2008 News

New Study Links Nurse Understaffing to Increase in Deadly Infections

06.25.2008

Findings Come as the Mass. State Senate Considers Action on a Bill to Require Much Needed Improvements in Hospital Nurse Staffing Levels along with Other Measures to Protect Patients

BOSTON–As the state Senate considers pending legislation (HB 4783) to require safer RN staffing levels in all Massachusetts hospitals, a new study published in the July issue of the journal Lancet Infectious Disease finds that understaffing of nurses is a key factor in the spread of methicillin-resistant Staphylococcus aureus (MRSA), the most dangerous type of hospital acquired infection.

According to the most recent estimates, more than 94,000 patients annually contract MRSA and nearly 19,000 die from the drug-resistant “Superbug,” which is one of the most common and lethal of the preventable infections patients get in the hospital. The Massachusetts Coalition for the Prevention of Medical Errors reports that more than 45,000 patients contract some type of preventable hospital-acquired infection and 2,000 people die in Massachusetts because of hospital infections every year. Apart from the incalculable human cost the CDC estimate that this adds $5 billion to the national healthcare bill and other experts estimate that treating individual cases of MRSA adds more than $35,000 to the patient’s hospital bill.

“Understaffing is both an ongoing and long-term future problem with severe consequences for hospital patients,” wrote the researchers, who noted there is a significant association between health-care worker-to-patient ratios and infection rates. The drive toward greater efficiency by reducing the number of hospital beds and increasing patient throughput has led to highly stressed health care systems with unwelcome side effects.”

“Overcrowding and understaffing have had a negative effect on patient safety and quality of care, evidenced by the flourishing of health-care-acquired MRSA infections in many countries, despite efforts to control and prevent these infections from occurring. There is an urgent need for detailed study of the relative effects of acute short-term and chronic long-term resource constraints on the dynamics of MRSA infection and a concurrent requirement for developing resource allocation strategies that minimize MRSA transmission without compromising the quality and level of patient care,” the researchers concluded.

The authors note that common attempts to prevent or contain MRSA and other types of infections such as requirements for regular and repeated hand washing by nurses are compromised when nursing staff are overburdened with too many patients. They also note that hospitals now involve nurses in a “vicious cycle” where a call for nurses to increase their infection control procedures “are seldom accompanied by increases in staffing levels and thus represent an additional work burden on nursing staff” that leads to a greater spread of infections.

“This is yet another in a long line of recently published studies that clearly demonstrate the need for passage of the Patient Safety Act to ensure that nurses have the ability to provide the care to prevent the needless suffering of patients in our state’s hospitals,” said Karen Higgins, RN, an ICU nurse at Boston Medical Center and co-chair of the Coalition to Protect Massachusetts Patients, an alliance of 130 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.”

Last month, the state House of Representatives voted 119 – 35 to approve the bill, which calls upon the Massachusetts Department of Public Health to set safe limits on nurses’ patient assignments, prohibits mandatory overtime, and includes initiatives to increase nursing faculty and nurse recruitment. The law, when enacted, will make Massachusetts only the second state in the nation to set safe staffing limits in hospitals.

The “Patient Safety Act” will now move to the Senate for consideration. The bill responds to increased concern over quality care in Massachusetts hospitals, as well as to evidence linking disease and deaths to poor patient oversight caused by nurses being forced to care for too many patients at one time. In recent years, medical errors and hospital-acquired infections have soared. Numerous studies link the rise in hospital-acquired infections and other medical complications to understaffing of nurses. For example, a report published in the July 2007 issue of the journal Medical Care found that safe RN staffing levels could reduce hospital acquired infections by 68 percent.

In May 2006, the Massachusetts House of Representatives passed the same version of The Patient Safety Act, but the bill was not taken up by the Senate. The bill is co-sponsored by State Representative Christine Canavan (D-Brockton) and State Senator Marc Pacheco (D-Taunton).

“The time has come to pass this law and to protect the patients of the Commonwealth,” said John McCormack, co-chair of The Coalition to Protect Massachusetts Patients. “Every day we wait, another patient and another family suffers needlessly for the lack of appropriate nursing care.”

FPO