The Role of Understaffing in Central Venous Catheter-Associated Bloodstream Infection

Abstract

Nursing staff reductions below a critical level, during a period of increased TPN use, may have contributed to the increase in CVC-BSI in the SICU by making adequate catheter care difficult. During healthcare reforms and hospital downsizing, the effect of staffing reductions on patient outcome (i.e., nosocomial infection) needs to be critically assessed.

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

“…Seven research teams focused on BSI [15–21], 1 team focused on urinary tract infection [22], and 1 team focused on ventilator-associated pneumonia [23]. The studies employed cross-sectional and cohort research designs, and the sample sizes ranged from 19 units to >13,000 patients.…”

Prevention of central venous catheter-related infection in the intensive care unit

“…Nursing staff reductions below a critical level may contribute to increase catheter-related infection by making adequate catheter care difficult. One study reported a four times greater risk of catheter infection when the patient-to-nurse ratio was doubled [14]. Moreover, replacement of regular nurses by float nurses further increases the risk of device-related infections [15].…”

Incidence and clinical implication of nosocomial infections associated with implantable biomaterials – catheters, ventilator-associated pneumonia, urinary tract infections

“…care teams have been associated with substantially lower rates of catheter related infections [56]. In accordance to this understaffing has also been identified as an independent risk factor [57]. …”