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Hospital overcrowding, understaffing contribute to MRSA incidence
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Overcrowding and understaffing in hospitals can often lead to a failure of methicillin-resistant Staphylococcus aureus control programs, which in turn leads to increased inpatient hospital stay, bed blocking and further infection control failure, researchers from the University of Queensland, Australia, reported.
The structure of health care systems is changing in many high-income countries because of a drive towards increased efficiency and cost-cutting, noted Archie Clements, PhD, in a review in the July edition of The Lancet Infectious Diseases. In Australia,
there has been a 40% decrease in public hospital beds per head, yet a 20% increase in patient throughput between 1982 and 2000, as well as a 14% increase in the overall number of patients treated between 1995 and 2000.
Same-day admissions and discharges are responsible for the majority of this change, the authors wrote in the report.
In the United Kingdom, higher patient admission rates together with bed reductions have led to 71% of health trusts exceeding the government target bed occupancy of 82%.
"The drive towards 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," including a lack of control over infection," Clements said in a news release. These issues are likely to be intensified by the aging trend in high-income countries and growth of populations, he added.
Likewise, fewer people in high-income countries are choosing nursing as a career, which will diminish the size of the health-care workforce. In the United States, for example, the average age of nurses has increased from 37.4 years in 1983 to 46.8 years in 2004.
Health-care-worker-to-patient ratios also have a significant association with observed infection rates, with one study showing that more than a quarter of health-care-acquired infection in intensive care units could be avoided with a ratio at or below 2.2 patients per health-care worker, the authors wrote.
Handwashing is vital for reduction of MRSA transmission, yet many studies show compliance in nurses is low and in doctors it is even lower, according to the authors. Compliance falls further during periods of understaffing and high workload.
Other MRSA control strategies, including isolation of colonized or infected patients, and cohorting – where patients are care for by specific, nominated health care workers – break down in the face of overcrowding and understaffing, the authors reported.
For more information:
- Clements A, Halton K, Graves N, et al. Overcrowding and understaffing in modern health-care systems: key determinants in methicillin-resistant Staphylococcus aureus transmission. Lancet Inf Dis. July 2008;8(7):427-434.