Nurse Burnout Linked to Risk for Hospital-Acquired Infections

Larry Hand

August 03, 2012

August 3, 2012 — Job-related burnout among nurses is "a plausible explanation" for some hospital-acquired infections among patients being treated for other conditions, according to an article published in the August issue of the American Journal of Infection Control. Reducing nurse burnout by 30% could prevent 4006 urinary tract infections and 2233 surgical site infections and save up to $69 million annually in healthcare costs, the authors estimate.

Prior research has suggested a link between nurse staffing and hospital-aquired infections, but the reason for the association has been unclear. To better understand the connection,Jeannie P. Cimiotti, DNSc, RN, from the New Jersey Collaborating Center for Nursing at Rutgers, the State University of New Jersey, Newark, and colleagues analyzed data from 3 merged sources: a study-specific survey of Pennsylvania nurses, the 2006 Pennsylvania Health Care Cost Containment Council (PHC4) report on hospital infections, and the annual survey on hospital characteristics by the American Hospital Association. In all, 161 acute care hospitals with an average of 227 beds and an average of 9758 patients reported infection data to the PHC4.

The researchers conducted the study-specific nurse survey in 2 phases. First, they mailed questionnaires to a random sample of registered nurses working at the 161 hospitals and living in Pennsylvania (n = 7076) and had a response rate of 41%. They then chose a random sample of 650 nurses who did not respond to the first survey to survey again, achieving a 92% response rate in that subsample with extensive follow-up and compensation.

The nurses had an average age of 44 years and an average total experience of 17 years. On average, they each cared for an average of 5.7 patients. Almost 37% (2544) of the nurses reported high levels of burnout.

The researchers found that 16 of 1000 patients acquired some type of infection at the study hospitals (8.6/1000 urinary tract, 4.2/1000 surgical site, 2.5/1000 gastrointestinal, and 2.1/1000 pneumonia). For modeling and further analysis, the researcher limited the types of infection in the study to urinary tract and surgical site infections, which are the 2 most prevalent types of infection reported in PHC4 and are infections that can be acquired in any hospital.

The authors calculate that an additional patient assigned to each nurse would produce a significant staffing coefficient of 0.86 (P = .02), or almost 1 additional urinary tract infection per 1000 patients, totaling 1351 additional infections. For surgical site infections, the coefficient amounted to .93 (P = .04).

In additional modeling, they found nurse burnout to be highly associated with urinary tract infections (β, 0.85; P = .02) and surgical site infections (β, 1.58; P < .01), a finding not reported in previous research.

"In other words, a 10% increase in a hospital's composition of high-burnout nurses is associated with an increase of nearly 1 urinary tract infection and 2 surgical site infections per 1,000 patients," the researchers write.

From a third modeling of data, the researchers did not find a significant staffing effect after adjusting for nurse burnout.

"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," the researchers write.

Limitations of the study include the fact that although all patients could be linked to the study hospitals, nurses could not be linked directly to specific patients, making it difficult to establish causality. The 2 infections modeled are also found in low-risk patients, while often infections occur in high-risk patients. However, the researchers controlled for severity.

"In this study, we provide a plausible explanation for the association between nurse staffing and health care–associated infections," the researchers write.

"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," they conclude.

This study was supported by the National Institute of Nursing Research, National Institutes of Health. The authors have disclosed no relevant financial relationships.

Am J Infect Control. 2012;40:486-490. Full text

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