of nurses with high scores on the Maslach Burnout Inventory-Human Services Survey, was associated with increases of 0.85 per 1,000 in urinary tract infections (P=0.02) and 1.58 per 1,000 in surgical site infections (P<0.01). 

In a statistical analysis, the researchers found that nurse burnout scores attenuated the association between staffing levels and infection rates.

"Based on our finding that the staffing-infection relationship is mediated by job-related burnout, practitioners should work to implement organizational changes known to build job engagement, such as educational interventions, performance feedback and social support, as strategies to reduce nurse burnout and thereby help control infections in acute care facilities," they wrote.

The data came from three sources: the 2006 American Hospital Association Annual Survey, which included 7,000 Pennsylvania nurses; the Pennsylvania Health Care Cost Containment Council report, which included data on healthcare-acquired infections in 161 hospitals; and annual hospital statistics compiled by the American Hospital Assocation.

Overall, 16 patients per 1,000 acquired some type of infection while hospitalized, the researchers found, with catheter-associated urinary tract infections (8.6 per 1,000) and surgical site infections (4.2 per 1,000) among the two most common types of infections.

After conducting a cost-savings estimate using CDC data on direct expenses related to treating infections, the researchers found that reducing nurse burnout 30% would result in an estimated 6,239 fewer total infections, with an annual cost savings of up to $68 million.

Study limitations included lack of data on specific patients cared for by nurses who participated in the study, which impeded the researchers' ability to determine causality.

Cimiotti JP et al. Am J Infect Control 2012; 40: 486-490.

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