Study shows nurse burnout linked to increased HAI
According to a recent study published in the August issue of the American Journal of Infection Control, nurse burnout has been linked to higher rates of healthcare-associated infections (HAI), which therefore costs hospitals millions of additional dollars each year.
Researchers from the Center for Health Outcomes and Policy Research at the University of Pennsylvania School of Nursing looked at data from more than 7,000 registered nurses at 161 hospitals in Pennsylvania to study the effect of nurse staffing and burnout on catheter-associated urinary tract infections (CAUTI) and surgical site infections (SSI). All of the data used for the study was previously collected from the Pennsylvania Health Care Cost Containment Council, the American Hospital Association Annual Survey and a 2006 study of hospitals and nurses in the state.
According to lead author Jeannie Cimiotti, more than a third of the nurses in the study said they had an emotional exhaustion score of 27 or greater on the Maslach Burnout Inventory-Human Services Survey, which is the equivalent of being "burned out."
"HAIs are a major problem. We have to step back and realize there are several factors that could contribute to these infections. There's been a decade or more of research on staffing related to infections but never a real explanation as to why this might be occurring," said Cimiotti. "We are the first to suggest that perhaps its burnout. The concept of burnout itself - it's a multifactorial syndrome. Disorganizational factors play into it."
Cimiotti noted that when there are understaffing problems and a lack of teamwork and support, it leads to increased stress. "The providers detach from the environment, both emotionally and cognitively, and that's when these errors often occur," she said.
"This study links quality of care with cost of care, and I'm not sure if that's always appreciated by hospital administrators," said Marcia Patrick, an Association for Professionals in Infection Control and Epidemiology (APIC) Board Member and infection prevention consultant. "Quality pays and this study demonstrates this very clearly."
Using the per-patient average costs associated with CAUTI ($749 to $832 each) and SSI ($11,087 to $29,443 each), the researchers estimate that if nurse burnout rates could be reduced to 10 percent from an average of 30 percent, Pennsylvania hospitals could prevent an estimated 4,160 infections annually with an associated savings of $41 million.
"Infections cost a lot of money and payers don't want to pay for them and CMS is not going to pay for them anymore. That puts the hospital at a loss when they are already suffering in this economic climate," said Cimiotti. "Hospitals must be adequately staffed, and you can increase the workload as long as you have the environment to support them."
Patrick agrees. "We have seen a number of changes that have gone to change the corporate culture of hospitals to one of quality... I think most hospitals are really working on the quality piece, improving their corporate culture and increasing patient satisfaction," she said.
