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Nurse staffing, burnout linked to HAIs

According to a recent study published in the August issue of the American Journal of Infection Control, nurse burnout has been linked to higher rates of healthcare-associated infections (HAIs), which therefore costs hospitals millions of additional dollars each year.

Researchers from the Center for Health Outcomes and Policy Research at the University of Pennsylvania School of Nursing looked at data from more than 7,000 registered nurses at 161 hospitals in Pennsylvania to study the effect of nurse staffing and burnout on catheter-associated urinary tract infections (CAUTI) and surgical site infections (SSIs). All of the data used for the study was previously collected from the Pennsylvania Health Care Cost Containment Council, the American Hospital Association Annual Survey and a 2006 study of hospitals and nurses in the state.

[See also: HAI report highlights improvement at Pennsylvania hospitals]

According to lead author Jeannie Cimiotti, more than a third of the nurses in the study said they had an emotional exhaustion score of 27 or greater on the Maslach Burnout Inventory-Human Services Survey, which is the equivalent of being "burned out."

"HAIs are a major problem. We have to step back and realize there are several factors that could contribute to these infections. There's been a decade or more of research on staffing related to infections but never a real explanation as to why this might be occurring," said Cimiotti. "We are the first to suggest that perhaps its burnout. The concept of burnout itself – it's a multifactorial syndrome. Disorganizational factors play into it."

Cimiotti mentioned that when there are understaffing problems and a lack of teamwork and support, it leads to increased stress. "The providers detach from the environment, both emotionally and cognitively, and that's when these errors often occur," she added.

According to the study, nurses had an average patient load of 5.7 patients. For every additional patient assigned to a nurse, there was about one extra catheter-associated urinary tract infection per 1,000 patients. When hospitals have 10 percent more burnt-out nurses, there was an additional one catheter-associated infection and two additional surgical site infections per 1,000 patients.

[See also: HAIs add millions to health system costs, harm patients]

"The nice thing about nurse burnout is that hospitals can improve the organizational climate for nurses at no cost. They don't have to make a monetary investment to improve the culture, they just have to support nurses and allow them to have more autonomy, make them more a part of the decision process and support that process," said Cimiotti. "It helps to foster these great relationships within an organization."

Using the per-patient average costs associated with CAUTIs ($749 to $832 each) and SSIs ($11,087 to $29,443 each), the researchers estimate that if nurse burnout rates could be reduced to 10 percent from an average of 30 percent, Pennsylvania hospitals could prevent an estimated 4,160 infections annually with an associated savings of $41 million.

"Infections cost a lot of money and payers don't want to pay for them and CMS is not going to pay for them anymore. That puts the hospital at a loss when they are already suffering in this economic climate," said Cimiotti. "Hospitals must be adequately staffed, and you can increase the workload as long as you have the environment to support them. Again, this doesn't cost anything."

[See also: Nurses at Massachusetts hospital take pay cut for 'safer' staffing levels]

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