Yet Another New Study Links RN Nurse Staffing To An Increase In Patient Infections And Hospital Costs

A new study published
in the July issue of the open access journal Critical Care finds that
understaffing of registered nurses in hospital intensive care units
increases the risk of serious infections for patients; specifically
pneumonia, a preventable and potential deadly complication that can add
thousands of dollars to the cost of care for hospital patients.


The study is the second in three months to link poor ICU staffing to
hospital infections, and the fourth this year to link poor RN-to-patient
ratios to poor patient outcomes for hospitalized patients. The new research
bolsters the case for increasing RN staffing in hospitals and limiting the
number of patients assigned to a nurse as has been proposed in pending
legislation, the Patient Safety Act (H.2059), currently before the
Massachusetts legislature.



Stephane Hugonnet and colleagues from the University of Geneva
Hospitals, Switzerland, investigated the number of patients admitted to the
ICU who developed ventilator-associated pneumonia (VAP), over a four-year
period. They then compared this to the number of nurses on duty for each
patient in the preceding days. VAP affected over a fifth of the 936
patients who received mechanical ventilation during the study. The team
found that when there were lower numbers of nurses, patients were more
likely to catch pneumonia six days or more after being placed on a
ventilator. This could be due to short-staffed nurses having less time to
follow hand hygiene recommendations and proper isolation procedures or
being unable to provide adequate care to the ventilated patient. The
nurses' training level had no effect on infection rates.



"This study shows that a low nurse-to-patient ratio increases the risk
of late-onset VAP," said Hugonnet. "It also adds to the growing body of
evidence demonstrating that adequate staffing is a key determinant and a
prerequisite for adequate care and patient safety." VAP is caused by
bacteria entering the lungs as a consequence of the ventilator tubing and
is one of the most common preventable problems affecting critically ill
hospital patients. It can cause a stay of about an average of 10 extra days
in the hospital at a cost of $10,000 to $40,000.



"This is yet another in a long line of recently published studies that
clearly demonstrate that improving RN staffing ratios has enormous societal
benefits in terms of lives saved and reduced complications, while also
being highly cost effective," said Karen Higgins, RN, an ICU nurses at
Boston Medical Center and co-chair of the Coalition to Protect
Massachusetts Patients, an alliance of 107 leading health care, civic and
consumer groups promoting passage of The Patient Safety Act. "There is no
longer any rationale for allowing hospitals to deprive patients of the
lifesaving care nurses are capable of providing if and when nurses have a
safe number of patients to care for at one time."



New Study Links ICU RN Staffing to Increased Infections/2



A 2003 report by the prestigious Institute of Medicine on the impact of
nurses' working conditions on patient safety found that poor RN staffing
and excessive overtime increased the likelihood of preventable patient
injuries and deaths. One of the recommendations of the IOM report was for a
strict limit of no more than two patients for nurses in ICUs as well as to
provide limits on overtime for nurses.



Nurses in Massachusetts hospitals, including those working in ICUs are
regularly forced to accept unsafe patient assignments as identified in the
new study. A study of actual RN staffing levels in the state's hospitals
conducted by the Massachusetts Nurses Association and Andover Economic
Evaluation in 2006 found that in a shocking 36 percent of observations
hospitals failed to meet the accepted minimum standard of no more than two
patients per nurse in the intensive care unit.



The Patient Safety Act (H. 2059) would dramatically improve care by
setting a safe limit on the number of patients assigned to a nurse. The
measure, which is co-sponsored by State Rep. Christine Canavan (D-Brockton)
and Senator Marc Pacheco (D-Taunton), calls upon the Department of Public
Health to set a safe limit on the number of patients a nurse is assigned at
one time. In addition, the bill calls for staffing ratios to be adjusted
based on patient needs. It also bans mandatory overtime, and includes
initiatives to increase nursing faculty and nurse recruitment. During the
last legislative session, the Massachusetts House of Representatives passed
a similar bill by a vote of 133-20. A hearing on the bill has been
scheduled before the Joint Committee on Public Health on Oct. 24, 2007.


The Coalition to Protect Massachusetts Patients

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