Volume 10, Number 11—November 2004
THEME ISSUE
ICEID & ICWID 2004
International Conference on Women and Infectious Diseases (ICWID)
Nurses’ Working Conditions: Implications for Infectious Disease
Patricia W. Stone*
, Sean Clarke†, Jeannie Cimiotti*, and Rosaly Correa-de-Araujo‡
, Sean Clarke†, Jeannie Cimiotti*, and Rosaly Correa-de-Araujo‡Table
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.
