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Nurse staffing levels affect health care infections

Studies link temp nurses, MRSA, and BSI

Hospitals struggling to decrease their rates of health care-associated infections such as methicillin-resistant staphylococcus aureus (MRSA) may want to consider a new strategy: Hiring more staff.

A review of 38 studies found a significant relationship between nurse staffing and health care-associated infections. Four of them explored the impact of temporary nurse staffing and found a link between the use of temporary (agency) nurses and infection rates.1

Two studies linked the use of temporary nurses with increased risk of bloodstream infections and two indicated an association between temporary nurse staffing and MRSA.

"It's clear that the frontline caregivers, the people seeing the patient every day, make a difference in these important infections," says Patricia Stone, PhD, MPH, MS, FAAN, lead author of the literature review and associate professor of nursing at the Columbia University School of Nursing in New York City.

Staffing may be interrelated with a culture of safety, she suggests. Temporary workers, no matter how diligent, are not vested in the ongoing issues of the facility, she adds.

"They don't know the system as well," Stone says. "Also, they're not committed to making the change, so these things don't happen again. When you have a lot of temporary workers, you're not building a better system. They don't have that organizational commitment."

The analysis of studies did not show a clear pattern between infection control staffing and infection rates. "We certainly need more studies to understand the impact of infection control and employee health, to see how they interact with the frontline people and how they can help," Stone says.


1. Stone PW, Pogorzelska M, Kunches L, et al. Hospital staffing and health care-associated infections: A systematic review of the literature. Clin Infect Dis 2008; 47:937-944.

[Editor's note: For the complete articles, please see the April 1, 2009, issue of Hospital Employee Health, also published by AHC Media LLC.]

This story was adapted from one originally published by AHC Media LLC (800-688-2421).

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