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Better Working Conditions for Nurses Might Decrease Patient Infections

objective measures of staffing, overtime and wages with payroll data. They also looked at hospital profitability and magnet accreditation (a national recognition program for nursing excellence in hospitals). Patient outcome data came from the Centers for Disease Control and Prevention (CDC) National Nosocomial Infection Surveillance system and Medicare files.

After careful review, findings revealed that ICUs with higher staffing had lower incidence of central line associated bloodstream infections (CLSBI), a common cause of mortality in intensive care settings. Other measures such as ventilator-associated pneumonia and skin ulcers, which are common among hospitalized patients who cannot move regularly, were also reduced in units with high staffing levels. Patients were also less likely to die within 30 days in these higher-staffed units.

Increased overtime hours in ICUs were associated with increased rates of another common hospital-associated infection, catheter-associated urinary tract infection, as well as increased rates of skin ulcers on patients.

"Our careful analysis found that decisions related to staffing, overtime, and overall work environment directly affected patient safety outcomes," said Andrew W. Dick, Ph.D., a senior health economist at the RAND Corporation and a co-author of this study. "Involvement from hospital administrators, staffing professionals, legislators and consumers is needed in order to address problems in the ICU work environment. Our hope is that with concentrated efforts, we can prevent hospital infections and improve patient safety in ICUs."

One possible solution presented in the study suggests increasing the availability of highly-qualified float nurses through cross training. This would allow hospitals to more appropriately staff their ICUs and further develop the skills of nursing staff based on other units.

The sample comprised 15,846 patients in 51 adult int
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