Nurse Burnout Linked to Risk for Hospital-Acquired Infections

A new study suggests that job-related burnout among nurses could be a plausible explanation for some hospital-acquired infections among patients being treated for other conditions.

Researchers at Rutgers University (Newark, NJ, USA) analyzed data from three merged sources; a study-specific survey of Pennsylvania nurses, the 2006 Pennsylvania Health Care Cost Containment Council (PHC4; Harrisburg, USA) report on hospital infections, and the annual survey on hospital characteristics by the American Hospital Association (AHA). They then examined urinary tract and surgical site infection, and estimated the effect of nurse and hospital characteristics on health care–associated infections. In all, 161 acute care hospitals with an average of 227 beds and an average of 9,758 patients reported infection data to the PHC4.

The researchers then conducted the study-specific nurse survey in two phases. First, they mailed questionnaires to a 7,076 registered nurses working at the 161 hospitals, with a response rate of 41%. They then chose a random sample of 650 nurses who did not respond to the first survey to survey again, achieving a 92% response rate in that subsample with extensive follow-up and compensation. The nurses had an average age of 44 years and an average total experience of 17 years. On average, they each cared for an average of 5.7 patients. Almost 37% (2,544) of the nurses reported high levels of burnout.

The results showed there was a significant association between patient-to-nurse ratio and urinary tract infection and surgical site infection. In a multivariate model controlling for patient severity and nurse and hospital characteristics, only nurse burnout remained significantly associated with urinary tract infection and surgical site infection. The researchers also found that hospitals in which burnout was reduced by 30% had 6,239 fewer infections, for an annual cost saving of up to USD 68 million. The study was published in the August 2012 issue of the American Journal of Infection Control.

“In other words, a 10% increase in a hospital's composition of high-burnout nurses is associated with an increase of nearly one urinary tract infection and two surgical site infections per 1,000 patients,” concluded lead author Jeannie Cimiotti, DNSc, RN, and colleagues. “We hypothesize that the cognitive detachment associated with high levels of burnout may result in inadequate hand hygiene practices and lapses in other infection control procedures among registered nurses.”

Related Links:
Rutgers University
Pennsylvania Health Care Cost Containment Council