Inadequate staffing linked to higher rates of hospital infections
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Key takeaways:
- Nearly 80% of acute-care hospitals had insufficient infection prevention staffing levels.
- A staffing calculator is available for use online as part of a public beta test in its development.
Insufficient infection prevention staffing can lead to higher rates of health care-associated infection, according to researchers who evaluated an online calculator that could help facilities meet staffing requirements.
The vast majority of acute-care hospitals in the study were insufficiently staffed, researchers reported, which can increase the risk for health care-associated infections (HAIs) that include central line-associated bloodstream infections (CLABSIs), catheter-associated urinary tract infections (CAUTIs), Clostrioides difficile infections and colon surgical site infections (SSIs).
“This facility-specific calculator for infection prevention and control staffing levels is a completely novel tool for our community and one that is clearly needed to help hospitals advocate for adequate resources to keep patients and health care workers safe,” Rebecca Bartles, DrPH, MPH, CIC, FAPIC, executive director of the Center for Research, Practice and Innovation at the Association for Professionals in Infection Control and Prevention (APIC), said in a press release.
Research has shown that increasing the number of infection preventionists (IPs) at hospitals and health care facilities can substantially decrease HAI rates.
The online calculator tested by Bartles and colleagues is a pilot project developed by APIC to help acute-care hospitals, long-term care facilities and ambulatory clinics determine how many people should be on their infection prevention teams, according to the organization.
Rather than using a ratio of ID clinicians per inpatient bed, the calculator adjusts optimal staffing ratios for facilities based on factors such as complexity of services, having an ED, or having specialized units for things like burns, stem cell transplants or inpatient rehabilitation to assess ideal staffing size, according to APIC.
Bartles and colleagues analyzed data from 390 acute-care hospitals that used version 1.0 of the staffing calculator between Dec. 15, 2023, and June 10, 2024. Among the hospitals, 91% had an ICU, 99% had an ED, 98.7% performed surgery and 84.4% were part of a larger health care system. Additionally, 87.7% of hospitals with more than 500 beds had a burn unit, stem cell transplant unit or inpatient rehab compared with about 50% of those with less than 200 beds.
The researchers chose an initial baseline staffing ratio of one IP full-time equivalent (FTE) per 85 inpatient beds, which was based on surveys and previously accepted ratios, according to the study. Among hospitals in the study, the mean IP FTE-to-bed ratio was 1:121 beds and the ratio decreased as the number beds in a hospital increased — with the calculator recommending a mean IP FTE-to-bed ratio of 1:65 beds among participating facilities.
According to the researchers, 79.2% of the facilities were below expected staffing, 3.3% had exactly the expected staffing and 17.4% had above expected staffing. Among them, 89.6% of hospitals with more than 100 beds were classified as having lower than expected staffing compared with 54.8% of facilities with less than 100 beds classified as being above expected staffing.
For the most part, the connection between properly staffed hospitals and standardized infection ratios (SIRs) for each of four infections was confirmed, according to the study:
- 61.7% of facilities with below expected staffing had a low CLABSI SIR compared with 85.5% of hospitals where staffing was above expectations;
- 57.6% of hospitals with below expected staffing had a low CAUTI SIR compared with 89.1% of hospitals where staffing was above expectations;
- 41.1% of hospitals with below expected staffing had a low C. difficile SIR compared with 58.2% of hospitals where staffing was above expectations; and
- 25.6% of hospitals staffed below expectations had a high colon SSI SIR compared with just 14.6% of those with larger than expected staffs.
In the study, Bartles and colleagues wrote that “the roles and responsibilities of an IP have evolved tremendously over the last decade and recommended staffing levels are not aligned. Appropriate staffing levels would allow IPs to meet the requirements of the role and ultimately prevent infections rather than control them.”
The calculator is available for use on APIC’s website as a beta version. APIC said the tool is under development and that its algorithm will be updated periodically to reflect data accumulated as more facilities use it.
“We look forward to updating the calculator soon with new categories and more granularity based on our experience with the beta tool and making it available to the infection prevention and broader health care communities,” Bartles said in the release.
References:
- APIC. APIC staffing calculator. https://apic.org/apic-staffing-calculator/. Accessed Oct. 14, 2024.
- APIC. Hospitals that are understaffed for infection prevention and control have higher rates of infection, study says. https://apic.org/news/hospitals-that-are-understaffed-for-infection-prevention-and-control-have-higher-rates-of-infection-study-says/. Published Oct. 10, 2024. Accessed Oct. 14, 2024.
- Bartles R, et al. Am J Infect Control. 2024;doi:10.1016/j.ajic.2024.09.004.
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