Patients in units with too few registered nurses ( RNs ) were 15 percent more likely to develop HAIs on or after the third day of exposure than were patients in units with adequate staffing for day and night shifts ."
( WISN ) to be a useful method to calculate the requirement of full-time equivalent infection preventionists based on actual workload . The researchers identified infection control activities , support activities and additional activities to be performed by four IPs with a total available working time of 6,132 hours for an annual workload of 6,238.25 (± 372 ) hours in an acute care hospital with 182 beds and 69,331 annual admissions . Core infection control activities consumed 78 percent of their time ; support and additional activities consumed the remaining 22 percent of their time . Active surveillance required 44 percent of their time and education consumed 32 percent of their time . WISN ratio of available staff and required staff was 0.75 . Through WISN ’ s eight steps , the researchers found that one additional full-time equivalent infection preventionist was identified as needed , which changed the staffing requirement from 3 to 4 .
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Hospital nurse understaffing may increase patients ’ risk for HAIs and reduce overall quality of care , ultimately leading to increased healthcare costs , Columbia Nursing research suggests . Patients in units with too few registered nurses ( RNs ) were 15 percent more likely to develop HAIs on or after the third day of exposure than were patients in units with adequate staffing for day and night shifts , lead author Jingjing Shang , PhD , RN , an associate professor , reported .
Such understaffing may produce excessive workloads for on-duty nurses and compromise their ability to conduct important protocols for identifying and preventing urinary tract infections , bloodstream infections , and pneumonia , Shang wrote . In addition to potentially decreasing nurses ’ well-being , understaffing may add to annual healthcare costs , she added . “ 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 .” In a cross-sectional analysis of data from more than 100,000 patients in a large urban hospital system , Shang and colleagues found that 15 percent of patient days had inadequate RN staffing levels during daytime shifts , while 6.2 percent of patient days had RN understaffing during both day and night shifts . Units with licensed practical nurses and nurse assistants were also understaffed , which contributed to patients ’ increased risk of HAIs , the researchers found .
Wrote Shang , “ 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 .”
In their study of unit-level staffing data to examine whether HAIs and nurse staffing are associated , Shang , et al . ( 2019 ) found that 15 percent of patient-days had one shift understaffed , defined as staffing below 80 percent of the unit median for a shift , and 6.2 percent had both day and night shifts understaffed . Patients on units with both shifts understaffed were significantly more likely to develop HAIs two days later . Of 100,264 patients , 4,390 ( 4.34 percent ) developed an HAI during hospitalization , including 2,594 ( 59.1 percent ) UTIs , 1,198 ( 27.3 percent ) BSIs , and 751 ( 17.1 percent ) PNUs . As Shang , et al . ( 2019 ) observe , “ Nurses play a critical role in the prevention of HAIs . In addition to providing bedside care , nurses often act as coordinators of the multidisciplinary healthcare team in the work of infection control and prevention … When a unit is understaffed , in our study ( staffing was below 80 percent of unit median ), nurses in the unit experienced excessive workloads . These heavy workloads may compromise infection prevention practices and surveillance activities for early recognition of signs and symptoms of infection . The effect of understaffing in one shift may be temporary as nurses may still manage to maintain patient surveillance . However , continuous understaffing throughout the day will undermine nurses ’ wellbeing , cause job-related stress , and negatively affect patient care . As indicated by our finding that patients in units understaffed for both day and night shifts were more likely to have HAIs , a break of continuous care due to nurse understaffing will directly affect patient outcomes . In addition , a continuous unit staff shortage may also indicate an underlying issue with the working environment . Nurse administrators need to implement effective solutions to ensure adequate nurse staffing and
provide safe and reliable care to acutely ill hospitalized patients .”
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A review by Mitchell , et al . ( 2018 ) of the relationship of hospital staffing and HAI risk found that most studies examined the relationship between nurse staffing and HAIs ( n = 50 , 92.6 percent ) and documented that nurse staffing variables were associated with an increase in HAI rates ( n = 40 , 74.1 percent ). Only five studies addressed nonnurse staffing , and those had mixed results . Physician staffing was associated with an increased HAI risk in 1 of 3 studies . Studies varied in design and methodology , as well as in their use of operational definitions and measures of staffing and HAIs . The researchers pointed to the organizational factors that influence the risk of HAIs , including nurse-to-patient ratio , level of nurse education , and job type ( temporary or permanent ). They also acknowledged that further compounding the issue is the need to use standardized HAI case definitions , adequate data sources , and complex risk adjustment methods . They explain , “ The web of causation linking staffing and HAI is difficult to understand and may include factors such as the complexity of the infection process , lack of time to comply with infection control measures , and jobrelated burnout . Methodological issues in studies examining the association between hospital staffing and adverse outcomes have also been identified . These include lack of application of standardized definitions of nurse staffing , different databases , and diverse risk adjustment methods . In addition , the temporal relationship between staffing and HAI occurrence has recently been noted as a methodological problem in studies examining hospital staffing and HAI . HAIs are by definition infections that occur 48 hours after hospital admission . Hence , staffing levels should be examined about 48 hours prior to detectable infection and not when the HAI is detected .”
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As we have seen , Weinstein , et al . ( 2008 ), who audited 42 papers , found that overall , the most common infection studied was bloodstream infection ( n = 18 ; 43 percent ). Most researchers examined nurse staffing ( n = 38 ; 90 percent ); of these , only 7 ( 18 percent ) did not find