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Volume 10, Number 11—November 2004

International Conference on Women and Infectious Diseases (ICWID)

Nurses’ Working Conditions: Implications for Infectious Disease

Patricia W. Stone*Comments to Author , Sean Clarke†, Jeannie Cimiotti*, and Rosaly Correa-de-Araujo‡
Author affiliations: *Columbia University School of Nursing, New York, New York, USA; †University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA; ‡Agency for Healthcare Research and Quality, Rockville, Maryland, USA

Main Article


Summary of studies on nurse staffing and healthcare-associated infectionsa

Investigator Sample Findings
Outbreak investigations
   Anderson et al. (17) 36-bed neonatal ICU; 8 cases During MRSA outbreak, 42% staff untrained, 
up to 62% from outside facility
   Archibald et al. (28) 1 pediatric ICU; 43 patients Decrease 2 infections/1,000 patient days for each 
unit increase in RN h: patient-day ratiob
   Fridkin et al. (25) 230-bed VA center; 170 patients Patient-nurse ratio increased during BSI outbreakc
   Harbarth et al. (22) 15-bed neonatal ICU; 8 cases Enterobacter cloacae outbreak terminated 
after decrease workload
   Vicca (23) 1 adult unit; 50 cases MRSAb cases associated with increase workload, 
decrease RN-patient ratio
Prospective studies
   Alonso-Echanove et al. (16) 8 ICUs; 4,535 patients Float RNs >60% central venous catheter days 
increased risk for BSId
   Haley et al. (26) 85-bed neonatal ICU; 76 infants MRSA infections increased within 1 month
 of worsening workloadc
   Robert et al. (21) 20-bed surgical ICU; 28 cases BSI associated with lower regular nurse-patient 
and higher pooled staff-patient ratiosb
Retrospective studies
   Amaravadi et al. (19) 32 hospitals; 353 patients Night nurse-patient ratio <1:2 associated with 
pneumoniac and BSIc
   Arnow et al. (27) 1 burn unit; 147 patients New cases MRSAb paralleled number of overtime h 
and number of shifts by outside staff
   Knauf et al. (30) 502 hospitals Pneumonia,c postoperative infection,c UTIc associated 
with low RN h and skill mix
   Kovner et al. (15) 530–570 hospitals; 10 states Increase nurse h per adjusted patient day associated 
with decreased pneumoniac
   Kovner & Gergen (24) 589 hospitals; 1,993 patients Increase RN FTEs associated with decreased UTIb 
and pneumoniab
   Lichtig et al. (20) 1,575 hospitals Pneumonia,b postoperative infection,b UTIb associated 
with low RN skill mix
   Needleman et al. (29) 799 hospitals; 6,180,628 patients Higher proportion RN h, higher RN h per day 
resulted in decreased UTIb
   Stegenga et al. (18) 44-bed pediatric unit; 
2,929 admissions <10.5 nurse h per patient day resulted in increased gastrointestinal infectionsc

aHAI, healthcare-associated infections; RN, registered nurse; MRSA, methicillin-resistant Staphylococcus aureus; BSI, bloodstream infection; UTI, urinary tract infection; VA, Veterans Administration; ICU, intensive care unit; FTE, full-time equivalent.
bSignificant at <0.005.
cSignificant at <0.05.
dSignificant at 0.01.

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