Hospital Staffing and Health Care–Associated Infections: A Systematic Review of the Literature

doi:10.1016/j.jcjq.2018.02.002

The Joint Commission Journal on Quality and Patient Safety

Volume 44, Issue 10, October 2018, Pages 613-622

https://doi.org/10.1016/j.jcjq.2018.02.002 Get rights and content

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Background

Previous literature has linked the level and types of staffing of health facilities to the risk of acquiring a health care–associated infection (HAI). Investigating this relationship is challenging because of the lack of rigorous study designs and the use of varying definitions and measures of both staffing and HAIs.

Methods

The objective of this study was to understand and synthesize the most recent research on the relationship of hospital staffing and HAI risk. A systematic review was undertaken. Electronic databases MEDLINE, PubMed, and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) were searched for studies published between January 1, 2000, and November 30, 2015.

Results

Fifty-four articles were included in the review. The majority of studies examined the relationship between nurse staffing and HAIs (n = 50, 92.6%) and found nurse staffing variables to be associated with an increase in HAI rates (n = 40, 74.1%). Only 5 studies addressed non-nurse staffing, and those had mixed results. Physician staffing was associated with an increased HAI risk in 1 of 3 studies. Studies varied in design and methodology, as well as in their use of operational definitions and measures of staffing and HAIs.

Conclusion

Despite the lack of consistency of the included studies, overall, the results of this systematic review demonstrate that increased staffing is related to decreased risk of acquiring HAIs. More rigorous and consistent research designs, definitions, and risk-adjusted HAI data are needed in future studies exploring this area.

Cited by (0)

Brett G. Mitchell, PhD, MAdvPrac, is Professor, Faculty of Arts, Nursing and Theology, Avondale College of Higher Education, Wahroonga, New South Wales, Australia.

Anne Gardner, PhD, is Adjunct Professor, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane.

Patricia W. Stone, PhD, RN, FAAN, is Centennial Professor of Health Policy, and Director, Center for Health Policy, Columbia University.

Lisa Hall, PhD, is Associate Professor, School of Public Health, University of Queensland, Brisbane, Queensland, Australia.

Monika Pogorzelska-Maziarz, PhD, is Assistant Professor, Jefferson College of Nursing, Thomas Jefferson University, Philadelphia.