Health Services Research & Development

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2017 HSR&D/QUERI National Conference Abstract

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4047 — Association of Nurse Staffing Changes with Hospital-Associated Infections

Lead/Presenter: Tony Van, COIN - Ann Arbor
All Authors: Van T (VA Ann Arbor) Yosef M (VA Ann Arbor and University of Michigan) Annis A (VA Ann Arbor) Robinson C (VA Ann Arbor) Sullivan S (VA Office of Nursing Services) Sales A (VA Ann Arbor and University of Michigan)

Objectives:
On July 19, 2010 the VA issued a directive mandating a standardized method for assessing appropriate levels of nurse staffing. In this analysis, we aimed to assess the association between changes in staffing and central-line associated bloodstream infection (CLABSI) and catheter associated urinary tract infection rates (CAUTI) as part of a nationwide quality improvement evaluation.

Methods:
Using nurse staffing data from 128 VA facilities between fiscal year 2009 and 2015, we conducted an interrupted time series analysis using segmented regression. An implementation time point was defined based on initial roll-out of the VHA directive. We modeled the monthly change in infection rates associated with staffing levels in the post-implementation period compared to the pre-implementation period as changes in slope and level, and adjusted for serial correlations by controlling for time trends. We operationalized nurse staffing levels as nursing hours per patient day (NHPPD), defined as total nursing workload hours divided by total number of patient bed days for all inpatient acute and intensive care units. Infection rates data were defined as number of infections per 1000 line days and catheter days for CLABSI and CAUTI, respectively.

Results:
In the post-implementation period, staffing level was associated with a .04 and a .07 reduction on nationwide average infection rates relative to the effect of staffing on the pre-implementation infection rates for CAUTI and CLABSI, respectively; these relative effects were statistically significant at the 5% level.

Implications:
In conjunction with other co-occurring VA hospital infection prevention initiatives, our findings suggest that changes in nurse staffing processes, as required by the staffing directive, are associated with reduced hospital-associated infections.

Impacts:
Overall, across VA, there have been net increases in nurse staffing in inpatient units following a national directive to use a standardized method for assessing recommended staffing levels. These changes are associated with improvements in important patient outcomes.