Nurse understaffing increases risk of healthcare-associated infections

By Robert Fedele|
2019-06-04T16:00:11+10:00
May 29th, 2019|

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Nurse understaffing directly increases the risk of healthcare-associated infections (HAIs) such as urinary tract infections (UTIs) and pneumonia, new research has revealed.


The findings also point to chronic understaffing threatening nurses’ wellbeing, triggering job-related stress and negatively affecting patient care and outcomes.

Healthcare-associated infections (HAIs) are one of the most common, serious and preventable patient safety issues in health systems that can result in high morbidity and mortality and increased healthcare costs.

Led by Associate Professor of Nursing at the Columbia School of Nursing in New York, Dr Jingjing Shang, the study investigated the link between HAIs and nurse staffing by analysing how many nurses were on shift when patients acquired infections.

Researchers looked at six years of data between 2007 and 2012 from a large urban hospital system where HAIs were identified and assessed their association with nurse staffing two days before HAI onset while taking individual patient risk into account.

HAIs included in the analysis were UTIs, bloodstream infections and pneumonia.

Almost 5% of nonsurgical patients had at least one of the three infections during their 30-day hospital stay.

The study acknowledged that nurses play a critical role in the prevention of HAIs and in addition to providing bedside care, often act as coordinators of multidisciplinary healthcare teams carrying out infection control and prevention.

Results from the study, published recently in The Journal of Nursing Administration (JONA), showed patients who had an HAI during hospitalisation were significantly older, more likely to be female, more likely to have stayed in a skilled nursing facility prior to their admission, and had more comorbidities, medical procedures and treatments than those without HAIs.

About 19% of shifts in intensive care units lacked enough registered nurses (RNs), the highest understaffing found across all wards.

Further, RN understaffing was observed on 22% of patient days, with about 15% of patient days having one shift understaffed and 6.2% of patient days having both day and night shifts understaffed.

The rate of HAIs in patients with RN understaffing on both shifts two days prior to infection onset was 15% higher than for those staying in wards staffed at or above 80% of average staff numbers.

“Controlling for patients’ demographics, comorbidity, medical procedures, treatment, patient turnover, and unit type, we found significant associations between HAIs and RN and NS (nursing supporting staff) understaffing,” the report states.

The study’s authors say their findings confirm previous studies linking nurse understaffing and HAI’s but for the first time provide stronger data.

Their report calls on policymakers to ensure adequate nurse staffing and provide safe and reliable care to acutely ill hospital patients.

Understaffing directly contributes to excessive workloads for nurses, compromising infection prevention practices and surveillance activities for early detection of infection, according to the report.

“The effect of understaffing in one shift may be temporary as nurses may still manage to maintain patient surveillance,” the report concludes.

“However, continuous understaffing throughout the day will undermine nurse’s wellbeing, cause job related stress, and negatively affect patient care.”

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