Are Nosocomial Infections, Such as MRSA, Caused by a Decreased Level of Staff Members in an Acute Care Setting?

Kayla Palmer, Chris Rogers, Ryan L. Simpson, Michael Fairchild, Kimberly Coats Dixie State University
Practice Question
Nosocomial infections such as MRSA are constantly being analyzed by the knowledge gained from evidence-based practice. MRSA is a huge cost to healthcare facilities across the nation. The transmission of MRSA from the nurse to patient, or from vectors contaminated by the MRSA bacteria have been raising at an alarming rate. Nurse to patient staffing ratios do play a role in the transmission of the infection, but upon further research there are other simple preventative measures that can provide additional safety to the patient and the healthcare community. evidence suggests that MRSA can compound problems of understaffing in hospitals through its effect on staff workloads and staff availability. Nursing workloads for those involved in the management of healthcare associated infections have been shown to rise as a result of an increase in both patient length of stay and severity of illness resulting from infection. Workloads for nurses caring for patients with infections caused by multi-resistant organisms are increased because of the increase in infection control and therapeutic activities that these infections require; however, such situations are seldom accompanied by increases in staffing levels, and thus represent an additional work burden on nursing staff (Clements, 2008).

Studies
Study 1 Peer reviewed, to determine whether staffing and bed occupancy rates had an immediate or delayed impact on the number of new MRSA acquisitions in a well-staffed ICU, and whether these variables could be used as predictors of future MRSA acquisitions. Population: ICU patients (chosen at random according to bed occupancy) Sample size: 796 beds Results: The risks posed by high workloads may have been mitigated by good compliance with infection control measures, nurse training and adequate staffing ratios in the ICU. Consequently, staffing policies and the infection control practices in the ICU do not need to be modified to address the rate of new MRSA acquisitions.

Preventative Methods
The Society for Healthcare Epidemiology of America (SHEA), The Centers for Disease Control and Prevention (CDC), National Guideline Clearinghouse (NGC) and The Institute for Healthcare Improvement (IHI) recommend: Hand hygiene and disinfection remains the most effective strategy to decrease the risk of MRSA. High nurse to patient ratio/appropriate staffing ratios.

Use of sterile equipment

Staff education to prevent transmission of MRSA Screening of new admits. Isolation of high risk patients.

Objectives
The simple task of hand hygiene seems like such a simple preventable measure to stop the spread of infection but when staffing levels are low and a patient overload occurs, even the simplest of tasks can be overlooked. The research found leans towards the spread of MRSA from poor nurse to patient ratios, but other factors also have an important impact on the spread of MRSA. This project will investigate the best methods for preventing the transmission of MRSA.

Study 3 Review of another study, this review presents evidence for the role of hospital overcrowding and understaffing in the failure of MRSA control programs. Mechanisms for the interaction between overcrowding, understaffing, and MRSA infection are described and the role of MRSA in compounding the problem is outlined, leading to the hypothesis of a vicious cycle. Finally, methods of MRSA control are discussed in this context and more effective decision frameworks are proposed for resource allocation by health policy makers and hospital managers. Population: Adults chosen at random Sample size: Millions, Worldwide Results: 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. Overcrowding and understaffing have had a negative effect on patient safety and quality of care, evidenced by the flourishing of health-careacquired MRSA infections in many countries, despite intense efforts to control and prevent these infections occurring.

Conclusion
Through all the research we have come to the conclusion that understaffing of nurses and increasing their workload, will contribute to new acquisitions of MRSA. Implementing stricter and more adequate hand hygiene practices is proven to be the main factor in the eradication of MRSA. When nurses have a heavier work load they are less likely to focus on the most important cross contaminations; hand hygiene. It is our recommendation that hand hygiene practices are retaught and that as possible the work load of nurses is not to exceed their abilities.

References
Clements, A., Halton, K., Graves, N., Pettitt, A., Morton, A., Looke, D., & Whitby, M. (2008). Overcrowding and understaffing in modern health-care systems: Key determinants in methicillin-resistant staphylococcus aureus transmission. The Lancet Infectious Diseases, 8(7), 427-34. Retrieved from http://search.proquest.com/docview/201575580?accountid=27045 Kong, F., Cook, D.,Patterson, D., Whitby, M., & Clements, A. (2012). Do staffing and workload levels influence the risk of new acquisitions of methicillin-resistant Staphylococcus aureus in a well-resourced intensive care unit?. Journal of Hospital Infection, 80, (4), 331-339.